Endoscopic Sinus Surgery Workshop And Hands On Cadaveric Dissection Course , 10 & 11, September,2011- GSVM Medical College, Kanpur , U.P., India

Endoscopic Sinus Surgery Workshop And Hands On Cadaveric Dissection Course , 10 & 11, September,2011- GSVM Medical College, Kanpur , U.P., India

Department of Otorhinolaryngoloy & Anatomy , GSVM Medical College, Kanpur in association with ENT Kanpur Chapter are organising an Endoscopic Sinus Surgery Workshop And Hands On Cadaveric Dissection Course ,on 10 & 11, September,2011 at , GSVM Medical College, Kanpur With Dr. T. Janakiram And Dr. Sanjay Sachdev as Guest Faculty . All are invited for this academic feast at the Historical City of kanpur.

For Registration Contact:

Org. Chirman Org. Secretary
Dr. Rajan Bhargva Dr. Sandeep Kaushik
Ph.- 9415044093 Ph.- 9935015199
E-mail -rishabhbha@gmail.com E-mail- dockaushik@gmail.com

Stapedectomy - A Diificult Situation

Mayo Clinic Endoscopic Sinus and Skull Base Surgery Course,November 10-12,2011

.A comprehensive course on state-of the-art strategies
in endoscopic sinus, skull base and orbital surgery
• Full-day dissection with image guidance on fresh
frozen cadavers in Mayo Clinic’s world class
laboratory (limited enrollment)
Mayo Clinic • Scottsdale Campus • Ashton B. Taylor Auditorium
13400 East Shea Boulevard • Scottsdale, Arizona 85259 • 480-301-4580


Distinguished Guest Faculty:
International: Piero Nicolai, M.D.
National: Peter H. Hwang, M.D.
James A. Stankiewicz, M.D.
Course Director:
Devyani Lal, M.D.

Staci King
CME Specialist | Mayo Clinic | Mayo School of Continuous Professional Development
(480) 301-5022 Pager
(480) 301-8323 Fax
Monday-Thursday 8am-3pm
Friday 8am-2pm


Dear friends,
I am sending the brochure and details of the FREE ENT CAMP to be conducted from 23rd August to 28th which we are doing for the past 21years since 1991 and please send deserving poor patients who need ent services and operatons which we will do totally free.
Please feel free to contact me for anydetials.

MOBILE:+91-9440290460, 9985002900

LAND LINE:+91-8514-243210,hospital 243220 direct

Neck ultrasonography for the evaluation of the etiology of adult unilateral vocal fold paralysis

Neck ultrasonography for the evaluation of the etiology of adult unilateral vocal fold paralysis
Head & Neck, 06/24/2011
Wang CP et al. – Ultrasonography revealed 16 patients (30%) having subclinical tumors, including thyroid papillary carcinoma in 7 patients, vagus nerve schwannoma in 2 patients, nodular goiter in 2 patients, malignant nodes in the lower neck in 4 patients, which were metastasized from lung cancer in 3 patients, esophageal cancer in 1 patient, and cervical esophageal cancer in 1 patient. Neck ultrasonography is useful to detect subclinical neoplasia, causing unilateral vocal fold paralysis. Thyroid cancer is the most common neoplastic etiology of adult unilateral vocal fold paralysis.

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Temporal bone dissection course on 7th October'2011 and Live Surgery workshop on "Basics of Ototology" on 8th and 9th October'2011

Dear Dr.
With a successful workshop last year, this year again we are organizing a Temporal bone dissection course on 7th October'2011 and Live Surgery workshop on "Basics of Ototology" on 8th and 9th October'2011 at The Mascot hospital & Research center, Gwalior, MP. It will include lectures and live surgical demonstration.

Looking Forward to welcome you in the city of Tansen, for an academic feast.
Please feel free to contact us for any further details.
May we also request you to please forward this mail to your friends whom you feel may be interested .

Thanks and regards

Dr Rahul Agrawal agrawalrahul77@rediffmail.com
Bunglow No 1, G R medical College
Gwalior, MP, 474009
Ph No. (R): 91-751-2321511
Ph No. (O): 91-751-2423700
Mobile: 91-9425101601

ENT Quiz Round 22


Dear Readers ,
After you submit the Answers in Quiz ,you will be able to see correct answers in the Response form.

