5^th International Conference on Rhinology and Otology November 16-17, 2018 Mercure Melbourne Albert Park | Melbourne, Australia

Biography:

Dr. Salahuddin has completed his M.Sc. & Ph.D. from United Kingdom in 1990. He was Professor & Chairman, Department of Statistics, University of Peshaw till 2013 and then joined CECOS University, Peshawar. He has also served as Professor of Biostatistics in University of Dammam, Saudi Arabia w.e.f. June 2014 to July 2017 and then rejoined CECOS University, Peshawar in August 2018 . He has published 54 research papers in reputed journals and presented papers in several international conferences held in Indonesia, Malayasia, Singapore, Thailand, USA & Turkey. He has been serving as an editorial board member of repute several research journals.

Abstract:

Coronary artery disease is the narrowing of the artery atherosclerotic heart arteries that supply blood. The basic aim of this study was to discover the important risk factors that cause coronary artery disease and to quantify the degree of the problem of  the disease in Peshawar by using the Cox regression technique of survival analysis.

The data were collected from the patients presenting to the catheterization laboratory of Postgraduate Medical Institute, Lady Reading Hospital, Peshawar, Pakistan for coronary angiography. The sampling procedure used was convenient sampling. With the help of a concise history and laboratory investigations, data of 215 patients were collected, which include the name, age, gender, smoking history, presence or absence of diabetes mellitus, family history, hypertension and hypercholesterolemia. Cox Regression was fitted to the data by considering survival time as a response variable and age, gender, diabetes, hypertension, hypercholesterolemia, smoking, family history, number of vessels involved, left main stem disease, total occlusions and number of lesions as explanatory variables, whereas death is considered as an event.

Cox regression results reveal that hypercholesterolemia, left main stem disease, total occlusion, and joint effects of diabetes mellitus and smoking are the significant risk factors. It was also found that the survival of the male is associated with their cholesterol level, number of vessels blocked and interaction effects of hypertension and smoking.

The results of this analysis show that males have very high odds of an event occurrence in hypercholesterolemia, hypertension and smoking. On the other hand, females are more at risk if they are diabetic, hypertensive or if they are aged. The main findings of this study are that cholesterol level, diabetes and smoking are the important risk factors that cause coronary artery disease

Biography:

R.Vasiwala, International Medical University, Malaysia

Abstract:

Introduction: Since 1977, the BAHA (Bone Anchored Hearing Aid) has proven successful for thousands of patients worldwide. The Baha System has yielded excellent results for certain patient groups, particularly for those individuals with conductive or mixed hearing loss, or single-sided sensorineural deafness. However, adverse skin reaction was commonly observed in skin incision as well as around the titanium implant which can impair benefit of the implant and the patient’s quality of life

Objective: To review current available evidence to evaluate the adverse skin reactions in conjunction with surgical techniques utilized.

Methods: The search was carried out using three search engines, PubMed, Google Scholar and Cochrane Database of Controlled Trials.  The literature search date was from January 2006 until December 2016.  All the study designs were included except case report.  Initial search identified was 821 publications.  We reviewed 16 articles those met the inclusion criteria.  The surgical technique used for the past 10 years were split thickness skin graft (STSG) using dermatome and scalpel, full thickness skin graft (FTSG), linear incision with tissue reduction (simplified Nijmegen technique), linear incision with tissue preservation, pedicle flap using dermatome, two stages and one stage procedure.  The skin reaction was evaluated postoperatively by using Holger’s grading system.

Result:  The most common surgical techniques identified were full thickness skin graft, Dermatome and linear incision techniques.Tissue preservation technique is associated with more positive outcome in terms of skin complication, compared to the skin thinning method.  Linear incision appears to be associated with the lower incidence of adverse skin reactions. Besides, the two-stage procedure showed higher complication rate compared to one stage procedure. 

Conclusion: According to the current literatures from the past 10 years, the use of one stage, linear incision and skin preservation provide better skin outcomes.  However, higher quality studies are needed to support this finding.

Biography:

Abstract:

JNA is a histologically benign yet locally aggressive vascular tumor occupying the nasopharynx, seen in adolescent male aged between 5-25 years. The incidence of nasopharyngeal angiofibroma in elderly is extremely low. It is characterized by paroxysms of unprovoked painless profuse epistaxis. These lesions typically arise from sphenopalatine foramen which presents as nasopharyngeal mass.

My case is a 40 year old male patient presenting with profuse and unprovoked episodes of epistaxis . Radiological examinations established a nasal tumor , which was surgically resected. Post-operative pathological examination revealed Angiofibroma.

