Comparison of visual analogue scale (VAS) and the Nasal Obstruction Symptom Evaluation (NOSE) score in evaluation of post septoplasty patients.

OBJECTIVE: To compare and correlate the efficacy of the NOSE score & the VAS score in determining the symptomatic benefit in patients undergoing septoplasty. MATERIALS AND METHODS: Eighty patients with deviated nasal septum undergoing septoplasty were included in the study. NOSE score & VAS score (out of 100) was documented before and after surgery. Results were correlated and compared statistically. RESULTS: In the NOSE score, the most bothersome symptom was trouble breathing through the nose (85.83); followed by Nasal obstruction or blockage (82.50). Wilcoxon test showed significant improvement with NOSE score and VAS score in all patients at 1 month and 3 months. Spearman's coefficient showed a positive correlation between the two, though the score improvement and patient satisfaction rate was significantly high with NOSE score. CONCLUSIONS: NOSE score and the VAS score both provide effective framework for evaluating treatment responses after septoplasty. However, the NOSE score showed higher improvement and better patient satisfaction rate when used to measure of nasal obstruction as compared to the VAS score.

Medical Graduate's Basic Knowledge and Clinical Skills Assessment in Otorhinolaryngology Post Internship.

Exposure to otorhinolaryngology in India has been shadowed by an inadequate curriculum. Our study brings forth the lacunae in medical education setup related to ENT. We introspect why the subject is not a first choice for specialization. 100 medical graduates were assessed at the end of internship postings for: (1) subject knowledge, (2) basic and emergency procedures, (3) diagnosis and investigation of common and emergency conditions. 84% take ENT as a minor subject. Least awareness is seen regarding its relation with skull base, head and neck and plastic surgery. Very few knew about advanced surgeries and instruments in the field. Majority rejected ENT as a primary choice and its upgradation as major subject. Routine and emergency procedures based on ENT were not a matter of ease by majority of subjects. Post internship doctors lagged in doing basic clinical and diagnostic steps. Diagnosis of various pathologies was not a skill of majority of subjects under study. A lack of basic knowledge of important emergency conditions in ENT was noticed. Our study points at inadequate training in ENT and under estimation of its scope. The outcome raises a need to revise the curriculum and methodology to come at par with world standards, reflecting its true expanse and tremendous scope.

Clinical Efficacy of Tinnitus Retraining Therapy Based on Tinnitus Questionnaire Score and Visual Analogue Scale Score in Patients with Subjective Tinnitus.

OBJECTIVE: Tinnitus is the annoying sensation of sound perception without acoustic stimulus. Tinnitus retraining therapy (TRT) is the habituation therapy used for the management of chronic subjective tinnitus. The objective of the study is to describe TRT and to evaluate its efficacy in patients with subjective tinnitus. METHODS: In total, 58 patients with tinnitus who did not respond to medications were enrolled in the TRT program. TRT included counseling as described in the neurophysiological model of tinnitus and sound therapy (aided or unaided) for six months. The tinnitus severity grade (TSG) 1-5, based on a validated tinnitus questionnaire score (TQS), and the visual analogue scale (VAS) score were documented before and after therapy. RESULTS: Before TRT, 53 patients (91.3%) exhibited TSG 3-5, and the average VAS score was 6.7±2.1. After TRT for two months, 49 patients (84.4%) showed TSG 1-3, and the average VAS score was 3.2±2.4. After six months of TRT, most of the patients found remarkable improvement in the symptoms, and 51 patients (87.9%) exhibited TSG 1-2, and the average VAS score was 2.1±2.6. Statistically significant difference was found in TSG and VAS score before and after TRT. Statistically significant correlation was observed between TSG and VAS score. CONCLUSION: TRT is an useful approach for amelioration of tinnitus. TQS is a very effective, cheap, and easy method to help otologists to grade the patients as per the severity of symptoms.

Evaluation and significance of Eustachian tube angles and pretympanic diameter in HRCT temporal bone of patients with chronic otitis media.

