Shibu George - Academia.edu (original) (raw)

Papers by Shibu George

Indian Journal of Otolaryngology and Head & Neck Surgery

International Journal of Otorhinolaryngology and Head and Neck Surgery

Background: A dysfunctional eustachian tube can cause failure of middle ear pressure regulation w... more Background: A dysfunctional eustachian tube can cause failure of middle ear pressure regulation which leads to chronic otitis media and tympanoplasty failure. The functional status of eustachian tube can non-invasively be assessed prior to tympanoplasty by impedence audiometry. This help to predict the outcome of the procedure as well as aid surgeons to plan the surgery accordingly. The aim of the study was to determine the role of pre-operative tympanometric evaluation of eustachian tube function in patients with chronic otitis media.Methods: This study was conducted on 42 patients with chronic otitis media underwent type-1 tympanoplasty in department of otorhinolaryngology, Government Medical College, Kottayam over a period of one year. Detailed history, clinical and audiological evaluation done. Type-1 tympanoplasty performed and reassessed after 3 months. Data compiled and analysed using SPSS.Results: Intra-operative findings were similar to the audiometric results. Majority of ...

Background and Objectives: Studies on the postoperative problems of endoscopic sinus surgery are ... more Background and Objectives: Studies on the postoperative problems of endoscopic sinus surgery are rare in literature. The objective is to study the postoperative symptoms of patients and findings on nasal endoscopy after functional endoscopic sinus surgery (FESS). Adequate postoperative care necessary after FESS and ways to reduce the cavity problems to be studied. Methods:113 patients who underwent FESS for various pathologies were followed up at regular intervals with nasal endoscopy. Postoperative symptoms of patients were documented, nasal endoscopy done and findings noted. Necessary interventions performed according to the problems visualized. Results were analysed at 1 month and 3 monthspost surgery and as required thereafter.Results: Postoperative review at 1 month showed symptoms of smell disturbances(24 cases), nasal obstruction(16 cases), headache(4) and nasal discharge(2). Nasal endoscopy revealed synechiae in 16 patients, significant crusting and fungal debris in 11...

International Journal of Otorhinolaryngology and Head and Neck Surgery

Background: Post traumatic hearing loss is one of the most common problems encountered among trau... more Background: Post traumatic hearing loss is one of the most common problems encountered among trauma victims. It can manifest as conductive, sensorineural or mixed hearing loss. It is against this background that the study evaluated the clinical and audiological outcome of 47 patients of trauma.Methods: A descriptive longitudinal study was conducted over a period January 2017 to March 2018. Follow up was done after 3 months of discharge. Study consisted of 47 patients presenting with features of trauma related injuries. After carrying out systematic clinical, audiometric and radiological evaluation, patients were managed conservatively.Results: Of the 47 patients studied, 89.98% were related to road traffic accidents (RTAs); and 76.60% were under the influence of alcohol at the time of trauma. Among the 32 cases of the RTAs involving two wheelers, 29 patients (90.62%) were not using protective devices like helmet. Nearly 90% of patients had temporal bone fracture. Audiological evalua...

Stanley Medical Journal, 2017

International journal of scientific research, 2017

This study done in the department of ENT, Medical College Kottayam during the period January 2002... more This study done in the department of ENT, Medical College Kottayam during the period January 2002 to August 2004 was a prospective analysis of 150 patients of all ages and both sexes presenting to the department for whom Tracheostomy was done for various reasons. The aim was to study the incidence of complications of Tracheostomy and do a statistical analysis and to suggest measures to prevent the same. The incidence of complications was 43.3% with no mortality, the commonest complication being per-operative bleeding. The common indication was malignancy (77.3%) of which laryngeal malignancy accounted for 87.7%. Glottis carcinomas accounted for 79% of laryngeal malignancy. We concluded that all complications are preventable and the best method of prevention is early intervention

