International consensus (ICON) on assessment of oropharyngeal dysphagia.

OBJECTIVE: To present international recommendations regarding the proper evaluation of oropharyngeal dysphagia (OD), both objectively and subjectively (self-evaluation). METHODS: Following a thorough review of the literature, 5 experts in the field from 4 different continents answered separately a questionnaire regarding the work-up of OD. Individual answers were presented and discussed during the world ENT conference that was held in Paris in June 2017. This article will present the recommendations issued from that meeting. RESULTS: For the initial objective assessment of OD, it is recommended to perform either a functional endoscopic evaluation of swallowing (FEES) or a videofluoroscopic swallowing study (VFSS). FEES is the more popular investigation given its increased ease of use and accessibility. When evaluating for the presence of aspiration during the objective evaluation of OD, it is recommended to perform either a FEES or a VFSS. In this case, FEES is the favored investigation given its likely increased sensitivity. In order to highlight the presence of oropharyngeal food residue following the deglutition process, it is recommended to perform either a FEES or a VFSS; FEES likely being the more sensitive investigation while VFSS allows a better quantification of the amount of pharyngeal residue. Is it also recommended to objectify the quality of the deglutition process by means of a score during the objective evaluation of OD. Finally, it is recommended to utilize a self-evaluation questionnaire during research studies exploring the deglutition process.

Spasmodic dysphonia: a seven-year audit of dose titration and demographics in the Indian population.

OBJECTIVES: This study aimed to evaluate the demographics of spasmodic dysphonia in the Indian population and to analyse the optimum dose titration of botulinum toxin type A in this group. A comparative analysis with international studies was also performed. METHOD: The study involved a retrospective analysis and audit of botulinum toxin type A dose titration in spasmodic dysphonia patients who visited our voice clinic between January 2005 and January 2012. RESULTS: The average total therapeutic dose required for patients with adductor spasmodic dysphonia was 4.2 U per patient per vocal fold (total 8.4 U per patient), and for patients with abductor spasmodic dysphonia, it was 4.6 U per patient. CONCLUSION: Our audit revealed that 80 per cent of the spasmodic dysphonia patients were male, which contrasts dramatically with international studies, wherein around 80 per cent of spasmodic dysphonia patients were female. Our study also revealed a higher dose titration of botulinum toxin for the Indian spasmodic dysphonia population in both adductor and abductor spasmodic dysphonia cases.

Vocal outcomes following subepithelial infiltration technique in microflap surgery: a review of 30 cases.

Understanding of the anatomy and physiology of the vocal folds, availability of better diagnostic tools and precise instruments has spurred the development of newer techniques for the management of benign lesions arising in the vocal folds. As the propensity of the superficial lamina propria to regenerate is minimal, it is of paramount importance to maximally preserve it. Microflap surgery of the vocal folds is based on this principle. There exists a dichotomy in opinion regarding the role of subepithelial infiltration in microflap surgery; the disadvantages cited being possible confusion of the surgical plane following infiltration and hydrodissection of the normal basement membrane from the superficial layer of the lamina propria. A prospective study was therefore carried out in 30 cases of benign glottic lesions and microflap surgery was performed with and without infiltration in similar pathologic lesions. The vocal outcomes i.e. fundamental frequency, jitter, shimmer and maximum phonation time were audited. The advantages of this technique with a review of the literature are discussed.

A vascular ring variant: an unusual case of vocal cord palsy due to an anomalous left carotid artery arising from a retrotracheal arch of the aorta.

We present the case of an unusual vascular ring in a 23-year-old male patient who presented for CT examination of the chest for diagnostic work up for unilateral vocal cord palsy. Contrast-enhanced CT revealed the left common carotid artery to be arising from the ascending part of a retrotracheal arch of aorta and traversing anterior to the trachea in the retromanubrial space.

Endoscopic excision of Juvenile nasopharyngeal angiofibroma - A comprehensive approach.

OBJECTIVE: Endoscopie excision of Juvenile Nasopharyngeal Angiofibroma (JNA) was carried out with (he objective of minimizing blood loss and attempting a complete excision of the tumor under direct vision with the help of Hopkins telescopes. STUDY DESIGN: A prospective 4 year study of 23 cases of JNA treated by endoscopie excision is presented. Of these, 18 were treated by endoscopie excision alone. The remaining 5 were treated with a two staged approach either by mid-facial degloving followed by endoscopy or by 2 endoscopie procedures. RESULTS: The tumor was excised completely in 17 out of the total 18 cases that were treated exclusively by endoscopy. One case has shown a recurrence. The 5 cases treated by the staged approach represented very large tumours or tumours with intra-cranial extensions. In I of these cases, inoperable tumor remnant engulfing the internal carotid artery was treated by radiotherapy post-operatively. CONCLUSION: With successful excision of JNA in all but one case, we could reasonably conclude, that endoscopie excision of JNA could become a safer and a more precise alternative to open surgery provided it is practiced judiciously by surgeons who have considerable experience in endoscopie surgery and the necessary backup to convert to open surgery should the need arise.

Management of acute vertigo with betahistine.

This open, prospective study was carried out in 29 outpatients of vertigo with Betahistine treatment at a dose of 16 mg three times daily far a maximum treatment period of 6 weeks or earlier until remission of vertigo attacks. The evaluations were carried out based on three parameters such as frequency, duration, and severity of vertigo attacks. Betahistino showed a significant improvement in the three parameters of frequency, duration and severity of vertigo attacks. Associated symptoms such as tinnitus, nausea, vomiting, headache, faintness showed a significant improvement with the therapy. Subgroup analysis showed a significant improvement of patients with severe and incapacitating verlign attaeks at baseline. Thus, this study proves excellent efficacy and goad tolerability of Betahistine as an anti-vertigo drug at a dose of 16 mg three times daily and gives a new insight for controlling acute or severe vertigo attacks without causing sedation.

Umbilical vein oxytocin in the management of third stage of labour.

The aim of the study was to evaluate the efficacy of intra-umbilical oxytocin in minimizing the blood loss during 3rd and 4th stage of labour. Seventy-five pregnant multigravidas without any obstetric or medical complications were studied. It was found that the expulsion of the placenta was rapid as compared to the group treated with normal saline but not with methylergometrine. The drop in hemoglobin and hematocrit was comparable in patients receiving intra-umbilical oxytocin and those with active management of 3rd stage with methylergometrine.