ENT Region Research Articles

Damage to the organ of hearing and upper respiratory tract in vasculitis associated with antineutrophil cytoplasmic antibodies

Antineutrophil cytoplasmic antibodies associated vasculitis (ANCA-AV) is a systemic necrotizing granulomatous vasculitis affecting mainly small-caliber vessels. ANCA-AV occupy a special place among systemic vasculitis, which is characterized by a highly active life-threatening course of the disease, requiring rapid differential diagnosis and aggressive immunosuppressive therapy. The ANCA-AV group consists of 3 nosologies: granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis and microscopic polyangiitis. The “calling card” of ANCA-AV is the lesion of the upper respiratory tract, especially the ENT organs (70–100 % of patients). The nasal cavity and paranasal sinuses are the most common areas of lesion in the head and neck (85–100 %), whereas ear damage occurs in about 35% (range, 19–61 %) of cases. Lesion of the ENT organs is typical for the debut of ANCA-AV, which makes early diagnosis difficult, since diseases of the upper respiratory tract are extremely common in all age groups. Diagnosis verification occurs mainly at the stage of generalized involvement of many organs and systems, causing severe course with the development of pulmonary-cardiac and renal insufficiency, which lead to the death of the patient. The main ENT manifestations of ANCA-AV can be grouped into several groups: sinonasal, otological, tracheobronchial, oral cavity lesions and others. Pseudotumors are often found in ANCA-AV. They are characterized by the appearance of parapharyngeal, parotid, submandibular, paratracheal volumetric formations. As a rule, the appearance of tumor-like formations is observed at an early stage of the disease and is associated with the presence of antibodies to proteinase 3, systemic manifestations of vasculitis. Pseudotumor in the ENT region may be accompanied by secondary neuropathies of cranial nerves, destruction of bone tissue, which requires histological verification of the disease.

ENT manifestation CCs in tuberculosis: a descriptive study

BackgroundAn attempt was made to study ENT manifestations in tuberculosis.Material and methodsA descriptive study was carried out among 200 patients with ENT manifestations of tuberculosis attending various departments at a government medical college hospital. Patients will be evaluated and followed up according to protocol. All patients diagnosed with tuberculosis were treated, according to the recent RNTCP guidelines using the CBNAAT testing.ResultsIn the present study, 66% of patients with tuberculosis of the ear, nose, and throat region were females. Seventy-five percent of patients with tuberculosis of ENT and neck region were between the age group of 11 and 40 years. Cases of tubercular lymphadenitis (89.5%), tubercular laryngitis (4.5%), tubercular otitis media (3%), TB of the oral cavity (2%), and TB of the nose (1%) were seen. Painless lymph node enlargement was found in 91.62% of cases. Lymph node enlargement, hoarseness of voice, painless profuse otorrhoea, hearing loss, nasal obstruction, rhinorrhea, odynophagia, ulcers in the oral cavity, and tonsil enlargement were seen in patients of respective ENT tuberculosis. Concomitant pulmonary TB was found in 8.37% of cases of cervical TB, 100% of cases of laryngeal TB, 50% of cases of TB otitis media, 75% of cases of oral TB, and 50% of cases of nasal TB. Biopsy and CBNAAT have a promising role in tuberculosis management.ConclusionEarly diagnosis of tuberculosis in ENT requires a high index of suspicion for patients non-responding to routine treatment

Náhodná aplikace vteřinového lepidla do nosní dutiny u čtyřleté holčičky – návrh strategie léčby v ORL oblasti

Cyanoacrylate adhesives (“superglues”) are mainly used in households. They undergo a rapid anionic polymerisation after application and form a hard solid mass. We report a case of a 4-year-old girl who applied a random cyanoacrylate glue to her nose. The glue was successfully removed under general anaesthesia by gentle dissection using Freer raspatory without causing any damage to the nasal mucosa. To the best of our knowledge, only 3 cases of cyanoacrylate intranasal instillation have been published in the literature so far. The case study suggests an algorithm to guide ENT and paediatric clinicians in the future management of this type of unusual “superglue” injury in the ENT region. Key words cyanoacrylate glue – foreign body – superglue removal – management algorithm

