Supra Auricular Approach in Management of Preauricular Sinus.

Aim of study includes review on supra-auricular approach and its clearance of the tract including its branches and also its efficacy in reduction of recurrence when compared to standard technique. Prospective study in which 10 patients attending ENT opd with clinically diagnosed preauricular sinus undergoing supra-auricular approach under GA/LA, willing to participate in study were selected. An elliptical incision of the standard technique extended higher upward to pre- and supra-auricular temporal region. Plane of temporalis fascia was delineated. Skin, anterior to the sinus and tragus was separated. Soft tissue between the plane of temporalis fascia (deep limit) and the skin anterior to the sinus excised along with the piece of adjoining helical cartilage. This excised tissue contains the entire tract with its possible branches giving no room for recurrence. Patients were followed up for 6 months. 10 patient's data was updated and analyzed. No recurrence observed in all 10 patients. Supra auricular approach is useful and helpful technique for preauricular sinus tract excision with no recurrence rate. However further studies are required with large sample size.

Study of Myringoplasty in Wet and Dry Ears in Mucosal Type of Chronic Otitis Media.

INTRODUCTION: Chronic otitis media is the most common cause of hearing impairment in the developing countries. Hearing loss can have serious effects on day to day life. Ear discharge in chronic otitis media may continue for months to years with increasing hearing impairment and also life threatening infective complications, which is more common in active and also in inactive disease form as well. Myringoplasty is an operative procedure to close the perforation in tympanic membrane. AIM: To compare the success rate of graft uptake in dry and wet ears and to compare the postoperative hearing improvement in dry and wet ear following myringoplasty. MATERIALS AND METHODS: The comparative study was carried out on total 30 patients with chronic otitis media with central perforation. Of these 15 patients belong to dry ear group and 15 patients with wet ear group. These selected patients on simple random basis were subjected to clinical, audiological, radiological and laboratory investigations and one day before operation, patients were admitted to the hospital and written informed consent was taken in all cases. All patients underwent underlay technique myringoplasty. Postoperatively all patients were evaluated for graft uptake and hearing improvement by pure tone audiometry at 3rd month follow-up. RESULTS: In our study, the successful graft uptake was seen in 80% in dry ear and 73.3% in wet ear, statistically p-value (χ2=1.24) is (p>0.05) which is insignificant. Postoperatively hearing gain was (0-5 dB) in 3 patients (20%) with dry ear and 2 patients (13.5%) with wet ear; (6-10 dB), in 4 patients (26.6%) with dry ear and 6 patients (40%) with wet ear; more than 10 dB in 5 patients (33.3%) with dry ear and 3 patients (20%) with wet ear, statistically p-value is χ2=1.24 (p >0.05) which is not significant. CONCLUSION: In this study the success rate of graft uptake and hearing improvement is found almost equal in dry and wet ear by using underlay technique of myringoplasty, also found statistically insignificant.

Incidence of Hypothyroidism in Meniere's Disease.

INTRODUCTION: Meniere's disease is a disorder of the membranous labyrinth of the inner ear manifesting as vertigo, tinnitus, sensory neural hearing loss and aural fullness of known or unknown origin. Some patients may present after years into typical forms. The endocrine disorders, especially hypothyroidism and the factors like inflammation, trauma, otosclerosis, autoimmunity explains the multifactorial causation for the basis of Meniere's disease. Endolymphatic hydrops is the pathologic term named for the defective regulation of endolymph volume with respect to production and absorption. However, hyper production of endolymph cannot be excluded. The cause of Meniers disease is multifactorial so clinical features of repeated attacks of variable duration cannot be explained satisfactorily based on single causation. AIM: To study the incidence of hypothyroidism in Meniere's disease and to assess the success rate of improvement in subjective symptoms after treatment. MATERIALS AND METHODS: The study was carried out on total 35 out patients who were clinically diagnosed of Meniere's disease and of these 35 patients, 12 patients were found to have hypothyroidism. All patients with hypothyroidism were treated with oral thyroxin supplements and they were evaluated clinically at 3 weeks, 3 months and 6 months interval for the improvement in subjective symptoms on outpatient basis. RESULTS: In our study, the subjective improvement of all symptoms was seen in all cases of Meniere's disease with hypothyroidism after 12 weeks of treatment. CONCLUSION: The improvement in clinical symptoms after treatment demonstrates an association between Meniere's disease and hypothyroidism which was found to be significant. Hence, clinicians should consider screening patients with Meniere disease for thyroid dysfunction who are not already taking supplements.

Role of Adenosine Deaminase in Common Chronic ENT Infections.

INTODUCTION: Adenosine Deaminase (ADA) has been suggested to be an important enzyme which is associated with the cell mediated immunity. But its clinical significance in ENT infections needs to be correlated. AIM: To evaluate the role of serum adenosine deaminase level estimation in common chronic ENT infections. MATERIALS AND METHODS: This was a prospective randomized study. The subjects were divided into 4 groups. Group A consisted of 25 normal healthy individuals who served as the controls. Group B consisted of 25 patients, who were clinically diagnosed as chronic tonsillitis. Group C consisted of 25 patients, clinically diagnosed as chronic rhinosinusitis and Group D consisted of 25 patients, clinically diagnosed as chronic otitis media of mucosal type. The serum levels of ADA were estimated in all the subjects. RESULTS: The level of serum ADA was found to be elevated in common chronic ENT infections (Group B,C and D), when compared to control group(Group A) and p<0.05, which is statistically significant. CONCLUSION: From the present study, it can be concluded that serum ADA level can be considered as one of the essential diagnostic tool in diagnosing common chronic ENT infections.

Elective open tracheostomy for patients under prolonged mechanical ventilation-a study.

OBJECTIVE: To determine the safety of elective open tracheostomy as a routine intensive care unit (ICU) procedure without any selection criteria, considering its peri- and postoperative complications. MATERIALS AND METHODS: This is a descriptive study conducted in two hospitals in Davangere for a period of three years between April 2005 and March 2008. 40 patients, both male and female, of all age groups who were under mechanical ventilation in whom open tracheostomy was performed were included in the study. All patients who recovered were followed-up for two months. Complications arising during this period were recorded in the proforma. RESULTS: Our study consisted of 40 patients comprising 30 males and 10 females with male to female ratio of 3:1 and average age of 35 years, all undergoing open tracheostomy for prolonged mechanical ventilation. Various indications for mechanical ventilation included polytrauma, head injury, septicemia with multiorgan failure and dengue encephalitis. The complications which arised during the procedure and follow-up period included cardiac arrest, surgical emphysema, reactionary hemorrhage, pneumothorax, tracheo-cutaneous fistula, tracheo-oesophageal fistula. CONCLUSION: Elective open tracheostomy seems to be a safe and simple procedure, when performed by experienced surgeon under controlled circumstances, and should be considered as an option for mechanically ventilated patients.

Tuberculosis of tonsil associated with pulmonary foci.

Tuberculosis of tonsil is one of the uncommon forms of extra pulmonary tuberculosis. We report a case of tuberculosis of tonsil associated with pulmonary foci. A 48-year-old male presented with history of severe left sided throat pain of 10-15 days duration and fever of moderate degree of 7 days duration. Clinical diagnosis of left peritonsillitis was made. As the symptoms did not subside with antibiotics and analgesics malignancy was suspected, biopsy was done under local anesthesia and sent for histopathology. Histopathology revealed tuberculosis. He was evaluated further and primary foci was found in lung. The possibility of tuberculosis should be considered in a case with unilateral severe throat pain with congested tonsil not responding to usual line of treatment.