DIAGNOSIS-:LINGUAL THYROID-;-USG neck- no thyriod gland in neck::Tc99-isotope uptake in base of toungue area::Cause-faliure of migration of thyroid tissue as endodermal pouch through foramen of caecum and sequestration within the tongue substance::HYPERTROPHY of the gland occurs when requirement increases as in puberty,metabollic stress,pregnacy,infection,
Wednesday 31 August 2011
ROBOTIC SURGERY IN ENT
There has been increasing interest in using robots to help the surgeon perform complex surgical procedures within small spaces thereby saving the patient more invasive incisions. Especially in the world of ENT, surgery that may have required large incisions to the face and/or neck can now be accomplished without any incisions by using robotics to perform the same surgery, but entirely through the mouth
Such robotic surgery performed through the mouth is called Trans-Oral Robotic Surgery, or simply TORS. The DaVinci system is the robotics platform that is most commonly used in TORS....
Using TORS and other approaches, head and neck surgeons have been able to remove the thyroid gland through the armpit, perform base of tongue cancer surgical excision (same cancer that Michael Douglas had), voicebox removal (laryngectomy), vocal cord surgery
In many of these and other surgeries, any procedure performed through the mouth traditionally was limited to two hands. With the DaVinci system, one technically can fit as many as FOUR "hands" inside the mouth enabling greater surgical flexibility and ease in performing fine dissections that otherwise would be impossible
There are some downsides however... namely, use of robotic surgery is not compensated by insurance and as such, major medical centers are the only locations where such high-tech equipment is available....
Sterile Ear Piercing
Sterile Ear Piercing Using Lab-Tested, Hypoallergenic, Packaged & Sealed Earring Studs-Performed in a sterile manner (numbing offered as well)
• Ear studs placed are hypoallergenic
• Ear piercing system used has been laboratory tested, packaged, and sealed
• Hypoallergenic studs and clasps are individually sealed with disposable earpiercer - avoiding any concern of cross contamination...
contraption designed to correct nasal deformity
A remarkable contraption designed to correct nasal deformity or septal deviation. It was completely ineffective and had only a brief window of popularity in France in the early 20th century. The metal device was held in position over the he...ad and nose with an elasticated band and the screws were then tightened so as, in theory, to correct any deviation from the midline. A rather beautifully engraved and and attractive little folly from medical history...
Cancer Patient Gets World's First Artificial Trachea
The patient, Andemarian Telesenbet Beyene, a 36-year-old geology student from Eritrea, had been suffering from late-stage tracheal cancer. A rare, aggressive tumor was blocking his windpipe making it hard for him to breath. Diagnosed in 200...8, Beyene had failed every conventional treatment including chemotherapy, radiation and surgery. He was running out of time, so rather than wait for a donor trachea for transplantation, his doctors suggested growing his own in the lab
This is not the first time a lab-engineered trachea has been used for transplantation. But in previous cases, the tracheas were built with donor organs. The donated tracheas were stripped of the donors' cells — leaving only the cartilage sc...affold — and then reseeded with stem cells derived from the recipients' own bone marrow. Once the stem cells took hold and grew on the scaffold, the tracheas could be transplanted into the patient without fear of rejection
Scientists created a Y-shaped framework for the new trachea, modeling it after the specific shape of the patient's windpipe. The form was made of polymers that had a spongy and flexible texture. Stiff rings around the tube mimicked the stru...cture of a human trachea.
The form was then bathed in a solution containing the patient's stem cells "to get the cells to grow on the sponge material," said David Green, president of Harvard Bioscience. Stem cells can divide and turn into a range of cell types, including those in organs
Polymer scaffold was made by Alexander Seifalian at University College London. The bioreactor that would hold the trachea and incubate it with Beyene's stem cells was created by Harvard Bioscience, near Boston. The scaffold and bioreact...or were then shipped to Stockholm, where the solution containing the patient's stem cells was added. The final product was days in the making, versus the months it could have taken to locate a donor organ
The artificial trachea was transplanted on June 9 in a 12-hour surgery led by Dr. Paolo Macchiarini, a pioneer in engineered trachea transplantation, at the Karolinska University Hospital in Stockholm. The patient appears to have accepted t...he new organ well, doctors said.
"It's working like a normal windpipe," Macchiarini told NPR's Shots blog. "He's able to cough. He's able to expel his secretions. He's breathing normally. He has the sensation he's breathing...
