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ORIGINAL ARTICLE
Indrani Hemantkumar

Anesthesia for Laser Surgery of the Airway

[Year:2017] [Month:January-April] [Volumn:9 ] [Number:1] [Pages:37] [Pages No:1-5][No of Hits : 1863]


ABSTRACT

Anesthesia for laser surgery carries a number of particular challenges and pitfalls. The airway is not only shared with the surgeon but also being operated upon. Personnel working inside the operating room must also be very aware of the benefits and dangers of medical lasers, and safety precautions must be taken to ensure their proper use. The anesthetist must have the knowledge and expertise to anesthetize a patient with a potentially compromised airway. This article deals with the anesthetic management of a patient presenting for laser surgery of the airway.

Keywords: Airway, Anesthesia options for laser surgeries, Fires, Laryngeal cancer, Laser.

How to cite this article: Hemantkumar I. Anesthesia for Laser Surgery of the Airway. Int J Otorhinolaryngol Clin 2017;9(1):1-5.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
Anand S Nirgude, Indrani Hemantkumar

Anesthesia Considerations in Microlaryngoscopy or Direct Laryngoscopy

[Year:2017] [Month:January-April] [Volumn:9 ] [Number:1] [Pages:37] [Pages No:10-15][No of Hits : 1646]


ABSTRACT

Patients of all ages including pediatric, adult, and geriatric age groups present to anesthesiologists for microlaryngoscopy (ML scopy) or direct laryngoscopy (DL scopy). Proper preoperative evaluation, adequate intraoperative care, monitoring, and postoperative monitoring provide a successful outcome in these patients. These procedures are day care procedures. The aim of anesthesiologists while dealing with such patients is maintaining adequate depth of anesthesia, maintaining adequate ventilation to the patients, and giving enough time to the surgeon to diagnose and evaluate the definitive cause of airway disease. Anesthesiologists should share the airway or maintain the ventilation in such a way as to give the surgeon proper and good visualization of the patient’s airway. The use of short-acting and potent anesthetic agents provides adequate intraoperative depth of anesthesia and speeds up postoperative recovery, i.e., awakening of the patient.

Keywords: Anesthesia, Direct laryngoscopy, Microlaryngoscopy.

How to cite this article: Nirgude AS, Hemantkumar I. Anesthesia Considerations in Microlaryngoscopy or Direct Laryngoscopy. Int J Otorhinolaryngol Clin 2017;9(1):10-15.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Santosh K Swain, Mahesh C Sahu

Management of Laryngeal Airway in Reinke’s Edema: An Anesthetic Overview

[Year:2017] [Month:January-April] [Volumn:9 ] [Number:1] [Pages:37] [Pages No:35-37][No of Hits : 1082]


ABSTRACT

Reinke’s edema (RE) is a benign polypoidal lesion of the vocal folds. The vocal folds show a white and translucent edema, confined into the superficial lamina propria. The lesions usually affect both vocal folds with fusiform appearance and even mobile during phonation. Hoarseness of voice is the most common clinical presentation in RE. Reinke’s edema is often associated with smoking habit, gastroesophageal reflux, and voice abuse. It usually occurs in middle-aged male or postmenopausal women who have a long-term history of smoking. We hereby report a case of a large polypoidal RE who presented with ventilation difficulties during general anesthesia using positive pressure mask ventilation.

Keywords: Anesthesia, Laryngeal airway, Reinke’s edema.

How to cite this article: Swain SK, Sahu MC. Management of Laryngeal Airway in Reinke’s Edema: An Anesthetic Overview. Int J Otorhinolaryngol Clin 2017;9(1):35-37.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Mohammed R Dawood, Ammar H Khammas

Diagnostic Accuracy of Radiology and Endoscopy in the Assessment of Adenoid Hypertrophy

[Year:2017] [Month:January-April] [Volumn:9 ] [Number:1] [Pages:37] [Pages No:6-9][No of Hits : 936]


ABSTRACT

Aim: To clarify the diagnostic accuracy of the lateral X-ray of nasopharynx, and the flexible nasopharyngoscopy in the assessment of adenoid hypertrophy, with the preoperative rigid nasal endoscopic observation, as it was considered as a reference standard guide.

Materials and methods: This is a prospective observational study that included 80 children who planned to undergo adenoidectomy due to the symptoms found related to adenoid hypertrophy. All the children underwent a relevant clinical history and full ear, nose, and throat (ENT) examination, and the grading of adenoid hypertrophy was done preoperatively with the lateral X-ray of the nasopharynx and the flexible nasopharyngoscopy. These findings were analyzed and compared with the peroperative rigid nasal endoscopic assessment of adenoid hypertrophy, which was considered as a reference guide.

Results: There were 44 boys (55%) and 36 girls (45%), with mean age of 5.176 (±1.873) years, and the highest frequency of adenoid hypertrophy was found in the age group of 4 to 6 years (62.45%); the most common grade of the adenoid size in all the types of the assessment was grade 3. The assessment of adenoid grading by both flexible and peroperative rigid nasal endoscopy versus radiology was statistically significant, with p value of 0.0001, while the adenoid grading between flexible and peroperative rigid nasal endoscopic assessment was almost comparable, as no significant difference was found, with p value of 0.46.

Conclusion: Flexible nasopharyngoscopy was a more reliable diagnostic tool in the assessment of the adenoid size than lateral nasopharyngeal X-ray, as it correlates well with peroperative rigid nasal endoscopic finding.

