ABSTRACT
Background: Aim- To study the presenting features correlates them with radiological finding & the management of JNA. Methods: A prospective study was done on 30 patients who were clinically &radiologically diagnosed as Juvenilenasopharyngeal angiofibroma &treated in department of ENT & HNS SCB Medical College Cuttack during the period of 1.8.2015 to 30.10.2017. All patients are examined & after stabilisation, CECT of nose and PNS done. Staging was done according to clinical &radiological finding by FISCH staging system. Patients were treated by surgical excision by various approaches. Most common procedure done is endoscopic guided excision by medial maxillectomy with lateral rhinotomy approach. Excised tissues send for HP study & patients are followed up for a period of one year. Results: All the patients in our study were males. Majority (70%) are in 11-18 yr age group with mean age of presentation 17.13yr. Most common presenting feature is epistaxis with progressive nasal obstruction. Palatal bulging & hearing loss is the commonest extra sinonasal manifestation. Hollman miller sign found in 50% of cases. Maximum patients presented in stage-2 disease. Post operatively 1 death occurred due to blood transfusion reaction. All patients HP study report is found to be nasopharyngeal angiofibroma. Conclusion: JNA is a benign tumour & should be suspected in all cases of adolescent male presented with epistaxis & progressive nasal obstruction. CECT, has a definite role in diagnosis, staging & plan of management of JNA & should be done within 1 wk prior of surgical management. Ram-Haran sign which is found most of cases of early stage, help in early diagnosis of JNA & can be a diagnostic criteria for JNA. Endoscope assisted external approach, is definitely beneficial in total disease clearance.
ABSTRACT
Background: Improvements in functional endoscopic sinus surgery (FESS) and computed tomography (CT) have concurrently increased interest in the anatomy of the nose and paranasal sinuses. Revolutionary changes in the surgical treatment of rhino sinusitis in recent years, particularly in endoscopic surgery, require the surgeons to have detailed knowledge of the anatomy of the lateral nasal wall, paranasal sinuses and surrounding vital structures . A number of anatomical variants in the region are encountered, many of which are detectable only by the use of CT . These variations might induce osteomeatal obstruction, preventing mucus drainage and predisposing to chronic rhino sinusitis. The aim of this prospective study was to analyze the incidence of anatomic variations in a series of 100 patients with persistent symptoms of chronic rhinosinusitis after failure of preliminary medical therapies and their correlation with paranasal sinus disease, to assess whether anatomic variations are associated with disease pathology and to identify those variants that may impact operative safety. Setting: Tertiary care otolaryngology unit. Methods: 100 consecutive cases of chronic rhino sinusitis patients attending the ENT outpatient department ,during a period of June 2015-May2017, who had chronic sinusitis for more than three months duration not responding to the medical treatment and who were willing to undergo Functional Endoscopic Sinus Surgery satisfying the inclusion criteria were studied. Results: In our study it was observed that 72% patients had anatomic variations. 43% of the chronic sinusitis cases had two or more anatomical variations and 29 % of the cases had single anatomical variation. Deviated nasal septum in 41% cases, Concha bullosa was found in 36%, paradoxical middle turbinate in 11%cases. Conclusion: Prevalence of multiple anatomical variations was more in our study in comparison to single anatomical variation. Deviated nasal septum was the most common anatomical variation encountered in our study followed by concha bullosa.
ABSTRACT
Background: To assess the outcomes of intratympanic steroids in the management of idiopathic sudden sensori-neural hearing loss. Study Design: Retrospective study. Setting: tertiary care medical centre. Methods: A total of 56patients with idiopathic sudden sensorineural hearing loss were included in our study. They received 4 doses of 0.3- 0.5ml of( 40 mg/mL ) of methylprednisolone injected into the middle ear with a gap of four days in between the doses. Pre- and post-injection hearing evaluation was done to determine overall success, morbidity, and prognostic factors. Patient variables as they related to recovery were studied and included patient’s age, time to onset of therapy, severity of hearing loss, and presence of associated symptoms. Results: A total of 56 patients were included in our study of which unilateral cases were 52 and bilateral cases were 4. Subjectively 38 patients reported improvement in hearing after the therapy while objectively we found 44 ears(74%) ,41 patients had improvement. The mean PTA pre ITS (intratympanic steroid) was 58.7 dB and after ITS it was 30.3dB. Thus mean PTA improved by 28.4 dB. Conclusion: Intratympanic steroids can be offered as a first line therapy for idiopathic sudden sensorineural hearing loss as it is minimally invasive, and can be performed as an office based procedure with no systemic side effects. No major complications has been reported in our study and results have been satisfactory.