Download Benign tumours

RAJIV GANDHI UNIVERCITY OF HEALTH SCIENCES,
KARNATAKA, BANGALORE
ANNEXURE-II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
1
Name of the Candidates and
address (In Block Letters)
SHIVANGOUDA. PATIL
C/O S.S INAMADAR H.NO.144
SHASTRINAGAR
NEAR JANNATH MASJID
BIJAPUR – 586201
2
Name of the Institution
RAIARAJESWARI MEDICAL COLLEGE AND
HOSPITAL BANGALORE
3
Course of study and subject
M.S (ENT & HEAD & NECK)
4
Date of admission to Course
21.08.2012
5
Title of the Topic
A CLINICAL STUDY OF BENIGN LESIONS
OF PINNA.
Introduction:
The ear is an organ of hearing. It is also concerned in maintaining equilibrium of the body. It
forms the major part of communication system. It consists of three parts
1. External ear
2. Middle ear
3. Inner ear
External ear consists of 1. Auricle (pinna)
2. External auditory meatus
Auricle (pinna):The auricle (pinna) projects at a variable angle from the side of the head & has
some functions in collecting sound. The lateral surfaces of the pinna has charesteristic
prominences and depressions which are different in every individual even among identical
twins. The curved rim is the Helix which often has a small prominence at its posterior auspect.
Anterior to and parallel with the helix is another prominence the antihelix. Superiorly this
divides into two crura between which is the triangular fossa; The scaphoid fossa lies above the
superior of the two crura. In front of the antihelix, and partly encircled by it ,is the concha. This
is divided into two portions by the descending limb of the anterior superior portion of the helix
known as crus of the helix, which rests just above the external auditory meatus. The smaller
superior position is the cymba conchae. The larger inferior portion is known as the cavum
conchae. Below the crus of helix and overlapping the external auditory maetus is the tragus,
which is a small blunt triangular prominance pointing posteriorly. Opposite the tragus, at the
inferior limit of antihelix, is the antitragus. The intertragic notch seperates the tragus from the
antitragus. The Lobule lies below the antitragus and is soft being composed of fibrous and
adipose tissue.
The body of the auricle is formed from elastic fibro cartilage & is continuous plate except for a
narrow gap between the tragus and the crus of the helix; where it is replaced by a dense fibrous
tissue band.
The cartilage extends about 8mm down the ear canal to form its lateral third. The cartilage of
the auricle is covered with perichondrium from which it derives its supply of nutrients, as
cartilage itself is avascular. Stripping the perichondrium from the cartilage as occurs following
injuries that cause haematotna, can lead to cartilage necroisis with crumpled up 'boxers' ears.
The skin of the pinna is thin and closely attatched to the perichondrium of the lateral surface.
On the medial surface, there is a definite subdermal
adipose layer that allows dissection during pinna plasty surgery. The skin of the auricle is
covered with fine hairs and most noticebly in the concha and scaphoid fossa, there are
sebaceous glands opening into the route canals of these hairs On the tragus and inter tragic
notch coarse thick hairs may develop in the middle aged and older male. Extrinsic and intrinsic
muscles are attached to the perichondrium of the cartilage these muscles are vestigial in
human being.
Purpose of study is to study prevalence and aetiopathological factors of benign lesions of the
pinna-2.
The Blood supply of auricle derived from the posterior auricular and Superficial
temporal arteries. The Lymphatics drain in to the auricular and post auricular and
superficial cervical lymphnodes .
Nerve supply: The two third of the lateral surface of the auricle are Supplied by
the auriculo temporal nerve and lower one – third by great auricular nerve the
upper two third of the medial surface are supplied by the lateral occipital nerve
and the lower one third by great auricular nerve. The root of the auricle is
supplied by the auricular branch of vagus nerve. The auricular muscles are
supplied through branches of fascial nerve.1
The pinna may be afflicted by congenital, traumatic, inflammatory or Neoplastic
disorders.
The congenital disorders include bat ear, preauricular appendages , preauricular
pit or sinus, anotia, macrotia & microtia.
Trauma to the auricle can result in to haematoma, laceration avulsion , frost bite
and keloid of auricle .
Inflammatory diseases of the Pinna includes Perichondritis, relapsing
Polychondritis, chondro dermatitis nodularis chronic helicis .
Benign tumours Pre auricular cyst or sinus
Sebaceous cyst
Dermoid cyst
Keloid
Haemangioma
Papilloma
Cutaneous horn
Keratocanthoma
Neurofibroma
Malignant –
Squamous cell carcinoma
Basal cell carcinoma
Melanoma
Of all the cases of ear carcinoma, 85% occur on the pinna, 10 % in the external
canal and 5% in the middle ear . Benign lesions are usually discovered during a
routine ear examination or patient may present with lesions over pinna.2
6.1 Need for the study :
Pinna contributes enormously to collection of sound and to the facial aesthesis.