Thanks for your support to Quiz Section .


Photo: Niraj Bhat,ENT Surgeon,Jamnagar

The Golden Oriole or European (or Eurasian) Golden Oriole/Peelak in Hindi

Silent sinus syndrome -contribution by Dr Harpreet Kocchar ,Greater NOIDA

Curr Opin Otolaryngol Head Neck Surg. 2008 Feb;16(1):22-5.
Silent sinus syndrome.

Annino DJ Jr, Goguen LA.

Division of Otolaryngology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. dannino@partners.org

PURPOSE OF REVIEW: Silent sinus syndrome is a clinical entity with the constellation of progressive enophthalmos and hypoglobus due to gradual collapse of the orbital floor with opacification of the maxillary sinus, in the presence of subclinical maxillary sinusitis. RECENT FINDINGS: It occurs secondary to maxillary sinus hypoventilation due to obstruction of the ostiomeatal unit. Correction of the problem is surgical. Surgery is endoscopic with reestablishment of maxillary aeration and drainage. The orbital repair can be staged. The endoscopic surgeon must be careful of the prolapsed orbital contents in to the maxillary sinus. SUMMARY: Silent sinus syndrome is rare and multiple findings are needed for the diagnosis. These include enophthalmos or hypoglobus in the absence of clinically evident sinonasal inflammatory disease. Treatment consists of correction of the maxillary sinus atelectasis and the orbital defects. There is evidence that a two-stage repair may eliminate the need to perform the orbital repair. Due to the lateral position of the uncinate, endoscopic maxillotomy needs to be done with care to avoid injury to the orbital contents.

PMID: 18197017 [PubMed - indexed for MEDLINE]

Oral lichen planus: clinical features and management.

Oral Dis. 2005 Nov;11(6):338-49.

Number V Oral lichen planus: clinical features and management.


Dermatology Research Associates, Cincinnati, OH 45230, USA. drore@eos.net


Oral lichen planus (OLP) is a relatively common chronic inflammatory disorder affecting stratified squamous epithelia. Whereas in the majority of instances, cutaneous lesions of lichen planus (LP) are self-limiting and cause itching, oral lesions in OLP are chronic, rarely undergo spontaneous remission, are potentially premalignant and are often a source of morbidity. Current data suggest that OLP is a T cell-mediated autoimmune disease in which auto-cytotoxic CD8+ T cells trigger apoptosis of oral epithelial cells. The characteristic clinical aspects of OLP may be sufficient to make a correct diagnosis if there are classic skin lesions present. An oral biopsy with histopathologic study is recommended to confirm the clinical diagnosis and mainly to exclude dysplasia and malignancy. The most commonly employed and useful agents for the treatment of lichen planus (LP) are topical corticosteroids but other newer agents are available.

CME FESS,Baroda,July 23-24

Mail : drrgaiyer@hotmail.com

DR . R. G. Aiyer
Professor, Head
Dept. of ENT
Medical College
Baroda INDIA

Surgery for plunging ranula: the lesson not yet learned?

Eur Arch Otorhinolaryngol. 2011 Feb 16. [Epub ahead of print]
Surgery for plunging ranula: the lesson not yet learned?
Samant S, Morton RP, Ahmad Z.
Department of Otolaryngology-Head and Neck Surgery, Counties-Manukau DHB, PO Box 98743, South Auckland Mail Centre, Manukau City, New Zealand.
Our objective is to review our experience with treatment of plunging ranula and examine the efficacy of transoral excision of sublingual gland as the principal treatment. This study comprises a case series with chart review. A secondary otolaryngology service was used as the setting. Retrospective analysis of patient records was performed for a series of 95 consecutive cases of plunging ranula, which presented to our department between January 2001 and February 2010. Clinical presentation, investigations, diagnosis, treatment, complications and outcome were recorded. Literature search was performed using MEDLINE and OLD MEDLINE. 81 cases of plunging ranula were treated surgically by transoral excision of sublingual gland and evacuation of ranula contents. Mean operating time was 75.3 min. Twelve patients had undergone previous surgery elsewhere. One patient in our series had a recurrence, needing excision of sublingual gland remnant. Two patients had trauma to submandibular duct requiring excision of submandibular gland. Other complications were minor and transient. Review of literature revealed many diverse methods of treating ranula, with varying results. Our series makes a substantial contribution to the number of plunging ranulas reported in the world, and supports the use of transoral sublingual gland excision as first-line treatment of plunging ranula.

