RECENT TRENDSRECENT TRENDS IN IN

OTORHINOLARYNGOLOGY OTORHINOLARYNGOLOGYBy

Dr. Vijayasundaram ASSO PROF .

MGMCRI

INTRODUCTIONINTRODUCTION

Diversity of subspecialitiesMultidisciplinary approachComputer guided surgeryAdvanced microsurgical techniques

Digital Hearing AidsDigital Hearing Aids

Multiprogram device with self adaptationSignals processed to suppress noiseAmplify specific frequenciesProvides clear hearingEnhanced sound qualityGreatly reduced feedback & easy handling

BAHABAHA

Direct bone conductionDirect vibration transmission pathThree modes of excitationParts of BAHAIndicationsContraindications

Auditory Brainstem ImplantAuditory Brainstem Implant

Electrical stimulation of 2nd auditory neuronNeurofibromatosis type 2 & traumatic cases21 channel electrodes placed in brainstemBody level speech processorTransmission coil on the scalpImproves conversational ability

Cochlear ImplantCochlear Implant

Latest C-II bionic ear implant90,000 updates/secStimulation rates of 91,000 pulses/secIn profoundly deaf patientsSingle & multichannel More speech understanding

BiomaterialsBiomaterials

Silicone rubber (silastic)TeflonTORP & PORP Future implants-Biomimetics

Meniere’s diseaseMeniere’s disease

• Endolymphatic sac decompression• Modification( of Portmann’s technique)• Transcanal gentamycin instillation• Selective vestibular neurectomy

Virtual reality simulatorVirtual reality simulator

• Special helmet and glove for viewing• 3-D world view• Virtual patient- data set of CT & MRI• Virtual Otoscopy- Display of 3 diff. views• Endoscopic sinus simulator

Facial Cosmetic SurgeryFacial Cosmetic Surgery

• Grafts• Tissue advancement techniques• Surgical decompression of facial nerve • Surgical rehabilitation of facial n.palsy• Non-specific techniques for neuromuscular

retraining

Skull Base SurgeriesSkull Base Surgeries

• Fisch Infratemporal fossa approach• Posterior approach• Lateral approach• Combined

Gallium ScanGallium Scan

• In Malignant Otitis externa• Stage I, II, III• Anti-pseudomonal antibiotics• Treatment duration depending on scan

Approaches to CFRApproaches to CFR• Anterosup sinonasal Area – Lat Rhinotomy• Anterosup sinonasl area & Frontal sinus – Lat Rhinotomy

with Lymel Extension• Supr Sinonasal Area – Mid Facial Degloving • Angiofibroma with intracranial extension through

cribriform plate –Transcervical Transmandibular Transpalatal

• Benign Tumours Involving Cribriform plate with minimal exrension to orbit-Medial Maaxillectomy with microscope

Eagle’s syndromeEagle’s syndrome

• Symptoms• Diagnosis by Digital Palpation, Intra-

anaesthetic solution injected.• Investigation –OPG, AP and Lat skull films• Treatment- Intra-oral & extra-oral approach

External approaches External approaches Anterior Cricoid Split Laryngofissure with Posterior Cricoid Split Laryngotracheoplasty Myo-hyoid flap with temporary stent Sternomastoid-clavicular periosteal flap Laryngeal Reconstruction by Augmentation Resection of Cricoid with Thyro-Tracheal anastmosis Resection with end to end anastomosis (Grillo)

StentsStents• Types : Finger Cots• Endotracheal Tubes• Montgomery T-Tubes• Artificial Support that maintains airway

patency• Sialastic Sheet Rolls• Aboulker Stent• Cotton – Lorenz Stent• Acrylic Stent

Phonosurgical techniquesPhonosurgical techniques

Vocal cord medialisation• - Injection: Teflon, fat,collagen• - Thyroplasty• - Arytenoid adduction• - Reinnervation 

Contd..Contd..

Lateralization procedure• Laser aryteniodectomy/cordotomy• Cordopexy with/without arytenoid

removal• Woodman's operation• Reinnervation• Endoscopic Augmentation Technique

Neck DissectionsNeck Dissections

• Radical Neck dissection• Modified Neck Dissection-Type I, II, III• Selective Neck Dissection Supraomohyoid neck dissection- Clearance of level I, II ,III ,IV

Lateral neck dissection-II, III ,IV & VI

- Central compartment dissection

LaryngectomyLaryngectomy

Wide field laryngectomyConservation surgerySupraglottic laryngectomySupracricoid laryngectomyVertical hemilaryngectomyNear Total and Total Laryngectomy

Provox 2 voice prosthesisProvox 2 voice prosthesis

• Latest voice rehabilitation prosthesis• Low resistance indwelling medical grade

silicone device• Prosthesis insertion tool & cleaning brush• Inserted through tracheostoma or mouth

Flaps in Head & Neck Flaps in Head & Neck ReconstructionReconstruction

• Local flaps - Random - Axial pattern• Distant axial - Deltopectoral - Cervical - Occipitomastoid• Myocutaneous • Free - Free Jejunal flap