OBJECTIVE: To evaluate the significance of Eustachian tube (ET) angles and ET pretympanic diameter on high resolution computed tomography (HRCT) Temporal bone in patients with chronic otitis media (COM). METHODS: A retrospective study was carried out at Tertiary care centre. Group A included 92 ears with COM (38 patients with bilateral COM and 16 with unilateral COM); and Group B included 108 normal ears (54 patients with bilateral normal ears). Reid plane-ET angle, Tubotympanic angle and the ET pretympanic diameter was evaluated by HRCT temporal bone, and compared in the two groups. Patients with chronic otitis media (Group A) were subdivided into Group A1 (Blocked ET) and Group A2 (Patent ET). The parameters were evaluated and compared in the subgroups too. RESULTS: The mean Reid plane-ET angle and Tubotympanic angle in Group A was 25.41 ± 2.57 and 148.12 ± 3.43 respectively; whereas in Group B it was 27.56 ± 3.62 and 145.14 ± 4.34 respectively. Reid plane-ET angle was significantly less in patients with COM and Tubotympanic angle was significantly more obtuse in COM patients. ET pretympanic diameter was (5.37 ± 2.10) mm in Group A and (6.47 ± 2.40) mm in Group B. It was significantly less in patients with COM. A significant correlation was found between the ET patency and the two ET parameters (Reid plane-ET angle and pretympanic diameter). CONCLUSIONS: Eustachian tube angles in adults may play a significant role in the etiology of chronic otitis media. Decrease in Reid plane-ET angle and pretympanic diameter on HRCT temporal bone can be used to predict ET dysfunction and to plan the surgical management of chronic otitis media.

Comparison between clinical and audiological results of tympanoplasty with modified sandwich technique and underlay technique / Comparação entre os resultados clínicos e audiológicos de timpanoplastia com a técnica "sanduíche" modificada e a técnica underlay

Abstract Introduction: Surgical repair of the tympanic membrane, termed a type one tympanoplasty is a tried and tested treatment modality. Overlay or underlay technique of tympanoplasty is common. Sandwich tympanoplasty is the combined overlay and underlay grafting of tympanic membrane. Objective: To describe and evaluate the modified sandwich graft (mediolateral graft) tympanoplasty using temporalis fascia and areolar fascia. To compare the clinical and audiological outcome of modified sandwich tympanoplasty with underlay tympanoplasty. Methods: A total of 88 patients of chronic otitis media were studied. 48 patients (Group A) underwent type one tympanoplasty with modified sandwich graft. Temporalis fascia was underlaid and the areolar fascia was overlaid. 48 patients (Group B) underwent type one tympanoplasty with underlay technique. We assessed the healing and hearing results. Results: Successful graft take up was accomplished in 47 patients (97.9%) in Group A and in 40 patients (83.3%) Group B. The average Air-Bone gap closure achieved in Group A was 24.4 ± 1.7 dB while in Group B; it was 22.5 ± 3.5 dB. Statistically significant difference was found in graft healing rate. Difference in hearing improvement was not statistically significant. Conclusion: Double layered graft with drum-malleus as a 'meat' of sandwich maintains a perfect balance between sufficient stability and adequate acoustic sensitivity.

Resumo Introdução: O reparo cirúrgico da membrana timpânica, denominado timpanoplastia tipo 1, é uma modalidade de tratamento já bem estabelecida. As técnicas overlay ou underlay de timpanoplastia são comuns. A timpanoplastia "sanduíche" é a técnica de enxerto de membrana timpânica overlay e underlay combinadas. Objetivo: Descrever e avaliar a timpanoplastia com a técnica "sanduíche" modificada (timpanoplastia mediolateral) utilizando fáscia temporal e fáscia aureolar. Comparar o desfecho clínico e audiológico da timpanoplastia com a técnica "sanduíche" modificada com o da timpanoplastia com a técnica underlay. Método: Foram estudados 88 pacientes com otite média crônica, 48 (Grupo A) foram submetidos à timpanoplastia tipo 1 com enxerto "sanduíche" modificado. A fáscia temporal foi utilizada na técnica underlay e a fáscia areolar na técnica overlay. 48 pacientes (Grupo B) foram submetidos à timpanoplastia tipo 1 com a técnica underlay. Foram avaliados os resultados da cicatrização e da audição. Resultados: O sucesso do enxerto ocorreu em 47 pacientes (97,9%) no Grupo A e em 40 (83,3%) do Grupo B. O fechamento médio do gap aéreo-ósseo no Grupo A foi de 24,4 ± 1,7 dB, enquanto no Grupo B foi de 22,5 ± 3,5 dB. Houve diferença estatisticamente significativa na taxa de cicatrização do enxerto. A diferença na melhora auditiva não foi estatisticamente significante. Conclusão: O enxerto de camada dupla e o tímpano-martelo posicionados como o "recheio" do sanduíche mantém um equilíbrio perfeito entre a estabilidade necessária e adequada sensibilidade acústica.

