Ramanuj Sinha

Ear, nose and throat foreign bodies in children: A search for socio-demographic correlates

OBJECTIVE Ear nose and throat foreign bodies in children are one of the most common emergencies faced by otorhinolaryngologists. Our objective in the study conducted in the otolaryngology department of R.G. Kar Medical College & Hospital was to find out the socio-demographic correlates of self inflicted foreign body insertion in ear-nose-throat in children presenting in out patient department and emergency. METHODS A cross sectional descriptive study was conducted from October 2009 to March 2010 in the out patient department and emergency of otolaryngology. Using a predesigned and pretested questionnaire, socio-demographic data was collected prospectively on every alternate day by examining clinically all new pediatric patients attending with self-inflicted foreign body and interviewing their caregivers after removal of foreign body. The data collected from 288 children was analyzed by using simple proportion, odds ratio with 95% confidence interval, χ(2), t-test and analysis of one way variance (ANOVA) test. Epi info 3.4.3 version (CDC, Atlanta, retrieved from WHO website, on 01.11.09) and SPSS 17.0 were used for statistical calculations. RESULTS Analysis showed male preponderance (59.72%) of cases from urban area (63.9%), predominance of 0-5 years age group with 5.19 ± 3.02 (mean ± standard deviation) years average age, nasal foreign body was on the top (44.4%), majority from low income (58.33%) joint family (65.3%) with housewives (75.0%) as primary care giver, majority of whom reported to have nil or low literacy (61.1%). 19.4% subjects having local pathology showed significant association with urban residence, joint family, low socio-economic status and two or less than two children of the mother of the participant children. Past history of similar incidence was found in 22.2% of study subjects and significantly associated with nasal foreign body insertion and higher among the children of housewives. CONCLUSIONS Increasing awareness of the prime caregivers by the routine grass root level health workers may be tried to reduce incidence of this risky health event and capacity building of the Primary level physicians to handle foreign body insertion cases can lessen the stress of the victim children and their parents.

Unusual Presentations of Adenoid Cystic Carcinoma in Extra-Salivary Gland Subsites in Head and Neck Region: A Case Series

Adenoid cystic carcinoma (ACC) is an uncommon malignant epithelial tumor occurring in head neck region, accounting for approximately 10% of all salivary gland neoplasms. Extra-salivary gland involvement of other head neck subsites by ACC may present in unusual modes creating clinical dilemma. Here we present some cases with extra-salivary gland ACC. In this series six cases with extra-salivary gland ACC were included. Three patients presented with external auditory canal and temporo-mastoid region involvement of whom two cases also had intracranial extension. In one case tongue was the site of involvement where it was confused with benign neurogenic tumour. Palatal erosion with formation of oro-nasal fistula was the the manifestation of ACC involving palate. On the other hand sinonasal bleeding mass which came out as ACC on histopathological examination did not cause any palatal erosion and was removed successfully via lateral rhiniotomy. In all these cases patients were treated with post-operative radiotherapy and were closely followed up for early detection of any distant metastasis. The experience about the various unusual manifestations of ACC and the therapeutic challenge poised by the cases is discussed here.

Large, solitary angiokeratoma in the posterior third and base of the tongue: case report

OBJECTIVE We present an extremely rare case of isolated angiokeratoma of the tongue. METHOD Case report and review of related literature. RESULTS An 18-year-old, male adolescent presented with a fleshy, intermittently bleeding mass in the posterior third and base of the tongue. The lesion was initially suspected to be a lingual thyroid or haemangioma, but histopathological features were consistent with angiokeratoma. Magnetic resonance imaging revealed that the lesion extended up to the vallecula and involved the lamina propria and superficial tongue musculature. No similar lesions were found elsewhere in the body. No metabolic derangements were identified in the patient or his family. The 2.6 × 1.5 × 0.5 cm mass was excised under general anaesthesia. CONCLUSION We present the 1st case of isolated lingual angiokeratoma in a male, the 4th such case overally, the largest ever documented. The lesion was situated in the posterior third and base of the tongue, a position not previously described.

Atypical Presentations of Rhinosporidiosis: A Clinical Dilemma?

