Wide Marsupialization of ranula.jpg

Medical treatment of Maxillary Sinusitis

Here are two images of CT scan of a person suffering from left Maxillary sinusitis. First Image depicts completely opacified maxillary sinus with adjacent ethmoid sinusits. He was treated with antibiotics, oral and topical steroids, decongestant nasal drops for six weeks. Second image shows complete resolution of sinus opacities with patent ostiomeatal complex.
So, it is essential to treat such cases medically for adequate length of time before deciding for surgery. After all Sinusitis is primarily a medical condition.

Attached is an image edited with BlackBerry Photo Editor Ultimate

ENT Clinic

Bath after Adenoidectomy, Tonsillectomy or ear surgery.

When can the child bath after adenotonsillectomy.?

Ans He can take bath anytime or better next morning as routine.If Myringotomy with Grommet insertion have also been undertaken then it is of utmost importance not to let water insider ear canal otherwise infection can develop.  To prevent this, use cotton plug smeared with vaseline or some ointment during bath. the advantage of using vaseline is that it repels water and it keeps cotton fibers bind together so that when you remove the plug, no cotton fiber is left behind. 

Progression of Leukoplakia tongue over years.

Tongue Lesion on 03 Dec 2011.

This is a common site in India where people chew tobacco and beetle nuts.This patient had this whitish lesion on lateral part of tongue for last one year and it is progressively increasing in size.

Same patient as above on 22 Jan 2020

patient lost to follow up but seen by other doctors. got biopsied multiple times and again presenting with a painful ulcer just ahead of white patch. this time lesion feels indurated. Multiple biopsy of the lesion taken and sent for HPE.

Regarding Oral Lichen Planus

Dear doctor,

I am 24 years, smoke a pack of cigarette a week(reduced, trying to quit!). I have got something unusual on my cheek(inside mouth) There is no pain feeling happening. I have visited many doctors and they say that it is nothing to worry about. But I am worried as it has been over a year since it is present on my inner cheek.

I read your post on Oral Lichen Planus and I thought you might be in better position to guide.

Please see the pictures in the attachment and give your opinion.

Thanks,

Sachin

Pediatric rhinosinusitis

Case of 11 year child with history of mouth breathing having Adenotonsillar hypertrophy. Patient was not referred but came on her own very late. In our country, timely referrals from paediatrician is rare. All cases of mouth breathing should have an ENT opinion at earliest.

? Chondroma or fibrous dysplasia

I recently operated this tumour. It ewas surrounded with thick wall with semisolid contents. Waiting for biopsy report. Dr Ajay Jain

Direction Map for clinic

Facebook newsfeed post by: Sophie Tdz

Sophie Tdz wrote:
A worried woman went to her gynecologist and said: 'Doctor, I have a serious problem and desperately need your help! My baby is not even 1 year old and I'm pregnant again. I don't want kids so close together'. So the doctor said: 'OK and what do you want me to do?

which is better-Hearing Aid or Cochlear implant

In a Case of deaf child, cochlear implant is indicated only if hearing aid does not work at all.
If a child is getting benefited by HA and. She is achieving comprehensible and spoken speech. Then no need for CI. Parents and her audiologist can better judge for improvement.

Which Steroids

What extra advantage Methylprednisolone has over prednisolone for sudden SNHL or Indirect Optic nerve injury.
Fact is Methylprednisolone is only marginally potent than prednisolone. Dexamethasone and betamethasone are 5 times potent than methylprednisolone. So then why not dexa or betamethasone espl when later have zero mineralocorticoid activity and hence less fluid retention.

Attacking Docs Non-bailable Offense in Maharashtra

The Maharashtra assembly has passed the Maharashtra Medicare Service Persons and Medicare Service Institution (Prevention of Violence and Damage or Loss to Property) Act, 2010 on Friday.

Bruxism (Grinding of Teeth)

Grinding of teeth is a topic of concern to parents. This commonly occurs in children or because of any drug which increases serotinin in brain. Increased serotinin leads to anxiety.

Grinding of teeth occurs during stage 2 of non rapid eye movement NREM sleep.

Treatment consists of reducing the anxiety and giving preventing oral appliance in consultation with dentist to prevent damage to teeth.

