Vikas Sinha

External vs. internal osteotomy in rhinoplasty

BackgroundThe aim of study is to compare the external osteotomy vs. internal osteotomy in patients undergoing rhinoplasty.MethodsThe study group comprised of 45 patients that had undergone rhinoplasty surgery. The 25 patients had undergone internal / endonasal continuous lateral osteotomy and 20 patients had undergone external / percutaneous perforating digital osteotomy. The internal osteotomy was done high to low to high using 4 mm. curved guarded osteotome. The external osteotomy was done by 2 mm sharp osteotome. The scoring system of Kara and Gokalan was followed for edema and ecchymosis.ConclusionExternal osteotomy is an easy approach to carryout and makes fracture with high precision along preset lines. The bone stump is stable. The damage to the nasal mucosa is much less. There is reduced bleeding, reduced edema and reduced ecchymosis around eyes. The cutaneous scar at the entry site of osteotome is invisible.

Foreign body in tracheobronchial tree

Foreign body inhalation into the tracheobronchial tree can prove to be a life threatening unless timely intervened and appropriate steps are being taken towards its management [1]. A review of 32 cases was done at MP Shah Medical College Jamnagar over a period of 2 years. Children were most susceptible to aspiration of foreign bodies. All the cases were selected on the basis of detailed clinical history, clinical features, and radiological findings. The cases which had a strong index of suspicion without any positive clinical history were also subjected to rigid bronchoscopy under general anesthesia. Maximum number of cases was in the age group of 1 to 3 years (62.5%). The minimum age group ranging from 6 months to maximum 8 years. The time of presentation of the patients varied from within 24 hours to upto 6 months. Only four patients presented within 24 hours. The maximum presenting period was within 1 week. Organic foreign bodies were most common presentation (groundnut). Other foreign bodies were grains, seeds, ball pen cap, stones and slate pencil. Definite history of inhalation was available only in 19 cases with symptoms of choking, breathlessness, cough and recurrent upper respiratory tract infection. Right main bronchus was found to be most common site of impaction (52%) followed by left main bronchus (32%) and tracheal foreign body (16%).

Extracorporeal septoplasty-how we do it at marienhospital stuttgart germany

Septoplasty is one of the most common surgery of ENT but even today the difficult septum still presents a great surgical problem. A severe septum deformity is usually due to an accident quite often in childhood. It is also seen in patients with malformation such as cleft lip and cleft palate deformity. It affects not only the nasal function, but also the aesthetic part of the nose. Severe septal deformities can not be corrected properly by the standard septoplasty techniques. Therefore in such cases an extracorporeal septoplasty is recommended. In this technique the whole septum is taken out, the bony and cartilaginous septum in one piece if possible, a new septal plate is reconstructed by different surgical techniques, followed by replantation and reconstruction of the cartilagenous dorsum. The first author kept on improving the safe septal fixation, rebuilding of cartilagenous dorsum and overall the extracorporeal septoplasty technique over the period of time and this technique with all its refinement can be recommended to all the surgeons dealing with this challenging noses.

Comparative study of attenuation measurement of hearing protection devices by real ear attenuation at threshold method

Aim: The aim of the present study was to find out the measurement of real protection of ear muffs and as well ear plugs along with comparison of the efficacy of different hearing rotection devices (HPDs) in attenuation of stimulus levels for various stimuli by real ear attenuation at threshold method. Materials and Methods: Subject group consisted of ten males with the mean age of 20 years having normal hearing sensitivity (pure tone audiometry (PTA) less than 25 dB). Sound field measurement of thresholds was carried out for various stimuli, that is, warble tone, narrow band noise, and speech noise. Frequencies from 250 Hz to 12 KHz were tested in a sound treated room. For comparison, experimenter personally fitted the HPDs, that is, ear muff using experimenter fit method. Occluded threshold levels, that is, threshold of audibility for the test signals were measured in exactly same way as was done for open thresholds. The same procedure was followed for ear plugs also. Measurements were summarized at each frequency in terms of grand mean and a standard deviation of the protection values for both HPDs. Results: In all cases the mean attenuation was similar to optimum figures suggested in the literature, but the standard deviation was relatively high. Ear plugs produce more attenuation for low as well as high frequencies of warble tone and narrow band noise, but ear muff are better attenuators at mid frequencies for both warble tone and narrow band noise and also for speech noise stimulus. Conclusion: The attenuations provided by different types of HPDs vary across various nature and frequencies of that noise. This is to be kept in mind while suggesting for appropriate type of Hearing Protection Devices [HPDs] for optimal benefit.

