S. B. S. Mann

Paranasal sinus mycoses in north India

Summary. Recognizing the high incidence of paranasal sinus mycoses in north India, we analysed retrospectively the clinical, mycological and management aspects of 178 patients with proven disease attending our institute. On the basis of clinical, radiological, histopathological and mycological findings, the patients could be categorized into those with allergic (8), non‐invasive (92) and invasive (78) disease types. Bony erosion without mucosal invasion by fungi was seen in 16 patients with non‐invasive disease. Young men from rural areas were the most commonly affected. Rhinorrhoea with nasal polyposis (45.8%) and proptosis (46.4%) was the most common presentation. Concurrent involvement of the maxillary and ethmoid sinuses was common in these patients, whereas isolated sphenoid and frontal sinuses were involved in the invasive variety only. Orbital and intracranial extensions were detected in 100% and 13.2%, respectively, of patients with the invasive type of disease. Aspergillus flavus (79.7%) was the most common isolate. Surgical debridement and sinus ventilation were adequate for the effective management of the non‐invasive disease. However, adjuvant medical therapy was included in treatment of the semi‐invasive and invasive varieties of the disease. Itraconazole was found to be most useful in prevention of recurrence in the invasive type. Mortality was highest (33.3%) among patients with zygomycotic infection. Invasive fungal granuloma with orbital and intracranial invasion is a distinct entity in terms of its clinical course and treatment compared with non‐invasive fungal sinusitis, and it needs to be treated aggressively with surgical excision and postoperative itraconazole.

Genetic correlation in otosclerosis.

PURPOSE The aim of this study was to determine the relationship of HLA typing in patients with otosclerosis. MATERIALS AND METHODS We used a prospective study in which HLA typing of 100 surgically confirmed otosclerosis patients were compared with age and sex matched normal individuals. RESULTS HLA-A3, HLA-A9, HLA-A11, and HLA-B13 were found to be significantly higher (P < .05, .01, and .01, respectively). HLA-A9 and HLA-A11 were found to be higher (P < .01) in patients with a positive family history, indicating genetic heterogenicity. CONCLUSIONS Higher values of HLA-A9, HLA-11, and HLA-B13 in patients with otosclerosis compared with normal individuals strongly suggests a genetic, HLA-related component.

Pleomorphic adenoma presenting as a base of tongue mass

A rare case of pleomorphic adenoma of the base of the tongue with a relevant review of literature is reported.

Osteogenic Sarcoma of the Temporal Bone

Osteogenic sarcoma is a highly malignant bony tumor that is rarely found in the facial and the cranial bones. It may be found in the mandible and maxillae but is very rare in the temporal bone. While reporting a case, Gertner et al’ could not find any other case in the English literature. Only 19 cases of osteogenic sarcoma of the temporal bone were found to have been reported in the world literature during an extensive scan by Sataloff et a1.2 Osteogenic sarcoma carries the worst prognosis of all temporal bone malignancies. We report a rare case of osteogenic sarcoma of temporal bone with an unusually long survival.

Ultrasound versus physical examination in staging carcinoma of the mobile tongue

Surgical therapy for early lesions of the tongue should have the potential to be both oncologically sound and easy to rehabilitate. Obviously, the amount of tongue left behind after surgery is proportional to the post-operative function. Hence accurate mapping of the diseased tongue is of paramount importance in order to limit or extend the resection margins. We have evaluated the use of ultrasound in carcinoma of the tongue, and also compared its relative accuracy with physical examination for determining the extent of growth, keeping the histopathological size as a gold standard. We found that ultrasound is more accurate in detecting T2 and T3 tumours than T1 lesions. Intraoral sonographic mapping may be the answer for such small lesions. In addition, ultrasonography is beneficial in showing spread to contiguous areas of the tongue. However, post-radiation fibrosis and frank residual disease were not differentiated accurately by ultrasound. Thus ultrasonography can be an effective investigative tool and together with physical examination it can increase diagnostic accuracy leading to precise surgery for carcinoma of the tongue.

Survival patterns in treated cases of carcinoma larynx in north india - a 10 years followup study

ConclusionPatients with stage I and II tumors had the best results with radical radiotherapy alone 5 years survival for patients with stage I and stage II tumors was 90-95% and 75-85% respectively Patients with advanced stage III & IV disease were treated Unoperable stage IV cancer patients had poor outcome and received only palliative treatment

Cryosurgery in vasomotor rhinitis—an analysis of 156 patients

156 patients of vasomotor rhinitis were treated with cryodestruction of nasal branches of vidian nerve. These patients were divided into two groups A and B. In Group ‘A’ intermittent partial nasal obstruction-was the main symptom (82 patients) and in Group ‘B’ watery nasal discharge was the predominant symptom (74 patients).

AUDIOVESTIBULAR PROFILE IN UNILATERAL CHRONIC SUPPURATIVE OTITIS MEDIA

AudioIogical tests including middle ear impedance test and vestibular function tests were administered to seventyfive patients of unilateral chronic suppurative otitis media. These patients were selected so as to exclude the influence of hereditory, drugs, systemic illness and the factors of aging. The subjects were subdivided into 3 groups : group 1 cases with central perforation; group 2 with marginal and group 3 with attic perforation respectively. On pure tone audiometry, 19 diseased ears (25.3%) showed sensorineural hearing loss of 40 dB or more at 4 KHz and 8 KHz. The difference in the mean bone conduction threshold of diseased and the nondiseased ears was statistically significant at 4 KHz and above. Results of specialised tests of hearing suggested cochlear pathology being responsible for sensorneural hearing loss. Electronystagmographic recording of saccades and bithermal caloric induced nystagmus revealed canal paresis on the diseased side in 4 patients (5.3%). These 4 patients had 15 years history of otorrhoea.

Presentation of carcinoma larynx and laryngopharynx— An analysis of 840 cases

Clinical records of 840 cases of carcinoma larynx and laryngopharynx were studied. These patients were admitted in Nehru Hospital, Postgraduate Institute of Medical Education & Research, Chandigarh during the period 1971–1986. Maximum number of patients (308) presented in the 5th decade of life. About 1,3rd of patients (302) belonged to Uttar Pradesh State of India. History of smoking was present in 668 patients (79.59%). The commonest site of involvement was supraglottis (264 patients). 508 patients (60.48%) presented in stage IV. Metastasis to the neck nodes was present in 571 patients (67.85%). 349 patients (41.54%) had healed pulmonary tuberculosis lesions while another 76 patients (9.09%) had active tubercular lung lesion. 96 patients (11.42%) had associated tuberculosis of cervical lymph nodes. Squamous cell carcinoma was the commonest histopathological variety in 97.73% patients. 203 patients were treated with combination of surgery and radiotherapy, curative radio therapy (5500 rads) was given in 196 patients and 441 patients had advanced disease, hence only palliative radiotherapy was given.

Unusual presentation of laryngeal foreign bodies - report of two rare cases.

Aspiration of a foreign body into the respiratory tract is a common and serious problem in childhood but is rare in adults. Two interesting cases in which the diagnosis of foreign body in the larynx was not suspected preoperatively are being reported. A three and half year old female child was diagnosed as a case of bronchitis and was later found to have a metallic spring in the supraglottic region which was removed by direct laryngoscopy under general anesthesia. The other patient, a 32-year-old male, was diagnosed to have a fibrous lesion in the larynx one year previously, and on laryngoscopy a vegetable, spiculated foreign body was found after excising the fibrous lesion on the left false cord. Both the cases are symptom free 18 months after endoscopy.