Biography:

Dr. Laurice Ann Canta has completed her medical degree from the University of the East Ramon Magsaysay Memorial Medical Center last 2014. She is currently in her 3rd year of residency at the Department of Otorhinolaryngology-Head and Neck Surgery at East Avenue Medical Center, Philippines

Abstract:

Tuberculous otitis media (TBOM) is a rare cause of chronic suppurative otitis media (CSOM) with variable clinical presentation. Currently, its symptomatology is evolving into a spectrum of simple otitis media to tumor-like manifestation. It is one of the cases easily misdiagnosed or undertreated.

This paper presents a case of a four year old male who had aggressive CSOM-like manifestations and distinctive intraoperative granulation tissue characteristic, initially deemed as a malignancy. It is one of the cases that needed surgical intervention and biopsy to arrive at the definitive diagnosis.

The aim of this case report is to describe and emphasize that surgical intervention and histopathologic studies can be employed to immediately arrive at a definitive diagnosis. This case represents the more severe end of the spectrum and supports the recommendation that high index of suspicion, especially in children with refractory otitis media, early detection, and prompt initiation of treatment are the imperative steps in managing TBOM.

Biography:

Dr Lucy Huang MD (2015) is a surgical resident medical officer at Flinders Medical centre, with a particular interest in Otorhinolaryngology Head and Neck Surgery. She is in her third post-graduate year. She completed internship at Lyell McEwin Hospital and is completing two years of surgical residency at Flinders Medical Centre. Dr Huang is currently in the process of applying for Masters of Surgery at Flinders University. She is also actively involved in clinical audits and multiple research projects with the Department of Otolaryngology Head & Neck Surgery, under the supervision of A/Professor Ooi .

Abstract:

Background:

Transnasal humidified rapid insufflation ventilatory exchange (THRIVE) is an anaesthetic technique that allows for prolonged apnoeic oxygenation without intubation. THRIVE is often conducted in patients with normal BMI and mild systemic disease. However, it is unclear if patients with an increased BMI or significant co-morbidities are able to safely undergo upper airway ENT procedure with THRIVE.

Methods:

A case note review of all ENT upper airway surgery conducted at Flinders Medical Centre and Flinders Private Hospital with the use of THRIVE and Optiflow was conducted. Factors extracted from the case notes were: age, BMI, ASA, smoking status, reflux disease, presence of respiratory and cardiac disease. Analysis utilised non-parametric tests and Odds Ratios.

Results:

THRIVE was used with the following upper airway procedures (n=56):  microlaryngoscopy with biopsy and/or injection laryngoplasty (n=20), microlaryngoscopy with KTP laser use (n=12), panendoscopy with biopsy (n=11), oesophageal dilatation (n=2), subglottic stenosis dilatation (n=10), and stapling of pharyngeal pouch (n=1). Rescue ventilation was required in 21.4% of cases (n=12). THRIVE related complications were reported in 1.8% of cases (1/56). Weight and BMI were associated with rescue ventilation (Mann Whitney U Tests; weight p=0.022, BMI p=0.045). A weight >100kg or BMI >30 were 5.7 times more likely to require rescue ventilation (Fisher Exact Test p=0.028 and p=0.021). Gender was also associated with rescue ventilation (Pearson Chi-Square r=-.319, p=0.017), with 75% being male. No other factors reported an association with rescue ventilation.  

Conclusion:

This case series demonstrates that THRIVE can be safely used for a variety of ENT upper airway procedures. However, there is a higher likelihood of rescue ventilation if patient is >100kg or has BMI>30. Continued investigation with a larger dataset is recommended

Biography:

Lauren Styan is an Ear Nose and Throat Principle House Officer currently working at Ipswich Hospital, QLD, Australia.

Abstract:

Introduction

Tonsillectomy is one of the most commonly performed procedures in children, typically for the management of sleep disordered breathing and/or recurrent tonsillitis. Intra-capsular coblation tonsillotomy is an emerging technique that has become popular due to its reported reductions in postoperative pain when compared to other methods. We aimed to investigate the outcomes of children undergoing intra-capsular coblation tonsillotomy for management of sleep disordered breathing in our department.

Methods

44 paediatric patients undergoing intracapsular coblation tonsillotomy (with or without adenoidectomy) for the management of sleep disordered breathing were recruited. Post operative pain levels, diet, analgesia requirement, return to normal activity and complication rates were collected. Validated self reported T-14 paediatric throat disorders outcome tools were completed by parent’s pre and post-operatively to assess for resolution of sleep disordered breathing symptoms. The outcomes were compared to a cohort of paediatric patients undergoing bipolar tonsillectomy.