A case study of Plummer-Vinson syndrome

The case series presents the pattern of association of different co-morbid conditions of Plummer Vinson’s Syndrome. The commonest morbidity is web at post cricoid level. The symptoms of dysphagia are more common and there appears to be a female preponderance. The presenting age us usually 5th decade. Although association with post cricoid carcinoma has been reported but only 10% of cases in the present series had carcinoma at the time of presentation. The effect of iron and B-complex supplementation has been clinically appraised and good symptomatic relief has been seen. Maybe this measure can prevent the progression to malignancy. Bouginage was effective in relieving symptoms in all the cases it was tried

Balloon and bougie dilation of benign esophageal strictures

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.

Juvenile nasopharyngeal angiofibroma—our experience at a referral hospital

Nasopharyngeal angiofibroma is a rare, highly vascular locally invasive tumor with a strong tendency to bleed. It usually occurs in young adolescent males. This is a retrospective study of 53 patients with nasopharyngeal angiofibroma. All the cases were treated surgically by different conventional approaches depending upon the extent of the mass. Transpalatal approach was used in 32 cases, lateral rhinotomy in 13 cases and a combination of transpalatine + lateral rhinotomy + caldwel-luc in 8 cases. There is no recurrence in 49 cases till date. However, recurrence was noted in four cases within six months. Three out of four patients with recurrence had to undergo repeat surgery for the removal of angiofibroma within six months while the remaining one was referred to radiotherapy as the mass was invading the cavernous sinus. The various clinical presentation and treatment modalities are discussed.

Endoscopic dacryocystorhinostomy with conventional instruments: results and advantages over external dacryocystorhinostomy.

BackgroundThe aim of study is to evaluate the Endoscopic dacryocystorhinostomy (DCR) with conventional instruments, its results and advantage over external dacryocystorhinostomy (DCR).MethodsThe study group comprised of 127 patients who underwent consecutive endoscopic dacryocystorhinostomy. The cases operated by one team were included in the study to make the uniform analysis and its result. There were 48 males and 79 female in this study and male female ratio was 1:1.6. The mean age of the patient was 37 years (range from 16 years to 58 years). There were wide variety of cases like epiphora, lacrimal sac abscess, lacrimal sac fistula, acute dacryocystitis and road vehicular accident. All the patients had undergone non-laser, non-powered conventional instruments surgery under local anesthesia. The lighted probe was not used in any case for sac identification. The free flow of saline through newly created stoma during sac syringing was considered as successful criteria. The stent was used in two cases of road vehicular accident and in remaining 125 cases no stent was used. There were 66 cases of epiphora, 30 cases of lacrimal sac abscess, 26 cases of acute dacryocystitis, 3 cases of lacrimal fistula and 2 case of road traffic accident with multiple fractures. The average follow up period was 17 months (maximum follow up 3 years and minimum 4 months.)ResultsThe success rate was 96 %.ConclusionThe endoscopic DCR with conventional instruments is safe with very high success rate without any complications. It can be done in acute cases and very much suited for lacrimal sac abscess and lacrimal sac fistula.

Efficacy of voice therapy in teachers: Using perceptual assessment protocol

Introduction: Teachers are professional voice users, and thus, they have more chances of having voice disorders. Risk factors due to occupation have been comprehensively examined; however, very little research has been done on the need of therapy and efficacy of voice therapy in teachers. Objectives: To assess the efficacy of voice therapy in teachers using qualitative assessment protocol and to recognize factors those are more sensitive to voice therapy. Methods: This study included two groups within the age range of 25-50 years. Group 1 included 10 participants having dysphonia who attended therapy and group 2 included five participants having dysphonia who could not attend therapy due to some reasons. Participants in both groups were teachers. Further, a perceptual assessment protocol was administered twice with the interval of 3 months. Results and Discussion: Voice therapy improved voice quality in group 1 who attended therapy compared to group 2. There was a significant difference seen in perceptual measures in group 1 pre- and post-therapy. Conclusion: Voice therapy lead to improvement in voice quality which is indicating that teachers should be sensitize for vocal hygiene and voice therapy, and further research is needed in this area.

Effects of background noise on transiently evoked otoacoustic emissions in newborn hearing screening

Introduction: Newborn hearing screening program is one of the services offered in Neonatal Intensive Care Units (NICU) by most of the neonatologist today. Aim of the Study: Present study aimed to investigate the ambient noise levels which allow successful transient evoked otoacoustic emission testing. Method: 25 normal hearing neonates (group 1) and 25 normal hearing adults (group 2) participated in the study. Both groups were tested at 30 dB sound pressure level (SPL), 40 dB SPL and 50 dB SPL noise levels. Results and Discussion: Tests results showed with increase in noise levels number of passing subjects decreased and also testing was done at times more than once. Conclusion: Tester should take care of noise levels while doing the test in NICU, which can give false negative responses.