Pradipta Kumar Parida

Pott's puffy tumor in pediatric age group: A retrospective study

OBJECTIVE To study the etiology, clinical features and treatment outcomes of pediatric Potts puffy tumor (PPT). METHODS This retrospective study was carried by reviewing medical case record of pediatrics PPT cases admitted to our hospital from January 2010 to august 2011. Data regarding the patients demographic details, presenting symptoms and signs, etiology, laboratory findings, imaging findings, management, complications and outcomes of treatment were collected and analyzed. RESULTS A total of five cases of PPT were found. Three were male and two were female with a mean age of 11.6 years. All patients presented with headache, fever and tender forehead swelling. Nasal polyps and discharging sinuses over forehead were present in one case and one case had preseptal orbital cellulites in addition to PPT. None of the patient had intracranial complications. Three cases (60%) were secondary to acute frontal sinusitis, one case was as complication of chronic sinusitis and one case was because of trauma. Contrast enhanced Computerized tomography (CECT) demonstrated features of acute sinusitis in 3 cases, sinonasal polyp in one, fracture of anterior table of frontal bone in one case, subperiosteal collection and erosion of anterior table frontal bone in all cases. All patients required surgical intervention; Endoscopic approach 2 cases (40%), combined approach in 2 cases (40%) and external approach in one case (20%) in addition to aggressive antibiotic treatment. There was purulent discharge in frontal sinuses in all cases. In 2 cases (40%), culture of pus drained during surgery was positive; one case methicillin resistant Staphylococcus aureus sensitive to vancomycin, other Pseudomonas aeruginosa sensitive to ceftazidime and amikacin. All cases improved with treatment. There were no postoperative complications or facial cosmetic deformity except facial scar in three cases. The average hospital stay was two weeks and ranged from 10 days to 21 days. All patients received antibiotics for 6-8 weeks to treat osteomyelitis of the frontal bone. The average length of follow up was 9 months (range 6-18 months). All patient are doing well and are under regular follow up. CONCLUSIONS PPT is a complicated infection of frontal sinusitis and trauma that requires broad spectrum antibiotics and surgical treatment. Diagnosis is made by high clinical suspicion of this condition and confirmed by CECT. Early treatment results in favorable outcomes and decreases the risk of further complications.

The efficacy of radiofrequency volumetric tissue reduction of hypertrophied inferior turbinate in allergic rhinitis.

OBJECTIVES To evaluate the efficacy of radiofrequency volumetric tissue reduction (RFVTR) technique in treatment of allergic inferior turbinate hypertrophy (ITH) and to study its effect on nasal mucociliary clearance. MATERIALS AND METHODS This prospective study was conducted over 50 perenial allergic rhinitis patients with persistent nasal obstruction due to bilateral ITH refractory to medical management received one time RFVTR of both inferior turbinates. Symptoms were subjectively assessed by Visual Analog Scale (VAS) and mucociliary clearance was measured by saccharin transit time (STT) pre-operatively, at 1 week, 1, 3, and 6 months post-operatively. RESULTS Forty-seven subjects completed study. All patients had significant symptomatic improvement which started from 1 week post-operatively and persisted up to 3 months. Post-operative VAS scores of nasal obstruction, rhinorrhea, sneezing, headache, and snoring at 1 week 1, 3 and 6 month follow up visits significantly decreased (P < 0.05) whereas significant decreased in post-operative VAS scores of hyposmia was observed at 1 month follow up (P < 0.05). Though increase in VAS scores was observed during 6 month follow up, the difference between pre-operative and 6 month post-operative mean VAS score was statistically significant (P < 0.05). Symptomatic improvement in nasal obstruction, rhinorrhea, sneezing, headache, hyposmia, and snoring persisted in 89.4%, 95.6%, 97.8%, 88.5%, 46.7%, and 100% of patients, respectively, during 6 month follow up. There was no significant change in STT following RFVTR except at 1 week follow up (P < 0.0001). CONCLUSION RFVTR is safe and effective in treatment of ITH in allergic rhinitis patients.

Pediatric recurrent acute suppurative thyroiditis of third branchial arch origin—Our experience in 17 cases

OBJECTIVE To describe clinical presentations, management and treatment outcomes of 17 cases of congenital pyriform sinus fistula (PSF) of third branchial arch origin presenting as left recurrent acute suppurative thyroiditis with cervical abscess. METHOD Medical record of these 17 cases (5-males, 12-females) presented during 2009-2013 were reviewed. RESULTS Average age was 9.6 years (range 3-15 years). Fistulous opening in neck was present in 10 cases (58.8%). Average number of episode of infection from first presentation to definitive diagnosis was 3 (range 2-5). All patient had history of incision and drainage (ID) of abscess (average 2, range 1-3). All cases had barium swallow and CT scan. Sixteen cases had telescopic hypopharyngoscopy. Barium swallow and telescopic hypopharyngoscopy detected PSF in 88.23% (15/17) and 100% (16/16) cases respectively. Fourteen cases were treated by transcervical excision (TE) (fistulectomy with left hemithyroidectomy), two cases were treated by endoscopic chemical cauterization (ECC) of internal opening at pyriform sinus using silver nitrate and only ID of abscess was done in one case. Success rate of TE and ECC was 93% and 100% respectively. Recurrence in one case initially treated by TE was managed successfully by ECC. CONCLUSION Presence of congenital PFS should be suspected when left-sided intra-thyroidal abscess formation occurs as gland is resistant to infection. Strong clinical suspicion, barium swallow study, telescopic pharyngoscopy and CT scan are the key to diagnosis. Both TE and ECC has comparable success rate. ECC may prove a useful and equally effective method of treatment for congenital PFS in future.

