Endoscopic dacryocystorhinostomy with flap suturing.

Multiple reports have demonstrated the efficacy of endoscopic dacryocystorhinostomy (DCR). However the results of the same have varied from centre to centre. Many still regard external DCR as the gold standard. To describe an endoscopic DCR technique which anatomically simulates an external DCR and assess its results. Prospective, nonrandomized and noncomparative interventional case series. Clinical charts of patients with nasolacrimal duct obstruction based on symptomatic, clinical and radiological basis were included in the study. All surgeries were done endonasally using standard operative technique. The modification in the standard technique included creating a wide exposure of the lacrimal sac, incising the sac and the suturing the medial wall of the lacrimal sac with the lateral nasal wall. The same was achieved by using either vascular clips or 5.0 vicryl sutures. Twenty (11 females and 9 males) were included in the study. The average age of the patients was 56.86 years old (range 27-85 years old). The main presenting symptom was epiphora and 1 patient with mucocele. Successful outcome was measured in terms of relief of sympto anatomical patency assessed by sac syringing and nasal endoscopy showing a wide patent lumen. A primary success rate of 95% and ultimate rate of 100% was achieved in the cases with a nasolacrimal duct (NLD) block while an overall success rate of 82.6% was noted when the cases with NLD block and common canalicular block were considered together. Endoscopic DCR can now easily replace external DCR as a standard. It is not only minimally invasive, but has minimal complications and using this technique, we have been able to achieve very high success rates.

Endoscopic repair of lateral sphenoid recess cerebrospinal fluid leaks.

Endoscopic repair of anterior cranial base has been widely reported. However there is still no uniformity in the technique of endoscopic repair of lateral sphenoid cerebrospinal fluid (CSF) leaks. To highlight the management of CSF leak or encephalocele in the lateral sphenoid recess and relate our experiences. We retrospectively reviewed the medical records of all our patients who underwent an endoscopic repair of CSF leaks in the lateral sphenoid recess during the period from September 2003 to January 2010 at our tertiary hospital. Fifteen cases with CSF leaks/encephalocele that were repaired by the endoscopic approach were included. The majority of our cases were spontaneous leaks. In all our cases we approached the site of defect by an end on approach. All our patients were successfully treated in the first attempt. Endoscopic repair of lateral sphenoid recess has shown better surgical outcome with reduced morbidity.

The study of co-morbid conditions in adults with allergic rhinitis, from Mumbai, Maharashtra, India and their comparison with children.

Allergic rhinitis (AR) is an allergen-induced inflammation of the nasal mucosa. Several studies have shown a link not only between AR and asthma but also with other co-morbid conditions. It is important to recognize the onset and existence of these co-morbid conditions, for adequate treatment, prevention of the development of new allergen sensitizations and air-way hypersensitivities. This is a prospective study of co-morbid conditions in adults with AR, from Mumbai, Maharashtra, India and compares them with those in children 23 consecutive children below 6 years (Group 1), 42 children between age of 6 years and 14 years in Group 2 and 57 adults in Group 3 were selected for the symptoms of AR (sneezing, watering and blocked nose), which were currently sufficiently troublesome to require medication. A high association of co-morbid conditions with AR was found. More than 80% suffered from one to three co-morbid conditions each. The most common co-morbid condition was asthma in all the groups. Often asthma and sinusitis was asymptomatic and a high degree of suspicion was needed for diagnosis. Adults had the highest prevalence of sinusitis and allergic conjunctivitis. Prevalence of urticaria was similar in children as well as adults. Studies with larger data samples are needed to confirm these associations.

The mini-rhino-conjunctivitis quality of life (qol) questionnaire (mrqlq) - self administered.

OBJECTIVE: Our aim was to administer the MRQLQ Questionnaire in Indian adults with allergic rhino-conjunctivitis (ARc). CRITERIA FOR INCLUSION IN THE STUDY: Adults with chronic ARc, with sufficiently troublesome current symptoms, attending The Allergy Clinic of The Hinduja Hospital, Mumbai, during March-August 2006 were selected. RESULTS: The five highest PS were seen with sneezing 290, irritation 238, running nose 228, stuffy nose 220, anxiety 203 and interrupted working 203. The 5 lowest PS were seen with disturbed sleep 83, dry throat 98, affected walking for 1/2 kilometre 98, do not sleep deeply 103 and phlegm 105. DISCUSSION: The five highest PS were due to symptoms of rhinitis, general irritation, anxiety & interruption of work. Thus rhinitis itself affects QOL. The 5 least PS were mainly sleep-related. CONCLUSION: We have applied the MRQLQ on Indian patients with ARc. We could obtain a product score for every item in it, on the basis of which we could classify the degree of its effect on his QOL. PS was highest in rhinitis-related symptoms. 2 Emotions related and 1 Role limitation item gave moderate PS, while all PS in eye related, Physical functioning, Social functioning, Sleep-related & Other Symptoms items were in the mild range. Larger data sample is needed to validate and show its discriminatory power.

The study of co-morbid conditions in children with allergic rhinitis, from Mumbai, Maharashtra, India.

Allergic rhinitis (AR), an allergen-induced inflammation of the nasal mucosa, is frequently associated with co-morbid conditions. It is important to recognize the onset and existence of these co-morbid conditions, for adequate treatment and prevention of the development of new allergen sensitizations and air-way hypersensitivities. The aim of our study was to determine the prevalence of co-morbid conditions associated with AR, in Indian children. We selected 65 consecutive children below the age of 18 years, who attended the Allergy and Asthma Clinic of our hospital, between March 1, 2005 to November 30, 2006 and compared them with the available literature. The most common co-morbid condition with AR was asthma (75.4%), followed by urticaria (33.9%), conjunctivitis (29.2%) and sinusitis (23.1%) in that order. Two patients (3.1%) each, had adenoid hypertrophy and nasal polyps. Psoriasis was seen in 4/65 (6.2%). Four patients (6.2%) were free from any co-morbid conditions as opposed to 61/65 (93.8%), who suffered from one to three co-morbid conditions each. Co-morbid conditions are a rule rather than an exception, the most common association being asthma. Asthma often is asymptomatic and routine PFT testing is valuable. The association of psoriasis is interesting.