Surgical Outcome of Endoscopic Dacryocystorhinostomy with and Without Prolene Stent in Chronic Dacryocystitis: A Randomized Controlled Trial.

Popularity of Endoscopic dacryocystorhinostomy is rising over a conventional external dacryocystorhinostomy. One of the most frequent reasons for procedure failure is the closing of neo-ostium. To compare the surgical results of endoscopic Dacryocystitis operations with and without Prolene stents in terms of procedure success rates and postoperative complications. A randomized controlled trial of 2 years was carried out including 100 patients of chronic dacryocystitis. The cases were randomly split into two groups with 50 cases each in Endoscopic DCR with stent and without stent groups. The results, both the subjective and objective were noted. At the end of 3 months, the overall success rate was 88% and 90% in group with and without stent respectively with no significant statistical difference. 12% subjects had wound infection, 8% had granulations around the rhinostoma, 6% had synechiae, 10% had discomfort from the tube in stent group. In Group B (without stent), 16% had wound infection, 4% had granulations around the rhinostoma. As Endoscopic DCR without stent has equally good results and less complications as compared to with stent, we recommend endoscopic DCR without stent. Use of Stent should be reserved for special conditions like revision cases, common canalicular block, fibrosed lacrimal sac.

Sociodemographic and Clinical Profile of Oral Submucous Fibrosis.

Background: Oral Submucous Fibrosis is a pre-cancerous, progressive condition caused by gutkha, areca nut consumption which is characterized by limited mouth opening, burning pain inoral cavity, stiffness and blanching of oral mucosa. Aim: To study sociodemographic characters and clinical profile of Oral Submucous Fibrosis and to assess the association of duration of adverse habits with clinical staging of Oral Submucous Fibrosis. Methodology: This cross-sectional study of 70 clinically diagnosed cases of oral submucous fibrosis was carried out at the Tertiary Health Care Centre in Central India. Over the course of two years, demographic and clinical information, including specifics on addiction and its duration, was gathered. On the basis of symptoms, the presence of palpable fibrous bands, and measuring mouth opening, clinical staging was carried out. Results: The average age of the patients in the study was 33.2 ± 12.66 years with Male female ratio of 3:1. Significantly higher proportion of patients belonged to low socioeconomic status. The maximum number of patients were seen in stage III (62.86%) followed by Stage II (21.43%) and subjects who had the adverse habits for a period of 5 to 10 years had more severe OSMF. Conclusion: In the present study, frequency of OSMF was more in young age group and in males. There was higher frequency of disease in lower socioeconomic status. Longer duration addiction was highly associated with severity of clinical stage of OSMF.

Paediatric Type 1 Tympanoplasty: Comparison of Full Thickness Tragal Cartilage Versus Temporalis Fascia Graft-A Randomised Controlled Trial.

Tympanic membrane perforation in children usually appears as a sequel of middle ear infection. This study was conducted to compare the anatomical and functional outcomes of cartilage and temporalis fascia graft in type 1 tympanoplasty in Paediatric population. DESIGN: A hospital based randomized controlled trial. SETTING: A tertiary care institute of central India. SUBJECTS: All consecutive paediatric patients between 5 and 18 years of either sex attending ENT OPD and Paediatric OPD fulfilling inclusion criteria were included in the study. Anatomical and functional results of total 90 patients who underwent tympanoplasty were analyzed. These patients were divided into two groups depending on the graft material used. The cartilage group and the temporalis fascia group each comprising of 45 patients respectively. METHODS: All patients underwent Type I tympanoplasty under general anaesthesia and with a post auricular approach. The surgeries were performed by senior surgeons. The graft success rate of the cartilage group (91.1%) was higher than the fascia group (84.44%) but the difference was not statistically significant (p = 0.449). The air bone gap closure was slightly better with temporalis fascia group than with cartilage group but the overall functional success rate in both the groups was not statistically significant.Cartilage and fascia grafts yield similar results for hearing gain and graft success rate in paediatric tympanoplasty.

Comparison of Surgical Outcome of Endoscopic with Microscopic Type I Tympanoplasty in Chronic Otitis Media: A Randomized Controlled Trial.