PMID: 21328001 [PubMed - as supplied by publisher]

Throat exercises from AJRCCM article

Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome.

Am J Respir Crit Care Med. 2009 May 15;179(10):962-6. Epub 2009 Feb 20.

Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome.


Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), University of São Paulo Medical School, Av Dr Enéas Carvalho de Aguiar, 44, CEP 05403-904, São Paulo, Brazil.



Upper airway muscle function plays a major role in maintenance of the upper airway patency and contributes to the genesis of obstructive sleep apnea syndrome (OSAS). Preliminary results suggested that oropharyngeal exercises derived from speech therapy may be an effective treatment option for patients with moderate OSAS.


To determine the impact of oropharyngeal exercises in patients with moderate OSAS.


Thirty-one patients with moderate OSAS were randomized to 3 months of daily ( approximately 30 min) sham therapy (n = 15, control) or a set of oropharyngeal exercises (n = 16), consisting of exercises involving the tongue, soft palate, and lateral pharyngeal wall.


Anthropometric measurements, snoring frequency (range 0-4), intensity (1-3), Epworth daytime sleepiness (0-24) and Pittsburgh sleep quality (0-21) questionnaires, and full polysomnography were performed at baseline and at study conclusion. Body mass index and abdominal circumference of the entire group were 30.3 +/- 3.4 kg/m(2) and 101.4 +/- 9.0 cm, respectively, and did not change significantly over the study period. No significant change occurred in the control group in all variables. In contrast, patients randomized to oropharyngeal exercises had a significant decrease (P < 0.05) in neck circumference (39.6 +/- 3.6 vs. 38.5 +/- 4.0 cm), snoring frequency (4 [4-4] vs. 3 [1.5-3.5]), snoring intensity (3 [3-4] vs. 1 [1-2]), daytime sleepiness (14 +/- 5 vs. 8 +/- 6), sleep quality score (10.2 +/- 3.7 vs. 6.9 +/- 2.5), and OSAS severity (apnea-hypopnea index, 22.4 +/- 4.8 vs. 13.7 +/- 8.5 events/h). Changes in neck circumference correlated inversely with changes in apnea-hypopnea index (r = 0.59; P < 0.001).


Oropharyngeal exercises significantly reduce OSAS severity and symptoms and represent a promising treatment for moderate OSAS. Clinical trial registered with www.clinicaltrials.gov (NCT 00660777).

ENT QUIZ ROUND 21 -- is on

Click here to Respond

Click here to see Response Sheet

Dix Hallpike Testing

The Dix-Hallpike test is a common test performed by examiners to determine whether the posterior semicircular canal is involved. It involves a reorientation of the head to align the posterior semicircular canal (at its entrance to the ampulla) with the direction of gravity. This test will reproduce vertigo and nystagmus characteristic of posterior canal BPPV


1]Ratio of histological Otosclerosis to clinical Otosclerosis is

A]5 : 1

B]10 : 1

C]1 : 1

D]20 : 1
2]Holman-Miller sign is seen in

A]Nasopharyngeal carcinoma

B]Juvenile nasopharyngeal angiofibroma

C]Fibrous dysplasia

D]Adenoid hypertrophy
3]Peritonsillar abscess is believed to arise from all except

A]Tonsillar crypta magna

B]Acute viral tonsillitis

C]Minor salivary gland

D]Parapharyngeal septic focus


Limitations of balloon sinuplasty in frontal sinus surgery

Limitations of balloon sinuplasty in frontal sinus surgery
European Archives of Oto-Rhino-Laryngology, 05/16/2011 Clinical Article
Heimgartner S et al. – It is essential to have knowledge of classical functional endoscopic sinus surgery of the frontal recess area. The drawbacks of not including a histopathologic exam should be considered in balloon only procedures.

