Aims To evaluate the efficacy, safety,

Introduction Aspergillosis of Larynx is very rare and may present with symptoms suspicious of malignancy. Prevention of dissemination warrants early diagnosis. It is found mainly in Immunocompromised patients and is usually necrotizing, invasive with disseminated systemic infection, associated with poor prognosis. In Immunocompetent patients it is extremely rare and may present as colonization associated with excellent prognosis. Case Report A 43 year old male patient presented with hoarseness of voice for about 3 months with whitish irregular lesion that involved the anterior 1/3 of both the vocal cords. A cheesy material was found covering indurated lesion of both the vocal cords, intraoperatively. Stripping of mucosa over vocal cords was done and cheesy material collected and sent for HPE which revealed Aspergillus hyphae overlying Mild dysplastic changes. Following diagnosis the patient was followed up with oral dosages of Itraconazole. Discussion The primary Aspergillosis of larynx is extremely rare. Involvement is always secondary to immunocompromised states like AIDS, malignancy, Diabetes, etc. This was a rare case in Immunocompetent patient. Management constitute removal of the vocal cord lesions during biopsy. Amphotericin B is first-line agent for this infection, however aerosolised and liposomal amphotericin B offer effective dosing with less toxicity. Newer antifungal Itraconazole may produce more reliable results.

Introduction Although external DCR was considered to be the Gold Standard treatment for NLD obstruction, endoscopic DCR appears to give comparable results,  with the advantage of the absence of external facial scar and no disruption of the medial palpebral ligament or the angular facial vessels. This study aims to evaluate the outcome of endoscopic dacryocystorhinostomy (DCR) and compare with the outcome of external DCR, based on data available on literature search. Materials and Methods In this prospective, longitudinal, interventional study, 67 cases of chronic dacryocystitis were operated endoscopically from January 2017 to December 2018. All patients were documented about detailed medical and operative history, thorough medical check up including ocular and ENT examination. Level of obstruction of nasolacrimal duct (NLD) was diagnosed by lacrimal syringing and probing. Surgery was performed under local anaesthesia except in uncooperative patients where general anaesthesia was used. 0˚ & 30˚ endoscopes were used in surgery. The surgical outcomes and complications were recorded, analyzed and compared to those of external DCR from available literature.   Results The overall success rate of endoscopic DCR was 94.7%, which is closely comparable to external DCR. Conclusion Endoscopic DCR is an effective and safe alternative to external DCR, with comparable results and better patient satisfaction.

BACKGROUND Postoperative hypocalcaemia is a common complication after total thyroidectomy but most often it is transient. Although these are mostly amenable to calcium and vitamin D supplementation, symptomatic patients sometimes need prolonged hospitalization following thyroid surgery, leading to increased healthcare costs. In the present study, we tried to find out factors which can predict the occurrence of post-operative hypocalcaemia & hypoparathyroidism in total thyroidectomy patients, facilitating their early detection and institution of definitive management in time, preventing emergency admissions & catastrophes. METHODS A prospective observational study was carried out in the Department of ENT & Head-Neck Surgery of a tertiary care govt. hospital in eastern India. Patients who underwent total thyroidectomy for multinodular goitre (MNG) and adenomatoid goitre (AG) or total/completion thyroidectomy for well differentiated thyroid carcinomas (WDTC), in the age group of 20-55 years were included in our study. We recorded the following parameters: Age, gender distribution of cases, type of operation, pre-operative Fine Needle Aspiration Cytology (FNAC) status, size of thyroid nodule operated (based on pre-operative ultrasonographic study), number of parathyroid glands preserved during operation, pre-operative vitamin D levels, post-operative serum calcium levels at 6 hours & 12 hours (positive i.e. increasing slope & non-positive i.e. decreasing/non-changing slope), early post-operative serum iPTH levels (at 6 hours), development of symptomatic hypocalcaemia-transient or permanent. RESULTS In the present study we measured serum calcium level 6 hours & 12 hours post-operatively. It has been found that patients with serum calcium levels on positive slope have lesser chances of occurrence of symptomatic hypocalcaemia & permanent hypocalcaemia than those on non-positive slope. We found that patients having serum iPTH level between 15-65 pg/ml showed lesser propensity to develop hypocalcaemia in comparison with those with serum iPTH level <15 pg/ml. In our study, it has been found that all the 3 cases who developed permanent hypocalcaemia were suffering from vitamin D deficiency; whereas, patients with normal vitamin D levels posed lesser risk of developing significant hypocalcaemia. In our observation, patients with only two parathyroid glands identified per-operatively have more chances of developing hypocalcaemia & those in whom all four parathyroid glands were preserved, very low risk of hypocalcaemia is associated. Furthermore, preservation of functional parathyroid gland with intact blood supply is found to be of immense importance than mere identification of the glands. In our series, it has been noted that with increase in the size of thyroid nodule, chances of hypocalcaemia increases. Patients undergoing complete thyroidectomy for histopathological report of WDTC in a previously benign (based on pre-operative FNAC) thyroid nodule, increased chances of development of post-operative hypocalcaemia. CONCLUSI...

