ABSTRACT
Ropivacaine is a long-acting amide local anaesthetic agent which has a significant vasoconstrictive property, long duration of action, least central nervous system and cardiac complications due to the pure (S)-enantiomer property by reversible inhibition of sodium ion influx in nerve fibres. By using additives the duration of analgesia may be prolonged. Ropivacaine has been used routinely in our otorhinolaryngology procedures since 2010 (10 years). The present article details the clinical applications of ropivacaine and its current place as a local anaesthetic in otorhinolaryngology practice.
ABSTRACT
Endoscopic Sinus Surgery is evolving day by day, there is a constant need for improvisation in terms of instrumentation with clear bloodless surgical field and good postoperative results. The applications of Dr. Ahila's Conchal Crusher for managing Concha bullosa in Functional Endoscopic Sinus Surgery (FESS) Surgery are presented. The creation/innovation of Dr. Ahila's conchal crusher will prevent raw mucosal surface area, bleeding and scope fogging with blood during FESS surgery after traditional conchoplasty. This new instrument makes it easy to reduce concha bullosa during nose and sinus surgery creating a bloodless field, no risk of destabilization or fracture of middle turbinate hence no postoperative synechiae which may otherwise lead to iatrogenic frontal sinusitis. Surgical instruments represent a major financial asset to the healthcare facility. Single instrumentation is essential to avoid costly replacements, surgeon satisfaction, reduce costs and delays in the Operating room and enhance patient safety. Dr. Ahila's conchal crusher may facilitate the performance of concha bullosa surgery and advance the art of Endoscopic Sinus surgery to a better level.
ABSTRACT
As endoscopic ear surgery is evolving day by day there is a constant need for improvisation in terms of instrumentation, visualization and clear bloodless surgical field. The applications of Ahila's Diathermy Round Knife for Endoscopic Ear Surgery are presented. The development of Ahila's diathermy round knife will prevent shifting to two handed ear surgery or the need for Endo holders. This new instrument is a game changer in endoscopic ear surgery creating a clean incision and bloodless field to operate. Surgical Instruments represent a major financial asset to the healthcare facility. Careful attention to care, handling and sterilization is essential to avoid costly replacements, enhance patient and surgeon satisfaction, reduce costs and delays in the Operating room and enhance patient safety. Ahila's round diathermy knife may facilitate the performance of surgery and advance the art of Endoscopic surgery to a higher level.
ABSTRACT
Techniques for inferior turbinate reduction vary with various surgical methods, which differ in the approach of preservation of tissue from total turbinectomy to limited submucosal cauterization. Our preferred method to address hypertrophic inferior turbinate by mini turbinoplasty-tunneling technique are presented. Critical steps include creation of window in the inferior turbinate with a 4 mm microdebrider blade and removal of both inferior turbinate mucosal hypertrophy and bony component to convert a convex looking inferior turbinate to concave shape. This allows proper debulking of the entire medial aspect of the inferior turbinate and widening of the nasal valve area. Mini turbinoplasty-tunneling technique for hypertrophic inferior turbinates, is a safe method in achieving turbinate size reduction with minimal morbidity and long-term relief of nasal obstructive symptoms without added risk of complications.
ABSTRACT
Migraine related vertigo (MRV) is largely accepted in the vestibular community and probably represents the second most common cause of vertigo after benign positional vertigo by far exceeding Meniere's disease. The data on vestibular migraine management is still relatively poor, despite its enormous importance in daily practice. A 55-year old male presented with history of giddiness, imbalance, sweating and sensation of nausea with severe pulsating headache of one day duration. Ear, Nose and Throat examination was normal. Neurological tests were negative. Audiogram and Electronystagmography were within normal limits. Nystagmus was positive on turning his head to left side. By reviewing the available literature on MRV, the report aims to outline a protocol for future management. The patient and caretakers were thoroughly counseled and educated, started on Flunarizine 10 mg and Dimenhydrinate 50 mg; advice healthy life style, necessary precautions, compliance to treatment. Patient was reportedly followed up and was symptom free over a period of 9 years. There is a call for proper diagnosis to address the complaint and manage of symptoms in acute attack and prophylaxis. In addition, this case highlight the ongoing need for proper systematic evaluation, therapeutic management, follow up by ensuring compliance to medication, necessary precautions and life style modification.
ABSTRACT
To compare the symptomatic improvement of nasal symptoms following septoplasty with partial inferior turbinectomy (groups A) versus septoplasty alone (groups B) and to assess the improvement of nasal symptoms in both surgical groups before and after surgery by NOSE scale. This Tertiary Hospital based study was carried out between August 2012 and April 2014. 60 cases with septal deviation and contralateral inferior turbinate hypertrophy. Nasal Obstruction Symptom Evaluation (NOSE) scale for evaluating nasal symptoms. Patients were alternatively divided into two surgical groups, group A. Septoplasty with partial inferior turbinectomy and group B septoplasty alone. Post-operative patient's symptoms evaluated by NOSE scale at 1, 3 and 6 months. Data analysed using tables, graph and percentage and test of significance like paired t test, Friedman test, Chi square test used. Post operative improvement following both group A septoplasty with partial inferior turbinectomy and group B in those undergoing septoplasty alone was highly significant (p < 0.001) at post-op 1, 3 and 6 months subjectively. When both groups were compared those undergoing partial inferior turbinectomy surgery with septoplasty had highly significant results (p < 0.001) for subjective assessment by NOSE scale. This study showed that hypertrophied turbinate need to be addressed in chronic cases of nasal obstruction with deviated nasal septum and contralateral turbinate hypertrophy. partial inferior turbinectomy should be done in addition to septoplasty, its highly effective modality for the treatment of nasal obstruction in patients with deviated nasal septum. NOSE score can be used as a subjective tool for symptomatic measurement of patients with nasal obstruction.
ABSTRACT
Middle ear anatomy is complex hence it is difficult to study the microscopic vibration of tympanic membrane and ossicles. The basic research has been done in few centres. Our experience is based on clinical data. The lack of quantitative understanding of structural and functional relationship in the mechanical response of the normal and reconstructed middle ear is major factor in poor hearing results after surgery (Merchant et al. in J Laryngol Otol 112:715-731, 1998). The vibration pattern of tympanic membrane changes with different frequencies. It depends upon shape, position and tension of tympanic membrane. Sometimes reconstructed tympanic membrane loses its shape and tension and thus its vibratory response (Pusalkar and Steinbach in Transplants and implants in otology II, 1992). Then what should be the shape, position, tension of the tympanic membrane and the ossicles. In order to have a serviceable hearing, dry and safe ear, there is a necessity of answering all these queries by us.
