Discussion - bilateral conductive loss

Saket Aggarwal
Had a child, 9 years old, with bilateral conductive loss approximately 40 dB, impedance type B, myringotomy with grommets done. No improvement after surgery, Hearing loss same, Would need input from the forum

Harpreet Singh Kochar Intraop findings? Any glue? How many days since surgery.

Kapil Sikka may be ossicular discontinuity, or a wrong diagnosis!!!

Surinder K Singhal Why Type B in Ossicular discontinuity? It should be be Type D

Ninad S Narkar How much was the compliance? Can think of congenital ossicular fixation if compliance is low. Glue was probably coincidental.

Gowri Shankar may be the grommets are non functioning and blocked, taking that all the tests are done well

Saket Aggarwal almost 6 months now, had effusion. grommets are working well. checked under microscope. TM is normal now.

Saket Aggarwal any one else with similar experience!

Gowri Shankar kindly provide some more data reg : adenoids,mobility of TM, HRCT temporal bone findings on ossicular status etc.,

Chandrashekhar Tengli plz rule out chr.adenoiditis and take required steps incl Surgery!!!

Suri Prabhu yes - Saket Aggarwal - you must be this childs second or third doctor - and, the first doctor would have put in grommets (in the antero-superior segment) - and the resulting tympanosclerosis would have fixed either the malleus itself, or the mallear ligaments - the child needs to subjected to a siegle examination (which is not very difficult with a nine year old) - and you will find that (probably) the malleus does not move - confirm by direct palpation - and if that is the case, the next action is predicated -

Suri Prabhu and likely - that the hearing loss is not equal - more like 20 db in one, and 40 db in the other (with both thresholds not improving after grommets)

Saket Aggarwal Dear Suri Prabhu, unfortunately, I am the first surgeon, and I have no obvious explanation for the outcome. Hearing loss is equal in both ears

Gowri Shankar then tympanotomy can be tried

Harpreet Singh Kochar Long standing OME tends to cause adhesions in ME leading to entrapment of SSS. Would give you a B curve and as obvious the audiometry would show a CHL less than complete osscicular fixation. in this case a 40 dB loss sort o fits into picture. One other possibility is of nitrous pushing in the glue to posterior mesotympanum if the same was not switched off during surgery. The gelatinous glue tends to persist there. I would do a HRCT to evaluate further

Harpreet Singh Kochar During grommet insertion excess bagging by anesthetists needs to be checked. Tends to displace glue from ME and the whole purpose is defeated.

Ravi Sharma very interesting. How long did the child have a hearring loss for, before surgery. I suspect ossicular fixation / tympanosclerosis or ME adhesions. Suggest doing a Tympanotomy +/- CT scan.

Mohamed Mahaboob Shareef What did the child present with? Is it deafness/ speech problems. If it is persistent deafness , could it be intra op damage to ossicles ?



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Otomycosis - Discussion

DrRajeev Adhana
‎50 % OPD is just otomycosis .....now a days.....

Ajit Man Singh: to add academics to this: role of systemic antifungals? role of additional antifungal/steroid ointmetn to reduce associated otitis externa?, role of the age old GV pain?

Chandrashekhar Tengli: I generally clean of and apply Betnovate-GM locally. If i feel there is need, i prescribe them antifungal+steroid drops..I am good results.

Vinod Felix: there is a good no of cases due to long term usage of antibiotic steroid drops..which pts get OTC& from GPs

Chandrashekhar Tengli: agreed sir@ Dr.Vinod Felix. Also the season,rain followed by bright sunlight creating perfect environment to grow in the ear!!!

Rajendra B Bohra: Monsoon has extended and so we are getting lot of cases of Otomycosis..because of humidity...they are keeping us busy and giving us sense of being busy practitioner...so make the hay while sun is shining( or is it raining..)....it has become bread and butter for now...

DrRajeev Adhana :suction and oint. is best ....drops increase the problem due to moisture .

