Nk Mohindroo

Auditory brainstem evoked responses in hyperlipidaemia: effect of various lipid fractions on auditory function.

OBJECTIVE To evaluate the effect of different lipid fractions on auditory brainstem evoked responses in hyperlipidaemia. METHOD We conducted a single institution (medical college), prospective, cross-sectional study of 25 hyperlipidaemic patients and 25 normolipidaemic controls, all with a normal hearing threshold on pure tone audiometry. Brainstem evoked response audiometry results were recorded in both groups. The hyperlipidaemic group were further divided into two subgroups, based on the serum value of each lipid fraction: those with less than and those with greater than the mean serum value. These two subgroups were further compared with the control group. RESULTS The hyperlipidaemic and normolipidaemic groups had statistically significant differences for all audiometry waves apart from the wave I and the III-V interpeak latencies. The subgroups had a statistically significant difference in brainstem evoked responses. We found a statistically significant association between low-density lipoproteins and many waveforms in the hyperlipidaemic group. CONCLUSION We found that low-density lipoproteins were significantly associated with many waveforms in hyperlipidaemic patients. Thus, low-density lipoproteins may be important in auditory dysfunction.

Pleomorphic adenoma of minor salivary gland with therapeutic misadventure: a rare case report

BackgroundThe benign tumors of nasopharynx are least encountered tumors in otolaryngology, as nasopharynx is considered one of notorious anatomical site for the malignant tumors. Pleomorphic adenoma of the minor salivary gland of nasopharynx and parapharyngeal space is rare. We present a pleomorphic adenoma of minor salivary gland which was mismanaged.Case presentationAn adult male presented with left nostril obstruction for five months. The examination found big mass extending from nasopharynx to oropharynx. On CT scan, this tumor was quite big and extending to the parapharyngeal space. The FNAB found it a carcinoma but it did not respond to radiotherapy. The excision biopsy of tumor revealed it as pleomorphic adenoma. We found only five published reports on this tumor arising from nasopharynx.Discussion and conclusionAlthough, in this case report exact origin of the tumor could not be ascertained as it also appeared to be a parapharyngeal tumor but we kept the possibility of a nasopharyngeal tumor on the basis of clinical features. The pleomorphic adenoma of nasopharynx is rare. It can be misdiagnosed as malignant epithelial tumor on histopathology. The differentiation from its malignant variant is also difficult. A possibility of benign tumor should always be kept in nasopharyngeal growth with no evidence of metastasis, and histopathological diagnosis of growth should be available before any definitive treatment.

Giant tonsillolith causing odynophagia in a child: a rare case report

Giant tonsillolith is a rare clinical entity. Commonly, it occurs between 20–77 years of age. We had a twelve years old female patient, who had odynophagia due to a giant tonsillolith. The stone was removed and tonsillectomy was performed. We reviewed the literature on this rare clinical entity and found that this is the fourth case of giant tonsillolith in a child and largest ever tonsillolith to be reported in English literature.

Hearing loss with phosphodiesterase-5 inhibitors: a prospective and objective analysis with tadalafil.

To assess the effect of tadalafil on auditory functions.

Clinicopathological and radiological evaluation of cervical lymph node metastasis in head and neck malignancies.

The cervical lymphadenopathy due to metastasis carry poor prognosis. The status of cervical nodes is of critical interest to surgical, radiation and medical oncologists who manage patients with head and neck cancers. We conducted a prospective randomized study to assess the role of palpation, ultrasound and CT in detection of cervical metastasis in 25 patients presented to us with head and neck malignancy irrespective of cervical nodal status. It was observed that clinical examination was least sensitive (73.33%) when compared with computerized tomography (80%) and ultrasound (93.93%). The computerized tomography was found to be most specific (90%) when compared to clinical examination or ultrasonography (70% each).

Cardiopulmonary functions and adenotonsillectomy: surgical indications need revision.