Keywords: Adenoid hypertrophy, Nasal endoscopy, X-ray nasopharynx.

How to cite this article: Dawood MR, Khammas AH. Diagnostic Accuracy of Radiology and Endoscopy in the Assessment of Adenoid Hypertrophy. Int J Otorhinolaryngol Clin 2017;9(1):6-9.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Vijay Stephen, Shobin S Abraham, Paresh P Naik, Mary Kurien

Petechial Hemorrhage of Tympanic Membrane in a Case of Attempted Suicide by Hanging: A Sign of Severity

[Year:2017] [Month:January-April] [Volumn:9 ] [Number:1] [Pages:37] [Pages No:16-17][No of Hits : 814]


ABSTRACT

Assessment of a patient who has attempted suicide by hanging is an important emergency room call for an otorhinolaryngologist. As a norm, it is the neck that is assessed first in such a patient. Here, we discuss the otoscopic findings of petechiae of the tympanic membrane in these patients, which will help in finding the severity of the hanging, which in turn will be helpful to provide round-the-clock careful vigilant care for these patients.

Keywords: Partial hanging, Petechiae, Tympanic membrane.

How to cite this article: Stephen V, Abraham SS, Naik PP, Kurien M. Petechial Hemorrhage of Tympanic Membrane in a Case of Attempted Suicide by Hanging: A Sign of Severity. Int J Otorhinolaryngol Clin 2017;9(1):16-17.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Kamran A Syed, P Naina, Sheeja S John, Ajoy M Varghese

Relapsing Polychondritis: An Otolaryngologist’s Perspective

[Year:2017] [Month:January-April] [Volumn:9 ] [Number:1] [Pages:37] [Pages No:18-20][No of Hits : 661]


ABSTRACT

Relapsing polychondritis (RP) is an uncommon autoimmune disease with varying clinical presentations. Relapsing polychondritis frequently involves the ear, nose, and throat cartilages, often causing subtle and episodic symptoms that can pose a diagnostic challenge to the otolaryngologist. A high index of suspicion is needed to identify these subtle signs leading to early diagnosis. Here, we report a case of RP presenting with hoarseness of voice; we reviewed the literature and clinical signs discussed from an otolaryngologist’s perspective. Greater awareness about its episodic and myriad presentation is needed for early diagnosis and management of this uncommon clinical condition.

Keywords: Relapsing polychondritis, Saddle nose, Tracheal stenosis.

How to cite this article: Syed KA, Naina P, John SS, Varghese AM. Relapsing Polychondritis: An Otolaryngologist’s Perspective. Int J Otorhinolaryngol Clin 2017;9(1):18-20.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Lília Ferraria, Sílvia Alves, Helena Rosa, Mário Santos, Luis Antunes

Unilateral Congenital Choanal Atresia in a 48-Year-Old Patient

[Year:2017] [Month:January-April] [Volumn:9 ] [Number:1] [Pages:37] [Pages No:28-31][No of Hits : 651]


ABSTRACT

Aim: To report a case of unilateral choanal atresia diagnosed in a 48-year-old, presenting with fatigue as the major symptom. To highlight the importance of a detailed clinical history and physical examination for an accurate diagnosis.

Background: Choanal atresia is an uncommon and often poorly recognized cause of unilateral or bilateral nasal obstruction. It is a congenital condition that occurs in approximately 1 in 5,000 to 8,000 live births.

Case report: This study reports a case of unilateral choanal atresia diagnosed in a 48-year-old presenting with fatigue as the major symptom. The patient presented with a lifelong history of tiredness investigated in cardiology. She was treated by a combined transseptal and transnasal endoscopic surgical technique. Topic use of mitomycin was performed with no use of stents, with clinical regression of the symptoms.

Conclusion: Unilateral choanal atresia usually presents in younger patients but can be undiagnosed until adulthood due to the nonspecific nature of the symptoms. This diagnosis should be, therefore, considered in all ages and bedside diagnostic procedures should, then, be done. Nasal endoscopy and computed tomography (CT) scan are the gold standard for the diagnosis. The use of stents and mitomycin C topically as an adjunct to the surgical repair of choanal atresia is a controversial subject.

Keywords: Choanal atresia, Endoscopic surgical procedure, Mitomycin C.

How to cite this article: Ferraria L, Alves S, Rosa H, Santos M, Antunes L. Unilateral Congenital Choanal Atresia in a 48-Year- Old Patient. Int J Otorhinolaryngol Clin 2017;9(1):28-31.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Diptiman Baliarsingh, Arun Rath, Ashutosh Hota, Rajlaxmi Panigrahi

Open Safety Pin in Larynx: A Case Report and Review of Literature

[Year:2017] [Month:January-April] [Volumn:9 ] [Number:1] [Pages:37] [Pages No:21-24][No of Hits : 605]


ABSTRACT

A foreign body in the respiratory tract is a serious event, and it needs urgent attention. It is important to know the type of foreign body with careful history taking. Usually, such cases come in pediatric age group due to accidental ingestion or inhalation. We present a case of 12-year-old female who presented with an impacted open safety pin lodged in the larynx. Its sharp end was upward in position and penetrated the subglottis and anterior commissure. A tracheotomy was done for securing airway, and the foreign body was removed with the help of rigid endoscope. The child had an uneventful recovery.

Keywords: Foreign body, Larynx, Safety pin, Tracheotomy.