Soon, six months jail for disclosing the health status of a person

Soon, six months jail for disclosing the health status of a person

As per the new proposed Right to Privacy Bill, doctors and hospitals cannot disclose the health status of a person. If they do, they could face imprisonment up to six months and/or a fine of up to Rs 1 lakh.

Hearing problem

sir  i am saying DS chandel , sir jab se ear ka bahna band ho gaya hai tab se hearing problem jyada ho gayee hai , sir whai i do
 good night sir


Hi
It happens that you hear better sometimes when ear is discharging as pus forms temporary contact between sound conducting structures. I shall suggest you to show ENT doctor who will assess damage ang may advise you to undergo surgery .. Dr Ajay Jain

Tubercular Abscess

Keratosis Pharyngis

Keratosis Pharyngis- Note white debris deposited in crypts of both tonsils. 

Whitish spicules due to hyperkeratinized areas of epithelium are sometimes extensive over tonsils and lingual tonsils. It is usually a chance finding. No treatment is required for this condition unless it is associated with tonsillitis.
(Look at both the tonsils having whitish spicules. Interestingly this girl had same thing over base of tongue also. I advised frequent gargles only)

Telephonic consultation

Very true Dr Ajay.

I never encourage my patients to call for consultation. I would rather insist them to consult me physically. I may/may not charge them but at least I know what I'm dealing with.
Sach, trend is such that a lot of people will enroll in such services in time to come for various reasons but you don't indulge into it. :)


Best Regards,
Dr Vimal Hemani

Submandibular Calculi

This is a special X Ray called Occlusal view where X ray film is kept in mouth and beam is aimed from below.

Unilateral Pansinusitis

This patient presented with six month history of gradually progressing nasal obstruction. CT shows complete opacification of left side sinuses. Soft tissue cuts were suggestive of Fungal mass because of heterogeneous opacities. To my surprise, it was just thick secretions in Frontal, ethmoid and sphenoid sinus. The nose and maxillary sinus was filled up with very thick walled mass with secretions inside.
Lesson: Thick secretions can mimick as fungal mass.

Concha Bullosa

 

Bilateral large Concha Bullosa

Concha Bullosa means when the middle turbinate contains air or it is opened instead of like the inferior one as shown. It may not cause any problem or it may cause narrowing of sinus passage. It may be cause of headache especially in allergic cases. Treatment is straightforward. Excise the lateral half of this turbinate facing the sinus with help of endoscope and preserving its mucosa.

common tongue picture without any symptoms.

What are these? are these hypertrohied taste buds?

Oral Lichen Planus

This is chronic condition of mouth where the cheek

mucosa acquires shades of red grey or white. The exact

cause is not clear but may be related to stress. This

is treated by topical steroids and sometimes steroids

given by systemic route. Anti oxidants, antacids may

also be prescribed. In doubt of diagnosis, biopsy may

be necessary.

Endoscopic Cauterization of bleeding points in nasal bleeding.

It's better to look inside the nose before packing the nose with help of nasal endoscope. If bleeding is localized especially in form of  spurter, then immediate cauterization is useful. In cases of chronic renal failure or other chronic medical illness where bleeding is diffuse, cauterization may not be beneficial and keeping a gel foam or keeping merocel over diffuse bleeder will stop the bleeding. Gel foam may not need to be removed as it dissolves soon.  

FAQs about Tongue Tie

First Point: Type of Anaesthesia: I often get phone calls where parents ask the question whether the surgery will be done in local or general anaesthesia. Most often the patient is small kid and the site to be operated is very vascular (full of bleeding vessels). So, its is safer to operate under general anaesthesia as this will protect his wind pipe getting choked with blood and surgeon can carry the procedure as planned.

A large Benign vocal polyp

This polyp was very big in very small space inside the larynx. Patient was heavy smoker. it was removed under microscope. The histopathological examination confirmed it to be benign polyp.

The patient has left smoking now and on regular follow up and have been advised speech therapy.

Consent information for Otoplasty (Pinnaplasty)

CONSENT INFORMATION – PATIENT COPY

OTOPLASTY (also known as Pinnaplasty)

PLEASE READ THIS SHEET BEFORE YOU CONSENT FOR YOUR PROCEDURE

This information sheet provides general information to a person having an Otoplasty. It does not provide advice to the individual. It is important that the content is discussed between the patient and the concerned doctors who understand the level of fitness and medical condition.
What is “Otoplasty”?