Pattern of ENT Emergencies in Tertiary Level Hospital

Background: Emergencies in ENT practice has a wide spectrum and management of each condition requires specialized skills. Crucial decisions are necessary to save patients life in hurried situations.
 Objectives: This study is carried out with an objective to find out pattern of ENT emergencies in tertiary level hospital.
 Methods: This is a cross sectional study was done in two major tertiary level hospitals (Dhaka Medical College Hospital, Sir Salimullah Medical College Mitford Hospital) of Dhaka, Bangladesh. This study was conducted in a period of six months and took into account all inpatient and outpatient emergencies in this period. These included 496 patients either admitted as emergency or took emergency treatment without admission from department of ENT and Head-Neck surgery of two tertiary level hospitals.
 Results: 496 patients of between age ranges 2 months-80 years with a mean age 26.3 years were included. Male female ratio was 1.9:1.55.65% patients are from rural area. The total throat related cases were maximum (40.52%) in comparison to ear (32.26%) and nose (27.22%). Inflammatory condition in pharynx (46.27%) is the most common among throat related emergencies, followed by foreign body in throat (32.26%). Fish bone impaction is the most common (33.36%) emergencies among foreign body in throat. Foreign body in throat was mostly seen in 0 to 10 age group. Acute upper respiratory tract infection is the highest (27.96%) among the pharyngeal emergencies. Laryngeal emergencies with stridor were most common (47.62%) among laryngeal, tracheal and bronchial emergencies other than foreign body. Among the otological emergencies external ear emergencies other than foreign body (40%) was most common. Vegetables foreign body in the ear was most common (40%) among the foreign body in ear. Foreign body in ear mostly found in 0 to 10 age group. Traumatic injury to external ear is the most common (18.75%) among external ear emergencies other than foreign body. Among the sinonasal emergencies epistaxis was most common (39.26%). Most of the cases were managed surgically (71.97%) 87.5% cases were recovered from emergencies with overall mortality of (1.21%).
 Conclusion: Epistaxis emerged as the leading cause of ENT emergencies followed by foreign body in ENT region. Most of the ENT emergencies were managed surgically under local anaesthesia. So, presence of otolaryngological department in thana and district level hospital could avoid unnecessary referral.
 Sir Salimullah Med Coll J 2022; 30: 67-74

A study of otorhinolaryngological diseases with ophthalmic complications: at a tertiary care center

<p class="abstract"><strong>Background:</strong> The close proximity of the eyeball and the orbit to the ENT region, makes the involvement of the orbit and there of ophthalmological manifestations common in the practise of Otorhinolaryngology. The diseases of ENT with orbital extension must be considered whenever a patient presents with signs and symptoms of orbital disease such as proptosis, orbital mass, restriction of eye movements, neurological dysfunction of eye, chemosis, vision disturbances or epiphora.</p><p class="abstract"><strong>Methods: </strong>Patients presenting with ophthalmological manifestations due to various ear, nose, throat and head–neck pathologies were constituted in this prospective study which was carried out on 50 patients of the age group 10 years to 60 years with ophthalmological complications along with ENT diseases who came to the department of ENT and department of Ophthalmology of N.S.C.B. Medical College, Jabalpur from August 2019 to August 2021.</p><p class="abstract"><strong>Results: </strong>Males were affected more than female with ophthalmic complications. Sinonasal tumours were the most common cause of orbital complications, of which carcinoma of maxilla was the commonest , followed by sinonasal lymphoma .Nasal obstruction was the most common ENT complaint and proptosis was the commonest orbital sign.</p><p class="abstract"><strong>Conclusions: </strong>A firmer knowledge of orbital anatomy with respect to sinonasal region is required for any surgeon dealing with this important area, for a safer and more secure management in this complex region. Surgery remains the main stay of treatment for sinonasal diseases with orbital complications. Rapid diagnosis and treatment are of utmost importance in preserving vision and life in these patients.</p>