International Journal of Otorhinolaryngology and Head and Neck Surgery

Carcinoma of unknown primary (CUP) represents a heterogeneous group of malignancy metastasis uniq... more Carcinoma of unknown primary (CUP) represents a heterogeneous group of malignancy metastasis unique biology of which remains poorly understood. Even after a complete diagnostic workup including positron emission tomography and computerised tomography (PET-CT) scans the primary site of origin may remain unclear. This case series analysed the diagnostic value of bilateral palatine tonsillectomy in evaluating PET-CT negative head and neck squamous cell CUP. From retrospective analysis of cluster of 68 cases with metastatic cervical nodes with no obvious primary referred for ENT evaluation during a period of 20 months, we identified 5 cases where pan endoscopy and radiological evaluation including PET-CT were negative in detecting the primary. All 5 patients underwent bilateral palatine tonsillectomy along with biopsies from base of tongue and nasopharynx as a part of completion of diagnostic work-up. Tonsillar squamous cell carcinoma was revealed by subsequent histopathology examinatio...

International Journal of Otorhinolaryngology and Head and Neck Surgery, Dec 22, 2017

INTRODUCTION Mastoidectomy ranks among the commonest surgical procedures performed in the otologi... more INTRODUCTION Mastoidectomy ranks among the commonest surgical procedures performed in the otological realm and is aimed at therapeutic excenteration of mastoid air cells. 1 Chronic otitis media is the commonest indication for performing this surgery, where continued inflammation of the middle ear cleft leading to osteitis and irreversible mucosal changes, or presence of cholesteatoma causing bone erosion, necessitate surgical disease clearance. It is also indicated in other inflammatory diseases or tumors of the middle ear and mastoid. Two basic surgical approaches have been evolved for mastoid clearance, namely the canal wall up and the canal wall down procedures. 2 The canal wall up procedure include cortical mastoidectomy, combined approach tympanoplasty, and mastoidectomy with canal wall reconstruction. Canal wall down procedures include modified radical mastoidectomy and radical mastoidectomy. Need for added procedures like tympanoplasty is decided by the findings encountered during surgery, when the mastoid surgeon must individualize the procedure appropriate for each patient to optimize the outcome of surgery. The aim of the study is to conduct a chart review of patients undergoing mastoidectomy, over a period of one ABSTRACT Background: Mastoidectomy is a common otologic surgery and at times can be a lifesaving procedure. The aim of the study is to analyze surgical indications, operative parameters and per-operative findings encountered. Methods: This is a retrospective study done in patients who had undergone mastoid surgeries between 1 st Jan 2016 to 31 st Dec 2016 in the Department of Otorhinolaryngology, Govt. Medical College hospital, Trivandrum. Results: Of the 137 patients the peak age incidence was 16-30 years. Cholesteatoma was present in 32% of which 91% had canal wall down mastoidectomy. 64% patients, mostly chronic otitis media-mucosal and inactive squamosal, underwent canal wall up procedure. In 62% cases the ossicular chain was eroded, which was mainly incus (87%). Abnormalities encountered within the mastoid during surgery were mainly dehiscent facial canal (17.5%), low lying dura (16.8%) and contracted antrum (15.3%). A positive association could be noted between contracted antrum and the position of sinus and dural plates, and was statistically significant. Coexistence of facial canal dehiscence with lateral canal fistula and dural plate dehiscence were also noted. The tympanoplasty procedures commonly employed in canal wall up procedures was Type I and 2, and in canal wall down procedure was Type 3. Conclusions: Adequate skill development of the ear surgeons in the tertiary centre should be ensured, to individualize the procedure appropriate for each patient and optimize the outcome of surgery. Early referral to the nearby otological centre should be promoted not only to prevent complications but also for better post-surgical functional outcome.

