To Determine the Prevalence of Laryngopharyngeal Reflux in Patients of Various Throat Disorders and to Evaluate the Efficacy of Anti-reflux Therapy.

To study the prevalence of Laryngopharyngeal reflux in individuals having throat complaints by applying the Reflux Symptom Index and Reflux finding score as a prognostic tool after anti reflux therapy. Materials and Methods: A Cross-sectional study of 75 patients of age 18 years and above with clinical diagnosis of Laryngopharyngeal reflux was conducted in ENT. Cases were examined with detailed history and thorough examination with indirect laryngoscopy and Hopkins 70 degree endoscope. Symptoms and findings of patients were assessed by Belafsky Reflux Symptom Index and Reflux Finding Score. Patients presenting Belafsky Reflux Symptom Index > 13 and also Reflux Finding Score > 7 were classified as having Laryngopharyngeal reflux. After 6 weeks of treatment, patients were reassessed and Reflux Symptom Index and Reflux finding score were calculated. Results: The mean age of the study subjects was 37.12 ± 12.39 years. Most common symptom reported based on RSI questionnaire was excessive throat mucus (81.33%) followed by clearing of throat (75%) and coughing on lying down and heartburn. Based on the Laryngoscopy, about 57.33% had thick endolarygeal mucus, 56% had diffuse erythema, 45.33% had granulations and 29.33% had subglottic edema. Based on the reflux symptom scores, we found 53.33% and 80% of patients based on reflux findings score to have Laryngopharyngeal Reflux. The mean Reflux Symptom Index scores were 16.25 ± 5.53 and 10.73 ± 4.40 and also the mean Reflux Finding scores were 13.81 ± 2.42 and 6.61 ± 2.16 respectively before and after the treatment which was statistically significant.

Efficacy of Betahistine by Patient-Reported Outcomes and its Tolerability Profile in Indian Patients with Vestibular Vertigo.

OBJECTIVE: Patients with vestibular vertigo suffer from disabling symptoms which affect their quality of life. This article presents the efficacy and safety profile of betahistine hydrochloride in Indian patients suffering from vestibular vertigo (OSVaLD study). METHODS: Study included patients suffering from vertigo, who were prescribed betahistine (48 mg/day) according to local label. Safety and efficacy populations of this study included 80 and 75 subjects respectively. The study included three visits: an initial baseline visit, and two follow-up visits (one month and three months [final visit] post-commencement of betahistine therapy). Efficacy was assessed by administering three patient-reported outcomes (PROs) namely, Dizziness Handicap Inventory (DHI), Hospital Anxiety and Depression Scale (HADS), and Medical Outcome Study Short Form-36 version2 (SF-36®v2). Safety assessment was made by reports of Suspected Adverse Drug Reactions (SADRs) which began during the study. RESULTS: Mean changes in total DHI score for Indian efficacy population at follow-up and final visits were 31 and 44 points respectively. These changes indicated significant improvements in self-perceived impairment associated with vertigo. Similar improvements in quality of life were observed by HADS subscales (HADS-A and HADS-D) and SF-36®v2 summary scores (PCS [physical component summary] and MCS [mental component summary]). There was only one report of SADR in this study in a female subject receiving betahistine 16 mg t.i.d. This SADR was gastritis of mild severity and was probably not related to betahistine. CONCLUSIONS: A significant number of vestibular vertigo patients reported fair degree of spontaneous recovery. Betahistine treatment improved quality of life, was safe and well-tolerated by Indian patients suffering from vertigo.

Transmastoid repair of superior semicircular canal dehiscence.

OBJECTIVE: The aim of this study was to describe the successful operative management of a patient with superior semicircular canal dehiscence syndrome, using the transmastoid approach under local anaesthesia. METHODS: The transmastoid approach was used to plug the superior semicircular canal. RESULTS: Post-operatively, the patient experienced significant improvement in his symptoms of sound- and pressure-induced dysequilibrium, autophony and imbalance. CONCLUSION: Successful operative management of superior semicircular canal dehiscence can be achieved via the transmastoid approach under local anaesthesia.

Mondini dysplasia and pyogenic meningitis.

Mondini dysplasia with cerebrospinal fluid leak is a rare cause of recurrent pyogenic meningitis in children. We describe an eleven-year-old female child who presented with the fifth recurrent episode of pyogenic meningitis and unilateral sensorineural deafness. Mondini dysplasia of the inner ear with CSF-perilymph fistula was proven on an HRCT of the temporal bone and MRI. Successful operative intervention was undertaken to close the defect. Though rare, Mondini dysplasia should be considered as a cause of recurrent meningitis in children, especially if they have sensorineural deafness.

Giant frontoethmoid osteoma nasoendoscopic resection using intranasal drill.

Ostenmas of the paranasal sinuses are common. Most arc however asymptomatic and a chance radiographic finding. In this article we present a less invasive yet safe and effective approach to treatment. The 45° nasoettdoscopic approach using an intranasal drill provides a good operative field and is safe and effective technique ,with the potential to become the treatment of choice in selected cases.

Spontaneous CSF otorrhoea - Presenting as conductive deafness.

