Papers by Ramaswamy Balakrishnan
Chondrosarcomas constitute 1 to 3% of all head and neck tumours. 2% of all chondrosarcomas are of... more Chondrosarcomas constitute 1 to 3% of all head and neck tumours. 2% of all chondrosarcomas are of the clear cell†variety which follow a locally aggressive, relatively indolent course without predominant invasion of soft tissue. We present a 45-year-old woman presented with a bleeding mass in the oral cavity with change of voice of one year duration with pain of one month duration and histopathological analysis revealed a clear cell chondrosarcoma
Sinonasal region as a site of metastasis is a rare occurrence. About 30 % of cases of renal cell ... more Sinonasal region as a site of metastasis is a rare occurrence. About 30 % of cases of renal cell carcinoma first come to clinical attention because of metastasis, and may present with symptoms owing to the site of metastasis. Metastatic renal cell carcinoma to the sinonasal region is rarely documented in literature. We hereby report an uncommon clinical presentation of an occult renal cell carcinoma, presenting with epistaxis secondary to metastatic renal cell carcinoma in a 63 year old male patient.
International Archives of Otorhinolaryngology
Introduction Psychoeducational counselling and residual inhibition therapy (RIT) are traditional ... more Introduction Psychoeducational counselling and residual inhibition therapy (RIT) are traditional approaches used in many clinics to manage tinnitus. However, neurophysiological studies to evaluate posttreatment perceptual and functional cortical changes in humans are scarce. Objectives The present study aims to explore whether cortical auditory-evoked potentials (CAEPs; N1 and P3) reflect the effect of modified RIT and psychoeducational counselling, and whether there is a correlation between the behavioral and electrophysiological measures. Methods Ten participants with continuous and bothersome tinnitus underwent a session of psychoeducational counselling and modified RIT. Perceptual measures and CAEPs were recorded pre- and posttreatment. Further, the posttreatment measures were compared with age and gender-matched historical control groups. Results Subjectively, 80% of the participants reported a reduction in the loudness of their tinnitus. Objectively, there was a significant re...
Indian Journal of Otolaryngology and Head & Neck Surgery, 2019
To determine Ethnic differences in the frequency of the relatively common anatomical variants alo... more To determine Ethnic differences in the frequency of the relatively common anatomical variants along with difference in anatomy of sinonasal region with surgical importance. A study was conducted to determine the frequency of anatomical variants, volumes of paranasal sinuses using computed tomography and to identify any difference between Group A consisting of people of Indian subcontinent and Group B consisting of people from north east Asian region. Volumetric analysis done using cumulative of area multiplied by slice thickness. The results were compared using Chi square test, p value \ 0.05 was considered statistically significant. Among the common and uncommon anatomical variants (Agger nasi, pneumatized uncinate, concha bullosa etc.) there was no significant difference between the two groups. In both the groups Keros Type 1 was the most common type of ethmoid roof seen. On volumetric analysis sphenoid sinus volume was found to be higher in Indians without mongoloid features. Hence it's ideal that in this era of endoscopic sinus surgery we tailor make approaches to address individual anatomical variation.
International Journal of Otorhinolaryngology and Head and Neck Surgery
Background: Thyroid gland invasion in advanced laryngeal/hypopharyngeal malignancy is not uncommo... more Background: Thyroid gland invasion in advanced laryngeal/hypopharyngeal malignancy is not uncommon. The preservation of the contralateral lobe of thyroid and associated parathyroid glands with its blood supply, in suitable patients, can be beneficial in reducing the incidence of both hypothyroidism and hypoparathyroidism. The aim of the study was to assess the functionality of the contralateral preserved hemi-thyroid gland with its parathyroid glands, during total laryngectomy with or without partial/total pharyngectomy (TL/TLP), with or without post-operative radiation therapy.Methods: A retrospective study of patients with advanced laryngeal or hypopharyngeal malignancy who underwent TL/TLP with contralateral hemi-thyroid and parathyroid gland preservation, between January 2012 and May 2019 were included in this study. Pre-operative thyroid/parathyroid function was assessed by estimation of blood levels of T3, T4, TSH and calcium. The same were evaluated at 1week and 6 weeks follo...