Consent information for Myringoplasty

CONSENT INFORMATION – PATIENT COPY

MYRINGOPLASTY

PLEASE READ THIS SHEET BEFORE YOU CONSENT FOR YOUR PROCEDURE

This information sheet provides general information to a person having a Myringoplasty. It does not provide advice to the individual. It is important that the content is discussed between the patient and the concerned doctors who understand the level of fitness and medical condition.
What is “Myringoplasty”?

Cosent information for Laryngoscopy

CONSENT INFORMATION – PATIENT COPY

LARYNGOSCOPY

PLEASE READ THIS SHEET BEFORE YOU CONSENT FOR YOUR PROCEDURE

This information sheet provides general information to a person having a Laryngoscopy. It does not provide advice to the individual. It is important that the content is discussed between the patient and the concerned doctors who understand the level of fitness and medical condition.
What is “Laryngoscopy”?

Consent Information for Septoplasty

CONSENT INFORMATION – PATIENT COPY

SEPTOPLASTY

PLEASE READ THIS SHEET BEFORE YOU CONSENT FOR YOUR PROCEDURE

This information sheet provides general information to a person having a Septoplasty. It does not provide advice to the individual. It is important that the content is discussed between the patient and the concerned doctors who understand the level of fitness and medical condition.

Consent information for Mastoidectomy

CONSENT INFORMATION – PATIENT COPY

MASTOIDECTOMY

PLEASE READ THIS SHEET BEFORE YOU CONSENT FOR YOUR PROCEDURE

This information sheet provides general information to a person having a Mastoidectomy. It does not provide advice to the individual. It is important that the content is discussed between the patient and the concerned doctors who understand the level of fitness and medical condition.

Consent information for Stapectomy or Stapedotomy

CONSENT INFORMATION – PATIENT COPY
STAPEDECTOMY

PLEASE READ THIS SHEET BEFORE YOU CONSENT FOR YOUR PROCEDURE

This information sheet provides general information to a person having a Stapedectomy. It does not provide advice to the individual. It is important that the content is discussed between the patient and the concerned doctors who understand the level of fitness and medical condition.

Consent form for Adenoidectomy

CONSENT INFORMATION – PATIENT COPY

ADENOIDECTOMY

PLEASE READ THIS SHEET BEFORE YOU CONSENT FOR YOUR PROCEDURE

This information sheet provides general information to a person having an Adenoidectomy. It does not provide advice to the individual. It is important that the content is discussed between the patient and the concerned doctors who understand the level of fitness and medical condition.

Consent form for Oesophagoscopy

CONSENT INFORMATION – PATIENT COPY

OESOPHAGOSCOPY (also known as Gastroscopy)

PLEASE READ THIS SHEET BEFORE YOU CONSENT FOR YOUR PROCEDURE

This information sheet provides general information to a person having an Oesophagoscopy. It does not provide advice to the individual. It is important that the content is discussed between the patient and the concerned doctors who understand the level of fitness and medical condition.

Consent form for Rhinoplasty (Nose Job)

CONSENT INFORMATION – PATIENT COPY

RHINOPLASTY

PLEASE READ THIS SHEET BEFORE YOU CONSENT FOR YOUR PROCEDURE

This information sheet provides general information to a person having a Rhinoplasty. It does not provide advice to the individual. It is important that the content is discussed between the patient and the concerned doctors who understand the level of fitness and medical condition.

Cosmetic Surgery of the nose (Rhinoplasty)

Cosmetic Surgery of the nose (Rhinoplasty)


Rhinoplasty or nose job is a highly specialized surgical procedure, used to change the size, shape, and overall appearance of the nose.

RE: Left Ear Problem

Dear Mr. Vidyasagar,

 In first instance, I don't see any reason for hearing Aids not to work in your case. You need to discuss with your Audiologist. Regarding BAHA, It may be useful. I need to see your case in person.

I think hearing aid is only best option in your case.


with Best Regards,

Dr. Ajay Jain




Date: Mon, 6 Jun 2011 16:14:51 +0530
Subject: Left Ear Problem

 I identified my hearing loss 11 years ago( i.e, in the  year 2000 ) and went to a doctor. They tested and said that Left ear  sensory nerve lossed. Left Ear can receive the sound at 70 dB only and mixed hearing loss.
 Right Ear can receive the sound at 35 dB only and mixed hearing loss.
 Recently agiain i went for audiometry test; Left Ear can receive the sound at 80 dB only and mixed hearing l Right Ear can receive the sound at 35 dB only and mixed hearing loss.
 Even i use hearing aid, i am not getting much difference.

