Friday, September 30, 2022

Primary Laryngeal Lymphoma and Voice Hoarseness: A Rare Etiology for A Common Clinical Feature

 

Abstract

Primary Laryngeal Lymphoma is rare both as a hematological and as a laryngeal malignancy. Unlike squamous cell carcinomas, lymphomas require chemo-radiotherapy as 1st-line treatment. A 67-year-old lady presented with voice hoarseness, dyspnea and dysphagia for solids. An otherwise unremarkable physical showed “hot-potato like” voice. Labs were normal, while laryngoscopy and CT revealed an epiglottic mass, which was resected. Biopsy results showed DLBCL. The patient then underwent chemotherapy with complete success. Voice hoarseness has a vast differential diagnosis depending on its character and complementary symptoms. Less than a 100 cases of Primary Laryngeal Lymphoma have been reported in the literature, proving the rarity of this clinical entity.

Keywords:Primary laryngeal lymphoma; voice hoarseness; diffuse large B-cell lymphoma; larynx; lymphoma; epiglottis; dysphagia; dyspnea; “hot-potato like” voice

Abbreviations:CT: Computed Tomography; PET-CT: Positron Emission Tomography- Computed Tomography; NHL: Non-Hodgkin Lymphoma; ECOG: Eastern Cooperative Oncology Group; WBC: White Blood Cells; NEU: Neutrophils; LYM: Lymphocytes; MONO: Monocytes; EOS: Eosinophils; BASO: Basophils; RBC: Red Blood Cells; Hgb: Hemoglobin; Hct: Hematocrit; MCV: Mean Corpuscular Volume; MCH: Mean Corpuscular Hemoglobin; PLT: Platelets; ESR: Erythrocyte Sedimentation Rate; LFTs: Liver Function Tests; AST: Aspartate Transaminase; ALT: Alanine Transaminase; γ-GT: Gamma-glutamyl transferase; Bil: Bilirubin; dBil: Direct bilirubin; iBIl: Indirect bilirubin; Cr: Creatinine; BUN: Blood Urea Nitrogen; Glu: Glucose; Alb: Albumin; TC: Total Cholesterol; TGL: Triglycerides; LDH: Lactate Dehydrogenase; CRP: C reactive protein; DLBCL: Diffuse large B-cell lymphoma; LPR: Laryngopharyngeal Reflux; NK: Natural Killer Cells; R-CHOP: Rituximab, Cyclophosphamide, Andriamycin, Oncovin, Prednisone; HD-MTX: High Dose Methotrexate; CNS: Central nervous system; SCC: Squamous Cell Carcinoma; MALT: Mucosa-Associated Lymphoid Tissue; EBV: Eibstein Barr Virus; BMI: Body Mass Index

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Friday, September 23, 2022

Gustatory Dysfunction in Covid 19 Patients: A Cross Sectional Study

 

Abstract

Background: Loss of smell and taste are considered potential discriminatory symptoms indicating triaging for coronavirus disease 2019 (COVID-19) and early case identification. However, the estimated prevalence essential to guide public health policy varies in published literature.

Methods: The prospective study evaluated 100 individuals with a COVID-19 infection, as confirmed by Reverse transcriptase PCR laboratory testing. Olfactory and gustatory testing were carried out by an examiner utilizing stringent safety standards and wearing full personal protective equipment.

Results: Among the 100 patients included in this study, 54% were male and 46% were female with a mean age of 38.82±12.21 years (18-72). Among the 100 patients included in this study, 13 patients had isolated taste dysfunction, 16 patients had isolated olfactory dysfunction, 51 patients had combined dysfunction, and 20 patients had neither taste nor olfactory dysfunction. Among the 51 patients who had combined olfactory and gustatory dysfunction, 31.3 % of them had predominant gustatory dysfunction, 47.1 % predominant olfactory dysfunction and 21.6% of the patients had both olfactory and gustatory dysfunction equally.

Conclusions: Olfactory and gustatory dysfunctions are strongly associated with SARS-CoV-2 infection. Olfactory with or without gustatory dysfunctions is potentially a reliable indicator of latent COVID-19.