International Archives of Otorhinolaryngology

Introduction The facial nerve is the most commonly paralyzed nerve in the human body, resulting i... more Introduction The facial nerve is the most commonly paralyzed nerve in the human body, resulting in far-reaching functional, aesthetic and emotional concerns to the patient. Objective Evaluation of the clinical outcome of 47 patients with traumatic facial nerve paralyses, with respect to clinical recovery and audiological sequelae. Methods A descriptive longitudinal study was conducted over 24 months between January 2017 and December 2018 at a tertiary center with detailed clinical, topodiagnostic, audiometric and radiological evaluation and regular follow-up after discharge. Results Road traffic accidents constituted 82.98% of the trauma cases, out of which 76.60% were found to be under the influence of alcohol.Delayed facial paralysis was observed in 76.60% cases. Temporal bone fracture was reported in 89.36%, with otic capsule (OC) sparing fractures forming 91.49% of the cases. Topologically, the injury was mostly at the suprachordal region around the second genu. The majority of ...

International Journal of Otorhinolaryngology and Head and Neck Surgery

Background: Chronic rhino sinusitis (CRS) is a common health problem affecting around 5-12% of th... more Background: Chronic rhino sinusitis (CRS) is a common health problem affecting around 5-12% of the general population in a year. Treatment of CRS consist of medical and surgical management. Surgical management is considered when patient is not responding to maximal medical treatment or in case of complication. Sino nasal outcome test 22 (SNOT- 22) is considered as the most appropriate instrument in the evaluation of HRQOL impairment in CRS patients. This study evaluated general health related quality of life (QOL) domains of SNOT- 22 changes following endoscopic sinus surgery.Methods: This study was conducted in 53 subjects who underwent endoscopic sinus surgery for chronic rhino sinusitis in Department of otorhinolaryngology, Government Medical College, Kottayam over a period of one year. Detailed history including SNOT-22 questionnaire enquired. Clinical, radiological and endoscopic examinations were performed. This patient followed up after 1 week, 1month and 3 months. SNOT-22 sc...

International Archives of Otorhinolaryngology

Introduction Vocal cord dysfunction is characterized by unintentional paradoxical vocal cord move... more Introduction Vocal cord dysfunction is characterized by unintentional paradoxical vocal cord movement resulting in abnormal inappropriate adduction, especially during inspiration; this predominantly manifests as unresponsive asthma or unexplained stridor. It is prudent to be well informed about the condition, since the primary presentation may mask other airway disorders. Objective This descriptive study was intended to analyze presentations of vocal cord dysfunction in a tertiary care referral hospital. The current understanding regarding the pathophysiology and management of the condition were also explored. Methods A total of 27 patients diagnosed with vocal cord dysfunction were analyzed based on demographic characteristics, presentations, associations and examination findings. The mechanism of causation, etiological factors implicated, diagnostic considerations and treatment options were evaluated by analysis of the current literature. Results There was a strong female predilec...

Journal of Evolution of Medical and Dental Sciences

BACKGROUND Nasal polyposis is a disease known to have significant association with asthma. The fi... more BACKGROUND Nasal polyposis is a disease known to have significant association with asthma. The first-line management is clearly anti-inflammatory, with topical and oral corticosteroids. Endoscopic sinus surgery is indicated in polyps resistant to steroids and improves nasal resistance; this should benefit patients with co-existing asthma by reduction in pulmonary resistance. MATERIALS AND METHODS This was a prospective 2-year study of 50 patients with asthma and nasal polyposis, on the benefits of functional endoscopic sinus surgery (FESS) on the lower airway parameters which includes forced expiratory volume (FEV1) and forced vital capacity (FVC) and forced expiratory ratio (FER) as measured by spirometry. RESULTS There was clinically and statistically significant mean increment in FEV1 (p=0.01), FVC (p=0.018) and FER (P=0.02). Significant improvement in PFT was noted in children and patients with allergic rhinitis while patients with Samter's triad demonstrated marginal improvement. CONCLUSION Functional endoscopic sinus surgery effects a small but significant improvement in lung function as evidenced by pre-and postoperative spirometric measures and could be considered early in the natural course of nasal polyposis with concomitant asthma.