Griselův syndrom – kazuistika

Introduction: By definition from the literature, Grisel’s syndrome is described as non-traumatic rotational atlantoaxial instability between C1 and C2 vertebrae. It can occur during an infection of a soft tissue in the cervicocranial region or after an operation in the ENT region. Because of the frequent occurrence after operations, we inclined to the definition which includes a traumatic subluxation as a cause of origin, and it’s not defined as non-traumatic only. The instability manifests itself with abnormal head posture that is called torticollis. Increased incidence in adolescence is more common because of a greater ligamentous laxity of the joint capsules, increased perfusion of antlantoaxial regions and longer alar ligaments. In this article, the case of a child with Grisel’s syndrome after adenotomy is described. The pathophysiology, symptomatology, diagnostic management and treatment are discussed. Keywords: Grisel’s syndrome – torticollis – atlantoaxial instability – adenotomy

A Study of Otorhinolaryngological Diseases with Ophthalmic Complications: At a Tertiary Care Center.

The eyeball and the orbit are neighbours of the ENT region. This close proximity, makes the involvement of the orbit and there of ophthalmological manifestations fairly common in the practise of Otorhinolaryngology. This was a prospective study. All the patients presenting with ophthalmological manifestations due to various ear, nose, throat and head-neck pathologies were constituted in this study. This study was carried out on 50 patients of all age groups with ophthalmological complications along with ENT diseases who came to the department of ENT and head-neck surgery and department of Ophthalmology of N.S.C.B. Government Medical College, Jabalpur from August 2018 to August 2019. The diseases of ENT with orbital extension must be considered whenever a patient presents with signs and symptoms of orbital disease such as proptosis, orbital mass, restriction of eye movements, neurological dysfunction of eye, chemosis, vision disturbances or epiphora. A firmer knowledge of orbital anatomy with respect to sinonasal region is required for any surgeon dealing with this important area, for a safer and more secure management in this complex region. Surgery remains the main stay of treatment for sinonasal diseases with orbital complications. Rapid diagnosis and treatment are of utmost importance in preserving vision and life in these patients.

Granular cell tumour (Abrikossoff's tumor) in the ENT region: about two cases report

<p class="abstract">Granular cell tumors also named Abrikossoff’s tumors, are very rare soft tissue tumors, almost always benign and can affect different organs. The head and neck location are the most common, particularly skin and the tongue. The larynx is concerned in 7 to 10% of the cervico-facial locations of this tumor (1, 2). In this article we report two cases of Abrikossoff’s tumor. The first case is of a 27 years old man, with no particular features in his medical history, who consulted for dysphonia, progressively evolving over 6 months. The nasal endoscopy found a whitish nodular lesion of almost 20 mm of diameter, involving the middle third of the right vocal cord. The tumor was removed under microlaryngoscopy. The second case is of ten days old newborn female, who presented dyspnea and dysphagia while breastfeeding, the clinical exam showed a round shaped lesion of 4 cm of diameter, implanted in the dorsal face of the tongue. The lesion was rooted out with electrocautery under general anesthesia. Anatomopathology examination with Immunohistochemistry of both patients’ surgical samples confirmed the diagnosis of granular cell tumor. The Origin of the Abrikossof’s tumors is uncertain. The recent immunohistochemical studies are orienting toward neurogenic origin. These tumors usually arise in the adult, between the ages of 20 to 60 years old, with female predominance. The symptoms are diverse and non-specific, only the anatopahtological examination permits to confirm the diagnosis. The main issues of these tumors are the compression of the adjacent structures and the high risk of recurrence, which requires long term surveillance.</p>

Disfiguring and fatal evolution of a rare and aggressive T lymphoma: Nasal NK

Lymphoma T nasal NK is a rare type of non-Hodgkin's lymphoma of the ENT region. The diagnosis is based on the clinic and immunohistopathology. This type of lymphoma has a poor prognosis even under treatment at advanced stages, requiring multidisciplinary management. We report a case in a young patient whose evolution was fatal with a rapidly evolving and disfiguring character.

