8^th International Conference on
Otorhinolaryngology

Dr. Abinaya Anand, graduated from Tirunelveli Medical College, Tamil Nadu and is pursuing her postgraduate in Otolaryngology in Kasturba Medical College, Manipal University, Karnataka, ranked fourth among the medical colleges in India. She is interested in original research work, new concepts in the emerging medical field, endoscopic and microscopic surgeries, and quality patient care. Having assisted the surgery of the above-mentioned case and being the resident on duty, she has first -hand knowledge of the surgical emergency presented by the post-operative complication. Each second wasted during the act will have an impact on the outcome of the patient.

Statement of the problem: The incidence of neck hematoma following thyroidectomy range from 1.36% to 2.57%. We identified certain unique features in our case which suggested an alternative cause for respiratory distress, not suggested in the literature. Case report: A 63-year old female patient was referred by the endocrinologist to the Department of Otorhinolaryngology and head and neck surgery for the surgical management of toxic nodular goiter. She was euthyroid and was also on active treatment for hypertension and diabetes mellitus. The surgical procedure went uneventful and just before extubation bilateral vocal cord mobility was confirmed. At around 4th hour after surgery blood pressure shot up to 190/130 mmHg and heart rate was between 35 and 40. She became restless rapidly, her breathing pattern changed, she developed up rolling of eyeballs and had a near cardiac arrest. She was immediately reintubated by the ananesthetist and the surgical resident evacuated a hematoma of 150 -200 ml from the surgical bed at the same time. Anterior jugular vein was identified as the bleeder vessel and ligated. She required inotrope support for a few hours and was extubated successfully after 24 hrs of monitoring. Discussion and conclusion: Causes suggested for respiratory distress following hematoma post thyroidectomy include tracheal compression and supraglottic lymphovenous edema. The rapidity with which she detoriated, the ease of reintubation, and the amount of hematoma collection found on re – exporation could not be explained by these. Hence, we propose cushing’s syndrome as the cause of respiratory distress in our case and propose the need for surgeons to be vigilant about this rare surgical emergency.

Amira Trini Raihana is a lecturer and specialist both in the Department of otorhinolaryngology Hasanuddin University and hospital. She is interest in rhinology and doing work in the teaching hospital under rhinology division.

A 23-years-old male presented with an acute rhinosinusitis, forehead skin abscess and periorbital abcess was diagnosed by computed tomography. Initially he had rhinitis 4 days before coming to the primary health care subsequently he had rapid periorbital edema, erythema both eyes, pustula on the nose and forehead skin and referred to the hospital 3 days after he had an oral antibiotics treatment by general practitioner. Screening for diabetes and immunocompromise was negative. Pus culture that was drained from periorbital abcess were positive for Methicillin resistant Staphylococcus aureus (MRSA) harbouring rhinosinusitis. Delayed administration of vancomycin therapy due to the delayed detection and referral to the hospital rapidly progress to sepsis. We suggest early detection of acute MRSA in these circumstances.

Andrei Makaryn-Kibak works as an ENT surgeon in the Department for Adults in the Scientific and Practical Center of Otolaryngology of the republic of Belarus for 6 years. In 2012 graduated from the Belarusian State Medical University. Passed advanced training in FESS and middle ear surgery in Jacksonville, USA, Innsbruck, Austria, Dresden, Germany, Tubingen, Germany.

The nasal valve is a complex three-dimensional structure consisting of several morphological structures. From the physiological point of view, this is the place of greatest resistance to the flow of air passing through the cavity. Thus, in accordance with Poiseuille's law, even minor narrowing of this area leads to a clinically significant disturbance of the patient's nasal breathing. The etiology of the nasal valve dysfunction is versatile, making it necessary to develop an individual treatment algorithm for patients with impaired nasal breathing. The conducted research allowed us to formulate an algorithm for helping patients with nasal valve dysfunction, which is based on data on the effectiveness of various treatment methods in the main types of pathology, as well as consideration of additional factors, such as operations and the shape of the external nose. To determine the risk factors of the nasal valve dysfunction, we examined and questioned 482 patients with complaints of obstructed nasal breathing. All the patients underwent computed tomography, endoscopy of the nasal cavity, as well as a set of rhinometry studies (acoustic rhinometry, anterior active rhinomanometry, rhinoresistometry) in accordance with the recommendations of the international consensus. In 86 patients nasal valve dysfunction was detected (17.8%). By means of statistical data processing, factors that are predictors of nasal valve dysfunction were identified, which allows screening patients without the need for extensive implementation of costly procedures (CT, acoustic rhinometry). Based on the data obtained, a mathematical prediction program and a complex diagnostic algorithm were developed. Considering the data of mathematical prediction, a complex personified approach of nasal valve dysfunction treatment was developed considering the level (levels) of narrowing. This allowed to justify the choice of treatment tactics, minimize the unjustified choice of the surgical treatment method.