The posterior part of the cricoid is slightly broader than the anterior and lateral parts, and is called the lamina, while the anterior part is the band; this may be the reason for the common comparison made between the cricoid and a signet ring
Cricoid is made up of hyaline cartilage..height of anterior lamina is 3-7mm and posterior lamina is about 20-30mm height..post surface of cricoid the post cricoarytenoid muscles are attached.When intubating a patient under general anesthes...ia prior to surgery, the anesthesiologist will press on the cricoid cartilage to compress the esophagus behind it so as to prevent gastric reflux from occurring: this is known as the Sellick manoeuvre
During Sellick manoeuvre cricoid pressure should not be more than 30N ...or can lead to fracture of cricoid cartilage..even linear fracture of the cricoid cartilage causes some resorption of cartilage and reduction of caliber of airway at t...he same level..resorption of cricoid cartilage can also be occured,if tracheostomy tube placed between cricoid and 1st ring...AS A GENERAL RULE INJURY TO CRICOID CARTILAGE HAS HIGEST INCIDENCE OF AIRWAY COMPROMISE...LEVEL OF CRICOID IS BETWEEN 5TH & 6TH CERVICAL VETEBRAL...
Layperson's Cure for Snoring and Obstructive Sleep Apnea
Apparently, there is a community in Australia where citizens put tongue bolts in their tongue, not because it looks cool, but because it really, truly helps with snoring as well as OSA. Apparently, when these citizens go to sleep, they plac...e a rubber band around the tongue bolt and anchor it to their front teeth. This method would prevent the tongue from vibrating as it would stretch and stiffen the tongue AND also prevent the tongue from falling backward.
This simple procedure actually duplicates the surgical procedures performed in the United States including hyoid advancement, genioglossus advancement, Repose tongue advancement, etc. All these surgical procedures for the tongue, in essence, try to anchor the tongue forward, just like the tongue bolt/rubber band technique
Tuesday 30 August 2011
ENT TODAY: PATULOUS EUSTACHIAN TUBE
Schwartze first described patulous eustachian tube in 1864 when he noted a scarred atrophic eardrum moving synchronously with respiration. This condition was first fully described in 1867 by Jago, who had a patulous eustachian tube
Patulous Eustachian tube, also known as patent Eustachian tube, is the name of a rare physical disorder where the Eustachian tube, which is normally closed, instead stays intermittently open. When this occurs, the patient experiences autophony, the hearing of self-generated sounds. These sounds, such as one's own breathing, voice, and heartbeat, vibrate directly onto the ear drum and can create a "bucket on the head" effect
Symptoms
Patulous Eustachian tube sounds very similar to the standard congestion one gets from a cold or allergies, though there are subtle differences. The effect is often described as "drier"; with normal congestion, breathing and talking echo in the head with a muffled sound. With patulous Eustachian tube, variations in upper airway pressure associated with respiration are transmitted to the middle ear through the eustachian tube. This causes an unpleasant fullness feeling in the middle ear and alters the auditory perception. Complaints seem to include "muffled" hearing and autophony. In addition, patulous Eustachian tube generally feels dry with no clogged feeling or sinus pressure.
Some patients with this condition are disturbed by the perceived volume of their voice, causing them to speak very quietly. Their own voice may also sound lower to other people, because the trachea has more volume when the Eustachian tube is open. The patient may also sound as if they have congestion when speaking. Some sufferers may have difficulty in normal activities. Increased breathing rate, such as that brought on by physical activity. The increased activity not only increases the rate and force of pressure changes in the airway, which is therefore transmitted more forcefully into the middle ear, but also drives increased blood flow to peripheral muscles, compounding the problem by further depleting the eustachian tube of extracellular fluid and increasing patency. The combination can lead to severe exacerbation of the symptoms. The urge to "clear" the ear is often mentioned
Diagnosis
Upon examination of a suspected case of patulous Eustachian tube, a doctor can directly view the tympanic membrane with a light and observe that it vibrates with every breath taken by the patient. A tympanogram may also help with the diagnosis. Patulous Eustachian tube is likely if brisk inspiration causes a significant pressure shift.
