A Comparative Study of Surgical Outcomes in Children with Cochlear Implantation Using Posterior Tympanotomy & Modified Veria Technique.

Purpose: To compare the two common approaches of cochlear implantations i.e., mastoidectomy with posterior tympanotomy approach (MPTA) and modified veria technique and to know whether veria technique and its later modifications are as efficacious as the classic approach in terms of duration of procedure, gain in hearing and acquisition and incidence of complications if any. Methods: A prospective comparative study was undertaken at a tertiary care teaching institute. 30 children were selected and randomised into 2 groups who then underwent surgery from the same surgeon after proper evaluation but with 2 different approaches. Their outcomes were then observed and compared in terms of surgical technique and complications and hearing outcomes. Results: 30 children were operated with 15 in each group. In the study, patients under Group A (MPTA) had mean surgical duration of 139.67 ± 16.53 min while Group B (modified Veria) had of 84.67 ± 11.72 min, which was statistically significant (p < 0.05). 1 patient in Group A suffered House Brackman grade 4 facial nerve injury that recovered over 3 months and another had discolouration of the skin flap. No complications were observed in group B. During follow-up CAP and SIR scores were compared and were found to be statistically non-significant between the 2 groups (p value > 0.05), but the paired differences within each group showed statistical significance (P value- <0.001). Conclusion: Veria Technique (and its later modifications) for cochlear implantation is a simple, safe and easy procedure, which is as efficacious as MPTA with added benefits of consuming lesser surgical duration. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-022-03399-1.

When bronchoscopy does not suffice for airway foreign body removal: a series of cases requiring tracheotomy.

PURPOSE: To illustrate the importance of tracheotomy in difficult cases of foreign body inhalation and to enumerate the indications of the same. METHODS: A retrospective analysis of 5 cases in which the standard rigid bronchoscopic approach had to be combined with the open surgical approach (tracheotomy) for the removal of the inhaled foreign body for different indications. RESULTS: Combining the two procedures lead to successful removal of foreign body and restoration of airway in all the cases. Tracheostomies whenever performed were temporary. CONCLUSIONS: Foreign body aspiration is an otorhinolaryngologic emergency that can rapidly prove fatal if not well-handled. Though most cases can be dealt with by traditional approaches, a proportion of the cases may prove challenging and need a quick tailoring of response according to the situation at hand. An approach combining tracheotomy with the traditional bronchoscopic approach is one such way and in well-selected cases, can have a significant impact on the outcome; sometimes even in terms of life and death.

Lateral Skull Base Lesions: Our Experience of 15 Years.

To analyse and report various aspects of lateral skull base surgery by describing the incidence and demographic variables, diagnostic and management challenges, surgical choices along with complications and their management and the long term morbidity and survival outcomes in our experience of 15 years. Retrospective review of complete records of all cases operated for lateral skull base tumors at a tertiary care teaching institution in India between timespan of 15 years from 2003 to 2018 was undertaken. 53 cases were selected and analysed. Those having follow up of less than 6 months were excluded. Outcomes were assessed in terms of incidence of types of tumors, benign or malignant, age and sex variation of the patients, staging status at presentation, status of facial and other lower cranial nerves pre-operatively, surgical techniques with complications if any, recurrences and survival. Of 35 benign tumors, tympanojugular paragangliomas were most common. Average age for these was 53 years with 19 females and 14 males. All were non-functional. Tinnitus and hearing loss were most common presentations. Class B2 and C1 tumors were most commonly encountered and the ITF A approach was most commonly used. Hearing loss and Facial palsy were commonest complication post-operatively. There were 2 recurrences. 18 malignancies were observed. Most were stage IV at presentation. Otorrhea and otalgia were most common presenting symptoms followed by hearing loss. 5 year survival was 55%. Successful treatment of lateral skull base lesions requires a multimodality therapy with team approach. Surgical resection is the primary management choice with variable approaches. ICA status related to the tumor is the most important consideration. Malignancies require more aggressive treatment for obtaining clear margins along with pre/post-op chemoradiation. Good results with acceptable complications can be obtained even with advanced tumors.

Spontaneous Esophageal Perforation in an Infant: A Rare Case.

Spontaneous perforation of the esophagus is an emergency that requires early diagnosis and management. It may be fatal and delay in treatment can cause an increase in morbidity and mortality. Despite of being very rare in infants, we have to be watchful whenever we encounter signs and symptoms related to it. Only 7 cases of spontaneous esophageal perforation in infants have been report in the literature to the best of our knowledge. Here we are reporting a rare case of spontaneous esophageal rupture in an infant.

Effectiveness of intravenous iron sucrose in management of iron-deficient anemia of pregnancy at rural hospital set up.

OBJECTIVES: Critical evaluation of iron sucrose (Malhotra, FOGSI Focus 9-11, 2009) in terms of efficacy, safety, and feasibility at rural setup for the treatment of anemia of pregnancy (Raja et al., Rawal Med J 28: 40-3, 2003) along with any reduction in blood transfusion rate at peripartum period of 37 weeks to 48 h within delivery. METHODS: In a prospective cohort study conducted in Department of Obstetrics and Gynaecology, during the year 2008 AVBRH-Wardha, 256 consecutive women of iron-deficient anemia (IDA) treated with intravenous iron sucrose were studied for feasibility, safety, and efficacy of drug. Blood transfusion rates were compared for the years 2007 and 2008 in cases of antenatal women from 37 weeks onward up to 48 h post delivery. Results were analyzed by Z-test. RESULTS: Mean rises in Hb g% were 1.1 ± 0.2, 2.3 ± 0.8, and 3.0 ± 0.4 after 1, 2, and 3 weeks, respectively. Decline in rate of blood transfusion among total anemic women at peripartum period was 9.36 %. CONCLUSION: Iron sucrose therapy is very much relevant in rural scenario.