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.