RECURRENT NASAL POLYPS
Allergic nasal polyps have a tendency to recur and treatment is designed in 3 steps to prevent this. Our recurrence rate is 5-10% using our techniques. As the MCV ENT Trust Hospital is situated in the textile belt of South India, most of the Nose-Sinus related surgeries done are for Nasal allergy related complications like, polyps and Allergic fungal sinusitis. Out of these one third of patients have undergone surgical treatment elsewhere and seek help to control recurrences.
The first Step is precise and complete removal of polyps, debris and to open up all blocked sinuses. This is done with Trans nasal endoscopic microdebrider, a technique proven to abolish polyp bearing areas with minimal or no damage to normal nasal membranes. To achieve our goal of early healing and decreasing patient discomfort, we do not use nasal packing following nose operations in 95% of patients. This is a singular difference between our practice and conventional nasal operations done elsewhere. The wounds of the operation heal within 3-4 weeks when compared with 4-6weeks for traditional endoscopic forceps technique or 6-8 weeks for Intra nasal laser application. Typically patient spends 2-4 days in the hospital for the procedure.
The Second Step is regular periodic cleaning of the operated areas. We use surgically placed small plastic tubes in the first 2 days after operation to flush the sinuses clean in a painless manner. Most important is to get the nose inspected & cleaned endoscopically at regular intervals for the next few years. MCV ENT Trust Hospital has trained Endoscopic surgeons in many Indian cities, Gulf countries and Malaysia and will give guidance in getting this treatment done at the nearest location.
The Third Step is use of regular medication to prevent allergic attacks. We rely less on oral medication and advise intranasal solutions, medicines to clear the airway of environmental pollutant particles and allergy control. The hospital dispenses medication made according to the need of the individual patient for these purposes. This is a very critical aspect to prevent recurrence and has to be done for 3-4 years following Step 1.
VOICE DISORDERS CAUSED BY R.L. NERVE PARALYSIS
We have been performing corrective surgery for Unilateral R.L. Nerve palsy with poor voice and Bilateral R.L. Nerve palsy with poor airway for the past 8 years. Experience with more than 150 cases have been accumulated. We have developed our own design of Type I thyroplasty instruments/implants based on anatomy of Indian peoples voice box dimensions.
We have combined the goretex technique and Isshik’s teachings to achieve optimum results. We acknowledge the guidance from Prof. Timothy Mc Cullogh in this regard.
The operations commonly done are Medialisation thyroplasty, Arytenoid adduction or a combination of both. Type II, III, IV are also done in combination with the previous operations.
Combination techniques are technically more challenging but the voice results justify the extra effort needed. Patients stay in the hospital for 3-5 days for these procedures.
MICRO EAR SURGERY FOR EAR DISCHARGE OR DECREASED HEARING
Routine micro ear surgical work in large numbers has provided extensive experience in dealing with these issues. The goals of ear surgery are dry ear, increased hearing and safety is achieved in 90-95% of operated patients. Hospital stay required is 2-3 days and one can go back to work after 7-10 days.
SURGICAL TREATMENT OF VERTIGO esp menieres
Intra tympanic treatment using techniques to hold back medicines on the round window membrane has been developed here. This work is being done since 1999 and now the treatment has become an outpatient procedure. We have 90% successful outcomes with this single stage procedure when combined with preventive drugs. We have developed a system where we can identify taste sensation anomolies in vertigo patients and give suitable medication.
Fibroscopic Laryngeal Surgery
This method was perfected at MCV in early 2000. The instruments have been designed inhouse and a reputed manufacturer (Santosh Surgicals (Mobile: 98202-22918), Mumbai) has taken up the instruments for their product line.
Profile view Of FLS procedure
Oral introduction of instrument during FLS.
The technique is used to do minimal laryngeal surgery for “VOCAL CORD POLYP, NODULES & BIOPSY PURPOSES”. There is no need for general anasthesia and admission to hospital. The technique saves lives of patients who have cardiac and other contra indications for anasthesia to undergo treatment. Another major indication is for patients with stiff and short necks for whom GA (General Anasthesia)is risky.
The latest Baloon sinoplasty technique in now available at MCV. This is a procedure that avoids operation for chronic sinusitis and is also useful in sinus operation failures.
Baloon Sinoplasty with ‘C’ arm guidance.
Dr.V.Anand performing Baloon dilation for a patient with glottic stenosis.