Thrombosis of the internal jugular vein in the ENT-department — Prevalence, causes and therapy: A retrospective analysis

ObjectiveLess than 5% of deep vein thrombosis is due to thrombosis of the internal jugular vein. Genetic, malignant or inflammatory underlying diseases as well as insertion of venous catheters can be responsible for this pathology. Due to its rare occurrence, it is difficult to find systematic research about thrombosis of the internal jugular vein. MethodsWe performed a systematic analysis of present patient data from our ENT department with the electronic patient record considering the period from 2012-2017. Search terms were “thrombosis” and “jugular internal vein”. We identified 41 patients with the requested diagnosis and performed further analysis of the cases. Internal jugular vein thrombosis was diagnosed in all patients using Duplex sonography and/or CT/MR angiography. ResultsParaneoplastic thrombosis was found in 22/41 patients (54%), in 15 of the 22 (68%), the tumor was located in the ENT region. Two out of seven (29%) of the patients with tumor entities outside the head and neck region had thrombosis of the internal jugular vein as the first symptom of the disease. Another 14/41 patients (34%) had underlying inflammatory diseases – mostly streptococci-associated – for example a cervical abscess. In two patients, insertion of a central-venous catheter was causal, in three patients we could not find any reason for the development of thrombosis. ConclusionTo diagnose the rare and often asymptomatic thrombosis of the internal jugular vein, ultrasound of the cervical region should always include vascular imaging. Thrombosis of the internal jugular vein results mostly paraneoplastic or due to inflammation/abscess. It can be the first symptom of a malignant primary disease and always requires detailed diagnostic clarification. Level of evidence4.

Carcinoma of Unknown Primary in Head and Neck Region.

Carcinoma of unknown primary (CUP) in head and neck region is diagnosed in 5% of patients with malignant tumour of head and neck. In the management of patients with CUP, complex investigation to diagnose the occult tumour is always necessary. Detection of origin allows targeted specific treatment that significantly improves the prognosis of the disease. Retrospective analysis of patients treated at the Department of Otorhinolaryngology and Head and Neck Surgery of the UK JLF and UNM in Martin between January 2012 until September 2017 for CUP in head and neck region. Diagnostic procedure and success of primary tumour detection were evaluated. In study group, there were 40 patients with average age 59.4 ± 1.5 years (35-78 years). CT scan and panendoscopic examination in general anaesthesia were performed in all patients. Ipsilateral tonsillectomy (TE) was performed in 34 patients (80%). For the remaining 6 patients, TE was not indicated - 2 found originally in the panendoscopic examination and in 4 TE was performed in the past. Blinded samples from the nasopharynx, the base of the tongue and the pyriform recess were taken in 38 patients (95%). PET/CT screening was indicated in 12 patients (30%). The primary tumour did not detect the primary tumour in any of them. Primary tumour was diagnosed in 21 cases (52.5%). In 16 patients (40%), the primary tumour was found in the upper aerodigestive tract, in 5 patients (12.5%) the primary tumour was located outside the ENT region. The primary tumour was not identified in 19 cases (47.5%). Despite the modern imaging and endoscopic methods, the primary tumour cannot always be identified.

Tuberculosis in otolaryngological practice

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Tuberculosis has become a common occurrence in Otorhinolaryngology with increasing number of extra pulmonary cases. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">This is a study of 27 patients who visited ENT OPD of Dr. D. Y. Patil Medical College, Pune, with variety of manifestations of tuberculosis in the ENT region. </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Majority of those suffered from tuberculous cervical lymphadenopathy, other manifestations included laryngeal tuberculosis, tuberculous otitis media, lupus vulgaris and tuberculous infection of a pre auricular sinus. FNAC and histopathologic examination proved to be reliable tools of diagnosis. Five of these patients suffered from concurrent pulmonary tuberculosis. All these responded well to category 1 anti-tubercular therapy well. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Tuberculosis in Otorhinolaryngology shows a variety of manifestations so it should be kept in mind whenever dealing with unusual presentations.</span></p>