Results

Coblation tonsillotomy was associated with significantly less postoperative pain (P<0.0001), earlier return to normal diet (P = 0.008) and activity (P = 0.013), and reduced analgesia requirement (P = 0.001). There was no statistically significant difference in the rates of post-tonsillectomy haemorrhage between the two groups (P= 0.109). Sleep disordered breathing outcomes have been excellent, with significant improvements in parent reported symptoms at three week postoperative follow-up (mean total T-14 score (/70) 23.9 preoperative, 2.4 three weeks postoperative, P<0.0001). Only a portion of the cohort has reached 12-month follow-up, however at this early stage there have been no reported recurrence of symptoms and no requirement for revision tonsil surgery.

Conclusion

Children with sleep disordered breathing who undergoing intracapular coblation tonsillotomy have less postoperative pain and faster recovery, when compared to bipolar tonsillectomy. Effective reduction of sleep disordered breathing symptoms is also demonstrated. Further studies are required to determine the long-term outcomes and also investigate the utility of this method for the management of recurrent tonsillitis.

Biography:

Mikyung Ye has completed her PhD at the age of 36years from Kyungpook National University and postdoctoral studies from University of Tennessee Health Science Center. She is the director of Public Relations of Korean Society of Otorhinolaryngology Head and Neck Sugery. She has published more than 100 papers in reputed journals and has been serving as an editorial board member of repute.

Abstract:

Gastroesophageal reflux disease (GERD) is related to lifestyles including eating habits. Patients with GERD often report decreased taste sensitivity when eating. Some patients  remark that food does not smell or taste the same. We aimed to investigate the effect of GERD on smell and taste functions. Four hundred eighty seven patients with taste disturbance who visited smell and taste clinic from 2010 to 2016 were evaluated. A questionnaire, which included questions regarding demographic information, taste and smell symptoms, taste preferences, and gastrointestinal symptoms was conducted. Diagnosis of GERD was based on the Korean version of GER questionnaires and/or esophagogastroduodenoscopy (EGD), 24hours PH monitoring. Olfactory testing was performed using the Korean version of sniffin’ sticks test. Whole mouth taste test was performed with successive solutions of sucrose, sodium chloride, citric acid, and quinine hydrochloride. The electrical taste thresholds were measured using an electrogustometer for four different sites in the oral cavity. One hundred ninety patients were diagnosed with GERD. Taste threshold and gastrointestinal symptom severity were significantly correlated. However, olfactory function test score was not significantly correlated with gastrointestinal symptom severity and with EGD findings. The patients with GERD showed higher taste preferences to salty, sour, and spicy food than without GERD group. Abnormalities in taste function were correlated with gastrointestinal symptom severity. Awareness of this high prevalence of GERD among patients with taste disturbance may help to better manage the taste disorder.

Biography:

Lauren Styan is an Ear Nose and Throat Principle House Officer currently working at Ipswich Hospital, Australia.

Abstract:

Introduction: The differential diagnosis of upper airway obstruction in adults is broad, including infection, foreign body aspiration, trauma, allergic reaction, malignancy and systemic disease. Upper airway obstruction secondary to laryngeal myxedema is a rare complication of severe hypothyroidism. There is limited literature to guide diagnosis and management, with only a small number of case reports available. We report the case of a patient with acute upper airway obstruction secondary to laryngeal myxedema, resulting in supraglottic oedema and bilateral vocal cord palsy. A review of the literature regarding the presentation, diagnosis and management of this rare, but life threatening condition is presented.

Case Presentation: A 54-year-old male presented to the emergency department with a 2 weeks history of progressive shortness of breath, productive cough and dysphonia. His past medical history was significant for hypertension, hypothyroidism and severe obstructive sleep apnea. He had self-ceased his antihypertensive and thyroxin two weeks prior. On initial evaluation the patient was in respiratory distress with significant stridor. Flexible nasendoscopy demonstrated diffuse edema of the supraglottis, with bilateral vocal cord palsy. His acute upper airway obstruction was managed with urgent fiber-optic intubation and subsequent tracheostomy. Laboratory studies revealed profound hypothyroidism and hyponatremia. The patient was admitted to the intensive care unit and commenced on thyroid replacement therapy and glucocorticoids. His bilateral vocal cord palsy and laryngeal edema resolved and he was successfully decannulated 4 weeks later.

Conclusion: Laryngeal myxedema is uncommon, but should be considered in patients presenting with upper airway obstruction and hypothyroidism. To our knowledge this is the only case reported in the literature in which laryngeal myxedema has resulted in bilateral vocal cord palsy. This case report and review of the literature suggests that, with appropriate airway management and treatment of underlying hypothyroidism, laryngeal myxedema is reversible and resolves over the course of two to four weeks.

