Sapna Nambiar - Academia.edu (original) (raw)

Papers by Sapna Nambiar

Research paper thumbnail of Challenges in treating patients with foreign bodies in hypopharynx and esophagus: our experience in a tertiary care hospital

International Journal of Otorhinolaryngology and Head and Neck Surgery, 2021

Background: Foreign bodies (FBs) of the hypopharynx and esophagus are among the common otolaryngo... more Background: Foreign bodies (FBs) of the hypopharynx and esophagus are among the common otolaryngologic emergencies. Every new case poses a clinical challenge with need for optimal treatment strategy. The objective of our study is to highlight a few of the challenges faced while treating these patients.Methods: A prospective study was done on all patients who reported to the ENT casualty, Government Medical College Kozhikode with history or suspicion of foreign body throat from January 2020 to January 2021. A total of 160 patients reported of which 48 (30%) patients required further evaluation with rigid endoscopy and foreign body removal in the operative room. A few challenges like migration of foreign bodies, dilemma in diagnosis with FB mimicking ossified cartilages on X-ray, FB removal in mentally challenged patients and treatment of esophageal perforation post rigid endoscopy are discussed.Results: Only 48 (30%) patients of the total 160 patients required rigid endoscopy and fo...

Research paper thumbnail of Focal Ectasia of Internal Jugular Vein

Medical Journal Armed Forces India, 2009

Research paper thumbnail of Comparison of the Structured Consent Process Using Modified Delphi Technique with the Standard Process in Obtaining Informed Consent for Procedures in ENT by PHASE III MBBS Students

Indian Journal of Otolaryngology and Head & Neck Surgery

Research paper thumbnail of Challenges in Tracheostomy

Laryngology [Working Title]

Tracheostomy is a life saving procedure of placement of a surgical airway. It is imperative for e... more Tracheostomy is a life saving procedure of placement of a surgical airway. It is imperative for every medical personnel to be conversant with it as it helps secure airway, the first step in resuscitation when necessary. It is not only thorough knowledge of the anatomy of the neck and procedural technique but also the awareness of the unusual challenging situations likely during this procedure that can help avoid complications and enable one to be better prepared for any eventuality. This chapter aims to draw the attention to the likely challenges during tracheostomy including pediatric tracheostomy and percutaneous dilatational tracheostomy. An encounter with pseudoneurysm of the internal carotid artery helps understand the gravity of the likely challenges that a surgeon must be prepared to manage.

Research paper thumbnail of A rare but important differential diagnosis for an oropharyngeal mass

Otolaryngology Case Reports

Research paper thumbnail of Endoscopic optic nerve decompression in traumatic optic neuropathy: our experience in a tertiary care centre

International Journal of Otorhinolaryngology and Head and Neck Surgery

Background: Traumatic optic neuropathy (TON) a vision threatening disorder requires early diagnos... more Background: Traumatic optic neuropathy (TON) a vision threatening disorder requires early diagnosis and prompt treatment. High dose steroid injections, optic nerve decompression or combined therapy are the available current treatment options. This study aims to determine the visual outcome with transnasal endoscopic optic nerve decompression in patients with TON having no improvement in vision despite high dose steroids.Methods: A prospective study was conducted at the department of ENT, government medical college Kozhikode; on patients who presented with loss of vision following history of trauma. All patients suspected of compressive optic neuropathy received injection methyl prednisolone (30 mg/kg/day) with assessment of vision and HRCT scan. Patients with deterioration or no improvement in vision despite high steroid therapy were taken up for trans-nasal endoscopic optic nerve decompression.Results: In our study 19 patients with TON underwent trans-nasal endoscopic optic nerve d...

Research paper thumbnail of Rhinosporidiosis: Report of an extra-ductal facial lesion

IDCases, 2017

Rhinosporidiosis is a chronic granulomatous mucocutaneous disease that is endemic in South Asia. ... more Rhinosporidiosis is a chronic granulomatous mucocutaneous disease that is endemic in South Asia. It commonly affects men in the second to fourth decade of life. The most common site of infection is the nose or nasopharynx with primary involvement of the parotid duct noted very rarely; only four cases reported in literature. We report a case of a 77 year old male patient who presented with a subcutaneous cheek swelling with no other clinical features to suggest the diagnosis of rhinosporidiosis. An unusual affliction in a patient in the seventh decade of life, at a site not reported previously with no past history of the same makes it imperative to ascertain the known facts about both the organism and the disease. However the histopathological report confirmed the diagnosis which reiterates the need to further study the pathogenesis of this condition.

