An International Journal of Otorhinolaryngology Clinics

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2018 | May-August | Volume 10 | Issue 2

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R Anil Kumar, Nikhil M John, Satish H Subbegowda

Ludwig's Angina: A Study on Etiology and Factors affecting the Prognosis and Management

[Year:2018] [Month:May-August] [Volume:10] [Number:2] [Pages:5] [Pages No:47 - 51]

Keywords: Airway management, Ludwig's angina, Surgical decompression

   DOI: 10.5005/jp-journals-10003-1289  |  Open Access |  How to cite  | 


Objectives: To evaluate the various etiological factors contributing to the development of Ludwig's angina, factors affecting the prognosis, and various modalities that will help in the management of this potentially dangerous condition and further complications. Materials and methods: A prospective study was conducted from January 2016 to December 2016 at the Department of ENT, Bangalore Medical College & Research Institute (BMC & RI), Bengaluru, India. Thirty patients with Ludwig's angina were studied. Age, sex, etiological factors, associated systemic diseases, microbiology, antibiotic therapy, duration of hospital stay, and social background of patients were evaluated. Results: Most patients were in the third decade of life; there was a preponderance of females in this study. Dental infection was the most common etiological factor (70%). Neck swelling (100%), pain (83%), fever (75%), and trismus (33%) were the most common complaints. Most common pathogens found were Streptococcus viridans (36.6%) followed by Staphylococcus aureus (16.6%), Streptococcus pyogenes (13.3%), and Klebsiella species (10%). Majority of patients (80%) were discharged by 2 weeks following the day of admission. Conclusion: Management of Ludwig's angina can often be challenging. Appropriate and aggressive antibiotic therapy, surgical decompression if required, and removal of infected foci can arrest the progress of disease process and prevent further complications.



Sanyaolu A Ameye, Adekunle Adeyemo, Josephine A Eziyi, Yemisi B Amusa

Clinical Profile of Otomycosis in a Sub-saharan African Tertiary Health Center

[Year:2018] [Month:May-August] [Volume:10] [Number:2] [Pages:4] [Pages No:52 - 55]

Keywords: Cohort study, Ear, Fungal, Otalgia, Otoscopy, Ototopic medication, Pruritus

   DOI: 10.5005/jp-journals-10003-1290  |  Open Access |  How to cite  | 


Aims: This study is aimed at determining the presentation, predispositions, types and treatment outcomes of patients diagnosed with otomycosis in our center. Materials and methods: We reviewed 83 cases of otomycosis who visited the otorhinolaryngology clinic of our center in the period of 5 years. Diagnosis of otomycosis was clinically based on presentation and findings on otoscopic appearance. Results: Records of 83 cases of otomycosis consisting of 40 males and 43 females were analysed. The mean age was 43.19 ± 20.74 years. Twenty-eight (33.7%) patients were asymptomatic with the otomycosis discovered following otoscopy during a clinic visit. Pruritus, ear ache and hearing loss were the commonest complaints among the symptomatic patients. Unilateral disease was seen in 57 (68.7%) of the patients and bilateral disease in 23 (27.7%) of the patients. The affected side was not stated in 3 (3.6%) of the patients. Examination findings revealed in most cases (78, 94.0%) reveal presence of fungal debris. The use of ototoptic medication was noted as the risk factor for more three-quarter of those with identifiable risk factor. Total fifty-one (61.4%) patients had complete resolution. Conclusion: We found otomycosis to be predominantly an adult disease and it is an incidental finding many case. The overall outcome is good regardless of the mode of treatment employed. Clinical significance: The limitation to due to non-available of a particular mode of treatment should not impair obtaining a good outcome when managing otomycosis.



