Oral submucous fibrosis refers to the deposition of fibrous tissue in the oral cavity and pharynx. It is widely seen in developing countries like India, Pakistan and Sri Lanka. It is strongly associated with the habit of betel-nut chewing. Areca nuts are either chewed alone or along with tobacco. The other factors involved in the aetiology of this disease are tobacco chewing, alcohol consumption and a poor socioeconomic status. The main histopathological finding in this disease is the presence of abundant eosinophils and lymphocytes in the tissues. The number of T helper cells in the oral cavity is substantially increased. These cells secrete cytokines which stimulate the proliferation of fibroblasts leading to increased collagen production. The activated T cells also produce anti-fibrotic cytokines in much lesser quantities than normal, which further augments collagen deposition. The patient presents with inability to open the mouth fully and difficulty in protruding the tongue. There is also a constant burning sensation in the oral cavity, which is aggravated during the intake of meals. The anti-inflammatory effects of steroids are used in treating the disease. It can relieve trismus in no time. Various surgical procedures are also now being practised for curing this disease.
A polyp is a non-neoplastic mass of oedematous mucosa. Polyps are commonly seen in the nasal or sinus mucosa. There are two main types of nasal polyps. They are the ethmoidal polyp and the antrochoanal polyp. Ethmoidal polyps are associated with allergy, disorders of ciliary motility as in Kartagener’s syndrome or abnormal mucous composition as in cystic fibrosis. The nasal mucosa at the level of the middle meatus becomes oedematous due to collection of extracellular fluid and forms a polyp. They are sessile initially, but become pedunculated later due to gravity. They lead to nasal obstruction stuffiness. Watery discharge from the nose is seen due to associated allergy. The most effective treatment is polypectomy. On the other hand, antrochoanal polyp arises from the mucosa of the maxillary antrum. It then grows into the nasal cavity through the choana. The patients present with unilateral nasal obstruction. Thick nasal discharge is also seen. It has to be differentiated from a thick blob of mucous and other neoplasms. An antrochoanal polyp is removed by a Caldwell-Luc operation.
Tinnitus refers to a ringing sound in the ear. It is also referred to by some people as a ringing noise. It can be present in both ears, but is unilateral most of the time. Tinnitus is not a disease. It is a symptom. So the cause of tinnitus should be found out as early as possible. It is perceived by the patient as roaring, swishing, hissing or rustling type. There are basically two types of tinnitus, subjective and objective. In subjective type of tinnitus the sound is perceived only by the patient. It can be due to a variety of causes like impacted wax in the ear canal, fluid in the middle ear, Meniere’s disease, otosclerosis, etc. In objective type of tinnitus, the noise can be heard by both the patient and the examiner. The common causes are vascular tumours like glomus tumours and palatal myoclonus. Tinnitus is of characteristic swishing type in glomus tumour. Tinnitus can be minimised by masking the noise. A loud ticking clock or a loud fan might be used. Psychotherapy is also needed in many patients.
