ABSTRACT
Larynx is the second most common site for cancer in the upper aerodigestive tract. One of the dreaded complications following total laryngectomy has been pharyngo cutaneous fistula (PCF). PCF merits special attention due to its significant negative impact on the recovery process. Total laryngectomy profoundly alters speech. Effective voice restoration is essential for the rehabilitation of these patients. Inadequate consensus exists as to the best technique of pharyngeal repair to decrease incidence of PCF and ensure good quality voice following total laryngectomy. 21 patients were included in the study for total laryngectomy with trachea oesophageal voice prosthesis placement. Patients were randomised into 2 groups. Group A had their pharynx repaired in two layers and Group B had it done in three layers. Post operatively the patients were followed up for a period of 12 months to look for incidence of PCF. Subjective and objective evaluation of voice was done. 9.52% of patients developed PCF. All of the cases of PCF were in the group repaired in three layers. In cases with repair by two layers the mean Voice Handicap Index 10 (VHI 10) score was 19.27 and those with three layers pharyngeal repair was 23.20. Average maximum phonation time amongst the study population was 13.09. In three layers and two layers pharyngeal repair the average maximum phonation time was 12.56 and 13.58 respectively. Surgical repair of pharynx in two layers excluding the third layer of pharyngeal musculature reduces the chance of PCF. Two layers pharyngeal repair supplemented by cricopharyngeal myotomy led to significantly better voice outcome.
ABSTRACT
Twenty patients in the age group of 45-55 years with carcinoma of larynx underwent tracheostomy for acute upper airway obstruction. Tracheostomy tubes (no. 36) commonly available in the market have varying angle of curvatures ranging from 120° to 130°. In respect of different curvatures of the tracheostomy tubes, the various complaints of the patients were noted. The mean ideal angle of curvature of the tracheostomy tube should be 112° that was calculated from CT scan of neck with tube in situ.
ABSTRACT
AIM: (1) To evaluate the role of vestibular exercises in the management of benign paroxysmal positional vertigo (BPPV). (2) To compare the three vestibular exercises (Semont's manoeuvre, Epley's manoeuvre or Brandt-Daroff exercises) in the treatment of BPPV. SETTINGS AND DESIGN: Prospective randomised study METHODS AND MATERIAL: Fourty-eight patients diagnosed as BPPV in the study period November 2005-2006 were included in the study. They were randomly assigned to one of three groups, and the corresponding manoeuvre was done on them. Follow-up were at 2 weeks and 3 months. RESULTS: Thirty-five of the 48 patients (72.91%) reported relief of symptoms at 2 weeks and no recurrence of symptoms at 3 months. Result was best for the group which was subjected to the Epley manoeuvre (87.5%). CONCLUSIONS: Performance of any of the three manoeuvres can be expected to give good results in the management of BPPV. The Epley manoeuvre appears to be better than the other two in terms of relief of symptoms and prevention of recurrence.
ABSTRACT
study included 40 patients treated for CSOM with central perforation. Only type I tympanoplasty was done in 30 patients with dry central perforation and simple mastoidectomy with type I tympanoplasty was performed in 10 patients with moist or discharging perforation. Type I tympanoplasty utilizing an underlay technique with TFG shows high probability of success (85%). Presence of bilateral perforations lowers the success rate (66.66%). Status of non-operated ear is a significant factor for success rate. An overall hearing gain of about 10db was achieved. Poor pre-operative hearing status of elderly adversely influences post-operative improvement of hearing. Typel tympanoplasty with simple mastoidectomy results excellent surgical success rate (100%) but gives less improvement of hearing (closure of A-B gap= 3.3db). In type I tympanoplasty alone surgical success rate drops to 80-75% but is offers more improvement of hearing (closure of A-B gap = 6.708 db).
