Mary Kurien

Hearing threshold in patients with diabetes mellitus.

Hearing threshold of 30 diabetic patients and 30 healthy controls attending the medical outpatient department were determined using pure tone audiometry (Arphi Digital 900). All subjects were less than 50 years old. Subjects with otological and other metabolic diseases were excluded from the study. The patients were categorized into groups according to age, duration of disease, complications and control of diabetes. These observations were compared with those from the control subjects using appropriate statistical methods. It was found that diabetics had a poorer hearing threshold than the non-diabetics; all age groups with diabetes showed a significant high frequency hearing loss, as compared to the control population; poorly controlled and complicated diabetics have significant, high frequency hearing loss as compared to those who were well controlled and uncomplicated; there was no relationship between duration of the diabetes and the level of hearing loss.

Maxillary sinus fusariosis in immunocompetent hosts

We report the first known cases of Fusariosis of maxillary sinus with granuloma and oro-antral fistula in two immunocompetent hosts. Fusarium solani was demonstrated in the direct microscopic examination and isolated in heavy growth from the biopsy materials. Both these patients were successfully treated with oral ketoconazole (200 mg daily) for three weeks followed by a Caldwell-Luc operation. Ketoconazole was continued for two months post-operatively.

External laryngotracheal trauma in children.

External laryngotracheal trauma in the paediatric population, although rare, presents a diagnostic and therapeutic dilemma for the attending surgeon. The purpose of this study was to evaluate the clinical profile, treatment and outcome and to establish a simple, effective management protocol in this emergency. A retrospective case series was studied. There were 12 patients aged 2-14 years in this series, eight of them (67%) having closed injuries. Their clinical presentation was correlated to conservative management, tracheostomy and surgical intervention. In the open injury group all the patients (100%) underwent tracheostomy, upper endoscopy and neck exploration. One patient (25%) in this group developed subglottic stenosis. In the closed injury group, seven patients (88%) had tracheostomy with upper endoscopy, and two of them (25%) had neck exploration in addition. One patient (13%), however, developed glottic stenosis. The patients with stenosis underwent multiple surgical interventions prior to final decannulation. There was no mortality. Breathing difficulty/stridor were the commonest clinical presentations in children with acute external laryngotracheal trauma. Tracheostomy and early surgical intervention appeared to be the treatment of choice. A protocol with major and minor criteria of clinical presentation is suggested for effective management.

Angiosarcoma of the nasal cavity and maxillary antrum.

Angiosarcoma (malignant haemangioendothelioma) of the nasal cavity and paranasal sinuses is extremely rare. Only a few cases have been reported in literature. A case of angiosarcoma of the nasal cavity and maxillary antrum in a 38-year-old male patient is reported. He was treated with pre-operative external radiotherapy followed by wide excision of the tumour. He currently remains free of the disease 10 months after diagnosis (and seven months after completing therapy).

Chronic adenoid hypertrophy in children — is steroid nasal spray beneficial?

ObjectivTo the efficacy of naial btvlomethosone spry in the treatmrnl of chronic adenoid hypertrophy in children.Method.-1 randomized double-blind placebo-controlled study Setting: Tertiary academic referral center Patients: Aged 3-12 years diagnosed to have chronic nasal obstruction due to hypertrophied adenoids.InterventionIntranasal beclomethasone at the dose of 200 microgramslday to one group and placebo to the other group in matched dispensers for 8 weeks. Outcome measures: Reduction of symptoms due to hypertrophied adenoids and the size of enlarged adenoids. Variables were noted at the beginning and end of the study for symptoms score severity. X-ray and flexible nasal endoscopie findings.ResultsAnalysis was done to find any significant improvement between the two groups. The Chisquare test was used to investigate the relationship between discrete variables. 26 children completed the study with 13 each in the drug and placebo group. There were 17 male and 9 female patients from 3 to 12 years of age. There was no significant difference in nasal obstruction, snoring or nasal discharge between the two groups. Comparison of x-rays and endoscopy also showed no significant difference between the 2 groups significant (P value =1.000 and P=0.0666 respectively).ConclusionThis study indicates that intranasal beclomelhasone therapy is not useful in treatment of ehronic adenoid hypertrophy in the general pediatrie population.