Biography:

Dr. Amarendra Singh has completed his MS (ENT) at the age of 29 years from Mahatma Gandhi Mission Medical College, Navi Mumbai. He has completed his fellowship in the skull base surgery from Grouppo Otologico Piacenza, Italy under Prof. Mario Sanna in the year 2016. He has worked for thirty months as the Senior Resident in the department of ENT at Heritage Insitute of Medical Science, Varanasi. Now, he has set up his own ENT centre, which is known as Kashi ENT Centre, Varanasi.

Abstract:

Olfactory Neuroblastoma is an uncommon malignant nasal tumour originating from the olfactory neurosurgical cells of nasal cavity. OAN represents less then 5 percent of all sinonasal malignancies.The incidence of this tumour has a nominal distribution with peak at 20 and 50 year of age,respectively.OAN is also as aesthesineuroblastoma or neuroendocrine carcinoma. A 50 year old male presented with mass in nasal cavity with intermittent epistaxis, who was treated by combined surgical excision and RT.

Biography:

Lucy Huang is a Surgical Resident Medical Officer at Flinders Medical Center with a particular interest in Otorhinolaryngology Head and Neck Surgery. She has completed her Internship at Lyell McEwin Hospital and is completing two years of Surgical Residency at Flinders Medical Centre. She is actively involved in clinical audits and multiple research projects with the Department of Otolaryngology Head and Neck Surgery.

Abstract:

Background: Trans nasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) is an anesthetic technique that allows for prolonged apnoeic oxygenation without intubation. THRIVE is often conducted in patients with normal BMI and mild systemic disease. However, it is unclear if patients with an increased BMI or significant comorbidities are able to safely undergo upper airway ENT procedure with THRIVE.

Method: A case note review of all ENT upper airway surgery conducted at Flinders Medical Centre and Flinders Private Hospital with the use of THRIVE and optiflow was conducted. Factors extracted from the case notes were: age, BMI, ASA, smoking status, reflux disease, presence of respiratory and cardiac disease. Analysis utilized non-parametric tests and odds ratios.

Result: THRIVE was used with the following upper airway procedures (n=56): micro laryngoscopy with biopsy and/or injection laryngoplasty (n=20), micro laryngoscopy with KTP laser use (n=12), panendoscopy with biopsy (n=11), esophageal dilatation (n=2), subglottic stenosis dilatation (n=10) and stapling of pharyngeal pouch (n=1). Rescue ventilation was required in 21.4% of cases (n=12). THRIVE related complications were reported in 1.8% of cases (1/56). Weight and BMI were associated with rescue ventilation (Mann Whitney U Tests; weight p=0.022, BMI p=0.045). A weight >100 kg or BMI >30 were 5.7 times more likely to require rescue ventilation (Fisher Exact Test p=0.028 and p=0.021). Gender was also associated with rescue ventilation (Pearson Chi-Square r=-0.319, p=0.017), with 75% being male. No other factors reported an association with rescue ventilation.

Conclusion: This case series demonstrates that THRIVE can be safely used for a variety of ENT upper airway procedures. However, there is a higher likelihood of rescue ventilation if patient is >100 kg or has BMI >30. Continued investigation with a larger dataset is recommended.

Biography:

Lauren Styan is an Ear Nose and Throat Principle House Officer currently working at Ipswich Hospital, Australia.

Abstract:

Introduction & Aim: Tonsillectomy is one of the most commonly performed procedures in children, typically for the management of sleep disordered breathing and/or recurrent tonsillitis. Intracapsular coblation tonsillectomy is an emerging technique that has become popular due to its reported reductions in postoperative pain when compared to other methods. We aimed to investigate the outcomes of children undergoing intracapsular coblation tonsillectomy for management of sleep disordered breathing in our department.

Method: 44 pediatric patients undergoing intracapsular coblation tonsillectomy (with or without adenoidectomy) for the management of sleep disordered breathing were recruited. Post-operative pain levels, diet, analgesia requirement, return to normal activity and complication rates were collected. Validated self-reported T-14 pediatric throat disorders outcome tools were completed by parent’s pre and post-operatively to assess for resolution of sleep disordered breathing symptoms. The outcomes were compared to a cohort of pediatric patients undergoing bipolar tonsillectomy.

Result: Coblation tonsillectomy was associated with significantly less postoperative pain (P<0.0001), earlier return to normal diet (P=0.008) and activity (P=0.013) and reduced analgesia requirement (P=0.001). There was no statistically significant difference in the rates of post-tonsillectomy hemorrhage between the two groups (P=0.109). Sleep disordered breathing outcomes have been excellent, with significant improvements in parent reported symptoms at three week postoperative follow-up (mean total T-14 score (/70) 23.9 preoperative, 2.4 three weeks postoperative, P<0.0001). Only a portion of the cohort has reached 12-month follow-up, however at this early stage there have been no reported recurrence of symptoms and no requirement for revision tonsil surgery.