Dr Amsyar Akil is a ORL specialist, has his expertise in evaluation of LPR in improving the health and quality of live. He works as a consultant both in the teaching hospital and education institutions.

Objective: We conducted a study to determine the presence of Helicobacter pylori in the 78 laryngopharyngeal reflux (LPR) patients. Our aim was to determine if there was any association among H pylori and LPR. Patients and Methods: A total of 78 LPR patients were diagnosed based on patient’s reflux symptom index (RSI) and reflux finding score (RFS), which were based on their questionnaire responses and findings on endoscopic examination of the larynx, respectively. Helicobacter pylori status was determined by Urease Rapid Test of laryngeal mucosal biopsy specimens obtained during direct laryngoscopy. Results: H pylori was present in 52 patients (66,7%) and absent in 26 patients (33,3%). There was a significant relationship complaints and disorders of the larynx between Hp urease test positive and Hp negative urease test (p<0.05) and there is a statistically significant relationship value of RSI and RFS of LPR patients was higher in Hpurease test positive than Hp negative urease test (p<0.05) and the Spearman Corelation test showed there is significant relationship that the higher the RSI value the higher the RFS value in LPR patients( p = 0.000). There is a significant relationship between the value of RSI and/or the value of RFS with Hp urease test of the LPR patients. Conclusion: our study has concluded that reflux of gastric contents into the laryngo-pharyngeal space in patients with LPR also carries Helicobacter pylori which can last for a long time in laryngeal mucosa.

Sri Wartati is an ORL specialist under neurotology division. She is work both in hospital and teaching both in the hospital and education institution

Congenital cholesteatoma is a well- described anatomical and clinical entity. Adult form is exceptional and rare but often diffuse. We describe a mastoid congenital cholesteatoma and compare this case to other infantile and adult forms describe in the literature. We present a non-classical presentation of congenital cholesteatoma with postaural fistula in the right ear, intact tympanic membrane, and normal hearing in a 23 year- old female. The temporal bone CT-scan showed a soft tissue density lesion of the middle ear with erosion in mastoid part. After investigation the patient underwent surgical management resulting in improvement of her symptoms. Existence of congenital cholesteatoma is well established. An extensive form is described in this case. Apparently, there are two types of congenital middle ear cholesteatoma: a closed keratotic cyst and an open matrix. Patient with open cholesteatoma may have a clinical presentation that is uniquely different from the classical description of congenital cholesteatoma. The specificity remains unknown. It is uncertain whether the adult and infantile forms have the same origin. A multifactorial or metaplastic mechanism could explain adult congenital cholesteatoma.

EU Technology & Innovation Manager

Introduction and aims: Nasal hygiene is critical to overall nasal health and provides protection against airborne contaminants, allergens and pathogens1,2. Nasal irrigation is often used both for nasal hygiene and managing sinonasal conditions3. Its use is endorsed as an adjuvant treatment in conditions such as allergic rhinitis, common cold, rhinosinusitis or post-operative care after sinonasal surgery4,5. The aim of this study is first to evaluate the ionic balance of an isotonic seawater solution (Stérimar Nose Hygiene Baby and Adults, SNH) in comparison to electrodialysed seawater (EDS); and, in parallel, to perform the preclinical efficacy evaluation of SNH using a validated and reproducible experimental protocol that mimics nasal congestion: 3D reconstituted human nasal epithelium model co-cultured with human airway fibroblasts (MucilAir™-HF). Methods: Ionic balance of the solutions was measured by mass-spectrometry and chromatography. For efficacy assessment, ATP release quantification assays and histological (alcian blue) together with immunohistochemical (aquaporin 3, AQP3) stainings were performed. Results: Ionic balance of SNH was more similar to human plasma and pure seawater compared to EDS. SNH helped tissues recover from hypotonic stress as evaluated by measurement of stress-associated ATP release, and maintained morphology of the tissues for longer periods than EDS as demonstrated by alcian blue and AQP3 staining levels and tissue distribution. Conclusions: This work shows that the ionic balance of SNH is closer to human plasma compared to EDS; and confirms its efficacy in maintaining good nasal hygiene and respecting tissue morphology, consistent with benefits of SNH demonstrated in clinical trials6.