Asian Journal of Pharmaceutical and Clinical Research
Ectopic thyroid is the result of the failure of migration of thyroid along its tract from the fl... more Ectopic thyroid is the result of the failure of migration of thyroid along its tract from the floor of the primitive foregut to its final pretracheal position. The incidence of an ectopic lesion in adults is 7%. Most common location is the base of tongue (lingual). Other diverse sites are larynx, trachea, mediastinum, and pericardium. These ectopic tissues may develop the same diseases as the thyroid gland. Here, we report a case of a young female presenting with a foreign body sensation in the throat and on examination revealed a smooth submucosal swelling involving the supraglottis. The entire cyst was excised in toto by KTP 532 laser via an endolaryngeal approach and it was reported as papillary carcinoma of the thyroid. Literature search reported only a few cases of intralaryngeal ectopic thyroid and none with a papillary carcinoma of the larynx. This is the first reported case of papillary carcinoma of thyroid in the larynx.
Indian Journal of Otology, 2021
Objective: The objective was to assess the efficacy of platelet-rich fibrin in increasing graft u... more Objective: The objective was to assess the efficacy of platelet-rich fibrin in increasing graft uptake and improved hearing outcome following Type I tympanoplasty by postauricular underlay technique. Materials and Methods: Adult patients without any comorbidities in the age group 20–40 years with chronic otitis media-mucosal (inactive) enrolled for type I tympanoplasty were included in this randomized control study. Sixty eligible patients were randomly grouped by lottery method into test (application of platelet-rich fibrin, n = 30) and control groups (without application of platelet-rich fibrin, n = 30). Postoperative closure of the perforation was compared on 1st month and 3rd month follow-up. Postoperative graft uptake was compared in both the study groups. Pre- and postoperative comparison of pure tone average (PTA) and air-bone gap (ABG) closure were measured in all patients. Results: The graft uptake rate in the test group was 100%, and for the control group was 86% on 3rd mo...
Indian Journal of Otology, 2003
Nasal encephaloceles are rare congenital malformations resulting in defect in bony framework of t... more Nasal encephaloceles are rare congenital malformations resulting in defect in bony framework of the skull and herniation of the intracranial contents. The usual presentation is swelling over the nose. Radiological investigations aid in the diagnosis and delineation of the herniated contents. These are treated by surgical excision and carry a favorable prognosis.
Indian Journal of Otolaryngology and Head and Neck Surgery, 1995
Abductor paralysis of the vocal cords has frustrated surgeons and patients alike since time immem... more Abductor paralysis of the vocal cords has frustrated surgeons and patients alike since time immemorial. The edoscopic lateralisation of the vocal cords is an elegant method for the treatment of this condition and is discussed.
Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India, 2005
Cricopharyngeal dysfunction is defined as the delayed or incomplete relaxation of the cricopharyn... more Cricopharyngeal dysfunction is defined as the delayed or incomplete relaxation of the cricopharyngeal muscle during swallowing. This may cause dysphagia and aspiration, affecting the quality of life. For this condition, injection of botulinum toxin into the cricopharyngeus, dilatation of cricopharynx with bougies and external cricopharyngeal myotomy have been the treatment of choice with varying results. We present in this paper the treatment of this clinical condition by KTP 532 laser a recent advance in the field of Otolaryngology and Head and Neck Surgery. Very few series have been reported in literature so far regarding the use of laser for cricopharyngeal myotomy. This is perhaps the first series of eight cases of KTP laser assisted microendoscopic cricopharyngeal myotomy and web excision reporting the benefit of this treatment by an Indian author in an Indian Journal. KTP laser assisted cricopharyngeal myotomy avoids an external scar; aids precise incision at the cricopharynx ...
