Intricacies of the Epitympanum-Endoscopically Revisited.

Endoscopic demonstration of the temporal bone and its related structures is a better tool specially for understanding the complex intricacies of the middle ear. In this study we aim to understand the anatomy of the epitympanum/attic with the aid of Otoendoscopy using transmastoid and transattic approaches. Fifty four adult cadaveric temporal bones were dissected at our centre. Transcanal and transmastoid approaches were performed to visualize the middle ear spaces. We could demonstrate Cog, a ridge of bone that extends inferiorly from the tegmen plate just anterior to the head of malleus, epitympanic diaphragm by exploring the three malleal ligamental folds, Prussak's space and its boundaries, pathways of ventilation. Better understanding of the ventilation pathways of the middle ear, restoration of adequate air access in the attic help in better healing and prevent recurrences of diseases. Thus having a three dimentional orientation of the attic and its contents aid the surgeon in performing better surgery and thus provide disease free ear.

Clinical Approach to Decision-Making in Nasogastric Tube Weaning and Tracheostomy Tube Decannulation.

Extensive resections for advanced malignancies of the oral cavity quite often require patients to have a tracheostomy tube and nasogastric tube for prolonged periods leading to dependence. Timely and safe removal of these tubes would help hasten the recovery and rehabilitation of these patients. A simple bedside protocol for evaluation and weaning of nasogastric tube and tracheostomy tube is outlined in this communication. This would help health care workers in resource-poor settings make safe clinical decisions and improve care.

Sphenoid Mucocele: A Complication of Skull Base Reconstruction with Nasoseptal Flap-A Critical Review and Our Experience.

The evolution of expanded endoscopic skull base surgery has enabled development of minimally invasive approaches for resection of large skull base tumors with the nasoseptal flap proving to be an indispensable tool in skull base reconstruction. We here present our experience of sphenoid mucocele development after skull base reconstruction with the nasoseptal flap along with a comprehensive review of the limited literature on the same. With the expanding scope of endoscopic skull base surgery, the nasoseptal flap is increasingly being used for reconstruction. Despite adherence to standard recommendations and use of meticulous technique during flap placement, the potential risk of mucocele formation under the flap should always be borne in mind. In our experience, displacement of the flap pedicle could lead to ostial obstruction and mucocele formation. Hence, in addition to meticulous technique, a close follow up of such patients via nasal endoscopy or imaging is important to further our knowledge and understanding of the long-term effects and complications of this flap.

Stapes Surgery Teaching Tool: A Simple and Stable Technique.

Stapedotomy followed by placement of a piston prosthesis is the mainstay for surgical management of otosclerosis primarily undertaken to improve hearing in patients. Although a simple and elegant procedure, prosthesis placement in stapes surgery is difficult to master. Improper surgical technique or improper placement of prosthesis may result in complications which may require revision surgery. We here describe a training technique that is simple, inexpensive, improves the skills and can be done using easily available materials such as a disposable syringe, stapler pin and micro-forceps. Regular practice with this training module minimizes surgical time and can even be done just prior to the surgery, however, this is not a substitute for temporal bone dissections.

Detection of bacteria by 16S rRNA PCR and sequencing in culture-negative chronic rhinosinusitis.

OBJECTIVE: Current studies on the association between bacteria and chronic rhinosinusitis (CRS) have relied solely on microbiological culture, which can sometimes be negative due to prior antibiotic therapy or lack of transport media. The objective of the study was to understand whether bacteria are associated with culture-negative cases. METHODS: We investigated 20 cases of CRS undergoing functional endoscopic sinus surgery by both culture and 16S rRNA gene polymerase chain reaction (PCR) followed by sequencing. The disease severity was assessed using Sino-nasal Outcome Test-22 (SNOT-22) scoring preoperatively. RESULTS: Of the 20 cases studied, only five were culture-positive. Bacteria were detected in all 15 culture-negative cases by 16S rRNA gene PCR. Sequencing indicated that Staphylococcus is the dominant group, followed by Enterobacter and Pseudomonas. In two cases, from which Pseudomonas was detected, SNOT-22 scores were above 80, indicating high disease severity. CONCLUSION: 16S rRNA gene PCR, followed by sequencing, would help the clinician understand the association between bacteria and CRS. Molecular detection and identification of bacteria would help the clinician better predict the outcome and plan further management accordingly. LEVEL OF EVIDENCE: NA. Laryngoscope, 128:2223-2225, 2018.

Bacterial Biofilms in Chronic Rhinosinusitis and Their Implications for Clinical Management.

To study the microbiological profile in patients with chronic rhino-sinusitis. To correlate disease severity with the presence of biofilms and host risk factors. To assess outcome of Sinus Surgery 2 weeks post operatively in terms of presence of bacteria and their ability to form biofilm. Prospective study. 50 cases of chronic rhino-sinusitis requiring Functional Endoscopic Sinus Surgery admitted in SDM Hospital, Dharwad, Karnataka were studied using intra-operative mucosal samples for microbiological analysis. The organisms isolated were tested for biofilm forming ability using three in vitro tests. Severity of disease was assessed using SNOT 22 scoring system. Of 50 cases studied, 66% showed presence of chronic rhino-sinusitis with polyposis and had higher SNOT scores compared to those without polyps. Bacterial isolates were obtained from only 17 samples. Staphylococcus species was isolated from 16 samples and Klebsiella pneumoniae from one. 11 Staph spp. isolates showed biofilm forming ability in vitro. Postoperative events in 3 cases yielded biofilm-forming Staphylococcus. Staphylococcus was the most dominant organism isolated and 11 isolates were biofilm formers. Thus the detection of biofilm forming organisms can be considered as a negative prognostic indicator and should forewarn the surgeon about the risk of recurrence.

Unicentric castlemans disease: unusual disorder of the neck a case review.

Castleman's disease (giant or angio follicular lymph node hyperplasia) was first described by Benjamin Castleman in the year 1957 and was named after him. It is an uncommon lympho proliferative disorder which is localised to single lymphnode (unicentric) or multiple lymph node level systemically (multicentric).It is a very rare disorder characterised by non-cancerous growths. The most common sites of this are mainly thorax (mediastinum or lung hilum) and abdomen. It rarely occurs in cervical area. We report a case of unicentric cervical castleman's disease of neck in an 18-year-old female, who came to ENT OPD with history of right sided neck mass since 6-8 months. After thorough clinical examination and investigations, complete excision of the mass was done. Histopathological examination confirmed the diagnosis of Castleman's disease. On follow-up for one year no recurrence has been seen.