Thursday, June 30, 2011

Importance of debrider in endoscopic management of fungal sinusitis

In this blog I wish to stress the importance of debrider in the endoscopic management of fungal sinusitis. Since debrider cuts only on one side the other normal areas of nasal cavity like the nasal septum are not traumatized. The other advantages include:

1. The debrider blade since it is attached to a suction apparatus sucks and holds the nasal polypi to the cutting surface.
2. The rotating blade cuts the tissue which is held by suction
3. The irrigation portal is connected to saline. This dripping saline prevents clogging of the debrider blade with debris.

This video clipping below amply demonstrates the role of debrider:

Thanks to drtbaluent videos.

Thursday, June 16, 2011

An interesting otoscopic finding


Erosion of outer attic wall has always been associated with cholesteatoma. Theoretically eustachean tube is found to be not functioning in these patients predisposing to the formation of attic retraction pocket.

Case report:

This case report would make us rethink the pathophysiology of outer attic wall (scutum) erosion.

40 years old female patient presented with hard of hearing right ear of 3 years duration.
She did not give any history of ear discharge / foul smell emitting from the affected ear. Even on prolonged questioning she denied history of ear discharge.
No history of previous ear surgery for any other ailment.

Video otoscopy showed:

1. Thinned out ear drum
2. Ear drum bulging on valsalva
3. The ear drum could be seen moving as the patient breaths indicating a patulous eustachean tube
4. Erosion of outer attic wall (scutum) without the presence of cholesteatoma

This video clipping would ensure that we start rethinking about the pathophysiology of scutum erosion.