Keywords:COVID-19; gustatory dysfunction; taste; SARS-CoV-2

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Friday, September 16, 2022

Oropharyngeal Manifestations in Covid-19 Patients

 

Abstract

Introduction: Coronavirus disease 2019 (COVID-19) an infectious disease was first identified in December 2019 in Wuhan, China, caused by severe acute respiratory syndrome corona virus 2 (SARS-CoV-2). It was considered by the World Health Organization (WHO) as a pandemic. Oropharyngeal manifestations like mucositis, glossitis, pharyngitis, tonsillar enlargement associated with COVID19 show inconsistency in their presentations. Hence the study aims at the early identification and better management of the oropharyngeal manifestations.

Aims and Objectives This study is to detect, analyze and to determine the prevalence of the different oropharyngeal manifestations reported in COVID19 positive patients

Materials: Patients who are diagnosed with COVID 19 using RT-PCR method, were assessed for symptoms and signs of oropharyngeal manifestations using standard questionnaires.

Method: Cross sectional study.

Results: Out of 486 COVID positive patients’ males outnumbered female patients. The highest number of oropharyngeal manifestations was seen in patients in the age group of 51-65 years (42%). Least age and highest age of the patient encountered in this study was 19 years and 78 years, respectively. Dry cough (37.8%) was the most common symptom followed by pharyngodynia (24.2%) with the least common being painful ulcers in mouth (4.9%). Among 486 COVID positive patients’ pharyngeal erythema(46.9%) was the most common manifestation followed by glossitis,(29.2%) and buccal mucositis(19.1%). Aphthous ulcer (4.9%) was the least common manifestation. In our study nearly 45.8% (223 in number) of patients had history of diabetes followed by hypertension in 38.7% (188 numbers) as the co morbidity found in COVID positive patients. Neoplasia was the least common co morbidity observed.

Conclusion: Oropharyngeal manifestations for COVID-19 are not common as fever and cough. But a universal questionnaire using well-defined COVID-19 manifestations is needed to make the COVID-19 data precisely defined, complete and homogenous and to differentiate from the etiology other than COVID 19.

Keywords:Oropharyngeal; COVID-19; manifestations

 

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Friday, September 9, 2022

Vocal Cord Paralysis –An Etiological Analysis

 

Abstract

Introduction: Vocal cord paralysis is the total interruption of nerve impulse resulting in absence of laryngeal muscle movement. The most common type of vocal cord paralysis found is due to recurrent laryngeal nerve injury. The pathology can be either along the course of the tenth cranial nerve from cerebral cortex to neuromuscular junction or could be from mechanical fixation of cricoarytenoid joint.

Objective: To study the various etiological factors contributing to vocal cord paralysis.

Materials and methods: Patients with vocal cord paralysis [unilateral and bilateral] who were treated at a tertiary institute for a period of 3 years were included. The immobility of cords was assessed with the use of indirect laryngoscopy via mirror or rigid angled telescopy or flexible laryngoscopy. The patients were categorized based on laterality of paralysis as well as based on various etiological factors into groups. Appropriate statistical analysis was done.

Results: Among 50 patients, 84 % cases had unilateral vocal cord paralysis. Surgical cause was found to be the most common etiology of unilateral vocal cord paralysis (34%) closely followed by idiopathic (18%) and neoplasm (16%). In bilateral vocal cord paralysis, surgical and neurological causes were found to be the main causative factor.

Conclusion: Vocal cord paralysis has a wide range of factors contributing to its occurrence with surgical cause being a common one. A comprehensive assessment of patient should be performed to determine the cause which facilitates a direct treatment plan.

Keywords:Vocal cord paralysis; etiologyb

Abbreviations:VCP: Vocal Cord Paralysis; RLN: Recurrent Laryngeal Nerve; UVCP: Unilateral Vocal Cord Paralysis

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Friday, September 2, 2022

Mastoid Exploration in the Management of Chronic Otitis Media with Complications

 

Abstract

Chronic suppurative otitis media is a common problem in developing countries. Complications due to chronic suppurative otitis media still pose a major problem in the developing countries. In cases of chronic suppurative otitis media associated with complications, after managing the complications, mastoid exploration should be done to remove the primary source of infection. Planning of mastoid exploration play an important role in the management. Here the management of primary otogenic septic foci, after the management of extracranial and intracranial complications is discussed.

