Postauricular Transcanal Posterior Tympanectomy (PT2) Approach - A Modified Surgical Technique for Jugulotympanic Paragangliomas

Abstract Introduction The surgical management of jugulotympanic paragangliomas has remained challenging. They are the second most common type of tumor of the temporal bone after acoustic neuroma. It has been noticed by the authors that the jugulotympanic paragangliomas may have extensions to the epitympanum and aditus in addition to the mesotympanum and hypotympanum. The modified technique could be an alternative to the conventional facial recess technique for complete removal of the tumors. Objective To highlight the modified surgical technique for the surgical treatment of jugulotympanic paragangliomas. Methods This is a retrospective review of 34 cases of jugulotympanic paragangliomas treated in a tertiary center with respect to clinical presentation, diagnosis, and surgical treatment. Tinnitus and hearing loss were predominant symptoms. A modified technique of postauricular transcanal posterior tympanectomy with extended hypo-tympanic access was performed in 29 patients. Only two cases were operated with a classical transcanal approach. A canal wall down the mastoidectomy was required in three patients. Results The patients operated on with the modified technique had complete excision evident by absence of any lesion in computed tomography and the disappearance of tinnitus. However, two patients had recurrence of symptoms and presence of tumor in the follow-up period. These two patients underwent revision surgery. None of the patients required postoperative radiotherapy or gamma knife therapy. Conclusions Jugulotympanic paragangliomas can be effectively managed with the modified technique to ensure complete removal of the lesions. This technique has not been reported earlier in the literature.

Recommendations for management of peripheral retinal degenerations

Some degenerations involving the peripheral retina can result in a rhegmatogenous retinal detachment. Currently, there are no clear guidelines for retinal screening and/or management of these peripheral retinal degenerations in patients with or without recent onset posterior vitreous detachment or in those prior to refractive surgery or intraocular procedures. This article aims to provide a set of recommendations for the screening and management of peripheral retinal degenerations based on a common consensus obtained from an expert panel of retinal specialists.

A comparative study between magnetic resonance imaging and transvaginal sonography for evaluation of uterine fibroid using histopathology as a gold standard

Background: Uterine fibroids constitute a substantial bulk of patients presenting to Gynaecology department. Many newer imaging modalities have evolved for their correct evaluation, but in a developing country like India, ultrasound is still being used as a screening as well as diagnostic modality. So, this study was done to compare ultrasound and magnetic resonance imaging for evaluation of uterine fibroids in terms of their sensitivity, specificity Trans vaginal  and positive predictive value using Histopathology as a gold standard so as to improvise on current clinical practices in this country.Methods: An ethically approved prospective study was done upon 50 patients with suspected uterine masses at SMS Hospital Jaipur. All included patients underwent Trans vaginal Ultrasound (TVS) and Magnetic resonance imaging (MRI) and were accordingly treated surgically. Histopathology report was traced postoperatively. Data was collected and subjected to various statistical tests including Cohen’s kappa.Results: Most of the patients were <50 years and presented with complains of pain abdomen. Among total 50 cases, the sensitivity of TVS and MRI was 44% and 92%, specificity was 96% and 88%, PPV was 91.67% and 88.46%, NPV was 63.16% and 91.67% respectively, kappa was 0.40 and 0.80 i.e. agreement between TVS and MRI v/s HPE was 40% and 80% respectively. The diagonal agreement between transvaginal USG and MRI, was 63%.Conclusions: TVS is a good screening modality but MRI is definitely better for proper characterization and localization of fibroids enabling clinicians to select the most appropriate management in everyday clinical practice.

Manuka Honey versus Antibiotic Ear Drops in Healing of Post-Operative Mastoid Cavity: A Prospective Randomized Trial / 대한이비인후과학회지

