Ajay Garg

Comparative evaluation of endoscopic with conventional septoplasty.

A study was conducted to assess the merits and demerits of endoscopic septoplasty. Fifty patients having symptomatic DNS were randomly divided into two groups of 25 patients each. One group underwent endoscopic septoplasty and other group underwent conventional septoplasty. The groups were compared regarding the complaints with pack in postoperative period, relief of symptoms after surgery and complications. The symptoms complained by the patients with pack in postoperative period and complications after surgery were significantly less in endoscopic septoplasty group.

Frontal sinus actinomycosis presenting as osteomyelitis of frontal bone.

Actinomycosis is an indolent, suppurative, and granulomatous infection caused by a gram-positive, anaerobic or microaerophilic, non–acid-fast bacteria of the genus Actinomyces. The species associated with human disease include A israelii, A naeslundii, A viscosus, and A odontolyticus; A israelii is the most common. All these species can be found in the mouth and respiratory and digestive tracts as normal commensals. They do not exist elsewhere in nature. Actinomycosis is thought to become a pathogen when some form of trauma allows it to access an anaerobic environment, such as is provided by devitalized tissue, where it rapidly multiplies. Four clinical forms of actinomycosis are recognized: 1) cervicofacial, 2) thoracic, 3) abdominal, and 4) genital. Over 50% of the cases occur in the head and neck region, but reports that involve the nose and sinuses are rare. The usual site of the rare infection in the nose and sinuses is the maxillary antrum. Occasionally it can involve ethmoid or sphenoid sinus. We report an unusual presentation of actinomycosis that involves the frontal sinus, causing osteomyelitis of frontal bone. To our knowledge this entity has not been reported until now. A 62-year-old female with diabetes was admitted to our hospital with history of left upper eyelid swelling that involved a forehead and unilateral headache for the last month. There was no history of any trauma. History revealed that she had an oro-antral fistula on the left side after tooth extraction 1 year earlier. She underwent a left Caldwell-Luc procedure and repair of oro-antral fistula. Material obtained from the left maxillary sinus was sent for histopathologic examination and revealed actinomycosis. She was put on penicillin for 3 months. On examination, a discharging fistula was present in lateral part of upper eyelid. Tenderness was present over the frontal bone, especially over the floor of frontal sinus. Nasal endoscopy revealed mucosal inflammation without pus in the region of frontal recess. A computed tomography (CT) showed destruction of both inner and outer table of skull with sequestrum formation in the left frontal sinus (Fig 1). We do not have an IRB; however, informed consent was

Extraluminal hypopharyngeal foreign body.

Ingestion of a foreign body is a problem seen in nearly all otolaryngologic practices. Ingested foreign bodies which migrate extraluminally are rare occurrences. If untreated, they may result in life threatening complications. We are reporting a case of sharp metallic pin which migrated extraluminally in the hypopharynx and became lodged in the soft tissue. It was successfully removed by direct laryngoscopy.

The role of functional endoscopic sinus surgery (FESS) in patients with asthma with chronic sinusitis

Abstract25 patients of bronchial asthma with chronic sinusitis were operated with the aim to evaluate the efficacy of functional endoscopic sinus surgery (FESS) on asthma symptoms. The mean postoperative daytime asthma symptom scores, nocturnal asthma symptom scores, mean postoperative nocturnal awakening scores and number of asthma attacks reduced significantly (p<0.001). The mean FEV1 observed postoperatively showed significant increase (p<0.001). 21 patients reported overall significant improvement in the asthma. 6 patients were completely taken off from all sort of anti-asthmatic drugs [inhalational corticosteroids (ICS) + long acting β2 agonist (LABA) ]. In 3 patients there was significant / substantial decrease in the dosage of anti-asthma drugs. It is concluded that FESS is a viable option for improving the control of asthma.

Role of rhinomanometry to assess nasal airflow and resistance in patients undergoing septoplasty

Nasal obstruction is a common symptom. Rhinomanometry is a tool to objectively assess the nasal airway. A prospective study was undertaken to assess the nasal airflow and nasal resistance in 25 patients of deviated nasal septum undergoing septoplasty using rhinomanometry preoperatively and postoperatively. Rhinomanometric improvement in nasal airflow and decreased nasal resistance were found in 88% patients after surgery.

Hypoglossia-hypodactyly syndrome in a newborn

Hypoglossia-hypodactyly syndrome is characterised by small tongue associated with limb deficiency. It is an extremely rare condition with around 30 cases reported in world literature. We report a case of hypoglossia-hypodactyly syndrome that in addition to features already described also had supernumerary nipples, microcephaly and micropenis with cryptorchidism. Hypodactyly was symmetrical in all four limbs. These features have not been reported previously.

Clinical experience of removing dentures from aerodigestive tract.

ObjectiveA denture as an aerodigestive tract foreign body continues to present challenges to otolaryngologists. Records of patients who presented with a denture as an aerodigestive tract foreign body were retrospectively reviewed. MethodsRecords of patients treated during the last 8 years were reviewed to gather information on the age, sex, and presenting symptoms of the patient, location of the denture, radiographic findings, and endoscopic procedure required. ResultsOur review identified 15 patients, with the mean and median age being 59.6 and 63 years, respectively. One patient presented with a denture in the valleculae, 4 patients with a denture in the airway, and 10 patients with a denture in the hypopharynx/esophagus. Rigid endoscopy was performed to remove the dentures in most patients. An esophagotomy was required in 1 patient. ConclusionsFixed partial dentures should be advised by dentists, especially in patients who have predisposing factors such as old age, epilepsy, mental retardation, or alcoholism.

Overlooked foreign body: eighteen years inside the bronchus.

A long-standing undiagnosed foreign body bronchus in an adult is very rare. We report a rare case of an overlooked foreign body in the bronchus. A 38-year-old man presented with the complaints of chronic cough with expectoration and wheezing for the last 18 years. Computed tomography of the chest detected a foreign body in the right lower lobar bronchus. Detailed history revealed that the patient had aspirated a whistle 18 years earlier that was overlooked by the treating clinicians. It remained undiagnosed in chest radiographs. It was extracted using a rigid bronchoscope. We emphasize the need to remain vigilant for endobronchial foreign bodies in patients with persistent cough and wheeze.

Cricopharyngeal achalasia — a rare cause of dysphagia

Cricopharyngeal achalasia is a rare clinical entity in which upper esophageal sphincter (cricopharyngeus) does not open adequately during swallowing leading to dysphagia. Barium swallow reveals a smooth posterior impression of cricopharyngeus at C6 level. We report cricopharyngeal achalasia in a 68 year male who was managed with dilatation.