Kiran M. Bhojwani

Benign lesions of larynx—A clinical study

ObjectiveA climical study was undertaken to analyze the age, sex distribution and symptomatology, sites of involvement and the prognosis of the common types of benign lesions of larynx.Study DesignA five year retrospective study from 1997 to 2002.SettingKMC Hospital Attavar —A tertiary referral hospital.PatientsA total of 42 patients with benign laryngeal lesions were included based on symptomatology such as hoarseness of voice, foreign body sensation, throat pain, neck mass and cough and with positive clinical findings on indirect laryngoscopy and neck examination. The patients ranged from 7–80 years. All non-operative cases and malignant cases were excluded. Diagnostic hematological and radiological investigations and therapeutic microlyryngoscopic procedures were employed.ResultsA male preponderance with M:F ratio of 3∶1 was observed. Majority of the patients were in the 30–40 age group. Vocal polyps were the commonest type of lesion. In our study, hoarseness of voice, cough, foreign body sensation and throat pain proved to be the commonest symptoms.ConclusionsMicro laryngeal surgery and voice rest offer a cost effective, useful and safe method for management of benign laryngeal lesions.

Presentation and management of deep neck space abscess

ObjectiveTo study the presentation, etiology, microbiology and morbidity of deep neck space infections.Study DesignRetrospective study Methods: 29 patients admitted in Kasturba Medical College Hospital, Mangulore, India between January 1997 and December 2002 with deep neck space infections.,were included in the study.RemitsThe most common space involved was the parapharyngeul space. No specific etiology was determined in .38%; an odontogenic cause was discovered in 28% of the patients; tonsillar/pharyngeal infections in 24% of patients and foreign body impaction in 7% of cases. The main morbidity was due to mediastinitis (5 patients). I patient succumbed to the disease. Mixed flora with aerobic and anaerobic infections was identified in most of the cases.

Tuberculosis in the Head and Neck in India: Down but not yet Dead

Background: The aim of this study was to evaluate the various manifestations of tuberculosis in the head and neck region, incidence of the different forms and the diagnostic modalities and the treatment modalities employed. We also studied its coexistence with pulmonary tuberculosis and human immunodeficiency virus infection. Methods: Our study was a prospective study done conducted in the otolaryngology and head and neck surgery departments, Kasturba medical college and allied hospitals in Mangalore, India. The study group comprised 70 patients diagnosed with tuberculous manifestations of the head and neck region over the period of 2 years from 2011-2013. Chest radiography and sputum AFB was also done in all the patients to rule out coexisting pulmonary tuberculosis. All patients were screened for HIV. Results: Our study included 70 patients with tuberculosis of the head and neck region. The most common presentation of tuberculosis in the head and neck region was tuberculous lymphadenitis in 77% followed by deep neck space abscess 10% then laryngeal tuberculosis in 8.50%, submandibular gland tuberculosis in 3% and 1.5% diagnosed with pharyngeal tuberculosis. 12.8% of our patients had coexisting HIV infection and 33% patients had associated pulmonary tuberculosis. Conclusions: Tuberculosis of the head and neck region though not very frequent, still remains an important clinical entity which should be kept in mind especially in developing countries. Involvement of the cervical lymph nodes remains one of the commonest manifestations.

Angiolymphoid Hyperplasia with Eosinophilia of Root of Nose: A Rare Phenomenon

Angiolymphoid Hyperplasia with eosinophilia (ALHE), also known as epithelioid haemangioma, is an atypical vascular tumour which occurs with a predilection for the head and neck region. It is characterized by the presence of solitary or multiple lesions with varying clinical appearances, from intradermal papules to subcutaneous nodules.

Role of estimation of arterial blood gases in the management of stridor

AimWe studied the epidemiology and etiology of stridor in our patients along with the role of arterial blood gas (ABG) analysis in their management. We also reviewed their prognostic indices and the clinical outcomes.Materials and methodsIt was a prospective study in a tertiary referral hospital in which 72 patients presenting with stridor, were independently evaluated by 3 different clinicians and clinically classified into mild, moderate and severe. Based on ABG values (pH, PO2, PCO2), we defined 3 groups of patients viz, those in respiratory failure, impending respiratory failure and those with no evidence of failure. Treatment was directed at the cause of stridor. Clinical outcomes were assessed and results classified as resolved, improved, stable and death.ResultsOut of 72 patients, kappa coefficient of agreement between the 3 observers were found to be 0.014, indicating poor interobserver reliability for the working clinical classification. However, ABG analysis indicated otherwise, with 6 patients in respiratory failure, 19 progressing to impending failure. Hence we complied by the more objective ABG analysis in planning management. Laryngomalacia in children and hypopharyngeal malignancies in adults were found to be the most common causes of stridor in our study. As compared to other conditions, laryngomalacia in children had a poorer outcome (p = 0.001).ConclusionEarly detection of impending respiratory failure was instrumental in achieving better clinical outcomes in our patients presenting with stridor. Thus we inferred that ABG analysis is a valuable tool in the effective management of stridor.

