MUTATIONAL FALSETTO: A PANORAMIC CONSIDERATION

            This article is intended to present everything that is known about puberphonia in a comprehensive yet concise manner. The evolution of the approach and attitude to its treatment from ancient concepts to recent trends is highlighted. 

AETIOLOGY AND MANAGEMENT OF EPISTAXIS IN CHILDREN - Prospective Study of a series of 50 cases

This prospective study was conducted on 50 pediatric patients in the age group of 0- 15 years presented with nasal bleed. The study was conducted for a period of one year from July 2009 toSeptember 2010. Descriptions of the patients (age, gender), cause of nasal bleeding, associated clinical features, treatment and results were noted. The common causes of epistaxis in children were idiopathic, digital picking, upper respiratory tract infections, and nasal foreign body. Most of the cases responded to conservative measures, in one case surgical treatment had to be done.

PREDILECTION OF SITE IN CHRONIC RHINOSINUSITIS: TOMOGRAPHIC FINDINGS IN 100 PATIENTS

OBJECTIVE:To study the pattern of mucosal involvement in chronic rhinosinusitis usingcomputed tomography of 100 patients.DESIGN:A prospective study of mucosal involvement of paranasal sinus region was done on100 computed tomography scans of patients with chronic rhinosinusitis.RESULTS: The most common site of involvement was osteomeatal complex followed bymaxillary antrum. This was followed by anterior ethmoids, posterior ethmoida, frontal sinus andsphenoid sinus, in that order.CONCLUSION:Osteomeatal complex is the most common site to get involved in chronicrhinosinusitis. The blockade in the osteomeatal complex subsequently leads to impaired drainageand inflammation in maxillary, ethmoid and frontal sinuses. Removal of disease in Osteomeatalcomplex region is the basic principle of Functional Endoscopic Sinus Surgery which is bestappreciated on CT scan.

AN UNUSUAL PRESENTATION OF EPITHELIAL - MYOEPITHELIAL CARCINOMA OF THE NASAL CAVITY

Myoepithelial carcinoma is a rare malignant epithelial neoplasm composed of variable proportions of salivary gland tumor. Most of cases which have been reported in the literature were located in salivary glands, except for a few cases occurring in unusual locations such as breast, lacrimal gland, nose, paranasal sinus, trachea, bronchus, and lung. We report a case 59-year-old female manifesting as nasal obstruction with left recurrent epistaxis and on nasalendoscopic examination was found to have a polypoid tumor in the left nasal cavity. The CT scan demonstrated a soft tissue mass without extension to the nasopharynx or bony destruction. The tumor was surgically treated with endoscopic excision successfully from the left nasal septum. Histopathologic examination revealed the tumor to consist of a mixture of asolid, tubular structures. Based on the histological and immunohistochemical findings, the tumor was diagnosed to be an myoepithelial carcinoma. The patient has had neither recurrence nor metastasis 8 months postoperatively The purpose of this study was to describe myoepithelial carcinoma with nasal location, which is exceptionally reported in the literature.

Coblation the Physics behind it

The technology of using plasma to ablate biological tissue was first described by Woloszko and Gilbride 1 . By their pioneering work in this field they proved that radio frequency current could bepassed through local regions of the body without discharge taking place. Radio frequency technology for medical use (for cutting, coagulation and tissue dessication) was popularized byCushing and Bovie 2 . Cushing an eminent neurosurgeon found this technology excellent for his neurosurgical procedures. First use of this technology inside the operating room took place onoctober 1 st 1926 at Peter Bent Brigham Hospital in Boston, Massachusetts. It was Dr Cushing whoremoved a troublesome intracranial tumor using this equipment.

A rare Cervical Nerve Root, C2-C3 Schwannoma

Schwannomas, neurilemmomas or neurinomas are benign nerve sheath tumors deriving from Schwann cells that occur in the head and neck region in 25-45% of cases.About 10% of schwannoma that occur in the head and neck region generally originate from the vagus or sympathetic nervous system, those arising from C2 nerve root are extremely rare.Preoperative imaging studies such as magnetic resonance imaging (MRI) and computed tomography (CT) are used to distinguish its location and origin. The treatment of schwannoma is surgical resection, with several surgical modalities have been introduced to preserve the neurological function.We present a rare case of Cervical nerve (C2-C3) root schwannoma of 70 years old male who presented with lateral neck swelling which also had intervertebral part and was removed successfully through neck incision with no post-operative neurological symptoms.