Algorithm of Behavior in Patients with Emergency in Otorhinolaryngology

Introduction: The preparation of a behavioral algorithm for patients with urgent conditions of otorhinolaryngology became particularly relevant after the publication of Regulation 10 on 04.11.2016 on the approval of the medical standard „Ear –nose -throat diseases“ issued by the Minister of Health and promulgated in the State Gazette, Issue 94 on 25.11.2016. Material and method: Object of the developed algorithms are ear–nose-throat diseases defined as urgent under item 14.4 of Ordinance 10 they are: 14.4.1 Open and closed traumas of ENT region 14.4.2 Respiratory failure of the inspiratory type 14.4.3 Bleeding by ENT region 14.4.4 Foreign bodies in the airways and esophagus 14.4.5 Intracranial and orbital complications by ENT origin In order to facilitate our work, we have merged points 14.4.1 and 14.4.3 into one and we have defined them as Open and Closed Trauma and Bleeding of ENT region. Discussion: The clinical decision in each particular case should include a compex analysis of the patient’s condition and available course of action. Clinical considerations are those that can cause the doctor in an emergency ward to decide what strategy to choose based on the algorithm for each individual group of urgent conditions in otorhinolaryngology. Conclussion: These guidelines may be revised and corrected if necessary in the light of changes in technology, new data or other aspects of clinical behavior.

The Demographic Study of Otorhinolaryngological Trauma Among Patients with Head and Neck Trauma and Their Management in a Tertiary Care Centre.

The trauma has been increasing in frequency, especially in recent decades because of the higher number of automobile accidents and violence. The ear, nose and face region is the area in the body that is commonly involved in head and neck injury. Trauma to this region is often associated with mortality and varying degree of physical, functional and psychological damage. To study the demography, aetiology, clinical presentation, outcome of ENT trauma in our tertiary care centre and to compare our study with previous studies to see the changing trends with passage of time. A prospective study was conducted on 200 head and neck patients with ENT injuries during a period of 1year from July 2014 to July 2015, who were admitted in ENT Department and Trauma Centre of Gajra Raja Medical College and J.A. Group of Hospital, Gwalior. Most of the patients were young adult males of age group 18-40years (45, 22.5%) with a male:female ratio 1.78:1. Among them 53% patients were from rural area while 47% were from urban area. RTA is the most prevalent cause of ENT trauma (37%), followed by interpersonal violence (25%). 27% of the patients had facial injury and multiple region injury each. Among 200 patients 33% were managed conservatively on the other hand 66% patients required surgical interventions. Mortality rate was 8%. Among all 184 survivors 25.5% suffered from hearing loss, 14.5% had tympanic membrane perforation with hearing loss, 12% had pinna disfigurement, 10% had change in voice, 6.5% had permanent nasal deformity, 2% had facialnerve palsy. Young male adults were the most prevalent victims of ENT trauma, and Road traffic accidents were responsible for majority of the ENT injuries. Screening of all the patients with head and neck injuries for the presence of trauma in the ENT region should be introduced to enable early detection and therefore prevention of complications.

ENT Manifestations of Wegener`s Granulomatosis

Objectives: The purpose of this study was to find out the presenting features, diagnostic problems, treatment, and prognosis of Wegener`s granulomatosis (WG), with special reference to ENT manifestations. Study Design: It was a prospective descriptive study. Study Setting: The study was conducted at the Department of Otorhinolaryngology and Head & Neck surgery, Pakistan Institute of Medical Sciences (PIMS), Islamabad, from 1st March1999 to 30th Sep 2001. Results: The ten patients included in this study comprised of six males and four females, with a male to female ratio of 1.5:1. The age of patients ranged from 16 years to 55 years with an average age of 38.5 years. The most common presentation in our patients was due to nasal involvement of disease. Nasal obstruction, epistaxis, and rhinorrhoea was seen in 80% of patients with WG. Next common symptom was headache (60%) followed by other symptoms Two patients had ear pain and conductive deafness along with nasal symptoms. One patient in addition to nasal symptoms mentioned presented with saddle nose deformity. One patient presented with hoarseness and progressive stridor, having subglottic stenosis as an isolated finding. Conclusion: Most common symptoms in WG localized to ENT region are nasal obstruction, rhinorrhoea and epistaxis. Biopsy and c-ANCA have key role in diagnosis of WG. ESR has a good prognostic relevance