Aim of the study was to compare the surgical outcome of endoscopic with microscopic Type 1 tympanoplasty in dry, mucosal type of chronic otitis media with respect to graft uptake rate, hearing gain and duration of surgery. This randomized controlled trial of 3 years was carried out at Tertiary Care Hospital of Central India. Total 80 cases of mucosal type of chronic otitis media posted for Type I tympanoplasty were included in the study. They were randomly divided into two groups viz. Endoscopic tympanoplasty and microscopic tympanoplasty with 40 patients in each group. Chi-square test was used to compare the qualitative results and student's t-test was used to compare quantitative results with a level of significance of p ≤ 0.05. Intraoperatively, widening of external auditory canal and auxiliary incision were required in 45% and 47.5% patients of microscopic group respectively. Mean operative time for endoscopic tympanoplasty (62.5 ±14.94  mins) was less as compared to microscopic tympanoplasty (74.88 ± 15.83  mins). Graft uptake rate was 95% and 92.5% in endoscopic and microscopic tympanoplasty groups respectively with statistically insignificant difference (p = 0.32). The preoperative mean air bone gap in both the groups was improved significantly 6 months postoperatively. Air bone gap closure was of 13.21± 4.37 dB in endoscopic group and 12.54  ± 4.14 dB in microscopic group with statistically insignificant difference. Endoscope provides superior visualization of hidden areas of middle ear cavity and has shorter operative time than microscopic tympanoplasty with comparable surgical and functional outcomes. hence endoscopic tympanoplasty can be a good option to microscopic surgery.

Effectiveness of Type I Tympanoplasty in Wet and Dry Ear in Safe Chronic Suppurative Otitis Media.

The aims and objectives of the study were to compare the rate of graft uptake after type 1 tympanoplasty in wet and dry ears and also to compare the postoperative hearing improvement in wet and dry ears. It was a Non Randomized Experimental Study. This study was done in ENT OPD at Tertiary Health Care Institute of Central India. It was conducted from November 2012 to October 2014 on 86 patients having Safe Chronic Suppurative Otitis Media. The patients were divided into two groups as Dry ear group and Wet ear group. Dry ear group included patients whose ear was dry for at least 6 weeks prior to the surgery. Wet ear group included patients who had minimal mucoid discharge in the middle ear which on culture and sensitivity showed no microorganisms. Type 1 Tympanoplasty was done in all patients. Results were analyzed statistically. Complete graft uptake was seen in 86.95% cases of Dry ear group and 80% of Wet ear group and the difference was statistically insignificant. Hearing improvement was achieved in 80% cases in dry group and 67.5% cases in wet group. The difference in hearing improvement in both groups was also statistically insignificant. So conclusion was drawn that, presence of minimal mucoid ear discharge at the time of surgery does not affect the success rate of Type 1 Tympanoplasty.

Diagnostic Accuracy of Nasal Endoscopy as Compared to Computed Tomography in Chronic Rhinosinusitis.

The study was done with the aims to evaluate the accuracy of nasal endoscopy as compared to computed tomography (CT) in diagnosing chronic rhinosinusitis (CRS) and to evaluate the correlation between Endoscopy Score and CT Score. It was a cross sectional study. Every consecutive, symptomatic patient of CRS who fulfilled the criteria of American Academy of Otolaryngology-Head and Neck Surgery Task Force were included in the study. Rigid diagnostic nasal endoscopy (DNE) was done and Lund-Kennedy scoring system was used. Plain CT of paranasal sinuses was done on the same day and severity was assessed using Lund-Mackay scoring system. Results were analysed considering CT as a gold standard. Out of 54 study patients, 45 (83.33%) had abnormal endoscopic examination while 50 (92.59%) were showing positive CT scan. Sensitivity and specificity of DNE against CT scan were 94% (95% CI 81.43-98.33%) and 75% (95% CI 42-99.24%), respectively. The positive predictive value was 98% and negative predictive value was 67%. Correlation between Lund-Mackay overall CT and Lund-Kennedy Endoscopy Score was high [Pearson's correlation coefficient (r) = 0.881, p value < 0.0001]. The conclusion was drawn that, endoscopy is valuable in individuals with symptoms consistent with CRS and can be used to confirm the diagnosis and to know the severity of the disease. CT scan can be advised in those with high clinical suspicion of CRS but negative endoscopy and in those having persistent symptoms after optimum medical management requiring Functional Endoscopic Sinus Surgery.

Necrotising fasciitis of the neck and anterior chest wall.

Necrotising fasciitis is a rare but rapidly progressive and potentially life threatening infection of the soft tissue, involving subcutaneous tissue and deep fascial layer. It may affect any part of the body, but the extremities, abdominal wall, and perineum are most commonly affected. Here we present a case of necrotising fasciitis of the neck and anterior chest wall which is a rare presentation. The risk factor of the disease was uncontrolled diabetes mellitus. We could treat this patient successfully by early recognition, aggressive surgical debridement, intravenous antibiotics, fractional doses of insulin to control diabetes and other supportive measures.