Research paper thumbnail of Comparative Study of the Outcomes of Tympanoplasty by the Conventional Microscopic and Endoscopic Techniques

Introduction: Chronic otitis media, a highly prevalent middle ear disease, poses problems of recu... more Introduction: Chronic otitis media, a highly prevalent middle ear disease, poses problems of recurrent ear discharge and hearing impairment. Tympanoplasty is the surgical remedy, and its outcome varies with the surgical technique used. The introduction of the operating microscope improved the accuracy of the technique; however, difficulty in visualization of certain areas of the middle ear including the anterior and posterior epitympanic spaces and sinus tympani made it necessary for frequent adjustments in either the microscope or the patient’s head. This made endoscopic tympanoplasty a more favorable technique for better visualization of hidden areas in the middle ear cavity with effective removal of disease. Purpose: This study, therefore, aimed to correlate the outcome of tympanoplasty by microscopic and endoscopic methods comparing the advantages and disadvantages of both. Methods: This is a prospective cohort study done on patients undergoing tympanoplasty type I at the Depart...

Research paper thumbnail of Saccular Cyst of the Larynx: A Case Report with Review of Literature

Kerala Medical Journal, 2015

Saccular cyst of the larynx is an uncommon laryngeal anomaly that has undergone evolution over th... more Saccular cyst of the larynx is an uncommon laryngeal anomaly that has undergone evolution over the years owing to advances in diagnostic and treatment modalities. These lesions should be fully evaluated and surgically excised as they can mimic or be associated with other more serious laryngeal pathology including carcinoma of the larynx. This article aims at an update in the management of saccular cyst of the larynx with review of literature. Keywords: Saccular cyst, Larynx

Research paper thumbnail of KEYWORDSChronic Otitis Media, Mucosal Disease, Tympanoplasty

Research paper thumbnail of Extrapulmonary Tuberculosis: An Otorhinolaryngologist’s Perspective

Indian Journal of Otolaryngology and Head & Neck Surgery

Research paper thumbnail of Tympanoplasty Type I Evaluation of the Surgical Results and Its Impact as the Treatment Modality in Chronic Otitis Media

Journal of Evidence Based Medicine and Healthcare

BACKGROUND Chronic Otitis Media (COM), mucosal disease is a common ailment with which patients pr... more BACKGROUND Chronic Otitis Media (COM), mucosal disease is a common ailment with which patients present to the ENT outpatient department. Tympanoplasty is the surgery performed with the goals of establishing an intact tympanic membrane, eradicating middle ear disease, creating an air-containing middle ear space and restoring the hearing by building a secure connection between the eardrum and the cochlea. The success of tympanoplasty depends on various factors including patient factors, disease factors and surgical factors. The aim of the study is to assess the present status and impact of tympanoplasty as the surgical treatment modality in cases of COM mucosal disease. MATERIALS AND METHODS 50 patients were selected by non-probability convenience method of sampling and were assessed prior to surgery. Tympanoplasty was carried out in all patients and they were assessed following surgery at 3, 6 and 12 months, respectively. Statistical analysis was done of the improvement following tympanoplasty. RESULTS The analysis carried out revealed the graft take up rate to be 86% with failure in 7 (14%) patients. Of the factors contributing to failure following tympanoplasty, the statistically significant factors in this study were the status of middle ear mucosa and the status of the opposite ear (p <0.05). Tympanoplasty continues to be an effective surgical modality of management in patients with COM, mucosal disease with a guarded prognosis in those having bilateral disease and persistent mucosal disease of middle ear cleft. CONCLUSION Tympanoplasty is the definitive and effective surgical modality in management of patients with COM mucosal disease. Of the factors considered relevant in the success of tympanoplasty, the status of middle ear mucosa and status of the opposite ear were found statistically significant in this study.

