Publications by authors named "Sunil Kumar Saxena"

45 Publications

Role of endotracheal tube size on nasal and laryngeal morbidity during awake fiberoptic nasotracheal intubation: A Randomized controlled trial.

J Anaesthesiol Clin Pharmacol 2022 Jan-Mar;38(1):124-129. Epub 2021 Dec 1.

Department of Ear, Nose and Throat, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.

Background And Aims: Awake fibreoptic nasotracheal intubation is associated with adverse airway and hemodynamic complications. The aim of this study was to evaluate the role of endotracheal tube size on nasal and laryngeal morbidity during awake fibreoptic-guided nasotracheal intubation.

Material And Methods: Eighty patients recruited to undergo awake fibreoptic intubation were randomly allocated to Group C (standard size endotracheal tube) and Group S (small size endotracheal tube followed by exchange to standard size using Airway Exchange Catheter under general anesthesia). Nasal morbidity was assessed by incidence of epistaxis, olfactory acuity, and mucociliary clearance. Patient discomfort during intubation was assessed using grimace score and hemodynamic parameters were recorded. Postoperatively, the incidence of nasal and laryngeal injury was recorded using nasendoscopy and telelaryngoscopy, respectively.

Results: Demographic profile between the two groups was comparable. Epistaxis was noted in 47.5% of patients in group C as compared to 12.5% in group S. Postoperative olfactory acuity was decreased [2 (1-4) vs 4 (2-5)] and saccharin clearance time was prolonged (314 s vs 134 s) in Group C as compared to Group S. (-value <0.001) Higher grimace score [2 (1-3) vs 1 (0-2)] and increased hemodynamic response was demonstrated in Group C. (-value <0.001) Incidence of nasal injury [2 (1-4) vs 1 (0-2)] and laryngeal injury [1 (0-2) vs 0 (0-2)] was more in Group C as compared to Group S.

Conclusion: Awake fibreoptic nasotracheal intubation with small size endotracheal tube followed by exchange to standard size under general anesthesia reduces nasal, laryngeal, and hemodynamic complications.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/joacp.JOACP_209_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9191795PMC
December 2021

Comparison of the Efficacy of Septoplasty with Nonsurgical Management in Improving Nasal Obstruction in Patients with Deviated Nasal Septum - A Randomized Clinical Trial.

Int Arch Otorhinolaryngol 2022 Apr 23;26(2):e226-e232. Epub 2021 Aug 23.

Department of Otorhinolaryngology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.

 In the current era, the major indication for septoplasty is nasal obstruction due to deviated nasal septum (DNS). Even though septoplasty is a commonly performed surgery, its effectiveness in relieving nasal obstruction in DNS has not been proven.  The present study involved the measurement of both objective (nasal patency) and subjective (quality of life measures) outcome measures for the evaluation of the efficacy of septoplasty as compared with medical management.  Patients with DNS presenting with nasal obstruction were included and randomized into a septoplasty group or into a nonsurgical management group, with 70 patients in each group. The improvement in nasal obstruction was assessed subjectively by the visual analogue scale (VAS), and the sino-nasal outcome test-22 (SNOT-22) and the nasal obstruction symptom evaluation (NOSE) questionnaires and was measured objectively by assessment of nasal patency by peak nasal inspiratory flow (PNIF) at 0, 1, 3, and 6 months of treatment in both groups.  The average VAS, SNOT-22 and NOSE scores for the septoplasty versus the nonsurgical group before treatment were 6.28 versus 6.0, 19.5 versus 15, and 14 versus 12, respectively, and at 6 months post-treatment, the scores were 2.9 versus 5.26, 10 versus 12, and 8 versus 10 (  = 0.001), respectively. The average PNIF scores at 0 and 6 months were 60/50 l/min and 70/60 l/min, respectively, in the septoplasty group (  = 0.001); the scores at 0 and 6 months in the nonsurgical management group were 60/60 l/min and 70/70 l/min, respectively (  = 0.001).  Surgical correction of DNS by septoplasty improves nasal obstruction better than nonsurgical management at 6 months postsurgery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0041-1730993DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9122760PMC
April 2022

'Shifting from anxiety to the new normal': A qualitative exploration on personal protective equipment use by otorhinolaryngology health-care professionals during COVID-19 pandemic.

Niger Postgrad Med J 2022 Apr-Jun;29(2):110-115

Department of ENT, JIPMER, Puducherry, India.

Background: The novel coronavirus pandemic has influenced the working practice of health-care professionals who come across symptomatic and asymptomatic COVID patients in their day-to-day practice. Especially, among HCWs in otorhinolaryngology, with the risk of exposure being high, hence were mandated to use personal protective equipment (PPE).

Materials And Methods: The change in perceptions and patterns of PPE use throughout the COVID-19 pandemic was studied in detail through interviews conducted among 15 key informants, and the data were analyzed using health belief model in our study.

Results: A health belief model explains the trajectory of PPE use by otorhinolaryngology health care providers during the COVID-19 pandemic. The course of usage of PPE by otorhinolaryngology health-care professionals during the COVID-19 pandemic was explained through the health belief model. During the initial days of the COVID-19 pandemic, intense perceived severity and susceptibility to COVID infection led to PPE use, and otorhinolaryngology HCWs resorted to higher grade PPEs which gave optimal protection; but in course of time with a better understanding of the natural course of illness, minimal PPEs without compromising HCW safety were used with minimal discomfort. Perceived severity of COVID infection on self and family, health knowledge, influence of peers, and support from the institution encouraged them in using PPEs.

