Papers by suma Radhakrishnan
Indian Journal of Medical Research, 2023
Diabetes
Skull base osteomyelitis (SBO) is a rare life-threatening disease, which is on the increase speci... more Skull base osteomyelitis (SBO) is a rare life-threatening disease, which is on the increase specifically the incidence of fungal skull base osteomyelitis. Objectives: To describe the demographic, and clinicoradiological profile, and to assess the outcome of skull base osteomyelitis. Methodology: A prospective study from a tertiary care centre, in Kerala from 1st February 2018 to 31st August 2019 with a minimum follow-up of 6 months. All patients diagnosed with skull base osteomyelitis were included. The demographic profile and relevant investigations, radiological correlations and treatment outcomes were analysed. Results and Discussions: 30 patients (23 males and 7 females) were studied. Incidence was found to be high in the age group 51-60 years. The mean (SD) of Age (Years) was 62.02 (14.21), ranging from 1.5-78 years. The most common presentation was a nocturnal earache (86.7%).13.3% of patients presented with headache alone, these cases were diagnosed to be central skull base o...
Indian Journal of Medical Research
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.
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...
Indian Journal of Otolaryngology and Head & Neck Surgery, 2021
To study spectrum of high resolution computed tomography (HRCT) imaging findings in otosclerosis,... more To study spectrum of high resolution computed tomography (HRCT) imaging findings in otosclerosis, to predict approximate length of prosthesis required from pre-operative HRCT measurements and to correlate between oval window niche (OWN) height preoperatively and difficulty in introducing foot plate perforator during surgery. A cross sectional study was conducted on 23 patients with a clinical diagnosis of otosclerosis from September 2018 to July 2020. Sensitivity of HRCT in detecting otosclerosis, correlation between pre-operative incudo-stapedial length (ISL) and intra operative prosthesis length, and correlation between OWN height and difficulty in introducing perforator were sought. The mean age of 23 patients studied was 39.9 years with a female preponderance of 56.5%. 17 out of 19 patients with foci of otosclerosis during surgery had HRCT findings of otosclerosis providing a sensitivity of 89.5%. Mean OWN height obtained was 1.29 mm preoperatively and a cut off value of 1.325 m...
Indian Journal of Otolaryngology and Head & Neck Surgery, 2020
The novel corona virus disease (COVID-19) has unfolded into a pandemic and is continuing to propa... more The novel corona virus disease (COVID-19) has unfolded into a pandemic and is continuing to propagate at a frightening speed. The aim of this article is to share our protocol for performing a safe surgical tracheostomy in this COVID-19 era. Tracheostomy procedures have a high risk of aerosol generation. To standardize institutional safety measures with tracheostomy, we advocate using a dedicated tracheostomy protocol applicable to all patients including those suspected of having COVID-19. We also did explore the current literature and recommendations for tracheostomy in patients with COVID-19 and studied the previous data from severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1), the virus responsible for the SARS outbreak of 2003. We have prepared a protocol for performing a safe surgical tracheotomy in patients affected by COVID-19. Surgeons who might be involved in performing the tracheostomies should become familiar with these guidelines.
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.
IDCases, 2020
Skull base osteomyelitis is a potentially life-threatening infection, usually seen in elderly imm... more Skull base osteomyelitis is a potentially life-threatening infection, usually seen in elderly immunocompromised patients secondary to malignant otitis externa (MOE) caused by Pseudomonas. Central or atypical skull base osteomyelitis often poses a diagnostic challenge as they present as head-ache with or without cranial nerve palsy often without any obvious source of infection. Although the incidence of fungal skull base osteomyelitis is increasing central skull base osteomyelitis due to invasive fungal sinusitis presenting with isolated hypoglossal nerve palsy has not been reported in the literature, to our knowledge. We report a case of a 59-year-old diabetic patient on regular treatment including steroid for acetylcholine receptor binding antibody positive myasthenia gravis with thymoma who presented with persistent head-ache and on evaluation, was found to have 12th cranial nerve palsy on the right side. She was diagnosed to have invasive fungal sphenoid sinusitis and central sku...
Skull base osteomyelitis typically occurs most often as a complication of malignant otitis extern... more Skull base osteomyelitis typically occurs most often as a complication of malignant otitis externa secondary to pseudo monas infection. Common risk factors are increasing age, diabetes mellitus and immunosuppression. If it happens in the absence of external otitis it is called atypical or central type. Medical management is the mainstay of treatment. Sur gical management is for a diagnostic biopsy and in some for debridement. Described below is a case report of a 75 years old male patient who was diagnosed to have skull base osteomyelitis and was started on intravenous antibiotics. Following an initial improvement of symptoms, after 4 weeks he developed ear and oropharyngeal bleed. Imaging revealed a massive aneurysm of petrous internal carotid artery with multiple brain infarcts and before we could intervene the patient expired. This case emphasizes a rarity in skull base osteomyelitis and the need for early diagnosis and aggressive treatment.
Journal of the Royal College of Physicians of Edinburgh
Introduction: Metastatic tumors to the nose and paranasal sinuses are unusual with 167 cases publ... more Introduction: Metastatic tumors to the nose and paranasal sinuses are unusual with 167 cases published in the literature since 1951. The most common locations of the primary tumors are renal, lung, breast, testis, gastrointestinal tract and thyroid gland. There are only 26 documented cases of metastasis to the sphenoid sinus of which only six are from follicular carcinoma thyroid. Materials and methods: Case reports of two patients referred to our department with ocular symptoms having a final diagnosis of follicular carcinoma thyroid with sphenoid sinus metastasis were studied and literature review done. Discussion: Metastasis to the sphenoid sinus from follicular carcinoma thyroid is a rare entity and here we present two more cases of which one was an occult thyroid carcinoma. Both patients presented with ocular symptoms and the features of metastasis was the first sign of disease. Conclusion: Early diagnosis of signs and symptoms relating to metastatic sphenoid disease is necessary as these are frequently the first presentation of malignancy. Even though cure of patients with sphenoid sinus metastasis has not been reported, palliation with resolution of morbidity is possible.
