Tongue histoplasmosis mimicking malignancy

A 42 year old male presented with progressive difficulty in swallowing for the past 6 months. Oral examination revealed ulcer on right dorsum of tongue, which was mistaken for malignancy. Histopathology of incision biopsy specimen diagnosed it as histoplasmosis. The patient was put on oral itraconazole therapy and responded well to the treatment.

Primary ciliary dyskinesia--an underdiagnosed entity

Primary ciliary dyskinesia (PCD) also known as immotile cilia syndrome is a genetic disorder characterised by chronic infections of the upper and lower respiratory tracts, male infertility and situs inversus totalis. Authors are presenting clinical details of a patient who was operated upon for recalcitrant rhinosinusitis. Investigations carried to find out the predisposing factors for such sinusitis, resulted in diagnosing the patient a case of PCD, a rare but well known cause of recalcitrant sinusitis.

Lupus vulgaris of external nose with septal perforation--a rarity in antibiotic era

Lupus vulgaris (LV) is the commonest morphological variant of cutaneous tuberculosis. Case of LV of external nose extending to internal nose causing septal perforation is documented here. Histopathology of biopsy taken confirmed the diagnosis of LV. Patient responded well to Anti-tubercular therapy (ATT).

Giant retropharyngeal abscess secondary to tubercular spondylitis

Chronic retropharyngeal abscess secondary to tubercular spondilitis is a rare phenomenon. Anatomical location of this abscess makes it a life threatening condition requiring prompt diagnosis and treatment thus preventing morbidity and mortality. Authors are documenting a case of tubercular spondylitis of cervical region in a 12-year old male child with huge retropharyngeal abscess extending to superior mediastinum. Clinically, patient had respiratory distress but no neurological deficit. USG (Ultrasonography) guided aspirate of abscess sent for microscopy and culture showed acid fast bacilli. Multiple USG guided aspirations under antibiotic and antitubercular cover (Category I) were done. Patient is doing well at three month follow-up.

Comparative evaluation of endoscopic with conventional septoplasty

A study was conducted to assess the merits and demerits of endoscopic septoplasty. Fifty patients having symptomatic DNS were randomly divided into two groups of 25 patients each. One group underwent endoscopic septoplasty and other group underwent conventional septoplasty. The groups were compared regarding the complaints with pack in postoperative period, relief of symptoms after surgery and complications. The symptoms complained by the patients with pack in postoperative period and complications after surgery were significantly less in endoscopic septoplasty group.

Branchio-oto-renal syndrome

Branchio-oto-renal syndrome (Melnick-Fraser syndrome) is a rare autosomal dominant disorder characterized by syndromic association of branchial cysts or fistulae along with external, middle & inner ear malformations and renal anomalies. Authors are reporting a 19 year male patient, who presented with profound deafness & low set "lop-ear" with right sided preauricular pit. USG abdomen revealed agenesis of the left kidney.

Role of rhinomanometry to assess nasal airflow and resistance in patients undergoing septoplasty

Nasal obstruction is a common symptom. Rhinomanometry is a tool to objectively assess the nasal airway. A prospective study was undertaken to assess the nasal airflow and nasal resistance in 25 patients of deviated nasal septum undergoing septoplasty using rhinomanometry preoperatively and postoperatively. Rhinomanometric improvement in nasal airflow and decreased nasal resistance were found in 88% patients after surgery.

Cricopharyngeal achalasia - a rare cause of dysphagia

Cricopharyngeal achalasia is a rare clinical entity in which upper esophageal sphincter (cricopharyngeus) does not open adequately during swallowing leading to dysphagia. Barium swallow reveals a smooth posterior impression of cricopharyngeus at C6 level. We report cricopharyngeal achalasia in a 68 year male who was managed with dilatation.

The role of functional endoscopic sinus surgery (FESS) in patients with asthma with chronic sinusitis

25 patients of bronchial asthma with chronic sinusitis were operated with the aim to evaluate the efficacy of functional endoscopic sinus surgery (FESS) on asthma symptoms. The mean postoperative daytime asthma symptom scores, nocturnal asthma symptom scores, mean postoperative nocturnal awakening scores and number of asthma attacks reduced significantly (p<0.001). The mean FEV(1) observed postoperatively showed significant increase (p<0.001). 21 patients reported overall significant improvement in the asthma. 6 patients were completely taken off from all sort of anti-asthmatic drugs [inhalational corticosteroids (ICS) + long acting β(2) agonist (LABA) ]. In 3 patients there was significant / substantial decrease in the dosage of anti-asthma drugs. It is concluded that FESS is a viable option for improving the control of asthma.

Bronchial foreign body: an unusual form of child abuse

Bronchial foreign bodies are common in pediatric population. Some times these events may be a form of child abuse. A rare case of child abuse in a 4-month-old boy is reported who presented with a nail in right bronchus. Rigid bronchoscopy was planned and nail was successfully removed. It is suggested that any non-ambulant infant with a foreign body must be viewed with suspicion.

Giant cell reparative granuloma of the base of the skull presenting as a parapharyngeal mass

Giant cell reparative granuloma is an infrequent non-tumoral lesion affecting the maxillary and mandibular bones and only rarely, the cranial bones. We report a case of giant cell reparative granuloma of the base of the skull in a 12-year-old female who presented with a parapharyngeal mass. Computerized Tomography (CT) showed the intracranial extension and destruction of surrounding bones.