The Journal of Laryngology & Otology, 1998
The authors have used the nasal endoscope for the precise identification of pathological abnormal... more The authors have used the nasal endoscope for the precise identification of pathological abnormalities of the nasal septum in relation to the lateral nasal wall including the osteo-meatal complex and in its ultraconservative management. The aim of the study was to compare the efficacies of endoscope-aided septoplasty (EAS) over traditional septoplasty (TS) in treating the pathological septum and turbinates, performed in 30 cases each. The subjective assessment was carried out by visual analogue scores and objective assessment by nasal endoscopy. This study demonstrates the superiority and limitations of the endoscopic approach in managing a deviated nasal septum and the turbinates. The endoscope-aided technique was found to be more effective in relieving the contact areas and nasal obstruction (p = ≤0.05). The authors advocate a combined approach – an endoscopic approach for inaccessible posterior deviation and the conservative traditional technique for accessible anterior deviation...
Indian Journal of Otology, 2008
Objective: : This is a study of clincopathological features and outcome of surgical management wi... more Objective: : This is a study of clincopathological features and outcome of surgical management with 3 years survival pattern following total! near total laryngectomy in advanced III,IV squamous cell carcinoma larynx. Methods: Retrospective observational study conducted between January 2000 to December 2013. with 87 patients of biopsy proved squamous cell carcinoma of larynx in advanced stage T3&T4. Radio residual cases were also included in the study. 79 patients were treated surgically with Wide field total laryngectomy and 8 with near total laryngectomy along with bilateral neck dissection. Average follow up period was 15 months postoperative. All cases received post op radiotherapy except the radio-residual cases which were managed with salvage surgery alone. Chemotherapy was added in 7 cases due to extra-capsular metastasis.. Data was analyzed using Kaplan Meier method of estimation to estimate the median survival time wherever applicable. Statistical analysis was carried out us...
Journal of Clinical Oncology, 2010
e16031 Background: Second primary (SP) in head and neck cancers accounts for 4-7% of cases. This ... more e16031 Background: Second primary (SP) in head and neck cancers accounts for 4-7% of cases. This reflects the possible role of same etiology for SP. Methods: Objectives: To determine the possible e...
Journal of Head & Neck Physicians and Surgeons, 2016
Aim: To evaluate the overall and disease specific survival rate in patients with hypopharyngeal c... more Aim: To evaluate the overall and disease specific survival rate in patients with hypopharyngeal cancers treated with KTP - 532 LASER. Materials and Methods: We present a retrospective observational study conducted between January 2000 and December 2012 on a total of 28 patients of biopsy-proven cases of squamous cell carcinoma of hypopharynx in Stages I-IV including eight radio-residual cases who underwent trans-oral micro-endoscopic KTP-532 laser-assisted excision of the primary lesion. All patients with clinically and radiologically positive N status underwent modified neck dissection within 10 days. Average follow-up period was 15 months. All the cases received adjuvant radiotherapy except for the radio-residual ones which were managed with salvage surgery alone. Observation and Results: 25/ 28 patients had no disease on their last follow-up with 3 locoregional recurrences. Nineteen patients were followed up for 2 years or more and we found two loco-regional recurrences within 2 years. Overall survival rate was found to be 89.2% and 2-year specific disease-free survival rate 89.4% as calculated using Kaplan-Meier scale. Conclusion: This study evaluates the efficacy and survival rate of patients who underwent trans-oral micro-endoscopic KTP-532 laser-assisted excision for hypopharyngealcancers in various stages as an alternative to conventional open surgeries.