How to cite this article: Baliarsingh D, Rath A, Hota A, Panigrahi R. Open Safety Pin in Larynx: A Case Report and Review of Literature. Int J Otorhinolaryngol Clin 2017;9(1):21-24.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Varun Rai, Vikas Malhotra, Naresh Kumar, Nita Khurana

Laryngeal Neuroendocrine Tumor: Atypical Presentation.

[Year:2017] [Month:January-April] [Volumn:9 ] [Number:1] [Pages:37] [Pages No:32-34][No of Hits : 553]


ABSTRACT

Neuroendocrine tumors of the larynx are the most common nonepidermoid tumors of the larynx and comprise less than 1% of the laryngeal tumors. Most of the symptoms and presentation mimic a usual laryngeal malignancy making the diagnosis difficult.

Keywords: Calcitonin, Laryngeal, Neuroendocrine tumor, Periodic acid–schiff.

How to cite this article: Rai V, Malhotra V, Kumar N, Khurana N. Laryngeal Neuroendocrine Tumor: Atypical Presentation. Int Int J Otorhinolaryngol Clin 2017;9(1):32-34.

Source of support: Nil

Conflict of interest: None


 
Original Article
Wail F Nasr, Samir S Sorour, Mohammed K Mobasher, Hesham R Abd El Aziz

Chronic Tonsillitis: A Recent Histopathological Study

[Year:2016] [Month:January-April] [Volumn:8 ] [Number:1] [Pages:44] [Pages No:1-5][No of Hits : 1227]


ABSTRACT

Objectives: The aim of this study is to assess the incidence of tonsillomycosis in chronic tonsillitis on histopathological basis post-tonsillectomy in children.

Study design: Cohort study.

Level of evidence: Level II.

Setting: Ter tiary University Hospital, Department of Otorhinolaryngology.

Materials and methods: This study included 75 cases of children suffering from chronic tonsillitis (43 females and 32 males). On assessment of the clinical condition of the children with history taking, clinical examination, and preoperative investigation, post-tonsillectomy tonsils are placed in a separate container in 10% formol saline, and then are sent for histopathological examination using hematoxylin and eosin and periodic acid-Schiff (PAC).

Results: The obtained result had 31.3% of tonsils (47/150) with histopathological evidence of fungal invasion of tonsillar tissue with immune reaction and the presence of chronic inflammatory cells. After statistical analysis of the collected crude data, we found that results have come in accordance with previous studies.

Conclusion: Tonsillomycosis is a cause of chronic tonsillitis. Haphazard use of antibiotics and dental caries has a significant predisposing role in tonsillomycosis. Neutropenia can be considered as an indicator for tonsillomycosis. It is considerable in hypertrophic tonsils.

Keywords: Chronic tonsillitis, Neutropenia, Tonsillomycosis.

How to cite this article: Nasr WF, Sorour SS, Mobasher MK, Abd El Aziz HR. Chronic Tonsillitis: A Recent Histopathological Study. Int J Otorhinolaryngol Clin 2016;8(1):1-5.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
Amit Kumar, Amit Goyal, Rahul K Singh

Coblation vs Microdebrider-assisted Inferior Turbinoplasty

[Year:2016] [Month:May-August] [Volumn:8 ] [Number:2] [Pages:43] [Pages No:51-52][No of Hits : 717]


ABSTRACT

Aim: The aim of this study is to compare the effectiveness of coblation and microdebrider-assisted turbinoplasty in reducing nasal obstruction due to inferior turbinate hypertrophy (ITHA).

Background: A comprehensive search of articles in English language was performed in PubMed using the keywords coblation turbinoplasty, coblation inferior turbinate reduction, microdebrider turbinoplasty, microdebrider assisted inferior turbinate reduction.

Review results: Primary search yielded 41 results with only two fulfilling the inclusion and exclusion criteria. In both studies, patients were assessed objectively as well as subjectively. Improvement in nasal obstruction was similar in both coblation and microdebrider groups up to 6 months of follow-up in both studies. However, in the study by Lee and Lee (2006) at 12 months postoperative follow-up, microdebrider-assisted turbinoplasty patients showed a better improvement in nasal obstruction both objectively on acoustic rhinometry and subjectively as compared with the coblation group (p < 0.05).

Conclusion: Despite getting better results with microdebriderassisted turbinoplasty in one of the study, it can be safely concluded that longer postsurgical follow-up period with bigger sample size is required to adequately comment on the extra benefit offered by either coblation or microdebrider.

Clinical significance: As and when further research is planned on comparing benefits of different powered instruments for turbinate reduction, it will be wise to prolong the follow-up period with increased sample size.

Keywords: Coblation, Descriptive review, Inferior turbinate, Microdebrider, Turbinoplasty.

How to cite this article: Kumar A, Goyal A, Singh RK. Coblation vs Microdebrider-assisted Inferior Turbinoplasty. Int J Otorhinolaryngol Clin 2016;8(2):51-52.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Sudhir M Naik, BL Yatish Kumar, S Ravishankara, T Shashikumar, RM Deekshith

Modified Sistrunk Procedure: A Novel Method of Hyoid Resection using Skin Punches in Subhyoid Thyroglossal Cysts

[Year:2016] [Month:September-December] [Volumn:8 ] [Number:3] [Pages:38] [Pages No:97-100][No of Hits : 695]


ABSTRACT

Background/objectives: Managing thyroglossal duct cyst requires surgical excision of the cyst with its tract through the tongue base. Incomplete removal results in cyst recurrence, the common complications of incompletely performed Sistrunk procedure. The Modified Sistrunk procedure using skin punches increases the easiness of surgery and chances of complete removal of the tract.

