Mohan Kameswaran

Khat and oral cancer.

Oral cancers in the Asir region of Saudi Arabia have been observed to occur mostly among patients who have been long-term khat users. In a survey that reviewed cancers for the past two years there were 28 head and neck cancer patients, 10 of whom presented with a history of having chewed khat. One of these was a case of metastatic cervical lymph node and unknown primary, one was a parotid tumour, and the remaining eight presented with oral cancers. All were non-smoking khat chewers and all of them had used it over a period of 25 years or longer. We conclude that this strong correlation between khat chewing and oral cancer warrants attention.

The aetiology and management of atrophic rhinitis

Atrophic rhinitis is a chronic, debilitating and recalcitrant disease of the nasal cavities that is prevalent in several parts of the world. It has unique epidemiological features and clinical characteristics. Clinicians and researchers for decades have tried to postulate theories for the aetiology of the primary form of the disease. Management of the disease has seen several medical therapeutic regimens including alternative forms of medicine. Surgical options for the condition are also not completely satisfactory with a number of failures and recurrences. The authors provide here a comprehensive review of the existing literature as regards the aetiology and management of this refractory condition.

Post intubation laryngeal sequelae in an intensive care unit

The incidence, severity and pattern of post-intubation laryngotracheal sequelae in a 12 bed multidisciplinary intensive care unit (ICU) were assessed in this prospective study. One-hundred and fifty consecutive patients requiring intubation for more than 24 hours for various indications were studied. Evaluation of the larynx and trachea was done using a fibreoptic bronchoscope introduced through the endotracheal tube prior to elective extubation. Rigid bronchoscopy and direct laryngoscopy were performed in very small children and adults requiring tracheostomy. One-hundred and thirty-one (87.6 per cent) patients had visible laryngeal pathology in the immediate post-extubation period. Thirteen (8.6 per cent) had long term sequelae. A high incidence of long term sequelae was noted in patients with seizures (25 per cent) followed by patients with head injury (19 per cent). Steroid therapy failed to offer any significant protection but resulted in doubling of pulmonary sepsis. A grading system was adopted to classify acute laryngotracheal injury and a significant correlation was found between the presence of slough in the immediate post-extubation period and subsequent development of long term sequelae. There was also a significant correlation between a deeper insertion of the endotracheal tube and development subsequently of long term sequelae. The significance of these findings is discussed.

Sensorineural hearing loss in neurobrucellosis

A case of neurobrucellosis presenting to the otologist with sensorineural hearing loss (SNHL) as the predominant clinical feature is reported. The diagnostic features and treatment options are discussed and the need for prolonged combination treatment to prevent relapse and further deterioration of hearing stressed. SNHL in neurobrucellosis has hitherto been reported principally in neurology literature as something of an incidental finding and so escapes the attention of otologists. It is hoped that this report will alert otologists in areas where brucellosis is endemic to the need to include tests for brucellosis in the routine diagnostic screening for SNHL. Practitioners in other locations should also consider this possibility when dealing with patients who have visited or lived in endemic regions.

Actinomycosis of the vallecula: report of a case and review of the literature.

A rare case of actinomycosis presenting primarily as a mass in the vallecula is described. The patient was a healthy, 65-year-old Saudi, lady who was not immunocompromised and had no other primary pathology in the oral cavity. The clinical presentation and management of the case are discussed and the relevant literature reviewed.

Otological manifestations of thalassaemia intermedia: evidence of temporal bone involvement and report of a unique cholesteatoma-like lesion

Thalassaemia intermedia should be considered in any chronically anaemic patient presenting from the Middle East with hearing impairment. We report here three Saudi siblings with thalassaemia intermedia and features of severe bone marrow expansion, particularly invading the temporal bone. They were seen first for their otological problems before they had access to proper haematological evaluation. One member was admitted for surgical exploration of a cholesteatoma, which was then found to be marrow expansion of the temporal bone. Screening of the family revealed two more anaemic siblings with thalassaemia intermedia. Audiological examination of all the family members showed that only the two affected members had a high frequency sensori-neural hearing loss. Bone marrow expansion into the temporal bone is a rare feature of thalassaemia intermedia. Cholesteatoma-like lesion has not been previously described. It has to be considered in all cases of symptomatic thalassaemia intermedia manifesting with cavitation and lytic lesions in the mastoid system. The likelihood that sensorineural hearing loss may complicate the thalassaemias is raised and the possible mechanism for such involvement discussed. The proper management for different otological manifestations of the thalassaemias is suggested. These cases would suggest a more extensive involvement of the temporal bone in the thalassaemias than has been previously recognized. Further large scale studies are required to illuminate the subject.

Reaction of human lungs to aspirated animal fat (ghee): a clinicopathological study

We report the clinical findings and pathological lung changes in four children following a cultural practice of forced feeding with animal fat (ghee) during infancy. The clinical presentation was of acute or chronic chest infection which failed to respond to antimicrobial therapy. The radiographic features ranged from extensive bronchopneumonia to collapse/consolidation and bronchiectasis. The light microscopy findings included diffuse mononuclear interstitial pneumonia, intraalveolar desquamation of pneumocytes, lipid granuloma formation, lung atelectasis and bronchiectasis. In the two children with longstanding reactions, the striking feature was the minimal lipid engulfment by the macrophages, the continuation of the mononuclear interstitial pneumonia, bronchiectasis and minimal lung fibrosis. In these two older children, the lung lymphatics were probably the main channels for drainage of the aspirated ghee.

Fibre-optic endoscopy in atrophic rhinitis

Primary atrophic rhinitis seems to have a high prevalence in the arid regions bordering the great deserts of Saudi-Arabia. Fibre-optic endoscopy was performed on 42 patients treated surgically. Fibre-optic endoscopy demonstrated the presence of crusts in the nasal cavities and their subsequent reduction following surgery. It also demonstrated ulceration of the cartilaginous nasal septum in some cases and this may explain the pathogenesis of septal perforation noted in a high number of our patients. Fibre-optic nasendoscopy was also helpful in demonstrating the reappearance of free mucus in the nasal cavity and helped to determine the optimal time for reversing Youngs procedure. Fibre-optic nasendoscopy is a reliable tool for verifying the results of surgery and comparing the efficacy of various treatment modalities.

Head and neck cancer in a referral center in Asir region.

This study looks at the incidence of head and neck cancer in the Southwest Region of the Kingdom of Saudi Arabia (Asir Region). There were a total of 204 newly diagnosed patients seen at Asir Central Hospital between 1987 and 1992; 113 males and 91 females. All were Saudi patients. Frequency at various sites with reference to sex and age was determined and comparison with local and international published reports was made. To the best of our knowledge, this is the first paper in the Kingdom to look at head and neck cancer as a distinct entity. In this study, skin cancer was the most common among males followed by oral and pharyngeal cancers. Among females, thyroid cancer was the most common followed by skin and oral cancers. Some preventive measures are discussed.

Is fine needle aspiration of the tonsil superior to a surface swab for isolating its core flora in recurrent tonsillitis

This prospective study was designed to explore the possible role of fine needle aspiration of recurrently inflamed tonsils in determining their core flora. Seventy-seven patients undergoing tosillectomy for recurrent tonsillitis were included. Colonies grown from fine needle aspirate and surface swab were compared with tonsillar core culture obtained after tosillectomy. The pathogens isolated by fine needle aspiration culture were not greatly different from surface swab results in comparison to core isolates. The results of fine needle aspirate do not appear to confer any advantage over surface swab in representing core flora. These findings would seem to indicate no clinical use for fine needle aspiration in the management of recurrent tonsillitis.