Management of Recurrent Aphthous Stomatitis: An Indian Expert Consensus.

Recurrent aphthous stomatitis (RAS) is characterized by painful, oral mucosal ulcers with wide range of prevalence ranging from 2 to 78%. Etiology of RAS is idiopathic and multifactorial. There are numerous gaps in assessment and management of RAS and the absence of guidelines or a consensus document makes the treatment further difficult. The aim of this document is to provide an Indian expert consensus for management of RAS. Experts from different specialties such as Otorhinolaryngology, Oral Medicine/Dentistry and Internal Medicine from India were invited for face to face and online meetings. After a deliberate discussion of current literature, evidence and clinical practice during advisory meetings, experts developed a consensus for management of RAS. We identify that the prevalence of RAS may lie between 2 and 5%. In defining RAS, we advocate three or more recurrences of aphthous ulcers per year as criterion for RAS. Investigation should include basic hematological (complete blood count) and nutritional (serum vitamin B12, and iron studies) parameters. Primary aim of treatment is to reduce the pain, accelerate ulcer healing, reduce the recurrences and improve the quality of life. In treating RAS, initial choice of medications is determined by pain intensity, number and size of ulcers and previous number of recurrences. Topical and systemic agents can be used in combination for effective relief. In conclusion, this consensus will help physicians and may harmonize effective diagnosis and treatment of RAS.

Ultrasonic Wave Bone Cutting Technique (Piezotome) in Cochlear Implant Surgery by Veria Technique.

To study use of ultrasonic wave bone cutting technique (piezotome) in cochlear implant surgery by veria technique. The Piezoelectric device is a bone cutting tool that transmits ultrasonic high frequency vibrations through a metallic tip to selectively cut bone while sparing the surrounding soft tissues. We have used the piezo tools instead of the perforator in over 50 cases of Cochlear Implant by the non mastoidectomy Veria technique [which uses a specially designed hand piece perforator with a guide (Kiratzidisa et al. in ORL J Otorhinolaryngol Relat Spec 64:413-416, 2002)]. These tools are helpful in: straightening the posterior bony canal wall, making the well for Implant bed, making space for excess electrodes and removing bone tissue close to dura without risk of injury to dura. Though use of Piezo tools in various otologic surgeries has been described but we feel the piezo tools will be an important tool in a CI surgeon's armament.

Cochlear Implant Made Easy by Bhopal Technique: Our Experience of 200 Patients.

AIM: The objective of this work is to present a modified Veria technique named as "Bhopal technique" for cochlear implantation and to discuss & compare its benefits and drawbacks with Posterior tympanotomy and Veria technique. MATERIALS AND METHODS: The study design is a surgical procedure description and prospective study on 800 patients who underwent Cochlear implantation by various techniques for bilateral profound sensorineural hearing loss at Divya Advanced ENT Clinic, Bhopal between 2014 and 2018 and followed up for 12-30 months. Implants used in were Digisonic SP, Cochlear CI24RE and Medel Sonata TI100. Out of 800 total patients, 200 patients were operated with Bhopal Technique. All the patients were reviewed on basis of total duration of surgery, intraoperative difficulties and development of any post-operative complications. RESULT: All the patients were in the age range of 11 Months-7 years and the male: female ratio was of 2:1. In 200 patients operated with Bhopal Technique complications like electrode migration into the canal, excess electrode caught into suture, transcanal injury (Fig. 1c), corda nerve injury was not seen as against other technique in which 2 incidences of electrode migration and in 5 different cases transcanal injury, chorda nerve injury, tympanic membrane perforation was seen. The actual surgical time (excluding device testing) was less with Bhopal technique and ranged between 45 and 55 min.Fig. 1Comparison of intraoperative difficulties and late post- operative complication between Bhopal and Veria Technique in percentage. CONCLUSION: Bhopal technique of Cochlear Implantation is a safe and versatile technique with good surgical outcomes which addresses shortcomings of Veria and posterior tympanotomy technique. It can be used for the implantation of all available devices with minimal operative risk and reduced operation time thus, offering prospects for better outcomes over other techniques.

Correction to: Cochlear Implant Made Easy by Bhopal Technique: Our Experience of 200 Patients.

[This corrects the article DOI: 10.1007/s12070-019-01673-3.].

Endoscopic endonasal transsphenoidal hypophysectomy: two hand versus four hand technique: our experience.

An endoscope was used in transsphenoidal surgery and eventually replaced the operating microscope as a tool for visualization. Initially patients underwent operation via a sublabial transseptal approach using a rigid endoscope in conjunction with an operating microscope. The subsequent operations were performed through a nostril using only rigid endoscopes, initially through single nostril by one surgeon (two hands) and later through both nostrils by two surgeons (four surgeons). This is a retrospective study of 96 patients who had pituitary adenomas in last ten years. Postoperatively all patients who had undergone endonasal endoscopic surgery had unobstructed nasal airways with minimal discomfort. More than half of the patients required only an overnight hospitalization.

Endoscopic DCR: How To Improve The Results.

Since Toti described the initial dacryocystorhinostomy (DCR) operation in 1904 many technical modifications have evolved (Becker in Ophthalmic Surg 19:419-427, 1988). Overall, three groups of procedures are currently practised; external DCR, endoscopic DCR with contact laser, and surgical endoscopic DCR without laser (Woog et al. in Am J Ophthalmol 116:1-10, 1993; Jokinen and Karja in Arch Otolaryngol 100:41-44, 1974. Many factors influence the outcome of these different approaches. The purpose of this study was to improve the long term surgical outcome in endonasal DCR. A retrospective analysis of more than 1,500 patients, who underwent primary endoscopic DCR, was done and specific small modifications were identified and applied in the next 108 cases showing an improvement in the results.