Materials and methods: Resection of the middle body of the hyoid was done by coring out the nonossified bone with 4.5 mm skin punches under 3.5× loupes and the tract above till the base.

Results: A total of 14 primary cases were operated by this slight modification, and no recurrences were seen on 1 year of follow-up.

Conclusion: Sistrunk operation is the treatment of choice for primary thyroglossal cysts. Modified Sistrunk operation using skin punches results in easy and precise coring of the hyoid bone with the tract attached to it. Secondary cysts should be treated with removal of core of tongue base muscle and foramen cecum mucosa along with hyoid and scarred cyst excision.

Keywords: Hyoid bone, Sistrunk’s operation, Skin punches, Thyroglossal cyst.

How to cite this article: Naik SM, Kumar BLY, Ravishankara S, Shashikumar T, Deekshith RM. Modified Sistrunk Procedure: A Novel Method of Hyoid Resection using Skin Punches in Subhyoid Thyroglossal Cysts. Int J Otorhinolaryngol Clin 2016;8(3):97-100.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Salman Amiruddin, Mohd Sayuti Razali, Kamaruzaman B Esa

Plunging Ranula mimicking Extensive Submandibular Gland Abscess: A Diagnostic Challenge

[Year:2016] [Month:September-December] [Volumn:8 ] [Number:3] [Pages:38] [Pages No:119-121][No of Hits : 533]


ABSTRACT

Ranula is a salivary gland cyst that typically presents as localized superficial swelling over the floor of the mouth. Complex or plunging ranulas develop when the mucus extravasation extends through or around the mylohyoid muscle, deeper into the neck, and present with neck lump along with or without swelling over the floor of mouth. It is not a straightforward diagnosis in case of superimposed infection as it will resemble a submandibular gland abscess clinically and radiologically. We report here a case of large plunging ranula, which initially diagnosed radiologically as submandibular gland abscess with extension to parapharyngeal space.

Keywords: Oral swelling, Ranula, Salivary gland.

How to cite this article: Amiruddin S, Razali MS, Esa KB. Plunging Ranula mimicking Extensive Submandibular Gland Abscess: A Diagnostic Challenge. Int J Otorhinolaryngol Clin 2016;8(3):119-121.

Source of support: Nil

Conflict of interest: None


 
INVITED ARTICLE
Pravin Virappa Ubale

Anesthetic Considerations in Functional Endoscopic Sinus Surgery

[Year:2015] [Month:January-April] [Volumn:7 ] [Number:1] [Pages:39] [Pages No:22-27][No of Hits : 3161]


ABSTRACT

Functional endoscopic sinus surgery is among the most challenging of ENT procedures for a variety of reasons including the need for immobility, hemostasis, and, especially, gentle emergence from anesthesia. Anesthesiologists have contributed significantly, using different anesthetic techniques to control intraoperative hemorrhage, thus significantly improving visualization of the surgical field.

Keywords: Airway, Anesthesia, Functional endoscopic sinus surgery, Hemostasis, Induced hypotension.

How to cite this article: Ubale PV. Anesthetic Considerations in Functional Endoscopic Sinus Surgery. Int J Otorhinolaryngol Clin 2015;7(1):22-27.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Harprit Kaur Madan, Suchita Kosare

Anesthesia for Middle Ear Surgeries and Cochlear Implant

[Year:2015] [Month:January-April] [Volumn:7 ] [Number:1] [Pages:39] [Pages No:1-9][No of Hits : 2506]


ABSTRACT

The attending anesthesiologist face several challenges in safe conduction of anesthesia for middle ear and cochlear implantation surgeries. Preoperative challenges includes counseling elderly patients with impaired hearing and counseling the parents of children with congenital ear anomalies, thorough evaluation of these patient with several comorbidities. Intraoperative challenges are to provide bloodless field, head positioning, effect of nitrous oxide on middle ear, facial nerve monitoring and avoid electrical disturbances due to electrocautery during stimulation of the cochlear implant electrode assembly. Postoperative challenges includes smooth and calm recovery, prevention and treatment of postoperative nausea and vomiting (PONV) and excellent analgesia. A close understanding and cooperation between the anesthesiologist and surgeon is the key for a positive outcome.

Keywords: Cochlear implant, Mastoidectomy, Middle ear, Tympanoplast.

How to cite this article: Madan HK, Kosare S. Anesthesia for Middle Ear Surgeries and Cochlear Implant. Int J Otorhinolaryngol Clin 2015;7(1):1-9.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
Deepa Suvarna, Sarita Fernandes

Anesthesia Management of Adenotonsillectomy

[Year:2015] [Month:January-April] [Volumn:7 ] [Number:1] [Pages:39] [Pages No:17-21][No of Hits : 1031]


ABSTRACT

Tonsillectomy is one of the most common pediatric surgeries done. Anesthesia for tonsillectomy and adenoidectomy is one of the most challenging to administer even in modern times. The types of anesthesia and drugs are usually dictated by the patient’s own pathophysiology and the anesthesiologist’s experience. The restricted space for working in these surgeries mandates an understanding and cooperation between the surgeon and anesthesiologist. Postoperative bleeding and airway obstruction have been leading causes of death in the postoperative period. Mortality though overall low may increase with reoperations. Most of these surgeries are carried out on ambulatory basis in modern times thus greater care has to be taken by the anesthesiologist to ensure street fitness in these patients. Even seemingly trivial issues like postoperative nausea vomiting may be of significant importance in these patients.

