A 19-year-old male presented with a history of pulsatile tinnitus on the left side after he underwent drainage for a tonsillar swelling. He had noticed a painless neck swelling one month ago that was associated with difficulty in swallowing. His physician had made a diagnosis of peritonsillar abscess, and drainage had been performed. After the procedure, the swelling had progressed further, leading to drooling of saliva and disabling tinnitus. When he presented to the emergency, local examination revealed a pulsatile neck swelling with peritonsillar mass. CT angiography/digital subtraction angiography (DSA) of the neck and brain revealed a large aneurysm of the distal cervical segment of the left internal carotid artery (ICA). The patient successfully underwent an urgent open repair. This case highlights the importance of a thorough history and examination in identifying a rare cause of pulsatile tinnitus. A stepwise approach to determine the reason behind tinnitus revealed an underlying ICA aneurysm of the extracranial segment.

INTRODUCTIONWith the advent of antibiotics in 1940s, the importance of acute respiratory tract infection as a cause of high mortality and morbidity, declined rapidly in developed countries and also it is decreasing in developing countries. However the burden of chronic diseases of respiratory system is increasing day by day. Tobacco smoking, socio economic development, urbanization, associated life style changes and resulting increase in air pollution are undoubtedly the underlying causative factors. Apart from the discomfort of the symptoms and the prolonged treatment, chronic respiratory diseases are associated with a variety of serious complications, which result in high treatment costs, reduced quality of life, reduced productivity, and shortened life expectancy. ABSTRACTBackground: Chronic respiratory diseases are becoming a challenge to public health due to its high morbidity and mortality. Most of these diseases are preceded by variable periods of chronic respiratory symptoms. If chronic respiratory symptoms can be diagnosed and managed properly and timely, we can reduce the incidence and complication of chronic respiratory diseases. Methods: A community based cross sectional survey was conducted in 20 electoral wards of Calicut corporation of Northern Kerala among the adult resident population of 20-70 years to assess the prevalence of chronic respiratory symptoms such as chronic cough, phlegm, wheezing, breathlessness and nasal allergy and the factors associated with these chronic symptoms. The information was collected from 1384 eligible subjects selected by cluster sampling using British research council respiratory questionnaire. Results: About 9.2% (n=95) of study population had at-least one of the chronic respiratory symptoms. 1.8% (n=19) had all the chronic respiratory symptoms. Prevalence of various chronic respiratory symptoms was chronic cough (8.7%), Phlegm (14.3%), wheezing (8.5%), breathlessness (2.2%) and nasal allergy (14.5%). Advancing age, current smoking, family history and past history of various respiratory diseases are significantly associated with the development of chronic respiratory symptoms. Female gender, longer duration of stay in Calicut corporation and regular alcoholism were significantly associated with chronic phlegm in the study population. Wheezing, breathlessness and chronic nasal allergy was significantly higher among lower socio economic status. Conclusions: Prevalence of chronic respiratory symptoms is high among the urban population of Northern Kerala. Older age group, smoking, past and family history of respiratory diseases are the major risk factors associated with these respiratory symptoms.