A. Ravikumar

Fungal Laryngitis in Immunocompetent Patients

The diagnosis of fungal laryngitis is often overlooked in immunocompetent patients because it is commonly considered a disease of the immunocompromised. Further confusion is caused by clinical and histological similarity to more common conditions like Leukoplakia. Demonstration of hyperkeratosis particularly if associated with intraepithelial neutrophils on biopsy should trigger a search for fungus using specialized stains. These patients usually present with hoarseness of voice. Pain is present inconsistently along with dysphagia and odynophagia. We present three cases of fungal laryngitis in immunocompetent patients out of which one underwent microlaryngeal surgery with excision biopsy. All these patients responded well with oral antifungal therapy.

Tracheostomal Myiasis: A Case Report and Review of the Literature

“Myiasis” is considered in Hindu mythology as “Gods punishment for sinners.” It is known to infest live human or animal tissue. Literature abounds with reports of myiasis affecting the nasal cavity, ear, nonhealing ulcers, exophytic malignant growth, and cutaneous tissue. But report of myiasis of the tracheal stoma is rare. Only a few cases of tracheal myiasis have been reported in literature. We report a case of tracheostomal myiasis in an elderly male. The species which had infested the stoma was identified as Chrysomya bezziana, an obligate parasite. This is to our knowledge the first case report of an obligate parasite (Chrysomya bezziana) infestation of the tracheostoma from India.

Role of Montgomery T-tube stent for laryngotracheal stenosis.

OBJECTIVE To identify the indications, complications and outcome of patients of LTS managed with Montgomery T-tube stenting and review the current literature about the role of stenting in LTS. METHODS Retrospective chart reviews of 39 patients of laryngotracheal stenosis managed by T-tube stenting for temporary or definitive treatment during the period 2004-2011 were considered. The data on indications for stenting, type of stent, problems/complications of stenting, duration of stenting, additional intervention and outcome of management were collected, tabulated and analyzed. RESULTS Of the 51 cases of laryngotracheal stenosis 39 patients were treated by Montgomery T-tube stenting. There was no mortality associated with the procedure or stenting. 82% of the patients were successfully decannulated. The problems and complications encountered were crusting within the tube in 44% and granulation at the subglottis in 33%. Two patients had complication due to T-tube itself: One patient developed tracheomalacia and the other had stenosis at both ends of the T-tube. CONCLUSION Stenting still has a role in management of inoperable or in some deadlock situations where resection anastomosis is not feasible. It is easier to introduce the stent and to maintain it. Complications are minor and can be managed easily. It is safe for long term use. We emphasize that the treating surgeon needs to use prudence while treating stenosis using stents.

Missing fish bone: case report and literature review

Missing fish bone: case report and literature review Sandeep Kumar Jha, MS⁎, S. Prasanna Kumar, DNB, L. Somu, MS, Arunachalam Ravikumar, MS Department of Otorhinolaryngology and Head & Neck Surgery, Chettinad Health Research Institute, Kelambakkam, Chennai 600015, Tamil Nadu, India Department of Otorhinolaryngology and Head & Neck Surgery, Sri Ramchandra Medical College and Research Institute, Chennai, Tamil Nadu, India Received 3 January 2012

Orbital apex syndrome in a child

A 8-year-old male presented with visual loss, diplopia, ptosis, pain behind the left eye, facial numbness and vomiting of one week duration. The ophthalmological, neurological and radiological examination showed a lesion of the left orbital apex with extension into the cavernous sinus. Examination of the nose and paranasal sinuses did not reveal any abnormality. Transnasal Endoscopic orbital decompression was performed and inflamed granulation tissue found in the orbital apex was removed. Microbiology showed fungal elements which on culture grew Aspergillosis flavus. Antifungal therapy with new generation oral drug (voriconazole) resulted in complete resolution of symptoms. Relevant literature is reviewed and discussed.

Adenoid hypertrophy presenting with systemic hypertension

A two and half year old male child was seen with systemic hypertension, left ventricular dysfunction, mitral regurgitation and congestive cardiac failure. Examination revealed adenoid hypertrophy. He was also suffering from obstructive sleep apnea. He was being treated with anti-hypertensive and anti-failure drugs. Adenoidectomy was performed following which obstructive sleep apnea symptoms disappeared and his cardiac status improved markedly. Subsequently he was weaned off anti-hypertensive and anti-failure therapy.

Functional study of nasal mucosa in endoscopic sinus surgery and its correlation to electron microscopy of cilia

The effect of functional endoscopic sinus surgery (FESS) was evaluated in 20 patients with chronic sinusitis. The physiological function of sinus mucosa and its mucociliary transport mechanism was assessed pre and post operatively in patients undergoing FESS by performing Saccharin clearance test. The effect of functional sinus surgery on nasal mucosa was evaluated using scanning electron microscopy and study of the ultrastructure of cilia in pre and post operative patients and correlation with histopathological examination. The mucociliary transport mechanism of the sinus mucosa improved 6 weeks following surgery. Histopathologically there was evidence of improvement in the ciliary population and decrease in inflammation, ulceration, fibrosis, vascular congestion, edema, squamous cell metaplasia, basement membrane thickening and polyp formation in comparison to the diseased mucosa sampled preoperatively. Scanning electron microscopic examination revealed considerable increase in the ciliary area as well as the orientation of cilia. Subjective improvement 6 weeks following surgery was confirmed by decrease in saccharin test time. This study revealed that FESS is an effective surgical procedure in chronic sinusitis and improves the overall function of the sinuses

Inflammatory pseudotumours of the paranasal sinuses

Inflammatory pseudotumors are clinocopathologically distinctive but biologically controversial entities. They have been described in the lungs, abdomen, retroperitoneum and extremities, but rarely affect the head and neck region. This report is of 2 cases of pseudo tumor of the paranasal sinuses with varied clinical presentation and successful outcome following treatment.

Giant tumour of the pterygopalatine fossa

Neurilemmomas are benign and slow growing tumours. Neurilemmomas of the pterygopalatine fossa are rare. In this paper we present a case of schwannoma arising in the pterygopalatine fossa with extension into infratemporal fossa and floor of the orbit. A transantral approach was used for excision of the tumor following which the defect in the floor of the orbit was reconstructed with the help of a temporoparietal flap.

Hearing benefit in middle ear reconstructive surgery: A comparative study of the current methods

The objective of this prospective study was to compare two methods of predicting the level of hearing benefit following reconstructive middle ear surgery, namely Glasgow benefit plot and Belfast rule of thumb. The correlation of hearing benefit as measured by using these methods was also compared with patient’s self-assessment of his/her hearing status. Sixty patients undergoing middle ear reconstructive surgery were studied. Hearing status was assessed pre and post operatively by pure tone audiometry and self-assessment by patient with a questionnaire. The accuracy of predictability of hearing benefit by the two methods was compared with the patient’s own assessment. Relevant literature on the subject is reviewed.