Conclusion: We found that various aspects of health belief model such as the perceived susceptibility, perceived severity of the disease, perceived barriers and benefits in PPE use, self-efficacy, health-related knowledge, and the cues to action influence PPE use among otorhinolaryngology HCWs. The key findings can be applied in behavior change models to promote the use of PPE in the hospitals, especially during the time of pandemic.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/npmj.npmj_10_22DOI Listing
May 2022

An unusual case of tongue swelling.

Cytopathology 2022 Apr 15. Epub 2022 Apr 15.

Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/cyt.13129DOI Listing
April 2022

Naso-Bronchial Rhinosporidiosis.

BMJ Case Rep 2022 Feb 9;15(2). Epub 2022 Feb 9.

Pathology, Sri Venkateshwaraa Medical College Hospital & Research Centre, Puducherry, India.

Rhinosporidiosis is a chronic mucocutaneous granulomatous disease caused by , commonly affecting the nose and nasopharynx. Endobronchial involvement is of rare occurrence but can pose challenging problems for diagnosis, surgical excision and anaesthetic management. We report a 40-year-old man with a history of recurrent nasal rhinosporidiosis who presented with unilateral nasal obstruction, cough, shortness of breath and a radiological feature of left lung collapse. Eight years since the last surgery, he presented with a recurrent lesion in the nose with concurrent endobronchial involvement. The patient underwent excision of the nasal and the endobronchial lesion successfully under general anaesthesia without any complication and good symptomatic improvement. The clinical presentation and the management of endobronchial rhinosporidiosis are discussed here. The surgical difficulties faced during the procedure are highlighted.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bcr-2021-247133DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8830203PMC
February 2022

Middle turbinate angiofibroma in an adolescent boy.

BMJ Case Rep 2022 Feb 7;15(2). Epub 2022 Feb 7.

Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India.

Bleeding nasal mass in adolescent boys has customarily been attributed to Juvenile nasopharyngeal angiofibroma. However, little is known regarding the extranasopharyngeal origin of angiofibroma, as highlighted in this case report of a 15-year-old boy who presented with recurrent epistaxis and nasal obstruction. On constructing a working diagnosis of nasal haemangioma, the patient was taken up for endoscopic excision under general anaesthesia. Intraoperative endoscopic findings and histopathological examination revealed the diagnosis of middle turbinate angiofibroma, which is an extremely rare extranasopharyngeal angiofibroma. Consequently, this represents the third described case of a juvenile angiofibroma arising from the middle turbinate.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bcr-2021-246490DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8823056PMC
February 2022

Change in dysphagia and laryngeal function after radical radiotherapy in laryngo pharyngeal malignancies - a prospective observational study.

Rep Pract Oncol Radiother 2021 30;26(5):655-663. Epub 2021 Sep 30.

Department of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram, India.

Background: Intensity modulated radiotherapy (IMRT) has the perceived advantage of function preservation by reduction of toxicities in the treatment of laryngo-pharyngeal malignancies. The aim of the study was to assess changes in dysphagia from baseline (i.e. prior to start of treatment) at three and six months post treatment in patients with laryngo-pharyngeal malignancies treated with radical radiotherapy ± chemotherapy. Functional assessment of other structures involved in swallowing was also studied.

Materials And Methods: 40 patients were sampled consecutively. 33 were available for final analysis. Dysphagia, laryngeal edema, xerostomia and voice of patients were assessed at baseline and at three and six months after treatment. Radiation was delivered with simultaneous integrated boost (SIB) using volumetric modulated radiation therapy (VMAT). Concurrent chemotherapy was three weekly cisplatin 100 mg/m.

Results: Proportion of patients with dysphagia rose significantly from 45.5% before the start of treatment to 57.6% at three months and 60.6% at six months post treatment (p = 0.019). 67% patients received chemotherapy and addition of chemotherapy had a significant correlation with dysphagia (p = 0.05, r = -0.336). Severity of dysphagia at three and six months correlated significantly with the mean dose received by the superior constrictors (p = 0.003, r = 0.508 and p = 0.024, r = 0.391) and oral cavity (p = 0.001, r = 0.558 and p = 0.003, r = 0.501). There was a significant worsening in laryngeal edema at three and six months post treatment (p < 0.01) when compared to the pre-treatment examination findings with 60.6% of patients having grade two edema at six months. Significant fall in the mean spoken fundamental frequency from baseline was seen at 6 months (p = 0.04), mean fall was 21.3 Hz (95% CI: 1.5-41 Hz) with significant increase in roughness of voice post treatment (p = 0.01).

Conclusion: There was progressive worsening in dysphagia, laryngeal edema and voice in laryngo-pharyngeal malignancies post radical radiotherapy ± chemotherapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5603/RPOR.a2021.0078DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8575359PMC
September 2021

A Trip Down the Bronchus- A Tracheostomy Complication in COVID Pandemic.

Indian J Otolaryngol Head Neck Surg 2021 Aug 22:1-4. Epub 2021 Aug 22.

Department of ENT, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Pondicherry, 605006 India.