Neonatal screening for hearing loss: pilot study from a tertiary care centre

Many developed countries have well established universal neonatal hearing screening programs. In India, the viability of such a program, in an already overburdened health system is indeed a challenge. This cross sectional study was undertaken to evaluate the possible burden of hearing loss among neonates born at a tertiary care hospital in Southern India. Five hundred neonates were screened with automated distortion product otoacoustic emission (aDPOAE) for hearing loss, 9.2% of whom had one or more high risk factors. Although 6.4% had hearing loss at initial assessment, only 1.6% had hearing loss on retesting with aDPOAE. Retesting with OAE before an automated Auditory brainstem response (aABR) helped to exclude patients without hearing loss. The frequency of moderate to moderately severe hearing loss in this study was 0.6%. This pilot study underscores the importance of the introduction of screening for congenital deafness in specialized centers in India, despite its challenges.

X-rays in the evaluation of adenoid hypertrophy: It's role in the endoscopic ERA

ObjectivesTo evaluate the reliability of X-rays in the diagnosis of adenoid hypertrophy and to validate this with flexible nasopharyngoscopy which is the existing gold standard.MethodLateral radiograph of the neck and a flexible nasopharyngeal endoscopy was done to evaluate adenoid enlargement in children aged 3–12 years who were included in a S week randomized double-blind placebo controlled study for the effect of beclomethasone in adenoid hypertrophy. These were graded independently by both the co-investigor and investigator X-ray and nasal endoscopy for reevaluation of adenoid size was done at the completion of the study. Variables of both the procedures were scored at the beginning and end of the study. The agreement between the two groups was assessed using weighted kappa statistic.ResultsThere were 26 patients in the study, 17 of them had complete correlation between the X-ray and endoscopy findings. The agreement between these findings was statistically significant (p<01) with the weighted kappa 0.51.ConclusionThis study shows that lateral X-rays of the neck, besides being a noninvasive procedure, still remains a very reliable and valid diagnostic test in the evaluation of hypertrophied adenoids.

Anterior skull base: High risk areas in endoscopic sinus surgery in chronic rhinosinusitis: A computed tomographic analysis

Computed Tomography (CT) scan of nose and paranasal sinuses play a key role in preoperative evaluation of patients undergoing endoscopic sinus surgeries (ESS) for chronic rhinosinusitis. The asymmetry of ethmoid fovea olfactory fossa, anatomical variations of lateral lamella and course of anterior ethmoid artery are critical in ESS as it may predispose to dangerous consequences like hemorrhage. CSF leak and intracranial complications. A prospective study was done on 75 patients of clinically and diagnostically proven chronic rhinosimusits. The coronal CT scan was evaluated with special attention to anatomical variations of anterior skull base including ethmoid fovea, olfactory fossa, lateral lamella and course of anterior ethmoid artery. The endoscopic surgeons awareness of these variations and its role in preventing complications are highlighted.

Fine needle aspiration in chronic tonsillitis: reliable and valid diagnostic test

Fine needle aspiration (FNA) of the tonsil as a diagnostic tool in evaluating the microflora in chronic tonsillitis has not been popularized. A prospective study of 30 patients with chronic tonsillitis undergoing tonsillectomy was undertaken. FNA of the tonsil core was done under local/general anaesthesia. The reliability of the culture by FNA of the tonsil core was then validated with the reference (gold) standard which is the dissected tonsil core. The sensitivity of FNA culture as compared to core culture was 100 per cent and 93 per cent under general and local anaesthesia respectively. The positive predictive value of FNA culture as compared to core culture was 92 per cent and 82 per cent for general and local anaesthesia respectively. These factors indicate that FNA of the tonsil core is reliable and valid. It can safely be performed as an out-patient procedure under local anaesthesia. This is reported for the first time. Identifying the bacterial organism within the infected tonsil for appropriate antibiotic therapy could revolutionize the management of chronic tonsillitis.

Endoscopic transsphenoidal approach to petrous apex cholesterol granulomas

Cholesterol granulomas of the petrous apex are inflammatory reactions due to obstruction of air cells within the petrous apex. We report two cases of petrous apex cholesterol granulomas that were treated via the endoscopic transsphenoidal route. The transsphenoidal approach is minimally invasive, preserves hearing and drains these cysts into the sphenoid sinus. We consider this approach to be the technique of choice for a cholesterol granuloma that abuts sphenoid sinus.