Spontaneous CSF otorrhea specially in older age is a rare condition. Congenital inner ear malformation is one of the commonest causes in pediatric age group and either because of trauma or spontaneously it comes out into middle ear. In pediatric age group usual presentation is with history of meningitis while adult patients may present as watery discharge from nose or ear. This is a case, presented with conducted deafness with negative middle ear pressure. Grommet was put presuming secretory otitis media but B2-transferrin levels of the secretion confirmed it as a CSF otorrhea. He was operated with past aural transmasioid approach. The defect was sealed in layers. Patient is in regular follow up is asymptomatic and without any recurrence.

Tubercular laryngeal abscess.

Tuberculosis, with its varied presentations and numerous complications, is a relatively common disease in developing countries like India. Amongst its many presentations, pulmonary tuberculosis is the commonest. A tubercular laryngeal abscess is an extremely rare entity. We report a 37-year-old male, diagnosed with a tubercular laryngeal abscess which was successfully treated under local anaesthesia by incision and drainage and in whom a tracheostomy could be avoided.

Tips for the novice nasal endoscopist.

Functional endoscopic sinus surgery has been a major advance in management of chronic sinusitis and other sinonasal diseases. However before one embarks on this surgery, the surgical anatomy of this region and its variations should be clearly understood by the surgeon, and the surgical steps of every stage of uperation should be mastered by adequate practice on cadavers. One has to proceed from simple endoscopic surgery to the advanced ones for better results.

Complication of frontal sinusitis-Not amenable to endoscopic surgery.

Endoscopic sinus surgery has brought a change in the concept of treatment of sinus disease. Frontal sinusitis, however, still gives rise to intra and extracranial complication often musked by antibiotic intake. Where endoscopic surgery may fail to completely eradicate disease or even not be feasible due to various anatomic factors and other limitation. It is here that the tried and trusted external approach to the frontal sinus finds a role even today. Four such cases of various complication not amenable to endoscopic sinus surgery are presented here with the view of maintaining the necessity of keeping the external approach within the present day surgical palette when treating complication of frontal sinus disease.

Pre and post betahistine therapy 99m Tc - HMPAO brain spect studies in patients with vertigo.

Vertebro basilar insufficiency (VBI) is a well known cause of vertigo. Brain Single Photon Emission Computed Tomography (SPECT) is an important diagnostic tool to detect and to quantitate the perfusion abnormalities in different areas of the brain. Effect of an antivertigo drug Betahistine on improving the hypoperfusion in different areas of the brain in vertigo patients was studied using brain SPECT. Betahistine at a dose of 16 mg three times daily was shown to improve perfusion in the hypoperfused areas of the brain resulting in relief from symptoms of vertigo. The cerebellar region, which is the most important area involved in vertigo patients with vascular pathology, showed almost complete normalisation of perfusion following Betahistine therapy.

HCFA tightens eligibility requirements for provider-based status.

On October 10, 2000, HCFA will implement new eligibility standards for all off-campus entities with a provider-based designation. Providers that wish to retain the provider-based status of their ambulatory care facilities need to take action to more fully integrate the ambulatory care facilities with their main facilities. In addition, the provider will need to show that 75 percent of the patient population served by the ambulatory care facility also is served by the provider's main facility.

A retrospective analysis of spontaneous sphenoid sinus fistula: MR and CT findings.

BACKGROUND AND PURPOSE: The sphenoid sinus is rarely implicated as a site of spontaneous CSF fistula. We undertook this study to evaluate the potential etiopathogenesis of spontaneous CSF fistula involving the sphenoid sinus and to review the imaging findings. METHODS: We retrospectively reviewed the imaging findings of 145 cases of CSF fistula from our departmental archives (August 1995 through August 1998). Fifteen (10%) patients had CSF fistulas involving the sphenoid sinus. Eleven (7%) patients had spontaneous CSF fistulas, whereas in four patients, the CSF fistulas in the sphenoid sinus were related to trauma. Of the 11 patients, nine underwent only plain high-resolution CT and MR cisternography. One patient additionally underwent contrast-enhanced CT cisternography, and one other patient underwent MR cisternography only. For each patient, the CSF fistula site was surgically confirmed. The MR imaging technique included T1-weighted and fast spin-echo T2-weighted 3-mm-thick coronal sequences obtained with the patient in the supine position. The plain high-resolution CT study included 3-mm-thick, and sometimes 1- to 1.5-mm-thick, coronal sections obtained with the patient in the prone position. Similar sections were obtained after injecting nonionic contrast material intrathecally via lumbar puncture for the CT cisternographic study. We evaluated each of the 11 patients for the exact site of CSF leak in the sphenoid sinus. We also determined the presence of pneumatization of lateral recess of the sphenoid sinus, orientation of the lateral wall of the sphenoid sinus, presence of arachnoid pits, presence of brain tissue herniation, and presence of empty sella in each of these patients. RESULTS: The exact sites of the CSF fistulas were documented for all 11 patients by using plain high-resolution CT, MR cisternography, or CT cisternography. In nine (82%) patients, the sites of the CSF fistulas were at the junction of the anterior portion of the lateral wall of the sphenoid sinus and the floor of the middle cranial fossa. In the remaining two (18%) patients, the sites of the CSF fistulas were along the midportion of the lateral wall of the sphenoid sinus. Of these 11 patients, one had bilateral sites of the CSF fistula at the junction of the anterior portion of the lateral wall of the sphenoid sinus with the floor of the middle cranial fossa. In nine (82%) patients, the presence of brain tissue herniation was revealed, and this finding was best shown by MR cisternography. Ten (91%) patients had extensive pneumatization of the lateral recess of the sphenoid sinus, with an equal number having outward concave orientation of the inferior portion of the lateral wall of the sphenoid sinus. In seven (63%) patients, the presence of arachnoid pits, predominantly along the anteromedial aspect of the middle cranial fossa, was shown. In seven (63%) patients, empty sella was shown. For comparison, we reviewed the CT studies of the paranasal sinuses in 100 age-matched control subjects from a normal population. Twenty-three had extensive lateral pneumatization of the sphenoid sinus along with outward concavity of the inferior portion of the lateral wall. None of these 23 patients had arachnoid pits. CONCLUSION: The sphenoid sinus, when implicated as a site of spontaneous CSF leak, yields a multitude of imaging findings. These are extensive pneumatization of the lateral recess of the sphenoid sinus, outward concave orientation of the inferior portion of the lateral wall of the sphenoid sinus, arachnoid pits, and empty sella. Considering the normative data, we speculate that this constellation of findings could play a role in the etiopathogenesis of spontaneous sphenoid sinus fistulas. Our findings also show the efficacy of noninvasive imaging techniques, such as plain high-resolution CT and MR cisternography, in the evaluation of sphenoid sinus CSF leak. Our data also suggest that spontaneous sphenoid sinus CSF leak is not an uncommon occurrenc