Background and Objectives@#This study investigates the role of manuka honey in the healing of postoperative mastoid cavity.Subjects and Method This was a single centre prospective study on 40 consecutive patients of chronic otitis media undergoing canal wall down mastoidectomy. Manuka honey soaked in gel foam was kept in the mastoid cavity for the study group and antibiotic soaked gel foam was kept for the control group. Culture swabs from mastoid granulations were sent at various times from both groups. The healing of the mastoid cavity was assessed in the follow up period. @*Results@#Preoperatively 15 out of 20 patients (75%) had a positive aural swab culture in the study group while 11 out of 20 (55%) in the control group had a positive aural swab culture. The most common organism isolated was Pseudomonas aeruginosa and Proteus mirabilis. One month after mastoidectomy only 4 patients (20%) had sterile culture and 16 patients (80%) had grown organisms; in the control group, 7 patients (35%) had sterile culture and 13 patients (65%) had growth on culture. The mean merchant scores for the study group and the control were 2.61 (2-5) and 2.05 (1-4), respectively. At 3 months 13 patients (65%) with sterile culture and 7 patients (35%) had growth on culture; in the control group, 16 patients (80%) had sterile culture and 4 had shown persistent growth on culture (p=0.28). All positive cultures were aerobic in both groups. The mean merchant scores for the study group and the control were 1.03 (0-4) and 0.7 (0-3), respectively (p=0.09). @*Conclusion@#Healing of mastoid cavity was almost similar in both groups (p>0.05). Manuka honey exhibited antibacterial activity against Pseudomonas, Proteus, Klebsiella, Escherichia coli, Staphylococcus.

A prospective study for the assessment of thyroid function by pre and post supervised exercise protocol in newly diagnosed patients of subclinical hypothyroidism

Background: The presence of raised serum TSH with serum free T4 and T3 within the reference range falls in subclinical hypothyroidism. It is a well-known fact that exercise affects the activity of thyroid glands and the production of their hormones. Author studied the effect of regular exercise in patients of newly diagnosed subclinical hypothyroidism. Pre and post-exercise thyroid function tests were evaluated to decide about the necessity to start thyroid replacement therapy or to adopt wait and watch policy.Methods: Study enrolled 100 newly diagnosed subclinical hypothyroidism patients attending this tertiary care hospital and randomised them in two groups, one group was subjected to regular physical exercise of 45-60 minutes daily along with supervised treadmill exercise stage 0 for 45-60 minutes once weekly followed by re-evaluation of thyroid function test after 30 days and second group was re-evaluated for thyroid function test without exercise after 30 days.Results: Thyroid profile parameters were compared and analysed by paired ‘t’ test, statistically significant increase in serum T3 (p value <0.05) and serum T4 (p value <0.05), along with significant reduction in TSH level (p value <0.05) were found in exercise group, while in non-exercise group changes in thyroid profile parameters were statistically not significant. There was significant reduction in mean weight in exercise group (p value <0.05), while in non-exercise group changes in weight were not significant.Conclusions: Present study concluded that regular physical exercise can improve thyroid function in patients of newly diagnosed subclinical hypothyroidism and convert them to euthyroid state.

Unilateral anterior persistent fetal vasculature in a child with blepharophimosis‑ptosis‑epicanthus inversus syndrome: A surgical challenge.

Blepharophimosis‑ptosis‑epicanthus inversus syndrome (BPES) is a rare autosomal dominant genetic disease. It is clinically characterized by four major features; blepharophimosis, ptosis, epicanthus inversus, and telecanthus. We report a case of a 1‑year‑old female with BPES with unilateral anterior persistent fetal vasculature (PFV). On examination, she was found to have all the clinical features of BPES, along with calcified and partially absorbed cataract with elongated ciliary processes in her left eye. B‑scan of left eye showed attached retina with no evidence of posterior PFV. Systemic examination was normal. She underwent cataract surgery with primary posterior capsulotomy with intraocular lens implantation under general anesthesia. Literature search did not reveal any previous reports of unilateral anterior PFV and BPES. The clinical features, other associations, and the difficulties in the surgical management of this condition are discussed.

Axial length and cone density as assessed with adaptive optics in myopia.

Aim: To assess the variations in cone mosaic in myopia and its correlation with axial length (AL). Subjects and Methods: Twenty‑five healthy myopic volunteers underwent assessment of photoreceptors using adaptive optics retinal camera at 2° and 3° from the foveal center in four quadrants superior, inferior, temporal and nasal. Data was analyzed using SPSS version 17 (IBM). Multivariable regression analysis was conducted to study the relation between cone density and AL, quadrant around the fovea and eccentricity from the fovea. Results: The mean cone density was significantly lower as the eccentricity increased from 2° from the fovea to 3° (18,560 ± 5455–16,404 ± 4494/mm2 respectively). There was also a statistically significant difference between four quadrants around the fovea. The correlation of cone density and spacing with AL showed that there was a significant inverse relation of AL with the cone density. Conclusion: In myopic patients with good visual acuity cone density around the fovea depends on the quadrant, distance from the fovea as well as the AL. The strength of the relation of AL with cone density depends on the quadrant and distance.