Wijaya Juwarna, Adlin Adnan, Tengku SH Haryuna

Noise Induced Hearing Loss in Begerpang Palm Oil Mill Workers

[Year:2018] [Month:May-August] [Volume:10] [Number:2] [Pages:5] [Pages No:56 - 60]

Keywords: Cross-sectional study, Noise-induced hearing loss, Palm oil factory, Workers

   DOI: 10.5005/jp-journals-10003-1291  |  Open Access |  How to cite  | 


Aim: The aim of this study is to determine the factors that can affect the occurrence of noise-induced hearing loss (NIHL) and the relationship between the intensity of noise with increased blood pressure on employees who work at Begerpang Palm Oil Mill PT Perusahaan (BPOMPL) Perkebunan London Sumatra Indonesia Tbk. Materials and methods: This was a cross-sectional study conducted from July to December 2013. The selected employee as the subject was 60 people. They first fill out the questionnaire and then get a clinical examination of ear nose and throat. Respondents were tested for blood pressure before and after working and also checked their hearing using a pure tone audiometer. Chi-square test was used, including the relationship of age, length of working, noise intensity, personal protective equipment to the occurrence of NIHL and the relationship between the intensity of noise with increased blood pressure. It is statistically significant if the p-value is <0.05. Results: It was found a significant relationship between the working period (p = 0.001), noise intensity (p = 0.008), and the use of personal protective equipment hearing (p = 0.001) with NIHL occurrence. There was also a significant relationship between noise intensity with increasing systolic (p=0.001) and diastolic (p = 0.001) blood pressure. Conclusion: This study proved a significant correlation between the working period, noise intensity and the use of personal protective equipment of hearing with NIHL occurrence and between noise intensity with increased systolic and diastolic blood pressure. Clinical significance : NIHL diagnosis is an important step to prevent hearing loss and increased blood pressure in workers.



Kartik Parelkar, Keya Shah, Walleed Al-Mutairi, Ankur Walli

Revision in “Shiann Yann Lee” Technique: End of the Road?

[Year:2018] [Month:May-August] [Volume:10] [Number:2] [Pages:3] [Pages No:61 - 63]

Keywords: Airway, Stridor, Subglottic stenosis

   DOI: 10.5005/jp-journals-10003-1292  |  Open Access |  How to cite  | 


In India, majority of patients of laryngotracheal stenosis come with a typical history of prolonged intubation, which in many is preceded by organophosphorus poisoning. Shiann Yaan Lee's technique of T-tube insertion is one of the many tested modalities to manage even complex cases of laryngotracheal stenosis. Though it may be successful in establishing a patent airway, it does not address the possibilities of future complications and their management options in our opinion. We would like to share our experience regarding a case of life-threatening recurrent laryngotracheal stenosis following initial management by this technique, so that the readers can keep in mind the future prospects in case of recurrence of the stenosis, before attempting this technique in their patients. Revision airway surgery following Shiann Yaan Lee's technique is rightly labeled as “end of the road” according to us.



Salman Amiruddin, Marina M Baki, Atiqah F Zakaria

A False Cord Mass: Can It be a Schwannoma?

[Year:2018] [Month:May-August] [Volume:10] [Number:2] [Pages:2] [Pages No:64 - 65]

Keywords: False cord mass, Schwannoma, Supraglottic area

   DOI: 10.5005/jp-journals-10003-1293  |  Open Access |  How to cite  | 


A false cord mass is very rare, and the condition is associated with airway morbidity if it is not recognized and addressed at an early stage. The mass could be an extension from a glottic and subglottic area, and the tissue diagnosis is mandatory to rule out carcinoma. We are presenting an elderly woman who came to us due to worsening hoarseness with an endoscopic finding of false cord mass that turned out to be schwannoma as a histological diagnosis.



N Raja Sekharam, Manoj Sharma, N Vishnu S Reddy, Murali Chintham, Rajesh Gudipudi

Isolated Laryngeal Lymphangioma: A Case Report and Literature Review

[Year:2018] [Month:May-August] [Volume:10] [Number:2] [Pages:4] [Pages No:66 - 69]

Keywords: Laryngeal lesion, Laryngeal lymphangioma, Tracheostomy

   DOI: 10.5005/jp-journals-10003-1294  |  Open Access |  How to cite  | 


Introduction: Lymphangiomas of larynx are extremely rare congenital lesions of lymphatic system. Most commonly seen in head and neck region, about 90% of them are detected by the second year of life. Adult laryngeal lymphangioma is very rare in occurrence with only a few cases reported in the literature. Case report: We report a rare case of isolated laryngeal lymphangioma, which was well treated by tracheostomy and thorough surgical excision using rigid endoscope with diode laser ablation without injuring the surrounding vital laryngeal structures. Conclusion: We discuss the presentation, diagnosis, and treatment of laryngeal lymphangioma with possible options for surgical management along with a review of pertinent literature.



