Manu Malhotra

Dual presentation of tuberculosis: Otitis media with retropharyngeal abscess - The first case report

Tubercular otitis media is a rare disease and its association with retropharyngeal abscess is rarer. We have not come across any such case in the English literature of the dual presentation of tuberculosis to the best of our knowledge so far. Early diagnosis and prompt management are the key to reduce the disease burden and also to avoid life-threatening complications.

Unilateral sensorineural hearing loss: A retrospective study

Background: This retrospective study was carried out to know the characteristics of patients suffering from unilateral sensorineural hearing loss (USNHL) (type and degree). Aims and Objectives: (1) To know the incidence of pure USNHL (other ear being normal) in patients complaining of HL. (2) To establish the type and degree of USNHL in patients. Materials and Methods: This study was conducted over a period of more than 1 year to find out the pattern of pure USNHL (other ear being normal) in the patients attending ear, nose, and throat outpatient department (OPD) with a complaint of HL. Pure tone audiometry data of 1800 cases between August 2014 and December 2015 with HL were analyzed for this study. Demographic characteristics were compared with types and degrees of unilateral sensorineural hearing impairment. Results: A total of 1800 OPD patients who had a complaint of HL and had undergone pure tone audigram (PTA) in a period of more than 1 year in the Department of Otorhinolaryngology and Head and Neck Surgery were studied. SNHL type was the highest with 802 cases (44.55%). Out of 802 cases of SNHL, 257 (32.05%) were USNHL - out of which, only 155 patients (60.31%) had pure USNHL with other ear being normal; this constituted the study group, i.e., 155 patients (8.6%) out of 1800. Age of patients ranged from 9 years to 76 years (mean age - 41.5 years). Male:female ratio was 1.31:1. Both ears were almost equally involved. The highest numbers of USNHL patients were seen in the age group of 31-40 years (23.87%). Most cases presented with mild (34.2%), followed by profound (31.6%) USNHL. Conclusion: Our study concluded that SNHL type is the most common type (44.55%) of hearing impairment among patients complaining of HL. The incidence of pure USNHL (i.e. other ear being normal) was 60.31% (155/257) cases of USNHL, 19.32% (155/802) cases of SNHL, and 8.6% (155/1800) cases of PTA performed on patients complaining of HL. Limited work has been published on incidence, characteristics, and causes of pure USNHL. Further studies and researches are required in the field of USNHL to know the incidence, functional and psychological impact, and treatment options.

Lacrimal Gland Abscess leading to Frontal Bone Chronic Osteomyelitis: A Rare Case Report

We report a case of a 15-year-old girl presenting with left lacrimal abscess with chronic osteomyelitis of frontal bone, a rare sequelae, that of lacrimal adenitis. If lacrimal adenitis is left untreated, abscess formation can occur and can also lead to osteomyelitis. If lacrimal adenitis/abscess is diagnosed early in the disease process by understanding typical signs, conservative management can accomplish resolution without the complications and need for surgical exploration and the cosmetic implications of facial surgery.

Pediatric Lobular Capillary Hemangioma Nasal Cavity

A lobular capillary hemangioma (LCH) is a benign uncommon entity of unknown etiology among vascular lesions of the head and neck. Although it has no predilection for age, it is more common in the third decade and in females. Lobular capillary hemangioma usually involves the gingiva, lips, tongue and buccal mucosa. The nasal cavity is a rare location. The most common symptoms are nasal obstruction and epistaxis. The treatment is nasal endoscopic surgery. We review these vascular lesions and present the clinical features, radiological findings, treatment performed and histopathological results of two cases of LCH originating in the left inferior turbinate and septum. No recurrence was observed after complete endoscopic resection during 6 months follow-up. Lobular capillary hemangioma should be taken into consideration among the differential diagnosis of a painless hemorrhagic endonasal mass even though it is a rare entity. If complete resection is performed, prognosis is excellent and the recurrence rate is low.

Cortical bone total ossicular replacement prosthesis

Objectives: Evaluate an autologous cortical bone total ossicular replacement prosthesis (B TORP) made of cortical bone for cost effective and sustainable hearing results. Materials and Methods: A prospective study was undertaken in the patients who underwent tympanoplasty with new B-TORP from January 2011 to December 2011. All patients had an absent superstructure of the stapes and long process of the incus due to chronic otitis media. Totally 40 patients were evaluated. Hearing results were evaluated using four-frequency average pure tone air conduction and air-bone gap (ABG) measured at 0.5, 1, 2, and 3 kHz after a period of 12 months. Pre- and post-operative continuous variables were compared using a paired t-test and data from unequal groups were assessed for significant differences using unpaired t-test. Results: Successful rehabilitation of the ABG to 20 dB or less was achieved in 95% of patients. Overall mean improvement in ABG was 25.8 ± 5.6 dB, which was statistically significant (t = 26.8, P < 0.001). Mean postoperative ABG in the tympanoplasty only group was 12.9 ± 2.7 dB with an average improvement of 26.8 ± 4.9 dB (t = 22.0, P < 0.001) and in the intact canal wall group was 14.9 ± 5.1 dB with an average improvement of 24.5 ± 6.1 dB (t = 16.0, P < 0.001). There was no significant difference between ABG improvements of the two groups (t = 1.2, P > 0.5). Conclusion: The new autologous B-TORP provides sustainable hearing improvement and is bio-compatible, stable, and magnetic resonance imaging compatible.