Wheather BAHA surgery is useful for my case.
Please suggest the best solution for my case.
VIDYASAGAR

Video Nasal Douche or Jal Neeti

 Nasal Douche or Jal Neeti can be done by various methods.

Swimming is a natural and best way for Jal Neeti.

Traditional Indian method describe use of a specially made copper pot with a long snout and water kept overnight and then in particular position, put water from one side of nose, which comes out from other nostrils.

Surgical Tips for Tracheostomy

1. Always try to have a surgical or Anesthetist colleague with you who understand the airway. Assistant has an important role in performing tracheostomy.
2. Choose a good pair of right angle retractor. Hold the retractor parallel to floor and try to lift soft tissues so that the blunt dissection of underlying strap muscles becomes easier.

List of recommended Audiologists.

PRAMOD SPEECH and HEARING CLINIC- 9811158034
Based at Kaushambhi, Vaishali, Vasundhara, IP Extension.


SHALINI -SPEECH THERAPIST-9582440049
Based at IP Extension.


Raj Sharma-9811156358

RAJ SHARMA , Consultant: Audiologist. 
PRIORITY CLINIC for Voice Hearing &  Speech,
B-275 (Ground floor), C R Park, New Delhi-19. 
(B/w Nehru Place to GK II/Savitri flyover on ring road at Pomposh Bus Stop's footbridge)
Near Accord/Rockland Hotel. Phone:26270000 
By appointment only (5-8PM).
www.priorityhearing.com ,Mob:9911444666 

Meenakshi Speech & Hearing- Contact 9818325950
based at Bengali Market and Jagriti Enclave


S.K Speech Hearing Clinics

Kundan 9811519900

1)58/18,Jharsa Rd,opp Jyoti Hosp,Sec 15,Part-1,GURGAON
2)491,Sec 30,Faridabad
3)1-7a,Main Rd,Shalimar Park,East Delhi 32
4)H-19 Sec 22 Noida. -.

Post Operative Care after Septoplasty

POSTOPERATIVE CARE AFTER SEPTOPLASTY

Good healing needs good care of tissues in term of nutrition and preventing them from dryness which comes often after nasal surgery. Here are few points to discuss.

1. DIET: The diet should be semisolid for first 10 days. The reason behind is that the excess chewing may be associated with movement of facial muscles and cause discomfort to operated area. Physical rest is an absolute necessity for tissues to heal. Prefer semisolid diet like curd, Lentil Gruel (Khichri), fresh rice, milk, Kheer, Banana, Custard, and Ice-cream etc. It’s better to have cold foods instead of hot foods especially in initial part of recovery period as cold stops bleeding and hot can cause bleeding.

2. MEDICATIONS: ANTIBIOTICS need to be continued for at least a week. Beside this, some form of SALINE NASAL SPRAY will keep the nasal mucosa moist and is helpful in settling of mucosa (skin inside the nose) of the nose. A lubricating ANTIBIOTIC OINTMENT is helpful for preventing the dryness near the suture line and preventing infection. STEAM is very helpful in keeping the nose moist as steam can go to every corner of your nose with ease. JAL NEETI is another form of keeping the dried crusts out of your nose and it can be demonstrated by your doctor on request.

3. NASAL PACKING: Nasal packing is placed inside your nose after the surgery. This dressing helps in giving support to the operated area and prevents bleeding from the operated side. You may have to breathe through your mouth for 48 hours after surgery due to this nasal packing. It may also cause some headache, stuffiness and watering of eyes. It is usually removed after 48 hours.

4. SUTURE REMOVAL: It is not needed as these are absorbable sutures.

5. PAIN MANAGEMENT: Pain killers can be given for first three days and then given on need basis. Mild pain on touching the nose may remain for as long as 3 months after surgery.

6. PHYSICAL ACTIVITY: It’s better to limit the physical activity for first 7 days to movements inside your house alone. Any exertion can disturb the operated site and cause bleeding. Do not rub the nose or poke a finger inside the nose. Do not travel in a crowded public transport as someone may just pound over your face. A little trauma may spoil the good work done by surgeon.