Foreign body of the trachea and the bronchus are critical emergencies which can lead to life threatening complications. But the advent of the 2019 novel corona virus disease, pandemic has dramatically changed the comfort of these procedures since aerosol generating medical procedures pose a risk and spread of infection to the health care workers. Even the patients are uncomfortable visiting the hospital due to the fear of acquiring the COVID infection.A 41-year-old obese female with grade 4 subglottic stenosis status post tracheostomy presented with foreign body Fuller's tracheostomy tube flange in the right bronchus during the COVID 19 pandemic. The patient had delayed presentation to the hospital due to fear of getting exposed to COVID and poor access to health care facilities due to lockdown imposed in various places in the nation. The patient was tested for COVID and taken up for surgery where rigid bronchoscopy and foreign body removal was done via the tracheostoma. The details of the procedure, challenges faced during the procedure, the effect of the COVID pandemic on the patients and hospital staffs are discussed. The complications of the broken tracheostomy tube can be most efficiently dispelled by proper tube care by the attenders and frequent tube change.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12070-021-02813-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8380296PMC
August 2021

Lacrimal sac rhinosporidiosis.

BMJ Case Rep 2021 Jun 28;14(6). Epub 2021 Jun 28.

ENT, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.

Rhinosporidiosis is a chronic mucocutaneous granulomatous disease caused by , involving primarily the nose and nasopharynx. Very rarely, the disease can affect the lacrimal sac. Here we report a 35-year-old male patient who had rhinosporidial involvement of the nose 5 years ago, for which he underwent endoscopic nasal surgery. Five years after the excision of the nasal mass, he presented with lacrimal sac involvement. The clinical presentation and the management of lacrimal sac rhinosporidiosis are discussed here.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bcr-2021-243926DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8240581PMC
June 2021

Surgical corridors for congenital aural atresia with otogenic cerebellar abscess and lateral sinus thrombosis.

BMJ Case Rep 2021 May 19;14(5). Epub 2021 May 19.

ENT, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.

The following is a case report of an adolescent with mental retardation who had congenital aural atresia with contralateral congenital facial palsy. She developed multiple intracranial complications (cerebellar abscess and lateral sinus thrombosis) due to cholesteatoma. We managed her in a multidisciplinary approach. This report discusses case management, emphasising the meticulous intraoperative steps taken in identifying the landmarks and precautions adopted to avoid postoperative facial palsy and other complications.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bcr-2020-239403DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8137245PMC
May 2021

Internal drainage of retropharyngeal abscess secondary to esophageal foreign bodies: a case series.

Eur Arch Otorhinolaryngol 2022 Feb 30;279(2):955-959. Epub 2021 Apr 30.

Department of ENT, JIPMER, Pondicherry, India.

Introduction And Objectives: Foreign body oesophagus is a commonly seen emergency in ENT. It is seen both in children and adults. When sharp bony foreign bodies such as chicken, fish, and mutton bone gets impacted in the oesophagus, it predisposes the patient to various complications. The foreign body can migrate extraluminally with time and cause retropharyngeal abscess.

Materials And Methods: Retrospective study over a period of 6 months from November 2019 to April 2020 of patients with foreign body oesophagus. We came across 20 patients with oesophageal foreign bodies and five of them had associated retropharyngeal abscess. Rigid esophagoscopy with foreign body removal and internal drainage of pus through the oesophageal rent followed by conservative management with intravenous antibiotics based on culture and sensitivity was done.

Results: Patients improved drastically as the pus drained into the oesophagus via the rent in the posterior oesophageal wall and did not require an external incision and drainage. They were discharged in a week.

Conclusion: Removal of partial extraluminally migrated foreign body oesophagus and internal drainage of the abscess followed by nasogastric feeds till the rent resolves and intravenous pus culture-sensitive antibiotics fastens patient recovery and reduces the morbidity associated with external incision and drainage and oesophageal rent repair.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00405-021-06833-2DOI Listing
February 2022

Rhinitis caseosa.

BMJ Case Rep 2021 Mar 29;14(3). Epub 2021 Mar 29.

Department of Otolaryngology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bcr-2021-242126DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8009206PMC
March 2021

Factors Associated with Fracture and Migration of Tracheostomy Tube into Trachea in Children: A Case Series.

Iran J Otorhinolaryngol 2020 Nov;32(113):379-383

Department of ENT,JIPMER,Pondicherry- 06.

Introduction: Tracheostomy is done to bypass the obstructed upper airway. Rare complication of this procedure is the fracture of the tube. Early identification and management of this condition is a great challenge to an otolaryngologist. To study the factors associated with the fracture and migration of tracheostomy tube into tracheobronchial tree in paediatric age group.

Materials And Methods: This study is a case series study conducted on children with a diagnosis of fractured tracheostomy tube presenting as a foreign body airway over five years duration. Data regarding the possible patient and tube factors responsible for the condition were collected and analysed.

Results: Total 11 patients (males-5 and females-6, average age-10.18 years, range 1-15 years) wearing tracheostomy tube for an average period of 2 years (range 3 months-8 years) were included in the study. Aspirated tubes were Jackson's metallic inner tube, Romson polyvinyl chloride plastic tube and Fuller's outer tube flange in 5 (45.5%), 4 (36.4%) and 2 (18.1%) patients respectively. The most common fracture site was at the junction between tube and neck plate (90.9%). The most common causes for fracture tube were prolonged use in 10 cases (90.9%), stomal narrowing in 9 cases (81.8%), and infection with peri-stomal granulation tissue in 9 cases (81.8%).