Keywords:Mastoid exploration; otitis media; complications

 

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Friday, August 26, 2022

Lupine Publishers | Acute Infectious Cervical Lymphadenitis of Children in A Tropical Country

 

Abstract

Introduction: The volume increase of a cervical lymph node is frequent in infancy .It is most often secondary to a benign infection of the upper aerodigestive tracts [1,2]. It is a medical and surgical emergency frequently encountered in developing countries, despite the generalization of antibiotics. Its gravity depends on the virulence of the germ and the fragility of the patient.

Patients and Methods: It’s about a retrospectively study of all the medical files records of patients under 16 years old hospitalized at the ENT department of Fann Teaching Hospital for the management of infectious cervical lymphadenitis . The studied period is January 1st, 2008 to November 30th, 2017.

Results: We had collected 83 medical files of patients with acute infectious cervical lymphadenitis including 66 cases of suppurative acute lymphadenitis and 17 cases of simple acute adenitis (uncollected). The average age of our patients was 2.4 years with extremes ranging from 1 month to 16 month. The location of swelling was the submandibular region in 57 patients, upper jugular area in 8 patients and submental region in 6 patients. Stapphyloccocus aureus is the most frequent bacteria found in 29 cases. Initial antibiotic therapy consisted of the association of amoxicillin/clavulanic. A favorable evolution marked by an apyrexia after 48h of treatment with regression of the swelling and a resumption of the feeding was noted in 92% of the cases. We deplored two cases of death.

Conclusion: Acute adenitis is frequent in pediatric otorhinolaryngology. It is often secondary to oropharyngeal infections, dental and skin diseases. The treatment is essentially based on antibiotics.

Keywords:Acute lymphadenitis; pediatric infection; cervical lymph’s nodes

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Friday, August 19, 2022

Olfactory Outcome After Endoscopic Sinus Surgery in Chronic Rhinosinusitis

 

Abstract

Background: Olfactory dysfunction is one of the major symptoms of CRS. Olfactory dysfunction affects the quality of life. Endoscopic sinus surgery is the surgical modality of treatment in cases of failed medial therapy. Assessment of olfaction in patients undergoing endoscopic sinus surgery is essential to know the impact on olfaction.

Objective: To assess the olfaction before and after Endoscopic sinus surgery.

Methods: This is a prospective study. Total 45 Patients were included in this study based on the inclusion and exclusion criteria. Diagnostic nasal endoscopy and CT scan were done preoperatively. Olfaction was assessed in all patients preoperatively, postoperatively at 1month and 3 months using olfactory testing tool.

Results: There were 45 patients of both gender 57.78% were females and 42.22% were males. The mean age of patients in our study was found to be 39.82±6.264 years. Most of these patients were in fourth decade of life. Of 45 patients 75% had symptoms of hyposmia/anosmia before surgery. Average Lund Mackey score for CT scan findings was found to be 13.42 ± 3.1. The patients were assessed postoperatively at 1st month and 3rd month using olfactory testing tool. The mean composite olfactory score was 5.83±2.89 preoperatively increased to 8.28± 2.33 at 1 month and 10.12 ±1.11 at 3 months, this difference was found to be statistically significant (p < 0.001). All patients mean olfactory scores improved postoperatively. The mean composite olfactory scores improved following endoscopic sinus surgery by 3.5 in Anosmic patients, 2.22 in Hyposmic patients and 1.04 in Normosmic at 1 month. Whereas at 3 months, 6.65, 3.22 and 1.95 in Anosmic, Hyposmic and Normosmic patients, respectively. The study was an attempt to assess the olfaction preoperatively and postoperatively in patients undergoing ESS.

Conclusion: The evaluation of olfaction in patients undergoing endoscopic sinus surgery showed improvement in olfactory outcome following the surgery in patients with CRS. 61% to 69% of CRS patients have a reduced sense of smell. Approximately two thirds of cases are due to the sinonasal disease. Olfactory dysfunction as result of sinonasal disease is unlikely to improve spontaneously without treatment.

Keywords: Olfaction; endoscopic sinus surgery; chronic rhino sinusitis

Abbreviations: CRS: Chronic Rhinosinusitis; ESS: Endoscopic Sinus Surgery; CCCRC: Connecticut Chemosensory Clinical Research Centre 

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Primary Laryngeal Lymphoma and Voice Hoarseness: A Rare Etiology for A Common Clinical Feature

  Abstract Primary Laryngeal Lymphoma is rare both as a hematological and as a laryngeal malignancy. Unlike squamous cell carci...