Shreeya Kulkarni ¹, Kiran S. Burse ¹, Devashri Patil ¹, Chaitanya Bharadwaj ¹, Vandana Sancheti ¹, K. Manu Bharath ¹

Affiliations
1 ENT Department, Dr. Vasantrao Pawar Medical College and Hospital, IN

Abstract

Introduction: Chronic Suppurative Otitis Media (CSOM) is frequently associated with symptoms of inflammation like discharge from the ear or pain. In many cases, patients suffer from hearing loss causing communication problems and social withdrawal. Tubotympanic type of chronic suppurative otitis media is characterized by a perforation of pars tensa, while marginal & attic perforations are pathognomonic of attico–antral variety. The latter category is usually associated with the presence of cholesteatoma. In cases of cholesteatoma, complications like facial nerve paralysis, meningitis, cerebellar abscess, sigmoid sinus thrombosis may develop and potentially threaten the patient’s life. The aim of this study was to retrospectively perform analysis of patients suffering from Chronic Suppurative Otitis Media, visiting our Tertiary Health Centre, Nashik. Materials and Methods: This was a retrospective study, conducted in a tertiary care medical college hospital over a period of 5 years. The study group comprised 528 patients in and around Nashik District and were subjected to Tympanoplasty or Mastoid surgery. Results: Complete data records from 528 patients were available for statistical analysis. Maximum numbers of patients were in age group 21–40. High prevalence of CSOM was found in females. 408 patients had CSOM of Safe type. 97 patients had CSOM of unsafe type, whereas 23 patients had unsafe CSOM with complications. 381 patients underwent Type 1 Tympanoplasty, while 31 patients underwent Modified Radical Mastoid Surgery. 61 patients were operated for MRM with Tympanoplasty and 28 patients were operated for MRM with Myringostapediopexy. 27 patients were operated for revision tympanoplasty. Different methods of tympanoplasty were performed. Simple underlay was done in 123 patients. Maximum patients about 245 were operated by cartilage support method of tympanoplasty. Anterior tucking was done in 40 patients. Myringostapediopexy was done in 28 patients. Ossiculoplasty with tragal or conchal cartilage was done in 61 patients. Graft was not placed in 31 patients. Temporalis fascia was used in maximum patients. In 90.9% of patients temporalis fascia was used. Fascia Lata was used in 3.2% of patients. Conclusion: Retrospective study of patients with CSOM shows: females were affected more than males. Majority of patients were in age group of 21 to 40 years. The reason could be that this age group is socially active and health conscious. 77.3% of patients had safe CSOM while 22.7% of patients had unsafe CSOM. 2.27% of patients had extra–cranial complication, and 2.08% of patients had intracranial complications. 5.1% of patients underwent revision tympanoplasty surgery. Temporal is fascia as a graft material was used for tympanoplasty in maximum patients, and cartilage support method of tympanoplasty was used in majority of patients. Maximum patients were operated in year 2012. This was due to conduction of camps in peripheral areas around Nashik City which shows that CSOM is more common in patients of lower socioeconomic group, overcrowding, sub–standard hygiene and under resourced health care.

Keywords

Chronic Suppurative Otitis Media, Cartilage Tympanoplasty, Modified Radical Mastoidectomy Surgery

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Devashri Uday Patil ¹, Kiran S. Burse ², Shreeya Vinay Kulkarni ¹, Vandana Sancheti ³, Chaitanya Bharadwaj ²

Affiliations
1 MS ENT, Dr. Vasantrao Pawar Medical College Hospital, Nashik, IN
2 ENT Department, Dr. Vasantrao Pawar Medical College Hospital, Nashik, IN
3 ENT Department, DLO, Dr. Vasantrao Pawar Medical College Hospital, Nashik, IN