Conclusion: A fractured tracheostomy tube is a rare but preventable late complication of tracheostomy. Appropriate training about proper tracheostomy care, timely check-up of tracheostomy tube for signs of wear and tear, scheduled replacement, regular follow up and awareness may prevention this complication.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.22038/ijorl.2020.44797.2473DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7701484PMC
November 2020

Comparison of efficacy of potassium titanyl phosphate laser & diode laser in the management of inferior turbinate hypertrophy: A randomized controlled trial.

Indian J Med Res 2020 06;151(6):578-584

Department of Otorhinolarngology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India.

Background & Objectives: Inferior turbinate hypertrophy (ITH) is a common condition causing nasal obstruction. This study was undertaken to compare the efficacy of potassium titanyl phosphate (KTP) laser and diode laser in the reduction of the turbinate size.

Methods: This randomized controlled trial included 209 patients with ITH. Pre-operative symptoms were assessed based on the Nasal Obstruction Symptom Evaluation (NOSE) score. Diagnostic nasal endoscopy was done to rule out other nasal sinuses. Nasal mucociliary clearance was measured by saccharin transit time (STT). Postoperatively, the NOSE score, STT and complications were assessed at days one and two, at one week, one month and three months.

Results: Of the 209 patients analyzed at day one, the median NOSE score was 50 in the diode group and 40 in the KTP group, and at three months, 15 in the diode group and five in the KTP group. KTP laser showed a 93 per cent improvement in the NOSE score as compared to 77 per cent improvement shown by diode laser group. Among the intra-operative complications, of the 104 patients in the diode group, 6.73 per cent had burning sensation and 91.43 per cent had bleeding, and of 105 patients in the KTP group, 54.29 per cent had burning sensation and 36.54 per cent had bleeding. Among the post-operative complications in the KTP group, 32 and 34 per cent had bloody nasal discharge on days one and two, compared to 12 and 14 per cent in diode group. Crusting was present in 61 and 49 per cent on days one and two in KTP group as compared to 9 and 15 per cent in diode group, respectively. In the KTP group 30 per cent had synechiae as compared to 10 per cent in diode group.

Interpretation & Conclusions: KTP laser was more efficacious than diode laser in improving the NOSE scores but with slightly increased rate of complications in early post-operative period. Both the lasers impaired the mucociliary clearance mechanism of the nose till three months of post-operative follow up.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/ijmr.IJMR_424_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7602926PMC
June 2020

Comparison of middle ear function and hearing thresholds in children with adenoid hypertrophy after microdebrider and conventional adenoidectomy: a randomised controlled trial.

Eur Arch Otorhinolaryngol 2020 Nov 14;277(11):3195-3203. Epub 2020 Jul 14.

Department of Otorhinolaryngology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.

Background: Microdebrider has superior efficacy in clearing the adenoids, compared to curettage. We compared the improvement in middle ear function and hearing thresholds after adenoidectomy, by both methods.

Materials And Methods: 126 patients (median age-9 years) were randomized into groups A and B, where adenoidectomy was done by microdebrider and curettage, respectively. Middle ear function parameters and hearing thresholds were measured serially.

Results: The mean improvement in middle ear pressure, compliance and hearing thresholds were 92.5 ± 67.6 and 84.2 ± 71.4 daPa; (p = 0.40), 0.19 ± 0.34 and 0.27 ± 0.27 mL; (p = 0.07) and 3.20 ± 4.95 and 2.54 ± 3.98 dB; (p = 0.27), in groups A and B, respectively. Reversal of type B tympanograms was noted in both groups.

Conclusions: Middle ear function and hearing thresholds improved in both groups after adenoidectomy. More improvement was noted in the microdebrider group, which, however, was not significant.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00405-020-06197-zDOI Listing
November 2020

Diagnostic delay for head and neck cancer in South India: A Mixed-methods Study.

Asian Pac J Cancer Prev 2020 Jun 1;21(6):1673-1678. Epub 2020 Jun 1.

Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.

Background: Early diagnosis is an important aspect of quality of cancer care.Analysis of the diagnostic delays and the reasons for delay helps to plan strategies to improve cancer care.

Objectives: To determine the primary, secondary, and total diagnostic delay of patients diagnosed with head and neck cancer and to explore the reasons for the delay from the patient perspective.

Methods: Explanatory mixed method design was used. Two hundred persons with a confirmed diagnosis of head and neck cancer attending the ENT (ear, nose, throat) cancer clinic in a teaching hospital before the initiation of treatment were included in the study. The median delay and the association of the delay with the various factors were analyzed. Sixteen one-to-one interviews of patients were done to identify the reasons for the delays from the patient perspective.

Results: Median primary, secondary, and total diagnostic delays were 30 days, 30 days, and 73 days, respectively. Statistically, primary delay was found significantly longer among ever users of smokeless tobacco and significantly longer secondary delay was found among those with age less than 60 years. The reasons for the delay were grouped in the categories (i) Symptom appraisal delay due to low perceived seriousness and (ii) health-seeking behavior delay.

Conclusions: The diagnostic delay was considerable. Measures to enhance symptom appraisal by improving health literacy, opportunistic screening, and strengthening the referral system would decrease diagnostic delay.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.31557/APJCP.2020.21.6.1673DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7568875PMC
June 2020

Effect of Incudostapedial Reconstruction Using Conchal Cartilage Interposition Graft on Hearing Outcome.

Int Arch Otorhinolaryngol 2019 Jul 24;23(3):e262-e266. Epub 2018 Oct 24.

Ear, Nose and Throat Department, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India.

