INTRODUCTIONOtogenic brain abscess is a relatively common problem in developing countries, where the prevalence of chronic suppurative otitis media (CSOM) is reported to be in the range of 30-40% and 0.5%-1% of developing brain abscess. The most commonly encountered intracranial complication is meningitis followed by brain abscess. The mortality of the brain abscess is in the range of 30-40%. 1 The eradication of infection in the brain and the ear is a major challenge which was realized as early as 1893 by Sir Williams Macewan, who described mastoid approach to both the abscesses. However with the development of otology and neurosurgery as separate entities, otologists started relying on neurosurgeons for the intracranial abscess removal followed by mastoidectomy. 2Hence the standard treatment for otogenic brain abscess evolved in two separate procedures addressing primary focus in mastoid its secondary complications in the brain, each with its own surgical mortality and morbidity. 3,4 Chronic otitis media with cholesteatoma and/or granulation tissue are usually the cause. In developing countries with high incidence of cholesteatoma, brain abscess is not a rare complication. The first line of treatment is antibiotic, followed immediately by surgical evacuation of the abscess and cleansing the sources of infection.6 CT-scanning is the best available diagnostic tool. 1Due to improvement in the surgical and anesthesia techniques, recently the advantages of eradicating the ABSTRACT Background: Proper management of chronic otitis media may reduce the incidence of otogenic brain abscess. The objective of this study is to present our experience in the management of otogenic brain abscess by neurosurgical and otolaryngological surgery simultaneously. Methods: It is a retrospective study conducted between 2006-2015. 20 patients with otogenic brain abscess were admitted to neurosurgery and ENT wards for management were included in the study. On admissions patients had ENT, neurosurgery and neurological examinations. All the patients underwent neurosurgery followed by mastoidectomy. Repeat CT scanning/ MRI scanning done after 1 week to check for the success of the surgery and discharged on the 10th day after suture removal. Patients were followed up for 1-2 years. Results: The study included sixteen males and four females. Their age ranged between 4-32 years with mean of 18 years. Their chief complaints were severe headache, vomiting and fever with unilateral and or bilateral foul smelling discharge. Brain and HRCT temporal bone CT scanning showed equal incidence of abscess on the sides with 8 cerebellar, 6 temporal, 5 tempero parietal and 1 fronto parietal abscess. After completion of surgery, eighteen patients improved and two patents expired due to septic shock. Conclusions: This is technically more feasible technique with an added advantage of single anaesthesia, short stay of patient in the hospital and early disease clearance in the same procedure.
We report a case of 18-year-old female patient who came to ENT OPD with history of right sided slowly progressing neck swelling since 6-8 months. There was no history of fever or weight loss except mild fatigue. On examination firm, ovoid, non tender and mobile mass measuring 4 × 2 × 5 cm was situated in the right side of the neck. ENT examination and other systemic examinations revealed normal findings. Fine needle aspiration cytology (FNAC) showed moderate cellularity comprising of small lymphocytes in dys-cohesive and in small clusters. These clusters are composed of follicular dendritic cells and occasional spindle ells. These follicular dendritic cells have oval nuclei, evenly distributed chromatin, small nucleoli with abundant delicate cytoplasm containing small lymphocytes along with few plasmacytoid cells. Computed tomography showed intensely homogeneously enhancing well defined lesion located postero-medially to the sternocleidomastoid and postero-laterally to the carotid vessels in the mid portion of the neck (probably carotid space) on right side. USG abdomen and X-Ray chest were done to rule out multicentric type of disease. Hence, diagnosis of Castleman's disease was made by FNAC of the mass and CT scan of the neck [Table/ Fig-1].Ear,Nose and Throat Section
<p><strong>Background:</strong> Current study was done to know various clinical aspects of membranous patch over the tonsil.</p><p><strong>Methods: </strong>Data for the study were collected from patients who presented with membranous patch over the tonsil in the department of ENT at GIMS, Kalaburagi from January 2019 to December 2019. This is a prospective case study. 225 patients were included in the study. Once patient was presented to us detailed history, examination and necessary investigations were done.</p><p><strong>Results:</strong> The present study included 225 patients out of which out of which females were 132 (59%) and males were 93 (41%). The predominant clinical features were sore throat (225 cases), fever (212 cases), dysphagia (90 cases) and bull neck (45 cases). The most common cause of membranous patch over tonsil was found to be diphtheria (68%) followed by streptococcal tonsillitis (30%) and others (2%). In our study microbiological investigations like Albert stain was positive in 153 cases and culture was positive in 140 cases.</p><p><strong>Conclusions: </strong>It was observed in our study that diphtheria constitutes the majority (68%) and the incidence of adult is almost on par with paediatric age group. Despite of UIP we have seen increased incidence in the adult age group. Hence it requires the health agencies and the Government to increase immunization coverage, as India has witnessed the highest number of cases in the world for the year 2015. As evident from the shift in age groups being infected, adult booster dose has to be introduced at 10 years interval.</p>
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