Ayaz Rehman

Benign Mucosal Fold Lesion as a Cause of Hoarseness of Voice - A Clinical Study

Hoarseness of voice is a common disorder seen in day to day practice of Otorhinolaryngologist. Although, occasionally it can be a symptom of underlying malignancy, there are a variety of benign lesions causing the same. We analyzed a total number of 100 patients with history of hoarseness of voice for at least six months in whom the cause of hoarseness was the presence of a benign vocal fold lesion. Malignancies, vocal cord paralysis and Neurological lesions were excluded from the study. We found that vocal nodules were the commonest benign mucosal vocal fold lesion, (37% patients); followed by vocal polyps in 26%, LPR 23%, Reinke’s edema in 4%, intracordal cyst in 4%, contact ulcer in 3%, saccular cyst in 2% and papillomatosis in 1% of the patients.

Traumatic tympanic membrane perforation: An overview

Objectives: The purpose of this study was to determine the various etiologies of traumatic tympanic membrane (TM) perforations; their clinical presentation, observation and establish masterly inactivity as the main modality of management. Materials and Methods: A prospective study was performed on 350 cases of traumatic TM perforation in the Department of ENT, SKIMS Medical College, Srinagar from January 2010 to December 2014. Results: A total of 350 patients with the traumatic TM. Perforation was enrolled for this study. The group consisted of 231 male and 119 female patients. It affects all age groups with the highest incidence among middle age group. The right ear was involved in 94 (26.85%) patients, the left ear in 249 (71.14%) patients and bilateral ear involvement was seen in 7 (2%) patients. The type of trauma included compression injury in 243 (64.42%) patients, instrumental injury in 88 (25.14%) patients, and blast injury in 19 (5.42%) patients. Tinnitus was the most common complaint, followed by aural fullness, impaired hearing, otalgia, bleeding from ear and vertigo. 217 (62%) patients presented with conductive hearing loss in the range of 20–35 dB, 77 (22%) patients with <20 dB, 28 (8%) patients presented with >35 dB hearing loss, and 28 (8%) patients presented with no air-bone gap. Grade I perforation (<25% TM involvement) was seen in 91 (26%) patients, Grade II perforation (25–50% TM involvement) was seen in 221 (63.14%) patient, and Grade III perforation (>50% TM involvement) was present in 38 (10.90%) patients. Complete healing was observed within 2–6 weeks in 172 (49.10%) patients and within 7–9 weeks in 112 (32.20%) patients. 35 (10%) patients showed complete healing within 10–12 weeks. The minimum time taken to heal was 21 days and maximum time 72 days. Complete healing was observed in 319 (91.10%) patients. The intervention was only performed when spontaneous healing failed to occur after observing the patients for 1 week and included tympanoplasty in 8 (2.30%) patients, trichloroacetic acid cauterization in 14 (4%) patients. Residual perforation was observed in 9 (2.5%) patients. Conclusion: In our experience, traumatic TM perforation is still very common. Slap, instrumentation, road traffic accident, and blast injuries are common etiologies seen. It affects all age groups. Tinnitus and hearing loss are commonest symptoms. The masterly inactivity should be religiously followed and unnecessary surgical intervention should be discouraged.

Short term and long term subjective taste disorder after middle ear cleft surgery

Aim: The present study is a prospective study that looks into the prevalence of chorda tympani nerve injury and related symptoms following varying degrees of trauma to the nerve during four common types of middle-ear operations; namely, Tympanomastoid operations, myringoplasty, Tympanoplasty and Exploratory tympanotomy. Materials and Methods: 178 patients who underwent middle ear cleft surgery were included in this prospective study. Childrens below 20 years and patients with other potential cause of taste disturbance were excluded. Patients were given a single questionnaire, so as to assess their post-operative taste disturbance. Patient name, Age, Sex, Type of middle ear surgery, side of surgery were recorded. Any change in sense of taste immediately (after 2-4 weeks) or delayed (2-3 years)were recorded. Results: The number of patients with Chorda tympani nerve-related symptoms varied widely between these four groups. Increased occurrence of the nerve related symptoms were observed in Tympanomastoid and Myringoplasty, and a prolonged recovery time were observed in the tympanomastoid group. Stretching of the nerve produced more symptomatic cases than thermal injury or drying. Conclusion: It is important to inform patients about the possibility of Chorda Tympani Nerve injury during middle-ear operations, and it should also be emphasized that symptoms related to Chorda Tympani Nerve injury can occur irrespective of the type of damage to the nerve.

An Unusual Cause of Persistent Pneumonia in a Child: A Case Report

An 8 month old child was referred to us from department of paediatrics as a case of non-resolving pneumonia of 2 months duration. Bronchoscopy of the patient revealed obstruction as the cause, with a paddy grain in the right main bronchus. The grain was removed and was found in germinating phase confirming its presence for a long duration. The child improved clinically soon after the procedure.

Pattern of Hearing Loss from Otological Trauma due to Non-Explosive Blast Injury Caused by Slap to the Ear in Kashmiri Population

The aim of this study is to determine the pattern of hearing loss in otological trauma due to non-explosive trauma caused by slap in Kashmiri population. The study was conducted in otolaryngology clinic of a referral and a teaching tertiary care hospital Sher-i-Kashmir Institute of Medical Sciences Medical College, Bemina, Srinagar, Jammu and Kashmir, where 569 cases with non-explosive blast injury of the ear due to slap, gathered over a 3-year period, is presented. 522 Patients fulfill the inclusion criteria and 47 cases were excluded. All the selected cases underwent otological examination by clinical examination followed by otoscopic examination, PTA (Pure Tone Audiometry) and Impedance audiometry as required. Tympanic membrane perforation was identified and hearing loss was recorded. The frequency of CHL (Conductive Hearing Loss) and MHL (Mixed Hearing Loss) has been found to be 415 cases (79.5%) and 107 cases (20.5%) respectively. The severity of conductive hearing loss correlated with the size of the eardrum perforation. Male patients were more (68.008%) as compared to females (31.992%). Left ear was more commonly involved (72.16%) than right ear (28.74%). The age ranged from 10-60 years with a mean age of 26.3 years. All the patients demonstrated acute perforation of the ear drum that was confined solely to pars tensa. Anterior perforation occurred in 65 patients (12.46%) while posterior perforation occurred in 152 patients (29.12%). About (58.42%) i.e. 305 of the perforations involve adjacent portion of both anterior and posterior halves of tympanic membrane. Closure of air-bone gap following healing was significant p<0.01 while recovery of BC abnormality was less favorable. The most common cause of hearing loss was due to slap by spouses (among females) and slap by security personnel (among males), followed by fight among students. So, there is the need to educate on alternative punitive measure among students and security agents, early identification, evaluation and referral of patients reduces the attendant morbidity.