 Chronic otitis media is a widely prevalent condition in developing countries and is a cause of correctable hearing loss. The most frequent ossicular chain defect found during surgery for chronic otitis media has been a discontinuity of the incudostapedial joint. This study observes the effect of incudostapedial reconstruction using conchal cartilage on the hearing of the patient.  To evaluate improvement in hearing by incudostapedial reconstruction using conchal cartilage interposition graft in tympanoplasty and to identify the independent factors associated with erosion of the long process of incus among patients with chronic suppurative otitis media tubotympanic type.  This study was conducted in the department of ear, nose and throat (ENT) amongst 22 patients with tubotympanic-type chronic suppurative otitis media who were found to have erosion of the long process during tympanoplasty. These patients underwent incudostapedial reconstruction using conchal cartilage. Their hearing was again reassessed at 12 weeks postsurgery, and the changes were observed.  A statistically significant improvement in air conduction by 15.14 dB was found after undergoing incudostapedial reconstruction using conchal cartilage (  < 0.001). There was no statistically significant change in bone conduction ( value > 0.05). A total of 59.1% of patients in the study had an improvement in hearing ranging from 11 to 20 dB. It was also found that 50% of the patients had a postoperative hearing of 10 to 20 dB.  Conchal cartilage interposition graft effectively improved hearing when used for the reconstruction of the incudostapedial joint during tympanoplasty in patients of chronic suppurative otitis media.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0038-1661398DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6660304PMC
July 2019

Safety and Efficacy of Autologous Platelet-rich Fibrin on Graft Uptake in Myringoplasty: A Randomized Controlled Trial.

Int Arch Otorhinolaryngol 2019 Jan 9;23(1):77-82. Epub 2018 May 9.

Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, Tamil Nadu, India.

 Chronic suppurative otitis media is a common ailment in developing countries, and it generally presents with otorrhea and hearing loss. Different surgical procedures have been used to treat otitis media; among them is myringoplasty, which is a procedure that includes repair of the tympanic membrane. Platelet concentrates have been used widely in different types of wounds and are found to improve wound healing. Hence, the use of platelet-rich fibrin in myringoplasty will also improve the tympanic membrane healing.  To assess the safety and efficacy of autologous platelet-rich fibrin on graft uptake in myringoplasty.  Eighty-six patients were observed during the study period of two years. Forty-three patients in the study group underwent myringoplasty aided with platelet-rich fibrin, and 43 patients in the control group went through the same procedure but without the platelet-rich fibrin. The patients were observed for three months postoperatively by a blinded observer.  A total of 4.7% of the patients in the study group had postoperative infection, compared with a rate of 19% in the control group (  = 0.039). The graft uptake success rate was found to be 97.7% in the study group as compared with 81% in control group (  = 0.012). The results were found to be statistically significant.  Being autologous in nature, and by comparing the groups, platelet-rich fibrin is safe for patients. The postoperative graft uptake rate is better in cases in which platelet-rich fibrin was used. The postoperative infection rate was also lower in the same group.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0038-1649495DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6331294PMC
January 2019

Dynamic Slow Motion Video Endoscopy as an Adjunct to Impedance Audiometry in the Assessment of Eustachian Tube Function.

Int Arch Otorhinolaryngol 2018 Apr 16;22(2):141-145. Epub 2017 Jun 16.

Department of ENT, Jawaharlal Institute of Post Graduate Medical Education, Puducherry, India.

 Eustachian tube (ET) dysfunction plays an important role not only in the pathophysiology of various middle ear disorders, but also in predicting the outcome of the treatment. As there is no single test that assesses both the anatomic and physiological functions of the ET, a combination of tympanometry and dynamic slow motion video endoscopy may improve the sensitivity of ET function assessment.  To find out if there is any correlation between dynamic slow motion nasal video endoscopy and impedance audiometry in assessing ET function in patients with middle ear diseases.  Ours was a descriptive study performed with 106 patients attending the Ear, Nose and Throat (ENT) Outpatient Department of a tertiary care center in South India with features suggestive of middle ear disease. All patients underwent impedance audiometry and dynamic slow motion nasal video endoscopy, and were graded based on the severity of the ET pathology.  A total of 47 out of 97 patients with abnormal endoscopy findings also had abnormal impedance audiometry. The correlation was greater among the patients with higher grades of ET dysfunction. The endoscopy findings of 106 cases, when correlated with middle ear manometry, revealed that 56 cases showed complete agreement, and 50 cases showed disagreement. The nasal endoscopy results, when correlated with middle ear manometry studies by using McNemar's chi-squared (χ ) test, showed a significant association between the 2 tests (  = 0.017).  There is a significant alteration in middle ear pressure as the severity of the ET tube dysfunction increases. Impedance audiometry and nasal endoscopy provide a better measure of ET function.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0037-1603920DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5882376PMC
April 2018

Brain abscess and cervical lymphadenitis due to Paraclostridium bifermentans: A report of two cases.

Anaerobe 2018 Jun 9;51:8-11. Epub 2018 Mar 9.

Department of Ear, Nose and Throat, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.

Paraclostridium bifermentans (current nomenclature of Clostridium bifermentans since 2016) is a gram-positive, spore-forming anaerobic bacterium. Here, we describe two cases associated with this organism. The first, primarily a case of tubercular brain abscess where P. bifermentans was isolated as part of a polymicrobial flora, following a neurosurgical procedure for the same and the second, a case of cervical lymphadenitis from which it was isolated as the sole causative agent. There are only a few reported cases of P. bifermentans in literature and these cases illustrate the widening spectrum of infections related to it.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.anaerobe.2018.03.006DOI Listing
June 2018

Cranio-cervical junction cerebrospinal fluid leak after microdebrider-assisted adenoidectomy - A rare case report.

