Accidental Entry of Fish into Throat While Bathing in a Pond

While fish bones are common foreign bodies in the throat, a whole live fish in the pharynx is very rare. We report a case where a whole fish accidentally entered the throat of a 52-year-old male, where it became lodged causing throat pain and dysphagia. The fish was removed as an emergency procedure

Management of Laryngotracheal Trauma: A Five-Year Single Institution Experience

Introduction: Laryngotracheal trauma is a rare life-threatening emergency that requires early identification and immediate intervention. Here, we present 26 patients with laryngotracheal trauma from a tertiary hospital in India. The aim was to describe the clinical presentation and management of laryngotracheal trauma patients.   Materials and Methods: This was a retrospective study of laryngotracheal trauma patients treated between January 2011 and March 2016. Patients who presented with a breach in the laryngotracheal framework were included, while those who had penetrating neck injuries superficial to strap muscles/platysma, burn injuries, caustic ingestion, or endotracheal injuries were excluded from the study.   Results: Of 253 patients with neck injury, 26 (23 adults, three children; 21 males, five females; age range, 5-60 years) presented with a breach in the laryngotracheal framework (15 blunt neck-trauma patients and 11 penetrating neck-trauma patients). The most common cause of neck injury was road traffic accidents, seen in 12 patients (46.2%). Computed tomography (CT) was performed in all blunt trauma cases and in four patients with penetrating trauma. All penetrating trauma patients underwent neck exploration. Twelve blunt trauma patients (46.1%) were managed conservatively, while three (11.5%) required surgical intervention. The most common neck exploration finding noted in patients with a penetrating injury was fracture of the thyroid cartilage, which was seen in eight patients (30.8%). Twenty patients (76.9%) had a normal voice, five patients (19.2%) had a hoarse voice, and one patient (3.8%) had a breathy voice post treatment.   Conclusion: Early intervention of laryngotracheal trauma is crucial. The role of a CT scan is essential in decision making in blunt trauma cases

Intraorbital and Intracranial Complications of Acute Rhinosinusitis: A Rare Case Report

Introduction: Complications of acute sinusitis affecting multiple sites are very uncommon in the antibiotic era. However, a significant proportion of patients (5–40%) suffering from acute sinusitis can have these complications mostly due to the delayed diagnosis of the disease. Patients can have variable presentations according to the site and extent of the infection.   Case Report: A 21-year-old male student presented with subperiosteal abscess and a brain abscess with a history of acute sinusitis. The patient had short history of left-side hemiplegia with foot drop. Endoscopic orbital decompression was performed and the subperiosteal abscess was drained when it did not respond to medical treatment. Complete clinical and radiological recovery was achieved after 1 month of medical treatment.   Conclusion: Complications affecting the multiple sites in acute sinusitis is very uncommon in the antibiotic era. A proper history and thorough clinical examination along with a radiological evaluation are key factors in the final diagnosis of the patients with suspected complications. A quick multidisciplinary approach among otorhinologsts, ophthalmologists and general physicians is always necessary to avoid unwanted life-threatening complications

Abiotic stress tolerance in mangroves with a special reference to salinity

Since mangroves are found near extremely transitional ecosystems, they face a lot of physico-chemical perturbations. As mangroves possess a unique ecotone, they experience many abiotic stressors viz. salinity, metal, oil, humidity temperature, nutrient and a wide range of biotic interactions. Amongst all, salinity is the most important factor affecting mangrove physiology and biochemistry, and thereby regulating the organic matter contribution to the consumers underneath. Exploitation by human, being a dominant biotic interference, is above the rate at which natural replacement of mangrove vegetation occur. Mal-nutrition is a limiting factor in growth and reproduction of many mangroves whereas nutrient replenishment reduces the phytotoxicity of heavy metals. Different environmental pollutants including heavy metals, recalcitrant, cosmetics, petroleum oil and endocrine disrupters have reported impact on various mangroves and associated biota. Stress tolerance in mangroves involves various mechanism including morphological and anatomical features, osmoregulation, water use efficiency, salt secretion, salt exclusion and salt accumulation and molecular regulations. Various aspects of salt tolerance strategies of mangroves related to their growth, biochemical anatomy and physiology were reported by many researchers

Stridor in an Elderly Woman: An Unusual Presentation of a Giant Thyroglossal Cyst