Conclusion: Children with sleep disordered breathing undergoing intracapsular coblation tonsillectomy have less postoperative pain and faster recovery, when compared to bipolar tonsillectomy. Effective reduction of sleep disordered breathing symptoms is also demonstrated. Further studies are required to determine the long-term outcomes and also investigate the utility of this method for the management of recurrent tonsillitis

Biography:

Arlene R. Fernandez is a 28-year-old 4^th year Resident Physician at Ospital ng Maynila Medical Center (OMMC), Manila Philippines. She graduated with degree of Medical Doctor at Pamantasan ng Lungsod ng Maynila (University of City of Manila). She is the current Chief Resident of the Department of Otorhinolaryngology, OMMC. She had presented at the recently held 17th ASEAN ORL-HNS congress at Yangon, Myanmar for her case study.

Abstract:

Epistaxis is the most common otolaryngologic emergency. Fortunately, almost 90% may be controlled by applying first aid measures. Although the prevalence of epistaxis is high, the public has limited knowledge on first aid intervention. This is a perspective descriptive study which aims to measure the level of knowledge, attitude, practices of patients and their caregiver seen by the Department of Otorhinolaryngology in a Tertiary Government Hospital in Manila. A total of 163 respondents were interviewed. Results showed that their knowledge of the cause and correct management of epistaxis is low. Only 7.4% answered the correct combination for first aid management which includes nose pinching and leaning forward. On knowledge of prevention avoiding hot weather was the highest which was parallel to the respondents’ perception of the major cause of the epistaxis. The attitude of respondents towards epistaxis were high, 89% answered that it is necessary to stop epistaxis by applying intervention. Lastly, for their practice on the management of epistaxis, the combination of pinching the nose on the ala part and head downward were correctly answered by only 6.7%. This study revealed the low knowledge and practices of patients and caregivers towards epistaxis. The attitude towards epistaxis of the respondents is high which demonstrates they are keen to learn and may have a good reception to educational material that may be presented to them to increase their awareness towards epistaxis. This may help to decrease the number of medical consults and to lessen the morbidity of incorrect management of epistaxis.

Biography:

Abstract:

Objective:

To compare local versus general anesthesia for endoscopic surgical treatment of  Sino nasal polyposis during operation as well as early and late postoperative period together with patient ^,s acceptance for surgery.

Methods:

A total of 40 patients (any age) with sinonasal polyposis will be included in the study. They are numbered from 1to 40, patients with odd number were put in group (1) and will undergo endoscopic nasal surgery under local anesthesia. And those with even number were in Group (2) patient will undergo endoscopic nasal surgery under general anesthesia.

Results:

Most of patients done under local anesthesia showed good acceptance for surgery, short time of surgery and less bloody field than those done under general anesthesia.

Conclusion:

Surgery of sinonasal polyposis under local anesthesia was an effective method for treatment of nasal polyposis as regard patient acceptance for surgery, time of surgery, very good surgical field and less cost.

Biography:

Lauren Styan is an Ear Nose and Throat Principle House Officer currently working at Ipswich Hospital, QLD, Australia.

Abstract:

Introduction:

The differential diagnosis of upper airway obstruction in adults is broad; including infection, foreign body aspiration, trauma, allergic reaction, malignancy and systemic disease. Upper airway obstruction secondary to laryngeal myxedema is a rare complication of severe hypothyroidism. There is limited literature to guide diagnosis and management, with only a small number of case reports available. We report the case of a patient with acute upper airway obstruction secondary to laryngeal myxedema, resulting in supraglottic oedema and bilateral vocal cord palsy.  A review of the literature regarding the presentation, diagnosis and management of this rare, but life threatening condition is presented.

Case Presentation:

A 54-year-old male presented to the emergency department with a 2 weeks history of progressive shortness of breath, productive cough and dysphonia. His past medical history was significant for hypertension, hypothyroidism and severe obstructive sleep apnoea. He had self ceased his antihypertensive and thyroxine two weeks prior. On initial evaluation the patient was in respiratory distress with significant stridor. Flexible nasendoscopy demonstrated diffuse oedema of the supraglottis, with bilateral vocal cord palsy. His acute upper airway obstruction was managed with urgent fiber-optic intubation and subsequent tracheostomy. Laboratory studies revealed profound hypothyroidism and hyponatraemia. The patient was admitted to the intensive care unit and commenced on thyroid replacement therapy and glucocorticoids. His bilateral vocal cord palsy and laryngeal oedema resolved and he was successfully decannulated 4 weeks later.

Conclusion:

Laryngeal myxedema is uncommon, but should be considered in patients presenting with upper airway obstruction and hypothyroidism. To our knowledge this is the only case reported in the literature in which laryngeal myxedema has resulted in bilateral vocal cord palsy. This case report and review of the literature suggests that, with appropriate airway management and treatment of underlying hypothyroidism, laryngeal myxedema is reversible and resolves over the course of two to four weeks.

