Madan HK, Kosare S. Anesthesia for Middle Ear Surgeries and Cochlear Implant. Int J Otorhinolaryngol Clin 2015;7(1):1-9.

To determine the frequency of antistreptolysin O (ASLO) positivity in cases of proven chronic tonsillitis.

The present study was conducted in a tertiary care center from January to October 2013. A total of 150 patients who presented with features suggestive of chronic tonsillitis and willing for surgery were included in the study. On admission, following a detailed history taking and clinical examination, preoperative investigations along with ASLO titers were done. Following medical and anesthetic fitness, the patients underwent tonsillectomy with or without adenoidectomy and the tonsillar specimens were sent for histopathological examination.

A total of five out of the 150 patients showed ASLO titer positivity (>200 IU/ml) and all were histopathologically proven cases of chronic tonsillitis.

Early detection and treatment of Streptococcal tonsillar involvement could be a preventive measure against the future predilection of other predisposed organs to more severe and debilitating streptococcal infections.

The aim of this study is to highlight the factors responsible for recurrence and to follow the clinical course to ensure against recurrence of rhinosporidiosis. External surgery in rhinosporidiosis should be avoided for the fear of implantation. With the advent of endoscopes and Lasers allow the surgeon to complete excision of the lesion with cauterization of the base.

A retrospective study of thirty two cases of rhinosporidiosis presented to us over a period of 10 years from 2002 to 2012. Out of which 14 cases presented to us for the first time and 18 cases were recurrent cases. The commonest age group of presentation was between 20 and 30 years in patients presenting for the first time and in recurrent cases the commonest age of presentation was between 50 and 60 years of age. Majority of patients were males with male to female ratio of 9:1. All patients underwent endoscopic excision, electro cautery was used in 30 patients and Laser was used in 2 patients.

Fourteen cases did not have any recurrence and in the 18 cases of recurrent cases three of them again had a recurrence where electro cautery was used to cauterize the base.

Endoscopic excision of rhinosporidiosis has a better result over nonendoscopic approaches with lesser recurrence rate. Our results show that use of endoscopes in patients who presented for the first time have a better results as the mucosa of recurrence patients have already been insulted due to previous surgeries.

Allergic rhinitis affects up to 20% of the general population and is one of the most common reasons for presentations to the outpatient department. We hereby present a case series which attempts to have a correlation between tissue eosinophilia (inferior turbinate) and increased eosinophil count in blood (>440 cells/mm³).

Thirty-six patients presented to the Outpatient Department of Bapuji Hospital and Chigateri General Hospital (Teaching Hospitals attached to JJM Medical College), Davangere, with nasal obstruction and symptoms suggestive of allergic rhinitis with turbinate hypertrophy who were posted for elective bilateral partial inferior turbinectomy with/without submucous resection/septoplasty. These patients had increased absolute eosinophil count in blood. Formalin fixed inferior turbinectomy specimens were routinely processed for histopathology. Eosinophils in the mucosa and submucosal region were counted by method of Shioda and Mishima.

Ten patients out of 36 showing increased eosinophil count in blood show ‘significant eosinophilia’ in turbinates (27.7%).

Peripheral eosinophilia does not always correlate with tissue eosinophilia which opens up a possibility of using nasal mucosa biopsy for confirmation of presence of eosinophils. Further studies are needed to explore the demonstration of ‘activated’ tissue eosinophils in the diagnosis of allergic rhinitis.

To present management dilemma in a challenging case of a benign orbitomaxillary pseudotumor and its importance of inclusion in the differential diagnosis of orbital disorders.

Case Report

Private multispecialty hospital in Kolkata, West Bengal.

A 36-year-old female patient with 1 year history of orbitomaxillary mass, deviation and protrusion of left eyeball, diplopia and left sided headache.

Resection of entire orbitomaxillary mass performed after assessing history, clinical and radiologic presentation of the case. Biopsy report came as mixed inflammatory lesion. Appropriate surgical intervention resulted in a dramatic improvement in patient's clinical condition. At present, patient is disease-free and asymptomatic.

Complete surgical resection is the treatment of choice for inflammatory orbitomaxillary pseudotumors followed by corticosteroids in case of incomplete resection. Radiation therapy is indicated only in case when corticosteroids or surgical intervention is unsuccessful or contraindicated.

Baldwa NM. Anticipated Difficult Airway in Ear, Nose and Throat Procedures. Int J Otorhinolaryngol Clin 2015;7(1):10-16.

