Balloon dilation laryngoplasty for acquired subglottic stenosis at a tertiary center in India.

To evaluate outcomes of balloon dilation laryngoplasty for laryngeal stenosis. It is a retrospective study done at Civil Hospital Ahmedabad from Feb 2017 to Jan 2019. All patients treated with laryngeal balloon dilation with acquired subglotticstenosis with normal vocal cord mobility. Stenosis severity, Measured using the Cotton and Meyer classification, and McCaffery grading system. A total of 10 patients of acquired subglotticstenosis ranging in age from 16-64 y (5 [50%] with grade II stenos is, 3 [30%] with grade I stenosis, and 2 [9%] with grade IIIstenos is) were included. A total of 10 balloon dilation laryngoplasties were performed, and 9 (90%) were deemed successful. Four of the 5 patients undergoing primary dilation (90%) had successful outcomes, and in the other 1 [10%], outcomes were unsuccessful and required either laryngotracheal reconstruction or tracheotomy. Five balloon dilations were performed as a secondary procedure after recent open surgery; all of the procedures (100%) were successful, and thus surgical revision was avoided. After balloon dilatation,among 7 tracheostomised patients, 6 patient got decannulated. Balloon dilation laryngoplasty is an efficient and safe technique for the treatment of both primary and secondary acquired laryngotrachealstenosis. Minimal intervention with maximum results.

Plasma Dissection Versus Tissue Dissection in Adenoid Surgery.

Aim is to compare coblation versus conventional adenoidectomy, to evaluate whether this approach is adequate, safer and could be a coblation a good alternative of conventional adenoidectomy? It is a prospective randomized controlled study done at Civil Hospital Ahmedabad from January 2016 to January 2017 with 70 patients. The study includes children between age groups 5-11 years divided into Group A (38 children underwent coblation adenoidectomy) and Group B (32 children underwent conventional adenoidectomy) with an average follow-up period of 10 days, 1 month and 3 months. Information on average time of operation, intra-operative blood loss, post-operative pain, and time required regaining normal breathing pattern, presence of residual adenoid tissue 4 weeks after surgery and postoperative hemorrhage were gathered and compared. We found statistically significant differences in average operation time (p < 0.001), intra-operative blood loss (p < 0.001), post-operative pain (p < 0.0001) and time required regaining normal nasal breathing pattern (p < 0.001) presence of residual adenoid tissue 4 weeks after surgery (p < 0.0001) However, post operative hemorrhage (p > 0.5) was not significantly different between two groups. This study suggested a significantly less intra-operative or postoperative complications and morbidity in coblation adenoidectomy in comparison with conventional method. Coblation was associated with less pain and quick return to normal nasal breathing pattern. These findings indicate that coblation adenoidectomy is a safer, method and can be a better alternative of conventional method.

CSF Gusher and Its Management in Cochlear Implant Patient with Enlarged Vestibular Aqueduct.

Aim is to share our experience of CSF gusher and its management during cochlear implant surgery in patients with enlarged vestibular aqueduct. All cases underwent classic cochlear implant surgeries via Veria technique. It is a retrospective study done at Civil Hospital Ahmedabad from January 2013 to March 2018 with 415 patients. The study includes 39 children between age groups 2-8 years who have enlarged vestibular aqueduct. In all 39 patients with enlarged vestibular aqueduct during cochleostomy there was CSF gusher which was managed by the covering the cochleostomy site with temporalis fascia. There was no need for use of fibrin glue in any case. But it was kept in standby mode in case needed. And there was no post operative CSF otorrea in any patients. While preparing the patient for cochlear implant whenever you come across enlarged vestibular aqueduct via HRCT temporal bone and MRI of cochlea, be prepared for CSF gusher while doing the cochleostomy. Csf gusher is intra operative challenge rather than a bad prognostic determine for post operative audiologic out come. Keeping fibrin glue in stand by helps if major CSF leaks happens. Finally, we achieved a simple stepwise algorithm for the management of gusher during cochlear implantation.