Sanjay Sood: GV paint is a good option for the non responsive to antifungals and also in recurrent otomycosis but it leaves a stain. Also instruct the patient not to keep the ear plugged

Vikas Agrawal: fungus grows on dead keratin of ear canal,with moisture...i always remove all the keratin layers under microscope with suction,then aft checking integrity of TM, pour surgical spirit,(which burns also apart from making patient giddy)and prescribe candid -o/otek ac type of ear drops to be filled in the ear canal 4 times a day for a week-10 days(they require at least 5-7 bottles)with use of hair dryer.....recurrence rate in rains in mumbai (moist)can be otherwise very high

Vikas Agrawal :never syringe,as many a times epithelium is alrady damaged and forceful syringing can cause perforation.......moisture any way has to be avoided

Live surgeries on FESS for ENT surgeons at APOLLO Hospital,Delhi on 9th October,2011

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3rd International Course on "Sialendoscopy" on December 2-3, 2011 at UCMS-GTB Hospital, New Delhi, India

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Live ABI Surgery in Delhi

Dear Dr Kalra,
I will be grateful if you can kindly inform ENT collegues around the country, that we are doing 4 ABI's on 21st, 22nd & 23rd. of Sept. 2011. Anybody interested to see the surgeries LIVE may kindly contact me.

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Effect of myringoplasty on inner ear function

Effect of myringoplasty on inner ear function
Reviewed by: Ahmed A Saada
May/Jun 2011 (Vol 20 No 2)

This is an interesting prospective study that describes bone threshold changes after myringoplasty, thus reflecting the effect of such a procedure on inner ear function. Eligible subjects included 134 patients who underwent primary underlay type I tympanoplasty (myringoplasty). Bone conduction thresholds were determined before surgery and 6-12 months postoperatively. Details of the surgical procedure and audiological testing are described; and several variables were considered such as possible ossicular chain trauma, cochlear dysfunction, perforation size, presence of tympanic granulation tissue, myringosclerosis or tympanosclerosis, ossicular chain fixation and external canal drilling. A transcanal approach was used in 59% of cases, whereas a postauricular approach was used in the remaining 41%. There were no significant differences in preoperative threshold by all variables except ossicular chain fixation, granulation tissue and tympanosclerosis. Postoperatively, the only significant differences were noted by perforation size, ossicular chain fixation, surgical approach and external canal drilling. Details of such differences in bone conduction threshold for each frequency tested are displayed in tables. Mechanisms of cochlear damage in cases of otitis media are discussed, including the role of endogenous and exogenous substances. However, other factors that may play a role in bone conduction hearing impairment are thoroughly analysed. In conclusion, the authors observed statistically significant evidence that mechanical factors are associated with poorer bone conduction thresholds. Moreover, they stated that anatomically successful myringoplasty can slightly improve bone conduction with minimal risk of impairment.
Inner ear function following underlay myringoplasty.
Redaelli de Zinis LO, Cottelli M, Koka M.

Beware of the tonsillar remnant

Beware of the tonsillar remnant
Reviewed by: James Kennedy
Jul/Aug 2011 (Vol 20 No 3)

Squamous cell carcinoma (SCC) of the tonsil is the most common malignant tumour of the oropharynx. However, squamous cell carcinoma of the tonsillar remnant (SCCTR) in a previously tonsillectomised patient is rare, with only one previously documented case report in the literature. This well presented study is a retrospective review of patients presenting with SCCTR at the head and neck unit at Guy’s, Kings and St Thomas’ NHS Trusts from 2000 to 2007. In the seven-year period, 251 patients presented with SCC, and ten (4%) had a tonsillectomy performed in childhood. In this study, five patients (50%) had no obvious site of primary tumour when initially seen in clinic. In patients with no primary indentified the authors stress the importance of a systematic approach and advocate following the BAO-HNS guidelines for the management of head and neck cancer. The therapeutic strategy for SCCTR will depend on the stage of the disease at diagnosis. In this series all patients deemed curable were given combined treatment with surgery and radiotherapy. The two year disease free survival was found to be 89% and for five year 83%. The study highlights the importance of a high index of suspicion in patients who have previously undergone tonsillectomies and who present with, potentially, occult primary SCC in the head and neck region. A tonsil biopsy should be performed when investigating an unknown primary, despite childhood tonsillectomy and a normal appearance of the tonsillar remnant. The series concludes by suggesting that SCCTR can be considered as a clinical sub-group within SCC of the tonsil. The management strategy of these patients however should be the same as for patients with primary SCC and they appear to have similar oncologic outcomes.
Squamous cell carcinoma of the tonsillar remnant – clinical presentation and oncological outcome.
Skilbeck CJ, Jeannon J, O'Connell M, Morgan PR, Simo R.


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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

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