Balakrishnan Ramaswamy

A study of antibacterial and antifungal properties of human cerumen

Objective: To investigate the effect of human cerumen on the growth of Staphylococcus aureus , Escherichia coli , Pseudomonas aeruginosa and Candida albicans . Study Design: Prospective study Setting: The study was conducted in the Department of Otolaryngology-Head and neck Surgery and Department of Microbiology, at a tertiary care teaching hospital in southern India. Materials and Methods: Cerumen samples were collected from 120 healthy cases by using sterile Jobson Horn Probe. Sterile samples were taken and further tested. The bacterial strains were cultured on nutrient agar and Candida was grown on SDA. Serial 10 fold dilutions of the test organisms were made using normal saline acting as control and using 3.5% cerumen suspension as test and were incubated at 37°C for 12 hours. Subcultures were performed from test as well as control tubes to assess the inhibitory activity of human cerumen. Results: Of 120 samples, only sterile samples were tested. At dilutions of 1 in 10 3 there was complete inhibition of Escherichia coli and Pseudomonas aeruginosa in all samples, complete inhibition of Staphylococcus aureus in 83.3% samples and Candida albicans in 80% samples. The order of inhibition demonstrated by cerumen in the present study was Escherichia coli > Pseudomonas aeruginosa > Staphylococcus aureus > Candida albicans. Conclusion: Human cerumen has antibacterial and antifungal properties against the commonest bacterial and fungal pathogens. Other than the physical barrier, wax acts as protective coating over the external auditory canal. Hence, routine wax removal/ear cleaning is not mandatory unless impacted wax is leading to earache or conductive hearing loss.

Anterior pneumatization of the maxillary sinus - Presenting as a facial swelling.

Over pneumatization of the paranasal sinuses is a fairly common finding on computerized tomography; but involvement of a small segment of the maxillary sinus especially the anteromedial aspect is very rare. We report a case of a twenty year old male who presented with a facial swelling. On CT scan, the swelling was found to be due to pneumatization of the anterior part of the maxillary sinus. Surgical treatment was carried out for cosmetic reasons.

Recurrent angioleiomyoma of the middle turbinate

We present a case of a middle-aged woman with a history of not only progressive nasal obstruction, facial pain, hyposmia and epistaxis, but also excision of the nasal mass diagnosed as a vascular leiomyoma. On examination, a smooth bulge was seen over the middle turbinate. Surgical excision along with histopathology and immunohistochemistry revealed a diagnosis of recurrent vascular leiomyoma of the middle turbinate.

Sclerosing lipogranuloma of the eyelid: unusual complication following nasal packing in endoscopic sinus surgery

An eyelid or orbital lipogranuloma can occur following nasal packing with liquid paraffin, petroleum jelly or an antibiotic-based cream. It usually presents a few weeks or months after the initial procedure. We present a report of three such cases of sclerosing lipogranuloma involving the eyelid, which occurred following a sinonasal surgery where nasal packing using petroleum jelly was performed. The typical clinical course and the classical histopathological features are highlighted. All cases were diagnosed by histopathological examination as sclerosing lipogranuloma. Complete surgical removal resulted in complete resolution on 1 month follow-up. The diagnosis is based on a high degree of suspicion following a detailed history of prior use of lipid-based products for nasal packing following endonasal surgery. Histopathology is diagnostic. Surgical excision is the treatment of choice, however, due to its infiltrative nature, it may be difficult to obtain a complete cure.

Amelanotic malignant melanoma of the cervical oesophagus

We report the case of a young woman who presented with progressive dysphagia and swelling in the anterior aspect of the neck of short duration. On evaluation, she was diagnosed with amelanotic malignant melanoma of the cervical oesophagus. She underwent total laryngopharyngo-oesophagectomy with gastric transposition with bilateral modified radical neck dissection with feeding jejunostomy and a permanent tracheostomy with postoperative combined chemoradiation therapy. However, in spite of aggressive treatment, the patient expired 8 months after initial presentation with distant metastasis.

