Comparing accuracy of cochlear measurements on magnetic resonance imaging and computed tomography:A step towards radiation-free cochlear implantation

Objective:Computed Tomography(CT)and Magnetic Resonance Imaging(MRI)are commonly employed in pre-operative evaluation for cochlear implant surgery.However,with a decrease in the age of implantation,even minor radiation exposure can cause detrimental effects on children over their lifetime.The current study compares different cochlear measurements from CT and MRI scans and evaluates the feasibility of using only an MRI scan for radiological evaluation before cochlear implantation.Methods:A longitudinal observational study was conducted on 94 ears/47 children,employing CT and MRI scans.The CT and MRI scan measurements include,A value,B value,Cochlear duct length(CDL),twoturn cochlear length,alpha and beta angles to look for cochlear orientation.Cochlear nerve diameter was measured using MRI.The values were compared.Results:The mean difference between measurements from CT and MRI scans for A value,B value,CDL,and two-turn cochlear length values was 0.567±0.413 mm,0.406±0.368 mm,2.365±1.675 mm,and 2.063±1.477 mm respectively without any significant difference.The alpha and beta angle measures were comparable,with no statistically significant difference.Conclusion:The study suggests that MRI scans can be the only radiological investigation needed with no radiation risk and reduces the cost of cochlear implant program in the paediatric population.There is no significant difference between the measurements obtained from CT and MRI scans.However,observed discrepancies in cochlear measurements across different populations require regionally or race-specific standardized values to ensure accurate diagnosis and precision in cochlear implant surgery.This aspect must be addressed to ensure positive outcomes for patients.

Primary endoscopic stapedotomy using 3 mm nasal endoscope:Audiologic and clinical outcomes

Objective:To report the use of a 3 mm rigid nasal endoscope in primary endoscopic stapedotomy and clinical and audiological outcomes.Materials and methods:Thirty patients diagnosed with primary otosclerosis underwent endoscopic stapedotomy that was performed using a 3 mm nasal endoscope(Karl Storz).At 6 months follow-up,the patients were evaluated for intraoperative findings,postoperative hearing outcomes and complications.Results:Canaloplasty was performed in 2(6.66%)patients,and no curettage of the canal wall was required in 12(40%)patients.Transposition of the chorda tympani nerve was conducted in 11(36.66%)patients.The average duration of surgery was 36 min(range 31e65 min).The air-bone gap(ABG)was 35 dB(range 24e50 dB)preoperatively and 14.63 dB(range 9e20 dB)postoperatively(p?0.00).At 6 months follow-up,<20 dB ABG was achieved in 93.33%of the patients.No major intraoperative/postoperative complications were detected.Conclusion:A 3 mm rigid nasal endoscope can be effectively used in stapedotomy to obtain adequate audiological outcomes.It can be considered as a better alternative to the standard microscope or 4 mm endoscope in preserving the posterior canal wall and chorda tympani nerve while minimizing operative time without causing significant complications.

Submental island flap reconstruction for carcinoma of the oral cavity: Experience in 30 cases

Objective:The submental flap can be utilized for soft tissue reconstruction in oral cavity malignancies because due to its close approximation to the surgical site,fewer donor site morbidity and the cost effectiveness of the procedure.Methods:A total of 30 patients with squamous cell carcinoma of the oral cavity were included in the study from July 2012 to August 2015 in a tertiary care referral hospital.Patients with clinical staging Ⅰ/Ⅱ/Ⅲ (T1/T2/T3,N0) oral malignancy were included in the study.Patients with nodal metastasis irrespective of the stage of disease and patients with chronic medical illness/revision cases were excluded from the study.Submental island flap was utilized for the reconstruction of the soft tissue defect in each patient.Patients were followed at monthly interval till 6 months in the postoperative period.Results:The buccal mucosa (12 patients),tongue (10 patients) and floor of mouth (8 patients) were the subsites in the oral cavity.Partial and complete skin necrosis was found in 4 and 2 patients respectively.Postoperative chemoradiation was required in 5 patients.None of the patients had loco regional recurrence till 6 months of follow-up.Conclusion:The submental island flap is considered to be the reliable option for the soft tissue reconstruction in oral cancer because of dependent vascular pedicle,less donor site morbidity and the lower cost compared to the free flaps,often preferred in patients with a lower socioeconomic condition.

Surgical management of extracranial nerve sheath tumours in a tertiary care center

Objective:Excision of the nerve sheath tumours of head and neck is always a challenge to the surgeon because of their close proximity of the neurovascular structures.Methods:It is a retrospective study contained 13 consecutive patients of nerve sheath tumours involving the head and neck from March 2013 to February 2017 in the department of Otorhinolaryngology and Head Neck Surgery in a tertiary care referral hospital The retrospective clinical data,diagnostic procedures,surgical approaches and their complications are analyzed after 12 months of surgery.Results:Total 13 patients,7 were females and 6 were males.Painless neck swelling was the most common presentation found in 6 and the most common site of origin was the vagus nerve in the parapharyngeal space (6 patients).Transcervical excision of the tumour was performed in 7 patients.Six needed combined surgical approach for the excision of the tumours.Neurovascular injury was detected in 3 patients,and one patient had recurrent disease during the follow-up period.Conclusions:Excision of the nerve sheath tumours of head and neck is always a challenge to the surgeon because of their close proximity of the neurovascular structure.Although the transcervical approach is commonly practiced for the majority of the tumours,combined approaches can be effectively applied for extensive nerve sheath tumours with the satisfactory clinical outcome.