OBJECTIVE To assess cardiac functions in adenotonsillar or tonsillar hypertrophy. METHODS A prospective, interventional, academic centre based study was conducted on 25 children with adenotonsillar or tonsillar hypertrophy. All patients underwent pulsed 2-dimensional Doppler echocardiography, pulse oximetry and 12-lead electrocardiography. These assessments were repeated three months later to determine the impact of adenotonsillectomy. RESULTS There were significant differences in mean arterial oxygen saturation, pulmonary flow acceleration time and mean pulmonary artery pressure post-operatively. Adenotonsillectomy led to significant improvements in pulmonary flow acceleration time and pulmonary flow velocity time index, while tonsillectomy resulted in right ventricular early and late diastolic velocity index improvement. CONCLUSION Upper airway obstruction in children affects cardiac functioning and this can subsequently lead to morbidity and delayed growth. Hence, revision of surgical indications is advocated in adenotonsillar hypertrophy to avoid irreversible damage to cardiopulmonary functions.

Evoked response audiometry in scrub typhus: prospective, randomised, case-control study.

OBJECTIVE To investigate the hypothesis of cochlear and retrocochlear damage in scrub typhus, using evoked response audiometry. STUDY DESIGN Prospective, randomised, case-control study. METHODS The study included 25 patients with scrub typhus and 25 controls with other febrile illnesses not known to cause hearing loss. Controls were age- and sex-matched. All subjects underwent pure tone audiometry and evoked response audiometry before commencing treatment. RESULTS Six patients presented with hearing loss, although a total of 23 patients had evidence of symmetrical high frequency loss on pure tone audiometry. Evoked response audiometry found significant prolongation of absolute latencies of wave I, III, V, and wave I-III interpeak latency. Two cases with normal hearing had increased interpeak latencies. These findings constitute level 3b evidence. CONCLUSION Findings were suggestive of retrocochlear pathology in two cases with normal hearing. In other patients, high frequency hearing loss may have led to altered evoked response results. Although scrub typhus appears to cause middle ear cochlear and retrocochlear damage, the presence of such damage could not be fully confirmed by evoked response audiometry.

Fibrolipoma of the eustachian ostium.

Nasopharyngeal fibrolipoma is extremely rare, with only four case reports in the literature. However, lipoma of the eustachian tube is the rarest with a single case report in the literature. A 50-year-old woman presented with obstruction of both nostrils for the past 1 year. CT scan showed a mass in the postnasal space extending from the right side of the nasopharynx to the oropharynx. The nasal endoscopy found a polypoidal mass arising from the posterior–inferior margin of the right eustachian tube ostium and extending to the oropharynx. Histopathological examination of the excised polyp found features suggestive of fibrolipoma. Fibrolipoma is characterised by prominent bundles of mature collagenous or myxocollagenous stroma intermixed with mature adipocytes. CT is useful in the diagnosis of lipoma but MRI is preferable. This is the second case of eustachian tube fibrolipoma to be reported in the literature that emphasises the role of nasal endoscopy and rarity of this tumour.

Primary non-Hodgkin's lymphoma of the infratemporal fossa: a rare case report

BackgroundThe head and neck are two of the most common sites of extranodal non-Hodgkins lymphoma (NHL). However, primary tumors of the infratemporal fossa are infrequent, and NHL in this region is extremely rare.Case presentationWe present a case of a 41-year-old female that presented with swelling in the right preauricular region that had persisted for the past two years. The patient was diagnosed as having a small lymphocytic NHL. She initially underwent chemo-radiation but reported relapse. The tumor was excised and again the patient underwent chemotherapy. The patient remained symptomatic and developed a second primary squamous cell carcinoma in the right retromolar trigone.Discussion and conclusionWe discussed NHL with an emphasis on extranodal manifestations. Extranodal NHL that is limited to a single site can be managed by surgery and regular follow up. To the best of our knowledge, this is only the second case of primary NHL of the infratemporal fossa to be reported in the literature.

Alternating extra medullary plasmacytoma of maxilla

Plasmatytomas of maxilla are rare lesions. Alternating plasmacytoma of maxilla is still rare. A case of maxillary extra medullary plasmacytoma is reported in a patient, who presented with same lesion in the opposite maxillary sinus within one year of initial presentation. On review of available literature we could not find bilateral medullary plasmacytoma involving both maxilla one after another.