Day 2 :
Bio-Medico University, Rome
Prof. Manuele Casale is specialized cum laude in Otorhinolaryngology at the University Campus Bio-Medico of Rome. He worked in prestigious university centres:Thomas Starzl Transplantation Institute in Pittsburgh, Humber River Hospital and the Hospital for Sick Children in Toronto, University Hospital in Sofia, House Ear Institute in Los Angeles. He attended the twentieth Advanced Course of Surgical Anatomy and Dissection in otology, the Course of Surgical Anatomy, Microsurgery intranasal endoscopic anterior skull base at the University of Zurich and the masters in head and neck surgery at the National Cancer Institute Regina Elena in Rome. It carries out research activities on several topics: molecular biology, clinical research, innovative design tools in Otolaryngology.
Background: This study was designed to prospectively evaluate the role of nebulized hyaluronic acid (HA) as a treatment for patients with rhinitis medicamentosa (RM). RM is a pathological condition of the nasal mucosa induced by prolonged, excessive or improper use of topical decongestants. Methods: Twenty-five patients were treated with HA nebulized via Spray-sol twice a day (morning and evening) for 10-days (T1). Subsequently, after three days of washout, patients were treated with physiological saline nebulized via Spray-sol twice a day (morning and evening) for 10 days (T2).
Results: The HA Spray-sol treatment group significantly improved visual analogue scale (VAS) scores, whereas there was no statistically significant difference in the saline Spray-sol treatment group, results confirmed by the anterior active rhinomanometry (AAR) data.
An improvement in the Global Rhinitis Score (GRS) was recorded in both groups, but plus in HA Spray-sol treatment group. Both groups showed a significant reduction in mucosal oedema and nasal secretions. Patients treated with HA Spray-sol reduced or even eliminated (11/25 patients) the use of topical decongestant within 10 days of treatment with HA.Conclusion: The results of this study suggest nebulized topical 9-mg sodium hyaluronate plays a pivotal role in the management of RM.
Fluminense Federal University, Brazil
Lilian Felipe worked as a PhD researcher in Health Sciences in the field of audiology and otoneurology in Brazil and The Netherlands. Experienced as a professor and lecture at many national and international conferences. She has long and depth education and experience in the field of audiology and vestibulogy. Her research interest are: audiology diagnosis and treatment, vestibular system (evaluation and treatment of dizziness), elderly, public/social health. Finalized her Post Doc in 2015. Currently, she is coordinator and chair professor in Fluminense Federal University at the Speech Therapy and Audiology Department, with main research in audiology and vestibular disorders.
Schistosomal myeloradiculopathy (SMR) is the most severe and disabling form of schistosomiasis. The diagnosis is based on clinical, laboratory, and image data. Vestibular-evoked myogenic potential (VEMP) is a neurophysiologic test that assesses the vestibulospinal pathway through acoustic or galvanic stimuli. The aim of this study was to evaluate cervical spinal abnormalities in patients with SMR. Fifty-two subjects were evaluated, of whom 29 had SMR and 30 did not (normal control). Normal VEMP was observed in all volunteers without SMR. Abnormal VEMP was recorded in 34% of the group with SMR. After treatment, abnormal VEMP was found in 80% of those with persistent neurologic abnormalities. VEMP is a functional test, and the alteration may precede image abnormalities. This procedure may be useful for early diagnosis of schistosomal cervical spinal cord involvement.
Jinnah Postgraduate Medical Center, Karachi
A 29 year old Postgraduate student, who is doing his fellowship training in Jinnah postgraduate medical centre Karachi Pakistan. An ambitious and hardworking fellow trainee who did his MBBS from Dow University and achieved gold medal in final year , and got distinction in Pharmacology and ENT. I presented twice my different researches at national level and one at international level at me oto conference held in dubai april 2017.
Object: To determine the incidence and management of Nasopharyngeal Angiofibroma at JPMC, Karachi from January 1981 – Aug 2014 (33 Years)
Design: Descriptive, Retrospective study.
Subjects and Method: The study was conducted at JPMC from January 1981 – Aug 2014 (33 Years). The data includes age of patients, gender, clinical presentation, staging, mode of treatment, status of pre-op embolization, surgical procedures performed, complications and recurrence rate.