Acta Otorrinolaringol Esp (Engl Ed) 2018 Jan - Feb;69(1):53-55. Epub 2017 Aug 9.

Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.otorri.2017.01.006DOI Listing
January 2019

Assessing the Viability of Hadad Flap by Postoperative Contrast-Enhanced Magnetic Resonance Imaging.

J Clin Diagn Res 2017 Jun 1;11(6):MC01-MC03. Epub 2017 Jun 1.

Assistant Professor, Department of Radiodiagnosis, Pondicherry Institute of Medical Sciences, Pondicherry, India.

Introduction: The Expanded Endonasal Approaches (EEAs) have been widely used for various skull base lesions. The reconstruction of the skull base defects is of vital importance to prevent postoperative complications. The vascular pedicled-nasoseptal flap (Hadad-Bassagasteguy flap) is used as a workhorse in reconstruction of majority of the defects.

Aim: The purpose of this study was: (a) To assess the postoperative MRI appearance of vascularised pedicled nasoseptal flap for its viability; (b) To determine the variations in MRI that may suggest potential flap failure.

Materials And Methods: A prospective study of 13 patients was done, who underwent endoscopic skull base surgery with reconstruction using the Hadad-Bassagasteguy flap. Pre-operative MRI was done to assess the size, extent and location of the lesion and a postoperative MRI was done to evaluate flap configuration, enhancement patterns, location, flap thickness and signal intensity characteristics.

Results: The postoperative MRI of all patients showed a detectable flap covering over the skull base defects forming an "open cup" appearance. They were uniformly isointense on T1-weighted/ fat suppressed images to the adjacent nasal mucosa and hyperintense on T2-weighted images. On the MRI scans done after four weeks, all 13 of our patients had enhancing flaps. One flap migrated slightly to the left side; however, there was no Cerebrospinal Fluid (CSF) leak.

Conclusion: Vascular pedicle nasoseptal (Hadad) flaps are being widely used. MRI is a very useful tool in assessing the viability of the flap postoperatively and to evaluate for variations that may suggest potential flap failure.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7860/JCDR/2017/26737.10118DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5535400PMC
June 2017

Factors predicting early diagnosis of pediatric laryngotracheobronchial foreign bodies.

Otolaryngol Pol 2015 ;69(6):45-52

JIPMER.

Objective: To study the clinical and radiological findings to make early diagnosis of foreign body (FB) aspiration in children.

Methods: This prospective study was conducted on 45 children below 12 years of age with a clinical diagnosis of FB aspiration undergone rigid bronchoscopy from September 2008 to may 2010.

Results: Bronchoscopy was positive for FB in 37 children. The results of these 37 children (15 female and 22 male) were analyzed. 81% of children were in age group of 1-3 years. Penetration syndrome (sudden onset coughing, choking and gagging when the child is having something in the mouth) (89.2%) and decreased breath sounds (86.5%) were the most common clinical features. Cough, respiratory difficulty and fever were present in 83.8%, 78.4% and 27% respectively. Tachypnoea, tachycardia, chest retractions, decreased chest movements and wheeze were present in 83.3%, 83.3%, 83.3%, 51.4% and 43.2% respectively. Unilateral hyperinflation (64.9%), mediastinal shift (45.9%), and collapse (21.6%) were common radiological sign on chest radiograph and in 13.5% patients the chest X-rays were normal. Sites of FB lodgments were larynx, trachea, right main bronchus, left main bronchus and bilateral bronchi in 10.8%, 10.8%, 35.1%, 37.8 and 5.5% respectively. Food related FBs were present in 30 cases (peanut in 54.1%) and inorganic FBs were present in 7 cases. FBs were removed successfully by rigid bronchoscopy in all cases without any mortality.

Conclusions: Penetration syndrome, localized decreased breath sounds, unilateral hyperinflation and/or mediastinal shift on radiology are predictors for early diagnosis of FB aspiration.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5604/00306657.1184544DOI Listing
February 2017

Voice Outcome Following Carbon Dioxide Laser Assisted Microlaryngeal Surgery.

Indian J Otolaryngol Head Neck Surg 2015 Dec 23;67(4):361-5. Epub 2015 May 23.

JIPMER, Pondicherry, India.

Very few studies have been conducted in South Indian population to evaluate glottic function and voice outcome following carbon dioxide (CO2) laser assisted microsurgery for benign lesions of the larynx. This is a descriptive study which aims at assessing the voice outcome (perceptual and acoustic) and vocal fold function (stroboscopic) following CO2 laser excision in benign vocal fold lesions. 50 adult patients with benign laryngeal lesions were selected to undergo CO2 laser excision in super-pulse mode at power setting of 6 watts. Perceptual analysis was done using GRBAS score. Voice analysis was done using Praat software and fundamental frequency, jitter, shimmer and harmonics to noise ratio were assessed. Stroboscopy was done to evaluate vocal fold function using glottic closure and mucosal wave pattern as parameters. Evaluation of these parameters was done pre-operatively and at 2, 6 weeks and 3 months post-operatively. Perceptual analysis revealed a significant improvement in the GRBAS score after surgery (p < 0.001). Acoustic analysis showed that all the parameters improved significantly after surgery (p < 0.001). Stroboscopy showed that vocal fold function improved in 98 % of patients in terms of completeness of glottic closure and regular, periodic mucosal wave. Super-pulse micro-spot carbon dioxide laser is a safe and effective treatment option for benign lesions of vocal folds, with excellent voice outcome.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12070-015-0853-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4678279PMC
December 2015

The Clinical Utility of Vestibular Evoked Myogenic Potentials in Patients of Benign Paroxysmal Positional Vertigo.

