Lalee Varghese

The efficacy of dynamic slow motion video endoscopy as a test of eustachian tube function.

OBJECTIVE To assess the efficacy of dynamic slow motion video endoscopy as a test of eustachian tube function based on its correlation with the eustachian tube swallow test. METHOD The eustachian tube swallow test and dynamic slow motion video endoscopy were performed on 100 clinically normal middle ears of adults undergoing rigid nasal endoscopy for various indications. The dynamic slow motion video endoscopy findings were interpreted by three observers who were blind to the results of the eustachian tube swallow test, and the findings of both techniques were compared. RESULTS There was a statistically significant correlation between the dynamic slow motion video endoscopy and eustachian tube swallow test results for some of the more lenient criteria. Five of the 100 eustachian tubes had a floppy medial cartilaginous lamina which appeared to contribute to the eustachian tube dysfunction. CONCLUSION Dynamic slow motion video endoscopy appeared to over-diagnose eustachian tube dysfunction when used as a standalone test of eustachian tube function. However, when used in combination with other tests of eustachian tube function, it can provide valuable information regarding the structural and functional status of the pharyngeal end of the eustachian tube.

Posaconazole: an emerging therapeutic option for invasive rhino-orbito-cerebral mucormycosis.

Posaconazole has significant activity against the Mucormycetes. However, data are limited on the clinical efficacy of posaconazole for treating rhino‐orbito‐cerebral mucormycosis (ROCM). The aim of this study is to assess the efficacy and safety of posaconazole in patients with ROCM. We included 12 consecutive adult patients admitted with ROCM and treated with posaconazole between January 2010 and February 2015. The main outcome of the study was the overall success rate (i.e. either complete or partial response) at the end of treatment. We also assessed serum posaconazole concentrations in a subgroup of patients. Of the 12 patients who received posaconazole, eight patients (66.6%) had complete resolution with median follow‐up of 6.5 months (range 2–24 months). Two patients (16.6%) had significant reduction of disease and two (16.6%) had marked residual disease on follow‐up. Uncontrolled diabetes was the predisposing factor in all except one patient. One patient developed diarrhoea on posaconazole, which settled without discontinuation of the drug. Posaconazole appears to be a safe and effective antifungal agent in diabetic patients with ROCM, especially in those who have toxicity with polyene therapy.

Solitary Fibrous Tumour: An Unusual Nasal Cavity Tumour

Objective: To describe the diagnosis and management of an unusual case of solitary fibrous tumor of nasal cavity. Methods: The case records of a patient with solitary fibrous tumor of nasal cavity were reviewed. Results: This patient presented with constant nasal obstruction of one and a half years duration. Nasal endoscopy revealed a firm polypoidal mass filling the left nasal cavity medial to middle turbinate. After imaging, she underwent endoscopic excision of the mass which on histopathological examination was diagnosed as solitary fibrous tumor. At follow up after one year, there was no recurrence of tumour. Conclusion: Solitary fibrous tumours are infrequent neoplasms of mesenchymal origin presenting as a well circumscribed, avidly enhancing mass that is iso- to hyperintense on T1W and T2W MRI images. Even though most SFTs are benign, some of these tumors can be locally invasive and have the potential to be malignant. Surgical excision with long term follow up is the treatment of choice.

Deep head and neck infections: outcome following empirical therapy with early generation antibiotics:

In order to study the bacteriological profile, antibiotic sensitivity and outcome following empirical therapy with early generation antibiotics in patients with deep head and neck infection, a retrospective review of 42 patients admitted for drainage and intravenous antibiotic therapy was performed. Ludwig’s angina was the commonest infection, with the most common organisms isolated being Group F ß-haemolytic (15%) and non-haemolytic (12.5%) streptococcus. All streptococci and anaerobic gram-positive cocci were susceptible to penicillin. S. aureus isolates were oxacillin-sensitive and enterococcus isolates were ampicillin-sensitive. All 42 patients received empirical therapy with either intravenous penicillin or its derivatives. In only three patients was a change of antibiotic required based on culture and sensitivity results. Early generation antibiotics appear ideal as empirical therapy for deep head and neck infection.

Sinonasal organising haematoma – a little known entity

INTRODUCTION Sinonasal organising haematoma is a recently described, rare, benign inflammatory condition, which closely resembles malignancy in its clinical presentation. OBJECTIVE To describe the clinical features of organising haematoma and to review the evolution of surgical options successfully used. METHODS A retrospective review of charts of all patients with a histopathological diagnosis of sinonasal organising haematoma was performed. RESULTS Six (60%) of the 10 patients were male with a mean age of 47.4 years. All patients had unilateral disease with recurrent epistaxis as the presenting symptom. Maxillary sinus was the most commonly involved sinus. There was no history of trauma in any of the patients. Hypertension (80%) was the most commonly associated comorbidity. Contrast-enhanced CT scan of the paranasal sinuses showed heterogeneous sinus opacification with/without bone erosion. Histopathological examination was diagnostic. Complete endoscopic excision was done in all patients resulting in resolution of the disease. CONCLUSION Awareness of this relatively new clinical entity and its evaluation and treatment is important for otolaryngologists, maxillofacial surgeons and pathologists alike. Despite the clinical picture of malignancy, histopathological features of benign disease can safely dispel such a diagnosis.

Elusive treatment for human rhinosporidiosis

OBJECTIVES The aim of this study was to clarify the contentious taxonomic classification of Rhinosporidium seeberi, the cause of human rhinosporidiosis, which may have treatment implications. METHODS PCR was used to amplify the internal transcribed spacer (ITS)-2 region from the genomic DNA of the aetiological agent obtained from a sample of human rhinosporidiosis lesions. The amplicon was sequenced and the organism identified using the Basic Local Alignment Search Tools (BLAST). RESULTS Phylogenetic analysis revealed that the aetiological agent clustered along with the R. seeberi isolated from humans and also with Amphibiocystidium ranae from frogs. This organism is a member of the order Dermocystida in the class Mesomycetozoea. A patient with disseminated rhinosporidiosis did not respond to conventional therapy with dapsone and surgical excision, and treatment with amphotericin B also proved futile. CONCLUSION An effective treatment for R. seeberi-a eukaryote belonging to the class Mesomycetozoea-is still elusive.

Unusual complication of dental extraction: Lingual abscess

Acute lingual swelling is a potentially life threatening clinical condition which is encountered very rarely, the differential diagnosis of which includes hemorrhage, infarction, abscess, tumor and edema. Herein we report a case of lingual abscess that presented with acute tongue swelling and respiratory distress after extraction of lower two incisor teeth.