Somchai Srirompotong

A randomized trial of the canalith repositioning procedure

Objective To compare the effectiveness and complications of our adaptation of the canalith repositioning procedure (CRP) with the expectation treatment for benign paroxysmal positional vertigo.

Ludwig's angina: a clinical review

Ludwigs angina is caused by a rapidly expanding cellulitis of the floor of the mouth and is characterized by a brawny induration of the floor and suprahyoid region (bilaterally), with an elevation of the tongue potentially obstructing the airway. In the pre-antibiotic era, Ludwigs angina was frequently fatal; however, antibiotics and aggressive surgical intervention have significantly reduced mortality. We reviewed nine patients with Ludwigs angina between July 1996 and June 2002, all of whom presented with fever, neck swelling, bilateral submandibular swelling and elevation of the tongue. In eight patients (89%) a dental infection appeared to be the underlying cause. High-dosage intravenous antibiotics directed towards the suspected causative microorganisms were given to all of the patients: two were treated successfully with conservative medical management, while seven underwent surgical drainage (a tracheotomy was necessary in one patient). Routine aerobic cultures were done on samples of drained material and the predominant microorganisms were Streptococus species in two patients; there were none in the other five. Two patients had post-operative complications, but all recovered.

Otosyphilis: A review of 85 cases

OBJECTIVE: To review the clinical manifestations and the follow-up hearing results of the treatment modalities in the patients with otosyphilis. STUDY DESIGN AND SETTINGS: A retrospective review between 1984 and 2000 at a university hospital. Patients who presented with cochleovestibular symptoms and were confirmed seropositive for specific treponemal tests were included. Excluded were patients older than 70, or who had other identified causes of cochleovestibular symptoms. RESULTS: Subjects included 56 males and 29 females with an average age of 59.5 years (range, 40 to 70). Common presenting symptoms included hearing loss (90.6%), tinnitus (72.9%), and vertigo (52.9%). The cerebrospinal fluid analysis was positive in 5.4%. The overall respective hearing results in the short- and long-term follow-up were improved or stable in 93.4% and 83.3% of patients. Even though adding steroids and neurosyphilis regimens tended to improve and stabilize hearing, the results were not statistically significant among treatment modalities. CONCLUSION: Further study about hearing outcomes among treatment modalities is suggested.

Nasopharyngeal Tuberculosis: Manifestations between 1991 and 2000

OBJECTIVES/HYPOTHESIS: To present the clinical manifestation of nasopharyngeal tuberculosis. STUDY DESIGN: Clinical analysis of 23 patients with pathologically confirmed nasopharyngeal tuberculosis was carried out retrospectively. SETTING: Srinagarind Hospital, Khon Kaen University. Thailand. RESULTS: The most common presenting symptom was cervical lymphadenopathy (91.3%). The common locations of nodes were the superior and middle cervical. The abnormalities of the nasopharynx were found in 16 patients. The pathological findings were caseous granuloma with positive acid-fast bacilli (AFB) in 15 cases, caseous granuloma with negative AFB in 3 cases, and chronic granulomatous inflammation with negative AFB in 5 cases. Pulmonary tuberculosis was found in 8 of 18 patients. Sixteen patients who received complete treatment responded well. CONCLUSION: Nasopharyngeal tuberculosis commonly presents with cervical lymphadenopathy. The differential diagnosis of tuberculosis from nasopharyngeal carcinoma is difficult. In the patients who have cervical lymphadenopathy and no other identified causes, biopsy of nasopharynx would give an additive information for diagnosis.

Tuberculosis in the upper aerodigestive tract and human immunodeficiency virus coinfections.

