Spasmodic dysphonia: a seven-year audit of dose titration and demographics in the Indian population.

OBJECTIVES: This study aimed to evaluate the demographics of spasmodic dysphonia in the Indian population and to analyse the optimum dose titration of botulinum toxin type A in this group. A comparative analysis with international studies was also performed. METHOD: The study involved a retrospective analysis and audit of botulinum toxin type A dose titration in spasmodic dysphonia patients who visited our voice clinic between January 2005 and January 2012. RESULTS: The average total therapeutic dose required for patients with adductor spasmodic dysphonia was 4.2 U per patient per vocal fold (total 8.4 U per patient), and for patients with abductor spasmodic dysphonia, it was 4.6 U per patient. CONCLUSION: Our audit revealed that 80 per cent of the spasmodic dysphonia patients were male, which contrasts dramatically with international studies, wherein around 80 per cent of spasmodic dysphonia patients were female. Our study also revealed a higher dose titration of botulinum toxin for the Indian spasmodic dysphonia population in both adductor and abductor spasmodic dysphonia cases.

Endoscopic excision of Juvenile nasopharyngeal angiofibroma - A comprehensive approach.

OBJECTIVE: Endoscopie excision of Juvenile Nasopharyngeal Angiofibroma (JNA) was carried out with (he objective of minimizing blood loss and attempting a complete excision of the tumor under direct vision with the help of Hopkins telescopes. STUDY DESIGN: A prospective 4 year study of 23 cases of JNA treated by endoscopie excision is presented. Of these, 18 were treated by endoscopie excision alone. The remaining 5 were treated with a two staged approach either by mid-facial degloving followed by endoscopy or by 2 endoscopie procedures. RESULTS: The tumor was excised completely in 17 out of the total 18 cases that were treated exclusively by endoscopy. One case has shown a recurrence. The 5 cases treated by the staged approach represented very large tumours or tumours with intra-cranial extensions. In I of these cases, inoperable tumor remnant engulfing the internal carotid artery was treated by radiotherapy post-operatively. CONCLUSION: With successful excision of JNA in all but one case, we could reasonably conclude, that endoscopie excision of JNA could become a safer and a more precise alternative to open surgery provided it is practiced judiciously by surgeons who have considerable experience in endoscopie surgery and the necessary backup to convert to open surgery should the need arise.

Management of acute vertigo with betahistine.

This open, prospective study was carried out in 29 outpatients of vertigo with Betahistine treatment at a dose of 16 mg three times daily far a maximum treatment period of 6 weeks or earlier until remission of vertigo attacks. The evaluations were carried out based on three parameters such as frequency, duration, and severity of vertigo attacks. Betahistino showed a significant improvement in the three parameters of frequency, duration and severity of vertigo attacks. Associated symptoms such as tinnitus, nausea, vomiting, headache, faintness showed a significant improvement with the therapy. Subgroup analysis showed a significant improvement of patients with severe and incapacitating verlign attaeks at baseline. Thus, this study proves excellent efficacy and goad tolerability of Betahistine as an anti-vertigo drug at a dose of 16 mg three times daily and gives a new insight for controlling acute or severe vertigo attacks without causing sedation.