Is Chemical Cauterization Safe on Septal Cartilage in Treatment of Recurrent Epistaxis?

Epistaxis is one of the most common emergencies. Topical agents such as silver nitrate, is known to be a strong oxidizing agent and have been widely used, especially in recurrent and refractory cases. The extent of depth of coagulative necrosis is dependent on time of exposure and concentration. 2 mm wide bar of nasal septum from 30 patients was taken and AgNO3 was applied for 10, 20, 40 s. H&E staining was then performed to see depth of penetration and intensity of stain deposits. It was observed that with increase time of application, depth of penetration and density of deposits were increased for both 75% and 100% concentration of solution. Distribution in depth of penetration was significant when 75% concentration was applied for more than 20 s. But when 100% concentration was used, similar findings were found even after 10 s in young age group. Our study shows that when silver nitrate is used for chemical cauterization in different concentrations and for different times, their penetration is different. Moreover, the depth of penetration depends more on the time of contact than concentration of silver nitrate. We would recommend using 75% solution for use with a contact time not more than 20 s in adults and 10 s in children.

Intraoperative tragal and conchal cartilage thickness: Comparative study for cartilage tympanoplasty.

INTRODUCTION: In conditions like recurrent perforations, atelectatic tympanic membrane and poor eustachian tube function, temporalis fascia graft fails to give the desired result. In such cases cartilage is used for tympanoplasty. It was demonstrated that if the thickness of cartilage is reduced to around 0.5 mm, the sound conduction is comparable to that of normal tympanic membrane with excellent mechanical stability. AIM: To intra-operatively measure the mean thickness of tragal and conchal cartilage and compare it for age and sex variations. MATERIAL & METHODS: A total of 114 tragal and conchal cartilage samples of 86 patients were included in the study. Thickness of cartilages was measured intra-operatively after removing the perichondrium from both sides. RESULTS: Out of 58 tragal cartilages, 32 were from males and 26 from females. Mean thickness was 1.18 ± 0.11 mm among males and 1.12 ± 0.14 mm among females. Out of 56 conchal cartilage taken, 29 were from males and 27 females. Mean thickness among males were 1.38 ± 0.13 mm and 1.35 ± 0.08 mm in females. In 28 patients both tragal and conchal cartilage was taken. Mean thickness of both tragal (1.22 mm) and conchal cartilage (1.36 mm) increased with increase in age. Among 16 males in whom both cartilages were taken, mean thickness of tragal cartilage was 1.25 ± 0.11 mm and conchal cartilage was 1.41 ± 0.12 mm. Similarly among 12 females where both cartilages were taken, mean thickness of tragal cartilage was 1.20 ± 0.13 mm and conchal cartilage was 1.35 ± 0.07 mm. CONCLUSION: Sliced cartilage tympanoplasty is a relatively better technique. When using cartilage splitter to get sliced cartilage, ideally thickness of every graft should be known. As it is difficult to measure the exact thickness in every case, so knowing the mean for age and sex for cartilage thickness is important to have an idea of which plates to use for a successful outcome of slicing. We concluded that thickness of tragal cartilage is significantly less than the thickness of conchal cartilage. Also there is significant age related difference between mean thickness of cartilages, both for tragal and conchal cartilage. Surprisingly the difference between thickness in male and female is not statistically different.

Otorhinolaryngological myiasis: the problem and its presentations in the weak and forgotten.

INTRODUCTION: Myiasis is common in tropical regions, but now increasing incidence is seen in the west due to international travel. Otorhinolaryngological myiasis is uncommon and is seen in diabetics, alcoholics or patients unable in self-care. OBJECTIVES: To study presentations of otorhinolaryngological myiasis, identify associated risk factors and species of flies causing myiasis. METHODS: Clinical findings and co-morbidities of 67 myiasis cases were noted. Maggots were identified, manually removed, and patients were managed with topical treatment, systemic ivermectin and antibiotics. FINDINGS: Thirty-three nasal myiasis, 13 aural myiasis and 5 patients with oral myiasis were noted. Seven patients with head neck wounds myiasis and nine patients of tracheostome myiasis were recorded. DISCUSSION: Warm humid climate of tropical regions is a major concern along with co-existing conditions like poor sanitation, alcoholism, psychiatric diseases and neuropathies. Hesitancy is seen in attendants and health care professionals to deal with myiasis. CONCLUSION: Awareness about risk factors is important in avoiding myiasis along with prompt treatment which reduces morbidity. Tracheostome myiasis is an under-documented entity rather than a rare presentation. FUNDING: None.