The charts of patients who underwent balloon sinuplasty from November 2007 to July 2010 at three different ENT- Centres were retrospectively analysed.
CT-analysis of the patients with failed access was performed.
Of the 104 frontal sinuses, dilation of 12 (12%) sinuses failed.
The anatomy of all failed cases revealed variations in the frontal recess (frontoethmoidal-cell, frontal-bulla-cell or agger-nasi-cell) or osteoneogenesis.
In 1 patient, a lymphoma was overlooked during a balloon only procedure.
The lymphoma was diagnosed 6 months later with a biopsy during functional endoscopic sinus surgery.
In complex anatomical situations of the frontal recess, balloon sinuplasty may be challenging or impossible.

THYROCON - 2011,20th & 21st August, 2011,Delhi

Dear Colleague,

It is a pleasure to inform you that the preparations of (THYROCON - 2011) to be held on 20th & 21st August, 2011 at Crowne Plaza, New Delhi, Rohini is progressing well.

The symposium will have a live surgical workshop covering the key aspects in surgical management of thyroid cancer and a CME covering the various modalities of treatment like radioiodine therapy, role of recombinant TSH (r-TSH), targeted therapy and other multimodality mode of management. Controversies in management will also be discussed.

The tentative scientific programme in place and has been uploaded to the institute’s website www.rgci.org

Two renowned international experts Dr Ashok R. Shaha and Dr R. Michael Tuttle both from Memorial Sloan-Kettering Cancer Center, New York, have confirmed their participation for this event. Many renowned national faculties, will also share their views in this symposium.

We have already obtained endorsement from ASI, ANMPI and FHNO for our conference.

We have applied for CME credit hours which will be communicated to you shortly.

Click here to View Brochure

Brochoscopy Workshop,August 14,Kurnool


ENT Surgical Workshop & Hands on FESS PGI Chandigarh,3-4 September,2011

Dear colleague,

This is for the information of all my dear friends and colleagues that due to unavoidable circumstances, we are compelled to postpone the 'ENT Surgical Workshop : An Update' being hosted by Department of Otolaryngology, Head and Neck Surgery at Postgraduate Institute of Medical Education and Research, Chandigarh to 3rd and 4th September 2011 instead of 2nd and 3rd April, 2011.

It will be preceded by a “Hands on cadaveric dissection” for endoscopic sinus surgery on the 2nd September, 2011. Each delegate would be provided with a separate set of endoscopic instruments, endoscope with a camera.

Distinguished international and national faculty have been invited to participate in this event. More than four hundred delegates from all over the country are expected to attend this scientific bonanza.

Thanking you,
Yours sincerely

(Prof. Ashok K. Gupta)
Organizing Chairman

Prof.Ashok K. Gupta
Prof & Head ( Unit II)
Deaprtment of Otolaryngology and Head Neck Surgery
Email: drashokpgi@hotmail.com

ENT QUIZ ROUND 20--Quiz`is on


1]Ratio of histological Otosclerosis to clinical Otosclerosis is

A]5 : 1

B]10 : 1

C]1 : 1

D]20 : 1

2]Holman-Miller sign is seen in

A]Nasopharyngeal carcinoma

B]Juvenile nasopharyngeal angiofibroma

C]Fibrous dysplasia

D]Adenoid hypertrophy

3]Peritonsillar abscess is believed to arise from all except

A]Tonsillar crypta magna

B]Acute viral tonsillitis

C]Minor salivary gland

D]Parapharyngeal septic focus

INVITATION TO CHINA --- A message from Dr. KJ Lee

This is to extend a cordial invitation to join me for an exciting 14-day educational tour of China, Hong Kong, and Taiwan, November 3-13, 2011 at a very econohttp://www.blogger.com/img/blank.gifmical price. In addition to unforgettable sightseeing, we will take part in the 3rd Hua-Ren (World Chinese) ENT meeting, Kaohsiung, Taiwan to exchange ideas on medical practice.
In addition, as the official delegation of the American Academy of Otolaryngology—Head and Neck Surgery, we will bring a message of greetings to the leading Chinese professors to invite them to our annual meeting in Washington, DC, in September 2012.

While in China, you will observe age-old traditions converging with modern Chinese life, learn about traditional medicine and the most advanced techniques. From bustling modern cities to the Great Wall, inside the Forbidden City, and the famous Terra Cotta Army, you will discover an unforgettable society where medicine first evolved some 4,500 years ago.

