Tonsillectomy is one of the commonly performed otolaryngological operations. Despite a range of different techniques post-operative pain remains a major side-effect of this operation. Coblation assisted tonsillectomy is a latest technique of tonsillectomy. This technique is said to be associated with less intra-operative bleeding and less postoperative morbidity. We conducted a study in 100 patients to compare the pain scores between coblation assisted and bipolar diathermy tonsillectomy by FLACC score and Wong Baker scale score. The data so collected was statistically analysed using a t test and p values were calculated. The p value was highly significant (p \ 0.001) for both scores in coblation assisted tonsillectomy 6 h postoperatively and on 1st postoperative day (p \ 0.05). On 7th post-operative day however there was no significant difference in post-operative pain score using FLACC score in both groups but Wong baker scale scores were still significant. We concluded that post-operative pain was less with coblator assisted tonsillectomy as compared to bipolar diathermy tonsillectomy at least in early post-operative period.
SummaryThe records of 120 patients who had undergone revision stapedectomy were analyzed to determine: (i) the causes of failure; (ii) how to prevent failure by taking precautions during primary surgery; (iii) hearing results; and (iv) possible identifying factors which might pinpoint those patients with a high risk of sensorineural deafness.A review of these cases demonstrates that the results of revision stapedectomy are different from those of primary stapedectomy. The commonest cause of failure was prosthetic dislocation (30.8 per cent), followed by fibrous adhesions (18.3 per cent) and otosclerotic regrowth (14.1 per cent). First revision operations resulted in post-operative bone-air gaps of 15 dB. or less in 46.5 per cent of cases, much better than 25 per cent for second revisions. Primary stapedectomy resulted in successful closure of the air-bone gap to 15 dB. or less in 89.5 per cent of cases.The sensorineural loss occurred in 11.3 per cent or first revisions and in 16.6 per cent of second revisions, as compared to 1.3 per cent after primary surgery. “Dead ears” were encountered in 2.2 per cent of first revisions, as compared to nil in the primary group.
Microdebrider adenoidectomy and Coblation adenoidectomy are the two new techniques available for adenoidectomy these days. The advantages of endoscopic power assisted adenoidectomy over cold steel adenoidectomy has been well established in the literature. As adenoidectomy is one of the most common paediatric surgical procedure there is always a concern to improve the outcomes and make postoperative experience more pleasant for the paediatric population. Cost difference between a coblator wand and microdebrider blade is always a confounding factor in decision making. The present study was conducted to compare both the techniques of adenoidectomy in terms of certain intraoperative and post operative parameters. The present study was a prospective randomized single blind study conducted in a university hospital on 140 subjects. The patients diagnosed with chronic adenoiditis grade 3-4 were randomly allocated in two groups after following the exclusion and inclusion criteria. the adenoidectomy in two groups; Microdebrider group and Coblation group were compared in terms of intraoperative time, post operative pain score; intraoperative bleeding, surgical field and some common complications. The data was analysed for significance by various statistical tests. The average adenoid size operated in both groups was Grade 3. The intraoperative time taken to complete the procedure in group A was 12.78 ± 3.8 min and in group B was 22 ± 3.3 min with p value\ 0.05. There was statistically significant difference in grade of Intraoperative Bleeding in both groups with mean grade of intraoperative bleeding being 1.4 ± 1.04 in group B and 3.5 ± 0.9 in Group A. The surgical field was poor to average in 33 cases (n = 70) in group A as compared to only 1 case (n = 70) in group B; the difference being statistically significant. The average postoperative pain score was 2.69 ± 0.99 and 1.17 ± 1.1 after post-operatively 24 h and 72 h respectively in group B; 7.14 ± 0.99 and 4.08 ± 1.42 respectively in group A. The p value for the same was \ 0.05. However there was no statistically significant difference between two groups in terms of any complications or completeness of removal. Though both the techniques are highly efficacious in adenoid removal and low complication rate in our study but still more studies with large sample size are encouraged to validate these results and establish the comparative efficacy of both the techniques in terms of the intraoperative parameters as well as post-operative recovery along with recurrence rates.
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