Ramesh K. Azad

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.

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.

Aspiration cytology in the preoperative diagnosis of granular cell tumor of thyroid region in an 11-years-old female child

Journal of Cytology / July 2013 / Volume 30 / Issue 3 Calymmatobacterium granulomatis also known as Donovan body. Pathogenicity is limited to humans only,[2] and is seen more frequently in Africa and Asia.[3] Incubation period ranges from 1 to 12 weeks. It begins as a painless papule on the genitalia, which ulcerates slowly.[2] In early stages donovanosis is difficult to differentiate from chancroid.[4] The chancroid ulcers are painful whereas those of donovanosis are painless. In later stages, it is difficult to differentiate from lymphogranuloma venereum (LGV) and anogenital cutaneous amebiasis.[4] LGV is also a STD caused by Chlamydia trachomatis characterized by painless ulcer and lymphadenopathy (buboes). Anogenital amebiasis is diagnoses by identifying ameba from the ulcers. Microscopically, Donovan body appears as rounded 1-2 μm in diameter, within thin-walled intracytoplasmic vacuoles inside mononuclear cells. They show bipolar condensation of chromatin, giving a closed ‘safety pin’ appearance in stained smears. Neutrophilic infiltrate without giant cells is often seen. Reactive epithelial cells are usually scant and marked reparative change may be found in case of ulceration. The differential diagnosis includes follicular cervicitis, granulation tissue, and other granulomatous diseases, including malakoplakia.[5] In follicular cervicitis, lymphoid cell infiltrate is seen instead of neutrophils along with tingible-body macrophages with cellular debris. In malakoplakia, cytoplasmic inclusions called Michaelis-Gutmann bodies are more dense, laminated and round, compared to Donovan bodies. Ancillary studies that may be helpful include special stains (e.g. Romanowsky and Warthin-Starry stains) to highlight Donovan bodies. In such granulomatous cases it is also important to perform acid-fast stains for mycobacteria and fungal stains (e.g. Gomori methenamine silver).

Isolated tubercular hypoglossal nerve paralysis

Hypoglossal nerve palsy is not an uncommon neurological finding but primary nasopharyngeal tuberculosis (TB) presenting as hypoglossal nerve palsy is very rare. A 31-year-old woman presented with headache and progressive tongue deviation towards the right side. Diagnostic nasal endoscopy revealed soft tissue mass lesion on the posterior wall of nasopharynx while MRI revealed isointense tumour in nasopharynx with normal hypoglossal nerve and brain. Histopathological examination found TB. We discuss the clinical challenges and possible pathogenesis of this rare clinical entity.

Effect of HIV and Antiretroviral Treatment on Auditory Functions

Introduction  Numerous studies have evaluated auditory functions in human immunodeficiency virus (HIV) patients; however, these studies had a few major limitations in terms of methodology as they used mainly evoked audiometry although this method is expensive, time consuming and not widely available. Therefore, we conducted a study in naïve HIV subjects with routine audiometry. Objective  To determine the effect of HIV and of the drugs used to treat it on the auditory functions. Methods  A prospective observational study was conducted in a medical college with 25 naive HIV-seropositive patients for over a year. Pure tone audiometry (250–8,000 Hz) and CD4 T-lymphocyte count were performed at the time of enrollment and 6 months after commencement of highly active antiretroviral treatment. Results  The subjects had increased hearing thresholds at high frequencies (4 KHz and 8KHz) in both ears at the time of enrollment that persisted at the same level (p > 0.05) on follow-up at 6 months. None of the subjects had any other otological symptom during the 6 months of observation. Seven subjects had sensorineural hearing loss in one or both ears at 0 and 6 months. These observations did not show any significant difference on Wilcoxon-signed-rank test. Spearman correlation did not find a significant correlation (p > 0.05) between CD4 T-lymphocyte counts and pure tone audiometry during the study. Conclusion  We found high-frequency hearing loss in all subjects with no relation with highly active antiretroviral therapy (HAART) and severity of the disease. This study advocates hearing assessment with pure tone audiometry in HIV subjects so that intervention can be initiated in a timely manner.

Thyroglossal Cyst Papillary Carcinoma: What Next Step must be done?

Thyroglossal duct cysts (TGDCs) are usually midline structure of the neck. The coexistence of carcinomas in TGDCs is found rarely, with most being papillary carcinomas. Usually, the diagnosis is made postoperatively after excision of the cyst. Although the Sistrunk procedure is often regarded as adequate, various controversies exist concerning the need for thyroidectomy depending on histopathological findings. We are reporting the case of a 56-year-old man, diagnosed with papillary carcinoma within a TGDC, who underwent total thyroidectomy as has been recommended for differentiated papillary cancer.

Alternating sudden sensorineural hearing loss in demyelinating disorders

Multiple sclerosis (MS) is the most common demyelinating disease of the central nervous system. MS is a neuromotor disorder which progresses with remissions and relapsing periods. Symptoms of MS plaques may regress completely or heal by leaving sequelae. Symptomatology of MS may be very variable. These symptoms usually show variations depending on the localization of demyelinated plaques in the central nervous system. In this case, we are presenting a case of sudden sensorineural hearing loss in alternate ears with magnetic resonance images suggestive of demyelinating disorders. These hearing losses are improved completely as disease has remission and relapsing periods.

Killian's polyp mimicking malignant tumor.

Killian polyp is predominantly found in children and any sinonasal tumor in elderly presenting with epistaxis and pain usually indicates malignant growth until proved otherwise. We present an unusual case of Killian polyp in an elderly patient that behaved as a malignant tumor. This case report reminded us that paranasal sinuses are still dark hollow mysterious cavities, and we should take utmost clinical acumen in managing such cases.