Role of Virtual Bronchoscopy in Evaluation of Suspected Foreign Body in Children's Tracheobronchial Tree.

Introduction The presence of foreign bodies in the airways remain a diagnostic challenge to healthcare professionals. They can become life threatening emergencies that require immediate intervention or go unnoticed for weeks and even months. Prevention is best but early recognition remains a critical factor in treatment of foreign body inhalation in children. Objective To study the diagnostic advantages of virtual over rigid bronchoscopy in the evaluation of children with suspected foreign body in the tracheobronchial tree and plan for early management. Methods A crossectional study conducted at a tertiary care hospital & medical college in India. A total 24 patients (0-12-years-old) who presented with complaints of sudden onset of coughing, choking, and breathing difficulty were included during the 2-year duration, from January 2018 to December 2019. All patients underwent virtual and rigid bronchoscopy. Results In 8 patients, foreign bodies detected by virtual bronchoscopy were confirmed by rigid bronchoscopy. There was one case in which virtual bronchoscopy showed no foreign body, but rigid bronchoscopy detected it. In 15 cases virtual and rigid bronchoscopy did not show foreign bodies. The sensitivity, specificity, positive and negative predictive value of virtual bronchoscopy were 88.88, 100, 100, and 93.75%, respectively. Conclusions Virtual bronchoscopy is less invasive and does not require general anesthesia but cost and availability are limitations. It can be used as method of investigation in children with suspected foreign body aspiration.

Causes of Failure of Canal Wall down Mastoidectomy.

AIMS: To identify the causes of failure of the canal wall down mastoidectomy and evaluate the causes for discharging mastoid cavity and to address the causes of failure of previous surgery to minimize the Revision surgery. MATERIALS AND METHODS: This was a prospective and retrospective observational study conducted at a tertiary care hospital from May 2019 to December 2021. Total 20 Patients (11 male & 9 female) with age group (0-60 years) who previously underwent canal wall down mastoidectomy and presented with complaints of persistent ear discharge were included. All patients underwent otoscopic, oto-endoscopic and microscopic examination. RESULTS: Out of 20 cases,13 cases had residual/recurrent cholesteatoma, 11 cases had narrow meatoplasty and 9 cases had high facial ridge.Other causes for failure are graft defect, incomplete removal of anterior and posterior buttress. CONCLUSION: Recurrent/residual cholesteatoma and Narrow meatoplasty are most common cause for failure of previous surgery. Persistent granulation at un-exenterated area was the most common cause for suppuration. Regular follow up and cleaning of the debris from cavity enhances the epithelialization and healing of the cavity.

Comparative Study Between Conventional Curettage Adenoidectomy Versus Endoscopic Microdebrider Assisted Adenoidectomy: Our Experience.

Adenoidectomy is one of the commonest surgical procedures performed by otolaryngologists however; its recurrence rates are very high. Our objective in this study was to compare safety and efficacy between conventional curettage and endoscopic assisted microdebrider adenoidectomy. This was a prospective comparative parallel randomized control trial conducted at a tertiary care hospital from April 2017 to December 2018. We divided patients (N = 42) into two groups i.e. conventional adenoidectomy (group A) (n1 = 21) and endoscopic microdebrider assisted adenoidectomy (group B) (n1 = 21) groups using the lottery method of randomization. Among 42 patients, 33 (79%) were male and 9 (21%) were female. The average operative time in group A was 16.15 min and in group B was 22.9 min with p value < 0.05. Average blood loss in group A was 35.57 ml and in group B was 37.14 ml. In group A, 1 (4.76%) of 21 patients developed temporary velopharyngeal insufficiency which was relieved after 4 weeks of surgery whereas in group B, 5 (23.8%) patients developed nasal bleed and 2 (9.52%) patients presented with nasal synechiae on follow-up. Eight (38%) patients in group A showed grade I adenoids after 3 weeks of surgery while group B showed complete clearance in all patients (p < 0.05). Conventional adenoidectomy has less intra-operative blood loss and shorter surgical time duration as compared to endoscopic assisted microdebrider adenoidectomy but with higher chances of residual adenoid tissue.

Comparative Study of CO2 LASER Assisted and Electrocautery Assisted Tonsillectomy with Conventional Tonsillectomy.

Tonsillectomy is the most common surgical procedure performed since many years. Various methods of tonsillectomy (Electrocautery, LASER, Harmonic scalpel, Coblation) have been practiced over the last century aiming for reducing intra and postoperative morbidity. We carried out prospective randomized control study using retrospective data as secondary data to compare blood loss, excision and hemostasis time, pain, recovery time and complication between CO2 LASER and Electrocautery assisted with conventional method. Average time for surgery with CO2 LASER (82.17 min) was more than conventional (77.77 min) and electrocautery (21.40 min) was least. The postoperative pain and recovery time was more in CO2 LASER and Electrocautery group than conventional. The blood loss was more in conventional group compared to other two group. We concluded that CO2 LASER group has longest operative time but least blood loss. Postoperative pain was more and lasted longer in Electrocautery group. Conventional method had least recovery time, least tissue reaction and least hospital stay.