Effectiveness of Volumetric Reduction of Middle Concha Bullosa by Crushing Technique in Chronic Nasal Obstruction.

To study the effectiveness of volumetric reduction of middle concha bullosa by crushing technique in chronic nasal obstruction cases on selection basis of 3Dimensional computed tomography measurements. Patients with complains of nasal obstruction underwent an Observational study. They were subjected to nasal endoscopy and computed tomography of paranasal sinuses with 3D size estimation of middle turbinate to confirm concha bullosa. 37 patients with unilateral/bilateral lesions were divided into 4 groups on the basis of ranged sizes. These were subjected to volume reduction by crushing technique with marsulizer under local/general anesthesia with necessary post-operative medications and the final outcomes were judged on basis for nasal endoscopy and computed tomography of paranasal sinus at 1 year. Out of 37 patients with total 42 concha bullosa, 5 had bilateral lesion. After crushing techniques, following results were obtained. In group A with pre-operative volume of concha between 0.60 and 0.80 ccm, 11 succeeded to achieve post-operative value of < 0.60 ccm. In group B, C, D with preoperative concha volume > 0.80 ccm all succeeded in achieving the post-operative value of < 0.60 ccm. 50% reduction in volume of concha occurred in 88% cases of group A and 100% in cases of other groups post-operatively at 1 year. Encouraging results with negligible consequences are ensued upon in case of chronic nasal obstruction due to concha bullosa by doing its volumetric reduction by crushing technique with marsulizer instrument.

Complex benign horizontal canal positional vertigo: new perceptual management

Abstract Objective: Horizontal semicircular canal site pathology of benign paroxysmal positional vertigo demonstrating three types of nystagmi on positional test were studied. We have attempted to design a protocol for its diagnosis and treatment. Methods: 320 patients of HSC-BPPV were subjected to two types of positional tests. Of these, patients with bilateral steady apogeotropic nysatgmus were treated with VAV modification of Semont's maneuver. Patients with unsteady or changing apo/geotropic signs were converted into steady geotropic ones by repetitive positional tests; followed by barbecue maneuver with forced prolong positioning. Results: Overall 88% of patients had a total recovery. 92% of patients with geotropic nystagmus showed no symptoms after second maneuveral sitting. 85% of patients with apogeotropic nystagmus recovered fully after third maneuveral sitting. Conclusion: Correct identification of subtypes of HSC-BPPV is based on provoked nystagmus by positional tests. After locating the site and side on the basis of nystagmic pattern, physician can apply the appropriate PRM. Level of evidence: II a.

Complex benign horizontal canal positional vertigo: new perceptual management.

OBJECTIVE: Horizontal semicircular canal site pathology of benign paroxysmal positional vertigo demonstrating three types of nystagmi on positional test were studied. We have attempted to design a protocol for its diagnosis and treatment. METHODS: 320 patients of HSC-BPPV were subjected to two types of positional tests. Of these, patients with bilateral steady apogeotropic nysatgmus were treated with VAV modification of Semont's maneuver. Patients with unsteady or changing apo/geotropic signs were converted into steady geotropic ones by repetitive positional tests; followed by barbecue maneuver with forced prolong positioning. RESULTS: Overall 88% of patients had a total recovery. 92% of patients with geotropic nystagmus showed no symptoms after second maneuveral sitting. 85% of patients with apogeotropic nystagmus recovered fully after third maneuveral sitting. CONCLUSIONS: Correct identification of subtypes of HSC-BPPV is based on provoked nystagmus by positional tests. After locating the site and side on the basis of nystagmic pattern, physician can apply the appropriate PRM. LEVEL OF EVIDENCE: II a.