Effect of the vertical facial canal to round window distance concerning neural response telemetry during cochlear implantation in children.

OBJECTIVE: To assess the correlation of the distance from the round window (RW) to the vertical facial canal (VFC) with neural response telemetry thresholds (T-NRT), which may have an influence on the insertion trajectory and aid in preoperative surgical planning and electrode selection. METHODS: An observational study was conducted on 30 prelingually deaf children under five years diagnosed with bilateral severe to profound hearing loss and received a cochlear implant. The preoperative high resolution computed tomography (HRCT) images in the axial cut bone window setting at the round window level was used to calculate the distance from the RW to the VFC on the RadiAnt DICOM Viewer. The intraoperative distance was measured with ScopyDoc version 8.2.4 software. In Auto-NRT mode, software-based recordings (Cochlear's Custom Sound EP 6.0) were used to measure and evaluate the T-NRT current level. RESULTS: A statistically significant positive correlation of the RW to VFC distance with the average T-NRT p = 0.02, r = -0.4 and with the mid-frequency, T-NRT p = 0.003, r = -0.5 was found. CONCLUSION: The insertion trajectory can be ascertained by a statistically significant correlation between average T-NRT and mid-frequency T-NRT with RW and VFC distance, and this reliable factor can be taken into account in future surgical technique modulation, electrode selection, and electrode design.

Endoscopic Repair of CSF Rhinorrhea: An Institutional Experience.

INTRODUCTION: Endoscopic repair is considered the treatment of choice in cerebrospinal fluid (CSF) rhinorrhea. The aim of our study was to analyze the etiopathogenesis of CSF rhinorrhea, the outcome of treatment and the causes of failure in a developing-country setting. MATERIALS AND METHODS: A retrospective review of patients treated with endoscopic repair for CSF rhinorrhea at a tertiary care hospital in southern India from January 2002 to December 2009 identified 36 patients, the majority of them being women. The defects were closed in three layers using fat, fascia lata and nasal mucosa along with a fibrin sealant in the majority of the patients. Per-operatively, a subarachnoid drain was placed in all patients. Patients were followed up for 1 year. RESULTS: Spontaneous onset of CSF rhinorrhea was noted in 61% of patients. The most common site of leak was found to be the left cribriform plate area. Hence the most common cause of CSF rhinorrhea in our study was spontaneous and the second most common was post-traumatic. Our success rate on the first attempt at endoscopic repair was 100%, with a recurrence rate of 6%. A large defect, failure of localization of the defect, or other co-morbid conditions such as chronic cough may be the most likely causes of recurrence of leak. CONCLUSION: Accurate localization of the site of lesion using a high-resolution computed tomography (CT) scan with magnetic resonance imaging (MRI) and confirmation of the site of leak by intraoperative Valsalva maneuver along with multilayered closure of the dural defect and post-operative lumbar drain appear to be essential for the successful endoscopic repair of CSF rhinorrhea.

Tracheal polyp treated with endobronchial electrocautery.

Fibroepithelial polyps of trachea are extremely rare. Here, we report a case of tracheal polyp in a 40-year-old woman that was managed successfully with endobronchial electrocautery with a review of the relevant literature.

Dentigerous cyst: A rare presentation.

Though Dentigerous cysts are encountered not so frequently by the otolaryngologist, a giant dentigerous cyst causing facial deformity and requiring a major reconstructive surgery is very rare. One such case is described.