Otolaryngology and Head & Neck Surgery

Endoscopic Management of Tympanic Membrane Retraction Pockets: A Two Handed Technique with Endoscope Holder Abstract The tympanic membrane retraction pocket is a pathological invagination of tympanic membrane into the middle ear space. The most common sites for formation of retraction pocket are pars flaccida and postero-superior parts. Decision about the procedure and the timing of the treatment of retraction pockets is debatable and depends on the functional and anatomic condition of the ear. To evaluate the results of the technique of two handed endoscopic management of retraction pockets with sliced tragal cartilage. Prospective Non Randomized Clinical Study. The study included 41 ears operated with the technique of two handed endoscopic cartilage tympanoplasty for retraction pockets with endoscope holders from November 2013 to May 2016 with a follow up period ranging from 22 to 53 months. Cases of cholesteatoma and tympanic membrane perforation were excluded from the study. Pre and postoperative symptoms and air–bone gaps were recorded. The average preoperative air–bone gap in the study group was 24.53 ± 4.326 dB. 28 ears were of pars tensa retractions (stage II-4, stage III-15, and stage IV-9) and 13 were pars flaccida retractions (stage III-8 and stage IV-5). 24 ears had ossicular erosion. The follow up revealed that, the results of two handed endoscopic sliced cartilage tympanoplasty for retraction pockets were stable and there was no recurrence of the retraction and the post-operative air–bone–gap closure was achieved to 13.62 ± 4.78, 14.13 ± 5.91 dB, 14.32 ± 3.46 and 14.57 ± 3.88 dB at 6 months, 1 year, 2 years, 3 years respectively. Though, indications for surgery are based mostly on anatomic status and observation of behaviour of retraction pocket over time, we recommend early management of retraction pockets by the technique of endoscopic sliced tragal cartilage tympanoplasty with tragal cartilage of 0.5 mm thickness using endoscope holder. Level of Evidence: Level 4.

Tracheostomy: Open Surgical or Percutaneous? An Effort to Solve the Continued Dilemma Abstract Due to lack of globally standardized guidelines and clarity on indications, patient selection, intra-operative preparations, technique, complications, postoperative care and decannulation protocols, percutaneous tracheostomy (PT) has come in vogue as compared to standard open surgical tracheostomy (OST). PercuTwist and guide wire dilatational method (GWDF), techniques of PT, offer lesser operative time and ease of surgery being a bedside procedure. There seems to be paucity of Indian literature on rising trend of increasing indications, post-operative care, management of complications and outcomes of tracheostomy. And thus, there arises a felt need to envisage a study in tertiary care setup targeting these issues and to question the so far unchallenged acceptance of new techniques and technology. Our aim is to study the recent trend of indications, complications, and outcomes of both OST and PT in a cohort of Indian patients who underwent tracheostomy. 80 patients with mean age of 59.0 ± 15 years underwent tracheostomy (OST: 48 (60%), PT: 32 (40%), and among PT, PercuTwist: 16 (50%), GWDF: 16 (50%)) for various indications with objectives to compare operative time, complications and decannulation rates of tracheostomy surgery, within the follow up period of 3 months. Most common indication of elective tracheostomy was prolonged ventilation, and for emergency ones, upper airway obstruction. Mean operative time taken by all the three techniques was comparable, i.e., 16.3 v/s 15 v/s 15.3 min (Open v/s PT GWDF v/s PT PercuTwist). Most common intra-operative complication of OST was haemorrhage (16.3%) and that of PT was false passage (8.8%). Early post-operative complications were haemorrhage (OST: 3.75%, PT: 1.25%) and tube blockage and dislodgement (equal distribution among OST and PT). Late post-operative complications were stomal granulations in PT: 7.5%. Outcomes of tracheostomy were significantly better with OST (36 (45%)) than PT (14 (17.5%)). In PT group, PercuTwist fared better than GWDF in terms of lesser complications (PercuTwist: 10%, GWDF: 18.6%) and better decannulation rates (PercuTwist: 13.6%, GWDF: 3.75%). Most common indication for tracheostomy remains prolonged intubation; complication of OST is intra and early post-operative haemorrhage and that of PT being tube dislodgement and blockage. Outcomes in form of successful decannulation are with OST.

