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A 30-year old male presents with gradually progressive hearing loss for 6 months but no other complaints.The tympanic membrane is normal to examination.Systemic examination is normal.The pure tone audiogram shows bilateral moderate mixed hearing loss with an air-bone gap of 30 dB on either side,and the acoustic reflexes are intact.Suggest the most appropriate line of investigation ( I ) and treatment ( T ).

I - 1]serial audiograms
I - 2]HRCT Temporal bone
I - 3]MRI Brain
I - 4]serum alkaline phosphatase

T - 1]reassurance and close follow-up
T - 2]oral sodium fluoride
T - 3]hearing aids
T - 4]stapedotomy

B-NOSE:true ( T ) or false ( F )

1]endarteritis obliterans is the predominant histological feature
2]acetic acid(vinegar) and liquid paraffin are instilled alternately to loosen and remove crusts
3]Young's closure is never done bilaterally at the same sitting
4]aggressive nasal surgery is a major risk factor

C-THROAT:single best answer

All of the following may be combined with uvulopalatopharyngoplasty(UPPP) in the treatment of obstructive sleep apnoea(OSA) except
3]hyoid suspension
4]tongue base resection

Determinants of spontaneous healing in traumatic perforations of the tympanic membrane

Clin Otolaryngol. 2008 Oct;33(5):420-6.
Determinants of spontaneous healing in traumatic perforations of the tympanic membrane.
Orji FT, Agu CC.

Department of Otolaryngology, Federal Medical Center Umuahia, Abia State, Nigeria. tochiorji@yahoo.com

To analyse the various factors influencing spontaneous healing of traumatic tympanic membrane perforation in West Africa.

Prospective clinical study. Setting: Tertiary referral centre.

Consecutive patients with traumatic tympanic membrane perforations without history of previous middle ear disease.

Healing outcome at 4, 8, 12 weeks; effects of perforation size, location, and mode of injury, active intervention and ear discharge on healing outcome.

Fifty-three patients, 32 (60%) men and 21 (40%) women, aged 2-86 years, with traumatic tympanic membrane perforation who met our inclusion criteria were analysed. Ninety-four percent of the perforations healed spontaneously. Spontaneous healing was significantly correlated with age (P < 0.05). It was significantly delayed by large perforations estimated at 50% or more of entire tympanic membrane, ear discharge, wrong intervention on acute perforation by ear syringing, and by penetrating injuries sustained through the ear canal (P < 0.05, P < 0.01, P < 0.01 and P < 0.01 respectively). Perforations in the anterior versus posterior quadrants showed no significant difference in the healing rate (P > 0.05). Non-healing of the traumatic perforation was significantly associated with the large perforations, ear discharge and wrong intervention by ear syringing in chi-square test (P = 0.01, P = 0.02 and P < 0.001 respectively), but only with penetrating injuries sustained through the ear canal and the ear syringing intervention in logistic regression test (P = 0.02 and P = 0.04 respectively).

The rate of spontaneous healing of traumatic tympanic membrane perforation varied inversely with age of patient and size of perforation. It was delayed by middle-ear infection, as well as in ears that sustain direct injuries and in ears that had wrong interventions. However, it was not dependent on whether the perforation was in the anterior or posterior location. Logistic regression analysis revealed that penetrating injuries sustained through the ear canal and the ear syringing intervention were the only risk factors important in predicting the non-healing of traumatic tympanic membrane perforation.

Lymphoma Thyroid

Midline mass moving with swallowing.FNAC shows Lymphoproliferative Disease.Throid Function Normal.US shows increased vascularity with small LN along internal jugular chain.

Rhinoplasty tutorial, Table of contents - FacialSurgery.com

Rhinoplasty tutorial, Table of contents - FacialSurgery.com

Guidelines on the Use of Surgical Masks

Guidelines on the Use of Surgical Masks

Sudden infant death: lingual thyroglossal duct cyst versus environmental factors.

Forensic Sci Int. 2006 Jan 27;156(2-3):158-60.
Sudden infant death: lingual thyroglossal duct cyst versus environmental factors.
Kanawaku Y, Funayama M, Sakai J, Nata M, Kanetake J.
Division of Forensic Medicine, Department of Public Health and Forensic Medicine, Tohoku University School of Medicine, Seiryo-Machi 2-1, Sendai 980-8575, Japan.
An 8-month-old female baby was found collapsed in the prone position 30 min after being positioned under soft-bedding. She was taken to the emergency room with cardiopulmonary arrest. Her heartbeat was recovered after resuscitation and continued for 20 h under artificial respiration, at which point the child died. At autopsy, the child showed no significant pathological abnormalities apart from a thyroglossal duct cyst of 2.0 cm diameter, therefore, it seemed that the cyst, which was close to the epiglottis, had caused asphyxia through airways occlusion. However, the child had shown no respiratory problems before death, and the risk of airway occlusion as a result of lingual cysts is more likely in a supine rather than a prone position. A small amount of evidence suggested that the child died as a result of suffocation from being covered by soft-bedding, which could have caused fatal asphyxia; it is also possible that a hypoxic state induced by airway obstruction might have been enhanced by being covered with bedding. It seemed reasonable to assume that death was caused by a combination of the lingual thyroglossal duct cysts and asphyxia caused by being covered in bedding, though the main factor appeared to be the large cyst.