Thyroglossal cysts are one of the most common midline neck masses. They usually present as midline painless cystic neck mass in the first three decades of life. These anomalies are very rare in elderly patients and may pose difficult diagnostic and therapeutic challenges. Here, we report a case of giant thyroglossal cyst in a 72-year-female patient who presented with stridor, hoarseness of voice, and vocal cord paresis with gross distortion of normal airway anatomy secondary to pressure effect of the mass. The gross distortion and displacement of airway along with respiratory distress in this patient posed a difficult situation in securing the airway. The airway was secured by a unique way of orotracheal intubation with the help of a ventilating airway exchange catheter. The cyst was excised in toto under general anaesthesia. The stridor completely resolved after surgery and tracheostomy was avoided

First Branchial Cleft Malformation with Duplication of External Auditory Canal

First branchial cleft anomalies are uncommon, accounting for less than 10% of all branchial abnormalities. Their rare occurrence and varied presentation have frequently led to misdiagnosis and inadequate and inappropriate treatment of these conditions leading to repeated recurrences and secondary infection. In this paper, a case of 11-year girl with type 2 first branchial cleft defect is described. She first presented with a nonhealing ulcer of upper neck from childhood. Diagnosis had previously been missed and treated as tubercular ulcer. We confirmed the correct diagnosis by history and computerized tomography fistulogram. The lesion was completely excised with no further recurrence

Potassium Titanyl Phosphate Laser Turbinate Reduction in the Management of Allergic Inferior Turbinate Hypertrophy: Our Experience

Background Allergic inferior turbinate hypertrophy is one of the most common causes of nasal obstruction. Several surgical methods can be used for the reduction of allergic inferior turbinate hypertrophy refractory to medical management. Herein, we share our experience with a potassium titanyl phosphate (KTP) laser, which is a relatively novel technique for turbinate reduction. Objectives To evaluate the efficacy of KTP laser turbinate reduction in terms of symptomatic improvement and its effect on nasal mucociliary clearance. Methods This study was conducted in the Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India, from November 2012 to July 2013. Thirty patients with inferior turbinate hypertrophy refractory to medical management were selected. A KTP laser was used at 6 W in continuous mode, with a spot size of 0.6–1 mm, and energy delivered through a 400–μm optical fiber. A follow-up was done at 1 week, 1 month, and 3 months. All the values (both by the Sino Nasal Outcome Test scoring system and saccharine transit time) were assessed before surgery and at each follow-up visit. Results The patients showed significant differences in the symptoms (p < 0.0001) at each follow-up. The mean saccharin transit time showed significant prolongation during the first week and first month after surgery, which indicated adverse effects on the mucociliary system (p < 0.0001). This, however, was a temporary effect, and the mean saccharin time returned to normal limits (17.96 minutes) at the third postoperative month. The mean operative time was 11.62 minutes. The procedure was not associated with any serious intra- or postoperative complications. Conclusion KTP laser turbinate reduction is a safe, effective, and minimally invasive procedure in the treatment of allergic inferior turbinate hypertrophy, with a minimal effect on the nasal mucosa. It can be done as an office procedure, with minimal complications

Xanthoma Disseminatum Presenting with Hoarseness

Introduction: Xanthoma disseminatum (XD) is a rare, benign, non-Langerhans cell histiocytic disorder with unknown etio-pathology. It manifests with multiple, grouped, red-brown to yellow papules and nodules involving the skin, mucous membranes, and internal organs with a predilection for flexures and the face.  Case Report: We report a patient who presented with disseminated xanthomatous papules and nodules involving the face, neck, trunk, axilla, groin, and oral cavity, along with hoarseness of voice. Video laryngoscopy revealed multiple yellowish nodules over the base of the tongue, vallecula, laryngeal surface of the epiglottis, ary-epiglottic folds, interarytenoid region, and subglottic region. Histopathology was suggestive of  xanthoma disseminatum and the patient was treated with tablet acitretin 25mg daily for three months without any response. Following this, the patient was prescribed tablet thalidomide 100 mg daily without any significant improvement at the end of two months.  Conclusion: Xanthoma disseminatum is a very rare form of non-Langerhans cell histiocytosis that classically presents with cutaneous xanthomas, mucosal xanthomas, and diabetes insipidus. Hoarseness of voice due to lesions involving the larynx is a rare symptom. Because the disease has punctated, numerous relapses and causes morbidity to the patient, its multisystem manifestations have to be known. Therefore, xanthoma disseminatum has to be kept in mind as a differential  diagnosis for hoarseness of voice