Groundnut as the commonest foreign body of tracheobronchial tree in winter in Northern India. An analysis of fourteen cases

In Northern India, in an institution like ours which receives quite a number of patients from surrounding rural areas, we found groundnut as the most common foreign body of tracheobronchial tree in children particularly in winter months of October to January. This article attempts to address the potential hazard of groundnut inhalation in children. In Northern India, in an institution like ours which receives quite a number of patients from surrounding rural areas, we found groundnut as the most common foreign body of tracheobronchial tree in children particularly in winter months of October to January. This article attempts to address the potential hazard of groundnut inhalation in children.

Clinicocytological correlation in establishing the aetiology of chronic rhinitis

Two hundred patients clinically diagnosed as having chronic rhinitis were provisionally grouped into allergic and non-allergic types of rhinitis on the basis of history, clinical examination, X-ray of the paranasal sinuses using the occipitomental view and other relevant investigations like differential and total leucocyte count. Whereas 158 cases were categorized into allergic rhinitis, 13 were diagnosed as suffering from vasomotor rhinitis, 25 from infective rhinitis and 4 patients from atrophic rhinitis. A nasal cytogram performed in all these cases showed allergic rhinitis in 107 cases, vasomotor rhinitis in 30 cases, infective on top of allergic rhinitis in 32 cases, common cold over allergic rhinitis in 3 cases, infective rhinitis in 20 cases, a non-infective non-allergic type in 4 cases and atrophic rhinitis in 4 cases. There was a good clinicocytological correlation; however, 30 patients clinically suspected to be having allergic rhinitis had an infective episode alone or on top of allergic rhinitis. Nasal cytology was thus found useful in modifying the treatment. It is a simple, easy and reliable investigation that can be done routinely in the out-patient department.

Wegener's granulomatosis: a case with laryngeal involvement

A patient of Wegener's granulomatosis (WG) with laryngeal involvement and respiratory difficulty has been described. Direct laryngoscopic biopsy led to the diagnosis of Wegener's granulomatosis. The patient underwent a tracheostomy and was subsequently treated with cyclophosphamide and corticosteroids to which he responded.

Effect of adeno-tonsillectomy on hearing threshold and middle ear pressure

Out of 50 children (100 ears) undergoing adeno-tonsillectomy, 34 ears had hearing threshold 20-50 dB (20 dB is normal) and 32 ears showed negative middle ear pressure of 100 to 400 mmH2O (100 mmH2O is normal). Post-operatively only 7 ears had hearing threshold of 20-30 dB and negative middle ear pressure of 100 to 200 mmH2O. Thus adenoidectomy improves eustachian tube functions.

Crystallization test for the detection of head and neck cancer

Twenty-five patients suffering from head and neck cancer and 25 healthy individuals were subjected to a blood crystallization test with 20% cupric chloride solution and the patterns were compared. In the healthy control group, the typical pattern was an eccentrically placed center of gravity with needles arranged in a radiating fashion, while in the malignant group, there was a transverse bar or transverse formation. The sensitivity of this test procedure was 88%. We therefore conclude that this study is an interesting reliable, economical and above all useful adjunctive for a mass screening programme in the diagnosis of malignant diseases of the head and neck region. The test is based purely on physical phenomena and hence should be performed under controlled physical conditions.

Nasal mucociliary clearance & mucus pH in patients with diabetes mellitus

Nasal mucociliary clearance (NMC) time and nasal mucus pH were studied in 50 patients suffering from diabetes mellitus and in a group of 50 healthy non-smokers and non-alcoholic controls. NMC time and pH values were found to be significantly increased in diabetics (NMC = 18.02 +/- 5.08 and pH = 7.96 +/- 0.75) as compared to controls (NMC = 7.49 +/- 1.06 and pH 6.43 +/- 0.67). The increase in NMC and pH was much more in patients having insulin dependent diabetes mellitus (IDDM) (NMC - 20.87 +/- 4.71 and pH -8.38 +/- 0.56) than in non-insulin dependent diabetes mellitus (NIDDM) (NMC - 15.16 +/- 3.67 and pH -7.53 +/- 0.687) and also when the duration of disease was more than 10 yr (NMC - 22.36 +/- 4.36 and pH -8.47 +/- 0.607). This impairment was attributed to osmotic diuresis with loss of water and electrolytes from all parts of the body and also small vessel abnormalities encountered in diabetes.

Tuberculosis of middle ear cleft

Three cases of tuberculosis of middle ear cleft who presented with ear discharge, postaurale swelling post-aural fistula and facial nerve palsy in one case are reported. Audiometry showed conductive deafness in two cases and sensorineural deafness in one case. Roentgenograms revealed bony erosion of the mastoid bone in two cases and coalescence of mastoid air cells in one case. Modified radical mastoidectomy was done in all the three cases and histopathology of tissue removed on operation revealed tuberculosis. All the symptoms except facial nerve palsy improved and post-aural wound healed completely with anti-tubercular therapy. Early recognition and specific therapy may avoid these complications like fistula formation, facial nerve palsy and deafness and may well reduce the need for surgical procedure.