IOSR Journal of Dental and Medical Sciences, 2017
Context: Evaluation of hearing acuity after small fenestra stapedotomy for stapedialotosclerosis.... more Context: Evaluation of hearing acuity after small fenestra stapedotomy for stapedialotosclerosis. Aim: The aim of this study was to profile the age/ gender distribution, symptoms and hearing evaluation (before and after surgery) of patients diagnosed with otosclerosis. Setting and design: The study was done at a tertiary care hospital. It was a cross sectional record based study. Subject and Methods: Forty three patients diagnosed with stapedialotosclerosis who satisfied the selection criteria and consented were included in the study. Age/ gender distribution, symptoms and hearing acuity (before and after surgery) were profiled. Statistical analysis used: Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 11.5 (SPSS: An IBM company). For the current study frequency and percentage were considered. Results: Majority of the patients presented between the age of 21 and 40 years. There were more females than males in our study group, hearing loss was the most common symptom. Most of the patients had a pre-operative air-bone (AB) gap of 31-50 dB, which improved to less than 10 dB six months after surgery. Conclusion: Small fenestra stapedotomy is a safe and effective surgery for the patients having stapedialotosclerosis.
Indian Journal of Otology
Journal of Evolution of Medical and Dental Sciences, 2016
BACKGROUND Laryngeal cancer is the second most common head and neck cancer in India. The onset, r... more BACKGROUND Laryngeal cancer is the second most common head and neck cancer in India. The onset, rate of progression and duration of symptoms are variable for supraglottic, glottic and subglottic cancer. Smoking and alcohol are also most important risk factors for laryngeal cancer. Data regarding cases of laryngeal cancer in relation to age, sex, symptoms and signs, aetiological factors with special reference to smoking and alcohol, histopathological types, tumour staging, treatment and outcomes are important to assess changing trends in laryngeal cancer treatment. MATERIALS AND METHODS This study is about retrospective descriptive analysis of diagnosed and treated cases of laryngeal cancer in the Department of ENT from 2005 to 2008. Total fifty patients with laryngeal malignancy were seen from May 2005 to May 2008 with average 1 year of follow-up. Data regarding cases of laryngeal cancer in relation to age, sex, symptoms and signs, aetiological factors with special reference to smoking and alcohol, histopathological types, tumour staging, treatment and outcomes were analysed using SPSS software. All patients who were diagnosed to have laryngeal cancer and treated were included in the study. RESULTS In this descriptive analysis, 62% patients are between 51-70 years. Most of the patients had been symptomatic for 3-5 months; 58% patients presented with voice change followed by other complaints like throat pain, foreign body sensation, otalgia, breathing difficulty. Voice change was distinctly the most common symptom regardless of tumour site. It was more prevalent in glottis cases, but it was also the leading symptom in supraglottic tumours. Glottis tumours were more often found at an early stage and patients with a supraglottic tumour presented more often with neck node metastasis. CONCLUSION Laryngeal malignancy is one of the head and neck malignancies, which are more common in males. Tobacco is an important risk factor in causation of the laryngeal malignancy. Patient usually presents with voice change. Voice change is the most common presenting symptom in glottic cases than supraglottis. Squamous cell carcinoma is most common type and moderately differentiated squamous cell carcinoma is most common variety. As laryngeal cancer is a public health problem with early detection and increasing the awareness of smoking hazards, it is possible to decrease the incidence of laryngeal cancer.
The Journal of Laryngology & Otology, 2017
Background: Dysphagia is a relatively common symptom following laryngectomy. An anterior pharynge... more Background: Dysphagia is a relatively common symptom following laryngectomy. An anterior pharyngeal diverticulum is a rare cause of post-laryngectomy dysphagia. However, it is often an incidental finding on rigid telescopic examination. Methods and results: This article describes two patients with a symptomatic anterior pharyngeal diverticulum. They were treated by transoral micro-endoscopic potassium titanyl phosphate 532 nm laser assisted resection. Both patients could take feeds orally after the procedure without any difficulty. One patient died one and a half years after the procedure because of secondary lung cancer. The other patient died after three years as a result of regional recurrence. The patients were able to swallow during their survival period post treatment. Conclusion: Laser-assisted micro-endoscopic resection is a relatively safe, quick and effective procedure for the management of anterior pharyngeal diverticulum.
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Papers by Ramaswamy Balakrishnan