Vascular hamartoma of the paranasal sinuses: report of 3 rare cases and a short review of the literature - page 2 | Ear, Nose & Throat Journal

Vascular hamartoma of the paranasal sinuses: report of 3 rare cases and a short review of the literature - page 2 | Ear, Nose & Throat Journal

All 3 tumors described herein are unusual in the sense that they were microscopically characterized by the presence of widely spaced, variously sized, blood-filled vascular channels embedded in a connective tissue stroma that varied from loose fibroadipose tissue (patient 1) to dense fibroblastic tissue (patients 2 and 3). These morphologic features are consistent with the designation of vascular hamartoma. Morphologically, hemangiomas bear a close resemblance to vascular hamartomas, and it is often difficult to distinguish the two. However, unlike the histology seen in these 3 cases, most of the hemangiomas that have been reported in the sinonasal region were either classic capillary hemangiomas, cavernous hemangiomas, or ossifying angiomas.

Laryngeal Assessment by Using 30 and 70 Degree Rigid Endoscope

This video shows the hypopharyngeal and laryngeal inlet view by using 30 and 70 degree endoscope. Limited view of larynx visualized by using 30 degree scope whilst the best view obtained by using 70 degree scope.

NBI Narrow Band Imaging

NBI Narrow Band Imaging

Narrow Band Imaging (NBI) in Assessment of Dysplatic Laryngeal Lesions

ENT Quiz Round 25----The Quiz is on


You will be able to see Answers in Response form immediately after you submit the form.

Superelastic Nitinol in stapes surgery.mp4

Phlebectasia of the External Jugular Vein

Phlebectasia of the External Jugular Vein

Jugular phlebectasia, an entity increasingly recognised in recent years, is an isolated saccular or fusiform dilation of a vein without tortuosity. There is a controversy about etiology. This paper reports a case of localised distension of the external jugular vein in a 24-year-old male patient complaining of intermittent right neck swelling while lying down or straining (Valsalva maneuvre). The diagnosis was confirmed by color Doppler ultrasonography, surgical excision was carried out without any complication.

The possible differential diagnosis for the swelling could include a branchial cyst, cystic hygroma, laryngocoele, cavernous haemangioma and superior mediastinal cysts

Water as a fast acting wax softening agent before ear syringing.

Water as a fast acting wax softening agent before ear syringing.
Pavlidis C, Pickering JA.
Dimboola Medical Centre, Victoria. drpavlidis@bigpond.com
Dispute exists over the best treatment for softening occlusive earwax. Some require the patient to go away for days before returning for syringing. Some syringe immediately with no preparation.

An open, nonblinded, randomised controlled trial was conducted in one rural general practice. Effects of instillation of water into the ear canal for 15 minutes before syringing were compared to effects of syringing immediately.

Thirty-nine ears (of 26 patients) were randomised. Ear wax was removed entirely by syringing in all ears. Prior instillation of water required a mean 7.5 (+/- 7.3) attempts at syringing versus a mean 25.4 (+/- 39.4) attempts for ears that were syringed immediately (p=0.043).

Prior installation of water before syringing seems to be an effective and simple method of reducing the number of attempts required to clear the ear of occlusive wax.

“ENT Surgical Workshop: An update” on 3rd and 4th September, 2011,PGI,Chandigarh

Dear Friends/Colleagues

As you are already aware that the department of Otolaryngology and Head & Neck Surgery, PGIMER, Chandigarh is organizing “ENT Surgical Workshop: An update” on 3rd and 4th September, 2011. It will be preceded by a “Hands on cadaveric dissection” for endoscopic sinus surgery on the 2nd September, 2011. In this connection, I am sending you the brochure of the Workshop highlighting the detailed programme of the Workshop.


With warm regards

(Prof. Ashok K. Gupta)
Prof & Head
Department of Otorhinolaryngology( Unit-II)
PGIMER, Chandigarh
Clinical Rhinology
Ph Office: 01722756766
Mobile: 91-9814198850.


63rd hands on cadaver FEST,9th - 12th November 2011,Hyderabad


63rd hands on cadaver FEST

(under the auspices of Hyderabad ENT Research Foundation)

9th - 12th November 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.


Department of ENT, AIIMS and NES (Neuro-Otological Equillibriometric Society of India) invite you to vertigo 360 degree, a one day exhaustive CME workshop on vertigo. Date: 22-7-2011, Time: 10:00 am, Venue: Ramalingaswamy board room, AIIMS


Bone-anchored devices in single-sided deafness.

