Prasad Deshmukh

Primary tuberculosis of nasopharynx (adenoid)- a rare presentation.

Tuberculosis has global presence and no part of human body is immune to it, most frequent site beings lungs. Nasopharyngeal tuberculosis is a rare type of extrapulmonary tuberculosis comprising only less than 1% of tuberculosis found in the upper respiratory tract. The authors are presenting here a case of primary tuberculousis affecting the nasopharynx (adenoids) which is one of the rare differential diagnosis of nasopharyngeal mass. Isolated nasopharyngeal tuberculosis is a rare condition even in the endemic areas. In literature there are varied clinical presentations of nasopharyngeal tuberculosis. Tuberculosis should be one of the differential diagnosis of nasopharyngeal lesion. Biopsy and histologic study should be performed in every patient to avoid misdiagnosis. When treated properly, nasopharyngeal tuberculosis carries a excellent prognosis, and complete resolution of disease is the rule.

Nasal Septal Deviation and External Nasal Deformity: A Correlative Study of 100 Cases

A prospective study of 100 consecutive patients of deviated nasal septum to analyze association of septal deviation with external nasal deformity was undertaken at Acharya Vinoba Bhave rural Hospital of Jawaharlal Nehru Medical College, Sawangi (Meghe) Wardha from January 2009 to September 2010. Nasal septal deviations were evaluated by clinical examination and diagnostic nasal endoscopy while external nasal deformities, after evaluating, were documented using high resolution photography Nasal septal deviations were classified in seven types from I to VII by using Mladina’s classification modified by Janardhan et al. Jang classification was employed to classify external nasal deformities. 66% of the patients with deviated nasal septum were symptomatic while 34 lacked symptoms. Nasal obstruction was the most frequent symptom in 64% followed by nasal discharge in 33% Type VII was the most common type of deviation in 29%. Study revealed that 67% of the patients with deviated nasal septum had external nasal deformity and of the 67 patients with external deformity, Type I deformity was most frequent (26%). Remarkable feature of our study was Type I, III, V septal deviations were not associated with external deviation Type II septal deviations were commonly associated with Type III external deformity (7%) and Type IV septal deviation were closely associated with Type I external deformity (12%).

Unusual Sites of Epidermoid Cyst

Epidermoid cyst is usually due to infection of pilosebaceous gland or due to traumatic migration of epidermis to the deeper structure of skin. They may present in any place of body which is lined by squamous epithelium. They are rarely present in head neck and in oral cavity. We are presenting rare cases of epidermoid cyst presenting in post aural region and floor of mouth.

A comparative study of ceruminolytic agents

A prospective study was done to access the efficacy of ceruminolytic agents, i.e 2% paradichlorobenzene, 10% sodium bicarbonate, 2.5% acetic acid and normal saline. All score 4 hard impacted ear wax cases in the adult population (>20 years) were accrued for the assessment of the relative efficacy. Upon analyzing the comparative efficacy of four ceruminolytic agents, by taking into consideration three parameters (post) ceruminolytic cerumen score, attempts of syringing required to extrude the cerumen mass, post-ceruminolytic use and appearance of the removed cerumen mass. 2% paradichlorobenzene emerged as the most superior ceruminolytic, closely followed by 10% sodium bicarbonate. 2.5% acetic acid fared moderately while normal saline emerged as the least efficacious ceruminolytic agent.

Acute laryngeal abscess following acute sinusitis: A rare presentation in the modern era

Acute laryngeal abscess is a rare but potentially lethal condition. There are historic descriptions of its association with systemic illnesses like typhoid fever or as a result of spread of infection following upper respiratory tract catarrh. The etiology of laryngeal abscess in recent times has changed to those with underlying malignancy, trauma due to airway instrumentation, nasogastric intubation, and external beam radiotherapy. Here we report a case of acute laryngeal abscess following catarrh, identical to the historic descriptions, probably the first such report in the modern era, highlighting the importance of its early diagnosis and high index of suspicion, which led to a very good recovery in our patient.

Tuberculous retropharyngeal abscess without cervical spine TB

Tuberculous retropharyngeal abscess is a rare presentation. It is present in adults usually due to involvement of cervical spine by tuberculosis. Retropharyngeal space usually gets involved in children due to pyogenic organisms or secondary to trauma. Here is a case of tuberculous retropharyngeal abscess in an adult female, with pulmonary tuberculosis. The patient was not having tuberculous involvement of cervical spine and was managed surgically by aspirating the retropharyngeal abscess transorally and AKT Category I.

