Rubeena Arora

Paediatric tympanoplasty: comparative study between patients aged 5–8 years and those aged over 14 years

OBJECTIVE To evaluate and analyse the success rate of tympanoplasty type I in paediatric patients aged 5 to 8 years compared to a control group (patients aged over 14 years). METHODS In this prospective study, 60 patients (of either sex) with chronic suppurative otitis media inactive mucosal disease were divided into 2 groups (30 in each): group A comprised paediatric patients aged 5-8 years and group B consisted of older individuals aged over 14 years. All patients underwent tympanoplasty type I with an underlay technique using a temporalis fascia graft. RESULTS Impressive surgical success rates of 87 and 90 per cent were recorded in groups A and B, respectively. Furthermore, audiological success rates of 69 and 78 per cent were achieved in groups A and B respectively. Statistical analysis of the data revealed that eustachian tube function had no impact on the outcome of tympanoplasty. CONCLUSION Tympanoplasty type I performed in children aged five to eight years gives comparable results to those of older individuals.

Management of otogenic lateral sinus thrombosis

OBJECTIVE To evaluate the changing clinical course and trends in management of otogenic lateral sinus thrombosis (OLST), in view of the rarity of the said lesion and antibiotic abuse. METHODS A retrospective case study was done in 6 patients referred to our tertiary care centre with OLST over a period of three years from May 2007 to May 2010: Department of Otorhinolaryngology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi - a tertiary care university teaching hospital under central government of India. Medical records of all the patients were scrutinized and data pertaining to patient profile, type of chronic suppurative otitis media (CSOM), clinical course with any other complication and management were tabulated. The said data was scientifically analyzed w.r.t. current medical literature on the subject. RESULTS Clinically, it was observed that all patients had protracted CSOM - attico antral type, with history of rampant misuse of antibiotics. The attack of OLST in each case was triggered off by an acute attack of suppurative otitis media. Moreover, in all the cases OLST was masquerading as an intra-cranial complication, with no specific clinical features thereby causing missed diagnosis initially. All these patients were diagnosed by CT scan, and underwent modified radical mastoidectomy (MRM) with needle aspiration of sinus under antibiotic cover. The said treatment protocol resulted in excellent prognosis with no morbidity or mortality whatsoever. Pathologically, cholesteatoma was detected in 5 of the six cases with one case having only granulations. CONCLUSIONS In this era of antibiotic abuse, the clinical presentation of OLST has altered substantially, and mimics other intra-cranial complication with vague signs and symptoms. There are conflicting views in contemporary medical literature regarding management of OLST. In our experience, MRM with needle aspiration under antibiotic cover is the treatment of choice for all cases of OLST associated with CSOM attico antral disease/cholesteatoma disease.

A rare case of congenital rhabdomyosarcoma with review of the literature.

We present a rare case of rhabdomyosarcoma of lip in a neonate with multiple lesions within the head and necksub site hitherto unreported in the medical literature. This case report also reviews the scant medical literature on neonatal rhabdomyosarcoma.

Tympanoplasty: does dry or wet temporalis fascia graft matter?

OBJECTIVES To evaluate the success rate of dry and wet temporalis fascia grafts in type I underlay tympanoplasty. METHODS A prospective, randomised study was conducted. One hundred adult patients (males and females) with chronic suppurative otitis media (mucosal type) were divided into 2 groups of 50 each: one group underwent dry graft tympanoplasty and the other underwent wet graft tympanoplasty. Fibroblast count was calculated in dry and wet grafts. RESULTS The dry graft and wet graft groups had overall surgical success rates of 82 and 90 per cent, respectively; this finding was not statistically significant. A statistically significant high fibroblast count was observed in wet grafts, but it did not correlate with surgical success. CONCLUSION A dry or wet temporalis fascia graft does not influence the outcome of tympanoplasty type I.

A Rare Case of Congenital Simple Cystic Ranula in a Neonate

Congenital ranula in a neonate is an uncommon occurrence. We present one such case of the said lesion where the clinical presentation and management were found to be interesting, hitherto unreported in the medical literature. This clinical record also reviews the scant medical literature on congenital ranula in neonates.