Occult Foreign Bodies in ENT

IntroductionForeign bodies are common ENT emergencies. Histories are usually forthcoming from the patient himself or the relatives . Three occult foreign bodies are reported here, which were missed even by treating doctors, with discussion about steps to avoid such errors in future.
 Case SeriesCase 1: Though the history was apparent, the foreign body was removed only after 13 years from the Zygomatic region.Case 2: The parents were aware of the foreign body but inadequate investigations led to a delayed diagnosis.Case 3: The history clinched the diagnosis. Pre operative localization and separate incision to remove the foreign body saved the vital structures.
 DiscussionA high index of suspicion, meticulous history and proper investigation like x-ray or CT scan or MRI of the diseased area may help in locating the hidden foreign bodies in the ENT region.

A93: Childhood Granulomatosis With Polyangiitis: Standardized Disease Assessment in 6 Czech Children

Background/Purpose:Granulomatosis with polyangiitis is a rare primary systemic vasculitis affecting small blood vessels with predilection for the respiratory tract and kidneys. We describe clinical outcome of a small patient cohort as captured by the recently developed tools the Paediatric Vasculitis Activity Score (PVAS) and the Paediatric Vasculitis Damage Index (PVDI).Methods:A retrospective and prospective analysis of data gathered from 2006 to 2013 on patients fulfilling the EULAR/PRINTO/PRES criteria for GPA. Disease activity and damage items have been systematically recorded, data from the time of diagnosis and from the last follow‐up (F/U) are presented.Results:Characteristics of the 6 girls identified are summarized in the . The median F/U was 4 years. Disease manifestations were recorded under PVAS and PVDI sections with 6/9 and 8/10 systems affected with active disease or damage, respectively. General, ENT and pulmonary manifestations were observed in 4/6 patients. Nephritis developed in 2/6 patients. Cumulative damage was noted in all cases with ENT region most commonly affected. Persistent remission was achieved in one case with limited disease, in the other one subglottic stenosis caused an episode of airway obstruction and cerebral ischemia leading to apalic syndrome and later to death. Clinical inactivity on treatment was achieved in 2 girls. Patient characteristics Patient 1 2 3 4 5 6 Age at onset (years) 14 14 13 12 15 14 F/U (years) 5 2 5 5 3 0.2 ANCA Atypical IF c‐ANCA p‐ANCA Atypical IF c‐ANCA c‐ANCA Treatment CS, CP, MMF CS, MTX CS, MTX CS, MTX, CP, AZA CS, CP, MMF, RTX CS, CP, RTX PVAS category (section score) Onset F/U Onset F/U Onset F/U Onset F/U Onset F/U Onset F/U General 0 0 3 0 1 0 0 0 3 0 2 N/A Cutaneous 0 0 0 0 0 0 0 0 3 0 5 N/A Mucous memb./Eyes 0 0 0 0 6 0 2 0 0 0 0 N/A ENT 0 0 6 0 0 0 6 0 4 0 6 N/A Chest 3 0 0 0 0 0 6 0 6 0 6 N/A Renal 12 4 0 0 0 0 0 0 12 0 0 N/A PVAS total 15 4 9 0 7 0 14 0 28 0 19 N/A PVDI category (section score) Onset F/U Onset F/U Onset F/U Onset F/U Onset F/U Onset F/U Musculoskeletal 0 0 0 0 0 0 0 0 0 2 0 N/A Skin/Mucous memb. 0 0 0 0 0 0 0 1 0 0 1 N/A Ocular 0 0 0 0 0 1 0 1 0 0 0 N/A ENT 0 0 0 3 0 1 0 2 0 1 1 N/A Chest 0 0 0 0 0 0 0 3 0 1 1 N/A Renal 0 1 0 0 0 0 0 0 0 1 0 N/A Nervous system 0 0 0 0 0 0 0 2 0 0 0 N/A Other 0 1 0 1 0 0 0 3 0 0 1 N/A PVDI total 0 2 0 4 0 2 0 12 0 5 4 N/A F/U–follow‐up, N/A‐non–available, CS‐Corticosteroids, CP‐Cyclophosphamide, MTX‐Methotrexate, MMFMycophenolate mofetil, AZA‐Azathioprine, RTX‐RituximabConclusion:This small series of patients illustrates a variety of GPA outcomes. A standardized scoring of disease activity and damage enables systematic patient F/U and drives appropriate treatment decision‐making.

