Use of endoscope in middle ear surgery is not new, yet there is resistance to its use in stapedotomy. This is due to perceived long learning curve in shifting from conventional microscope to the endoscope and fear of one-handed work. (1) to present a case series of endoscopic stapedotomies and analyze the operative findings. (2) Discuss the merits and demerits of same. 20 patients with otosclerosis underwent stapedotomy over 5 years using 0°, 4 mm nasal endoscope of 18 cm length. Visualization of middle ear structures, surgical steps, operative time, hearing results and complications were analyzed. In all 20 cases, (13 males, 7 females, age: 32.7 years) manipulation of endoscope within the canal was easy facilitating endomeatal incision and elevation of tympanomeatal flap. An optimum exposure of incudo-stapedial joint was obtained in 88.24 % cases. Adequate exposure of crura was obtained in 82.35 % and the footplate in 95 %. The removal of postero-superior bony wall was required in 30 % and chorda tympani mobilization in 25 % of cases. The average operative time was 31 min. Audiometry done at 6 weeks showed, complete air-bone gap closure in 55 %, mild conductive hearing loss (up to 20 dB) in 30 % and mixed hearing loss in 2 cases (BC up to 30 dB and air-bone gap up to 20 dB). In one patient who initially had hearing improvement post operatively, developed moderate conductive hearing loss at 10 weeks. Performing fully endoscopic stapedotomy using a 4 mm nasal endoscope is a feasible option giving excellent visualization with good results.
Subjective Visual Vertical (S.V.V.) assesses the ability to perceive verticality which depends on visual, vestibular and somatosensory inputs. The judgment of verticality is altered when there is otolith dysfunction. Objective of our study was to present a simple method to assess S.V.V. and to analyze S.V.V. changes in various vestibular disorders. 100 subjects presenting with vestibular disorders in period of 1 year 2 months were subjected to Neurotological history and examination. Patients with non-vestibular causes were excluded. S.V.V was tested with a simple innovative device-a specially designed bucket. The angle of deviation from vertical was noted in degrees. Normal deviation is 0 ± 2°. Out of 23 patients with vestibular neuritis 83 % showed abnormal S.V.V. Amongst 11 patients of Meniere's disease, 55 % and 42 patients of BPPV, 71 % had abnormal S.V.V. Amongst 24 patients with other causes 15 % showed abnormal S.V.V. S.V.V is a reliable screening tool in assessment of vestibular dysfunction along with other clinical tests. It has a prognostic value during recovery following vestibular damage. The modified 'Bucket' is a simple, easy to use and cost-effective device to do the S.V.V. in daily practice.
The objective of this study was to present an unusual case of isolated dystrophic calcification in masseter and the diagnostic challenge it posed. A case report on a 14-year-old boy presented with swelling in left parotid region along with the review of literature was reported. Histopathological and biochemical analyses of the excised mass diagnosed this affliction as dystrophic calcification. Dystrophic calcification is deposition of calcium salt in degenerated tissues in the presence of normal calcium and phosphorous metabolism. It usually occurs in injured tissues. This is different from systemic mineral imbalance causing metastatic calcification and needs to be differentiated. On reviewing the literature, this appears to be the second reported case in the world wide literature. The unique presentation, diagnosis, and surgical management of dystrophic calcification have been described.
The pharmacodynamic interaction between paracetamol and ondansetron coadministration does not block but instead increase paracetamol analgesia, reduce the postoperative analgesic requirement, and improve the postoperative comfort level.
Taste is a chemical sense responding to chemical stimuli. In our daily practice as ENT practitioners or Neurologists we do come across patients complaining of taste disturbances. Tests for taste have to be performed regularly in the clinical centres as well as in neurological labs as a part of complete work up for neurotology cases. Assessment of taste sensation can be easily done in a neurological clinic by chemogustometry as described by Claussen. The stimuli used are chemicals, representative substances for the four qualities of sweet, salty, sour and bitter, in graded solutions. These semi-quantitative results are plotted on a pentagon scheme devised by Claussen. The points of the best results for glucose, sodium chloride, citric acid, phenylthio-urea and quinine then are connected with a coloured line. That gives a linked graphic structure, which can be read by the physician at one glance. Different patterns are obtained for normal taste, taste-blindness for phenylthio-urea, ageusia, partial ageusias for glucose, or sodium chloride or citric acid or quinine or their combinations and parageusias. In this article we present different patterns of taste disturbances depicted on the pentagon chart highlighting the easy interpretation of chemogustometry.
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