BACKGROUND This article describes a procedure to salvage graft failures in cases of Tympanoplasty done using Temporalis Fascia by early intervention, Post operatively. METHODS It was an Observational study using 30 patients with residual perforations on 3 rd-6 th post-operative week out of 131 patients who underwent Type 1 Tympanoplasty with Cortical Mastoidectomy using Temporalis fascia as graft material. Study was conducted over a period of 18 months. Patients having residual perforation underwent the procedure after proper informed consent. 4 Quadrant blocks were given in External Auditory canal. The Epithelialized margin was freshened using a Micropick and medialised graft was repositioned after placing of a piece of Gelfoam in middle ear. The perforation was reinforced with a Gelfoam laterally in External Auditory Canal. Patient was then followed up with a course of Antibiotic and antihistaminic. RESULTS Out of 131 patients of cortical mastoidectomy with tympanoplasty 30 had residual perforation on follow up i.e., 77% success rate while 23% failure rate in our hand. These 23% patients, who were found to be failing, underwent this intervention. 24 out of these 30 patients (80%) i.e., 18% of overall cases showed healed drum after intervention on further follow up. Thus, a good number of failing Tympanoplasty could be salvaged and overall success achieved is almost 95% as compared to 77% previously.

Introduction Autologous reshaped Incus and Teflon partial ossicular replacement prosthesis (PORP) are commonly used for ossicular chain reconstruction. The present study attempts to assess the post-operative outcome with these two prostheses. Materials and Methods  A Randomized prospective study was conducted in Tertiary referral care hospital to determine which material, among autologous reshaped Incus and Teflon partial ossicular replacement prosthesis (PORP) gives better postoperative hearing result in Ossiculoplasty. Patients presenting at outpatients’ department with the clinical diagnosis of chronic otitis media with perforation or retraction. The study population consisted of a total of 50 patients. Ossiculoplasty with reshaped Incus or PORP was performed after Canal Wall Up mastoidectomy. Hearing results were measured by Air-Bone gap in PTA after 6 months of surgery. Results  Selecting the criteria <20 dB ABG as success when Stapes superstructure is present, Incus has 64.29% success rate, whereas PORP has 31.81% success. Extrusion rate of different prosthesis shows PORP has 18.18% extrusion whereas autologous Incus has lower (7.14%) extrusion rate. Conclusion  Among these two ossiculoplasty materials, autologous Incus gives better postoperative hearing gain and lower extrusion rate.

Introduction Deviated nasal septum (DNS) can be asymptomatic in an individual or may cause nasal obstruction. The condition is generally diagnosed clinically and based on clinical diagnosis it is managed Surgically by large without much heed to diagnostic procedure. Thus, often underlying other causes of Obstruction is missed. Thus, it becomes essential to evaluate every patient presenting with history of Nasal obstruction and clinically Deviated septum, with aid of Nasal Endoscopy and CT scan Nose Paranasal Sinuses (PNS) to rule out/diagnose other coexisting conditions. Methods and Methodology 100 patients who presented with nasal obstruction and clinically diagnosed to have Deviated Nasal Septum were then subjected to Nasal Endoscopy and CT scan Nose and PNS and findings were noted for analysis. Results and Analysis Of these 100 patients, 48 patients were found to have coexisting pathological conditions/anatomical variants. Various anatomical and pathological Conditions were found to coexist together. Inferior turbinate hypertrophy in 34% is the most common pathological condition found to be associated with DNS followed by of sinusitis in 25% patients apart from polyp, concha bullosa and paradoxical middle turbinate. Discussion Studies done so far shows there is a definite link of deviated nasal septum to various anatomical and pathological conditions of the nose.  CT Scan Nose PNS and Nasal Endoscopy plays a vital role in diagnosing such anomalies. Conclusion Most of the patients, presenting with nasal obstruction and having Deviated Nasal Septum, undergo management without proper analysis and returns with recurrence of symptoms which could be analyzed properly if Nasal endoscopy and CT scan is employed during diagnosis of the condition, reducing risk of treatment failure.