Research paper thumbnail of Rhinosporidiosis: Report of an extra-ductal facial lesion

IDCases, 2016

Rhinosporidiosis is a chronic granulomatous mucocutaneous disease that is endemic in South Asia. ... more Rhinosporidiosis is a chronic granulomatous mucocutaneous disease that is endemic in South Asia. It commonly affects men in the second to fourth decade of life. The most common site of infection is the nose or nasopharynx with primary involvement of the parotid duct noted very rarely; only four cases reported in literature. We report a case of a 77 year old male patient who presented with a subcutaneous cheek swelling with no other clinical features to suggest the diagnosis of rhinosporidiosis. An unusual affliction in a patient in the seventh decade of life, at a site not reported previously with no past history of the same makes it imperative to ascertain the known facts about both the organism and the disease. However the histopathological report confirmed the diagnosis which reiterates the need to further study the pathogenesis of this condition.

Research paper thumbnail of A Review of the Clinicopathological and Radiological Features of Unilateral Nasal Mass

Indian Journal of Otolaryngology and Head & Neck Surgery, 2011

Unilateral sinonasal pathology are common presentations but are regarded with caution as neoplast... more Unilateral sinonasal pathology are common presentations but are regarded with caution as neoplastic conditions during their early stages may mimic an inflammatory pathology. The aim of the review was to analyse the varied presentations of patients with unilateral nasal mass and to identify features suggestive of neoplastic pathology. A retrospective review of all cases of unilateral nasal mass/polyp from Jan 09 to Jan 10 presenting at a tertiary care hospital were analysed. The patients were grouped as per their histopathological diagnosis as inflammatory and neoplastic. The demographic data, presenting symptoms, radiological and histopathological findings were compared between the two groups. Out of the 53 patients of unilateral nasal mass, 44 (83.1%) had inflammatory conditions and 9 (16.9%) had neoplastic conditions. Benign nasal polyp and inverted papilloma were the commonest inflammatory and neoplastic condition. Neoplastic conditions were significantly commoner in males (P = 0.0315) and in the age group above 50 years (P = 0.0046). Epistaxis and extranasal symptoms like facial pain, dental and orbital complaints were found to be significantly higher in neoplastic conditions. Neoplastic lesions of nose and paranasal sinus are one of the most challenging conditions that otolaryngologists have to diagnose and treat due to their hidden nature and late presentations. In our review neoplastic conditions were found to be higher in elderly male with epistaxis, extranasal symptoms and presence of extensive soft tissue involvement and bony destruction on CT scan. The clinician should have a high index of suspicion to rule out a neoplastic aetiology in all cases of unilateral nasal mass.

Research paper thumbnail of Endoscopic Sinus Surgery in Chronic Rhinosinusitis and Nasal Polyposis: A Comparative Study

Indian Journal of Otolaryngology and Head & Neck Surgery, 2011

Nasal polyposis are common presentations in patients of chronic rhinosinusitis and are considered... more Nasal polyposis are common presentations in patients of chronic rhinosinusitis and are considered to be associated with more severe forms of disease with poor treatment outcome. The presentation and treatment outcome after endoscopic sinus surgery in patients of chronic rhinosinusitis and nasal polyposis have been analysed in this study. A prospective analysis of 90 patients of chronic rhinosinusitis who were classified into two groups depending on presence and absence of nasal polyps was performed in the study. The two groups were evaluated using subjective (patient complaints) and objective (computed tomography scan and endoscopy scores) criteria. Preoperative data were compared with data obtained 12 months post endoscopic sinus surgery. The study included 38 patients of chronic rhinosinusitis and 52 patients of nasal polyps. The patients of nasal polyp group presented with increased severity of symptoms of nasal blockage, nasal discharge and reduced sense of smell as compared to the chronic rhinosinusitis group who had significantly higher presentation of headache and facial pain. The preoperative CT scan revealed significantly higher bilateral disease with increased involvement of multiple sinuses in nasal polyp group. Post endoscopic sinus surgery both the groups showed significant improvement in their symptoms with the nasal polyp group demonstrating reduction in improvement on 1 year follow up. In our study we have found the patients with chronic rhinosinusitis and nasal polyp have varied severity of symptoms with the nasal polyp group having higher nasal symptoms and increased severity as compared to chronic rhinosinusitis group. Though the universal rationale of management by adequate drainage and ventilation of sinus is similar in both groups, there is a reduction in both objective and subjective scores during 1 year follow up in the nasal polyp group.

