Comparison of the Efficacy of Septoplasty with Nonsurgical Management in Improving Nasal Obstruction in Patients with Deviated Nasal Septum - A Randomized Clinical Trial

Abstract Introduction In the current era, the major indication for septoplasty is nasal obstruction due to deviated nasal septum (DNS). Even though septoplasty is a commonly performed surgery, its effectiveness in relieving nasal obstruction in DNS has not been proven. Objective The present study involved the measurement of both objective (nasal patency) and subjective (quality of life measures) outcome measures for the evaluation of the efficacy of septoplasty as compared with medical management. Methods Patients with DNS presenting with nasal obstruction were included and randomized into a septoplasty group or into a nonsurgical management group, with 70 patients in each group. The improvement in nasal obstruction was assessed subjectively by the visual analogue scale (VAS), and the sino-nasal outcome test-22 (SNOT-22) and the nasal obstruction symptom evaluation (NOSE) questionnaires and was measured objectively by assessment of nasal patency by peak nasal inspiratory flow (PNIF) at 0, 1, 3, and 6 months of treatment in both groups. Results The average VAS, SNOT-22 and NOSE scores for the septoplasty versus the nonsurgical group before treatment were 6.28 versus 6.0, 19.5 versus 15, and 14 versus 12, respectively, and at 6 months post-treatment, the scores were 2.9 versus 5.26, 10 versus 12, and 8 versus 10 (p= 0.001), respectively. The average PNIF scores at 0 and 6 months were 60/50 l/min and 70/60 l/min, respectively, in the septoplasty group (p= 0.001); the scores at 0 and 6 months in the nonsurgical management group were 60/60 l/min and 70/70 l/min, respectively (p= 0.001). Conclusion Surgical correction of DNS by septoplasty improves nasal obstruction better than nonsurgical management at 6 months postsurgery.

Papillary carcinoma in a thyroglossal cyst: a rare case report and review of literature

Thyroglossal cysts are the most common thyroid anomaly with a majority of it being diagnosed at fourth decade of life. Authors report a case of 32-year-old lady with a globular swelling of 3×2 cm moving with deglutition with no cervical lymph nodes and a normal thyroid function test. Intra operatively a distinct lesion of 3×2 cm was found superior to the thyroid gland with firm nodules in the right lobe of the thyroid. Patient underwent total thyroidectomy with central compartment neck dissection and Sistrunk’s operation followed by a negative radio iodine scan and thyroid hormone suppression. This was considered based on intraoperative nodularity of the thyroid gland.

Effect of Incudostapedial Reconstruction Using Conchal Cartilage Interposition Graft on Hearing Outcome

Abstract Introduction Chronic otitis media is a widely prevalent condition in developing countries and is a cause of correctable hearing loss. The most frequent ossicular chain defect found during surgery for chronic otitis media has been a discontinuity of the incudostapedial joint. This study observes the effect of incudostapedial reconstruction using conchal cartilage on the hearing of the patient. Objectives To evaluate improvement in hearing by incudostapedial reconstruction using conchal cartilage interposition graft in tympanoplasty and to identify the independent factors associated with erosion of the long process of incus among patients with chronic suppurative otitis media tubotympanic type. Methods This study was conducted in the department of ear, nose and throat (ENT) amongst 22 patients with tubotympanic-type chronic suppurative otitis media who were found to have erosion of the long process during tympanoplasty. These patients underwent incudostapedial reconstruction using conchal cartilage. Their hearing was again reassessed at 12 weeks postsurgery, and the changes were observed. Results A statistically significant improvement in air conduction by 15.14 dB was found after undergoing incudostapedial reconstruction using conchal cartilage (p < 0.001). There was no statistically significant change in bone conduction (p value > 0.05). A total of 59.1% of patients in the study had an improvement in hearing ranging from11 to 20 dB. It was also found that 50% of the patients had a postoperative hearing of 10 to 20 dB. Conclusion Conchal cartilage interposition graft effectively improved hearing when used for the reconstruction of the incudostapedial joint during tympanoplasty in patients of chronic suppurative otitis media.

Role of Biochemical Parameters and GFR as Prognostification Factors in PUV Patients

Posterior urethral valves (PUV) are the most common cause of lower urinary tract obstruction in the male child with broad spectrum of clinical presentation, disease severity and associated sequelae. Methods: Baseline investigations included pre fulguration blood renal profile, radiological (DTPA) investigation followed by post fulguration blood renal profile and radiological investigation. The outcome has been studied by the analysis of the biochemical markers & GFR & statistical tests shall be applied where ever necessary Improvement in quality of life in terms of dribbling, enuresis, pant wetting, school dropouts, growth & development. Results: The mean urea, Hb and creatinine level at different interval was non- significant (P> 0.05). The most common case of USG was B/l HDN (5) and B/L hydronephrosis (5). Conclusion: Aggressive surgical treatment is better policy to treat the patients with PUV. Urine cultures should be done in the follow up of PUV patients to prevent the recurrent UTI as it adversely effects the kidneys.