Abstract

Chronic suppurative otitis media is one of the common otological conditions in India for which patients seek advice from an otorhinolaryngologist. Chronic suppurative otitis media is recurrent and progressive disease which is characterized with tympanic membrane perforation and suppurative discharge. Pure tone audiometry is the most common test used to evaluate auditory sensitivity. Since hearing loss is a common complication of chronic suppurative otitis media, we designed this study to evaluate preoperative pure tone audiometry findings in patients with chronic suppurative otitis media and its correlation with the intra-operative findings. Aims and Objectives: 1] To assess the intra-operative findings in patients with chronic suppurative otitis media. 2] To evaluate the correlation between the preoperative pure tone audiometry findings and intra-operative findings in patients with chronic suppurative otitis media. 3] To assess the type of hearing loss and degree of hearing loss in patients with chronic suppurative otitis media. Materials and Methods: This is an Observational study carried over a period of 3 years from August 2011 to August 2013. Total number of patients included in this study was 100. Result: Out of 100 patients studied 69 % of patients had Tubo-Tympanic type of CSOM, 31 % of patients had Attico-antral type of CSOM. In patients of Safe CSOM; Central perforation was seen in maximum cases 46.4 %, anterior central perforations was seen in 8.7 % cases, posterior central perforations seen in 20.2 % cases, and subtotal perforations seen in 24.63 % cases. In patients of Unsafe CSOM posterosuperior cholesteatoma was seen in maximum cases 67.74 %, and attic cholesteatoma was seen in 32.2 % cases. In safe CSOM patients all ossicles were intact and mobile whereas in unsafe CSOM patients only 4 patients had intact ossicular chain, while maximum patients had ossicular defect. Conclusion: Hearing loss depends on size of perforation. Hearing loss increases as the size of perforation increases. Average air conduction threshold and air bone gap did not differ significantly between various groups of ossicular defect. This shows us that neither air conduction nor air bone gap are reliable parameters on basis of which we can predict ossicular status preoperatively.

Keywords

Chronic Suppurative Otitis Media, Hearing Loss, Puretone Audiometry, Air Bone Gap.

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Chaitanya Bharadwaj ¹, K. S. Burse ¹, Shreeya V. Kulkarni ¹, Sumeet Kaur Ghai ¹, Sharyu Shelke ¹

Affiliations
1 Department of ENT, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik, Maharashtra - 422003, IN

Abstract

Choanal atresia is a rare congenital condition wherein there is unilateral or bilateral obstruction of posterior nasal passage. We report a case of bilateral choanal atresia in a two days old female presenting with chief complaints of respiratory distress since birth. Transnasal endoscopic surgery was used to obtain a patent airway.

Keywords

Bilateral Choanal Atresia, Endoscopic Diagnosis, Stenotic Choanae, Transnasal Endoscopic Canalization.

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Rushika Patel ¹, Sumeet Kaur Ghai ¹, Shreeya V. Kulkarni ¹, Chaitanya Bharadwaj ¹, Vandana Sancheti ¹, K. S. Burse ¹

Affiliations
1 Department of ENT, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik - 422003, Maharashtra, IN

Abstract

Background: Ossiculoplasty is defined as reconstruction of the ossicular chain using various graft materials and techniques. Aim: Audiological analysis with Pure Tone Audiometry (PTA) of results of ossiculoplasty in cases of safe and unsafe csom and its correlation with preoperative middle ear status using Kartush’s Middle Ear Risk Index (MERI). Methodology: Non randomized prospective study conducted over 2 years in 34 patients with CHL; ossiculoplasty conducted with cartilage, remodeled autologous incus or malleus, malleostapediopexy and PORP; preoperative and 3 months postoperative PTA done. Kartush’s MERI to correlate preoperative middle ear status with postoperative hearing results done. Out of 34 patients operated: 10-cartilage ossiculoplasty, 6-autologous incus, 2-autologous malleus, 4-PORP and 12-malleostapediopexy. Results and Conclusion: Hearing improvement was seen in all types of osssiculoplasties using various materials and techniques. However, there was no significant statistical difference between the various types in relation to the postoperative hearing improvement. Kartush’s MERI was found to be an indicator of postoperative hearing improvement. It was found that as the value of the index increases, the postoperative hearing improvement decreases.

Keywords

Chronic Suppurative Otitis Media (CSOM), Middle Ear Risk Index (MERI), Ossiculoplasty, Pure Tone Audiometry.