Research paper thumbnail of Challenges in treating patients with foreign bodies in hypopharynx and esophagus: our experience in a tertiary care hospital

International Journal of Otorhinolaryngology and Head and Neck Surgery, 2021

Background: Foreign bodies (FBs) of the hypopharynx and esophagus are among the common otolaryngo... more Background: Foreign bodies (FBs) of the hypopharynx and esophagus are among the common otolaryngologic emergencies. Every new case poses a clinical challenge with need for optimal treatment strategy. The objective of our study is to highlight a few of the challenges faced while treating these patients.Methods: A prospective study was done on all patients who reported to the ENT casualty, Government Medical College Kozhikode with history or suspicion of foreign body throat from January 2020 to January 2021. A total of 160 patients reported of which 48 (30%) patients required further evaluation with rigid endoscopy and foreign body removal in the operative room. A few challenges like migration of foreign bodies, dilemma in diagnosis with FB mimicking ossified cartilages on X-ray, FB removal in mentally challenged patients and treatment of esophageal perforation post rigid endoscopy are discussed.Results: Only 48 (30%) patients of the total 160 patients required rigid endoscopy and fo...

Research paper thumbnail of Focal Ectasia of Internal Jugular Vein

Medical Journal Armed Forces India, 2009

Research paper thumbnail of Comparison of the Structured Consent Process Using Modified Delphi Technique with the Standard Process in Obtaining Informed Consent for Procedures in ENT by PHASE III MBBS Students

Indian Journal of Otolaryngology and Head & Neck Surgery

Research paper thumbnail of Challenges in Tracheostomy

Laryngology [Working Title]

Tracheostomy is a life saving procedure of placement of a surgical airway. It is imperative for e... more Tracheostomy is a life saving procedure of placement of a surgical airway. It is imperative for every medical personnel to be conversant with it as it helps secure airway, the first step in resuscitation when necessary. It is not only thorough knowledge of the anatomy of the neck and procedural technique but also the awareness of the unusual challenging situations likely during this procedure that can help avoid complications and enable one to be better prepared for any eventuality. This chapter aims to draw the attention to the likely challenges during tracheostomy including pediatric tracheostomy and percutaneous dilatational tracheostomy. An encounter with pseudoneurysm of the internal carotid artery helps understand the gravity of the likely challenges that a surgeon must be prepared to manage.

Research paper thumbnail of A rare but important differential diagnosis for an oropharyngeal mass

Otolaryngology Case Reports

Research paper thumbnail of Endoscopic optic nerve decompression in traumatic optic neuropathy: our experience in a tertiary care centre

International Journal of Otorhinolaryngology and Head and Neck Surgery

Background: Traumatic optic neuropathy (TON) a vision threatening disorder requires early diagnos... more Background: Traumatic optic neuropathy (TON) a vision threatening disorder requires early diagnosis and prompt treatment. High dose steroid injections, optic nerve decompression or combined therapy are the available current treatment options. This study aims to determine the visual outcome with transnasal endoscopic optic nerve decompression in patients with TON having no improvement in vision despite high dose steroids.Methods: A prospective study was conducted at the department of ENT, government medical college Kozhikode; on patients who presented with loss of vision following history of trauma. All patients suspected of compressive optic neuropathy received injection methyl prednisolone (30 mg/kg/day) with assessment of vision and HRCT scan. Patients with deterioration or no improvement in vision despite high steroid therapy were taken up for trans-nasal endoscopic optic nerve decompression.Results: In our study 19 patients with TON underwent trans-nasal endoscopic optic nerve d...

Research paper thumbnail of Rhinosporidiosis: Report of an extra-ductal facial lesion

IDCases, 2017

Rhinosporidiosis is a chronic granulomatous mucocutaneous disease that is endemic in South Asia. ... more Rhinosporidiosis is a chronic granulomatous mucocutaneous disease that is endemic in South Asia. It commonly affects men in the second to fourth decade of life. The most common site of infection is the nose or nasopharynx with primary involvement of the parotid duct noted very rarely; only four cases reported in literature. We report a case of a 77 year old male patient who presented with a subcutaneous cheek swelling with no other clinical features to suggest the diagnosis of rhinosporidiosis. An unusual affliction in a patient in the seventh decade of life, at a site not reported previously with no past history of the same makes it imperative to ascertain the known facts about both the organism and the disease. However the histopathological report confirmed the diagnosis which reiterates the need to further study the pathogenesis of this condition.