Juvenile Aggressive Cemento-ossifying Fibroma of the Sphenoid Sinus with Proptosis: A Surgical Dilemma

The term fibro-osseous lesion has currently grown in popularity as an overall designation for a number of rare, histologically benign head and neck lesions that are made up of bone, fibrous tissue and cementum. Cemento-ossifying fibroma is a variant of cementifying fibroma and is a fibro-osseous disease. They are usually small innocuous lesions which follow a slow benign course and are commonly seen in the skull bone rather than the sphenoid. It is rare for these tumours to attain large size, behave aggressively, destroy bone and require a radical surgery. One such rapidly growing juvenile cemento-ossifying lesion of sphenoid in our 10-year-old young patient causing proptosis and impaired vision is reported here because of its uncommon nature and its surgical dilemma. Selection of surgical approach to resect this tumour becomes difficult because it is deeply seated and needs a multidisciplinary approach.

A Retrospective Study to Assess the Role of Using Fine Needle Aspiration Cytology and Frozen Section in the Diagnosis of Thyroid Swelling

The most cost-effective test is fine needle aspiration cytology (FNAC). Many surgeons use intraoperative frozen section to confirm the FNAC findings and to guide the extent of thyroid surgery. Though it is a valuable tool in the diagnosis of the thyroid lesion and determining the extent of thyroid surgery, still in certain cases diagnosis can be incorrect or inconclusive, so histopathology of the excised specimen remains the most reliable test. The purpose of this study will be to compare the result attained by FNAC and frozen section of the thyroid to the final histopathological diagnosis, in order to establish their role in thyroid surgery today. A retrospective study with a total of 140 patients who underwent thyroid surgery at the ENT department, of a tertiary hospital in coastal Karnataka. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for FNAC and frozen section. The sensitivity, specificity, positive predictive rate, and negative predictive rate of frozen section was found to be 66.7%, 88.4%,76.6%, 82.4% respectively for detecting malignancy. This was found to be higher than the results of FNAC for the same which were 64.4%, 77.8%, 64.4%, 77.8% respectively. As the sensitivity of FNAC is similar to frozen section in detecting malignant cases, FNAC is a good tool for screening the patient for determining malignancy in thyroid, but frozen section is more specific in confirming the malignancy.

Nasal septal schwannoma: a rare sinonasal tumour with certain peculiarities

Sinonasal schwannomas constitute 4% of head and neck nerve sheath tumours; however, schwannomas involving the nasal septum are quite rare. We present a 57-year-old male patient with nasal septal schwannoma who was managed successfully by endoscopic excision. 32 cases of septal schwannoma have been reported so far in the literature. This report discusses certain peculiar features exhibited by schwannomas of the nasal septum. Septal schwannoma does not show any age, sex or side predilection. However, they tend to involve posterior part of the septum and presumed to arise from the nasopalatine branch of the trigeminal nerve. Imaging findings of the sinonasal schwannoma are non-specific, but the histopathological characteristics are diagnostic, with seldom need for immunohistochemistry. Endoscopic excision is the safe and effective treatment option for the septal schwannoma of any size and location. Recurrence has not been reported in the literature following endoscopic excision.

Ganglioneuroblastoma of Skull Base.

Neuroblastic tumours are common in childhood and adrenal glands are the most common site. Head and neck ganglioneuroblastomas are extremely rare and nose is a very uncommon site for a ganglioneuroblastoma. The management of this primitive sympathogonic tumour may vary depending on the age of the patient and stage of the tumour. We present a middle-aged man with a ganglioneuroblastoma of skull base, management of this tumour and a review of literature.

Endoscopic Approach to Middle Turbinate Squeeze Syndrome

Middle turbinate squeeze syndrome (MTSS) refers to sino-nasal headache due to intense contact between the middle turbinate and the nasal septum and/or between middle turbinate and other structures in the lateral nasal wall. This study was intended to evaluate the efficacy of precise endoscopic surgical treatment of MTSS. This is a prospective study of 126 patients with refractory cephalgia due to endoscopically confirmed MTSS who underwent functional endoscopic naso-sinus surgery (FENS) wherein the contact points and ostio-meatal complex obstruction were endoscopically relieved. 91% of cases reported improvement/resolution of headache and 95% of cases had relieved contact points as documented endoscopically. This surgery was also found to facilitate resolution of sinus disease, both radiologically (in 64% of cases) and endoscopically (in 94% of cases). Cephalgia caused by MTSS can be effectively treated by an ultra-conservative endoscopic approach.