Role of circumferential subannular tympanoplasty in anterior and subtotal perforations.

OBJECTIVE This study aimed to evaluate the surgical success of a modified inlay tympanoplasty technique, known as circumferential subannular tympanoplasty, for anterior and subtotal perforations. METHODS This prospective study was performed in a tertiary care teaching hospital between October 2013 and April 2016. A total of 58 adult patients of both sexes with anterior or subtotal perforations underwent circumferential subannular tympanoplasty under local anaesthesia. In this technique, after tympanomeatal flap elevation, the temporalis fascia graft is placed directly onto the annulus instead of being tucked underneath the tympanic membrane remnant. Outcome data were graft uptake and hearing improvement. RESULTS This technique had a surgical success rate of 97 per cent and led to significant hearing improvement. CONCLUSION Circumferential subannular tympanoplasty has a definitive role in managing anterior and subtotal perforations.

A Rare Case of Angiofibroma Arising from Inferior Turbinate in a Female.

A rare case of extranasopharyngeal angiofibroma arising from the inferior turbinate in a young female of 28 years is presented. The case is discussed in light of scant contemporary literature on the cited subject. This clinical record highlights the distinct clinical nature of Extranasopharyngeal angiofibroma (ENA) and importance of Immunohistochemistry in diagnosis of such lesions. With this case we report a rare clinical entity which presented in an extremely rare manner.

A rare case of intratonsillar abscess in an adult

A rare case of intratonsillar abscess is presented in a 25-year old healthy adult male, where the clinical presentation was found to be unique hitherto unreported in the medical literature. The clinical record also highlights the importance of incision and drainage in the management of such cases. With this case, we illustrate a rare entity that present in an extremely rare manner.

Predictors of nature of ingested foreign bodies in children & assessment of operative outcomes

OBJECTIVE To examine sensitivity/specificity of history & radiology to identify ingested foreign body (FB) and develop a protocol for management of ingested FBs in paediatric patients; to assess outcomes of removal of lithium button battery foreign body (LBBFB). METHODS Retrospective review. Children presenting to ENT emergency with suspected FB ingestion underwent rigid esophagoscopy and FB removal. Average age, number of attempts, duration of ingestion, success rate, and complications were analysed. RESULTS Cases of coin/LBBFB ingestion: 916/70. Mean age: 5.8/2.03 years (p < 0.001). Average duration of ingestion: 37/9.5 h (p < 0.001). Patients below 3: 31.3/62.8% (p < 0.001). Suggestive history/radiological signs: 100%/100%, 75.7%/98.6% (p < 0.0001). Site of impaction cricopharynx: 60.3%/74.3% (p = 0.02). LBBFB group: Successful removal in 1st attempt: 66 (94.3%). Cases requiring multiple attempts due to impaction: 4 (5.7%). Parenteral steroids were administered before successful reattempt. No relation was found between duration of ingestion/impaction. Five (7.1%) cases developed complications. Average follow-up duration: 13.59 months. CONCLUSIONS Children <3 years with vague history of FB ingestion and suggestive chest x-ray should be sent urgently for FB removal. Parenteral pre-and postoperative short course steroid use may be considered to improve outcomes.

Image analysis of interarytenoid area to detect cases of Laryngopharyngeal Reflux: An objective method

PURPOSE To diagnose Laryngopharyngeal Reflux by observing colour (Red, Green, Blue) at the interarytenoid area during 70° laryngeal endoscopy. MATERIALS AND METHODS Endoscopic images from 50 normal controls and 50 patients of LPR were obtained in this observational study. LPR patients were selected on the basis of RSI and RFS. Images were analysed using ImageJ, a free image analysis software, developed by the National Institute of Health (NIH). Colour changes in the form of RGB (red, green, blue) values were calculated and analysed at the interarytenoid area. The values in the normal and patient group were compared and correlated with RSI and RFS. RESULTS RGB values of the LPR group and the normal group were statistically different (P value<0.01). Strong correlation was also found between R and G values and both RFS and RSI. However, no correlation was seen with B values. CONCLUSION Image analysis is an easy, economical and objective method to diagnose LPR.