Multi Level Single Stage: Barbed Reposition Pharyngoplasty and Nasal Surgery in Treatment of OSA-Our Experience.

It has become increasingly clear in the past decade that surgical management of OSAHS is most successfully managed with multilevel surgery (Cahali in Laryngoscope 113(11):1961-1968, 2003; Friedman et al. in Otolaryngol Head Neck Surg 131:89-100, 2004; Laryngoscope 114:441-449, 2004; Pang and Woodson in Otolaryngol Head Neck Surg 137(1):110-114, 2007; Li and Lee in Laryngoscope 119:2472-2477, 2009; Vicini et al. in Head Neck 36:77-78, 2014; Mantovani et al. in Acta Otorhinolaryngol Ital 32:48-53, 2012; Morgenthaler et al. in Sleep 30:519-529, 2007). In particular, drug-induced sleep endoscopy (DISE) has shown that the nose and soft palate are important anatomic components of obstruction in OSAHS and therefore should be treated as far as possible as a single stage procedure. The nasal patency being pivotal in the outcome of the sleep apnoea surgery. To ascertain the effectiveness and ease of carrying out multilevel single stage procedure in patients of obstructive sleep apnoea, and to use BARB sutures for relocation palatoplasty as a new technique to address level 2 collapse without excising much of soft palatal tissue. We have carried out a prospective study of 50 OSA (mild to severe) patients with nasal and retropalatal obstruction specifically without BOT or hypopharyngeal component of obstruction. The nasal component being treated with various procedures depending on the deformity or nature of obstruction and retropalatal component addressed by barbed relocation pharyngoplasty (BRP) being a relatively new procedure. We observed that nasal surgeries along with BRP can provide as an effective and safe option with very promising results. Adding BRP in the same stage with nasal surgery has been proved to be a simple, easy to learn, safe procedure with promising results in the management of OSA. Key points to be, the level of obstruction noted on DISE and proper patient selection can help us give the patients a good surgical result in a single stage procedure.

Neonatal Screening for Prevalence of Hearing Impairment in Rural Areas.

Hearing is one of the most important sense organs for man. Hearing loss is often associated with delayed speech and language development in young children. Early identification and intervention improves the chance a child gets to lesser delays in development and improving the overall quality of life. To find out the prevalence of hearing loss in neonates in the rural taluka of Maval, Pune, Maharashtra, India. Prospective Non Randomized Clinical Study. The study was carried out between April 2012 and April 2015. A total of 8192 babies were screened across various centers around the Maval area. The babies who had some high risk factors were 1683 in number and babies who had no high risk factors i.e. well babies were 6509. In our study, the overall prevalence of hearing loss in neonates in Maval taluka of Maharashtra was found to be 3.54 per 1000 live births, in normal born neonates (well babies) was 1.689 per 1000 births, in high risk babies was 10.69 per 1000 high risk births. The prevalence of low birth weight neonates, hyperbilirubinemia neonates and neonates with craniofacial abnormalities developing hearing impairment was found to be 5.9, 3.56 and 1.18 per 1000 high risk births respectively. India is the second most populated country in the world with nearly a fifth of the world's population. There is a need for the universal neonatal screening for deafness for earlier detection of deafness and rehabilitation. Level of Evidence: Level IV.

Role of Extracorporeal Septoplasty in Deviated Noses.

Severe gross septal deviations present big surgical challenges for operating surgeon. Septal deviations has direct effect on aesthetic and functional part of nose. Correcting septal deviations during rhinoplasty is basic procedure. Extreme deviations of septum especially on dorsal and caudal end of cartilaginous septum are difficult to treat. The classical septoplasty approach becomes unsuitable for such severe deviations. Gubisch has first reported in 1995 about extracorporeal septoplasty. To report the experience of Extracorporeal septoplasty and the complication rates with the technique. Retrospective study of 112 patients who underwent extracorporeal septoplasty in primary rhinoplasty from May 2009 to June 2014. Patient's pre and postoperatively evaluation was done by photographs, nasal endoscopy and subjective by symptoms evaluation satisfaction scale 6 and 12 months postoperatively. Nasal endoscopy revealed significant improvement in nasal airway and nasal valve and subjective evaluation satisfaction score was very encouraging. Complications like septal perforation, bleeding, aesthetic complications were minimal (9 %) On basis of results obtained, shows that this technique, increases patients nasal airway and aesthetic look of the patients. Irrespective of extreme nasal deviations.

Simultaneous involvement of larynx and middle ear in pulmonary tuberculosis.

We present a rare case of simultaneous involvement of larynx and ear in a patient with pulmonary tuberculosis. The aim of this article is to create an awareness of Ear Nose Throat tuberculosis, and to consider tuberculosis in the differential diagnosis of ear and laryngeal diseases.