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Dr. Luis Alfonso de J. Ortiz Armenta, Otolaryngologist, Mexico

Objective:  Present my 31 years of experience in the transtemporal management of acoustic schwanomas.   

In the first part, there is a review of the typical clinical presentation of those tumors, emphasizing the need of audiological and vestibular test, and also stressing that the diagnosis is made by magnetic resonance imagin of the brain, with special attention to the internal auditory canal and the cerebello pontine angle, always with gadolineo.

Presenting   the cases I treated in the las 3 years as a terciary referral center, analizing the size of the tumors and the transtemporal approaches used.

In another part I will show you the advantages of the translabyrinthine management in all size of tumors, and also I will present the middle fossa approach to the internal canal schwanomas, with the possibility to preserve preoperative hearing’.

In the last part of the presentation there will be a step by step surgical technique of the translabyrinthine and the middle fossa approach with surgery video clips and some tips to respect the tumor of the cerebello pontine angle and of the internal auditory canal with the possibility to preserve hearing and facial nerve preservation

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Balloon Dilatation in Sinus Surgery

Datuk Dr Kuljit Singh, Prince Court Medical Centre, Malaysia

Since 2005 this technology has progressed both in terms of scientific literature and clinical acceptance in treating chronic sinusitis.

The progress of balloon dilatation today has made sinusitis easily treated with very short recovery time and smaller percentage of recurrence when compared to the functional Endoscopy Sinus Surgery [FESS]. In many parts of the world, balloon dilatation is performed in clinics with minimal sedation and hence time spent is reduced.

The advantage balloon dilatation is the precision and immediate outcomes but the disadvantage is the cost. However there is still a huge skepticism on this technology amongst the rhinologist but its hoped that this novel technique will be soon be adopted in a wider way.

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Innovations In Otology

Dr. Ravinder Verma, Verma Hospital and Research Centre, India

It remains a great challenge for all medical men to keep themselves abreast with the rapidly developing and changing scenario.

In the last three decades , speciality of otolaryngology has progressed by leaps and bounds and very rapidly. It is due to the fact that there have been lot of innovations leading to minimally invasive, safe and result oriented procedures. The super speciality of otology is even much more challenging. There has been significant advances in the understanding middle ear mechanism and inner ear physiology. The innovations in Endoscopic, robotics, lasers, cochlear implants and their further developments, newer imaging modalities have been of great help to the treating physician. Many new exciting developments have emerged. Some are still in the research stage whilst others have been duly tested to be in use for the benefit of human.

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CPC Chondrosarcoma

Dr. Swaroop, Dept of ENT, Subharti medical college, India.

42 year old male XYZ, resident of Ghaziabad, Hindu by religion, farmer by occupation, was admitted on 23rd Jan 2019, with complaints of pain and swelling in left retroauricular region since past 1 month associated with Left sided facial swelling and weakness from past 1 week. Nature of pain was of throbbing type and aggravated on touch. Facial swelling and weakness were insidious in onset, gradually progressive. He was a Hukka smoker for around 30 years. Gen. Condition was fair, vitals were normal. There was no pallor, icterus, cyanosis,    clubbing/lymphadenopathy. CNS, CVS, Respiratory and per abdomen were within normal limits. There was a swelling on left side of face involving left post auricular region and extending upto mandible it was approximately 11x7cm in size. Temperature was raised and tenderness present with fluctuation.  He was diagnosed as a case of Left postaural abscess with facial swelling and weakness under investigation.

He was immediately started on me /V fluids, me /V antibiotics and other supportive medications.

Incision and drainage under L.A. was done and pus was sent for culture.

His Blood investigations showed

1. Hb-16.7 g/dl

2. TLC- 17.7

3. DLC- P88, L07, E02, M03

4. P.C. - 2.81

5. B.urea-18.0 mg/dl

6. S.Cr-0.86 mg/dl

7. Na+ - 141 mmol/l

8. K+- 5.4 mmol/l

9. RBS- 105 mg/dl

10. HIV, HBS Ag and anti-HCV- negative

X ray skull lateral view showed lytic, expansile lesion with loss of pneumatisation and reactive sclerosis and scattered patchy radiodensities suggestive of intralesional calcification. HRCT Temporal bone showed an expansile destructive bony lesion causing bony involved the petrous part of left temporal bone. Partial erosion of middle ear ossicles was noted with partial dehiscence of the facial canal. Scalloping and sclerosis of left lateral mass of atlas vertebra was noted.


Surgical manegment of deep nck space infections

Dr. Adham, ENT Resident Hamad Medical Corporation, Doha – Qatar

With the advancing era of antibiotics, incidence of deep neck space infections largely decreased due to early identification and treatment of pharyngeal, tonsillar and odontogenic infectionsns. deep neck space infections need to identified and treated early to prevent extension into danger space which may result in severe life-threatening complications or even death. Cases of deep neck space infections, are going to be presented with course of treatment and different lines of management for each patient



Dr. Angel Castro-Urquizo, Autonomous University of Sinaloa, Mexico.

OBJECTIVE: To evaluate the use of the bucket test as a screening test in the evaluation of vestibular disorders.

STUDY DESIGN: Cross-sectional study

PLACE: Secondary attention center.

METHODS: Inclusion criteria: subjects older than 18 years with some vestibular disorder. The visual subjective vertical was assessed binocularly using the bucket test. Five measurements were made in a clockwise direction and five in the counterclockwise direction.

RESULTS: Fifty healthy volunteers were included and mean normal values ranged from -1.0 ° to + 3.0 °. In addition, there were 80 volunteers with vestibular disorders. 55 were women with an average age of 53 years. The total average value found was 0.91 ° ± 2.8 ° SD for all subjects and 2.60 ° ± 1.88 ° SD without negative numbers (affected side) Results in benign paroxysmal postural vertigo (51 subjects) were: 0. 71º ± 3.10 º SD before the epley maneuver and: 0.57º ± 2.16º SD after the epley maneuver. The deviation corresponded to the altered side in: 57% of the subjects BPPB. In the case of patients with Ménière's disease (25 subjects) the results were: 1. 22º ± 2.61º SD and without negative numbers: 2.74º ± 2.03º SD. The deviation corresponded to the altered side in: 52% of Ménière's disease. The results in patients with vestibular migraine (2 subjects) were: 0.2 ± 0.14º SD.

CONCLUSION: We observed that in patients the side of the deviation corresponded to 56% of the altered vestibular side. The average (0.91 ° ± 2.8 ° SD) fell in the normal range (-1.0 ° to + 3.0 °) but, however, in pathologies with active crisis, the values tended to be modified towards the affected vestibular side.


Evaluation of the efficacy of recurrent laryngeal nerve identification utilizing the Zuckerkandl tubercle

Sherif K Abdelmonim, Consultant & HOD of H&N surgical oncology, KAMC, KSA

Recurrent laryngeal nerve identification is an essential step in thyroid surgery for preserving the patients’ voice and thus their quality of life. Methods of dissection and identification are adopted according to the surgeon’s preference. Objective: The aim of the study was to demonstrate the efficacy of recurrent laryngeal nerve identification using the Zuckerkandl tubercle as an anatomical landmark in comparison with the usual infero-superior dissection of the tracheoesophageal groove. Patients and methods: Four-hundred patients undergoing thyroidectomy were enrolled in a prospective comparative study. They were divided into two equal groups; each group being subjected to a specific technique. Results and conclusion: There was a nonsignificant statistical difference between the two techniques, thus validating the efficacy of Zuckerkandl tubercle as an anatomical landmark for identification of the recurrent laryngeal nerve.

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