We report two extremely unusual and remarkably similar patients having complete absence of all posterior elements of the axis vertebra and mobile, partially reducible dislocation of the axis over the third cervical vertebra. Anterior decompression followed by a fixation procedure appears to be a satisfactory form of treatment for this complex clinical problem.
Objective: To compared the outcome of Type 1 tympanoplasty with cartilage-perichondrium graft in comparison with temporalis fascia graft in terms of post-operative graft take-up and hearing results. Materials and Methods: A prospective observational study among 80 patients between 15 and 60 years of age satisfying the inclusion criteria with complaints of ear discharge and hearing loss due to COM - mucosal type was conducted. Patients were grouped in two groups of 40 patients each. Group A patients underwent Type 1 tympanoplasty with temporalis fascia and Group B with cartilage-perichondrium graft. Patients were followed up for graft uptake, hearing improvement and rate of failure are compared for both the grafts. Graft uptake was assessed at the end of the 1st month, 3rd month, and 6th month, and hearing was assessed at the end of the 6th month with pure tone audiometry. Results: Patients with temporalis fascia graft showed a take-up rate of 80% and cartilage-perichondrium graft of 92.5% by 6 months. Among the fascia group, graft failure was seen in 20% (8). One patient had failed take-up of graft and four patients showed reperforation. In cartilage group, three patients showed failure of take-up of graft during the 1st month. No patient had reperforation or retraction. Air-bone gap in fascia group showed a closure to 10 dB in 17.5% (7). In the cartilage group, 10 dB in 25% (10 patients). In our short-term follow-up of 6 months, we found that cartilage-perichondrial graft reduces the chance of reperforation and retraction even with variation in middle ear pressure due to eustachian tube catarrh. It gives good take-up rate and comparable hearing result as that of the fascia graft. It does not affect the sound conduction when thinned out to appropriate thickness. It is available from the same surgical field and in sufficient quantity for the closure of the TM defect. Cartilage-perichondrium graft for Type 1 tympanoplasty could be a successful replacement for temporalis fascia giving good result with neotympanum.
Background: In spite of the advent of antibiotics, the incidence of mastoiditis and mastoid abscess is not uncommon in the ENT practice. The pathogenesis is due to virulence of organism, insufcient antibiotics use, and ineffective antibiotics. Treatment consists of simple incision drainage to modied radical mastoidectomy. However, there seems to be no unanimous agreement on the best management strategy for this problem. The present study presents the outcome of patients undergoing treatment and also presents a protocol followed in VIMS, Pawapuri, Nalanda, Bihar and its prognostic value. Aim of the Study: The aim of this study is to review the available management protocols for treatment of mastoiditis and mastoid abscess and formulate our own hospital-based guidelines and protocol. Materials and Methods:Astudy was conducted on 53 patients aged between 11 and 60 years, who presented with mastoiditis or mastoid abscess. All the patients were treated according to surgical protocols available. Demographic data, history, and otoscopy ndings were recorded. Patients with mastoiditis were treated with mastoidectomy, and the patients with mastoid abscess were treated initially with incision and drainage and after 2 weeks with mastoidectomy. Laboratory investigations such as audiometry, culture, and sensitivity of pus from the ears were done. All the patients were followed for 6 months. Observations and Results:Atotal of 53 patients were enrolled in this study. Mean age was 25.45 ± 2.35 in males and 23.76 ± 1.85 in females who presented with mastoiditis. Similarly, the mean age was 23.76 ± 1.85 and 20.46 ± 2.10 years for patients of mastoid abscess. There were 39/53 (73.58%) males and 14/53 (26.41%) females. Audiometry could be done in 32/37 (86.48%) patients with mastoiditis and 8/16 (50%) patients with mastoid abscess. These 40/56 (71.42%) patients had conductive deafness with a mean pure tone average of 32.45 dB. There were no post-operative complications reported during follow-up of 6 months. Conclusions:Adenitive management protocol is a must for every hospital to avoid delay and complications before and after surgical treatment in mastoiditis and mastoid abscess. Treatment guidelines should be followed meticulously in the diagnosis, laboratory investigations, and decisionmaking of denitive surgical procedure to be adopted in mastoiditis and mastoid abscess.
Deviated nasal septum is a common condition, which is quite often asymtomatic, but may present with persistent morbidity in some. In this prospective cross sectional study, 100 patients with deviated nasal septum were included who were symptomatic. 48 patients needed surgical intervention while 52 were managed conservatively. Results were compared on follow up. 96% cases reported improvement in nasal obstruction post surgery, compared to 79% following conservative management.
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