Results: Total number of cases were 386. Males were 381, females were 05. Minimum age was 13 years and maximum was 36 years and median age was 17.5 years. According to stage, they were 08 % patients presented with stage 1 disease, 39 % of patients presented with stage II disease, 42 % of stage III, 08 % of stage IVa and 03 % with IVb. Geographically 48 % were from hot/desert areas and 52 % were from cold/high altitude areas. Commonest symptom was nasal obstruction presented in 98 % of the patients and among them 75 %, it was of unilateral. Epistaxis was present in 70 %, surgical excision was performed in 375 patients while radiotherapy was done in 11 patients of stage IVb disease. Embolization was done in 297 patients while 78 patients were not embolized due to non availability of the facility earlier. Surgical approach commonly adopted was lateral rhinotomy in 300 patients. Mid facial degloving was performed in 33 patients, endoscopic excision was done in 14 patients and transpalatal route was chosen in 28 patient. Complications of surgery were kept in record from 2011 till present. Major complications were massive bleeding which was seen in 04 patients, cutaneous fistula near medial canthus of eye was seen in 02 patients, lymphedema near upper lip was noted in 01 patient and ectropion was seen in 01 patient. Recurrence was seen in 7.8 % (n=30). Follow up was done after 3 months and 6 months and then for 1 year.
Conclusion: This is a common vascular tumor in Pakistan reported from both hot and cold areas. Nasopharyngeal Angiofibroma is rare in females but 05 were reported and their genetic analysis was done. Before preoperative embolization era, recurrence was uncommon but more blood transfusion was required. After preoperative embolization the recurrence has increased but blood transfusion has reduced. Earlier patients presented in late stage but now they present usually by stage II & III.
Professor Hossam Thabet graduated from Alexandria University School Of Medicine (M.B.B.Ch )in 1980 with general grade of " Excellent with honors”. He finished his Master of Otolaryngology (M.Ch.ORL) in, 1984. He finished two years Clinical & Research Fellowship in Washington University (Barns Hospital), St Louis Missouri. USA 1988-1990. He got his Doctorate of Otolaryngology & Head and Neck Surgery in 1991. Hi is the head of the H&N Surgery Unit in Otolaryngology-H&N Surgery Department in Alexandria University. He has more than 35 publications in international & Egyption Journal
Paragangliomas are neuro-endocrine tumors of the extra-adrenal paraganglionictissues derived from neural crest and has been recognised as a part of the AminePrecursor Uptake and Decarboxylation of Pearse (APUD) system. They are found in the head and neck region commonly as carotid body tumors, glomus jugulare, glomustympanicum, glomus vagale , and sympathetic paragangliomas. Surgical excision is the preferred treatment of head and neck paraganglioma. Safe surgical excision requires; good preoperative planning based on angiographic study and preoperative hemodynamic carotid & cerebrovascular flow studies, Wide surgical exposure, meticulous hemostasis assisted in selected cases by preoperative embolization, proximal and distal vascular control, careful dissection of all major neurovascular structures, & co-operation of a vascular surgeon skilled in carotid reconstructive techniques.
Queen Joanna University, Bulgaria
Martha Nikolova graduated from Sofia Medical University in 2013. From 2014 she is working in University Hospital “Tsaritsa Joanna”, Sofia, in ENT Department as a resident. As well she has shifts in Emergency Department in ENT area. She has participations in Bulgarian and European Conferences and Congress. Till now she was working in ENT ward for kids and for Oncology and Head and Neck surgery.
Chronic dysfunction of the Eustachian tube (ETD) with a failure in the ventilation of the middle ear becomes socially significant problem because it causes complications on more than 4% of the adult population in the world. As a result of ETD, chronic inflammatory and adhesion processes are developed in the middle ear. The purpose of this study was to evaluate the results of radiofrequency tuboplastic (RFETP) to solve problems with tubal pathology and the result of otological complications in patients with preserved membranes and those with mesotympanum perforations. A prospective clinical study was carried out at 76 (40 - m. 34 - f.) Patients with chronic multiple ETD treated conservatively and some otological surgery. In all of them RFETP was done with a using of a bipolar electrode, HFITT equipment and fiber optics with a transnasal access. Objective parameters of functional tests for the E. tube patency and the ventilation of the middle ear showed a significant improvement in 68.4% of patients after 2 mounts (74% after 1 year). The function of a tube can be optimized in 70% of patients after removal of the pathological structures in the ostium of E. tube by RFETP, which is recommended in patients with abnormal ventilation of the middle ear.