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Shreeya V. Kulkarni ¹, Monika B. Bhagat ¹, K. S. Burse ¹, Chaitanya Bharadwaj ¹, Vandana Sancheti ¹

Affiliations
1 Department of ENT, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Adgaon - 422003, Nashik, Maharashtra, IN

Abstract

Background: Chronic Suppurative Otitis Media (CSOM) is one of the most common chronic childhood infections worldwide. People are relatively less aware regarding the complications of this disease and so less effective measures are employed resulting in high rate of complications. Aims: 1. To evaluate the relation of the clinical features with intraoperative findings in CSOM, and 2. To compare the preoperative X-ray/HRCT findings with intraoperative findings in patients with safe and unsafe CSOM with or without complications. Methods and Methodology: A total number of 100 patients of CSOM were included after they satisfied the eligibility criteria. Written informed consent was taken from all the study participants. The standard procedure of examination of ear, nose, throat, oral cavity was carried out on each patient in the outpatient department of the hospital. The detailed history of the patient was as per the proforma. Dry aural toilet was done to remove adherent debris. Otoscopic examination was done and the details were noted. Results and Conclusion: CT scan and X-ray have proved to be valuable diagnostic tools in determining the accuracy with which there was an agreement (correlation) between the clinical features, intraoperative findings and radiological findings in safe and unsafe CSOM. It was determined by the kappa coefficient using SPSS statistical analysis software.

Keywords

Chronic Suppurative Otitis Media, Complications, ENT.

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Rohan Vijay Gupta ¹, Shreeya Vinay Kulkarni ², Kiran Burse ³, Chaitanya Bharadwaj ⁴, Vandana Sancheti ⁵, Rushika Patel ⁶

Affiliations
1 Former PG Resident, Department of ENT, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik - 422003, Maharashtra, IN
2 Professor, Department of ENT, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik - 422003, Maharashtra, IN
3 Professor and Head, Department of ENT, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik - 422003, Maharashtra, IN
4 Associate Professor, Department of ENT, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik - 422003, Maharashtra, IN
5 Senior Resident, Department of ENT, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik - 422003, Maharashtra, IN
6 Assistant Professor, Department of ENT, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik - 422003, Maharashtra, IN

Abstract

Background: Chronic suppurative otitis media is a common otological condition in India causing hearing loss for which patients seek advice from an otolaryngologist. The perforation seen in chronic suppurative otitis media may be the only sequel remaining when the pathological process in middle ear cleft has healed. Tympanoplasty, the procedure for repairing the perforations of the pars tensa, can be done using a variety of graft materials. In this study two different types of graft materials, fascia lata and temporalis fascia, which can be used in tympanoplasty will be studied. The study will help to know which is better in terms of graft uptake as well as improvement in hearing. This will help in a better understanding of which grafts can be used in tympanoplasty in the future. Aims and Objectives: To compare hearing gain and graft uptake rate between temporalis fascia and fascia lata in tympanoplasty and to study the postoperative morbidity/complications associated with the 2 modalities. Materials and Methodology: The study was conducted on 42 patients divided in 2 groups of 21 each. The 1st group underwent tympanoplasty type 1 by endomeatal approach using fascia lata graft and the 2nd group by a post aural approach using temporalis fascia graft. Regular follow ups and otoscopic examination was done on the patients to check the graft uptake. Pure tone audiometry was done after a minimum period of 2 months post-surgery and was compared with the preoperative audiometry to assess the hearing improvement in hearing. Results and Conclusions: This study compared both temporalis fascia and fascia lata as graft materials used in tympanoplasty. Graft uptake results and gain in hearing were better with temporalis fascia as compared to fascia lata. Temporalis fascia was also associated with lesser post-operative complications. So this study finds that tympanoplasty done by postaural technique using temporalis fascia is better in terms of graft uptake, hearing improvement and postoperative complications when compared to tympanoplasty done by fascia lata.

