Endoscopic Cartilage Butterfly Tympanoplasty: A Two-Handed Technique with Endoscope Holder.

The aim of the study was to evaluate and report the short-term results of two-handed endoscopic cartilage butterfly tympanoplasty using endoscope holders. The efficacy of the operative technique was evaluated and assessed by comparing the air-bone-gap on pure tone audiometry preoperatively and on follow-up at 6 months and 1-year post operatively. Patients with uncomplicated otitis media and healthy middle ear status with no ossicular involvement underwent endoscopic transcanal cartilage butterfly tympanoplasty. Small and medium sized tympanic membrane perforations were included in the study. Pre- and postoperative air-bone gaps and presence for any residual perforation was noted. A total 69 patients consisting of 45 males and 24 females with a mean age of 24.45 years were included in the study group. Small perforations involving only one quadrant were 39 in number while the medium sized perforations involving two quadrants were 26 in number and the ones involving three quadrants were 4 in number. At the end of the follow-up period of 6 months and 1 year, successful closure occurred in 67 of 69 patients with a success rate of 97.1%. The mean preoperative Air-Bone gap was 34 ± 3.45 dB which showed a steady decline on follow-up at 6 months 13 ± 4.53 and 15.34 ± 3.39 dB at 1 year following surgery. Recurrent perforation was noted in two patients involving three quadrants of the tympanic membrane. Endoscopic two-handed butterfly cartilage tympanoplasty can be safely performed in small and medium sized perforations with no middle ear disease/ossicular involvement. The hearing outcomes and successful closure rate are similar to those of other surgical methods. Our study uses the endoscope which provides superior image quality and the use of an endoscope holder makes the technique a two handed one, thereby making the manoeuvring of the microear instruments easier. Moreover, it can be performed under local anaesthesia with low complication rates and quick recovery. Level of Evidence Level 4.

Simple Economical Solution for Personal Protection Equipment (Face Mask/Shield) for Health Care Staff During COVID 19.

Coronavirus disease 2019 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2. It has taken a toll of lots of lives since its outbreak. Infection prevention at present is an appropriate control measure in addition to other measure like hand hygiene and personal protective equipment (PPE). In our country with a large population, supplying PPE to all the health care workers of all hospitals definitely is an economic burden. Hence we have come up with an economic and simple solution for face mask.

Safety Guidelines for Sterility of Face Shields During COVID 19 Pandemic.

Face shields are personal protective equipment devices that are to be used by many health care workers during COVID 19 pandemic for protection of the facial area and associated mucous membranes (eyes, nose, mouth) from droplet spread of infection. Face shields are generally not used alone, but in conjunction with other protective equipment like cap, mask, goggle, and are therefore classified as adjunctive personal protective equipment. In the wake of scarcity of face shields during the COVID 19 Pandemic, consideration of innovating newer methods of manufacturing must be considered to overcome the present day scarcity without jeopardising the safety of front line Heath care workers. All initial fast innovations comes with advantages and disadvantages, hence we thought of putting down simple guidelines for new emerged face shield use.

Modified Endoscope Holder for Two Handed Endoscopic Ear Surgery.

We have been doing Endoscopic ear surgeries since 2013. Inorder to overcome the disadvantage of the single handed endoscopic ear surgery technique, we have developed the endoscope holders, Justtach® and EndoHold®. Due to its certain limitations, we modified the pre-existing, endoscope holder-Justtach, to add more features as well as to increase the comfort and ease of the technique. The aim of this paper is to describe the design of our modified endoscope holder and to report our preliminary experience of two handed endoscopic ear surgery with it. Descriptive study. A total number of 68 two handed endoscopic tympanoplasties have been operated with the modified endoscope holder from January 2017 to May 2018 with a minimum follow up period of 10 months. Our study reports the successful application of the modified endoscope holder for two handed endoscopic ear surgery, highlighting its advantages. Our modified endoscope holder, is a good option for two handed endoscopic tympanoplasties and mastoidectomies. Level of Evidence Level 4.

The Goat Model for Exclusive Two Handed Endoscopic Middle Ear Surgery Training: A Novel Technique.

With the popularity of exclusive transcanal endoscopic ear surgery, the need for a suitable and affordable surgical training model has grown. To develop an ex vivo animal model for exclusive endoscopic ear surgery. In an experimental study, we studied goat middle ear anatomy in 8 specimens to assess the similarity with the human middle ear as a model for two handed endoscopic ear surgery with endoscope holders. After confirming its suitability, we have developed a surgical training program for grommet insertion, canaloplasty, myringoplasty, butterfly tympanoplasty, ossiculoplasty, atticotomy. The goat model is suitable for two handed endoscopic ear surgery using endoscope holder. We describe a novel, exclusively two handed endoscopic approach in an ex vivo animal model for middle ear surgery. The proposed surgical program will guide the trainee endoscopic ear surgeon for a step by step through the main otologic procedures to enhance his or her surgical skills.