In Taiwan, professionals will attend the World Chinese ENT meeting, while others go sightseeing. Then the group will see the wonders of Chinese art and culture in Taipei, before departing for the US.

I look forward to welcoming you personally to our Seventh Official Delegation to China and Hong Kong and our first Delegation to Taiwan. Please forward this invitation to your colleagues who might also be interested in a memorable and historic delegation of otolaryngologist—head and neck surgeons to China and Taiwan.
Kind regards,

AAO-HNS Past President
AAO-HNSF Regional Advisor for the Pacific Rim on the International Steering Committee

For program details, contact KJLeemd@aol.com, phone 1-203-777-4005, fax 1-203-776-7741.

Package Rate per Person: US $4,210.00
Including hotels, all breakfasts, eight (8) lunches, six (6) dinners, tour manager, local tour guide, entrance fees, coaches, bullet train, domestic flights within Chinese mainland, China to Hong Kong, and Hong Kong to Taiwan. It does NOT include flight from US to China or Taiwan to US. Soft drinks included. Alcoholic beverages not included. Single occupancy will cost an extra US $1,300.00.

Payment Schedule
US $1,000.00 payable at booking, the remaining due on Sep 28, 2011. 90% of the $1,000 deposit refundable up to September 28, 2011, (10% kept for processing fee). 50% of all payment refundable up to October 12, 2011. No refunds after October 12, 2011. Please consider purchasing cancellation insurance.

Call Donna Dalnekoff toll-free 1-800-243-1806 or 1-203-772-0060 or email donna@newhaventravel.com to do your booking. Donna can also help you with the intercontinental flights. Contact Dr. KJ Lee at 1-203-777-4005 or kjleemd@aol.com for questions.



1]All are empirically used in the management of idiopathic sudden sensorineural hearing loss except




D]Hyperbaric oxygen
2]The following are part of the nasal septum except

A]Ethmoid bone

B]Lacrimal bone

C]Palatine bone

D]Sphenoid bone
3]All are precancerous lesions except


B]Lichen planus

C]Migratory glossitis

D]Submucous fibrosis


Effectiveness of the Cough Reflex in Patients with Aspiration Following Radiation for Head and Neck Cancer

Lung. 2007 Sep-Oct;185(5):243-8. Epub 2007 Jul 28.
Effectiveness of the cough reflex in patients with aspiration following radiation for head and neck cancer.
Nguyen NP, Moltz CC, Frank C, Millar C, Smith HJ, Dutta S, Nguyen PD, Nguyen LM, Lemanski C, Ludin A, Jo BH, Sallah S.
Department of Radiation Oncology, University of Arizona, 1501 N Campbell Avenue, P.O. Box 245081, Tucson, Arizona 85724, USA. NamPhong.Nguyen@yahoo.com
The effectiveness of the cough reflex in patients who aspirated following radiation for head and neck cancer was evaluated in 89 patients (49 chemoradiation, 33 postoperative radiation, and 7 radiation alone). All patients had modified barium swallow because of dysphagia. The cough reflex was graded as present and effective, ineffective, intermittently effective, or absent. All patients were cancer-free at the time of the swallowing study. The cough reflex was present and effective in 46 patients (52%), ineffective in 17 patients (19%), and absent in 26 patients (29%) on initial investigation. Among the 43 patients who had ineffective or absent cough reflex, their treatment was chemoradiation (26), postoperative radiation (13), and radiation alone (4). In 30 patients who had sequential modified barium swallow, the cough reflex was constantly effective, ineffective, or intermittently effective in 12 (40%), 13 (43%), and 5 (17%) patients, respectively. The cough reflex was frequently ineffective or absent in patients who aspirated following radiation for head and neck cancer. Cough may also be intermittently ineffective to protect the airways following radiation.

PMID: 17661135 [PubMed - indexed for MEDLINE]

Polyp in concha bullosa: a case report and review of the literature.