OBJECTIVE To describe the clinical manifestations of tuberculosis in the upper aerodigestive tract. DESIGN Retrospective chart analysis. SETTING Srinagarind Hospital, Department of Otolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. METHODS A review of medical records of patients diagnosed with mycobacterial infection of the upper aerodigestive tract between January 1991 and December 2000. MAIN OUTCOME MEASURES Presenting symptoms, clinical findings, pathologic findings, pulmonary involvement, and outcome of treatment. RESULTS Forty-five patients presented with upper aerodigestive tract tuberculosis. The nasopharynx was involved in 23 patients, the larynx in 16, the tonsils in 6, and the soft palate in 1. One patient had tuberculous infections in both the nasopharynx and tonsils. The mean duration of symptoms before diagnosis was 2.1 months. The pathologic findings included caseous granuloma and/or positive acid-fast bacilli (AFB) in 39 cases and chronic granulomatous inflammation with negative AFB in 6 cases. Pulmonary tuberculosis was found in 19 of the 36 patients who underwent radiography. A positive serologic test for human immunodeficiency virus (HIV) infection was found in 4 of 26 patients. These 26 patients, who received a full course of treatment, responded well. CONCLUSION The most common site of tuberculosis in the head and neck involved the cervical lymph nodes and nasopharynx. Upper aerodigestive tract tuberculosis is difficult to differentiate from carcinoma; thus, tissue biopsy is necessary for a definite diagnosis. Chest radiography and screening for HIV infection are recommended in all patients with upper aerodigestive tract tuberculosis.

Disseminated septicaemic melioidosis: an unusual presentation of masticator space infection

Melioidosis is an infectious disease caused by a saprophytic bacterium, Burkholderia pseudomallei. It is endemic to Southeast Asia and Northern Australia. The spectrum of melioidosis in humans varies from sub-clinical to overwhelming protean manifestations resembling other acute and chronic bacterial infections. Disseminated septicaemia melioidosis presenting as a masticator space infection is reported here. This is germane to those treating diabetic patients with deep neck infections living in, or having visited, areas endemic for B. pseudomallei.

Movement of the tympanic membrane causing pulsatile tinnitus

Abstract Background: Movement of the tympanic membrane can be a cause of pulsatile tinnitus. There are many etiologies that cause movement of the tympanic membrane, including otogenic pneumocephalus. This is an uncommon presentation after head injury that may be missed as the diagnosis of the primary cause of the symptoms. Objective: To report a rare case of pulsatile tinnitus because of otogenic pneumocephalus. Methods: Case report from chart review with relevant investigations and treatment. Results: We describe the very interesting case of a patient who presented with pulsatile tinnitus because of otogenic pneumocephalus. On examination, we found a moving tympanic membrane. A CT scan revealed pneumocephalus in the right temporoparietal region that was continuous with the adjacent mastoid air cells. There was a transverse fracture through the mastoid process. A meticulous mastoidectomy with unroofing of the epitympanum was performed with widening of the aditus ad antrum. The mastoid cavity was closed without fat obliteration. After the operation, the pulsatile tinnitus ceased completely. Conclusion: Mastoidectomy and unroofing the epitympanum without fat obliteration is a very simple and effective option for the treatment of pulsatile tinnitus because of pneumocephalus.

P102: Psychiatric Co-Morbidity in Vertiginous Patients

OBJECTIVES: In the treatment of carcinoma of the external auditory canal (EAC), surgical resection has mainly been applied for patients with external ear carcinoma. However, surgical resection severely compromises the quality of life due to sacrificing of organ function. For organ preservation, superselective intra-arterial (IA) rapid infusion chemotherapy was combined with radiotherapy against carcinomas of the EAC. METHODS: Stages, feeding arteries, and outcomes were reviewed. Tumors were staged according to the Pittsburgh staging system. Chemotherapy was administered intra-arterially in the angiography suite via transfemoral catheterization of the feeding arteries. The patients received up to four weekly infusions of cisplatin (100 mg/body). The patients received external beam radiation simultaneously with IA cisplatin infusion chemotherapy at a dose of 2.0 Gy per fraction once daily five days a week with photon beam energy of 6MV (total dose of 60Gy). RESULTS: Four patients underwent superselective IA infusion chemo-radiotherapy. The median follow-up period was 23 months ranging from 12 to 42 months. Two patients were staged as T2 and other patients were staged T3 and T4. All patients were free from neck metastases. Cisplatin was delivered through the posterior auricular artery in three patients and the superficial temporal artery in one patient. Complete response (CR) was obtained in all four patients. Overall toxic side effects were modest. CONCLUSIONS: Surgical treatment of carcinoma of the EAC has always caused functional disturbances such as hearing loss even at its early stages. Superselective intra-arterial infusion chemotherapy can be an effective organ preservation treatment with high cure rates.