Safety and Efficacy of Autologous Platelet-rich Fibrin on Graft Uptake in Myringoplasty: A Randomized Controlled Trial

Abstract Introduction Chronic suppurative otitis media is a common ailment in developing countries, and it generally presents with otorrhea and hearing loss. Different surgical procedures have been used to treat otitis media; among them is myringoplasty, which is a procedure that includes repair of the tympanic membrane. Platelet concentrates have been used widely in different types of wounds and are found to improve wound healing. Hence, the use of platelet-rich fibrin in myringoplasty will also improve the tympanic membrane healing. Objectives To assess the safety and efficacy of autologous platelet-rich fibrin on graft uptake in myringoplasty. Methods Eighty-six patients were observed during the study period of two years. Forty-three patients in the study group underwent myringoplasty aided with plateletrich fibrin, and 43 patients in the control group went through the same procedure but without the platelet-rich fibrin. The patients were observed for three months postoperatively by a blinded observer. Results A total of 4.7% of the patients in the study group had postoperative infection, compared with a rate of 19% in the control group (p = 0.039). The graft uptake success rate was found to be 97.7% in the study group as compared with 81% in control group (p = 0.012). The results were found to be statistically significant. Conclusion Being autologous in nature, and by comparing the groups, platelet-rich fibrin is safe for patients. The postoperative graft uptake rate is better in cases in which plateletrich fibrin was used. The postoperative infection rate was also lower in the same group. (AU)

Dynamic Slow Motion Video Endoscopy as an Adjunct to Impedance Audiometry in the Assessment of Eustachian Tube Function

Abstract Introduction Eustachian tube (ET) dysfunction plays an important role not only in the pathophysiology of various middle ear disorders, but also in predicting the outcome of the treatment. As there is no single test that assesses both the anatomic and physiological functions of the ET, a combination of tympanometry and dynamic slow motion video endoscopy may improve the sensitivity of ET function assessment. Objective To find out if there is any correlation between dynamic slow motion nasal video endoscopy and impedance audiometry in assessing ET function in patients with middle ear diseases. Methods Ours was a descriptive study performed with 106 patients attending the Ear, Nose and Throat (ENT) Outpatient Department of a tertiary care center in South India with features suggestive ofmiddle ear disease. All patients underwent impedance audiometry and dynamic slow motion nasal video endoscopy, and were graded based on the severity of the ET pathology. Results A total of 47 out of 97 patients with abnormal endoscopy findings also had abnormal impedance audiometry. The correlation was greater among the patients with higher grades of ET dysfunction. The endoscopy findings of 106 cases, when correlated with middle ear manometry, revealed that 56 cases showed complete agreement, and 50 cases showed disagreement. The nasal endoscopy results, when correlated with middle ear manometry studies by using McNemar's chi-squared (χ2) test, showed a significant association between the 2 tests (p = 0.017). Conclusion There is a significant alteration in middle ear pressure as the severity of the ET tube dysfunction increases. Impedance audiometry and nasal endoscopy provide a better measure of ET function.

The efficacy of radiofrequency volumetric tissue reduction of hypertrophied inferior turbinate in allergic rhinitis.

Objectives: To evaluate the efficacy of radiofrequency volumetric tissue reduction (RFVTR) technique in treatment of allergic inferior turbinate hypertrophy (ITH) and to study its effect on nasal mucociliary clearance. Materials and Methods: This prospective study was conducted over 50 perenial allergic rhinitis patients with persistent nasal obstruction due to bilateral ITH refractory to medical management received one time RFVTR of both inferior turbinates. Symptoms were subjectively assessed by Visual Analog Scale (VAS) and mucociliary clearance was measured by saccharin transit time (STT) pre-operatively, at 1 week, 1, 3, and 6 months post-operatively. Results: Forty-seven subjects completed study. All patients had significant symptomatic improvement which started from 1 week post-operatively and persisted up to 3 months. Post-operative VAS scores of nasal obstruction, rhinorrhea, sneezing, headache, and snoring at 1 week 1, 3 and 6 month follow up visits significantly decreased (P < 0.05) whereas significant decreased in post-operative VAS scores of hyposmia was observed at 1 month follow up (P < 0.05). Though increase in VAS scores was observed during 6 month follow up, the difference between pre-operative and 6 month post-operative mean VAS score was statistically significant (P < 0.05). Symptomatic improvement in nasal obstruction, rhinorrhea, sneezing, headache, hyposmia, and snoring persisted in 89.4%, 95.6%, 97.8%, 88.5%, 46.7%, and 100% of patients, respectively, during 6 month follow up. There was no significant change in STT following RFVTR except at 1 week follow up (P < 0.0001). Conclusion: RFVTR is safe and effective in treatment of ITH in allergic rhinitis patients.