ABSTRACT
Introduction: Adenoids together with palatine tonsils tubaltonsils and lingual tonsil form the inner Waldeyer’s ring andits enlargement depends on external factors such as allergy,immunosuppression, passive tobacco smoke but mainlychronic bacterial and viral infection. The study comparesthe effectiveness of certain factors in conventional curettageversus endoscopic adenoidectomy in a tertiary care centrein Trivandrum, Kerala, India. Study was done with theobjectives to study the perioperative collateral injury, presenceof residual adenoid tissue and recovery time in conventionalversus microdebrider assisted endoscopic adenoidectomy inchildren less than or equal to 12 years.Material and methods: An observational study was done ina group of 60 patients of age less than or equal to 12 yearswho satisfied the inclusion criteria who underwent treatmentin department of ENT in Sree Gokulam medical collegeduring a period of 2017 – 2018. Patients were grouped into 2groups of 30 each. Group A underwent conventional curettageand group B underwent microdebrider assisted endoscopicadenoidectomy. Patients were followed up 1 week and 2months following the procedure by post operative nasalendoscopy to assess collateral damage and residual adenoidtissue.Results: The residual tissue in conventional adenoidectomywas 20% and 20 – 50% in 2 cases and more than 50% in 4cases. This was the main cause of persistence of symptomsin conventional adenoidectomy. The mean recovery timewas 4.1 days in conventional and 3.2 days in endoscopicadenoidectomy. In conventional adenoidectomy 3 cases(10%) had collateral damage in which 2 cases had injury toeustacian tube orifice and 1 case had injury to torus tubaris.In the endoscopic microdebrider assisted surgery no collateraldamage was recorded.Conclusion: The study showed that the completeness ofdissection, collateral injury and recovery time was better inthe endoscopic adenoidectomy compared to conventionalcurettage.
ABSTRACT
OBJECTIVE: To compared the outcome of Type 1 tympanoplasty with cartilage-perichondrium graft in comparison with temporalisfascia graft in terms of post-operative graft take-up and hearing results.MATERIALS AND METHODS: A prospective observational study among 80 patients between 15 and 60 years of age satisfyingthe inclusion criteria with complaints of ear discharge and hearing loss due to COM - mucosal type was conducted. Patientswere grouped in two groups of 40 patients each. Group A patients underwent Type 1 tympanoplasty with temporalis fasciaand Group B with cartilage-perichondrium graft. Patients were followed up for graft uptake, hearing improvement and rate offailure are compared for both the grafts. Graft uptake was assessed at the end of the 1st month, 3rd month, and 6th month,and hearing was assessed at the end of the 6th month with pure tone audiometry.RESULTS: Patients with temporalis fascia graft showed a take-up rate of 80% and cartilage-perichondrium graft of 92.5% by6 months. Among the fascia group, graft failure was seen in 20% (8). One patient had failed take-up of graft and four patientsshowed reperforation. In cartilage group, three patients showed failure of take-up of graft during the 1st month. No patient hadreperforation or retraction. Air-bone gap in fascia group showed a closure to 10 dB in 17.5% (7). In the cartilage group, 10 dBin 25% (10 patient s). In our short-term follow-up of 6 months, we found that cartilage-perichondrial graft reduces the chanceof reperforation and retraction even with variation in middle ear pressure due to eustachian tube catarrh. It gives good takeup rate and comparable hearing result as that of the fascia graft. It does not affect the sound conduction when thinned outto appropriate thickness. It is available from the same surgical field and in sufficient quantity for the closure of the TM defect.Cartilage-perichondrium graft for Type 1 tympanoplasty could be a successful replacement for temporalis fascia giving goodresult with neotympanum.