Management of blow-out fractures (BOF) is addressed by different specialities which have a substantial difference in opinions. However, there is a wide consensus that patients with the potential for late enophthalmus development require early surgical intervention. If improperly diagnosed or treated, these fractures may lead to serious complications, usually diplopia, enophthalmus, hypoglobus, restriction of eyeball motility and disturbances in sensory innervations. The timing of treatment, surgical technique and type of reconstruction material used is debated. The key to successful surgical repair of these injuries are adequate exposure, complete visualization of the entire fracture and anatomic reconstruction of the defect. The recently advocated combination of traditional transconjunctival approach and endoscopic transantral approach allows reduction and reconstruction under clear endoscopic vision without a facial skin incision.
NMC Hospital, Dubai, UAE
Bibin Georgie Thomas , MASLP, is a Audiologist in the otolaryngology department, NMC Dubai.Bibin Georgie earned both his undergraduate degree and his Masters Degree from the University of Kannur and University of Mangalore. He is board certified in Audiology. To his credit, Bibin Georgie Thomas has Several National & International papers got selected for presentation which includes British voice association conference -2013, 39th annual symposium: care of the Professional voice, held in Philadelphia, USA,American speech & hearing association Annual Convention (ASHA) 2013 , ISHACON Chennai (2012) and XXXII World Congress of Audiology Brisbane in May 2014. In 2010rd KSB ISHACON held in Ernakulum (Kerala) (2010) which got best paper award. In 2014 he received South India's Best Audiologist Award from Amplifon and also Nominated for Charles Holland Award for Best Audiological practice in India (Amplifon) year 2015.
Ramsay Hunt syndrome occurs when a shingles infection affects the facial nerve near one of your ears. In addition to this, Ramsay Hunt syndrome can cause facial paralysis and hearing loss in the affected ear. The present study investigates the audiological features and auditory processing of patient with this syndrome.Investigating auditory processing skills using a series of behavioural and objective tests known to be sensitive enough to assess a 40 year old women using Behavioural tests such as speech perception in noise, gap detection, and duration pattern and objective tests like ABR, MLR responses and OAE.Investigations of the peripheral auditory system revealed a right moderate sensorineural hearing loss, Poor scores on speech perception in noise, gap detection and duration pattern. These results confirmed using objective tests where the absence of OAE, abnormal latencies and interpeak latencies of the ABR and absence of MLR.The results of the present case study focus on the presence of auditory processing disorders and audiological features suggested test shows presence of auditory processing disorder and cochlear and retro cochlear involvement. Thus, cautious investigations of audiological evaluation are necessary in these individuals.
Md Monjurul Alam has completed MBBS, FCPS (ENT) MS (Otolaryngology). He is a Professor,Dept.of Otolaryngology & Head-Neck Surgery.
Background: Endoscopic ear surgery is a emerging technique with advancement highlighting advantages over the traditional microscopic approach.In Bangladesh we started doing myringoplasty since 2005 with otoendoscope and stopped due to few problems But again, since 2007, all types of middle ear surgeries with nasal endoscopes has been being done with bright , wide & clear view. We did different types of Transcanal Tympanoplasties, ossicluplasties, stapedotomies, also few cholesteatoma surgeries by endoscope.As Rigid endoscopy allows for wide-field view of the surgical field improved resolution with high magnification, and the ability to look around corners , enabling direct visualization of the hidden recesses including the retrotympanum, epitympanum, supratubal recess, peritympanum and hypotympanum, granulation tissue or cholesteatoma matrix can be removed easily.
Methods: A cross sectional study done during March,2010 to June,2014 in otolaryngology & Head-Neck surgery dept of Bangabundhu Sheik mujib Medical University (BSMMU) after having permission from Ehethical review board of the University.
Results : During the study period 1200 different types of transcanal Endoscopic Tympanoplasties like underlay & interlay tympanoplasty using different graft matrials ;temporalis fascia,perichondrium, cartilage with graft taken up rate & hearing gain equivalent with tympanoplasty done by microscope. 517 different types ossicluplasties and stapedotomies were done with similar hearing gain done by microscope.117 cholesteatoma surgery – Atticotomy, attico-antrostomy with reconstruction have been done without any major complication or recurrence. Learning curve of surgery among the residents is higher with endoscope.
Conclusions: Endoscopic ear surgery is a new technique which is gaining momentum in Bangladesh and there is enthusiasm for its incorporation into future practice. Further investment in training courses and guidance for those who looking to start or advance the use of endoscopes in their practice will be vital in the the years to come.
Sichuan University, China
Yang Xu is studying his PhD at the age of 25 years in West China School of Medicine, who is concentrating on scientific research about rhinology and otology.