A Study on Outcome of Myringoplasty in Dry Ear (Quiescent/Inactive CSOM) Without Using Gelfoam in Middle Ear Abstract Myringoplasty is a common surgery done for patients with tympanic membrane perforation in our clinical practice. This study was done to know the outcome of myringoplasty done without using gelfoam as a scaffold material. Simultaneously other parameters influencing the outcome were analysed. In a total of 80 patients assessed over 25 months were divided into test and control group by quasi randomisation. All patients underwent endoscopic underlay myringoplasty. Control groups had gelfoam bed created with gelfoam, whereas the test group only middle ear air pocket created with a proper seal without using gelfoam. The study revealed that without using gelfoam and creating a good middle ear air pocket the results were comparable to the method of using middle ear gelfoam bed. Also few insights and understanding regarding the parameters we need to asses preoperatively were also observed. With comparable healing and hearing results without using gelfoam in the middle ear, the normal physiology is restored in the postoperative period much earlier. The result of the surgery also becomes evident in the second postoperative week when the use of gelfoam in the middle ear is avoided.

Biomarkers in Head and Neck Cancer an Update Abstract The study is aimed at establishing the purpose of tumour markers, their application, classification, diagnostic and therapeutic roles in the management of head and neck cancer. A literature review using Medline, Scopus, Google Scholar, the Cochrane Database of Systematic Reviews and the Cochrane central register of controlled trials for articles published between 1993 and 2016 on tumour markers and their role in head and neck cancer was performed. A broader search of prognostic markers in head and neck cancer was also carried out to avoid missing other pertinent markers. Natural history, tumour biology, stage and prognostic factors influence the outcome of management in patients with Head and Neck Squamous cell carcinoma (HNSCC). Evaluation of the cellular lineage and histogenic origin of diverse neoplasms can be done using tumour biomarkers. Identifying predictive tumour markers can lead to improvement in preventive management of HNSCC. There has been remarkable advancement in molecular technology with gene expression and proteomic profiling. Integration of specific tumour markers into routine clinical practice requires substantiation through well designed clinical trials. The investigation of tumour markers is imperative as they influence the prognosis of HNSCC and provide the potential to improve outcomes of treatment through targeted therapy. We have outlined recent tumour biomarkers in this review which have significant role in diagnosis, screening and prognostication in HNSCC. Recent advancement in clinical applications, therapeutic strategies of tumour markers has been highlighted.

Three Dimensional Rhinoplasty and Nasal Airway Improvement in Cleft-Nose Deformity Abstract Septorhinoplasty is particularly challenging among revision surgeries for cleft sequelae. The challenge of cleft septorhinoplasty is mainly due to the complex anatomy of nose, deformity of each of its components and the difficulty and lack of clarity in surgical management. From 2014 to 2017, 26 patients with cleft lip nose deformity were operated by the same cleft team. The study was conducted to assess the improvement in nasal airway and appearance following secondary rhinoplasty with extracorporeal septoplasty. Post operatively each patient was evaluated using the standard modified rhinoplasty outcome evaluation questionnaire, a validated instrument that aids in stratifying patients according to their subjective response. All patients reported great relief of nasal obstruction and improved breathing. More than 80% of our patients were satisfied with improved aesthetics and reported better self-confidence. Secondary cleft rhinoplasty with extracorporeal septoplasty surgery significantly improves the cosmesis and nasal airway opening, subsequently giving them improved self-confidence.

Giant Warthin's Tumour of the Parotid Gland: A Rare Case Report Abstract Warthin's tumour was first adequately described in 1929 by an American pathologist, Aldred Scott Warthin. It is synonymous with papillary cystadenoma lymphomatosum (PCL), cystadenolymphoma or adenolymphoma. Giant salivary gland tumours are usually pleomorphic adenomas. The average size of Warthin's tumour is reported to be about 2–4 cm. In the current fascinating case, an enormous disfiguring salivary gland tumour was reported which turned out to be Warthin's tumour on histopathology, which is probably the largest PCL reported till date.