Biography:

Dr Lucy Huang MD (2015) is a surgical resident medical officer at Flinders Medical centre, with a particular interest in Otorhinolaryngology Head and Neck Surgery. She is in her third post-graduate year. She completed internship at Lyell McEwin Hospital and is completing two years of surgical residency at Flinders Medical Centre. Dr Huang is currently in the process of applying for Masters of Surgery at Flinders University. She is also actively involved in clinical audits and multiple research projects with the Department of Otolaryngology Head & Neck Surgery, under the supervision of A/Professor Ooi .

Abstract:

Background:

Transnasal humidified rapid insufflation ventilatory exchange (THRIVE) is an anaesthetic technique that allows for prolonged apnoeic oxygenation without intubation. THRIVE is often conducted in patients with normal BMI and mild systemic disease. However, it is unclear if patients with an increased BMI or significant co-morbidities are able to safely undergo upper airway ENT procedure with THRIVE.

Methods:

A case note review of all ENT upper airway surgery conducted at Flinders Medical Centre and Flinders Private Hospital with the use of THRIVE and Optiflow was conducted. Factors extracted from the case notes were: age, BMI, ASA, smoking status, reflux disease, presence of respiratory and cardiac disease. Analysis utilised non-parametric tests and Odds Ratios.

Results:

THRIVE was used with the following upper airway procedures (n=56):  microlaryngoscopy with biopsy and/or injection laryngoplasty (n=20), microlaryngoscopy with KTP laser use (n=12), panendoscopy with biopsy (n=11), oesophageal dilatation (n=2), subglottic stenosis dilatation (n=10), and stapling of pharyngeal pouch (n=1). Rescue ventilation was required in 21.4% of cases (n=12). THRIVE related complications were reported in 1.8% of cases (1/56). Weight and BMI were associated with rescue ventilation (Mann Whitney U Tests; weight p=0.022, BMI p=0.045). A weight >100kg or BMI >30 were 5.7 times more likely to require rescue ventilation (Fisher Exact Test p=0.028 and p=0.021). Gender was also associated with rescue ventilation (Pearson Chi-Square r=-.319, p=0.017), with 75% being male. No other factors reported an association with rescue ventilation.  

Conclusion:

This case series demonstrates that THRIVE can be safely used for a variety of ENT upper airway procedures. However, there is a higher likelihood of rescue ventilation if patient is >100kg or has BMI>30. Continued investigation with a larger dataset is recommended.

Biography:

Abstract:

A case of unusually large brown tumour of mandible mimicking cherubism in a patient with chronic kidney disease with tertiary hyperparathyroidism. Clinical Details: A 41 year male, of short stature and short neck, presented in Head and Neck Oncosurgery with a grossly enlarged and protruding lower jaw, open mouth with chronic kidney disease on dialysis. Patient was immobile and limited to wheelchair.  Biochemical Investigations: Serum Calcium 10.2mg/dL. Serum PTH was 4808.0 pg/mL & 25–OH Vitamin D 16.3 g/mL. Sestamibi scan showed left inferior parathyroid adenoma (below the lower pole of left thyroid gland). Ultrasound in addition to sestamibi showed all the four enlarged parathyroids as hypoehoic nodules in their normal location behind the thyroid with characteristic arc of vascularity. Chest X Ray: showed gross cardiomegaly. Bilateral clavicles, scapula, humerus and multiple ribs showed mixed lytic and sclerotic areas. Calcification of the trachea and bilateral bronchi was seen Echocardiography: showed global left ventricular hypokinesia with paradoxical septal motion, thickened and calcific mitral valve leaflet with moderate MR (mitral regurgitation) Radionuclide Bone Scan (20mCiof Tc-99m MDP): showed focal abnormal uptake in the grossly enlarged mandible and maxilla. Increased uptake also noted in calvarium. CT Facial Bones  Generalised increased bone density with multiple lytic and sclerotic lesions in all bones of skull. Gross expansion and marked thinning of cortex of bilateral maxilla, causing narrowing of the nasopharynx and nasal cavities. The expanded mandible displacing the tongue posteriorly and causing narrowing of oropharynx and hypopharynx. Significant destruction of the alveolar arches in maxilla and mandible was seen giving a “ floating appearance to the teeth”. Discussion: With the enlarged mandible and floating teeth appearance cherubism was initially considered as a differential diagnosis. Cherubism is a rare genetic childhood disorder which causes enlargement of the lower part of face due to  abnormal growth of the mandible and maxilla, where the bone enlarges and is replaced by cysts. It is considered as a variant of fibrous dysplasia. With further imaging the generalised metabolic abnormality of bones is suggested. In view of markedly raised parathormone levels, brown tumors in maxilla and mandible is likely diagnosis. Histopathology showed fibrocollagenous tissue admixed with irregular spicules of woven trabecular bone. Multple multinucleated osteoclastic type giant cells are seen. Foci of calcification seen. Findings consistent with brown tumor syndrome.