Since a long time scrofuloderma (SCF) was thought to be a common disease of childhood and was attributable to Myco_ bacterium tuberculosis. In 1951, a new entity nontuberculous scrofuloderma was described and it is caused by atypical mycobacteria namely Mycobacterium scrofulaceum. The clinical picture closely mimics tuberculous scrofuloderma but diagnosis should be established through culture isolation and identification, because drug susceptibility may be different in these cases.

In this article, we report a case of a 22-year-old pregnant female patient who presented to us with scrofulaceous lesion on the right side of neck.

Langerhans cell histiocytosis (LCH) is a relatively rare and unique benign disease characterized by an abnormal proliferation of immature dendritic cells which usually affects children and young adults. Jaws are involved in less than 10% of children with the disease.

To add on to the literature one more case of this rare and unique disease which accounts for less than 1% of all bone tumors and also to discuss its oral manifestation and management.

Case report

Private maxillofacial surgery institute, Kolkata, West Bengal.

A 2 years and 8 months old male child with solitary swelling over the lower left jaw since one and half months. Lesion was fixed to underlying bone and there was an expansion of buccal cortical plate at the body of mandible.

Enucleation of the lesion performed after assessing history, clinical and radiological dertails and also considering patient's age. Postoperative biopsy result came as LCH presenting as a unifocal eosinophil granuloma. Appropriate surgical intervention resulted in a dramatic improvement in patient's clinical condition. At present, patient is disease-free and asymptomatic.

Surgical enucleation or curettage is a preferred treatment option for maxillary and mandibular lesion. Potential for the unifocal disease to become multifocal should not be underestimated as the disease can be unpredictable. We recommend long-term follow-up due to uncertainty of the disease.

Suvarna D, Fernandes S. Anesthesia Management of Adenotonsillectomy. Int J Otorhinolaryngol Clin 2015;7(1):17-21.

We present an interesting diagnostic dilemma between superior vena cava syndrome and Ludwig Angina to highlight ways to differentiate between these two seemingly similar conditions.

A 50-year-old man presented with complaints of progressive breathing difficulty with diffuse brawny swelling in the neck and clinically gave impression of Ludwig angina, however, on further evaluation was diagnosed with superior vena cava syndrome (SVCS) secondary to non small cell carcinoma of lung.

This paper illustrates an interesting scenario in which clinical presentation of SVCS mimicked Ludwig's Angina. SVCS with a gradual onset may have minimal symptoms with facial edema, erythema and venous distension in the chest and neck. Occasionally atypical presentation of Ludwig's angina may mimic SVCS where high degree of clinical suspicion is needed to discriminate them.

Superior vena cava syndrome may present with symptoms suggestive of Ludwig's angina, especially if the obstruction is slowly progressive. A high index of suspicion is necessary in these cases.

Ubale PV. Anesthetic Considerations in Functional Endoscopic Sinus Surgery. Int J Otorhinolaryngol Clin 2015;7(1):22-27.

Ectopic glial tissue, presenting at various sites of body is a rare embryonic developmental anomaly. Very few cases are reported in adults, most being incidentally detected, revealed only by histopathological findings. One of the rarest locations is the sphenoid sinus.

We present here the case of a middle aged female, presenting with spontaneous cerebrospinal fluid (CSF) rhinorrhea and meningitis. With the radiological finding of a soft tissue density in sphenoid sinus with erosion of left temporal skull base, she underwent lateral craniotomy, with excision of the mass and middle cranial fossa floor repair. Histopathology revealed a heterotopic glial tissue. Peroperative finding of a well-defined defect in the lateral wall of an extensively pneumatized sphenoid showed typical features of a patent Sternberg's canal.

This case could be a living proof for the existence of this rare developmental anomaly. A persisting Sternberg's canal should be considered as the source of spontaneous CSF leaks with or without lesions in sphenoid sinuses with extensive lateral pneumatization. Most of the cases may be treated with an extended endoscopic approach. Extreme lateral lesions like this would benefit most from a craniotomy approach for proper closure of skullbase defect. Three years after successful surgery, she remains symptom free.

Preauricular sinus (PAS) is not uncommon congenital anomaly. It is usually asymptomatic and does not require any treatment. Patient presenting with discharge, recurrent infections and preauricular abscess will require management with antibiotics and surgical extirpation of the sinus tract. Here, it is a rare case report of PAS presenting as a recurrent postaural abscess.

Harde M, Bawankar T, Bhadade R. Ear, Nose and Throat Emergencies and Anesthesia. Int J Otorhinolaryngol Clin 2015;7(1):28-34.

Sahu A. Chronic Pain Management in ENT Disorders. Int J Otorhinolaryngol Clin 2015;7(1):35-39.