Mohnish Grover

Isolated sphenoid mucormycosis presenting as visual impairment: changing trends?

Mucormycosis of the paranasal sinuses represents an important cause of morbidity and mortality in patients whose host defenses have been altered by primary disease or immunosuppressive therapy. The pattern of involvement by this fungus is changing with reports of mucormycosis occurring also in immunocompetent host. The involvement of isolated sphenoid sinus is rare. In the present case, the only presenting symptom was visual impairment. These changing trends in presentation, the extent, and the area of involvement are challenging for the otorhinolaryngologist, ophthalmologist, and neurosurgeon. High index of suspicion, prompt intervention, and aggressive therapy are required to reduce the morbidity and mortality associated with this disease.

Cochlear implant in Thalassemia patient – Case report

Introduction: Beta-thalassemias are a group of hereditary blood disorders characterized by anomalies in the synthesis of the beta chains of hemoglobin. Iron overload occurs in thalassemia, with blood transfusion therapy being the major cause. Deferoxamine continues to be the mainstay of therapy to remove excess iron in patients requiring long-term transfusions. One of the most important complications of deferoxamine therapy is neurosensory toxicity, including sensorineural hearing loss (SNHL). Labyrinthine hemmorhage (LH) is thought to result from altered capillary hemodynamics or reperfusion injury. It is theorized that LH incites a reparative response that cascades from fibrosis to sclerosis and ultimately ossification of the inner ear structures. Case presentation: We present a case of 3-year-old thalassemic child with bilateral profound sensorineural hearing loss. Patient was on regular blood transfusions with chelation therapy. HRCT temporal bone and MRI brain and temporal bone had features of labyrinthitis ossificans (LO). Child underwent uniateral cochlear implantation and postimplantation speech perception and production outcomes were normal. Discussion: This case illustrates the unique feature of labyrinthitis ossificans in a thalassemia patient which has not yet reported in the English literature. Hearing screening of all thalassemia patients and therefore early diagnosis of SNHL prompts early intervention and improved quality of life.

Successful cochlear implantation in Langerhans cell histiocytosis: A rare case

An 8-year-old girl presented with a 1-year history of bilateral progressive hearing loss and vertigo for 6 months. High-resolution computed tomography of the temporal bones demonstrated multiple lytic lesions. Histopathology examination confirmed a diagnosis of Langerhans cell histiocytosis (LCH). She underwent chemotherapy for 12 months. Following treatment, she was in remission. However, the bilateral profound sensorineural hearing loss persisted. She underwent right cochlear implantation with very good functional audiological outcomes. This is the first known reported case of successful auditory rehabilitation through cochlear implantation in a patient with bilateral profound hearing loss due to isolated bilateral temporal bone LCH.

Removal of an Unusual Neglected Foreign Body in Infratemporal Region Using Navigation.

A 19-year-old male presented with complaint of a bluish mass in the hard palate since 3 months. The patient had a history of trauma 8 years back in the left zygomatic area with a pen. It was lodged in the wound and removed at that time. Computed tomography scan was revealed a linear heterogenous dense structure extending from left infratemporal fossa to oral cavity, traversing through left maxillary sinus, with bone defect seen in lateral and medial wall of maxilla, and in the hard palate, most likely a neglected foreign body. The foreign body was removed by navigation-assisted endoscopic surgery and the palatal perforation repaired using local rotation flap. There were no intraoperative or postoperative complications. Navigation-guided removal of foreign body in proximity to vital structures, in the infratemporal region, is a valuable option with minimal morbidity.A 19-year-old male presented with complaint of a bluish mass in the hard palate since 3 months. The patient had a history of trauma 8 years back in the left zygomatic area with a pen. It was lodged in the wound and removed at that time. Computed tomography scan was revealed a linear heterogenous dense structure extending from left infratemporal fossa to oral cavity, traversing through left maxillary sinus, with bone defect seen in lateral and medial wall of maxilla, and in the hard palate, most likely a neglected foreign body. The foreign body was removed by navigation-assisted endoscopic surgery and the palatal perforation repaired using local rotation flap. There were no intraoperative or postoperative complications. Navigation-guided removal of foreign body in proximity to vital structures, in the infratemporal region, is a valuable option with minimal morbidity.