TRACHEOSTOMY COMPLICATIONS AND THEIR MANAGEMENT.

The word tracheostomy derived from two greek words meaning 'I cut the trachea' has been known for about 3500 yrs. The process has evolved over the years and has undergone revolutionary changes in the methodology, instrumentation and indications. Although tracheostomy is now commonly used the complication rate remains high. In our series it was 48% which is comparable with other series. The purpose of this paper is to discuss the complications of tracheostomy with special attention to their management and prevention.

Intranasal supernumerary tooth.

Eruption of ectopic and supernumerary teeth into the nasal cavity is quite an uncommon condition and may present with varying degree of morbidity. The purpose of this short report is to highlight the mode of presentation, management and review of relevant literature of this rare occurrence.

Study of prevalence and aetiology of the hearing loss amongst school going children.

School survey study to assess the prevalence rates and aetiological factors causing hearing loss among children in and around Pune Cantonment covering urban and semiurban population has been carried out. We encountered deafness prevalence rate of 11.7% and chronic suppurative otitis media (4.75% of the deaf children) the commonest cause. Maximum number of patients were in age group of 6-11 years and semiurban children and those from lower socio-econimic group had higher prevalence rate as compared to urban children and those from upper socio-econimic group. Relevant suggestions for prevention and management of deafness have been made. This study emphasizes the fact at most of the aetiological factors in causing hearing impairment in school going children are treatable and hence deafness can be prevented to a large extent if remedial measures are taken in time.

Composite graft tympanoplasty.

Seventy six ears with chronic suppurative otitis media and fit for tympanoplasty were subjected to grafting with combination of perichondrium and cartilage (composite graft) for restoration of sound conducting apparatus and reconstruction of canal wall. A comparison with temporal fascia grafting has been done. Composite graft procedure gave better functional improvement, helped in reconstruction of canal wall and was also useful in elimination of retraction pockets.

Vestibulo-cochlear functions in diabetes mellitus.

Vestibulo-cochlear functions in 30 diabetics and 30 controls were evaluated. Hearing loss mild to moderate was detected in 40% of diabetics. This was typically bilateral symmetrical, more in high frequencies and cochlear in nature. Incidence of hearing loss was more in higher age groups, in poorly controlled diabetics, and in those without a family history of diabetes. There was no correlation between hearing loss and duration of diabetes. There was no evidence of vestibular dysfunction in the diabetics studied.

Branchial cleft fistulae.

Three rare and interesting cases of complete branchial cleft fistulae including two cases with unusual presentation are reported. Total excision of the fistulae was carried out by step ladder technique in all the three cases resulting in their successful surgical management. Relevant available literature on the subject has been reviewed.

Clinico-pathological correlation study of cervical lymph node masses.

One hundred and ten cases of cervical lymph node masses were subjected to clinical evaluation and aspiration cytology. Eighty six cases which subsequently underwent open biopsy were subjected to histopathological evaluation. Accuracy, specificity and sensitivity of clinical diagnosis were 86.1%, 93.6% and 91.1% respectively as compared to 88.3%, 97.6% and 93.6% respectively for aspiration cytology. Reliability coupled with other advantages makes aspiration cytology the first line investigation in evaluating cervical lymph node masses reserving open biopsy for certain specific indications. Based on the conclusions a protocol is being recommended for evaluation of cervical lymph node masses.

MIDDLE EAR RECONSTRUCTION - OUR EXPERIENCE.

A comparative study of ossicular reconstrution using four different graft material was carried out on 40 patients as a second stage procedure from July 1989 to June 1991. The graft materials used were : aulologus ossicular bone graft, allogeneic ossicular bone graft, autologus cartilage and bio-compatible materials. All patients were observed for a period ranging from one to two years. Extrusion of ossicular graft was prevented by use of a lace of cartilage between the ossicular graft and neotympanic membrance. Satisfactory results were obtained with cartilage graft in 6%, allogeneic ossicles 70%, autologus ossicular graft 80% and bio-compatible materials 33.3%.

HAEMOPTYSIS - INDICATIONS FOR BRONCHOSCOPY.

Fifty patients who were taken up for bronchoscopy for evaluation of haemoptysis have been studied retrospectively in order to confirm specific diagnosis, identify the bleeding site and find the incidence of malignancy and other lesions in lower respiratory tract. We encountered over all 30% diagnostic yield. Malignancy was found in 4% of our patients and overall diagnostic yield was higher (35.7%) in patients of more than 40 years of age as compared to that (26.6%) in patients younger than 40 years of age. Criteria and indications of bronchoscopic examination in haemoptysis have been described.

METALLIC FOREIGN BODY IN LEFT MAIN BRONCHUS (A Case Report).

A child with accidental inhalation of a metallic foreign body into left main bronchus is reported. The foreign body was removed by rigid bronchoscopy. The problems in management are discussed and current literature reviewed.

NEW SUSPENSION DEVICE FOR LARYNGEAL ENDOSCOPIC PROCEDURES.

In view of the economic constraints in acquiring sophisticated equipments in service hospitals, a new suspension device for endolaryngeal surgery using anaesthetic laryngoscope and routinely available tonsillectomy instruments has been developed. This device is a modification of Ijadoula's suspension laryngoscope.