Tuesday, April 19, 2016

Quote


No surgery is minor and no surgery is major. Appropriate case selection and the trust of the patient is vital to successful outcome.

Saturday, April 16, 2016

Anomalous vascular loops in close relations to vestibular cochlear nerve complex as possible cause of tinnitus



Anomalous vascular loops are seen in close relation to vestibulo-cochlear nerve complex on either side at the exit zone (CISS seq uence). Vestibulo-cochlear nerves on either side are normal in course and caliber.

Inner ear anatomy is well defined with normal apical, middle and basal turns on both sides.

All three semicircular canals are normally visualized.
The saccule and vestibule are normally visualized.

Bilateral trigeminal nerves are normal in course and calibre with a normal course at the origin and in the region of the Meckel's ca ve on either side.

Bilateral mastoid air sinuses are normal.

IMPRESSION MR FINDINGS ARE SUGGESTIVE OF ANOMALOUS VASCULAR
LOOP AT THE EXIT ZONE OF VESTIBULO-COCHLEAR NERVE COMPLEX ON EITHER SIDE.

Thursday, April 14, 2016

Endoscopic powered Adenoidectomy



This is one surgery in ENT where a blind person can do this surgery. Are you surprised?. I am not kidding. In fact, this surgery is still done blindly by many ENT Surgeons. Adenoid tissues, which are like tonsils but placed behind the nose, is not easily visible. In a child of 3-4 yrs of age, sometimes it is not possible to put typical 4 mm nasal telescopes through nose which is commonly available with ENT surgeons. So, surgeon feels the adenoid tissues through putting a finger through the mouth and with help of specially designed shavers, shaves them off without actually seeing them.

This is no more scene now specially with availability of angled microdebriders. This is wonderful to work like as you are working on a video game but here the real stake is a youngster kid and a little overconfidence may prove detrimental. you have to be very careful not to go too deep with Microdebrider unless it will chop off normal mucosa also.

A typical Microdebrider blade costs roughly around Rs. 6000 INR and most of the insurance company have not recognized this cost and the efforts involved in this endoscopic surgery precluding this as a viable option for many of ENT colleagues. Microdebrider itself costs around 400000/- INR. No wonder, this is not widely available.

Study of Middle ear through perforated ear drum

Almost subtotal perforation of ear drum showing Incus, Incudostapedial joint, Stapes, facial nerve, stapedius tendon, round and oval windows. Identinfy and correlate with next photograph.


Saturday, April 9, 2016

Congenital Cholesteatoma

Better do MRI in case of congenital cholesteatoma as CT will not tell about extension from intracranial part or ruling out CPA cholesteatoma.  Also do MRI after surgery to rule out cerebritis or abscess after surgery.   

Wednesday, April 6, 2016

X-Ray Adenoid-which view is better-Open Mouth or close mouth

Soft tissue x-ray of Adenoid in lateral position. Compare the view obtained with open mouth and close mouth.
I often see x ray of lateral view of adenoids taken with mouth open. Perhaps that is common belief with radiology technician that all x rays ordered by ENT Surgeon have to be taken with mouth open.

You yourself note that how misleading is the x ray with mouth open. What we are seeking from this x ray is that air passage between adenoid tissues and soft palate. If we keep mouth open, then that air column never forms. So such cases many undergo mistakenly for adenoidectomy.

I hope that my radiologist and ENT friends will spread this message to x ray technicians and correct the positioning of the child for such x rays.