Keywords: General anesthesia, Post-tonsillectomy bleed, Tonsillectomy.

How to cite this article: Suvarna D, Fernandes S. Anesthesia Management of Adenotonsillectomy. Int J Otorhinolaryngol Clin 2015;7(1):17-21.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Uma Garg, Ritika Batra, Neha Salaria, MK Garg

Scrofula Mimicking Cutaneous Malignancy: A Rare Case Report

[Year:2015] [Month:Number] [Volumn:7 ] [Number:1] [Pages:28] [Pages No:13-15][No of Hits : 979]


ABSTRACT

Since a long time scrofuloderma (SCF) was thought to be a common disease of childhood and was attributable to Myco_ bacterium tuberculosis. In 1951, a new entity nontuberculous scrofuloderma was described and it is caused by atypical mycobacteria namely Mycobacterium scrofulaceum. The clinical picture closely mimics tuberculous scrofuloderma but diagnosis should be established through culture isolation and identification, because drug susceptibility may be different in these cases.
In this article, we report a case of a 22-year-old pregnant female patient who presented to us with scrofulaceous lesion on the right side of neck.

Keywords: Tuberculosis, Primary scrofuloderma, Scrofula, Nontuberculous mycobacteria.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
S Saimanohar, Raveendra P Gadag, Vijayalakshmi Subramaniam

Management of Traumatic Perforations of the Tympanic Membrane: A Clinical Study

[Year:2015] [Month:September-December] [Volumn:7 ] [Number:3] [Pages:43] [Pages No:114-116][No of Hits : 968]


ABSTRACT

Objective: To compare the outcome of conservative management vs surgical intervention (realignment of torn edges) in traumatic perforations of the tympanic membrane (TM).

Design: Cohort study, Interventional, Observational, Prospective.

Setting: Karnataka Institute of Medical Sciences, Hubli, Karnataka.

Patients: All patients attending the Department of Otolaryngology with otological injuries.

Interventions: Patients with isolated traumatic tympanic membrane perforations without evidence of temporal bone fractures were managed either conservatively or surgically by realigning the torn edges of perforation under local anesthesia and supporting with gelfoam.

Main outcome measures: Healing of perforation, duration taken for complete healing and hearing outcome by pure tone audiometry.

Results: Perforations in patients taken up for surgical intervention healed faster. Though the difference in outcome, i.e. healed TM perforation between the 2 groups was not statistically significant, the difference in duration taken for healing was observed to be statistically significant (p < 0.05).

Conclusion: Minimal surgical intervention involving realignment of torn edges of perforation and supporting with gelfoam enables faster healing.

Keywords: Perforations, Trauma, Tympanic membrane.

How to cite this article: Saimanohar S, Gadag RP, Subramaniam V. Management of Traumatic Perforations of the Tympanic Membrane: A Clinical Study. Int J Otorhinolaryngol Clin 2015;7(3):114-116.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Namita Mahesh Baldwa

Anticipated Difficult Airway in Ear, Nose and Throat Procedures

[Year:2015] [Month:January-April] [Volumn:7 ] [Number:1] [Pages:39] [Pages No:10-16][No of Hits : 956]


ABSTRACT

Contrary to general and obstetric populations, where difficult airway is widely studied and well documented, it requires further research in elective and emergency ear, nose and throat (ENT) surgeries. American Society of Anesthesiologists (ASA) has published practice guidelines for the management of difficult airway, which help us deal with it perioperatively. All patients posted for ENT surgeries with difficult airway should be evaluated preoperatively and the strategy for management of difficult intubation as well as extubation chalked out. In the event, that the primary approach fails, the secondary plan should always be clear preoperatively, to reduce morbidity and mortality.

Keywords: Difficult airway, Management, Predictors.

How to cite this article: Baldwa NM. Anticipated Difficult Airway in Ear, Nose and Throat Procedures. Int J Otorhinolaryngol Clin 2015;7(1):10-16.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Sharanabasappa Rudragouda Malipatil

Preauricular Sinus as Recurrent Postaural Abscess: A Rare Presentation

[Year:2015] [Month:Number] [Volumn:7 ] [Number:1] [Pages:28] [Pages No:26-28][No of Hits : 919]


ABSTRACT

Preauricular sinus (PAS) is not uncommon congenital anomaly. It is usually asymptomatic and does not require any treatment. Patient presenting with discharge, recurrent infections and preauricular abscess will require management with antibiotics and surgical extirpation of the sinus tract. Here, it is a rare case report of PAS presenting as a recurrent postaural abscess.

Keywords: Preauricular, Sinus, Postaural, Abscess.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
UP Santosh, KB Prashanth, Nitha Mary George

Antistreptolysin O Positivity in Chronic Tonsillitis: Rare or Common?

[Year:2015] [Month:Number] [Volumn:7 ] [Number:1] [Pages:28] [Pages No:1-2][No of Hits : 908]


ABSTRACT

Objective: To determine the frequency of antistreptolysin O (ASLO) positivity in cases of proven chronic tonsillitis.