A Study of Manifestations of Extrapulmonary Tuberculosis in the ENT Region

Though tuberculosis (TB) primarily affects lungs, extra pulmonary tuberculosis (EPTB) is also common, especially in high disease load areas and mainly manifests in ENT region. To study the different manifestations of tuberculosis in ENT region in terms of presentation, disease process, treatment and outcome. Records of patients diagnosed and treated for TB in the ENT region at our institute's DOTS centre for a two and half year period were analysed for presenting complaints, examination findings, diagnostic features, treatment modes and outcome. Out of 3750 cases diagnosed as TB, 230 had EPTB. 211 cases had ENT manifestations. Majority of the cases were male and in the fourth decade of life. Commonest manifestation was cervical lymphadenopathy with 201 cases. Fine needle aspiration cytology was mostly diagnostic and category I anti TB treatment (AKT) achieved cure. The six cases of TB otitis media presented with ear discharge, sometimes bloody and had varied tympanic membrane findings and facial palsy in two cases with different types and degrees of hearing loss. Diagnosis was confirmed by histology of tissue removed during surgery. Patients completed category I AKT. Hearing and facial palsy did not improve. There were three cases of TB laryngitis and one of nasal TB both of which were confirmed by tissue diagnosis and responded well to AKT. Most of the results in the present study conform to findings of other studies. High degree of suspicion is necessary to reach diagnosis. Category I AKT is effective. Some cases may require surgery.

Objawy otologiczne w świetle najnowszej wiedzy o ziarniniaku Wegenera

ObjectiveWegener granulomatosis (WG) presents nasal, laryngeal and otologic symptoms as an initial signs of the disease and finally can affect the ENT region in 3/4 patients. The authors want to analyze 7 cases of WG with early aural symptoms, connected with the diagnostics dilemma, discuss the problems of otologic manifestation in WG and present the newest concepts of diagnostics and treatment of this condition. Material and methodsAll patients were treated in the ENT University Department in Poznań in the years 2002–2010. Three patients manifested isolated aural symptoms at the time of the initial clinical presentation (otitis media with effusion, facial palsy and sensorineural profound hypoacusis), whereas in four aural problems were the first, the most expressed and pronounced. In the last four cases neither the initial stage of respiratory nor renal failure were the immediate reason for applying to the doctor, but in two the rapid onset of hypoacusis combined with purulent discharge and facial nerve palsy and in two quick progression of mixed type hypoacusis. ResultsThe age of the patients ranged from 32 to 46. The outcome of initially otologic cases, which developed generalized form of WG was poor (first died after 2 months, second after 7 days, third in a two-month observation had the pulmonary insufficiency, fourth in one month had severe renal failure), whereas other 3 patients with localized form of the disease have been successfully under control for 3–5 years. ConclusionsAs Wegeners granulomatosis in some cases presents ENT problems as an initial sign, it is important to take it into consideration in atypical inflammatory states of the ear. The otologic onset of WG is very insidious and prompt diagnosis in early stage of disease is a challenge.

Foreign Body in Ear, Nose and Throat: Experience in a Tertiary Hospital

To study the incidence of various foreign bodies in patients of different age and sex, attending E.N.T. Department, a retrospective review was done in Department of E.N.T., Burdwan Medical College and Hospital, Burdwan. About 334 patients with foreign body in ENT region presented to Department of E.N.T., Burdwan Medical College and Hospital from October 2008 to September 2010 were included in the study. Foreign body in ENT region is a common problem frequently encountered in both children and adults. Their accurate diagnosis and management without any complications is often challenging.