Biography:

Dr.Md.Mofakkarul Islam has completed his Graduation: M.B.B.S,2003 from JRRMCH under SUST, Bangladesh. and postdoctoral studies Post Graduation:D.L.O, 2009 from DMC Under Dhaka, University,Bangladesh. He also has Fellowships on Otology 2013 from MIMER,Pune, India, Rhinology 2015 from Asan Medical Center, Seoul, South Korea, and also on Skull Base Surgery 2016 from Taipei Veterans General Hospitals, Taipei, Taiwan. After working at different  institutions of Bangladesh, Joined at JRRMCH on 2012 as Junior Consultant of ENT. Currently working as Assistant  Professor of ENT in the same institution.

Abstract:

Cancer of the external auditory canal (EAC) and middle ear (ME) is rare, accounting for less than 1% of all head-and-neck malignancies of which squamous cell carcinoma (SCC) is the most common. Even though squamous cell carcinoma [SCC] of the middle ear and malignant otitis externa  or Chronic supporative otitis media(CSOM) co-exist, no definitive correlation has been proven. Here we are presenting a case of an elderly patient who had been suffering with severe otalgia, profuse otorrhea,shortness of hearing, and associated facial palsy having predisposing factors such as Diabetes mellitus. Immune compromised states also be worked up for the diagnosis of malignant otitis externa or skull base osteomyelitis. A provisional diagnosis of malignant otitis externa and non responding chronic suppurative otitis media(CSOM) was made and treated accordingly but response of the treatment was not satisfactory. Then we further evaluate the patient as per the available logistics in this region e.g. CT scan,culture & sensitivity,viral culture, audiometry.And decided for exploring the mastoid and finally  radical mastoidectomy was done.  Histology of the explored  mastoid specimen revealed  Invasive  squamous cell carcinoma grade-2, which was treated with radical radiotherapy. Objective of this presentation is to bring attention to the coexistence of malignant otitis externa, CSOM and squamous cell carcinoma ear and also the importance to detect these lesions at an early stage. This report also highlights the requirement of histopathological analysis in mastoidectomy and discusses the aetiology and management of squamous cell carcinoma of the middle ear in a rural developing medical institute where there were some challenges of shortages of skill medical personnel, less than expected  health infrastructure, modern & updated equipment and required pathological support. Moreover must assemble logistics often not seen.

Biography:

Dhaniel Abdi Wicaksana has completed his medical degree at the age of 24 years from Krida Wacana Christian University and otorhinolaryngology head and neck surgery residency program at the age of 31 years from Brawijaya University. He is the Pelita Harapan University Lecturer.

Abstract:

Background: Fungal chronic rhinosinusitis is a major health problem because of the large impacts associated with declining quality of life and difficult medical treatment as well as the prevalence that tends to increase. There is currently opportunity to establish diagnosis without invasive intervention by utilizing β-glucan which is the largest component of fungal cell wall. Purpose: To discover the congruity of β-glucan level in paranasal sinus tissue and blood serum as a potentially diagnosis marker for fungal chronic rhinosinusitis patients. Methods: This was a cross sectional study which involved 20 subjects. Blood sampling and maxillary sinus surgery were performed, then fungi identification in the sinus mucosa was done by polymerase chain reaction PCR technique. If a fungi species with β-glucan was found, then the examination was continued with the measurement of β-glucan by enzyme-linked immunosorbent assay (ELISA) technique in sinus and blood. Results: Aspergillus flavus is the most commonly found fungus. All subjects passed the positive β-glucan limit (≥ 80 pg/mL) of the mucosal sample and only 1 subject had intermediate results (60-79 pg/mL) from blood. Paired t test result was no significant difference between the level of β-glucan in blood and mucosal sinus (p=0.886), so that β-glucan examination of blood can describe β-glucan levels in paranasal sinuses. Conclusion: β-glucan may be used to establish the diagnosis of fungal chronic rhinosinusitis so it is hoped that the process of diagnosis of chronic rhinosinusitis fungus can be obtained quickly and precisely without the need for invasive procedure although it requires more research, especially related to diagnostic test.