Materials and methods: The present study was conducted in a tertiary care center from January to October 2013. A total of 150 patients who presented with features suggestive of chronic tonsillitis and willing for surgery were included in the study. On admission, following a detailed history taking and clinical examination, preoperative investigations along with ASLO titers were done. Following medical and anesthetic fitness, the patients underwent tonsillectomy with or without adenoidectomy and the tonsillar specimens were sent for histopathological examination.

Results: A total of five out of the 150 patients showed ASLO titer positivity (>200 IU/ml) and all were histopathologically proven cases of chronic tonsillitis.

Conclusion: Early detection and treatment of Streptococcal tonsillar involvement could be a preventive measure against the future predilection of other predisposed organs to more severe and debilitating streptococcal infections.

Keywords: Chronic tonsillitis, Rheumatic factor, Antistreptolysin O antibodies, Rheumatic fever, Streptococcal infection, Tonsillectomy.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Pratik Dipak Shah, Srijon Mukherji

Langerhans Cell Histiocytosis Presenting as a Unifocal Eosinophilic Granuloma in the Body of the Mandible: A Rare Report

[Year:2015] [Month:Number] [Volumn:7 ] [Number:1] [Pages:28] [Pages No:16-18][No of Hits : 886]


ABSTRACT

Introduction: Langerhans cell histiocytosis (LCH) is a relatively rare and unique benign disease characterized by an abnormal proliferation of immature dendritic cells which usually affects children and young adults. Jaws are involved in less than 10% of children with the disease.

Objective: To add on to the literature one more case of this rare and unique disease which accounts for less than 1% of all bone tumors and also to discuss its oral manifestation and management.

Design: Case report

Setting: Private maxillofacial surgery institute, Kolkata, West Bengal.

Patient: A 2 years and 8 months old male child with solitary swelling over the lower left jaw since one and half months. Lesion was fixed to underlying bone and there was an expansion of buccal cortical plate at the body of mandible.

Results: Enucleation of the lesion performed after assessing history, clinical and radiological dertails and also considering patient’s age. Postoperative biopsy result came as LCH presenting as a unifocal eosinophil granuloma. Appropriate surgical intervention resulted in a dramatic improvement in patient’s clinical condition. At present, patient is disease-free and asymptomatic.

Conclusion: Surgical enucleation or curettage is a preferred treatment option for maxillary and mandibular lesion. Potential for the unifocal disease to become multifocal should not be underestimated as the disease can be unpredictable. We recommend long-term follow-up due to uncertainty of the disease.

Keywords: Langerhans cell histiocytosis, Eosinophilic granuloma, Benign.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Manish Kumar, SK Kanaujia, Ashutosh Singh

A Comparative Study of Endoscopic Myringoplasty vs Conventional Myringoplasty

[Year:2015] [Month:September-December] [Volumn:7 ] [Number:3] [Pages:43] [Pages No:132-137][No of Hits : 866]


ABSTRACT

Objective: To evaluate the efficacy of endoscopic myringoplasty and comparison with conventional myringoplasty.

Materials and methods: Sixty cases of clinically diagnosed chronic suppurative otitis media with dry central perforation were taken into account of which 30 cases were undergone endoscopic myringoplasty and 30 cases undergone conventional myringoplasty. All patients were followed up on 3rd, 7th, 15th day, 6th weeks, 3rd and 6th months after surgery.

Results: The tympanic membrane’s perforation healing rate was 86% (26/30), in conventional group of myringoplasty and 83% (25/30) in endoscopic group of myringoplasty and average hearing gain in conventional group was 13.96 dB and in endoscopic group was 15.03 dB.

Conclusion: The surgical outcome of endoscope assisted myringoplasty in terms of graft uptake and hearing improvement was comparable to the conventional microscope assisted myringoplasty, but in terms of cosmesis and postoperative recovery patients in the endoscope group had better results.

Keywords: Chronic suppurative otitis media, Endoscopic, Myringoplasty.

How to cite this article: Kumar M, Kanaujia SK, Singh A. A Comparative Study of Endoscopic Myringoplasty vs Conventional Myringoplasty. Int J Otorhinolaryngol Clin 2015;7(3): 132-137.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
UP Santosh, KB Sunil Kumar, Aniketh Shyamsunder Pandurangi

Clinicopathological Correlation Between Peripheral Blood Eosinophilia and Inferior Turbinate Tissue Eosinophils

[Year:2015] [Month:Number] [Volumn:7 ] [Number:1] [Pages:28] [Pages No:6-8][No of Hits : 860]


ABSTRACT

Background and objectives: Allergic rhinitis affects up to 20% of the general population and is one of the most common reasons for presentations to the outpatient department. We hereby present a case series which attempts to have a correlation between tissue eosinophilia (inferior turbinate) and increased eosinophil count in blood (> 440 cells/mm3).

Materials and methods: Thirty-six patients presented to the Outpatient Department of Bapuji Hospital and Chigateri General Hospital (Teaching Hospitals attached to JJM Medical College), Davangere, with nasal obstruction and symptoms suggestive of allergic rhinitis with turbinate hypertrophy who were posted for elective bilateral partial inferior turbinectomy with/without submucous resection/septoplasty. These patients had increased absolute eosinophil count in blood. Formalin fixed inferior turbinectomy specimens were routinely processed for histopathology. Eosinophils in the mucosa and submucosal region were counted by method of Shioda and Mishima.

