Saurabh Varshney

Epistaxis: A retrospective clinical study

Epistaxis is a common otolaryngologic problem. A 2.5 years retrospective study (June 1998 December 2000) of patients attending outdoor or indoor services of Department of ENT with complaint of nasal bleeding was done. The study was conducted on 88 patients for the incidence, age and sex relation, etiological factors, clinical findings, and treatment methods for epistaxis.

Ossicular Chain Status in Chronic Suppurative Otitis Media in Adults

This study was conducted to find out the status of the ossicles in cases of chronic suppurative otitis media (CSOM). One hundred and fifty cases of CSOM, who underwent surgery, were included and their intra-operative ossicular chain findings noted. Ossicular erosion was found to be much more common in unsafe CSOM than in safe CSOM. Malleus was found to be the most resistant ossicle to erosion whereas incus was found to be the most susceptible.

Verrucous carcinoma of larynx

A 55 years male presented with hoarsness of voice (4 months), cough (1 month), difficulty in breathing (15 days). Patient underwent an emergency tracneostomy and further workup proved it to be a case of verrucous carcinoma of larynx. Patient was treated surgically with satisfactory result.

Clinico bacteriological evaluation of surface and core microflora in chronic tonsillitis.

The present study is undertaken on 50 tonsillectomy cases to determine the correlation between surface culture swabs and tonsillar core. Tonsillar disease may stem from the bacteria within the core of the tonsil, rather than the bacteria identified on its surface. Also no consistent pattern of combinations of different pathogenic bacteria was noted. The study proves that surface culture does not reliably predict core pathogens.

Deafness in India

Deafness means loss of hearing and it may be partial or total. Hearing impairment cannot be seen and hence its effects are not visible to others, so deaf suffers in silence. Unlike blindness, deafness often provokes ridicules rather than sympathy. A deaf person is so isolated from family and friends and greeted by unsympathetic attitude he/she is often depressed and needs psychological counseling. The consequences for a child born with hearing loss are quite severe. It is well established that a child with hearing loss cannot develop speech and language abilities. This puts the child at a disadvantage in school, higher education, and limits future professional opportunities. The problem of the child deaf from the birth is quite different from that of the adult who has become completely deafened after school age or in adult life. The hard of hearing person whose deafness has developed slowly over the years is different again. But, for all of them, the handicap is the same – the handicap of the silent world, the difficulties of communicating with the hearing and speaking world.

Primary extraskeletal Ewing's sarcoma of the maxilla with intraorbital extension.

Extraskeletal Ewing’s sarcoma is often described as a tumour involving the soft tissues of the lower extremities and the paravertebral region. Primary Ewing’s sarcoma of the cranium is extremely rare, with only 17 cases reported so far [24]. Involvement of the paranasal sinus is a very rare entity. Involvement of facial bones is characterized by clinical and radiological features distinct from those commonly observed in other sites. Because of the above peculiarities a delay in diagnosis and thus in starting treatment is very probable in such cases. Primary Ewings sarcoma rarely arises in the facial skeleton and only occasionally in the maxilla. To date, there have been 22 cases of maxillary Ewing’s sarcoma reported in the English-language literature [25]. We report here a new case of Ewing’s sarcoma localized to the maxillary sinus, nose and the orbit, successfully treated by surgery, local high dosage radiotherapy and systemic chemotherapy.

Anterior craniofacial resection — for paranasal sinus tumors involving anterior skull base

Management of anterior skull base tumors is complex due to the anatomic detail of the region and the variety of tumors that occur in this area. Currently, the “gold standard” for surgery is the anterior craniofacial approach. Craniofacial resection represents a major advance in the surgical treatment of tumors of the paranasal sinuses involving anterior skull base. It allows wide exposure of the complex anatomical structures at the base of skull permitting monobloc tumor resection. This study presents a series of 18 patients with anterior skull base tumors, treated by a team of head-neck surgeons and neurosurgeons. The series included 15 malignant tumors of the nose and paranasal sinuses and 3 extensive benign lesions. All tumors were resected by a combined bi-frontal craniotomy and rhinotomy. The skull base was closed with a pediculated pericranial flap and a split-thickness free skin graft underneath. There were no postoperative problems of wound infection, cerebrospinal fluid-leakage or meningitis. Recurrent tumor growth or systemic metastasis occurred in 3 out of 15 patients with malignant tumors, 6 months to 2 years postoperatively. Craniofacial resection was thus found to give excellent results with low morbidity in malignant lesions and can also be adapted for benign tumors of anterior skull base.

