D. S. Grewal

Tuberculoma of the mastoid

Tuberculoma is a rare but known complication of tuberculosis. It rarely occurs in the mastoid bone. When it occurs in the middle ear cleft, it can lead to intracranial complications if there is a delay in the diagnosis and management. A rare case of tuberculosis of the middle ear cleft which presented as tuberculoma of the mastoid bone with infranuclear facial palsy is described. The tuberculoma was removed and a canal wall down tympanomastoidectomy was performed. Post-operatively the patient was kept on antituberculous therapy. The various problems encountered in the diagnosis and management of this case are discussed.

Labyrinthine fistula: a complication of chronic suppurative otitis media.

A labyrinthine fistula is a frequent complication of long-standing unsafe chronic suppurative otitis media. It is characterized by a slowly progressive erosion of the bony labyrinth. In this paper we present our observations regarding the diagnosis and management in 50 patients with unsafe chronic suppurative otitis media with labyrinthine fistula.

Otitic hydrocephalus of tubercular origin: a rare cause

Otitic hydrocephalus is characterized by increased intra-cranial pressure without focal signs of neurological dysfunction. It usually occurs secondary to lateral sinus thrombosis more commonly on the right side, but it can also occur without lateral sinus thrombosis. With the advent of new antibiotics there has been a spectacular decrease in the complications of otitis media. Otogenic intra-cranial hypertension, always an uncommon condition, is seen only very rarely nowadays. Tubercular otitis media still occurs in India, and due to delays in its diagnosis it usually presents with complications. We present three patients with otitic hydrocephalus of tubercular origin.

Retraction pockets in chronic suppurative otitis media- our experience.

Retractions of the tympanic membrane constitute a large proportion of ear diseases causing concern to the otologist. The clinical features in a case of retraction pocket are varied and cholesteatoma. Also, that a retraction pocket in the posterosuperior region and pars ftaccida is a precursor of cholesteatoma is now well recognized. We have studied 60 cases of retraction pockets during a period of 5 years and have attempted to find out the etiology as well as the most effective treatment in such cases. Though over the years along with a dysfunctional eustachian tube, a sclerotic mastoid has been implicated as one of the causes of Retraction Pockets, we in our study have seen a large sized mastoid antrum (beyond 2 mm vf Lateral Semicircular Canal) as a consistent feature in most of our cases. This was subjectively assessed as a surgical finding in tympanomastoidectomy and objectively assessed by a high Resolution Computed Tomography of the temporal bone. We have found that a canal wall down mastoidectomy was the most effective in preventing the recurrence of retraction pockets. In a coutry like India, canal wall down mastoidectomy offers an acceptable solution to the problem of retraction pocket as not only is the follow up of patients poor but also the “Second- Look” procedure is not always possible. The use of 1- 0 chromic catgut in the middle ear instead of the more conventionally used silastic in preventing recurrent retractions can be considered as an effective single-staged procedure.

Nasopharyngeal angiofibroma-an unusual origin & presentation

Case report presenting an unusual site of angiofibroma is described. An adult male presented with a mass hanging out from the right nostril with epistaxis. A C.T. scan performed in this cast described it to be an infected polyp. The patient was operated upon. The mass arose from the septum and bled on removal. The histopathological diagnosis of the mass showed characteristic features of an angiofibroma.

Surgical decompression in bell’s palsy — our viewpoint

AbstarctBell’s palsv or acute idiopathic lower motor neuron facial palsy is a common cause of facial palsy seen in clinical practice. The cause of this disease is not exactly known though there arc many theories regarding Ils etiology. In this article, we present the theory of ”Tertiary is chacmia “ in eases of pertinent Bell’s palsy. Our concept of Tertiary ischaemia is further supported by histological findings of the nerve sheath biopsy taken during surgical decompression In eases of Bell’ s palsy. The procedure, of performing posterior tympanotomy and improving the exposure of the middle ear structures therein is also explained.

Acoustic effects of lightning

The effects of lightning on the audiovestibular apparatus vary with the degree of injury. This depends on whether the individual is struck directly or indirectly by lightning. We reported two cases where lightning has caused trauma to audiovestibular apparatus and have reviewed the available literature. One patient was struck directly by lightning leading to rupture of the tympanic membrane and a conductive hearing loss. The other patient was struck indirectly via telephone cable and had a mixed hearing loss with tympanic membrane intact.

The melkersson - rosenthal syndrome as a rare cause of facial nerve palsy - a case report.

The Melkenson Rosenthal syndrome is the rarely encountered triad of intermittent facial paralysis, recurrent facial oedema and lingua plicata. The intervals between the recurrence of symptoms may vary in duration. The cause of this syndrome is yet unknown. This paper discuses the pathology, clinical features and management as well as reports a case of this unusual disorder.

Unusual cases of foreign bodies in air passage in children.

Tracheobronchial foreign bodies when not treated promptly continue to be a source of morbidity and mortality specially in the paediatric population. Chevaliar Jackson, through meticulous analysis of mechanical problems related to foreign bodies in the air and food passages and their solution, created a science of rehearsed and tested instrumental techniques for their extraction (Jackson and Jackson, 1936). They developed instruments to achieve remarkable results with an almost unbelievably low morbidity and mortality.Aspiration of foreign bodies is seen more commonly in the paediatric age group and nearly 94% of them occur in infants and children (Holinger and Holinger, 1978). According to Jackson, nearly 90% of these foreign body accidents are due to carelessness, and are therefore avoidable. We present two unusual cases of inorganic foreign bodies in the air passages in children with special reference to the problems encountered in their diagnosis and management.

Otogenic abscesses — our experience

Otogenic abscesses are the result of acute or chronic suppurative inflammation of the middle ear cleft caused by pus forming organisms, which lead to extracranial or intracranial abscesses. When it leads to intracranial abscesses, it may be life- threatening. Otogenic abscesses are commoner in India than in the Western countries due to many factors which have been discussed in this paper.Here we publish a study of fifty cases of otogenic abscesses with reference to our experience of their presentation and management.