Aphthous ulcer over left tonsil was beign treated as Acute tonsillitis.

Hi This gentleman was being treated with antibiotics for left side throat pain. When I examined him, I found an aphthous ulcer over left tonsil which requires probiotics and NOT antibiotics.

The treatment of these two conditions are different. In fact, Antibiotics may enhance the formation of Aphthous ulcers by killing friendly bacteria of the mouth. These friendly bacteria are essential part of defense mechanism  of oral mucosa.  Such patients do respond to probiotics (present naturally in curd), multivitamins (especially B Complex groups) and local protective gel (glycerin). Passing motions regularly, Exercise, good sleep, maintaining good dental hygiene, High fiber diet and avoiding excess use of tea/alcohol/ caffeine/tobacco and junk foods helps in early healing of ulcers.

Noise induced hearing loss audio gram

Note dip in hearing especially at 4 KHz characteristics of noise induced hearing loss.   

Oral lichen planus

Benign lesion of Larynx appearing like malignancy

An arrow shows the vocal cord lesion. please note the appearance of white slough over the lesion looking more sinister in favour of malignancy

This 50 year gentleman presented with hoarseness of voice for last 18 months. He is non smoker and runs a shop where he has to speak a lot.

He underwent Microlaryngal surgery GA. It was a difficult case as the growth appeared to be pedunculated and appeared to have originated from just below anterior commissure (or just adjacent to anterior commissure from undersurface of left vocal cord).

Histopathological examination of excised specimen showed fibrinoid areas with fibrovascular core with underlining stratified squamous epithelium.

Now he is advised Voice therapy along with anti inflammatory therapy in form of enzymes and low dose steroids for few days.

He is advised to have regular follow up.

CT Scan photographs of Atrophic Rhinosinusitis.

Giant keloid behind the ear

Keloid is a hypermature scar with

Vascular (having good amount of blood in it)

Itching

Spreading

Tender

The treatment of keloid is extremely difficult sometimes. Such big lesions have to be excised meticulously under microscope sometimes and to prevent recurrence, weekly subcutaneous injection of Kenacort (steroid) and Hyluronidase ( enzymes) are given. Oral steroids may be given rarely if benefit outweigh the risks of steroids.

Iatrogenic Septal Perforation

Septal perforation is a possible complication of septal surgery. Commonly such patients complaints of dryness of nose and occasional whistling sound (very small perforation).

Various factors play a role in formation of these perforation. Most important is handling of flaps on both sides of cartilage. Ideally one septal flap should be lifted intact. (But that is no guarantee that septal perforation will not happen). next even if accidental tears happen on both side of nasal septum then they ideally should not be at same location. Even if that happens then make it sure that a good piece of septal cartilage or bone lies in between the tear.

Try to give quilting suture to hold both flaps in contact so that no dead space forms and do a soft packing so that by pressure blood supply of flap is not hampered with.

Give good broadspectrum antibiotic cover and keep both flaps lubricated or moist with saline spray.