Rhinosporidiosis is a chronic inflammatory disease common in India and Sri Lanka. Its manifestations are mostly nasal, though extranasal ones in head and neck region are not rare. Occasionally these presentations lead to diagnostic dilemma. Here we present some cases with its associated confusions if any. In this study thirty five patients were included. Extranasal manifestations were noted in nine cases. Two patients attended with laryngopharyngeal and one with lacrimal sac presentation–subsequent nasal endoscopic examination revealed presence of nasal masses, too. Other six cases presented with polypoidal mass hanging from nasopharynx into oropharynx. One of them was confused with nasopharyngeal angiofibroma. Two laryngopharyngeal masses were removed successfully with rigid laryngoscope followed by cauterisation of the base. The solitary lacrimal sac mass was excised by external approach combined with nasal endoscope guided excision of nasal mass. The other six cases with nasopharyngeal attachment were subjected to nasal endoscope guided removal. In all these cases, the base of the lesions was cauterised. The experience about the various manifestations and diagnostic problems is discussed here.

Open safety pin in the nasal cavity.

Foreign bodies in the nasal cavity are common-day occurrences in Otolaryngologic practice. But an open safety pin in nose with it’ s sharp end directed towards roof is a rare incidence, and available literature is silent about this presentation; it is probably, the first of it’ s kind being reported. Two cases of safety pins inside the nasal cavity, one open and the other closed, have been presented here with a brief review of literature.

Pediatric Otolaryngological Emergency: An Experience from a Tertiary Care Teaching Institution at Kolkata, India

AbstractOtolaryngological conditions constitute a major share of emergency medical problem among children. The present study was conducted to assess the patient profiles, incidences morbidities, mode of presentation and managements of different otolaryngological emergencies among pediatric patients presented in a tertiary care hospital. Descriptive cross-sectional study by analysing retrospectively collected information pertaining to the patients attended ENT emergency service department of a tertiary care hospital, Kolkata. Data were collected using predesigned proforma and were analysed with the help of SPSS version 20. About 39.0% of total ENT emergency attendance was contributed by pediatric age group. The male female ratio was 1:1.33 with average age of 58.95 ± 34.42 (mean ± SD) months. Half of the attendees had ear problem and almost one-third reported complaints related to nose. The major complaints at the time of presentation were earache (32.3%), nasal foreign body (24.0%) and aural foreign body (13.3%) closely followed by aero-digestive tract foreign body (12.0%). Inflammatory conditions affected the ears more, foreign bodies found most commonly in nose and miscellaneous condition such as impacted wax was found to be related to ear in significantly higher proportion. Conservative management was provided to 96.25% of patients. Foreign body insertion was found to be associated with lower age group. Most of the emergencies were managed conservatively which might be done at subdivision or district level to reduce the undesirable burden on the tertiary care medical colleges.

Primary tuberculosis of the nasal septum: The non-ulcerated form presenting as septal thickening

A 40-year-old woman presented with insidious-onset nasal obstruction and anosmia since two months. Examination revealed a grossly thickened and bulged septum that was non-tender, firm, non-fluctuant, with normal-appearing mucosa [Fig. 1]. There was no history of facial trauma, epistaxis, and nasal discharge. However, the patient admitted to have the habit of frequent nose-picking. She was also having frequent evening rise of temperature since three months, although she experienced no significant weight loss, cough or hemoptysis. There were no palpable cervical nodes. Routine hematologic investigations were acceptable except the erythrocyte sedimentation rate (87 mm; 1st hour). Her chest skiagram was unremarkable, and her serology reports were non-reactive. Contrast-enhanced computed tomography (CT)-scan showed heterogeneous soft-tissue thickening of the septum that extended throughout its antero-posterior and cranio-caudal dimensions, involving the cribriform area/olfactory fossa [Fig. 2]. A biopsy from the septal thickening under local anesthesia was planned.

Extensive mucosal erosion and Sloughing of tongue: a hitherto unknown complication of topical clotrimazole preparation.

Clotrimazole, a broad-spectrum imidazole antimycotic, is a widely-used prescription as well as an over-the-counter drug for treatment of mucosal (oral, vulvovaginal) candidiasis and dermatophytes. An extremely safe and well-tolerated drug, its safety profile has been well-explored in researches and trials. The commonest complaints are almost always non-serious-pruritus, rashes, paraesthesia (stinging/burning sensation) and erythema on topical applications, and nausea, vomiting, unpleasant taste sensation and elevated liver enzymes on oral preparations (troches). However, mucosal ulceration on topical clotrimazole preparation has not been reported in literature before. We present here the first documentation of extensive bilateral erosions and necrosis of tongue involving the mucosa, submucosa and musculature on application of one percent weight/volume clotrimazole mouth paint in a 27-year-old immunocompetent woman who presented with oral candidiasis.