Lesions affecting the pinna can lead to overt disfigurement and change in entire
appeal of the face. Not much worked up regarding aetiopathological factors and
prevalence or the burden understanding.
Review of literature:
According to the U.S National library of medicine and national institute of health the human ear
consists of outer , inner and middle parts and people use all the three parts to hear. The NIH
states that a variety of ear conditions can affect a persons hearing and valence, and that ear
conditions can be caused by prolonged exposure to loud noises, ear trauma and certain medical
conditions-3.
Outer ear tumours are condition of the outer ear. The Merck manuals website states that outer
ear tumour may benign or malignant and that most outer ear tumours are discovered by a
persons physicion during otoscopic examination to determine the cause of hearing loss or
hearing reduction. According to Merck manual website, benign tumours can manifest in the
outer ear canal causing hearing loss and wax accumulation. Common types of benign outer ear
canal tumours include sebaceous cyct, osteomas or bone tumours and keloids it also states
surgical excision or removal of the tumour can restore a persons hearing-4.
Trauma can cause numerous outer ear conditions. According to Merck manual website, blunt
force trauma to the outer ear can cause bruising between the ears catilage and the
perichondrium. As the blood accumulates in this space and persons outer ear swells and takes
on purple hue. The accumulated blood known as haematoma can decrease the blood flow to
the ears cartilage, causing part of the cartilage to die, and deformities to arise. The deformities,
known as cauliflower ear, occurs frequently among wrestlers, boxers, rugby players and others
who engage in pugilistic endeavours. It also states that blunt force jaw trauma can also affect
the function of the outer ear, distorting and narrowing of the outer ear canals shape , but that
surgical intervention can often correct the problem -5.
Kishore Chandra Prasad et-al have done comprehensive study of the lesions of pinna. They have
worked on 307 cases of men and women presenting with swelling of pinna who attended the
department of ENT at KMC Mangalore during February 1992 to June 2002 result prompt
surgical intervention under good anti biotic cover gave excellent results with minimum
complications-6.
PAGE 5 :
Nemechuk, amedee RG et al a Variety of medical specialists are exposed to patients who seek
treatment of external ear neoplasms. They are uncommon occurances and malignancies if the
external ear are even rarer. Only one patient in 10000 with an year complete will have
pathologically proven malignancy of external ear. Tumours of the external ear both malignant
and benign commonly resemble one another. A timely and correct diagnosis is necessary to
avoid affecting the external ears ability to collect sound but also avoid more morbid and mortal
complications of an external ear malignancy, related histopathology and treatment which
encompasses a myriad of modalities and specialities. 7
Ear tumours : ear tumour are classified into
I. Benign tumours include - osteoma, exostosis, chemodectoma, acoustic neuroma.
II. Malignant tumours include - squamous cell carcinoma, basal cell carcinoma. 8
Leferink VJ, nicolai et al from 1982 - 1986, 17 patients with malignant tumours of the external
ear were treated in regional center for plastic and reconstructive surgery Arnhem
(Netherlands). There were 15 men and 2 women the mean age was 73 yrs. There were 4
basal cell and 12 squamous cell carcinomas and 1 had malignant melanoma of the external ear.
9 of these tumours were on the helix. During the follow up period, 6 patients had local
recurrent disease. In 7 patients, re-excision had to be performed several times after
incomplete excision. 69 patients are alive without any signs of disease and 3 patients died.
Tumours of the ear may be non cancerous or cancerous. Most of the tumours are found, when
people see tumour or when doctor looks in the ear because people notice their hearing seems
decreased. Non cancerous tumours may develop in the ear canal, blocking it and causing
hearing loss ad building of ear wax. Such tumours include small sacs filled with skin secretions
(sebaceous cyst), osteoma, keloids. The most effective treatment is surgical excision of tumour.
After treatment hearing usually returns to normal. 10
Benign cyst or tumour will have symptoms of small soft skin lumps on behind, or infront of the
ear, usually not painfull or tender. Cysts within the external ear canal can be extremely
painful.The symptoms of benign tumours include ear disconmfort, a grudual hearing loss in 1
ear. There may be no symptoms as well. Treatment if the cyst or tumour is not painful and
does not interfere with hearing, treatment is not necessary. if cyst or tumours are infected or
present with symptoms treatment may include antibiotics or surgical removal. 11
6.3.1. Aim of studies
To know the burden of the disease or prevalence of the disease.
6.3.2. Objectives of the study
1. To find out the prvalence of the disease at Rajarajeswari Medical College and Hospital
attending patients. Hospital based studies.
2. To evaluate aetiopathological factors of the disease (benign lesions of pinna)
7 Materials and method
1. Study setup - This is hospital based study. Patients attending RRMCH, ENT department are
studied.
2. Study design - Cross sectional study.
3. Study duration - From January 2013 to December 2013 - 1yr study.
4. Study population - All patients attending RRMCH with benign lesions of pinna.
5. Sample Size - All the patients - Of all the age groups of either sex attending RRMCH during
the year 2013 with benign lesions of pinna.