Comparison between clinical and audiological results of tympanoplasty with double layer graft (modified sandwich fascia) technique and single layer graft (underlay fascia and underlay cartilage) technique.

INTRODUCTION: Surgical repair of the tympanic membrane, termed a type one tympanoplasty is a tried and tested treatment modality. Overlay or underlay technique of tympanoplasty is common. Sandwich Tympanoplasty is the combined overlay and underlay grafting of tympanic membrane. OBJECTIVE: To describe and evaluate the modified sandwich graft (mediolateral double layer graft) tympanoplasty using temporalis fascia and areolar fascia. To compare the clinical and audiological outcome of modified sandwich tympanoplasty with underlay tympanoplasty. METHODS: A total of 88 patients of chronic otitis media were studied. 48 patients (Group A) underwent type one tympanoplasty with modified sandwich graft. Temporalis fascia was underlaid and the areolar fascia was overlaid. 48 patients (Group B) underwent type one tympanoplasty with underlay fascia technique. 48 patients (Group C) underwent type one tympanoplasty with underlay cartilage technique. We assessed the healing and hearing results. RESULTS: Successful graft take up was accomplished in 47 patients (97.9%) in Group A, in 40 patients (83.3%) Group B, and in 46 (95.8%) patients in Group C. The average Air-Bone gap closure achieved in Group A was 24.4±1.7dB, in Group B, it was 22.5±3.5dB and in group C, it was 19.8±2.6dB. Statistically significant difference was found in graft healing rate. Difference in hearing improvement was not statistically significant. CONCLUSION: Double layered graft with drum-malleus as a 'meat' of sandwich maintains a perfect balance between sufficient stability and adequate acoustic sensitivity.

Comparison between clinical and audiological results of tympanoplasty with modified sandwich technique and underlay technique.

INTRODUCTION: Surgical repair of the tympanic membrane, termed a type one tympanoplasty is a tried and tested treatment modality. Overlay or underlay technique of tympanoplasty is common. Sandwich tympanoplasty is the combined overlay and underlay grafting of tympanic membrane. OBJECTIVE: To describe and evaluate the modified sandwich graft (mediolateral graft) tympanoplasty using temporalis fascia and areolar fascia. To compare the clinical and audiological outcome of modified sandwich tympanoplasty with underlay tympanoplasty. METHODS: A total of 88 patients of chronic otitis media were studied. 48 patients (Group A) underwent type one tympanoplasty with modified sandwich graft. Temporalis fascia was underlaid and the areolar fascia was overlaid. 48 patients (Group B) underwent type one tympanoplasty with underlay technique. We assessed the healing and hearing results. RESULTS: Successful graft take up was accomplished in 47 patients (97.9%) in Group A and in 40 patients (83.3%) Group B. The average Air-Bone gap closure achieved in Group A was 24.4±1.7dB while in Group B; it was 22.5±3.5dB. Statistically significant difference was found in graft healing rate. Difference in hearing improvement was not statistically significant. CONCLUSION: Double layered graft with drum-malleus as a 'meat' of sandwich maintains a perfect balance between sufficient stability and adequate acoustic sensitivity.

Comparison between perioperative treatment with calcium and with calcium and vitamin d in prevention of post thyroidectomy hypocalcemia.

Even though thyroid surgery is quite safe, mechanical damage, devascularization or inadvertent removal of the parathyroid glands are possible. Though postoperative mortality is extremely low, post thyroidectomy hypocalcemia is one of the most common and potentially life-threatening complication following thyroid surgery. The clinical manifestation varies from minimal twitching to life threatening tetany and can prolong the hospital stay. The purpose of this study is to evaluate the clinical usefulness of routine oral calcium with Vitamin D supplements in reducing the incidence and severity of hypocalcemia after total thyroidectomy. This safe and cost effective therapy may prevent the threatening complications like tetany and reduce the hospital stay.