Keywords

Endomeatal, Fascia Lata, Postaural, Temporalis Fascia, Tympanoplasty

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Saloni Raisoni ¹, K. S. Burse ², S. V. Kulkarni ³, Chaitanya Bharadwaj ⁴, Vandana Sancheti ⁵, Rushika Patel ⁶

Affiliations
1 Former PG Resident, Department of ENT, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik - 422003, Maharashtra, IN
2 Professor and Head, Department of ENT, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik - 422003, Maharashtra, IN
3 Professor, Department of ENT, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik - 422003, Maharashtra, IN
4 Associate Professor, Department of ENT, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik-422003, Maharashtra, IN
5 Senior Resident, Department of ENT, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik-422003, Maharashtra, IN
6 Assistant Professor, Department of ENT, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik-422003, Maharashtra, IN

Abstract

Background: Functional Endoscopic Sinus Surgery (FESS) is a physiological and also well accepted surgical treatment for chronic sinus disease that is unresponsive to medical treatment. The most frequent intraoperative complication is bleeding. Various methods are being tried to reduce the bleeding during FESS. But, none of these methods consistently provide the desirable bloodless field for the surgeons. Blockage of Pterygopalatine Fossa (PPF) through the greater palatine foramen is an alternative approach to reduce blood loss during ESS, which is an easy procedure, associated with little complication. Pterygopalatine Fossa Block (PPFB) along with general anaesthesia is effective in patients undergoing FESS surgery. Aims and Objectives: To assess the effect on and the difference in heart rate and blood pressure after pterygopalatine fossa block during FESS surgery. Materials and Methodology: 25 Patients with bilateral nasal pathology undergoing FESS were selected from ENT wards after a written informed consent. The PPFB was done only on one side, while the opposite nostril acted as control, thus each case acted as their own control. Various vital parameters like – heart rate (HR), blood pressure [(BP) systolic and diastolic] were calculated every 15 mins and their average noted. Surgery on the first side was completed and then followed by surgery on the second side. Applying paired-t Test, results were obtained. Results and Conclusion: There was a significant fall in heart rate and blood pressure. There was a positive correlation between these factors. “p value” was found to be highly significant in both the parameters tested. Pterygopalatine fossa block is an effective adjunct to general anaesthesia for controlling heart rate and blood pressure during FESS surgery.

Keywords

Blood Pressure, FESS, Heart Rate, Pterygopalatine Fossa

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Chaitanya Bharadwaj ¹, Rushika Patel ², Shreeya Kulkarni ³, Kiran Burse ⁴, Vandana Sancheti ⁵, Preeti Dudhe ⁶

Affiliations
1 Associate Professor, Department of Otorhinolaryngology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Adgaon Nashik, Nashik – 422003, IN
2 Assistant Professor, Department of Otorhinolaryngology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Adgaon Nashik, Nashik – 422003, IN
3 Professor, Department of Otorhinolaryngology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Adgaon Nashik, Nashik – 422003, IN
4 Professor and Head, Department of Otorhinolaryngology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Adgaon Nashik, Nashik – 422003, IN
5 Senior Resident, Department of Otorhinolaryngology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Adgaon Nashik, Nashik – 422003, IN
6 Former PG Resident, Department of Otorhinolaryngology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Adgaon Nashik, Nashik – 422003, IN

Abstract

Introduction: Fibrous Dysplasia (FD) is a fibro-osseous lesion of the osseous structures of the body. The exact etiology is not known. Monostotic (when one bone is involved), polyostotic (when multiple bones are involved) and craniofacial are the three subtypes of craniofacial dysplasia. When the lesions are limited to contiguous bones of the craniofacial skeleton, it is termed as craniofacial dysplasia. McCune Albright syndrome is the triad of polyostotic fibrous dysplasia, Cafe aulait spots and endocrine pathology. Case Report: This case describes craniofacial dysplasia in a 30 year old female patient who had unusual presentation on the right side of the face involving maxilla, sphenoid, ethmoid and orbit. The clinical features, radiological findings and treatment have been discussed.

Keywords

Craniofacial Fibrous Dysplasia, Maxilla, Monostotic, Polyostotic

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