P. P. Singh

Chorda tympani in chronic inflammatory middle ear disease.

Objectives: To study the effect of chronic inflammatory middle ear disease on gustatory function of chorda tympani nerve. Methods: A prospective study was performed on 85 patients having unilateral chronic inflammatory middle ear disease of either cholesteatomatous or noncholesteatomatous type. Gustatory assessment on both sides of the tongue was performed using dry taste strips. Results: Comparison of mean taste scores on the side of diseased ear vs normal ear was done. On the diseased side the mean taste score was 9.16 and on the normal side the mean taste score was 13.24. The difference between the two was found to be statistically significant (P < 0.0001). The results were also analyzed for various other parameters like type, duration, and location of disease. Conclusion: A patient with chronic inflammatory middle ear disease already has dysfunctional chorda tympani and is unlikely to notice a change in the taste sensation in the event of cutting of the nerve during the course of an ear surgery.

Sialendoscopy: Introduction, Indications and Technique

Recent decades have been marked by clinical research in otolaryngology and head & neck surgery directed towards the concept of organ and function preservation. Morbidity in head and neck diseases has been greatly reduced with acceptance of conservation procedures and open surgical approaches are getting largely replaced with endoscopic ones, wherever possible. Though there are more or less set treatment protocols for tumors of salivary glands, other pathologies like sialolithiasis and juvenile recurrent parotitis have been treated on arbitrary basis. Sialadenitis secondary to obstructive pathologies including sialoliths, strictures and ductal polyps, remains the most common disorder of the salivary gland [1–3]. Patients would receive sorts of treatment like antibiotics, steroids, sialogogues, anticholinergics or would undergo surgeries like intraoral incision and removal of the sialolith or even gland removal. Also, there were no answers to pathologies like ductal stenosis secondary to chronic inflammation. Introduction of sialendoscope has brought in a paradigm shift in the management of these pathologies. This minimally invasive technique was first described by Katz and Fritsch [4] in 1990s who used flexible endoscope for evaluation of salivary gland ducts. Since then, enhanced optical resolution and miniaturisation of instruments through various advances in technology has resulted in advanced techniques in sialendoscopy. Otolaryngologists and some other clinicians including oral surgeons at certain centres pioneered this speciality and have propagated the philosophy through structured training programmes. Sialendoscopy has emerged as a preferred diagnostic as well as therapeutic tool for management of salivary gland pathologies and has helped significantly reduce the morbidity, loss of work hours and hospital stay. Though a lot of research is still going on in this field, but a set of indications and techniques have evolved over a period of time.

Generating an evidence base for information, education and communication needs of the community regarding deafness: A qualitative study

Background: India is a significant contributor to the world’s total burden of deafness. Out of all causes, almost 50% of the causes of decreased hearing are preventable. With the launch of the National Programme for Prevention and Control of Deafness, the need for an effective information, education and communication (IEC) campaign was felt. There is negligible information available about the status of awareness levels of the community about the various aspects of hearing loss. We carried out this research with the objective of getting to know the existing awareness related to hearing loss in the community to generate an evidence base for formulating various messages to be incorporated in IEC materials for dissemination in the community. We also asked the participants about their suggestions for the various information resources so that an IEC campaign could be designed accordingly. Materials and Methods: We carried out 10 focus group discussions among various groups of population and analyzed the discussion. Results: A descriptive analysis of the observations regarding the awareness about deafness in the community and prevalent myths and suggested information resources is presented. Conclusion: We highlight the lacunae in the existing awareness of various causes of deafness and the preventive measures that could be taken to prevent hearing loss. The evidence generated was used to formulate relevant messages for the various target groups, which were then incorporated in development of the IEC materials for the dissemination in the community.

Parapharyngeal space lipoma

I ipomas of the Para-pharyngeal space are rare lesions Very few cases of such tumors have be en reported in the literature Definitive diagnosis and decision regarding the surgical approach Here difficult in the pre CT scan era This was further compounded by the complex anatomy of the Para pharyngeal space A case of Para pharyngeal lipoma is being presented because of its ratity and characteristic radiological features After confirmation of the diagnosis the tumor was excised via a transcertical approach

Antrochoanal polyp — Validating its origin and management by endonasal endoscopic sinus surgery (eess)

