Pneumatization of inferior turbinate.

Pneumatization of inferior turbinate

Recirculation phenomenon maxillary sinus

This video shows the recirculation phenomenon of mucus through the accessory Audio. (Courtesy: Dr. Sukhbir Singh, ENT Surgeon, Sangrur)

Recirculation phenomenon is a common cause of failure in endoscopic sinus surgery.

This occurs when secretions transported out of the natural maxillary ostium return to the sinus via a surgically created or accessory ostium

North West zone ENT conference at Jammu in 2001.

Rhinocon 2013, Vadodara

Humoral and ideal way of putting the nose drops

If you put nose drops in the supine or sitting position, the drops will easily flow into your throat. The best way is either like this way (Impossible) or just keep a pillow under your shoulder and let your neck go into a hyperextended position. Other best position are like Namaaj position, Matha Tek or kneeling head down position. 

Speech therapist

Himani Tyagi

Audiologist and Speech therapist

Yashoda hospital 

Kaushambi. 

tel:9953145730

I strongly recommend her name for speech therapy cases She also do swallow therapy in vocal cord palsy cases. Dr. Ajay Jain 

Squamous cell carcinoma of the right ala of nose repaired with Naolabial flap in an old patient.

I

Torus Palatinus

Cochlear implant beyond surgery

Well cochlear implant is a surgery an average ENT doctor can do. But pre and postoperative care is more important

 

CI orientation and information sharing is very important to choose the hearing aid.  

Counseling is very important to parents. Parents are given a questionnaire which judges their expectation. 

Risks are explained to parents and the recurrent cost of the implants are explained. Surgical complications like facial palsy, perilylymph gusher etc are explained. 

Implant is a foreign body and could be rejected by body at any time. 

Avoid using monopolar cautery for surgery in future. They are given special certificate while passing through metal detector. During flight they should turn off these device. 

Audiologist and speech language Pathologist

Ajit Kumar

(Audiologist and speech language pathologist)

Qualification

Master in Audiology and Speech-Language Pathology (MASLP), Kasturba medical college, Mangalore Campus, Manipal  University, Karnataka, India

Bachelor of Science in Audiology and Speech-Language Pathology(B. Sc. ASLP),  Helen Kellers’s Institute of Speech and Hearing, Osmania University , Hyderabad, AP, India

Facilities available

AUDIOLOGY

     Pure Tone Audiometry (PTA)

·         Impedance Audiometry

·         Speech Audiometry

·         Behavioral Observational Audiometry (BOA)

·         Special Tests of hearing.

·         Hearing Aid Programming and Fitting.

·         Trouble shooting of hearing aids  

SPEECH LANGUAGE PATHOLOGY

Assessment and intervention of:

·         Children with Speech and language disorders

·         Adult with Speech and language disorders

·         Adult neuro-communication disorders (Aphasia)

·         Neuro-motor speech disorders

·         Voice disorders

·         Fluency disorders

·         Hearing loss

·         Learning disabilities

·         Apraxia

Forthcoming services:

AUDIOLOGY:

·         Oto-Acoustic Emission (OAE)

·         Brainstem  Evoked Response Audiometry (BERA)  

·         Auditory Steady State Response (ASSR)

·         Vestibular Evoked myogenic potential (VEMP)

·         Electro-acoustic measurement of different hearing aids  

·         Ear mould making.

SPEECH AND LANGUAGE PATHOLOGY:

    ·      Speech Therapy

RESEARCH

1.    Effect of hearing loss On Vestibular evoked myogenic potential response. 

2.    The effect of acute sleep deprivation on temporal processing and frequency resolution in normal healthy adults.

3.    Effect of close and open eye on ocular vestibular evoked myogenic potential.

 Residence: C-164, F-1, Near Trevenidam Hanuman Mandir, Shalimar Garden Ext-2, Sahibabad, Ghaziabad.

Contact Number: 8470081358   Email: ajitkumarnayan@gmail.com

Button batteries as foreign body in the nose

Button batteries are extremely dangerous foreign bodies in nose. Their potential lies in inducing changes in delicate and sensitive mucosa of the nose and cause damage by mechanical, electrical and chemical means. This multidimensional attack often result in septal perforation leading to saddle nose and features of Atrophic Rhinitis.

The key to limiting the complications is duration between contact of foreign body with the mucosa of the nose. The other key point after foreign body removal is management of the nose. Steroids are often required to limit the escharing. Saline irrigation, gentle debridement away from the septum and application of steroids antibiotic ointment should limit the damage. Oral steroids and antibiotics help to reduce chemical inflammation and limit the nasal damage.

I prefer general anesthesia especially in children as then copious saline irrigation can be done to wash off chemical leaked from batteries.

 

Photo of the leaked button battery

 

5 days after removal of foreign body, the child was again taken up under general anesthesia to remove a very hard crusts which was involving septum, right inferior and middle turbinate blocking right ostiomeatal complex causing right maxillary sinusitis.

 
See the other side of the septum. An imminent septal perforation is evident

 

 

67 year old male, non smoker, presented with hoarseness of voice more for last 6 months. he has history of tonsillectomy in 1967 and two times vocal cord biopsy in 2000 and 2005 which was negative for malignancy. Voice is more or less same for last 6 months. This video shows a mall over left vocal cord posteriorly. Now my question is whether this mass should be touched with MLS or we just observe it or treat with steroids. Please state exact diagnosis too.

Giant Concha bullosa

Concha bullosa is a term used for enlarged middle turbinates filled with air. Most of the time they are asymptomatic but with their mass effect they can cause stuffy nose. Deviated nasal septum can be associated with this compromising other side of the nose as well. Concha bullosa may itself become diseased sometimes. Concha bullosa may obstruct the drainage of maxillary sinus giving rise to maxillary sinusitis as well.

Treatment involves removing a part of bone on its lateral side with preservation of mucosa (lateral turbinectomy). 

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.

Oral Cancer in India

This is a common picture in India especially among the labour class where the form of smoke known as Bidis is common along with tobacco either as inhalation or in chewable form. First Oral Submucous fibrosis develops with restriction of mouth opening and then some form of non healing ulcer or growth erupts. Because of ignorance and poverty, there is often delay in treatment. No wonder, Oral cancer is most common form of cancer in this subcontinent of Asia

Cholesteatoma protruding through previous cortical mastoid cavity

 

Well lined cholesteatoma sac seen protruding through Mastoid bone. He underwent cortical Mastoidectomy 10 years back and was almost symptom free except for once annual ear discharge for last 3 years which used to respond to antibiotics. This ear discharge was from postaural fistula. This time, his ear discharge responded partly and it came from ear canal as well with typical fishy smell of Cholesteatoma.

Memorial Sloan Kettering Cancer Hospital, New York

 

Dr. Jatin P Shah, Chief of Head & Neck Surgery (middle) with Dr. Apostoles (Italy) and Dr. Ajay  Jain (India) at his 10th floor Office at MSKCH

 

With Fellows  of Head & Neck Surgery at MSKCH, New York

 

Tympanic Membrane perforation following blast injury.

This is a case of blast injury and this patient has been following for last 4 weeks. Margins of the perforation are healing slowly. Clot has retracted. Stapedius tendon, Round window and Incudostapedial joint is clearly visible.

Question: How long do you wait for these perforation to heal before taking up for surgery?
(I Plan to wait for at least 3 months)