Anatomical Study of the Facial Recess with Implications in Round Window Visibility for Cochlear Implantation: Personal Observations and Review of the Literature.

Introduction Posterior tympanotomy through facial recess (FR) is the conventional and most preferred approach to facilitate cochlear implantation, especially when the electrode is inserted through the round window. The complications of the FR approach can be minimized by proper understanding of the anatomy of the FR. Objective The present study was undertaken to assess the various parameters of FR and round window visibility, which may be of relevance for cochlear implant surgery. Methods Thirty-five normal wet human cadaveric temporal bones were studied by dissection for anatomy of FR and posterior tympanum. Photographs were taken with an 18 megapixels digital camera, which were then imported to a computer to determine various parameters. Results The mean distance from the take-off point/crotch of the chorda tympani nerve (CTN) to the stylomastoid foramen was 4.08 ± 0.8 mm (range of 2.06 - 5.5 mm). The variations in the course of the CTN included origin at the level of the lateral semicircular canal. The mean chorda-facial angle in our study was 26.91° ± 1.19°, with a range of 25° to 28.69°. The mean FR length ranged between 9.4 mm and 18.56 mm (mean of 12.41 ± 2.91mm) and varied with the origin of the CTN and pneumatization of temporal bone. The average maximum width of the FR was 2.93 ± 0.4 mm (range 2.24-3.45 mm) and the mean width of the FR at the level of the round window was 2.65 ± 0.41 mm. Conclusion The FR approach provides good access to the round window membrane in all cases. In some cases, table adjustment is required.

Pneumatization Pattern in Squamousal Type of Chronic Otitis Media.

To study the pneumatization pattern of mastoid bone in cases of squamousal type of chronic otits media and analyze pneumatization pattern of opposite normal ear in cases of unilateral chronic otitis media (COM). A total of 94 patients (104 ears) between the age group of 7-84 years attending the E.N.T outpatients, inpatients and casualty of Acharya Vinoba Bhave Rural Hospital, Sawangi (Maghe), Wardha, after applying inclusion and exclusion criteria were found suitable and hence selected for the present study and were subjected to bilateral X-ray mastoid (Schuller's view). HRCT temporal bone done in selected 55 patients. On analyzing patients radiologically (X-ray mastoid), it was found that out 104 ears, mastoid was pneumatized in 2 (1.92 %) diploic in 20 (19.23 %) and sclerotic in 82 (78.85 %) ears. Contralateral mastoid of 70 normal ears, mastoid was pneumatized in 30 (42.86 %) diploic in 22 (31.43 %) and sclerotic in 18 (25.71 %) ears. Most of the diseased ear demonstrated non pneumatized mastoid (98.08 %) whereas contra lateral mastoid of 70 normal ear, showed significantly more pneumatization This difference is statistically significant (P value < 0.0001). Significantly more sclerosis and non pneumatization in the ear with COM of squamousal type than the healthy contralateral ear supports the environmental theory.

Effect of Tridax procumbens (Linn.) on bile duct ligation-induced liver fibrosis in rats.

The present study was undertaken to clarify whether methanolic extract of Tridax procumbens prevents liver fibrosis in rat. The hepatic fibrosis was induced by 28 days of bile duct ligation in rats. The 4-week treatment with Tridex procumbens reduced the serum aspartate aminotransferase (U L⁻¹), glutamate pyruvate transaminase (U L⁻¹), alkaline phosphatase (IU L⁻¹), lactate dehydrogenase (IU L⁻¹), total bilirubin (mg dL⁻¹), direct bilirubin (mg dL⁻¹) and hydroxyproline (mg gm⁻¹) content in liver and improved the histological appearance of liver section. The results of this study led us to conclude that T. procumbens can reduce the degree of hepatocellular damage and may become antifibrotic agent for liver fibrosis.

Combined Middle Cranial Fossa and Trans-Mastoid Approach for the Management of Post-Mastoidectomy CSF Otorrhoea.

Cerebrospinal fluid (CSF) otorrhoea is an uncommon condition arising from defects in the tegmen and middle cranial fossa. 33 year gentleman presented with post-mastoidectomy CSF otorrhoea of 5 year duration. Imaging finding were suggestive of fracture in the tegmen region. A combined middle cranial fossa/transmastoid was used to repair the defect. Defect was identified in the tegmen plate and it was closed with pedicled pericranial graft, laterally based pedicled temporalis muscle graft reinforced by bone dust and supported with intact mucosal flap. The leak stopped completely following surgery. The patient is doing well at follow up. Repair of these defects need careful analysis of imaging findings to understand pathological anatomy, and a well planned surgical approach to achieve meticulous repair.

A comparative study of ceruminolytic agents.

A prospective study was done to access the efficacy of ceruminolytic agents, i.e 2% paradichlorobenzene, 10% sodium bicarbonate, 2.5% acetic acid and normal saline. All score 4 hard impacted ear wax cases in the adult population (>20 years) were accrued for the assessment of the relative efficacy. Upon analyzing the comparative efficacy of four ceruminolytic agents, by taking into consideration three parameters (post) ceruminolytic cerumen score, attempts of syringing required to extrude the cerumen mass, post-ceruminolytic use and appearance of the removed cerumen mass. 2% paradichlorobenzene emerged as the most superior ceruminolytic, closely followed by 10% sodium bicarbonate. 2.5% acetic acid fared moderately while normal saline emerged as the least efficacious ceruminolytic agent.