Archive for Particular Patients

Ear canal foreign body: Alkaline button battery

A child with a very edematous ear canal with suspected foreign body was x-rayed. Button battery was clearly visible impacted in the EAC. Removed by post-aural route.

IMG0070A

Foreign body esophagus: Glass Marble

Glass marble swallowed by a child. Rigid esophagoscopy and ureteric stone removal basket used to retrieve it.

IMG0068A

IMG0069A

Medical Therapy for Maxillary Sinusitis

A 57 year old male patient was diagnosed clinically and radiologically as a case of bilateral Maxillary & Ethmoidal sinusitis with complete obliteration of both maxillary sinuses and involvement of anterior ethmoids.

This is a CT-PNS Coronal Section Before instituting medical therapy trial.

Photo0024

Patient was then put on medical therapy trial for 6 weeks.
This is post therapy view of CT-PNS Coronal Section showing almost complete resolution of the sinus pathology.
Photo0023

These type of cases reinforce the validity of medical therapy trials before advising surgical interventions.

Neck Swelling: Prominent Carotid Bulb

A 24 year old female patient came to The ENT Clinic for a neck swelling.The patient was lean and thin without too much subcutaneous fat.
The swelling was not causing any symptoms other than a fear of an unknown swelling in neck.

It turned out to be a prominent carotid bulb on Doppler USG, without any anomaly.

No treatment apart from counseling was necessary after the patient was made aware of the asymmetric enlargement of carotid bulb.

Congenital swelling at root of nose (nasion)

Pulsating swelling at the nasion of a 4 months old infant brought to the clinic. Diagnosed as Congenital Meningocele.

Difficulty in swallowing (dysphagia) for 2 months

45 years old female presenting with gradual onset dysphagia for last 2 months , non-smoker, non-alcoholic, hemoglobin-12 g%.
A very common complaint in females is usually assigned a vague diagnostic term as Globus or FOSSIT especially when the patient is non-smoker and non-alcoholic.
Globus can be differentiated clinically from a definite lesion by sharply defined history given by the patient especially time of onset, progression and whether it is difficult to swallowing solids or to liquids. Patient is very particular and specific in answering the questions asked.

Barium Swallow was ordered
IMG0056A

IMG0057A

Mid-Esophageal irregularity ? Growth

Esophagoscopy has been advised with biopsies.

Unusual presentation of Tetanus: Dysphagia preceding tetany.

This case represents the fact that no textbook can ever replace the training received in actual clinical encounters.

During my ENT residency training, a patient (a farmer) presented with mild dysphagia and mild back pain. He did not have neck or messeter muscle spasms ( Lock Jaw) at that point of time and had come to the ENT clinics at hospital on his own & was neurologically stable and normal.

Oral, throat and indirect laryngoscopy exams were normal.
Patient was sent with symptomatic treatment and radiology investigations were ordered for throat.

A week later during one of my night emergency duties, I received a call for elective tracheostomy from Internal Medicine department in their tetanus ward. I attended to the call and was surprised to see that it was for the same farmer who had earlier presented with dysphagia without muscle spasms.

On further interaction with the Internal Medicine doctor it came to be known that the farmer was diagnosed as a case of tetanus on clinical grounds and the more important fact of a puncture injury to the foot he had received while tending to his farms.

Usually muscle spasms precede dysphagia in tetanus patients but in this case it was concluded that the dysphagia had preceded the muscle spasms.

Dysphagia Plus Melena

Patient presented with dysphagia with off and on melena for past 4 months. Esphagoscopy revealed esophageal growth (intraluminal) involving complete mid esophageal segment.
Awaiting HPE report.

Sensorineural hearing loss after Oral ATT

A 23 year old male (diagnosed case of pulmonary tuberculosis) referred for having developed tinnitus after the onset of oral ATT. Patient came to me after 6 months of ATT and reported to have developed tinnitus 4 months back i.e. 2 months into his Oral ATT course.
Pure tone audiometry has confirmed bilaterally symmetrical high frequency hearing loss of moderate to severe levels.
A very strange case considering no noise exposure, no streptomycin or 2nd line ATT exposure, no family history of deafness etc.
Still treating and investigating.

Carcinoma in oral vestibule of non-smoker, non-alcoholic patient

32 years old non-smoker, non-alcoholic male patient presented with angry looking ulcer in left lower gingivo-labial sulcus. Good oro-dental hygiene, no other known carcinogen exposure reported by patient. Size approximately 2cm. Incision Biopsy done and sent for HPE at two different pathology labs. Both confirm Squamous cell carcinoma.
Another young adult (non-smoker and non-alcoholic) attacked by malignancy.