An unusual cause of epistaxis in a young patient: the supernumerary nasal tooth

Eruption of supernumerary teeth into the nasal cavity is a rare pathological condition. Identification of such teeth is important as they can sometimes cause significant morbidity. This report describes a young female patient with a complaint of epistaxis from the right nasal cavity. The diagnosis of a supernumerary nasal tooth was confirmed by computed tomography and the tooth was removed endoscopically with minimal morbidity.

A giant prolactinoma with nasopharyngeal extension presenting with nasal blockage and epistaxis.

A 35-year-old woman presented to the ear, nose and throat outpatient department with headache and a blocked left-sided nasal canal with epistaxis for 2 years. Medical history revealed secondary amenorrhoea for the past 19 years with regression of secondary sexual characteristics with no galactorrhoea. Physical and ophthalmological examinations were within normal limits. Nasal examination revealed a left-sided choanal mass. As the mass was bleeding on …

Venous malformation of right angular vein.

A 34-year-old lady presented to us with complaints of a progressively enlarging swelling in the region between the medial canthus of right eye and root of the nose, since 4 years. She did not give any history of nasal complaints, epiphora or pain from the swelling. There was no history of trauma to face in the past. On examination, the swelling was found to be about 2 cm × 2 cm in size, soft in consistency and non-tender. There was a bluish hue of the overlying skin. The underlying bone was found to be intact. The swelling was completely compressible on palpation, and would slowly fill up on release. An increase in the size of the swelling was noted on performing valsalva manoeuvre. X ray of the paranasal sinuses did not reveal any underlying bony defect. We proceeded to do a contrast enhanced computed tomogram (CT) in order to establish the diagnosis. CT revealed a 2 cm × 1 cm homogenously enhancing soft tissue density with normal surrounding bony and soft tissues. There was no surrounding soft tissue inflammation or collections noted. The above lesion appeared to be in continuous with a tortuous dilated angular vein which in turn drained into the right external jugular vein (Fig. 1). Hence a diagnosis of venous malformation was established.

Interesting case: displacement of fractured maxilla into pharyngeal space.

Atypical fracture patterns of the facial region have been reported infrequently. An unusual displacement of fractured posterior maxillary segment into the lateral pharyngeal space is described.

Perception of nursing students toward integrated methods of teaching the ENT clinical examination in south India

Context: Assessment of integrated teaching methods are lacking in Indian setup of nursing education. AIM: To assess the perception of nursing students towards integrated methods of teaching ENT Clinical Examination. Materials and Methods: Large group teaching was carried out for teaching ENT examination in a theory class of nursing students. This large group teaching included facilitations such as dividing the one hour session into three short sessions of 20 minutes each, group activity, five minute evaluation, and usage of video. The impact was assessed by scoring the group generated checklist, individual response on a short answer question and obtaining a feedback on video teaching and group activity. Results: At the end of the class after three assessments, the overall mean group score was 85.4%. The students showed positive reaction when they were allowed to solve a specific task in groups as reflected by their feedbacks. Authors found that these factors promoted most of the aspects of the cognitive domain in the students, improved the clarity of the student for a complex topic and improved the attention span of the students. Conclusion: These integrated systems worked out well in our setup and can be used regularly in nursing students teaching.

Manual stapedotomy still holds good in the era of laser

CONTEXT In the present era of stapedotomy, there is an inevitable role for laser. But the conventional technique with manual burr still has its own merits in various settings such as usage in resource poor setting in developing countries and avoidance of laser hazards. AIMS To evaluate the audiometric outcomes after manual stapedotomy. SETTINGS AND DESIGN The present study was retrospective record-based study. Patients who have been diagnosed otosclerosis and those who were not willing for surgery with laser, but gave consent for manual stapedotomy were included for the study. MATERIALS AND METHODS Preoperatively, and at each subsequent post-operative follow-up visits, patients were required to undergo a pure-tone audiogram. The air-bone gaps at the end of 6 months were used for final analysis. STATISTICAL ANALYSIS USED Data was analyzed with using Statistical Package for Social Sciences (SPSS) version 12 (Chicago, IL, USA). Descriptive frequency distributions, mean, standard deviation of audiometric data were calculated. The paired t test was done to see the improvement in the air bone gap post-operatively. RESULTS The mean age of presentation is 32.2 years. Overall, the male:female ratio was found to be 1:1.2. Post-operative air bone closure to 15 decibels was obtained in 80% of patients. There was no significant correlation between the pre-operative hearing loss and post-operative gain, age, and gender of distribution of focus. CONCLUSIONS The post-operative hearing after stapedotomy has been remarkable in all the patients even with manual burr. There were no major vestibular complications in any of these patients. The study has shown that the significant post-operative hearing results can be still achieved with meticulous surgery by an experienced surgeon with manual burr in the present laser era.