Background: Different delivery modes may affect the susceptibility to allergic diseases. It is still unknown whether early intervention with probiotics would counteract this effect. Objectives: The effect of different delivery modes on immune status and nasal symptoms was investigated on established allergic rhinitis (AR) mouse model. In addition, the immunoregulatory effects and mechanisms of different feeding manners with Bifidobacterium breve(B. breve) were examined.
Methods: Live lyophilized B. breve was orally administered to BALB/c mice born via vaginal delivery (VD) or cesarean delivery (CD) for 8 consecutive weeks, after which they were sensitized by ovalbumin(OVA) to establish experimental AR. Nasal symptoms, serum immunoglobulins, cytokines, splenic percentages of CD4+CD25+Foxp3+ regulatory T(Treg) cells and nasal eosinophil infiltration were evaluated.
Results: Compared with VD mice, mice delivered via CD demonstrated more serious nasal symptoms, higher concentrations of OVA-specific immunoglobulin (Ig) E, more nasal eosinophils and lower percentages of splenic CD4+CD25+Foxp3+Treg cells after establishing experimental AR. These parameters were reversed by administering B. breves hortly after birth. However, the effect of B. breve did not differ between different delivery modes.
Conclusion: CD aggravates the nasal symptoms of AR mice compared to VD. This is the first report that oral administration of B. breve shortly after birth can significantly alleviate the symptoms of AR mice born via both deliveries, probably via activation of the regulatory capacity of CD4+- CD25+Foxp3+Treg cells.
Indraprastha Apollo Hospital, India
Dr Kalpana Nagpal is a senior consultant in the department of ENT head and neck and Robotic surgery .She completed her graduation in medicine from Osmania medical college and MS in ENT from Armed forces medical college Pune India .She also has visiting fellowship in nose and sinus disease from memorial medical centre Savannah Georgia USA.Robotic surgery training from Seoul south korea .In addition she has done DNB ENT also in the year 1995.she has published frontal sinus rescue procedure in American journal of rhinology in1999.
Post tympanoplasty graft mucolization leads to continuous discharging ear even after successful graft uptake because of presence of mucous secreting glands on the lateral aspect of graft .Process of epitheliasation or mucolisation of margins of perforation in the settings of chronic otitis media is known .Total annulus excision is an interlay type of tympanoplasty where graft is kept between mucosa medially and canal skin epithelium laterally .The advantage of TAE(total annulus excision ) is complete excision of diseased tympanic membrane and no weeping neotympanium in future .excision of annulus also ensures rich neovascularization around the graft.The neoannulus is kept at original place to prevent anterior angle blunting .
Tehran University, Iran
She is a physicaltherapy student in MS.c cours at tehran university of medical science ,which is preparing the my MS.c program.she has been published 2 articles in view of rehabilitation in asthma diseases as a co-worker in the iranina medical science journals, as well, an article was accepted to present on the 1th intetnational congress of physical therapy in tehran ( title: Effect of Therapeutic Pulsed Ultrasound on Smell Dysfunction in Subjects With Chronic Rhinosinusitis (2017)
Smell dysfunction is one of the main symptoms in chronic Rhinosinusitis (CRS). Therapeutic ultrasound (US) is suggested as a novel method for treating the CRS. No study has evaluated the effect of therapeutic US in CRS.The aim of this study was to demonstrate the effects pulsed ultrasound (PUS) in CRS subjects with Olfactory dysfunction .
Eleven CRS subjects with smell dysfunction (mean age 47.90±4.6 yrs; male 7; female 4) participated in a pretest-posttest study design with 2 measurements before and after 10 treatment sessions, and after one month follow up. Participants received pulsed US (1:9), frequency 1 MHz, intensity/duration 1 W/cm²/5 minutes and 0.5 W/cm²/4 minutes for the maxillary and frontal sinuses, respectively. Subjects underwent for ten treatment sessions, three days a week, with US given every other day. The outcome measures were the Persian versions of SNOT-20 and University of Pennsylvania a Smell Identification Test (UPSIT). The repeated measures ANOVA were used for analysis.
The mean changes of UPSIT scores (11/1 to 19/7) and SNOT-20 scores (41/4 to 19/6) were significantly improved after PUS therapy (p<0.001). At one month fallow up, the improvements were sustained.
Conclusions: The pulsed ultrasound was effective in improving smell dysfunction and symptoms severity in this sample of patients with rhinosinusitis.