J Clin Diagn Res 2015 Jun 1;9(6):MC01-3. Epub 2015 Jun 1.

Professor, Department of Otolaryngology and Head and Neck Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research , Puducherry, India .

Context: Vestibular Evoked Myogenic Potentials (VEMP) is an emerging tool to diagnose Benign Paroxysmal Positional Vertigo (BPPV). The clinical utility of VEMP has been reported only in small accord in Indian literature.

Aim: To study the latency and amplitude of VEMP in patients with BPPV and compare it with that of normal subjects.

Settings And Design: The study included two groups. Group one (control group) were 18 normal subjects. Group two (test group) were 15 subjects with unilateral BPPV.

Materials And Methods: Those subjects who fulfilled the selection criteria based on case history and audiological assessment were taken for the VEMP recording. The VEMP response consist of positive and negative successive waves (pI-nI), with latency values in adults about 13 and 23 milliseconds respectively.

Statistical Analysis: Data was analysed using Statistical Package for Social Sciences (SPSS) version 12 (Chicago, IL, USA). Unpaired t-test was employed to measure the statistical difference between control group and test group.

Results: The difference in n23 and the peak to peak amplitude between the ipsilateral and contralateral ears of the test group were statistically significant, whereas such a difference in the p13 latency turned out to be statistically insignificant. It should be noted that, out of 15 patients in the test group, five patients showed only artifact tracer recordings in both the ears which is considered as no response. The heterogeneity of the results extended from absence of VEMP to prolongation of both p13, n23; prolongation of p13 alone; and even side to side variations.

Conclusion: Absent response from the ipsilateral ear, prolonged latency of n23 and decreased peak to peak amplitude (p13, n23), indicates the disease pathology. However, large sample size is required to draw further conclusions and to consolidate the usage of VEMP in the diagnosis of BPPV.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7860/JCDR/2015/9953.6058DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4525529PMC
June 2015

Pediatric recurrent acute suppurative thyroiditis of third branchial arch origin--our experience in 17 cases.

Int J Pediatr Otorhinolaryngol 2014 Nov 1;78(11):1953-7. Epub 2014 Sep 1.

Department of Otorhinolaryngology and Head-Neck Surgery, JIPMER, Puducherry, India.

Objective: To describe clinical presentations, management and treatment outcomes of 17 cases of congenital pyriform sinus fistula (PSF) of third branchial arch origin presenting as left recurrent acute suppurative thyroiditis with cervical abscess.

Method: Medical record of these 17 cases (5-males, 12-females) presented during 2009-2013 were reviewed.

Results: Average age was 9.6 years (range 3-15 years). Fistulous opening in neck was present in 10 cases (58.8%). Average number of episode of infection from first presentation to definitive diagnosis was 3 (range 2-5). All patient had history of incision and drainage (ID) of abscess (average 2, range 1-3). All cases had barium swallow and CT scan. Sixteen cases had telescopic hypopharyngoscopy. Barium swallow and telescopic hypopharyngoscopy detected PSF in 88.23% (15/17) and 100% (16/16) cases respectively. Fourteen cases were treated by transcervical excision (TE) (fistulectomy with left hemithyroidectomy), two cases were treated by endoscopic chemical cauterization (ECC) of internal opening at pyriform sinus using silver nitrate and only ID of abscess was done in one case. Success rate of TE and ECC was 93% and 100% respectively. Recurrence in one case initially treated by TE was managed successfully by ECC.

Conclusion: Presence of congenital PFS should be suspected when left-sided intra-thyroidal abscess formation occurs as gland is resistant to infection. Strong clinical suspicion, barium swallow study, telescopic pharyngoscopy and CT scan are the key to diagnosis. Both TE and ECC has comparable success rate. ECC may prove a useful and equally effective method of treatment for congenital PFS in future.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijporl.2014.08.034DOI Listing
November 2014

Fractured and migrated tracheostomy tube in the tracheobronchial tree.

Int J Pediatr Otorhinolaryngol 2014 Sep 19;78(9):1472-5. Epub 2014 Jun 19.

Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.

Objective: To study the clinical presentation and management of fractured tracheostomy tube (FTT) presenting as tracheobronchial foreign body (FB) in children.

Methods: A retrospective chart review of children with a diagnosis of FTT, FB in tracheobronchial tree was carried out. Data regarding the patients' demographic details, diagnosis, clinical presentation and management were noted and analyzed.

Results: Total 8 cases (males 3 and females 5, average age 8.8 years, range 1-15 years) wearing tracheostomy tube for an average period of 2 years (range 3 months-4 years) were found. Indications for tracheostomy were bilateral abductor palsy, subglottic stenosis and congenital subglottic hemangioma in 4 (50%), 3 (37.5%) and 1 (12.5%) cases, respectively. Classical triad of FB aspiration (coughing/choking, wheezing and reduced breath sounds) was present in 6 (75%) patients. Aspirated FTTs were Jackson's metallic inner tube, Romson's polyvinyl chloride plastic tube and Fuller's outer tube flange in 4 (50%), 3 (37.5%) and 1 (12.5%) respectively. The most common fracture site was at the junction between tube and neck plates {in 7 (87.5%) children}. Sites of lodgment of FTT were right bronchus, trachea and both trachea and left bronchus in 5 (62.5%), 2 (25%) and 1 (12.5%) cases, respectively. FTTs were retrieved by transtracheostomal rigid bronchoscopy and exploring the tracheostomal wound in 7 cases and 1 case, respectively.