Rote of adaptation exercises in clinical practice.

Adaptation, habitution and compensation are the mechanisms involved in rehabilitation of vertigo patients. In Vestibular Rehabilitation Therapy (VRT), patients are advised to perform a series of maneuvers involving head, eye and body movements which stimulate the in-built adaptive mechanisms. Cawthorne and Cooksey were the first to describe adaptation exercises, which are further modified. Norre has designed VRT test battery of specific exercises. Drug treatment used along with VRT should not interfere with the compensation mechanism. Anti-vertigo drug Betahistine has been shown to hasten the compensation and hence is suitable for use with VRT.

Evaluation of high-resolution CT and MR cisternography in the diagnosis of cerebrospinal fluid fistula.

PURPOSE: We undertook this study to determine the accuracy of MR cisternography and plain high-resolution CT as a noninvasive alternative to CT cisternography in the diagnosis of CSF fistula in patients with clinically suspected CSF rhinorrhea. METHODS: Forty-five consecutive patients with clinically suspected CSF rhinorrhea were examined prospectively for CSF fistula with MR cisternography and plain high-resolution CT. Twenty-one patients also underwent CT cisternography. The MR imaging technique included 3-mm thin-section T1-weighted coronal sequences and fast spin-echo T2-weighted coronal, axial, and sagittal sequences in the supine position. The plain high-resolution CT study included 3-mm and sometimes 1- to 1.5-mm thin coronal sections in the prone position. Similar sequences were used after injecting nonionic contrast material intrathecally via lumbar puncture for the CT cisternographic study. The plain high-resolution CT and MR cisternographic studies were compared with results of CT cisternography; surgical findings were used as the standard of reference. RESULTS: Plain high-resolution CT successfully depicted the presence or absence of CSF fistula in 42 of 45 patients, whereas MR cisternography was correct in 40 patients. MR cisternography or plain high-resolution CT correctly showed the site(s) of CSF fistula leakage in 36 of the 38 cases proved surgically. The combined techniques also correctly indicated the absence of CSF leakage in seven cases, six of which were confirmed at CT cisternography. Both MR cisternography and high-resolution CT failed to definitively locate the CSF fistula in two patients. High-resolution CT was accurate in 93% of patients, whereas MR cisternography was accurate in 89% of patients. The combination of high-resolution CT and MR cisternography was accurate in 96% of patients. CONCLUSION: In the presence of clinically diagnosed CSF leakage, the combination of MR cisternography and plain high-resolution CT is highly accurate in locating the site and extent of CSF fistula and should be considered a viable noninvasive alternative to CT cisternography.

Cerebrospinal fluid otorhinorrhea in patients with defects through the lamina cribrosa of the internal auditory canal.

We describe three patients with bilateral cerebrospinal fluid (CSF) otorhinorrhea with unilateral progressive hearing loss in whom CT showed the defect to be located in the lamina cribrosa of the internal auditory canal. CT cisternography showed the CSF fistula in two of the three patients who had Mondini malformation, whereas the CSF fistula was obvious on the plain high-resolution temporal bone CT study in the third patient, who had a posttraumatic (nonsurgical) fracture of the lamina cribrosa. Fast spin-echo T2-weighted coronal MR cisternography also showed the site of leakage in the third patient. In the presence of an intact tympanic membrane, the CSF egressed to the nose via the eustachian tube in all three patients.