7.1 Source of data :
History taking and clinical examination of the case of benign lesion of pinna in a proforma.
7.2 Methods of data collection :
Prior informed consent will be taken from the study subject. History taking, clinical examination
of the case of benign lesions of pinna in a proforma.
Plan for data analysis :
Data collected will be entered in Ms-Excel worksheet. And results will be expressed in
percentage.
Inclusion criteria :
1. All the patients attending ENT department of RRMCH Banglaore with clinical features of
benign lesions of pinna.
2.Patients willing to participate in present study.
Exclusion criteria :
1. Inflammatory conditions of pinna.
2. Infections of the pinna.
3. Malignant conditions of the pinna.
4. Patients who do not give consent to participate in studies.
7.3 Does the study require any investigations or interventions to be conducted
on patients or other human or animals? If so please describe briefly.
Ans : No
7.4 Has ethical clearance been obtained from your institution.
Ans : Yes
List of references :
1.
Geroge G Browning, Martin J Burton etal scot brown’s otolaryngology 7th edition Vol-3
page 3107
2.
PL Dhingra etal, diseases of ear, nose and throught, fourth edition pages 104, 105.
3.
Martin hughes DC Conditions of outer ear july 28,201
National Institute of health : Ear disorders
Live strong. com
4.
Martin hughes DC Outer ear
tumours by Merck manual : Tumours
Live strong. com
5.
Martin hughes Outer ear trauma by
Merk manual - Injury
Live strong. com
6.
Kishore chandra prasad et al A comprehensive study on lesions of pinna by American
journal of Otalaringology- Head & Neck, medicine and surgery vol-25 issue 1 pages 1-6, January
2005
7. Nemechek et al Tumours of external ear
Thlone university school of medicine, department of otolaryngology U.S.A
J-La state med soc 1995 june ; 147 (6); 239-42
8.
Http : // www. Fpnotebook.com/ear tumour
Ear neoplasms (10013449)
9.
Malignency tumours of the external ear
Leferink et at
Regional center for plastic and reconstructive surgery ARNHEM (Netherland)
10. Eji yanagisaw Ear tumours
Merk manual home health hand book
11. Guahyin MD Reliable medical information on disease and their associated health
conditions.
1
2
Signature of the Candidate :
Remark of the Guide :
3
11.1
Name and designation of
Guide
(in block letters)
4
11.2 Signature
DR II NAGARAJ T.M. PROFESSOR
AND HEAD OF THE DEPARTMENT
ENT AND HEAD AND NECK
RAJAJESWARI MEDICAL COLLEGE
AND HOSPITAL BANGALORE
5
6
11.3 Co- Guide (if any)
11.4 Signature
7
11.5 Head of the
Department
11.6 Signature
8
9
10
11
11.6 Signature
12.1 Remarks of the
Chairman and dean
12.2 Signature
DR II NAGARAJ T.M
CONSENT FORM
I Mr / Mrs
am exercising my free power of
choice, here by give my consent to be included as a subject in the study “A
CLINICAL STUDY OF BENIGN LESIONS OF PNNA. “ I understand that the
information I give will be kept confidential. I have been informed to my
satisfaction by the researchers about the nature and purpose of the study and I
may or may not immediately benefit from the study. I am also aware of right to
opt out of the study at any time during the course of the study without having to
the reason for doing so.
SIGNATURE OF THE PATIENT
DATE :
PLACE :
PROFORMA
Name of the patient
:
Age
:
I.P.NO :
Sex
:
D.O.A :
Occupation
:
D.O.D :
Religion
:
Address
:
Socio economic status
: High
: Middle
: Low
Chief Complaints :
1.
2.
3.
4.
H/O Presenting illness :
Duration
: Days
: Months
: Years
Onset
: Insidious/ Sudden
Progression
: Progressive/ Non progressive
H/O Trauma
: Present/ Absent / Not known
Types of trauma
: Piercing
: Assault
: Fall
: Others
Site of Lesion
:
No. of Lesions
:
Size of Lesion
:
Shape of Lesion
:
Skin over Lesion
: Normal/ Inflamed
Visible Pulsations
: Present / Absent
Past History :
Personal History :
Appetite :
Diet :
Sleep :
Bowel & Bladder habits :
Family History :
General Physical examination :
Here is a child/ adult/ elderly male/ female aged about------- yrs.
Poorly/ moderately/well built. Poorly /moderately / well nourished. Conscious,
Co-operative/ un co-operative.
Pallor
Cyanosis
Oedema:
:
:
Icterus
Clubbing
Lymphadenopathy
Vital Signs:
Pulse
B.P
RR
Temp.
Local Examination :
Site :
Size :
Number :
Consistency:
Tenderness :
Local rise of temperature :
Pulsations :
Systemic Examination :
CVS:
RS:
PA:
CNS:
Diagnosis :