Journal of Evolution of Medical and Dental Sciences

BACKGROUND Minimally invasive ear surgery has developed along with endoscopic techniques; this av... more BACKGROUND Minimally invasive ear surgery has developed along with endoscopic techniques; this avoids other unnecessary incisions and soft tissue dissections. The endoscopic approach also provides better visualisation of hidden areas in the middle ear cavity and provides better visualisation of structures parallel to the axis and beyond the shaft of the instruments that otherwise can cramp surgery using a microscope. One major disadvantage of using a smaller-diameter endoscope in the ear is a narrow and tubular viewing. The use of a traditional 4 mm, 18 cm nasal endoscope could effectively negate this major disadvantage by providing a close-up wide-angled vision. MATERIALS AND METHODS This was a prospective 4-year study of endoscopic type 1 tympanoplasty, using 4-mm 0 0 nasal endoscope, in 35 patients with chronic otitis media (COM), having inactive mucosal disease. Per-operative parameters and post-operative results were analysed by standard proforma. RESULTS There was satisfactory graft uptake in 83.86% (n=29) cases with good air-bone gap closure. 17.14% (n=6) of patients complained of thermal irritation in the ear during surgery. Post-operative infection rate was on the higher side (22.86%). Operating time was comparable to microscopic tympanoplasty. CONCLUSION The nasal endoscope provides unmatched middle ear visualisation and image quality with significant benefits in teaching with comparable results to microscopic tympanoplasty. Light source should be used in lower setting to prevent thermal irritation to the ear. Meticulous sterilisation of the endoscope is prudent to prevent post-operative infection.

International Journal of Otorhinolaryngology and Head and Neck Surgery

Background: Vascularized flaps are preferred in repair of skull base defects since they provide q... more Background: Vascularized flaps are preferred in repair of skull base defects since they provide quality tissue volume and allow rapid healing. Though nasoseptal flap is the gold standard it may not be available always and has its own share of pitfalls; this makes the middle turbinate flap a viable alternative. This descriptive study was designed to analyze the efficacy of middle turbinate flap in endoscopic closure of skull base defects and to define indications and limitations of the flap. Methods: 20 patients who underwent endoscopic closure of small and medium sized skull base defects using middle turbinate mucoperiosteal flap were analyzed and followed up. Etiology, presentation, site and co-morbidities associated with such defects were studied. Effectiveness of closure was analyzed by the ability to cover fully, graft uptake and complications. Results: Successful flap take up was noted in all 20 cases (100%) on long term follow up; transient cerebrospinal fluid leak was observed in 1case (5%) during the immediate post-operative period which subsided fully. Spontaneous CSF rhinorrhea (n=11 [55%]) was the most common indication for closure and unilateral watery rhinorrhea was the commonest presentation (n=13 [65%]). Benign intracranial hypertension was found to have significant association with cerebrospinal fluid rhinorrhea. Most common site of leak was the medial lamella of cribriform plate (n=11 [55%]). Conclusions: Middle turbinate flap is an effective alternative to nasoseptal flap for small and medium sized anterior skull base defects; efficacy in larger defects and posterior sellar defects cannot be substantiated.

International Journal of TROPICAL DISEASE & Health, 2016

Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India, 2000

Rosai Dorfman Disease (Sinus Histiocytosis with massive lymphadenopathy) is a rare self-limiting ... more Rosai Dorfman Disease (Sinus Histiocytosis with massive lymphadenopathy) is a rare self-limiting histiocytic disorder of unknown etiology usually presenting with cervical lymphadenopathy and haematological abnormalities. Extra-nodal presentation is rare . This ease is such a rare presentation of Rosai Dorfman Disease.

Indian Journal of Otolaryngology and Head & Neck Surgery

International Journal of Otorhinolaryngology and Head and Neck Surgery

Stanley Medical Journal, 2017

International journal of scientific research, 2017

International Journal of Otorhinolaryngology and Head and Neck Surgery

International Journal of Otorhinolaryngology and Head and Neck Surgery, Dec 22, 2017

International Archives of Otorhinolaryngology

International Journal of Otorhinolaryngology and Head and Neck Surgery

International Archives of Otorhinolaryngology

Journal of Evolution of Medical and Dental Sciences

International Journal of Otorhinolaryngology and Head and Neck Surgery

International Journal of TROPICAL DISEASE & Health, 2016

Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India, 2000