An International Journal of Otorhinolaryngology Clinics
Chronic middle ear infection is highly prevalent in our country. Retraction pockets elude early d... more Chronic middle ear infection is highly prevalent in our country. Retraction pockets elude early detection due to lack of overt symptomatology. The exact etiology of development of retraction pockets is still unknown. But it is certain that faulty middle ear aeration is the primary cause for this clinical entity. This paper is aimed to study the effectiveness of tragal cartilage perichondrial composite autograft in the management of posterosuperior retraction pockets of pars tensa of the tympanic membrane and also to study the predisposing factors responsible for the development of retraction pockets. Eighty-nine ears of 56 patients with retraction of pars tensa were studied. There were 30 males and 26 females; age varies from 6 to 45 with an average of 20 years. Most of the patients in this study had mild or moderate hearing loss. Very few had a severe conductive hearing loss or sensory neural hearing loss. The severity of hearing loss does not bear any relation to the stage of the retraction of the tympanic membrane. Very severe retraction may be associated with mild hearing loss and vice versa. Similarly, the presence or absence of ossicular necrosis does not make any difference in the degree of hearing loss. Out of this 56 patients, 29 underwent surgical management. Twenty-two out of this 29 patients had ossicular necrosis. Twenty-five patients had no recurrence of retraction after the surgery. Even though four patients developed retraction that was only around the cartilage graft and there were no pocket formations, and the retraction was not directly in contact with the ossicles. There was no graft failure as such; that means graft take up was 100 percent. So the study suggested early surgical intervention with cartilage perichondrial composite grafting is a successful technique for management of posterosuperior retraction pockets of pars tensa to safeguard hearing and to prevent possible cholesteatoma formation later.
Journal of Evolution of Medical and Dental Sciences
BACKGROUND Temporalis fascia is the most commonly used graft material for tympanoplasty with clos... more BACKGROUND Temporalis fascia is the most commonly used graft material for tympanoplasty with closure of the perforation of 70% to 90% of cases. We propose a novel modification of inlay surgical technique, pedicle temporalis fascia graft, to improve the graft take-up rate without compromising the hearing results Aim-The purpose of this study is to assess the take-up rate and hearing results of type 1 tympanoplasty using pedicle temporalis fascia graft. MATERIALS AND METHODS This is a retrospective study conducted from 01/06/2013 to 30/09/2015. 43 patients with safe central perforations, who underwent type 1 underlay tympanoplasty using a pedicle temporalis fascia graft were studied. The outcome measurements were graft take-up rate and audiometric results. RESULTS Graft take-up rate in this study was 97.4% and hearing improvement was about 90%. Graft take-up rate is comparable with the best results achieved by any other technique and hearing improvement is at par with most of the studies. CONCLUSION Our modification of type 1 tympanoplasty using a pedicle temporalis fascia graft gives excellent graft take-up rate. This technique needs refinement, and we strongly recommend trying this in difficult cases and in revision tympanoplasties.
Infection and drug resistance, 2017
Mucormycosis is a life-threatening infection affecting patients with diabetes. It is an angioinva... more Mucormycosis is a life-threatening infection affecting patients with diabetes. It is an angioinvasive disease often resistant to treatment with a debilitating course and high mortality. Here, we report a case of a 45 year old woman with type 2 diabetes mellitus who presented to us with history of right-sided ptosis and facial palsy, and subsequently developed loss of vision and palatal palsy. She was in diabetic ketoacidosis. Nervous system examination revealed involvement of right second, third, fourth, sixth, seventh, ninth, and tenth cranial nerves, suggestive of Garcin syndrome. The hard palate had been eroded with formation of black eschar. Computed tomography of paranasal sinuses revealed right maxillary and ethmoid sinusitis, with spread of inflammation to infratemporal fossa and parapharynygeal neck spaces. Debridement of sinus mucosa was done, and culture of the same yielded growth of rhizopus species. Histopathological examination of the tissue showed angioinvasion and fun...
Otorhinolaryngology Clinics - An International Journal, 2014
Ectopic pituitary adenomas are uncommon lesions and are found along the migratory pathway of the ... more Ectopic pituitary adenomas are uncommon lesions and are found along the migratory pathway of the Rathke's pouch. Sites reported include suprasellar region, clivus, sphenoid sinus, naso pharynx, third ventricle, petrous temporal bone, hypo thalamus, etc. Compared to intrasellar adenomas, a higher proportion of the ectopic examples are functional and most commonly produce adenocorticotropic hormone (ACTH). The authors report two cases of ectopic pituitary adenoma in the sphenoid sinus in two male patients 36 and 40 years old, presenting with epistaxis. Both the patients did not have any endocrine abnor malities. The clinical and imaging findings were suggestive of sinonasal malignancy. The final diagnosis was made after histopatho logical examination and immunohistochemistry for cytokeratin, chromogranin and pituitary hormones. The diagnosis of ectopic pituitary adenomas is difficult especially in those tumors that are nonfunctioning. After extensive literature search, we could find only six cases of nonfunctioning adenomas reported in the sphenoid sinus and in all these cases the correct diagnosis could be made only by histopathology.
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Papers by suma Radhakrishnan