An Update of Rhinosinusitis

Rhinosinusitis is one of most common disease worldwide, affecting the quality of life of the person afflicted by it. Its causes and pathophysiology has been well delineated so far, but its treatment is changing fast due to change in organisms causing itand also emergence of resistance to antimicrobial agents, thus making the management challenging. This article highlights the changing microbial pattern, classification of the disease, its socio-economic burden, medical treatment and ever evolving surgicaltreatment, with its indications.

Unsafe CSOM still a challenge in rural areas

AIMS AND OBJECTIVESTo determine the frequency of complications in unsafe chronic suppurative otitis media.MATERIAL AND METHODSThis prospective study was conducted in the department Otorhinolaryngology MMIMSR over the timeduration of one year from March 2011 to April 2012. Fifty consecutive patients were selected whoseclinical diagnosis was CSOM Attico-antral type.Conclusion:The rate of complications, especially more serious intracranial complications ,observed in developing countries is significantly more than those observed in studies from the developed countries.(12). In our study the frequency of extracranial complications excluding ossicular erosion is 22% and thefrequency of intracranial complications is 4%. It was observed by Memon et al (13) in 2008 that in aseries of 390 patients of chronic discharging ears that the rate of extracranial complications was 4.10%and rate of intracranial complications was 2.3%of the unsafe variety . The high frequency in our study may be explained by the fact that we are sitting in a rural background with very poor socio-economicbackground patients. Osama U et al (14) from Turkey reveals the rate of 1.35% of extracranial complications and 1.97% of intracranial complications in his study.

Sensorineural Hearing Loss Associated with Kawasaki Disease

Kawasaki disease (KD) is an acute systemic vasculitis of children characterized byfever, rash, conjunctival hyperemia, oropharyngeal erythema, edema and erythema of the hands and feet, and cervical adenopathy [1]. A variety of other features are also characteristics of this syndrome, including coronary artery aneurysms, urethritis, anterior uveitis, mild hepatobiliary dysfunction, and gallbladder hydrops. Coronary artery abnormalities, including aneurysms and ectasia, occur in approximately 20% of untreated patients [2]. Neurologic involvement is rare. Cranial nerve palsy, especially involving the seventh nerve, has been reported [3], as well as hemiparesis caused by cerebral thrombosis and infarction, and convulsions.Although about 30% of patients with acute KD in the United States have beenreported to suffer mild sensorineural hearing loss (SNHL) [4], only a few such cases have been reported in Japan. On the other hand, in both countries, a few cases of severe or profound SNHL in children who were in the acute phase of KD have been documented [5].

RECURRENT EPISTAXIS OF ADULT IN TROPICS

ABSTRACTIntroductionThe ENT specialist in a tropical environment is very often confronted with nosebleed. It is the revealing sign of a general or local disease.The objective of this work was to study the different etiological factors and therapeutic aspects of recurrent nosebleed encountered in our service.Patients and MethodsThis study was conducted from January 2011 to April 2012 focused on 75 patients seen in consultation or hospitalized in the department of ENT diseases, reference health center N°IV Bamako (MALI).All patients of both sexes with bleeding repetitive nature found by the anterior rhinoscopy are included in the study.The laboratory tests are requested.ResultsWe found on 75 patients of the study 36 men (48%) and 39 women (52%) aged from 16 to 90 years old with an average age of 39 years. The causes of recurrent epistaxis were: Subatrophic rhinitis 36 cases (48%), Arterial hypertension 13 cases (17.34%). Nosebleed originated in majority of the anterior part ofthe septum in 55 cases (73.33%), and was primarily unilateral in 41 cases (54.66%).In most of the patients in the study 39 cases (52%) bleeding sedation has been obtained in the majority in cases by the lubricants of the nasal mucosa.ConclusionRecurrent nosebleed is a common pathology in tropical rhinology. The site of the bleeding was the anterior part of the nasal septum. Most of our patients have been improved by the use of nasal lubricants.