Conclusion: Though FTT presenting as pediatric tracheobronchial FB is rare, it should be considered in differential diagnosis in a tracheostomised child with respiratory distress. When diagnosed, FTT removal is best done using a rigid bronchoscope through the tracheal stoma.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijporl.2014.06.011DOI Listing
September 2014

A comparative study of temporalis fascia graft and vein graft in myringoplasty.

Indian J Otolaryngol Head Neck Surg 2013 Dec 17;65(Suppl 3):569-74. Epub 2012 Mar 17.

Department of E.N.T, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, 605006 India.

To compare the surgical outcome of temporalis fascia graft (TFG) and vein graft (VG) in myringoplasty. This prospective study was carried out over 60 patients with inactive tubotympanic type of chronic suppurative otitis media, with small to moderate size central perforation in Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry from November 2009 to March 2011. Patients were equally randomized into two groups; TFG group and VG group according to the graft material used for myringoplasty. After routine investigations, X-ray mastoid and paranasal sinuses and pure tone audiometry, all cases were operated under local anesthesia using underlay technique. Patients were followed at 2 week, 1 and 3 month postoperatively. Graft uptake, audiological improvement, degree of hearing improvement, and complications were studied during follow up. In TFG group, graft uptake rate was 80 % and hearing improvement was present in 66.7 % whereas in VG group graft uptake rate was 83.3 % and hearing improvement was present in 70 %. No patient had deterioration in hearing, sensory neural hearing loss or any other complications postoperatively. Difference between the preoperative and postoperative air bone (AB) gap was considered as degree of hearing improvement. Postoperative AB gap was <10 dB in 60 % and 66.7 % of patients of TFG group and VG group respectively. The difference in graft uptake rate and hearing improvement between two groups was not statistically significant. Both TFG and VG are equally effective in terms of graft uptake and hearing improvement in myringoplasty.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12070-012-0543-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3889340PMC
December 2013

Diode laser turbinate reduction in the treatment of symptomatic inferior turbinate hypertrophy.

Indian J Otolaryngol Head Neck Surg 2013 Aug 19;65(Suppl 2):350-5. Epub 2012 Feb 19.

Department of E.N.T, Jawaharlal Institute of Post Graduate Medical Education and Research, Pondicherry, 605006 India.

To evaluate the efficacy of diode laser turbinate reduction procedure in treatment of symptomatic inferior turbinate hypertrophy (ITH) and to study the effect of it on mucociliary clearance of nose. This prospective study was carried out over 45 patients with symptomatic ITH refractory to medical management from July 2009 to March 2010 in Department of E.N.T, Jawaharlal Institute of Post Graduate Medical Education and Research, Pondicherry, India. Each symptom (nasal obstruction, rhinorrhoea, sneezing, headache, hyposmia and snoring) was assessed by visual analogue scale (VAS). Mucociliary clearance was measured by saccharin transit time (STT). All patients underwent diode laser turbinate reduction (LTR) under local anesthesia. The patients were followed up at 1 week, 1, 3 and 6 months postoperatively. During each follow up visit, symptoms were reassessed by VAS score. Difference between preoperative and postoperative VAS score was statistically significant. All patients had significant symptomatic improvement which started from 1 week postoperatively and persisted throughout the follow up period. Prolongation of STT following diode laser turbinate reduction was significant. SST returned back to preoperative value by the end of 6 months. Crusting and pain were the main postoperative complaints. Diode laser turbinate reduction is safe, minimally invasive and effective in relieving the symptoms associated with ITH and can be performed on a day care basis under local anaesthesia. Longer follow up is required to assess the development of late complications and recurrence of symptoms after LTR.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12070-012-0515-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3738787PMC
August 2013

Development of hemangioma in a tongue harboring long-standing angiokeratoma circumscriptum.

Ear Nose Throat J 2012 Nov;91(11):E7-E10

Division of Head and Neck Oncology, Jewish General Hospital, 3755 Cote Ste. Catherine Rd., Montreal, QC H3T 1E2, Canada.

Angiokeratoma is a very rare vascular lesion of the papillary dermis. It is characterized by vascular ectasia with overlying epidermal hyperkeratosis. The systemic form of angiokeratoma is associated with Fabry disease and fucosidosis. There are several localized forms. Tongue involvement is uncommon. Hemangiomas are tumors made up of capillaries; they grow by active endothelial proliferation as opposed to expansion of vascular spaces in vascular malformations. Lingual hemangiomas are usually indolent, but they can cause cosmetic deformities, recurrent hemorrhage, and functional problems with speaking, mastication, and deglutition. We report a case of angiokeratoma of the tongue with an underlying hemangioma in a 30-year-old woman. Angiokeratomas have been reported to develop over arteriovenous malformations and in the area of lymphangioma circumscriptum following repeated local trauma. To the best of our knowledge, the development of a lingual hemangioma in a patient with long-standing angiokeratomatous lesions has not been previously reported in the literature.
View Article and Find Full Text PDF

Download full-text PDF

Source
November 2012
-->