Research paper thumbnail of Comparative Study of the Outcomes of Tympanoplasty by the Conventional Microscopic and Endoscopic Techniques

Introduction: Chronic otitis media, a highly prevalent middle ear disease, poses problems of recu... more Introduction: Chronic otitis media, a highly prevalent middle ear disease, poses problems of recurrent ear discharge and hearing impairment. Tympanoplasty is the surgical remedy, and its outcome varies with the surgical technique used. The introduction of the operating microscope improved the accuracy of the technique; however, difficulty in visualization of certain areas of the middle ear including the anterior and posterior epitympanic spaces and sinus tympani made it necessary for frequent adjustments in either the microscope or the patient’s head. This made endoscopic tympanoplasty a more favorable technique for better visualization of hidden areas in the middle ear cavity with effective removal of disease. Purpose: This study, therefore, aimed to correlate the outcome of tympanoplasty by microscopic and endoscopic methods comparing the advantages and disadvantages of both. Methods: This is a prospective cohort study done on patients undergoing tympanoplasty type I at the Depart...

Research paper thumbnail of Saccular Cyst of the Larynx: A Case Report with Review of Literature

Kerala Medical Journal, 2015

Saccular cyst of the larynx is an uncommon laryngeal anomaly that has undergone evolution over th... more Saccular cyst of the larynx is an uncommon laryngeal anomaly that has undergone evolution over the years owing to advances in diagnostic and treatment modalities. These lesions should be fully evaluated and surgically excised as they can mimic or be associated with other more serious laryngeal pathology including carcinoma of the larynx. This article aims at an update in the management of saccular cyst of the larynx with review of literature. Keywords: Saccular cyst, Larynx

Research paper thumbnail of KEYWORDSChronic Otitis Media, Mucosal Disease, Tympanoplasty

Research paper thumbnail of Extrapulmonary Tuberculosis: An Otorhinolaryngologist’s Perspective

Indian Journal of Otolaryngology and Head & Neck Surgery

Research paper thumbnail of Tympanoplasty Type I Evaluation of the Surgical Results and Its Impact as the Treatment Modality in Chronic Otitis Media

Journal of Evidence Based Medicine and Healthcare

BACKGROUND Chronic Otitis Media (COM), mucosal disease is a common ailment with which patients pr... more BACKGROUND Chronic Otitis Media (COM), mucosal disease is a common ailment with which patients present to the ENT outpatient department. Tympanoplasty is the surgery performed with the goals of establishing an intact tympanic membrane, eradicating middle ear disease, creating an air-containing middle ear space and restoring the hearing by building a secure connection between the eardrum and the cochlea. The success of tympanoplasty depends on various factors including patient factors, disease factors and surgical factors. The aim of the study is to assess the present status and impact of tympanoplasty as the surgical treatment modality in cases of COM mucosal disease. MATERIALS AND METHODS 50 patients were selected by non-probability convenience method of sampling and were assessed prior to surgery. Tympanoplasty was carried out in all patients and they were assessed following surgery at 3, 6 and 12 months, respectively. Statistical analysis was done of the improvement following tympanoplasty. RESULTS The analysis carried out revealed the graft take up rate to be 86% with failure in 7 (14%) patients. Of the factors contributing to failure following tympanoplasty, the statistically significant factors in this study were the status of middle ear mucosa and the status of the opposite ear (p <0.05). Tympanoplasty continues to be an effective surgical modality of management in patients with COM, mucosal disease with a guarded prognosis in those having bilateral disease and persistent mucosal disease of middle ear cleft. CONCLUSION Tympanoplasty is the definitive and effective surgical modality in management of patients with COM mucosal disease. Of the factors considered relevant in the success of tympanoplasty, the status of middle ear mucosa and status of the opposite ear were found statistically significant in this study.