Metallic foreign body migrating into prevertebral muscles: how we did it?

Accidental ingestion of foreign bodies is common in ENT practice. A very small number of ingested foreign bodies perforate the esophagus and even a smaller fraction of extra mucosal migration penetrates into the soft tissues of the neck. Most cases reported in the literature involve fish bones. If left untreated, they may result in life threatening complications. This case presents a patient with a metallic foreign body [metal wire] in the esophagus which migrated extraluminally into the prevertebral muscle of the neck and describes the difficulties encountered in removing the migrated foreign body. Intra-operative radiography using two metallic pointers was used to locate the exact position of the foreign body during exploration of the neck

External jugular vein aneurysm with thrombus presenting as painful neck mass: a case report

External jugular vein aneurysm with thrombosis presenting as neck swelling is a rare clinical entity and rarely encountered in routine clinical practice. We present a case of a 45-year-old female with external jugular vein aneurysm presenting as a painful lump in the neck. Ultrasound of the neck and CT angiography showed saccular dilation of the lower end of the external jugular vein with thrombosis within the aneurysm. Saccular aneurysm of the external jugular vein is very uncommon and can lead to thrombotic complications with serious consequence

Endothelial cell study in a case of Werner's syndrome undergoing phacoemulsification and Yettrium-Aluminum-Garnet laser capsulotomy.

Werner's syndrome (WS) is a rare autosomal recessive disorder with multisystem manifestations of premature aging from the second decade of life. Cataract is one of the features of WS. Cataract surgery is complicated with postoperative wound dehiscence and bullous keratopathy when the surgery is done by intracapsular or conventional extracapsular method. We report the short-term result of phacoemulsification and Neodymimum Yettrium-Aluminum-Garnet laser (Nd YAG) capsulotomy in a case of WS with bilateral cataracts. Postoperatively and post capsulotomy, there was no change in the endothelial cell morphology. There was an 8.6% decrease in endothelial cell count at the end of 15 months postoperatively and 11 months post YAG capsulotomy. This decrease is within the acceptable range of cell loss after phacoemulsification and YAG capsulotomy. To the best of our knowledge, this is the first reported case of YAG laser capsulotomy in WS.

A truly knotless technique for scleral fixation of intraocular lenses: Two-year results.

Scleral fixated intraocular lens (SFIOL) is a safe and effective option for managing optical aphakia. Suture related complications like suture erosion, suture breakage, endophthalmitis, etc. are unique to SFIOL. The knots can be covered by partial thickness flaps or they can be rotated into scleral tissues without flaps to reduce the complications. We performed a recently described novel technique which obviates the need for knot and scleral flaps in securing the SFIOL. This novel 2-point Ab externo knotless technique may reduce the knot related problems. Twenty-three eyes undergoing this knotless SFIOL procedure were analyzed for intraoperative and postoperative complications. Twenty-two eyes either maintained or improved on their preoperative vision. All patients had a minimum follow-up of 24 months.

Endomyocardial fibrosis.

We present a case report of a 26-year-old male from Bulandsahar, India. The patient presented with right heart failure. Evaluation revealed peripheral eosinophilia. An echocardiogram and MRI showed biventricular hypertrophy with obliteration of the ventricular apices, typical of endomyocardial fibrosis. This condition is rare in Bulandsahar, India.

Transient evoked otoacoustic emissions.

OBJECTIVE: The purpose of this study was to collect parametric measures of TEOAEs in normal hearing children of various age-groups and to establish a normative baseline for Transient Evoked Otoacoustic Emissions (TEOAEs). METHODS: Sixty subjects were investigated in three age-groups: neonates, 0-1 month; infants, 1 month-1 year; and children, 1-6 years. Each group comprised of 20 subjects. All the subjects underwent medical examination by a pediatrician and an ENT surgeon. Screening for hearing was done by immittance testing, behavior observation and conditioned play audiometry. The TEOAEs were analyzed for the parameters of amplitude, cross-correlation (wave reproducibility) and signal-to-noise ratio (SNR). RESULTS: There was no difference between the mean amplitudes of the right and left ears in the groups. The females in the neonates group had higher emission amplitudes than the males. The mean amplitude of the subjects in the neonates group was significantly higher than the subjects in the infants or children groups. The cross correlation (wave reproducibility) was constant across the age. The mean SNR for all the subjects were well above 3 dB at frequencies 1.5 k, 2 k, 3 k and 4 kHz. The neonates group showed the lowest SNR ranging between 3.47 to 9.62 dB. The infants group showed the highest SNR ranging between 6.13 to 13.11 dB. CONCLUSION: The TEOAEs response measures of SNR and cross correlation, at frequency bands 1.5, 2, 3 and 4 kHz, may provide more reliable outcomes than TEOAEs amplitude. Subjects in the age range of 0-1 month show lower SNRs than those in higher age ranges. The values can be used as normative data for screening and diagnostic purposes in the pediatric population.