Bilateral Vestibular Atelectasis with Tullio's Phenomenon Abstract Vestibular dehiscence or atelectasis is a rarity known to cause vertigo. This pathology poses many challenges especially in diagnosis and treatment simply due to the scarcity of reported cases. The etiologic factors, disease pathophysiology and complications remain unclear. We report a young adult female who presented with unsteadiness for 2 years associated with headache. Tullio's phenomenon was observed which led to a finding of bilateral vestibular dehiscence involving the medial walls on high resolution computed tomography.

Round Window Insertion in Veria Technique of Cochlear Implantation: An Essential Modification Abstract Cochlear implants have been done using various surgical approaches. The classical posterior tympanotomy approach has been practiced by majority of surgeons worldwide. An alternative approach is the transcanal Veria approach. This is non mastoidectomy approach where the electrode is threaded via a transcanal tunnel into the cochleostomy site. Majority of "Veria" surgeons are inserting the cochlear electrodes via a cochleostomy. This article focuses on round window insertion of cochlear electrode which has been proven to be a "softer "technique of electrode insertions and finds its role in preservation of residual hearing. Out of 115 cochlear implants done at AIIMS Patna between May 2014–May 2018, using the Veria approach, 52 patients have now been done using the round window insertion. Veria approach is a non-mastoidectomy technique where a special perforator is used to drill a trans canal tunnel which lodges the cochlear electrodes. All kind of implants were used and round window insertion was possible with different kind of electrodes. Out of 52 implants, 24 were MEDEL Sonata with straight electrode and flex soft electrode, 21 were Advanced Bionics Precurved 1 J electrode, 2 were (CI 24 REST) Cochlear devices standard straight array and 5 were Neurelec standard straight array devices. Insertion was uneventful in all the cases and intra op telemetry results were satisfactory post insertion. Round window insertion has now become routine for cochlear implants especially in cases where we have to preserve residual hearing. Veria approach earlier was considered to be only a "cochleostomy" approach but our successful insertion via the round window using the Veria technique is a landmark modification and alleviates any such limitation which was associated with this technique before.

Quality of Life in Patients with Nasal Septal Deviation After Septal Correction Abstract Septal Correction is an age-old procedure being practiced for the major part of a century now. The aim of this study was to assess the quality of life after Septal Correction. Fifty patients with complaints of nasal obstruction, trouble breathing via the nose, headache and facial pain were selected for the study. Initial pre-operative assessment was done based on a symptomatic score [Nasal Obstruction Symptom Evaluation Scale (NOSE Scale)]. The presence of a septal deviation was confirmed with an X-ray and computed tomography of the paranasal sinuses along with a diagnostic nasal endoscopy. Based on the extent and location of deviation, the malformed part was corrected. Post-operative assessment was done after a period of 8 weeks based on the NOSE Scale. The results were co-related and documented. It was found that the scores were better post-surgery. Thus, it can be concluded that Septal Correction as a surgical procedure is still relevant in today's World for symptomatic betterment and for a healthier lifestyle.

A Comparison of Surgical Outcomes of Carbon Dioxide Laser Versus Conventional Cold Instrument Excision of Benign Vocal Cord Lesions Abstract Benign vocal fold lesions affect the vibratory function of the vocal folds and cause dysphonia. Surgical excision has been the mainstay of management of benign vocal fold lesions for decades. This study compares the surgical outcomes of cold instruments versus carbon dioxide (CO2) laser excision of benign vocal fold lesions. A total of 49 cases diagnosed with benign vocal fold lesions were divided randomly to undergo excision either by conventional cold steel method or by CO2 laser. The postoperative assessment of the groups was done by videostroboscopy, acoustic analysis and voice handicap index. There was a significant improvement (P value < 0.05) when preoperative values of the parameters were compared with postoperative values in the individual groups. However, there was no significant difference when the two groups were compared with each other in terms of outcomes. Both the surgical techniques provide good outcomes in management of benign vocal fold lesions and each has its own advantages and disadvantages.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com