Research paper thumbnail of Rhinosporidiosis: Report of an extra-ductal facial lesion

IDCases, 2016

Rhinosporidiosis is a chronic granulomatous mucocutaneous disease that is endemic in South Asia. ... more Rhinosporidiosis is a chronic granulomatous mucocutaneous disease that is endemic in South Asia. It commonly affects men in the second to fourth decade of life. The most common site of infection is the nose or nasopharynx with primary involvement of the parotid duct noted very rarely; only four cases reported in literature. We report a case of a 77 year old male patient who presented with a subcutaneous cheek swelling with no other clinical features to suggest the diagnosis of rhinosporidiosis. An unusual affliction in a patient in the seventh decade of life, at a site not reported previously with no past history of the same makes it imperative to ascertain the known facts about both the organism and the disease. However the histopathological report confirmed the diagnosis which reiterates the need to further study the pathogenesis of this condition.

Research paper thumbnail of A Review of the Clinicopathological and Radiological Features of Unilateral Nasal Mass

Indian Journal of Otolaryngology and Head & Neck Surgery, 2011

Unilateral sinonasal pathology are common presentations but are regarded with caution as neoplast... more Unilateral sinonasal pathology are common presentations but are regarded with caution as neoplastic conditions during their early stages may mimic an inflammatory pathology. The aim of the review was to analyse the varied presentations of patients with unilateral nasal mass and to identify features suggestive of neoplastic pathology. A retrospective review of all cases of unilateral nasal mass/polyp from Jan 09 to Jan 10 presenting at a tertiary care hospital were analysed. The patients were grouped as per their histopathological diagnosis as inflammatory and neoplastic. The demographic data, presenting symptoms, radiological and histopathological findings were compared between the two groups. Out of the 53 patients of unilateral nasal mass, 44 (83.1%) had inflammatory conditions and 9 (16.9%) had neoplastic conditions. Benign nasal polyp and inverted papilloma were the commonest inflammatory and neoplastic condition. Neoplastic conditions were significantly commoner in males (P = 0.0315) and in the age group above 50 years (P = 0.0046). Epistaxis and extranasal symptoms like facial pain, dental and orbital complaints were found to be significantly higher in neoplastic conditions. Neoplastic lesions of nose and paranasal sinus are one of the most challenging conditions that otolaryngologists have to diagnose and treat due to their hidden nature and late presentations. In our review neoplastic conditions were found to be higher in elderly male with epistaxis, extranasal symptoms and presence of extensive soft tissue involvement and bony destruction on CT scan. The clinician should have a high index of suspicion to rule out a neoplastic aetiology in all cases of unilateral nasal mass.

Research paper thumbnail of Endoscopic Sinus Surgery in Chronic Rhinosinusitis and Nasal Polyposis: A Comparative Study

Indian Journal of Otolaryngology and Head & Neck Surgery, 2011

Nasal polyposis are common presentations in patients of chronic rhinosinusitis and are considered... more Nasal polyposis are common presentations in patients of chronic rhinosinusitis and are considered to be associated with more severe forms of disease with poor treatment outcome. The presentation and treatment outcome after endoscopic sinus surgery in patients of chronic rhinosinusitis and nasal polyposis have been analysed in this study. A prospective analysis of 90 patients of chronic rhinosinusitis who were classified into two groups depending on presence and absence of nasal polyps was performed in the study. The two groups were evaluated using subjective (patient complaints) and objective (computed tomography scan and endoscopy scores) criteria. Preoperative data were compared with data obtained 12 months post endoscopic sinus surgery. The study included 38 patients of chronic rhinosinusitis and 52 patients of nasal polyps. The patients of nasal polyp group presented with increased severity of symptoms of nasal blockage, nasal discharge and reduced sense of smell as compared to the chronic rhinosinusitis group who had significantly higher presentation of headache and facial pain. The preoperative CT scan revealed significantly higher bilateral disease with increased involvement of multiple sinuses in nasal polyp group. Post endoscopic sinus surgery both the groups showed significant improvement in their symptoms with the nasal polyp group demonstrating reduction in improvement on 1 year follow up. In our study we have found the patients with chronic rhinosinusitis and nasal polyp have varied severity of symptoms with the nasal polyp group having higher nasal symptoms and increased severity as compared to chronic rhinosinusitis group. Though the universal rationale of management by adequate drainage and ventilation of sinus is similar in both groups, there is a reduction in both objective and subjective scores during 1 year follow up in the nasal polyp group.