Head Face Med. 2006 May 8;2:11.
Polyp in concha bullosa: a case report and review of the literature.
Erkan AN, Canbolat T, Ozer C, Yilmaz I, Ozluoglu LN.
Baskent University Faculty of Medicine, Department of Otorhinolaryngology, Ankara, Turkey. alpernabierkan@yahoo.com
Polyp originating within a concha bullosa is uncommon; we report only the third such case in the English literature. A 45-year-old man presented with nasal obstruction and headache. Examination of the nose revealed right septal deviation and a hypertrophic left middle concha. Computed tomography confirmed right septal deviation and identified left concha bullosa with thickening of the mucosa covering this lesion. The lateral lamella of the affected turbinate was removed and a mass was excised. Histopathologic examination of the excised mass revealed polypoid hyperplasia. The rare finding of polyp in concha bullosa is discussed with a review of the literature. In any case of concha bullosa, computed tomography images should be carefully evaluated before surgery to check for other pathologies that might have arisen within the lesion.

PMID: 16681852 [PubMed - indexed for MEDLINE] PMCID: PMC1471777 Free PMC Article

Evaluating Abnormal Sounds

If the patient reports hearing abnormal sounds, check for the following:

An unusual rushing sound may be due to a fistula involving the carotid artery. To check for this, auscultate the artery for a bruit. If present, gently pressing on the artery should change the quality of the sound perceived by the patient.

Patients with a ventriculoperitoneal shunt (for low pressure hydrocephalus) may hear a flowing sound.

Patients with myoclonus may hear clicking sounds.

Inadvertent catheterization of the internal jugular vein with subclavian line placement can produce a bubbling sensation in the ears.

Inflammation of the eustachian tube can produce a bright clicking sound heard by the examiner through the otoscope while the patient experiences it as tinnitus (Leudet's sign).

In otitis media patients may hear their own breath sounds.

Tinnitus with dizziness and vertigo that improves at high altitude such as in an airplane suggests Ménière's disease (Bigger's sign).

Tinnitus associated with crepitus in the jaw, headache, and ear pain suggest temporomandibular joint syndrome.

Button battery as a foreign body in the nasal cavities. Special aspects.

Rhinology. 1994 Jun;32(2):98-100.
Button battery as a foreign body in the nasal cavities. Special aspects.
Gomes CC, Sakano E, Lucchezi MC, Porto PR.
Department of Otolaryngology, Campinas University, UNICAMP-SP, Brasil.
Alkaline batteries as foreign bodies in the nasal cavities are dangerous because they can cause liquefaction necrosis with subsequent severe local tissue destruction. Batteries found in the nasal cavities should be removed immediately to prevent sequelae such as septal perforations or nasal meatus stenosis. Due to the common use of these batteries (e.g. watches, electronic toys and games, calculators) physicians and the general public should be more aware of this type of foreign body and the peculiarities in their management. We present five cases of button battery foreign bodies in the nasal cavities and review 12 cases described in the literature and discuss the special aspects of these foreign bodies.

*Button batteries spontaneously leak corrosive electrolyte solution on exposure to moisture. Tissue in contact with such solution will undergo liquefaction necrosis.

How to Diagnose and Manage this Case?

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Dr.Pookamala, Chennai

TB of Submandibular node/ gland,

"Initial investigations:
hemogram with ESR, Blood sugar, Mantoux,discharge for gram staining, fungal staining and C&S
Biopsy of sinus margin with skin and base of sinus.
X-ray -Panorex (Mandible)
Second line investigations:
Usg neck
Discharge-TB Culture
Tissue sample for TB-PCR

Differential diagnosis:
Atypical Tuberculosis(Scrofuloderma),Osteomyelitis of mandible, calculus sialadenitis with Orocutaneous fistula, cervical actinomycosis.

Spot The Dx 5

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The Response Sheet

Migratory glossitis-Quick Review

Migratory glossitis is a psoriasis-like or psoriasis-related condition of the tongue resulting in the production of snaky white lines on the tops and sides, often with small parallel grooves adjacent to them. As in psoriasis, these lines "roam" around the tongue, changing locations or appearances on a weekly, sometimes daily, basis. Many times these lines slowly radiate from a central area of smooth red mucosa, i.e. the normal tongue papillae or "bumps" disappear temporarily. The latter appearance often imparts an appearance similar to that of a globe of the Earth, with irregular white lines representing outlines of continents, hence, the common name for this disease: geographic tongue. Occasional patients have no white lines but have instead smooth red patches, sometimes with small grooves at their edges. Migratory glossitis is usually without symptoms, but some may complain of a burning or tingling sensation, often from secondary fungus or bacterial infection, possibly from a developing anemia (unrelated to the geographic tongue). No treatment is normally needed, but antifungal and antibacterial medications may be used for symptomatic cases; topical or systemic cortisone or prednisone may also be effective. There is no malignant potential.