Inverted papilloma of atypical origin with unusual extension into the oropharynx.

Inverted papilloma is a benign tumor with malignant potential that commonly arises from the lateral wall of the nose. We present a case of inverted papilloma, in a premalignant stage, of unusual origin and with oropharyngeal extension. The patient presented with complaints of a nasal mass arising from the left nasal cavity and progressively increasing in size since 2 years. On examination a fleshy, firm, sensitive mass was noted, which was attached to the medial wall, and extending posteriorly and inferiorly into the oropharynx. Diagnostic nasal endoscopy and complete excision of the mass was performed with a stable postoperative period. Histopathology of the mass revealed an inverted nasal papilloma of the septum with carcinoma in situ.

Ageing effect on air-conducted ocular vestibular evoked myogenic potential

One of the recent diagnostic tests to assess the function of otolithic organs is through vestibular evoked myogenic potential (VEMP) testing. There are equivocal findings on effect of aging on ocular VEMP (oVEMP) parameters with reference to latencies. Hence this study was taken up to investigate the age related changes in oVEMP parameters. This present study considered 30 participants in each age group i.e., young adults, middle-aged adults and older adults. oVEMP were recorded using insert earphone at 100dBnHL at 500hZ short duration tone burst. The results showed in older adult significant difference in response rate, latencies and amplitude as compared to young and middle adult. Hence age should be taken into consideration when interpreting oVEMP results.

Role of electronystagmography in balance disorders: A clinical study

Aim and Objectives: To evaluate the role of electronystagmography (ENG) in the diagnosis of balance disorders, to localize the level of lesion in cases of vertigo, and to classify the etiology into peripheral and central causes. Materials and Methods: This study included 120 patients who presented with primary complaints of vertigo or dizziness. The inclusion criteria were all patients with complaints of vertigo with satisfactory vision. All patients underwent a thorough examination and appropriate investigations. Patients were subjected to ENG under optimal conditions and the results were obtained in the form of a butterfly chart after analysis of the ENG data. Results and Observations: Of the 120 patients subjected to ENG, we found that half the patients who presented with complaints of dizziness turned up as normal. 39 patients (33%) were diagnosed with peripheral vestibular lesion whereas 17% showed a central lesion of the vestibular system. The presence of a vestibular lesion was confirmed by performing a Dix-Hallpike maneuver. This returned a positive result in 33% of the cases. Canal paresis and directional preponderance, which were taken as the parameters of our study were analyzed in detail and significant correlation between the two was found. For higher values of directional preponderance, the canal weakness assumed greater significance. Conclusion: ENG has proven to be a useful first-line investigation in the diagnosis of vertigo. It can also act as a useful screening tool to differentiate between classical vertigo and other causes of the disequilibrium. It has special significance in localizing the side of the lesion which is especially useful in the further management of disorders like benign paroxysmal positional vertigo.

Measuring Vestibular Evoked Myogenic Potential Using Two Different Procedures.

Latest developments in technology has equipped the clinician’s ability to evaluate otolithic function through VEMP testing. The present study was taken up to investigate the changes in the VEMP parameters while recording VEMP response with visual feedback system to control EMG. VEMP testing was administered on 20 participants between 20-40 years of age. The study results showed no statistically significant difference in amplitude and latency of cVEMP and oVEMP responses with and without visual feedback system. However, with visual feedback system standard deviations were observed to be reduced for both cVEMP and oVEMP responses. Hence we can conclude that using the visual feedback system to monitor the muscle contraction in otological disorders is easier and more reliable than testing without visual feedback.

Tinnitus: Characterization of associated hearing loss and modalities of treatment

Purpose: To assess the characteristics of hearing loss with respect to tinnitus and to study the efficacy of various modalities of treatment of tinnitus. Design: Prospective study. Materials and Methods: Patients were assigned into three groups. All patients underwent a complete ENT examination, followed by pure tone audiometry, tinnitus matching, and tinnitus handicap inventory (THI) score. Patients were treated with gingko biloba, gabapentin, or tinnitus-retraining therapy (TRT) for a period of 6 weeks following which above investigations were repeated. Results: The study showed a positive correlation between tinnitus loudness matches and frequency of maximum hearing threshold ( r = 0.687, P = 0.001) and a significant relation between tinnitus loudness matching and THI score ( r = 0.383, P = 0.001). However, no correlations were observed between pitch match frequency and THI scores. Gingko biloba and TRT were found to be effective in the management of tinnitus ( P P = 0.051). Conclusion: Tinnitus loudness matches near the threshold of frequency of maximum hearing loss, thus indicating that as threshold of hearing increases, the perception of tinnitus loudness increases. However, pitch match frequency does not affect severity of tinnitus. Gingko biloba and TRT are useful in the treatment of tinnitus.