No abstract

A 67-year-old gentleman of Chinese ethnicity presented with a 6-month history of worsening dysphagia, initially with solids, followed by liquids, resulting in poor oral intake. He denies coughing or choking while swallowing. He smoked 20-pack years of cigarettes and stopped 6 months prior to presentation. There was significant weight loss of 30 kg in 6 months associated with lethargy.An oesophagodeudonoscopy at the fourth month revealed mild oesophagitis with a grade three (Type I) hiatus hernia. He was treated with proton pump inhibitors, but the dysphagia worsened. A flexible laryngoscopy revealed unremarkable true and false cords, with no pooling of saliva or evidence of aspiration. He underwent a barium swallow to rule out a mechanical cause.During the barium swallow, he was aspirating silently, with significant amounts of barium contrast in his right bronchus (Fig. 1). The study was halted immediately, and the patient was propped up, with vigorous suctioning. There was no evidence of oxygen desaturation.

Objectives Inlay butterfly cartilage tympanoplasty (IBCT) is a simple grafting technique. Endoscopy facilitates visualization by eliminating blind spots. We analyzed the outcomes of IBCT using both endoscopic and microscopic approaches, and assessed how trainees perceived the educational opportunities afforded. Materials and methods Sixty patients who underwent IBCT were allocated to Group I (n = 30; microscopic IBCT) and Group II (n = 30; endoscopic IBCT) by the dates of their visits. Anatomical success was defined as an intact, repaired tympanic membrane; functional success was defined as a significant decrease in the air–bone gap. Postoperative discomfort was analyzed using a visual analog scale (VAS). Thirteen trainees completed structured questionnaires exploring anatomical identification and the surgical steps. Results The surgical success rates were 96.7% in Group I and 100% in Group II. We found no between-group differences in the mean decrease in the air–bone gap or the extent of postoperative discomfort. Significant postoperative hearing improvements were evident in both groups. The mean operative time was shorter when the microscopic approach was chosen (17.7±4.53 vs. 26.13±9.94 min). The two approaches significantly differed in terms of the identification of external and middle ear anatomical features by the trainees, and their understanding of the surgical steps. Conclusion Both endoscopic and microscopic IBCT were associated with good success rates. The endoscopic approach facilitates visualization, and a better understanding of the middle ear anatomy and the required surgical steps and thus is of greater educational utility.