Prevalence of sustained hypertension and obesity in urban and rural school going children in Ludhiana.

BACKGROUND: Increasing trend of hypertension is a worldwide phenomenon. The data on sustained hypertension in school going children is scanty in India. The present study was conducted to evaluate the prevalence of sustained hypertension and obesity in apparently healthy school children in rural and urban areas of Ludhiana using standard criteria. METHODS AND RESULTS: A total of 2467 apparently healthy adolescent school children aged between 11-17 years from urban area and 859 students from rural area were taken as subjects. Out of total 3326 students, 189 were found to have sustained hypertension; in urban areas prevalence of sustained hypertension was 6.69% (n=165) and in rural area it was 2.56% (n=24). Males outnumbered females in both rural and urban areas. The mean systolic and diastolic blood pressure of hypertensive population in both urban and rural population was significantly higher than systolic and diastolic blood pressure in their normotensive counterparts (urban normotensive systolic blood pressure:115.48+/-22.74 mmHg, urban hypertensive systolic blood pressure: 137.59+/-11.91 mmHg, rural normotensive systolic blood pressure: 106.31+/-19.86 mmHg, rural hypertensive systolic blood pressure: 131.63+/-10.13 mmHg, urban normotensive diastolic blood pressure: 74.18+/-17.41 mmHg, urban hypertensive diastolic blood pressure: 84.58+/-8.14 mmHg, rural normotensive diastolic blood pressure: 68.84+/-16.96 mmHg, rural hypertensive diastolic blood pressure: 79.15+/-7.41 mmHg). Overweight populationwas significantly higher in urban area. There were 287 (11.63%) overweight students and 58 (2.35%) were obese. In rural population overweight and obese students were 44 (4.7%) and 34 (3.63%) respectively. There was significant increase in prevalence of hypertension in both rural and urban population with increased body mass index in urban students; those with normal body mass index had prevalence of hypertension of 4.52% (n=96), in overweight it was 15.33% (n=44) and in obese it was 43.10% (n=25). In rural area, the overweight students showed prevalence of sustained hypertension in 6.82% (n=3) and in obese group it was 61.76% (n=21). None of the student with normal body mass index in rural area was found to be hypertensive. The mean body mass index of hypertensive population in both rural and urban areas was significantly higher than respective normotensive population (mean body mass index in urban normotensive group: 20.34+/-3.72 kg/m2, hypertensive group: 24.91+/-4.92 kg/m2; mean body mass index in rural normotensive group: 18.41+/-3.41 kg/m2, hypertensive group: 21.37+/-3.71 kg/m2, p<0.01). CONCLUSIONS: Prevalence of sustained hypertension is on the rise in urban area even in younger age groups. Blood pressure is frequently elevated in obese children as compared to lean subjects. This is possibly related to their sedentary lifestyle, altered eating habits, increased fat content of diet and decreased physical activities.

Mucosal neuromas and prominent corneal nerves without MEN IIB.

Multiple endocrine neoplasia type II B or the mucosal neuroma syndrome is an autosomal dominant hamartoneoplastic syndrome. This is a report of a 17 year old female who presented with mucosal neuromas at age 7 years and had surgical excision of the lesion. Ten years later (at age 17 years) she had further recurrence of mucosal neuromas which were again surgically excised. She has been thoroughly investigated & followed, however to date she has no evidence of thyroid carcinoma which is a major complication of this syndrome.

Bilateral congenital choanal atresia.

Our experience with the diagnosis and management of bilateral choanal atresia is presented. Four patients were treated by endoscopic transnasal approach followed by stenting with portex endotracheal tube for four to six weeks. Meticulous postoperative care particularly stent management is crucial for successful treatment of choanal atresia.