Patulous Eustachian tube is frequently misdiagnosed as standard congestion due to the similarity in symptoms and rarity of the disorder. Audiologists are more likely to recognize the disorder, usually with tympanometry or nasally delivered masking noise during a hearing assessment, which is highly sensitive to this condition.[1]
When misdiagnosis occurs, a decongestant medication is sometimes prescribed. This type of medication aggravates the condition, as the Eustachian tube relies on sticky fluids to keep closed and the drying effect of a decongestant would make it even more likely to remain open and cause symptoms. The misdiagnosed patient may also have tubes surgically inserted into the eardrum, which increases the risk of ear infection and will not alleviate patulous Eustachian tube. If these treatments are tried and failed, and the doctor is not aware of the actual condition, the symptoms may even be classified as psychological.
Incidentally, patients who instead suffer from the even rarer condition of superior canal dehiscence are at risk for misdiagnosis of patulous Eustachian tube due to the similar autophony in both conditions.........
Causes
Patulous Eustachian tube is a physical disorder. The exact causes may vary depending on the person. Weight loss is a commonly cited cause of the disorder due to the nature of the Eustachian tube itself. Fatty tissues hold the tube closed most of the time in healthy individuals. When circumstances cause overall body fat to diminish, the tissue surrounding the Eustachian tube shrinks and this function is disrupted.[2]
Activities and substances which dehydrate the body have the same effect and are also possible causes of patulous Eustachian tube. Examples are stimulants (including caffeine) and exercise. Exercise may have a more short-term effect than caffeine or weight loss in this regard.
Pregnancy can also be a cause of patulous Eustachian tube due to the effects of pregnancy hormones on surface tension and mucous in the respiratory system
Treatment
Historically, to temporarily alleviate symptoms, patients have tried positional maneuvers, such as tilting their head to one side or upside down, lie down on their backs, or sit in a chair with their head between their knees. Similarly, a routine of lying down four times per day with legs elevated to around 20 inches for at least two weeks has been attempted as well. Depending on the underlying cause of the disorder, the individual may need to remove caffeine from their diet, reduce exercise, or gain weight.
Estrogen (Premarin) nasal drops or saturated potassium iodide have been used to induce edema of the eustachian tube opening. Nasal medications containing diluted hydrochloric acid, chlorobutanol, and benzyl alcohol have been reported to be effective in some patients, with few side effects. Food and Drug Administration approval is still pending, however
Local Therapy to Patulous Eustachian Tube
Bezold method (Bezold,1908)
Narrow the lume of the Eustachian Tube by salicylic accid/bolic accid insufflation
Narrow the lumen ofthe Eustachian Tube by extrinsic compression
Paraffin injection (Zollner,1937), Teflon injection (Pulec,1967),Gelatine sponge injection (Ogawa,1976)
Alter the function of palatal muscles (Misurya,1974)
Pterygoid hamulotomy (Virtanen,1982),Occlusion of the bony Eustachian Tube with a tympanotomy(Bluestone,1981)
Myryngotomy and insertion of a ventilating tube (Suehs,1960)
Temporary relief
Diathermy (Robinson,1989)
Using a ureteric Diathermy probe
Patients with a patulous eustachian tube who are pregnant and those with mild symptoms (most patients) need informative reassurance alone. Patients who have symptoms during pregnancy are symptom-free after delivery.
Advise patients to do the following:
■Increase or regain lost weight
■Avoid diuretics
■Recline or lower head when symptoms occur
Topical administration (nasal preparation) with anticholinergics may be effective for some patients........
Patulous Eustachian tube, also known as patent Eustachian tube, is the name of a rare physical disorder where the Eustachian tube, which is normally closed, instead stays intermittently open. When this occurs, the patient experiences autophony, the hearing of self-generated sounds. These sounds, such as one's own breathing, voice, and heartbeat, vibrate directly onto the ear drum and can create a "bucket on the head" effect
Symptoms
Patulous Eustachian tube sounds very similar to the standard congestion one gets from a cold or allergies, though there are subtle differences. The effect is often described as "drier"; with normal congestion, breathing and talking echo in the head with a muffled sound. With patulous Eustachian tube, variations in upper airway pressure associated with respiration are transmitted to the middle ear through the eustachian tube. This causes an unpleasant fullness feeling in the middle ear and alters the auditory perception. Complaints seem to include "muffled" hearing and autophony. In addition, patulous Eustachian tube generally feels dry with no clogged feeling or sinus pressure.
