Hallmark Speciality ENT Clinic

 https://www.hindustantimes.com/cities/pune-news/higher-number-of-post-covid-patients-in-pune-report-mucormycosis-a-rare-fungal-infection-101619016283235.html

     Trivial looking head trauma due to fall from skidding bike.      This young man got admitted for intense headache and watery discharge from right nose. Watery discharge is nothing but CSF leak suggesting skull base injury.     CT cysternography revealed collection of dye in rt sphenoid with air in extradural space but no obvious fracture.      Surgery was planned after covid testing. The plan was to identify the leak, closure and sos burr hole to drain the air.       Endoscopic transnasal sphenoidotomy done and mucosa stripped off from the sinus cavity. There was evident undisplaed fracture in rt para-sellar region extending to planum sphenoidale.  There was no scope for plugging the defect with fat, hence glue applied directly on fracture line with fat, fascia as onlay graft and middle turbinate incised at the ant end, rotated and placed as pedicle graft. One sided nose packed with Ivalon for a week.          In post op there was no leak, headache relieved and CT scan on 5 th po

    Since last couple of weeks entire world is facing this dangerous pandemic of corona. Started with China's Wuhan province, it has spread to almost every continent on earth. And with the influx of tourists, NRI residents, students it is rapidly spreading inside India.       We don't know the structural similarity between corona and Spanish flu virus of 1918. But the way corona is spreading across the globe with a killing spree, we don't have a choice but to compare it with Spanish flu that killed  millions of people across the globe.       Only difference I see is, while Spanish flu killed youngsters with same ferocity as elderly, corona is mainly taking away seniors particularly those with pre-existing health problems.       Spanish flu came to India on ships brought by infected, ailing indian soldiers in British army stationed in Europe. From the dockyards it spread to suburbs of Mumbai and with flleeing populace it spread to interiors of India, affecting towns conn

Curious case of pearloma !😊      Life is full of surprises ! Recently a case was referred by neurosurgeon with severe ear pain , stenosed ear canal and with the above CT findings😱. A case of fibrous dysplasia with temporal bone invo lvement and huge expanded mastoid cavity and petrous temporal bone.      First of this kind of experience😒. Nevertheless took the case for decompression of the lesion . It was huge skull due to expansion, Changed the routine of endaural to postural incision. The bone of mastoid was like ping pong ball and almost non existing ear canal because of anteriorly collapsed post canal wall. Little drilling and cavity opened with pus and debri and then in between pearls of none other than our old aquaitance as if saying 'Hey ! Get me out of hear if you want relief for your pt and your self😉. Inferiorly dehiscent jugular and a closed cavity with collapsing walls on all sides    with only suction doing the job like in soft pituitary tumors. T

      Whenever as a doctor you get a patient with some serious illness which is difficult to manage,  a sense of gloominess prevails. Patients of uncontrolled diabetes do get some life threatening infections and to treat them becomes a challenge. Invasive fungal rhino sinusitis is one such dreaded infection which until recently was having almost fatal outcome and even if saved were left with serious morbidities like lost vision, lost orbit. The only effective anti fungal amphotericine is highly toxic and its liposomal variant is expensive.         Last month managed one such pt, a 50 yr old lady with uncontrolled diabetes , blood sugar levels touching 350 mg/dl admitted in the hospital with severe headache, diplopia due to ophthalmoplegia of rt eye. Diagnostic nasal endoscopy revealed pale darkening mucosa , took smear and tissue for biopsy. CT and MRI revealed opacities in adjoining ethmoid and frontal sinuses. All the picture was suggestive of invasive fungal disease[ mucormycosis

     Last week operated a challenging case of spontaneous CSF leak in a 40 yr old young lady. She is an avid Kathak dancer and recently had gone for snorkeling. Severe headache with profuse watery discharge from nose and physicians rightly suspected it to be a case of Meningitis with CSF rhino-rhea [Brain fluid leaking into nasal passage through a defect in skull base].     Thoroughly investigated, done CT cysternogrphy and found the suspicious defect in sphenoid sinus. I myself with Dr Chandrashekhar an eminent neurosurgeon performed the surgery. It was endoscopic trans nasal surgery, defect was identified in sphenoid clivus as multiple tiny leaks in a localised area c,w some drilling done with diamond bur to make a single defect good enough to be plugged with fat , with overlay  fascia lata and glue in a five layer closure. Pack was removed on 7th post op day and pt is discharged . This is a very rewarding minimally invasive surgery for a grave problem.      However this lady wil