Richa Jindal, Kuldeep Kaur

Left-sided Paraganglioma of Larynx mimicking Carcinoma: A Rare Entity

[Year:2018] [Month:May-August] [Volume:10] [Number:2] [Pages:3] [Pages No:70 - 72]

Keywords: Larynx, Paraganglioma, Zellballen

   DOI: 10.5005/jp-journals-10003-1295  |  Open Access |  How to cite  | 


Paragangliomas are a rare group of tumors composed of neuroendocrine cells. Head and neck are the uncommon sites of its origin and very few cases have been reported so far about its origin in larynx. Most paragangliomas arise from the right side of larynx. We are hereby reporting a rare case of left-sided laryngeal paraganglioma in a 55-year-old female.



Sanjeev Gupta, Suryakanta Pradhan, Ambika P Dash, Jitendu Mohanty, Anup K Rana

A Rare Case of Live Fish in Oropharynx and Its Management

[Year:2018] [Month:May-August] [Volume:10] [Number:2] [Pages:3] [Pages No:73 - 75]

Keywords: Climbing perch, Live fish in oropharynx, Live foreign body, X-ray neck

   DOI: 10.5005/jp-journals-10003-1296  |  Open Access |  How to cite  | 


Fish bone as foreign body in throat is very common in otorhinolaryngology practice. But a live fish in oropharynx is very rare. Small fishes, if ingested, can cross the oral cavity and migrate to esophagus, nasopharynx, or airway, but large fishes get impacted in the oropharynx. Most of these cases are life-threatening and require immediate intervention to save the patient. Sometimes, tracheostomy is required to establish the airway and to remove the fish. We are reporting a case of live climbing perch (Anabas testudineus) which was successfully removed from the oropharynx of a 30-year-old male without tracheostomy. We will mainly discuss the proper technique to remove live foreign bodies without causing any complications.



Samuel Rajan, Vikas Malhotra, Anju Chauhan, Komal Lamba, Nidhi Mahajan

Biphasic Synovial Sarcoma of the Hypopharynx with Vertebral Metastasis: A Rare and Aggressive Entity

[Year:2018] [Month:May-August] [Volume:10] [Number:2] [Pages:4] [Pages No:76 - 79]

Keywords: Pyriform sinus, Radiotherapy, Synovial sarcoma

   DOI: 10.5005/jp-journals-10003-1297  |  Open Access |  How to cite  | 


Introduction: Synovial sarcoma is a malignant tumor which is mesenchymal in nature and most commonly involves the joints of the lower limbs. Sarcomas of the head and neck region are very rare, accounting for less than 1% of all neoplasms of the head and neck. Case report: A 60-year-old male presented to ear, nose, and throat (ENT) emergency with complaints of change in voice and difficulty in swallowing since 10 days. On indirect laryngoscopic examination, there was a reddish smooth mass seen involving the left lateral pharyngeal wall and obscuring left pyriform sinus. A contrast-enhanced computed tomography (CECT) scan of the neck was done, which revealed a well-defined heterogeneously enhancing soft tissue lesion in the left pyriform sinus. On direct endoscopic assessment, a friable reddish mass was seen in the left pyriform sinus, which was excised and sent for biopsy. Pathological examination showed a biphasic lesion comprising of epithelial component arranged in nests and stromal component arranged in spindled out cells. Immunohistochemistry was positive for vimentin and cytokeratin suggestive of biphasic synovial sarcoma. Before definitive management as a part of metastatic work-up, patient underwent magnetic resonance imaging (MRI) of neck and spine, which revealed a metastatic lesion in cervical spine. Subsequently, the patient was referred to radiation oncology for radiotherapy. Conclusion: Synovial sarcoma is a rare malignant tumor whose management is mainly surgical resection with postoperative radiotherapy for residual or recurrent disease. We have presented this case on account of its rarity of occurrence and its aggressive nature, as it presented with vertebral metastasis which further emphasizes the need for a complete metastatic work-up for cases before being planned for surgery.


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