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Role of flexible bronchoscopy in early diagnosis and management of laryngotracheobronchial foreign bodies

2019-01-01T00:00:00Z

Title: Role of flexible bronchoscopy in early diagnosis and management of laryngotracheobronchial foreign bodies Authors: Dr. Anuja M Panicker

A Study Of Drill Induced Hearing Loss In The Contralateral Ear Following Mastoid Surgery.

2020-01-01T00:00:00Z

Title: A Study Of Drill Induced Hearing Loss In The Contralateral Ear Following Mastoid Surgery. Authors: Kumar, Ashima Abstract: Background: Chronic otitis media is the inflammation of the mucoperiosteal lining of the middle ear space and mastoid cavity. Mastoidectomy is considered to be the mainstay of treatment of COM. The usage of micro motor drill on the ear has effect on the contralateral ear due to the noise induced by the drill and the sound-conducting characteristic of the intact skull. The ipsilateral cochlea is exposed to a 100 dB sound during drilling, while the opposite cochlea to levels 5 to 10 dB lower. This in turn can lead to dysfunction of the outer hair cells, thus causing temporary or permanent hearing loss. Aims and Objectives: 1. To identify the drill induced hearing loss in the contralateral ear, by transient evoked otoacoustic emissions. following mastoidectomy. 2. To identify the relation between the type of burr tip used and the amount of hearing loss. 3. To identify that hearing loss is found to be more, if drilling is done for a longer duration of time. Methodology: It is a hospital – based prospective study, from November 2018 to April 2020. A total of 63 patients that underwent mastoidectomy were included in this study, with age ranging from 8 to 50 years. For each patient a thorough clinical history was taken with a detailed otologic examination was done, to make sure the contralateral ear was normal. Routine blood investigations along with a x-ray mastoid was done for all patients. Each patient was subjected to a pre-operative PTA and TEOAE. PTA was repeated on POD-1 and POD-7. TEOAE was done on POD-1,3 and 7 for each patient. If any changes in TEOAE readings are detected, a repeat OAE was done until normal values were obtained. A repeat TEOAE will be done on day 15, 30, 60 and 90 postoperatively, if required. TEOAE was recorded at 1000, 2000, 3000 and 4000 Hz. Intraoperatively, the type of surgery, the type of burrtip used as well as the individual drilling time for each type of drill bit was recorded, using a stopwatch. Results: Out of the 63 patients enrolled in this study, 30 patients (47.6%) developed transient and temporary SNHL on POD-1 and 7 patients (21.2%) had impaired hearing by POD-3. 4 patients (10.8 %) recovered by POD-3, 19 patients (51.4 %) had normal TEOAE readings by POD-7, 10 patients (27.0 %) were normal by POD-15, while the remaining 4 (10.8 %) recovered by POD-30. It was observed that higher frequencies of 3000 Hz and 4000 Hz were more commonly affected. All patients recovered by POD-30. No change was detected on pre and post-operative PTA. It was also detected that drilling with a cutting burr for an average of 45.4 minutes resulted in drill induced hearing loss, whereas when used for an average of 37.5 minutes, normal TEOAE readings were achieved. It was established that usage of a diamond burr for an average of 13.8 minutes resulted in hearing loss in the contralateral ear. However, no hearing impairment was noted when drilling was done for an average of 10.8 minutes. Conclusion: Thus, drilling with a cutting burr for more than 40.2 minutes, can lead to hearing loss. This has a sensitivity of 70% and a specificity of 69%. On the other hand, drilling with a diamond burr for over 12.5 minutes, can lead to hearing impairment, with a sensitivity of 68% and a specificity of 65%. The drill is not only a source of noise but is also a strong vibration generator, and a strong oscillation is transmitted into the cochlea. Thus surgeons should pay more attention to the vibrations and lessen the intensity of drill induced hearing loss by an appropriate selection of burrs and drills, thus minimizing the vibrations of the temporal bone.

Study Of Matrix Metalloproteinase 9 And Histopathology In Sinonasal Diseases Before And After Endoscopic Surgery

2019-01-01T00:00:00Z

Title: Study Of Matrix Metalloproteinase 9 And Histopathology In Sinonasal Diseases Before And After Endoscopic Surgery Authors: Yasmin, Kauser Abstract: BACKGROUND:. Headache and facial pain are one of the most common symptoms encountered in day to day ENT practice. One of the reasons for this is disease of sinomucosa which causes distress to the patient in carrying out their daily activities. Incomplete treatment of these diseases leads to chronicity. Understanding the pathogenesis and the changes occurring at molecular and histological level in the sinonasal mucosa can help in better outcome of treatment. Methods: A comparative study was carried in 55 patients with sinonasal disease in the ENT dept from November 2017 to June 2019.All 55 patients underwent Endoscopic Surgery. Nasal mucosa biopsies was taken (preoperatively and postoperatively 1st, 3rd and 6 month) for histopathological study. Concentration of MMP-9 was measured by using commercially available ELISA. RESULTS: The present study was conducted in 55 patients presenting with sinonasal diseases who underwent FESS. It was found that MMP-9 value significantly decreased over time(P<0.05).The fall of mean MMP-9 was maximum (53%) from pre-op to 1month which subsequently subsidized from previous value. Histopathological findings like presence goblet cell hyperplasia ,inflammatorycells,stromal edema and angiogenesis were found to be positvely correlated with higher level of MMP-9 values. These findings were consistent over the follow up time of 1st,3rd and 6th month.It was also found that the presence .of fibrosis was negatively correlated with the level of MMP-9 CONCLUSION: Expression of MMP-9 in epithelium was positively and statistically significantly correlated with a higher number of inflammatory cells in nasal epithelium and mucosa. A decreased number of inflammatory cells, decline in hypertrophy of the mucous glands indicate a positive effect of treatment on the inflammatory process, which may also account for a more functional nasal epithelium and lower nasal airway resistance. This may also account for the post treatment improvement of symptoms and in quality of life.

Prospective Study To Assess Sensorineural Hearing Loss Following Middle Ear Surgeries

2010-01-01T00:00:00Z

Title: Prospective Study To Assess Sensorineural Hearing Loss Following Middle Ear Surgeries Authors: Tejaswini, Patel Abstract: Background: Sensoryneural Hearing Loss (SNHL) may result from drill generated noise produced during middle ear surgeries. Though it is suggested by many it is not properly documented. Objective: This study was carried out to assess sensoryneural hearing loss following middle ear surgeries. Methods: 60 patients were studied and their bone conduction levels were recorded pre-operatively and post-operatively on first, seventh and twenty-first days. The presence or the absence of SNHL was determined by comparing between the two. Results: Pre operative and post operative bone conduction levels were compared by using paired-t test. The p values post operatively first day (p-0.484), seventh day (p 0.716), twenty-first day (p-0.665) were insignificant. Interpretation and conclusion: In our study there was no sensorineural hearing loss following middle ear surgeries. No significant correlation was found between duration of discharge, type of surgery, duration of surgery and SNHL.