Sara Alqahtani is a Medical Student.
Functional endoscopic sinus surgery (FESS) is most commonly performed procedure for inflammatory and infectious sinus diseases including those of sphenoid. A rough guide to enter sphenoid ostium is the face of the sphenoid is approximately 7 cm from the nasal spine at a 30° angle from the horizontal and the superior turbinate aids in the confirmation of the sphenoid position in difficult cases.
Objectives: This study was conducted to find out the easiest fixed bony landmark for localizing the sphenoid sinus ostium for FESS and Pituitary Surgery so as to avoid injury to the internal carotid artery and the optic nerve which are the anatomically close to sphenoid sinus and are at risk during these surgical procedures.
Methods: It was a retrospective study in which computerized tomographic (CT) scan axial cut of sinuses from 166 patients were reviewed to determine average distance between Posterior Maxillary Wall (PMW) and the Front of Spehnoid (FOS) in both right and left sides.
Results: Mean age of the patients was 41.18±14.75 (95% CI = 38.92 – 43.44) years. Males (n=88, 53.01%) and females (n=78, 46.99%) were almost equally participated in the study. The average anterior-posterior distance from the PMW to the FOS was on the right side 7.1mm and on the left side 7.9mm, the average in both right and left respectively was 7.5mm in the CT scans.
Conclusions: The posterior maxillary sinus wall may act as a concrete and unmistakable bony landmark on CT scan to localize the face of sphenoid sinus for the sinus surgeons performing FESS and pituitary surgery.
Key words: Sphenoid, posterior maxillary wall, functional endoscopic sinus surgery, pituitary surgery
Dr sambhaji chintale has completed ms ent from Dvmgmc solapur from muhs nashik INDIA
Dr chintale is director OF COSMO ENT SUPERSPECIALITY HOSPITAL AURANGABAD india have published papers inmany reputed journals and also serving as an author of online journal of otorhinolaryngolgy also work as reviewr for international journal
Background: Local Anaesthesia is now being accepted universally as a safe alternative to generalanaesthesia for thyroid surgery. Aim: This study was carried out to compare the outcomes of patients undergoing thyroid surgery under local and general anaesthesia. Material and Methods: two atients who underwent thyroid surgery for benign and malignant diseases under local and generalanaesthesia from march 2014 to march 2017 were analysed. Patient characteristics analysedwere age, sex, pathology lesion size, operating time, length of stay, cost and post operative complications.Results: Mean lesion sizes were 5.26 cms. and 6.33 cms. in local and general anaesthesia group
respectively. Mean operating time was 41.6 minutes and 74.5 minutes in local anaesthesia and generalanaesthesia group respectively. Mean cost incurred was Rs.8000 in local anaesthesia and Rs.18000 in general anaesthesia group. Mean length of hospital stay was 39.26 hours and 71.06 hours in local anaesthesia and general anaesthesia group respectively. Conclusion: Local anaesthesia is a safe alternative to general anaesthesia for patients undergoing thyroid surgery. Use of local anaesthesiahas resulted in a decreased length of stay, cost and mean operating time, hence useful in a setup ithlimitedanaesthesia time and increased work load.
Key words: Local anaesthesia, thyroid surgery, general anaesthesia
Nitin Arora has completed his MBBS degree, at the age of 23 years from GMC, Patiala, Punjab ,India and is currently pursuing his MS degree, from Baba Farid university of health sciences,(Faridkot) Punjab, India.
He has presented many oral and poster presentation in various state and national level conferences and has won post graduate quiz twice in Punjab state conference
Bone destruction seen in chronic otitis media mainly involves the ossicles, incus being frequently involved ossicle. So, an investigation of the histopathological changes in incus from CSOM patients was carried out, and was compared with histology of normal incus taken from cadavers with normal TM.
Materials and Methods: Ten normal incuses and ten pathological incuses which were removed during the surgery for chronic otitis media (both with and without cholesteotoma) were studied histologically, after staining with haematoxyline and eosin.
Results: Normal incus showed compact bone pattern of concentric rings, like that of any long bone of body. Pathological incuses of chronic otitis media (both with and without cholestoetoma) showed similar changes, i.e stratified squamous epithelium, with distorted concentric rings and increased osseous spaces.
Conclusion: the study was undertaken, so that the knowledge to histological changes may help the clinicians to take more rational decisions regarding their diagnosis and therapeutic interventions to prevent the changes occurring in the bone in COM.