Neonatal Screening for Prevalence of Hearing Impairment in Rural Areas.

Hearing is one of the most important sense organs for man. Hearing loss is often associated with delayed speech and language development in young children. Early identification and intervention improves the chance a child gets to lesser delays in development and improving the overall quality of life. To find out the prevalence of hearing loss in neonates in the rural taluka of Maval, Pune, Maharashtra, India. Prospective Non Randomized Clinical Study. The study was carried out between April 2012 and April 2015. A total of 8192 babies were screened across various centers around the Maval area. The babies who had some high risk factors were 1683 in number and babies who had no high risk factors i.e. well babies were 6509. In our study, the overall prevalence of hearing loss in neonates in Maval taluka of Maharashtra was found to be 3.54 per 1000 live births, in normal born neonates (well babies) was 1.689 per 1000 births, in high risk babies was 10.69 per 1000 high risk births. The prevalence of low birth weight neonates, hyperbilirubinemia neonates and neonates with craniofacial abnormalities developing hearing impairment was found to be 5.9, 3.56 and 1.18 per 1000 high risk births respectively. India is the second most populated country in the world with nearly a fifth of the world's population. There is a need for the universal neonatal screening for deafness for earlier detection of deafness and rehabilitation. Level of Evidence: Level IV.

Endoscopic Septoplasty-Two Handed Technique with Endoscope Holder: A Novel Approach.

The popularity of endoscopes has been expanding not only in diagnostics but also in therapeutics. The traditional septal surgery also has come under the purview of endoscopic surgery in the last few decades. Endoscopic septoplasty has definitely many advantages over the conventional procedure. But the only disadvantage of endoscopic surgery is that it is a single handed technique as the other hand is used for holding the endoscope which may compromise the overall surgical time as the hemostasis and suctioning of the surgical field off the blood cannot be done simultaneously, in addition to the surgeon fatigue associated with holding the endoscope in the left hand. Endoscope holder allows both hands of the surgeon to be free for surgical manipulation and also imitates more or less same actions of the left hand. To report the preliminary use of Khan's endoscope holder for endoscopic septoplasty. Prospective Non Randomized Clinical Study. Khan's Endoscope Holder, which was primarily designed for endoscopic ear surgery, has been used for two handed technique of endoscopic septoplasty. The design of the Endoscope holder is described in detail. A total of 49 endoholder assisted endoscopic septoplasties were operated from Nov 2014 to Jan 2015 in MIMER Medical College and Sushrut ENT Hospital, Talegaon D, Pune, India. Our Endoscope Holder is a good option for two handed technique in Endoscopic Septoplasty due to its advantages. The study reports the successful usage and applicability of the endo holder for endoscopic Septoplasty. Level of evidence IV.

Novel Concept of Attaching Endoscope Holder to Microscope for Two Handed Endoscopic Tympanoplasty.

UNLABELLED: The well established techniques in tympanoplasty are routinely performed with operating microscopes for many decades now. Endoscopic ear surgeries provide minimally invasive approach to the middle ear and evolving new science in the field of otology. The disadvantage of endoscopic ear surgeries is that it is one-handed surgical technique as the non-dominant left hand of the surgeon is utilized for holding and manipulating the endoscope. This necessitated the need for development of the endoscope holder which would allow both hands of surgeon to be free for surgical manipulation and also allow alternate use of microscope during tympanoplasty. To report the preliminary utility of our designed and developed endoscope holder attachment gripping to microscope for two handed technique of endoscopic tympanoplasty. Prospective Non Randomized Clinical Study. Our endoscope holder attachment for microscope was designed and developed to aid in endoscopic ear surgery and to overcome the disadvantage of single handed endoscopic surgery. It was tested for endoscopic Tympanoplasty. The design of the endoscope holder attachment is described in detail along with its manipulation and manoeuvreing. A total of 78 endoholder assisted type 1 endoscopic cartilage tympanoplasties were operated to evaluate its feasibility for the two handed technique and to evaluate the results of endoscopic type 1 cartilage tympanoplasty. In early follow up period ranging from 6 to 20 months, the graft uptake was seen in 76 ears with one residual perforation and 1 recurrent perforations giving a success rate of 97.435 %. Our endocsope holder attachment for gripping microscope is a good option for two handed technique in endoscopic type 1 cartilage tympanoplasty. The study reports the successful application and use of our endoscope holder attachment for gripping microscope in two handed technique of endoscopic type 1 cartilage tympanoplasty and comparable results with microscopic techniques. LEVEL OF EVIDENCE: IV.