Role of dynamic slow motion video endoscopy in etiological correlation between eustachian dysfunction and chronic otitis media: A case-control study

Objective: To assess the role of dynamic slow motion video endoscopy (DSVE) for diagnosing eustachian tube (ET) dysfunction in the cases of middle ear disorders and to classify eustachian dysfunction into mechanical and functional for the purpose of systematic management of middle ear disorders. Materials and Methods: A prospective, case-control study was carried out on total 84 patients (168 ears) of whom 64 patients with ear complaints (total 95 ears) having middle ear disease was taken as cases. Remaining 20 patients without any ear and nasal complaints (40 ears) and the normal ears among the case group (33 ears) were taken as controls (total 73 ears). DSVE was performed in cases and controls to compare the incidence of eustachian dysfunction in the two groups. Tubal movements were classified into four grades depending on: (1) Appearance of tubal mucosa, (2) movements of medial and lateral cartilaginous lamina, (3) lateral excursion and dilatory waves of the lateral pharyngeal wall, (4) whether tubal lumen opened well or not and (5) presence of patulous tubes (concavity in the superior third of tube). Results: On correlating the DSVE findings of ET in both case and control group, 4 times higher incidence of abnormal ET dysfunction was obtained in cases of middle ear disorders as compared to controls (P = 0.001, odds ratio of 4.0852). We found that 29 tubes had mechanical type of dysfunction (Grades 2A and 3A), whereas 30 tubes had functional type of dysfunction (Grades 2B and 3B and patulous). Conclusion: There is a positive etiological correlation between eustachian dysfunction and chronic otitis media by DSVE. It provides valuable information regarding the structural and functional status of the pharyngeal end of the ET and in classifying the type of eustachian dysfunction into mechanical or functional, which has management implications.

Bilateral pneumothorax: Perils of emergency tracheostomy

Tracheostomy is a life-saving procedure performed in both emergency and elective setting. Development of bilateral pneumothorax in adults following tracheostomy is a rare complication. We report a case of bilateral iatrogenic pneumothorax in 33-year-old woman from rural Maharashtra in central India, immediately following emergency mid-level tracheostomy done for post- radiotherapy fibrosis with laryngeal perichondritis and retropharyngeal infection associated with prolonged dyspnea. No pleural injury or posterior tracheal wall injury had occurred. Sudden left-sided chest pain with immediate reoccurrence of dyspnea prompted us to do urgent chest X-ray. Bilateral pneumothorax was identified, more on the left side. The patient was treated with tube thoracostomy. The case is being reported to highlight the possibility of occurrence of this rare life-threatening complication due to the underlying mechanism in any case of emergency tracheostomy.

Cysticercosis of the neck: a case report.

Abstract The neck is a rare site for cysticercosis. Very few cases of cysticercosis presenting in the neck have been reported. We report one such case creating diagnostic dilemma.

Applied anatomy of round window and adjacent structures of tympanum related to cochlear implantation

INTRODUCTION Various aspects of the round window anatomy and anatomy of posterior tympanum have relevant implications for designing cochlear implant electrodes and visualizing the round window through facial recess. Preoperative information about possible anatomical variations of the round window and its relationships to the adjacent neurovascular structures can help reduce complications in cochlear implant surgery. OBJECTIVE The present study was undertaken to assess the common variations in round window anatomy and the relationships to structures of the tympanum that may be relevant for cochlear implant surgery. METHODS Thirty-five normal wet human cadaveric temporal bones were studied by dissection for anatomy of round window and its relation to facial nerve, carotid canal, jugular fossa and other structures of posterior tympanum. The dissected bones were photographed by a digital camera of 18 megapixels, which were then imported to a computer to determine various parameters using ScopyDoc 8.0.0.22 version software, after proper calibration and at 1× magnification. RESULTS When the round window niche is placed posteriorly and inferiorly, the distance between round window and vertical facial nerve decreases, whereas that with horizontal facial nerve increases. In such cases, the distance between oval window and round window also increases. Maximum height of the round window in our study ranged from 0.51-1.27mm (mean of 0.69±0.25mm). Maximum width of round window ranged from 0.51 to 2.04mm (mean of 1.16±0.47mm). Average minimum distance between round window and carotid canal was 3.71±0.88mm (range of 2.79-5.34mm) and that between round window and jugular fossa was 2.47±0.9mm (range of 1.24-4.3mm). CONCLUSION The distances from the round window to the oval window and facial nerve are important parameters in identifying a difficult round window niche. Modification of the electrode may be a better option than drilling off the round window margins for insertion of cochlear implant electrodes.