Sensitivity and Specificity of High-Resolution Computed Tomography (HRCT) of Temporal Bone in Diagnosing Cholesteatoma and Its Correlation with Intraoperative Findings.

High resolution computed tomography (HRCT) of temporal bone helps in understanding the complex anatomy of temporal bone and in identifying disease in temporal bone. However, its role in diagnosing cholesteatoma and analyzing its extent and complications is not established unequivocally. Present study was undertaken to check sensitivity and specificity of HRCT in diagnosing cholesteatoma and assessing its extent and in identifying ossicular destruction and other complications. In this prospective study in 50 patients with clinical diagnosis of cholesteatoma, preoperative high-resolution temporal bone CT scans axial and coronal view were carried out and compared with intra-operative findings. Kappa statistics was used for radio-surgical correlation. Comparison of CT scan findings with intraoperative findings revealed perfect correlation for sigmoid plate erosion, mastoid cortex dehiscence and scutum erosion, strong correlation for erosion of malleus, posterior superior wall and peri labyrinthine cells, good for erosion of incus and stapes, labyrinthine fistula, tegmen erosion and extent of disease and moderate correlation for facial canal dehiscence. HRCT scan of the temporal bone is useful preoperative investigation for cholesteatoma surgery for identification and documentation of ossicular status, location and extent of disease, erosion of tegmen or sinus or labyrinthine dehiscence, with the exception of facial canal dehiscence. Although it serves as road map for surgery, it still has some false positives and false negatives and the importance of a skilful, aware and alert surgeon cannot be overemphasized.

Evaluation and Customization of WHO Safety Checklist for Patient Safety in Otorhinolaryngology.

The WHO has designed a safe surgery checklist to enhance communication and awareness of patient safety during surgery and to minimise complications. WHO recommends that the check-list be evaluated and customised by end users as a tool to promote safe surgery. The aim of present study was to evaluate the impact of WHO safety checklist on patient safety awareness in otorhinolaryngology and to customise it for the speciality. A prospective structured questionnaire based study was done in ENT operating room for duration of 1 month each for cases, before and after implementation of safe surgery checklist. The feedback from respondents (surgeons, nurses and anaesthetists) was used to arrive at a customised checklist for otolaryngology as per WHO guidelines. The checklist significantly improved team member's awareness of patient's identity (from 17 to 86%) and each other's identity and roles (from 46 to 94%) and improved team communication (from 73 to 92%) in operation theatre. There was a significant improvement in preoperative check of equipment and critical events were discussed more frequently. The checklist could be effectively customised to suit otolaryngology needs as per WHO guidelines. The modified checklist needs to be validated by otolaryngology associations. We conclude from our study that the WHO Surgical safety check-list has a favourable impact on patient safety awareness, team-work and communication of operating team and can be customised for otolaryngology setting.

Correlation of nasal nitric oxide measurement with computed tomography findings in chronic rhinosinusitis.

Nitric oxide (NO) is a biological messenger produced by mammalian cells serving various functions including regulation of blood flow, platelet function, immunity, and neurotransmission. The paranasal sinuses and nasal mucosa are a major source of exhaled NO. The aim of the study is to compare the nasal NO (nNO) levels in patients with chronic rhinosinusitis with those of common cold patients and controls and to correlate CT scores with nNO levels. The nasal concentration of NO was measured by electroluminescence in 13 healthy volunteers, in 13 patients suffering from common cold and 13 patients with chronic rhinosinusitis. The concentration of NO was correlated with symptom scores, endoscopic findings and CT findings. The measured levels of NO did not differ between healthy volunteers and common cold patients, but they were significantly lower in patients suffering from chronic rhinosinusitis. As NO is a regulator of mucociliary activity and has bacteriostatic and antiviral effects, the decreased concentration of nNO in patients suffering from sinusitis suggests that lack of NO may contribute to the pathogenesis of this disease. Thus, nNO, which is easily measured, provides a valuable non-invasive objective measure of chronic rhinosinusitis.