Biography:

Abstract:

Background:

 In the field of rhinology, the majority of studies focus on mucosal immunology of the nose without giving attention to the underlying bones. Recent evidence indicates that the inflammation of chronic rhinosinusitis (CRS) is beyond the mucous membrane and involves the underlying bone of the paranasal sinuses as well. In the current study we tried to assess the prescence of osteitis in ethmoid bone and tissue eosinophilia in nasal mucosa of patients with chronic rhinosinusitis.

Patient and Method:

A total of 85 patients (37 females and 48 males) who underwent surgery in our university hospital contributed to this study by providing bone samples from the ethmoid bone. They were divided into four groups: group I are Allergic Fungal Sinusitis (AFS) patients; group II are Chronic Rhinosinusitis patients without nasal polyp (CRSsNP); group III are Chronic Rhinosinusitis patients with nasal polyp (CRSwNP) and group IV are patients who underwent septoplasty as control group. Histological evaluation for osteitis (periosteal thickening and remodeling, osteoblastic and osteoclastic activity, and osteomyelitis and bone destruction) that was graded from 0 to IV, where grade 0 is normal histology and grade IV is frank osteomyelitis and bone destruction.

Results:

 Descriptive histology of the ethmoid bone analysis demonstrated osteitis of different grades in patients suffering from CRS: AFS patients; grade I (13.3%), grade II (46.7%), grade III (33.3%) and grade IV (6.7%). CRSsNP patients; grade 0 (10%), grade I (30%), grade II (40%), grade III (16.7%) and grade IV (3.3%). CRSwNP patients; grade 0 (10%), grade I (50%), grade II (20%), grade III (20%) and Control patients(DNS); grade 0 (70%), grade I (30%).

Conclusion:

 Herein, we show evidence of osteitis in CRS and confirm the presence of a higher grade osteitis in the AFS patients. This sinus bone remodeling may contribute to the chronicity of the disease and carries special consideration in the treatment of CRS.

Biography:

Dr. Christen-Zen I. Sison earned her B.Sc. Degree Double Major in Biology and Kinesiology at the York University in Toronto, Canada in 2008. She went on to complete her M.D. Degree from the University of Santo Tomas Faculty of Medicine and Surgery in 2014. She is currently in her 3rd year of residency with the Department of Otorhinolaryngology-Head & Neck Surgery at the University of Santo Tomas Hospital in Manila, Philippines.

Abstract:

Unilateral hearing loss is a significant complaint that is often encountered in otolaryngology practice and if left uninvestigated, it may have dire consequences. In this case, we encountered a rare condition of a 12-year old girl who initially presented with progressive unilateral sensorineural hearing loss, with no evidence of facial palsy. Neuroimaging demonstrated stenosis of the internal auditory canal. Isolated cases of congenital primary stenosis of the internal auditory canal (IAC) is a rare condition although other temporal bone conditions may also accompany this condition. Even though the majority of patients exhibit sensorineural hearing loss, there are also cases wherein the hearing is normal in patients with stenotic canals, leading several studies to investigate the causal link between this anatomic abnormality and deafness. Typical radiographic findings are described in this case, and the relevant embryological origins of the ear are traced in detail. The association of isolated IAC stenosis and hearing loss in this case suggests a correlation between stenosis and deafness. Most of the literature is focused on the effect of IAC stenosis on the outcome of cochlear implantation. There is currently no consensus regarding the therapeutic management for these types of cases since there are only a few reports in literature.

Biography:

Dr. Christen-Zen I. Sison earned her B.Sc. Degree Double Major in Biology and Kinesiology at the York University in Toronto, Canada in 2008. She went on to complete her M.D. Degree from the University of Santo Tomas Faculty of Medicine and Surgery in 2014. She is currently in her 3rd year of residency with the Department of Otorhinolaryngology-Head & Neck Surgery at the University of Santo Tomas Hospital in Manila, Philippines.

Abstract:

Unilateral hearing loss is a significant complaint that is often encountered in otolaryngology practice and if left uninvestigated, it may have dire consequences. In this case, we encountered a rare condition of a 12-year old girl who initially presented with progressive unilateral sensorineural hearing loss, with no evidence of facial palsy. Neuroimaging demonstrated stenosis of the internal auditory canal. Isolated cases of congenital primary stenosis of the internal auditory canal (IAC) is a rare condition although other temporal bone conditions may also accompany this condition. Even though the majority of patients exhibit sensorineural hearing loss, there are also cases wherein the hearing is normal in patients with stenotic canals, leading several studies to investigate the causal link between this anatomic abnormality and deafness. Typical radiographic findings are described in this case, and the relevant embryological origins of the ear are traced in detail. The association of isolated IAC stenosis and hearing loss in this case suggests a correlation between stenosis and deafness. Most of the literature is focused on the effect of IAC stenosis on the outcome of cochlear implantation. There is currently no consensus regarding the therapeutic management for these types of cases since there are only a few reports in literature.