Adv Otorhinolaryngol. 2011;71:92-102. Epub 2011 Mar 8.
Bone-anchored devices in single-sided deafness.
Stewart CM, Clark JH, Niparko JK.
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Single sided deafness (SSD) implies sensorineural hearing loss in one ear with normal contralateral hearing function. Traditionally, SSD patients have been overlooked due to a belief that the preserved functioning of the contralateral ear compensates for the nonhearing side. SSD patients however experience multiple audiological difficulties, particularly when the sound source is situated on the non-hearing side or in the presence of competing sounds. Through reviewing current literature, we describe the role of bone-anchored devices (Baha) in the management of SSD patients. Recent publications for Baha in SSD have demonstrated consistent objective and subjective improvement in audiologic metrics when compared to unaided conditions. There is also evidence of benefit provided by Baha by the Abbreviated Profile of Hearing Aid Benefit, in global measures of ease of communication, reverberation, and background noise, but not typically in aversiveness to sounds. Interestingly, despite some patients gaining minimal objective or subjective benefits, the majority of these patients still report improved quality of life and would recommend the procedure. Despite increasing evidence for the role of Baha in the management of SSD in the literature, much of these data are based on older technology. Further reports should specify the processor type used and the etiology of the hearing loss to ensure accuracy of future data.

ENT QUIZ ROUND 24 --- The Quiz is on


Lahaul Spiti : Dr Pushkar Lele ( Nashik)

Endoscopic repair of incudostapedial dislocation

Dr. Atul Gawande Surgical Check List


Live Workshop,9th and 10th September 2011,SALEM,TAMILNADU

Live Workshop on Contemporary Surgical techniques, Video Endoscopic and Open Thyroid surgeries to be Held on 9th and 10th September 2011 in VINAYAKA MISSIONS K.V MEDICAL COLLEGE AND HOSPITAL, SALEM,TAMILNADU

MAIL : Dr.A.DhanyanHarshidan

35th Annual AOI-GSB CONFERENCE -December 16-18,2011,Ahmdabad


Wrong-site sinus surgery in otolaryngology

Approximately 10 percent of survey respondents know of a case of wrong-site sinus surgery occurring; the majority of respondents are concerned about a wrong-sinus or wrong-sided surgery occurring in their practice. Otolaryngologists should be vigilant regarding the potential for inverted computed tomography images; there should be national efforts to address this latent systems defect. Surgeons should be trained in understanding the role of and engaging in disclosure and in other techniques that are of greatest support to the patient. Consideration of sinus-specific checklists should be led by the societies representing sinus surgeons.


  • Use site markers
  • EUM must before starting Ear Surgery.
  • Read CT again & correctly at table.
  • Faith in others may cause error.
  • Avoid multi tasking.
  • Analyse near misses
  • Use a ckeck List

cute signing baby!...baby sign language

Speech in Parkinsons Disease

Tuberculous Laryngitis

CT Chest of patient with Rt V C Palsy

CT revealed a mass in mediastinum .
Plan : US guided FNAC

Histopathology Skin--Lichen sclerosus et atrophicus

Discoid lupus erythematosus Ear

The lesions typically present as well-circumscribed, erythematous plaques with telangiectasia and scales and atrophy in long-standing disease.

DLE is a Benign subtype of lupus erythematosus involving the skin, particularly the face and can involve pinna as in the above case. It is characterized by various-sized, erythematous, well-defined, scaly patches, which tend to heal with atrophy, scarring and pigmentary changes. The onset of the lesions may be precipitated by trauma, mental stress, sunburn and exposure to cold. Visceral involvement does not occur, but a small percentage of patients with DLE may later develop a systemic lupus erythematosus. Haematological and serological changes in about half the patients suggest an autoimmune aetiology.
Rx-corticosteroids are prescribed to decrease the immune system response. Topical creams that are applied to the rash areas are effective in reducing their spread and severity. A cortisone injection directly into lesions is another alternative. Antimalarial medications are also effective treatments for discoid lupus.

Spot the Dx

This patient has Vel0pharyngeal Insuffciency due to short soft palate
Plan : Pharyngoplasty


Speech Therapy for Parkinsons Disease

Speech Therapy for Parkinsons Disease

Otolaryngology Poll

A 45 year old lady with dry central perforation in one ear . No complaints.Should we operate ?


A flock of Birds in Leh (Photo:Dr RCV)

3rd RAMACHANDRA TEMPORAL BONE COURSE – RTBC (Otology Skills Development Workshop) on 23rd July 2011

The Department of ENT, Head & Neck Surgery
Sri Ramachandra University
The Skills Lab, 2nd Floor, OPD Block
Department of ENT, Head & Neck Surgery
(Otology Skills Development Workshop)

onDr. V.V. Ramachandran,
Dept. of ENT, Head & Neck Surgery
Chennai- 600116.
Mobile: 09444570157
Email: vedhachalamram@yahoo.co.in

ENT Quiz Round 23


Male Purple Sun Bird at Budha Garden

PHOTO: Dr RC Vashishtha,ENT Surgeon ,Delhi