Endoscopic cartilage tympanoplasty: A two-handed technique using an endoscope holder.

OBJECTIVES/HYPOTHESIS: Endoscopic ear surgery provides a minimally invasive approach to the middle ear. The disadvantage of endoscopic ear surgery is that it is a single-handed surgical technique. The nondominant hand of the surgeon is utilized for holding and manipulating the endoscope. This necessitated the need for the development of an endoscope holder that would allow both hands to be free for surgical manipulation. The aim of this article is to report our preliminary experience using our newly designed and developed endoscope holder, which allowed us to perform cartilage tympanoplasty utilizing both hands for surgery. STUDY DESIGN: Retrospective nonrandomized clinical study. METHODS: The endoscope holder was designed and developed to aid in endoscopic ear surgery and to overcome the disadvantage of single-handed endoscopic surgery. The design of the endoscope holder is described in detail, along with instructions on how it can be used. A total of 179 endoscope holder-assisted cartilage tympanoplasties were performed to evaluate the feasibility of a two-handed technique and to evaluate the results of surgery. RESULTS: In an early follow-up period ranging from 6 to 20 months, the graft take was seen in 174 ears, with one residual perforation and four recurrent perforations, giving a success rate of 97%. The endoscope holder eliminates the disadvantages of single-handed surgery and is a good option for those who wish to perform endoscopic ear surgery using both hands. CONCLUSION: The study reports the successful application and use of the endoscope holder in a two-handed technique of endoscopic tympanoplasty. LEVEL OF EVIDENCE: 4. Laryngoscope, 126:1893-1898, 2016.

Concept, Design and Development of Innovative Endoscope Holder System for Endoscopic Otolaryngological Surgeries.

Endoscopic surgeries have gained popularity not only in ENT but also in other surgical faculties. Endoscopic approach for sinus surgeries and otologic surgeries is well known. However, the major disadvantage of endoscopic aided surgeries as against microscope aided surgeries is thought to be the effective reduction in the working hands as the non-dominant hand of the surgeon is utilized for holding the endoscope. This urged the need for development of the endoscopic holder so as to allow both the hands of the surgeon for surgical manipulation.

Day care ear surgery: our experience of 4 years.

Day care surgery is gaining wide popularity not only in the West, but also in our country. We present our experience of 4 years of day care surgery in otological practice. To identify the scope of day care ear surgery in our rural setup and to determine the rate of complications, if any, of day care ear surgery. A prospective study of major ear cases operated in M.I.M.E.R. Medical College and Sushrut ENT Hospital was carried out from January 2005 to December 2008 with a minimum follow up of 2 years. In the period from 2005 to 2008, a total of 527 major ear cases were operated. There was re-admission of 5 operated patients (0.94%). The acceptance of day care ear surgery is enormous in our rural setup due to its obvious advantages.

Primary cartilage tympanoplasty: our technique and results.

UNLABELLED: Cartilage has shown to be a promising graft material to close tympanic membrane perforations. However, due to its rigid quality, doubts are raised regarding its sound conduction properties. It has been suggested that acoustic benefit may be obtained by thinning the cartilage. We describe our innovative method for harvesting tragal cartilage from the same endaural incision and also describe preparation of the graft by slicing it. We present our 3-year experience of shield cartilage type 1 tympanoplasty using sliced tragal cartilage-perichondrium composite graft. AIM: The aim of this study was to prove the success rate of our technique of shield cartilage tympanoplasty using sliced tragal cartilage graft in terms of functional and anatomic results. STUDY DESIGN: Retrospective analysis of type 1 cartilage tympanoplasties using sliced tragal cartilage was carried out in MIMER Medical College and Sushrut ENT Hospital during May 2005 to January 2008 with a minimum follow-up of 2 years. METHOD AND MATERIALS: A total of 223 ears were operated by our technique. RESULTS: The overall success rate of our technique was 98.20% in terms of perforation closure and air bone gap closure within 7.06 ± 3.39 dB. The success rates in the various age group are as follows: 11 to 20 years, 97.67%; 21 to 40 years, 99.12%; and 41 to 60 years, 96.96%. CONCLUSION: Our technique of type 1 cartilage tympanoplasty achieves good anatomic and functional results.

Simultaneous involvement of larynx and middle ear in pulmonary tuberculosis.

We present a rare case of simultaneous involvement of larynx and ear in a patient with pulmonary tuberculosis. The aim of this article is to create an awareness of Ear Nose Throat tuberculosis, and to consider tuberculosis in the differential diagnosis of ear and laryngeal diseases.