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.

IntroductionExtra-cranial meningioma or ectopic meningioma is a rare tumor. This tumor has been reported in various anatomic sites in the head and neck, mediastinum, skin and soft tissues. We report a rare case of ectopic meningioma in the submandibular region detected by using fine-needle aspiration cytology, histopathology and immunohistochemistry. This case represents another unusual site for extra-cranial meningioma, which prompted us to report it.Case presentationAn 18-year-old Dravidian woman presented with swelling in the right submandibular region. The computed tomographic scan findings were suggestive of a neoplastic mass lesion in the right submandibular region. Fine-needle aspiration cytology led to the differential diagnosis of a monomorphic adenoma of a salivary gland or an ectopic meningioma. The patient underwent excision of the submandibular gland and tumor. The histological examination and immunohistochemistry studies confirmed that the lesion was an extra-cranial meningioma. At her two-year follow-up examination, there was no recurrence of the tumor.ConclusionOur experience with this case indicates that, although rare, meningioma should be entertained in the differential diagnosis of a mass lesion in the head and neck region.

No abstract

ObjectiveTo evaluate the significance of Eustachian tube (ET) angles and ET pretympanic diameter on high resolution computed tomography (HRCT) Temporal bone in patients with chronic otitis media (COM).MethodsA retrospective study was carried out at Tertiary care centre. Group A included 92 ears with COM (38 patients with bilateral COM and 16 with unilateral COM); and Group B included 108 normal ears (54 patients with bilateral normal ears). Reid plane-ET angle, Tubotympanic angle and the ET pretympanic diameter was evaluated by HRCT temporal bone, and compared in the two groups. Patients with chronic otitis media (Group A) were subdivided into Group A1 (Blocked ET) and Group A2 (Patent ET). The parameters were evaluated and compared in the subgroups too.ResultsThe mean Reid plane-ET angle and Tubotympanic angle in Group A was 25.41 ± 2.57 and 148.12 ± 3.43 respectively; whereas in Group B it was 27.56 ± 3.62 and 145.14 ± 4.34 respectively. Reid plane-ET angle was significantly less in patients with COM and Tubotympanic angle was significantly more obtuse in COM patients. ET pretympanic diameter was (5.37 ± 2.10) mm in Group A and (6.47 ± 2.40) mm in Group B. It was significantly less in patients with COM. A significant correlation was found between the ET patency and the two ET parameters (Reid plane-ET angle and pretympanic diameter).ConclusionsEustachian tube angles in adults may play a significant role in the etiology of chronic otitis media. Decrease in Reid plane-ET angle and pretympanic diameter on HRCT temporal bone can be used to predict ET dysfunction and to plan the surgical management of chronic otitis media.

ObjectiveTo compare and correlate the efficacy of the NOSE score & the VAS score in determining the symptomatic benefit in patients undergoing septoplasty.Materials and methodsEighty patients with deviated nasal septum undergoing septoplasty were included in the study. NOSE score & VAS score (out of 100) was documented before and after surgery. Results were correlated and compared statistically.ResultsIn the NOSE score, the most bothersome symptom was trouble breathing through the nose (85.83); followed by Nasal obstruction or blockage (82.50). Wilcoxon test showed significant improvement with NOSE score and VAS score in all patients at 1 month and 3 months. Spearman's coefficient showed a positive correlation between the two, though the score improvement and patient satisfaction rate was significantly high with NOSE score.ConclusionsNOSE score and the VAS score both provide effective framework for evaluating treatment responses after septoplasty. However, the NOSE score showed higher improvement and better patient satisfaction rate when used to measure of nasal obstruction as compared to the VAS score.