Results: Ten patients out of 36 showing increased eosinophil count in blood show ‘significant eosinophilia’ in turbinates (27.7%).

Conclusion: Peripheral eosinophilia does not always correlate with tissue eosinophilia which opens up a possibility of using nasal mucosa biopsy for confirmation of presence of eosinophils. Further studies are needed to explore the demonstration of ‘activated’ tissue eosinophils in the diagnosis of allergic rhinitis.

Keywords: Allergic rhinitis, Tissue eosinophilia, Inferior turbinate.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Rajeshwary Aroor, Madhukar Muniswamy Gowda, Vadisha Srinivas Bhat, Satheesh Kumar Bhandary

Novel Approach to Rhinosporidiosis

[Year:2015] [Month:Number] [Volumn:7 ] [Number:1] [Pages:28] [Pages No:3-5][No of Hits : 851]


ABSTRACT

Rhinosporidiosis is a chronic enigmatic disease affecting mainly the upper aero digestive tract and is notorious for frequent recurrences as high as 70%. Higher incidences of recurrence are mainly due to nonendoscopic excision with resultant residual disease leading to seedling of the disease.

Objectives: The aim of this study is to highlight the factors responsible for recurrence and to follow the clinical course to ensure against recurrence of rhinosporidiosis. External surgery in rhinosporidiosis should be avoided for the fear of implantation. With the advent of endoscopes and Lasers allow the surgeon to complete excision of the lesion with cauterization of the base.

Materials and methods: A retrospective study of thirty two cases of rhinosporidiosis presented to us over a period of 10 years from 2002 to 2012. Out of which 14 cases presented to us for the first time and 18 cases were recurrent cases. The commonest age group of presentation was between 20 and 30 years in patients presenting for the first time and in recurrent cases the commonest age of presentation was between 50 and 60 years of age. Majority of patients were males with male to female ratio of 9:1. All patients underwent endoscopic excision, electro cautery was used in 30 patients and Laser was used in 2 patients.

Results: Fourteen cases did not have any recurrence and in the 18 cases of recurrent cases three of them again had a recurrence where electro cautery was used to cauterize the base.

Conclusion: Endoscopic excision of rhinosporidiosis has a better result over nonendoscopic approaches with lesser recurrence rate. Our results show that use of endoscopes in patients who presented for the first time have a better results as the mucosa of recurrence patients have already been insulted due to previous surgeries.

Keywords: Rhinosporidiosis, Endoscopic excision, Electrocautery.

Source of support: Nil

Conflict of interest: None


 
INVITED ARTICLE
Minal Harde, Tushar Bawankar, Rakesh Bhadade

Ear, Nose and Throat Emergencies and Anesthesia

[Year:2015] [Month:January-April] [Volumn:7 ] [Number:1] [Pages:39] [Pages No:28-34][No of Hits : 756]


ABSTRACT

Ear, nose and throat (ENT) emergency procedures demand significant anesthetic challenges. Variety of emergency conditions like deep neck space infections (Ludwig’s angina, retropharyngeal, parapharyngeal abscess), acute onset of stridor, epiglottitis, laryngotracheobronchitis, inhaled foreign bodies, facial injuries, etc. are a challenge to both the surgeon and the anesthesiologist and communication and cooperation is vital. Priority in emergency is to clear and secure the airway and consider requirement of ‘shared airway’. Preferred anesthesia and airway technique include awake flexible fiberoptic (FOB) guided intubation in cooperative patients’ and an inhalational induction in uncooperative patient or tracheostomy. Anticipation, vigilance, readiness for difficult intubation, emergency tracheostomy and team work is essential while managing ENT emergency procedures.

Keywords: Difficult intubation, ENT emergency, Shared airway.

How to cite this article: Harde M, Bawankar T, Bhadade R. Ear, Nose and Throat Emergencies and Anesthesia. Int J Otorhinolaryngol Clin 2015;7(1):28-34.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Gaurav Ashish, Amit Kumar Tyagi, Ann Mary Augustine, Ramanathan Chandrasekharan, Ajoy Mathew Varghese, Harshad Parmar, Balamugesh Thangakunam, DJ Christopher

Superior Vena Cava Syndrome vs Ludwig’s Angina: A Diagnostic Dilemma

[Year:2015] [Month:Number] [Volumn:7 ] [Number:1] [Pages:28] [Pages No:19-22][No of Hits : 697]


ABSTRACT

Introduction: We present an interesting diagnostic dilemma between superior vena cava syndrome and Ludwig Angina to highlight ways to differentiate between these two seemingly similar conditions.

Presentation of case: A 50-year-old man presented with complaints of progressive breathing difficulty with diffuse brawny swelling in the neck and clinically gave impression of Ludwig angina, however, on further evaluation was diagnosed with superior vena cava syndrome (SVCS) secondary to non small cell carcinoma of lung.

Discussion: This paper illustrates an interesting scenario in which clinical presentation of SVCS mimicked Ludwig’s Angina. SVCS with a gradual onset may have minimal symptoms with facial edema, erythema and venous distension in the chest and neck. Occasionally atypical presentation of Ludwig’s angina may mimic SVCS where high degree of clinical suspicion is needed to discriminate them.

Conclusion: Superior vena cava syndrome may present with symptoms suggestive of Ludwig’s angina, especially if the obstruction is slowly progressive. A high index of suspicion is necessary in these cases.