Some patients with this condition are disturbed by the perceived volume of their voice, causing them to speak very quietly. Their own voice may also sound lower to other people, because the trachea has more volume when the Eustachian tube is open. The patient may also sound as if they have congestion when speaking. Some sufferers may have difficulty in normal activities. Increased breathing rate, such as that brought on by physical activity. The increased activity not only increases the rate and force of pressure changes in the airway, which is therefore transmitted more forcefully into the middle ear, but also drives increased blood flow to peripheral muscles, compounding the problem by further depleting the eustachian tube of extracellular fluid and increasing patency. The combination can lead to severe exacerbation of the symptoms. The urge to "clear" the ear is often mentioned
Diagnosis
Upon examination of a suspected case of patulous Eustachian tube, a doctor can directly view the tympanic membrane with a light and observe that it vibrates with every breath taken by the patient. A tympanogram may also help with the diagnosis. Patulous Eustachian tube is likely if brisk inspiration causes a significant pressure shift.
Patulous Eustachian tube is frequently misdiagnosed as standard congestion due to the similarity in symptoms and rarity of the disorder. Audiologists are more likely to recognize the disorder, usually with tympanometry or nasally delivered masking noise during a hearing assessment, which is highly sensitive to this condition.[1]
When misdiagnosis occurs, a decongestant medication is sometimes prescribed. This type of medication aggravates the condition, as the Eustachian tube relies on sticky fluids to keep closed and the drying effect of a decongestant would make it even more likely to remain open and cause symptoms. The misdiagnosed patient may also have tubes surgically inserted into the eardrum, which increases the risk of ear infection and will not alleviate patulous Eustachian tube. If these treatments are tried and failed, and the doctor is not aware of the actual condition, the symptoms may even be classified as psychological.
Incidentally, patients who instead suffer from the even rarer condition of superior canal dehiscence are at risk for misdiagnosis of patulous Eustachian tube due to the similar autophony in both conditions.........
Causes
Patulous Eustachian tube is a physical disorder. The exact causes may vary depending on the person. Weight loss is a commonly cited cause of the disorder due to the nature of the Eustachian tube itself. Fatty tissues hold the tube closed most of the time in healthy individuals. When circumstances cause overall body fat to diminish, the tissue surrounding the Eustachian tube shrinks and this function is disrupted.[2]
Activities and substances which dehydrate the body have the same effect and are also possible causes of patulous Eustachian tube. Examples are stimulants (including caffeine) and exercise. Exercise may have a more short-term effect than caffeine or weight loss in this regard.
Pregnancy can also be a cause of patulous Eustachian tube due to the effects of pregnancy hormones on surface tension and mucous in the respiratory system
Treatment
Historically, to temporarily alleviate symptoms, patients have tried positional maneuvers, such as tilting their head to one side or upside down, lie down on their backs, or sit in a chair with their head between their knees. Similarly, a routine of lying down four times per day with legs elevated to around 20 inches for at least two weeks has been attempted as well. Depending on the underlying cause of the disorder, the individual may need to remove caffeine from their diet, reduce exercise, or gain weight.
Estrogen (Premarin) nasal drops or saturated potassium iodide have been used to induce edema of the eustachian tube opening. Nasal medications containing diluted hydrochloric acid, chlorobutanol, and benzyl alcohol have been reported to be effective in some patients, with few side effects. Food and Drug Administration approval is still pending, however
Local Therapy to Patulous Eustachian Tube
Bezold method (Bezold,1908)
Narrow the lume of the Eustachian Tube by salicylic accid/bolic accid insufflation
Narrow the lumen ofthe Eustachian Tube by extrinsic compression
Paraffin injection (Zollner,1937), Teflon injection (Pulec,1967),Gelatine sponge injection (Ogawa,1976)
Alter the function of palatal muscles (Misurya,1974)
Pterygoid hamulotomy (Virtanen,1982),Occlusion of the bony Eustachian Tube with a tympanotomy(Bluestone,1981)
Myryngotomy and insertion of a ventilating tube (Suehs,1960)
Temporary relief
Diathermy (Robinson,1989)
Using a ureteric Diathermy probe
Patients with a patulous eustachian tube who are pregnant and those with mild symptoms (most patients) need informative reassurance alone. Patients who have symptoms during pregnancy are symptom-free after delivery.
Advise patients to do the following:
■Increase or regain lost weight
■Avoid diuretics
■Recline or lower head when symptoms occur
Topical administration (nasal preparation) with anticholinergics may be effective for some patients........
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