Pre and post operative evaluation of hearing in chronic suppurative otitis media

Aim: To evaluate pre- and postoperative hearing status in patients of chronic suppurative otitis media (CSOM) undergoing mastoidectomy with tympanoplasty. Study type- Prospective. Materials and Methods: Eighty cases of CSOM were included. All patients underwent a pre-operative pure-tone audiometry (PTA) to find out the hearing status and to obtain documentary evidence for the same, and X-ray mastoid (bilateral Schullres view) to assess the pathology and surgical anatomy of the mastoid. All patients included in the study were categorized into three groups according to the surgery planned: Group-A: Tympanoplasty, Group-B: Canal wall up (CWU) mastoidectomy with tympanoplasty, and Group-C: Canal wall down CWD mastoidectomy with reconstruction. Post-operatively, after 10 weeks and 6 months, audiological examination (PTA) was carried out to compare pre- and post-operative hearing status. Results: In this study we found that postoperative hearing results were better in the case of safe CSOM as compared with unsafe CSOM and of tympanoplasty as compared with tympanoplasty with mastoidectomy.

Endoscopic Trans-Nasal Trans-Sphenoidal (TNTS) Approach For Pituitary Adenomas: Our Experience

Advances in optics, miniaturization, and endoscopic instrumentation have revolutionized surgery in the past decade. Current progress in the field of endoscopy promises to further this evolution: endoscopic telescopes and instruments have improved upon the optical and technical limitations of the microscope, and require an even less invasive approach to the sella. Pituitary surgery is traditionally within the realm of the neurosurgeon. However, since the reintroduction of the transseptal transsphenoidal approach and endoscopic transnasal transsphenoidal approach to the sella turcica for resection of pituitary adenoma, otolaryngologists have been active partners in the surgical management of these patients. Otolaryngologists have lent their expertise in nasal and sinus surgery, assisting the neurosurgeon with the operation. The otolaryngologist has the advantage of familiarity with the techniques and instruments used to gain exposure of the sella turcica by transnasal approach. Hence, the otolaryngologist provides the exposure, and the neurosurgeon resects the tumour. Such collaboration has resulted in decreased rates of complication and morbidity. We hereby discuss our experience of treating 54 cases of pituitary tumour by endoscopic transnasal approach at our hospital.

Clinico-pathological profile of sinonasal masses: An experience in tertiary care hospital of Uttarakhand

Background: The purpose of this study was to classify various types of non-neoplastic and neoplastic lesions presenting as sinonasal mass and characterize their clinico-pathological profile in a tertiary care center in the state of Uttarakhand. Materials and Methods: This was a prospective study where 110 cases of sinonasal masses were included over a period of 12 months. Clinico-pathological study was carried out in these cases. A provisional diagnosis was made after clinical assessment and radiologic investigations, but final diagnosis was made after histopathologic examination. Observations: The number of non-neoplastic lesions were more than the neoplastic lesion, 60% versus 40% respectively. In the neoplastic group, 19.8% and 23.76% patients presented with benign and malignant lesion, respectively. The incidence was more predominant in the age group of 11-20 years (22.72%) with male to female ratio of 1.08:1. In our study, among non-neoplastic lesions the occurrence of sinonasal polyps was highest seen in 80.30% cases. In neoplastic lesions, angiofibroma was most common benign lesion seen in 35% cases. Carcinoma nasal cavity was the commonest malignant lesion seen in 45.83% cases. In 3.63% patients, clinical and radiologic diagnosis was not correlated with histopathologic diagnosis. Only two cases required immuno-histocytochemistry to confirm the final diagnosis. Conclusion: We concluded that for proper evaluation of a sinonasal mass, clinical, radiologic, and histopathologic evaluation should be carried out conjointly in all the cases. Histopathology always gives a confirmatory diagnosis but in few cases immuno-histocytochemistry becomes the ultimate diagnostic technique for correct and timely intervention.