Aim and Objectives: 20 fresh cases of Antrochoanal Polyps were subjected to EESS for studying the site of origin and to validate its efficacy. Study Design: This was a prospective study in which the cases were subjected to surgery and were followed; up for evaluation of results. Methods: The surgery performed was an endoscopic endonasal sinus surgery preceded and followed by transcanne sinuscopy. Results/Findigs: The age at the time of presentation ranged from 7-35 years. Male to female ratio was 1:1:5. Occurrence Antrochoanal Polyp was 1.5 times more common on the left side. The mean duration of symptoms was 3 years. The main presenting symptom was unilateral nasal obstruction in 100% of cases. Allergic symtomps.were noticed in 10%. Vasmotor symptom were present in 15% of the patients. Antroscopy revealed the antral part.to be cytic in 100% of the cases. The site of origin of the polyp could be ascertained in only 12 out of 20 cases; in 7 of them it acrose from the infrolateral wall of maxillary sinus, in 2 from the infromedial wall und in 2 it appeared to arise from the supromedial wall while in 1 from margin of the ostium. Post-surgery intra-natral remnants were found in 3 out of 20 cases i.e. in 15% of them. In two cases it was removed through maxillary ostia but in one case removed through transcanine route. Conclusions: Endoscopic Sinus Surgery is the best modality of treating Antrochoanal Polyps. We report a success rate of 95% in our series.

Neurilemmoma of the Facial Nerve presenting as a Parotid Mass.

A facial nerve neurilemmoma manifesting as a parotide mass is a occurrence. Symptoms are slowly progressive and diagnosis is often delayed. We present a case report of a facial neurilemmoma, which presented as a parotid mass.

Effect of Mastoid Drilling on Hearing of Contralateral Ear

ceived daily intratympanic saline injections. Outcome Measurements: Auditory brainstem response (ABR) thresholds were determined preand one-day-post-treatment using 4 ms pure-tone bursts between 8 and 32 kHz. Statistical comparisons were completed using student’s two-tailed t-test. RESULTS: Pre-injection mean (SEM) ABR threshold in saline-treated ears was 44.6 dB (1.74) versus 44.1 dB (1.81) in M-ALA-treated ears (p 0.42). Post-injection mean (SEM) ABR thresholds were 45.3 (1.60) for saline-treated ears and 45.6 (1.71) for M-ALA-treated ears (p 0.38). Comparison of preto post-injection ABR thresholds showed no statistical difference within saline-treated (p 0.47) or M-ALA-treated ears (p 0.60). All ears displayed minimal granulation around tympanic membrane injection sites, although M-ALA treated ears showed slightly delayed development of minimal granulation compared to saline ears. Tympanic membranes of both groups showed no difference by 1 week after treatment, with healing perforations and decreasing granulation. CONCLUSION: Intratympanic application of methyl deltaaminolevulinic acid over a 7 day course in a murine model does not produce measurable acute ototoxicity and is well tolerated.

Impact of nasal polyps on quality of life of chronic sinusitis patients

ObjectiveTo study the significance of nasal polyps on the symptoms of chronic rhinosinusitis (CRS) and their influence on surgical outcomes.MethodsRetrospective analysis of prospectively collected data comparing two groups of patients diagnosed with CRS with and without polyps who underwent surgery with a minimum of 3 month follow up period. Subjective scoring was performed using the Sino-nasal Outcome Test (SNOT-20) questionnaire. Computed tomography (CT) scans were compared using the Lund-Mackay scoring system. Endoscopic findings were graded according to Lanza and Kennedy staging system. The two groups were analyzed for the need of revision surgery.Results30 patients underwent surgical management of CRS over a period of one year. 20 were male, 10 were female and the average age was 26 years (range 15–55years). Polyps were present in 15 patients with CRS while, the other 15 did not have polyps. The average CT score was 10.13 for the polyp group and 9.79 for patients without polyp.The Polyp group SNOT-20 preoperative scores averaged 20.27 with improvement to 3.80 at 2 weeks, 2.67 at 1 month and 2.93 at 3 months (86.21% improvement p=0.001). Non-polyp group SNOT-20 scores were 18.80 preoperatively with improvement to 4.67 at 2 weeks, 3.40 at 1 month and 3.27 at 3 months (81.83% improvement). Preop diagnostic endoscopy on polyp group was 5.27 which improved to 2.13 in 2 weeks, 1.33 in 1 month and 1.53 in 3 months (73% improvement). In the non polyp group it was 4.53 pre-operatively which improved to 1.20 in 2 weeks, 0.93 in 1 month and to 1.13 in 3months (69% improvement). 6 patients required revision surgery (20%), 3 (10%) belonging to polyp group and 3 (10%) who did not have polyps.ConclusionNasal Polyp has a significant negative impact on the patients with CRS. Patients with polyps have higher symptom scores, worse objective findings compared with patients without polyp, but patients with polyp show more improvement after surgical intervention and need for revision surgery is equal in both groups.

A case of large dentigerous cyst containing canine tooth in the maxillary antrum

A ease of large dentigeram cyst containing a canine tooth in the maxillary antrum is presented. This case is of interest because of its extension up to the skull base and presence of canine tooth in the cyst. Excision of cyst containing the eclopic tooth was made.