Keywords: Ludwig’s angina, Superior vena cava syndrome, Adenocarcinoma, Bronchoscopy.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
Pratik Dipak Shah, Srijon Mukherji

Management Dilemma in a Challenging Case of Inflammatory Pseudotumor of an Orbitomaxillary Mass: A Review of Literature

[Year:2015] [Month:Number] [Volumn:7 ] [Number:1] [Pages:28] [Pages No:9-12][No of Hits : 688]


ABSTRACT

Objective: To present management dilemma in a challenging case of a benign orbitomaxillary pseudotumor and its importance of inclusion in the differential diagnosis of orbital disorders.

Design: Case Report

Setting: Private multispecialty hospital in Kolkata, West Bengal.

Patient: A 36-year-old female patient with 1 year history of orbitomaxillary mass, deviation and protrusion of left eyeball, diplopia and left sided headache.

Results: Resection of entire orbitomaxillary mass performed after assessing history, clinical and radiologic presentation of the case. Biopsy report came as mixed inflammatory lesion. Appropriate surgical intervention resulted in a dramatic improvement in patient’s clinical condition. At present, patient is disease-free and asymptomatic.

Conclusion: Complete surgical resection is the treatment of choice for inflammatory orbitomaxillary pseudotumors followed by corticosteroids in case of incomplete resection. Radiation therapy is indicated only in case when corticosteroids or surgical intervention is unsuccessful or contraindicated.

Keywords: Diplopia, Inflammatory pseudotumor, Orbitomaxillary mass, Corticosteroids.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Shweta Gupta, Himani Lade, Deepak Verma, Noor Ul Din Malik

Cartilage Palisade Type 1 Tympanoplasty: Anatomical and Audiological Outcomes

[Year:2015] [Month:September-December] [Volumn:7 ] [Number:3] [Pages:43] [Pages No:117-120][No of Hits : 661]


ABSTRACT

Objectives: To evaluate the anatomical (an intact tympanic membrane without atelectasis or lateralization) and audiological outcomes of type 1 cartilage palisade tympanoplasty.

Methods: The prospective study was done at a tertiary referral institute included 30 patients with mucosal type chronic otitis media requiring type 1 tympanoplasty including subtotal or total perforations and revision cases. The tympanic membrane reconstruction was done using full thickness broad cartilage palisades harvested from the tragus or concha with attached perichondrium laterally. Patients were assessed at 1st, 3rd and 6th postoperative months for assessment of graft uptake, healing of tympanic membrane and hearing evaluation using pure tone audiometry.

Results: Total 27 out of 30 patients had fully epithelized completely healed grafts postoperatively at 1 month (success rate of 90%) while three patients had small defect. One out of these three patients showed complete healing of graft while remaining two had persistent defect at 3rd and 6th months postoperatively. The mean pure tone air bone gap considerably reduced from 33.27 ± 4.29 dB preoperatively to 12.67 ± 5.68 dB postoperatively at 6 months.

Conclusion: Tympanic membrane reconstruction using full thickness palisades of cartilage provides good anatomical and audiological results with significant improvement of hearing specially in cases of subtotal or total perforations, revision surgery, atelectasis and Eustachian tube disorders where healing of tympanic membrane has much poorer prognosis irrespective of the surgical technique used.

Keywords: Cartilage, Palisade, Tympanoplasty.

How to cite this article: Gupta S, Lade H, Verma D, Malik NUD. Cartilage Palisade Type 1 Tympanoplasty: Anatomical and Audiological Outcomes. Int J Otorhinolaryngol Clin 2015;7(3):117-120.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
R Suma, KJ Jeena, VM Pavithran, A Govindan

Glial Heterotopia of Sphenoid in Association with a Patent Sternberg’s Canal presenting with Meningitis

[Year:2015] [Month:Number] [Volumn:7 ] [Number:1] [Pages:28] [Pages No:23-25][No of Hits : 642]


ABSTRACT

Ectopic glial tissue, presenting at various sites of body is a rare embryonic developmental anomaly. Very few cases are reported in adults, most being incidentally detected, revealed only by histopathological findings. One of the rarest locations is the sphenoid sinus.
We present here the case of a middle aged female, presenting with spontaneous cerebrospinal fluid (CSF) rhinorrhea and meningitis. With the radiological finding of a soft tissue density in sphenoid sinus with erosion of left temporal skull base, she underwent lateral craniotomy, with excision of the mass and middle cranial fossa floor repair. Histopathology revealed a heterotopic glial tissue. Peroperative finding of a well-defined defect in the lateral wall of an extensively pneumatized sphenoid showed typical features of a patent Sternberg’s canal.
This case could be a living proof for the existence of this rare developmental anomaly. A persisting Sternberg’s canal should be considered as the source of spontaneous CSF leaks with or without lesions in sphenoid sinuses with extensive lateral pneumatization. Most of the cases may be treated with an extended endoscopic approach. Extreme lateral lesions like this would benefit most from a craniotomy approach for proper closure of skullbase defect. Three years after successful surgery, she remains symptom free.

Keywords: Glial heterotopia, Sternberg’s canal, Spontaneous CSF rhinorrhea and meningitis.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
Bandar Al-qahtani, Mohammed Al Tuwaijri, Mohammed Al Mokhatrish

Fat Myringoplasty and its Impact on the Hearing Mechanism of Middle Ear

[Year:2015] [Month:September-December] [Volumn:7 ] [Number:3] [Pages:43] [Pages No:138-140][No of Hits : 610]