Efficacy of hydrocortisone acetate/hyaluronidase vs triamcinolone acetonide/hyaluronidase in the treatment of oral submucous fibrosis.

BACKGROUND & OBJECTIVES: Oral submucous fibrosis is a common premalignant condition caused by chewing arecanut and other irritants in various forms. Its medical treatment is not yet fully standardized, although the optimal doses of its medical treatment is in the form of hydrocortisone acetate combined with hyaluronidase. The problem with the prevailing treatment was injections at weekly interval. In this study we compared the efficacy of hydrocortisone acetate and hyaluronidase at weekly interval versus triamcinolone acetonide and hyaluronidase at 15 days interval. METHODS: Patients of OSMF (100) were randomly divided into two groups A and B. Group A patients received combination of hydrocortisone acetate (1.5 ml)/hyaluronidase (1500 IU) at weekly interval submucosally in pterygomandibular raphe, half dose on each side for 22 wk. Group B patients received combination of triamcinolone acetonide (10 mg/ml)/ hyaluronidase (1500 IU) at 15 days interval for 22 wk. Treatment outcome was evaluated on the basis of improvement in symptom score, sign score and histopathological improvement. Student's 't' test was applied for comparing the results. RESULTS: No statistically significant difference in symptom score, sign score and histopathological improvement was seen between the two groups. INTERPRETATION & CONCLUSION: Treatment regimen of group B was more convenient to the patients because less number of visits required and cheap. No side effects were seen. A follow up study is required to see long term effects.

Retrospective and prospective study of singapore swing method on healing of mastoid cavity.

Chronic suppurative otitis media with cholesteatoma is a common problem. The majority of ENT surgeons find the canal wall down operation to be the safest and simplest means of treating cholesteatoma. The 'Singapore Swing' is a method of promoting healing of mastoid cavity. In this study our main objective was to do Singapore Swing technique in larger number of cases, have long term follow-up and to compare its results with other mastoid operations in which obliteration has not been used. Patients of cholesteatoma were divided into case group and control group. The case group (26 patients) was operated by canal wall down procedure with Singapore Swing obliteration while the control group (62 patients) was operated by same method without any obliteration. Both retrospective and prospective studies were done. Time period of drying of mastoid cavity, numbers of visits to the hospital and hearing status were observed. Subjective satisfaction score of patient (0-10) and Surgeon's satisfaction score (fully satisfied, partially satisfied and not satisfied at all) were measured in both the groups. The time of drying of cavity was <2 months in 88.5% of cases, while 27.5% of controls. Mean time of drying of cavity was 46 days (1½ months) in case group, while it was 89 days (3 months) in control group. Gain in air conduction was 11-30 dB in 33.3% cases and 15.7% of controls. 2 patients in control group had deterioration of 1-10 dB in air conduction. Subjective satisfaction score was 8-10 in 42.4% patients in case group, while 25% in control group. Surgeon was fully satisfied in 73% patients of case group and 45% patients of control group. The study suggested that Singapore Swing technique provides a dry, small and stable cavity with better hearing in less time.

Role of measurement of nasal mucociliary clearance by saccharine test as a yard stick of success of functional endoscopic sinus surgery.

AIM: The present study was done to establish normal nasal mucociliary clearance time (NMCT) in people of our region, study variations in NMCT in patients of chronic rhinosinusitis, to see change in NMCT after functional endoscopic sinus surgery (FESS) and to see whether saccharine test can be used as a yard stick of success of FESS. MATERIALS AND METHODS: NMCT of 100 normal individual was measured twice to establish control value. Fourtythree patients of chronic rhinosinusitis were divided into polypoidal and non-polypoidal. Their symptom score, endoscopic appearance score, CT scan score and NMCT was measured preoperatively and postoperatively. RESULTS: NMCT in control group was 6.61 ± 0.84 minutes, in unilateral (u/l) polypoidal sinusitis 13.45 ± 2.07 minutes, in bilateral (b/l) polypoidal sinusitis 21.31 ± 0.76 minutes, u/l non-polypoidal sinusitis 9.54 ± 1.00 minutes and in b/l non-polypoidal sinusitis 11.34 ± 0.93 minutes. Linear relationship was seen between preoperative NMCT and preoperative symptom score, endoscopic appearance score, CT scan score. NMCT improved significantly after FESS. CONCLUSION: NMCT measurement helps in selection of appropriate patients for surgery. It can be used as preoperative indicator of success of FESS.