Mahesh Chandra Hegde

Assessment of eustachian tube function in tympanoplasty

Objective: A clinically useful test for eustachian tube function (ETF) is still lacking. Here we plan to evaluate the mucociliary function of the ET by saccharin and methylene blue test, and compare the outcome of surgery with normal and abnormal ET functions. Study Design: Case series with planned data collection. Setting: Department of Otolaryngology–Head and Neck Surgery, Kasturba Medical College, Mangalore (Manipal University), a tertiary care center in South India. Subjects and Methods: This study comprised 86 patients diagnosed with mucosal chronic otitis media in quiescent/inactive stage. All were subjected to a detailed clinical examination and investigations. Preoperative evaluation of ETF was compared with postoperative outcome of surgery, and the results were analyzed. Results: The saccharin test and methylene blue dye test had a good correlation in evaluating ETF. The mean value for saccharin perception time and the clearance time for methylene blue were 17.5 and 8.1 minutes, respectively. ETF was best in anterior, worst among posterior, and intermediate in subtotal perforations. Type 1 tympanoplasty was successful in 94 percent with normal ETF and in 68 percent with partial dysfunction. Conclusion: The saccharin test is a simple, cost-effective, and valuable diagnostic tool to assess the mucociliary function of the ET. The outcome of middle ear surgery would be a success in normal ETF, whereas in partial dysfunction the outcome need not necessarily be a failure.

Maltoma of Thyroid: A Rare Thyroid Tumour

Introduction. Primary thyroid lymphomas constitute up to 5% of all thyroid malignancies and can be divided into non-Hodgkins lymphomas (NHLs) of B- and T-cell types, as well as Hodgkins lymphomas. Mucosa-associated lymphoid tissue (MALT) lymphomas are a relatively recently recognized subset of B-cell NHLs, and they are listed as extranodal marginal zone lymphomas according to the revised European-American lymphoma classification. Case Report. We report an uncommon case of a 44-year-old man, who noted a painless, growing mass on right side of his neck of the three-month duration. Thyroid profile was within normal limits. FNAC showed lymphocytic thyroiditis. The patient underwent a right hemithyroidectomy. The histologic examination and the immunohistochemistry showed an extra nodal marginal B-cell type maltoma (malt lymphoma). CHOP chemotherapy with rituximab was given. The clinical course has been favourable in the first year of followup, with no evidence of local or systemic recurrence of the disease. Discussion. Marginal zone lymphoma encompasses a heterogeneous group of B-cell tumours that variously arise within the lymph nodes, spleen, or extranodal tissues. A case of maltoma of thyroid is presented for its rarity and diagnostic dilemmas. Conclusion. Maltomas are slow-growing lymphomas. The optimal treatment and followup of patients with thyroid maltomas remain controversial at present.

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.

Cervical thymic cyst: a rare differential diagnosis in lateral neck swelling.

Introduction. Thymic cysts are among the rarest cysts found in the neck. Nests of thymic tissue may be found anywhere along the descent of the thymic primordia from the angle of the mandible to the mediastinum. Mediastinal extension is seen in 50% of cervical thymic cysts. Case Report. We report an uncommon case of a 15-year-old male, who noted a painless, growing mass on left side of his neck of one-year duration. Computerised tomographic scan showed a multiloculated fluid density lesion with enhancing septae in the left parapharyngeal space, extending from the level of mandible up to C7 vertebral level. Here, we discuss the surgical aspect, histopathology, and management of this rare lateral neck swelling. Discussion. Clinically, in most cases, cervical thymic lesions present as a unilateral asymptomatic neck mass, commonly on the left side of the neck, and 75% of patients present before 20 years of age. Conclusion. Thymic cyst should be included as differential diagnosis of cystic neck masses. Greater awareness among the pathologists may decrease misdiagnosis.

Melioidosis and tuberculosis: dual pathogens in a neck abscess.

INTRODUCTION Melioidosis is an infectious disease caused by a saprophytic bacterium, Burkholderia pseudomallei. It is endemic to Southeast Asia and Northern Australia. It may manifest as a pulmonary lesion, osteomyelitis, abscesses in soft tissue and various organs, or as septicaemia. CASE REPORT We report a case of a 40-year-old, diabetic man who presented with a neck lump resulting from super-infection of a tuberculosis cavity with B pseudomallei. The patient was successfully managed by drainage along with meticulous excision of the capsule and prolonged antibiotic and anti-tubercular treatment. DISCUSSION Melioidosis may be confused diagnostically with tuberculosis, as both diseases are endemic in the same regions. Our patient was unfortunate to suffer from both endemic diseases simultaneously, perhaps representing the first such case in the world literature. CONCLUSION Increased awareness of melioidosis is important as, although the organism is easy to culture, it may be dismissed as a contaminant.

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.

Radiotherapeutic effect on oropharyngeal flora in head and neck cancer.

The effect of radiotherapy on oropharyngeal bacterial and mycotic flora was studied. Thirty five patients were included from whom swabs were taken before and at the end of irradiation. Fifteen controls were included.It was found that Streptococcus pneumoniae was significantly decreased at end of irradiation, while there wan an increase in Staphylococcus aureus. Pseudomonas, Bacteroides and Candida species. There was no change in culture and sensitivity pattern prior to and after radiotherapy.

Mobile phones: Its effect on hearing

Background: Widespread concerns have been raised about the possibility that exposure to the radio frequency fields from mobile telephones or their base stations could affect peoples health. Materials and Methods: Effect on hearing in 120 mobile phone users and nonusers between age group of 18-30 years were studied over 3 years. Group 1 using mobile phone more than 1 hour per day for more than a year and group 2 no usage or less than 1 hour per day for less than a year. Results: Those using phones for 2-3 hours daily, loss of 5 dB in 10%, 10 dB in 3.3%, and 15 dB in 1.6% were noted. Also loss of 5 dB in 6.6% and 10 dB in 3.3% were noted in those using 3-4 hours daily. Sensorinueral hearing loss was seen in 26.6% of the subjects in study group and 3.3% in control group. Conclusion: Our study did not show any significant hearing loss in mobile phone users.

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.

Antrochoanal polyps and allergy-A comparative study.

Antrochoanal polyps, are solitary polyps arising from the maxillary autrum. Their aetiology largely remains unknown; allergy has been implicated. The study attempts to define the relation between antrochoanal polyps and allergy and the need for such an investigation by studying 24 cases with antrochoanal polyps and comparing them with 20 cases of sinonasal polyps. Nasal smear cytology, serum total IgE and polyp fluid IgE was evaluated. 52.38% of cases turned out to be allergic. In their presentation, antrochoanal polyps do not significantly differ from other polyps.