The prevalence of Samter's triad in patients undergoing functional endoscopic sinus surgery.

Ear Nose Throat J. 2007 Jul;86(7):396-9.
The prevalence of Samter's triad in patients undergoing functional endoscopic sinus surgery.
Kim JE, Kountakis SE.
Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia, Augusta, GA 30912, USA.
We conducted a retrospective study to determine the prevalence of Samter's triad (nasal polyps, asthma, and aspirin sensitivity) in 208 consecutively presenting patients who had undergone functional endoscopic sinus surgery (FESS) for chronic rhinosinusitis from September 2001 through August 2003. Overall, Samter's triad was found in 10 patients (4.8%); subgroup analyses showed that the prevalence of Samter's triad was 5.9% in adults, 9.4% in patients with nasal polyps alone, 16.9% in patients with asthma alone, and 25.6% among patients with both polyps and asthma. On average, patients with Samter's triad had undergone approximately 10 times as many previous FESS procedures as had the patients without Samter's triad (mean: 5.2 vs. 0.53; p < 0.001). In addition to Samter's triad, four other factors were independently and significantly associated with a higher number of previous FESS procedures: nasal polyps alone, asthma alone, both polyps and asthma, and cystic fibrosis alone. Finally, at 6 months following their most recent surgery, patients with Samter's triad had significantly higher rates of symptom recurrence (nasal obstruction, facial pain, postnasal drip, and anosmia) and a recurrence of nasal polyps.

PMID: 17702319 [PubMed - indexed for MEDLINE]

ENT Quiz Round 19


Summary of 128 Responses of Round 18

click on image


1]All are true for acoustic neuroma except
C]Hennebert’s sign

D]Hitselberger’s sign
2]In Sturge-Weber Syndrome,the common comorbidity is
A]diabetes mellitus

3]The high note nerve is the
A]External branch of superior laryngeal nerve
B]Internal branch of superior laryngeal nerve
C]Right recurrent laryngeal nerve
D]Left recurrent laryngeal nerve


62nd hands on cadaver FEST(under the auspices of Hyderabad ENT Research Foundation)11th - 14th August 2011


workshop secretariat
Dr.Rau's ENT super specialty hospital,
1/2rt, housing board colony, punjagutta,
Hyderabad - 500082
contact no’s - +919849085060, +919989225035
email - drgvsrao@raosentcare.com, drchaitanya@raosentcare.com
course coordinators - Dr.Krishna Reddy, Dr.Arun kumar, Dr.Anoop,
Dr.Chaitanya Rau.

Comment on Otoscopic Findings

Correct Responses
Dr Srinivas (Bangalore)
Dr. Prahlada N.B(Bangalore)
Dr. Rishi Gautam Aggarwal (Ambala)
Dr.Pankaj (Lucknow)
Dr. Deepak Dalmia(Mumbai)
Dr.Faizy (Cairo)
Dr.Rajeev Kapila(Ludhiana)
Dr.Venketasan (Chennai)

In some patients, an outwardly bulging, thin atrophic area or "herniation" of the tympanic membrane will be encountered. These “pulsion hernias” are asymptomatic and do not seem to interfere in any way with normal epithelial migration along the surface of the tympanic membrane.

There appear to be two prerequisites necessary for the development of a pulsion hernia.

The first is a preexisting defect in the fibrous middle layer of the pars tensa of the tympanic membrane.

The second is the presence of positive pressure within the middle ear, which forces the thinned portion of the tympanic membrane laterally into the canal (the pulsion).

If the fibrous middle layer of the pars tensa were intact, the tympanic membrane would be unable to herniated laterally to any significant extent.

The thinness of the pars tensa of the tympanic membrane over the pulsion pocket suggests that the herniation of the tympanic membrane occurred in an area where the fibrous middle layer of membrane has disappeared (e.g., the site of a previous, healed perforation or retraction pocket), leaving an area where the membrane consists of only two layers (a dimeric membrane).