7. WORK: Do not think about your work or study as a happy & stress free mind helps in better healing of wounds. So enjoy your resting period. You can resume work one week after surgery.

8. You will require follow-up visits for one about one month after surgery at frequent intervals as advised by the surgeon for inspection and cleaning of the nose.

REST IS THE BEST WAY OF HEALING. SO ENJOY YOUR REST PERIOD
AND WISHING YOU A SPEEDY RECOVERY.

Ent Problem

Hello sir,

I want operation my wife nose bones. She is facing problem and bleeding daily.

I want confirm what will be your charge.

Please replay me asap.

Thanks,

Dillip 

Not able to speak easily

Dear vicky,

You have not specified why are you not able to speak easily. The causes may developmental or socio-psychological.

You need to meet in person.


Dr. Ajay Jain

Sir, I am 18 year old and till i can\'t speak easily like others. And as u know i can\'t give any interview,please contact me sir Thanks for using our Medical Guide Services ! Regards Whereincity.com Team http://www.whereincity.com

How to open up the blocked ear because of cold?

The tube connecting the ear to nose gets blocked in cold. so, either to avoid this or to open it up again treat your cold. there are some simple things you can do....like...

1. Chewing gum or inflating a balloon will help to open up the blocked tube connecting ear and nose. The kids will love these activities. There are some toys available in form of a pipe or tube, when you blow them, they produce a sound or some paper work gets unfolded to amuse the child.
2. Valsalva Maneuver: Close your nose with your finger and try to blow air but keep your mouth closed. The air instead of going outside will go through your Eustachian tube to middle ear and you will like to hear some sound. Warning: do it gently otherwise thin eardrums may rupture also.
3. Toynebee Maneuver: Again close your nose with your finger and then try to swallow. This is very useful procedure but seldom told.
4. Contraction of floor of mouth: This is bit difficult but some persons may contract the floor of their mouth to cause opening of Eustachian tube.
5. Yawning: It is good exercise. Imitate like yawning.
6. Use some local nasal decongestants drops to open your nose.
7. Do some jogging, dancing or cycling. You will better with your nose and ears. :-)

Ear Bleed

Ears do not bleed spontaneously. Often the cause is self inflicted trauma. Often by fingernail or use of earbuds or matchstick. Ear may bleed after road traffic accidents. Tumour as a cause of bleeding is very rare.

In my practice, most often ear bleed happens after a slap on ear/cheek or when someone tries to clean the ear himself. If ear starts bleeding, then it is tendency of persons to put some kind of oil/fluid into ear. I discourage such practice strongly because this introduces the infection into the wound site. If ear drum is ruptured, then infections can go to middle ear and ear can start discharging.

Most of the ear bleeds stop on their own. At the earliest try to consult ENT specialist.

Nose needs no reason to bleed while the same is not true with ear bleeds. Trauma remains the most important cause of ear bleed which is often self inflicted during cleaning by the person.

RE: Discharge from ears,Tinnitus,hearing Impairment

Dear Isha,

Diabetes is a major factor which may prolong the severity and duration of discharging ears and hence further deteriorating the hearing.

Tinnitus can be treated if we can restore the hearing back. I am not saying that It can be cured in all cases but if I can address the cause of hearing loss or amplify his hearing by proper hearing aid and using tinnitus maskers, Tinnitus can be helped.

If you do not want any surgery, then hearing aid is the best option to treat hearing handicapped.


with Best Regards,

Dr. Ajay Jain


Dear Dr. Jain

My father is 55 years old,his ears have been discharging since his birth.He has undergone a surgery 15 years back for left eardrum which was not successful.Past 8 years back he has become diabetic,blood sugar level ranges b/w 150-250(after meals).Later in year 2007 he was diagnosed with a disease named tinnitus,since then his condition has become worse then before.Though he has been advised to use ear plugs and hearing aid,but he doesn't feel comfortable enough using hearing aid throughout a day.After reading his past history

Can you please answer my following questions:
*Is diabetes a major factor in making his condition worse?
*Can tinnitus be cured?If non then how can it be treated?
*Without undergoing any surgery can his hearing impairment be treated.
*Your suggestions Looking towards for your reply.

Yours Truly
I.A

RE: Urgent help needed regarding Hemangioma tongue

Hello,

The management of hemangioma tongue depends upon the site, extent of lesion, age of the patient and the present symptoms. It's difficult to generalize. Pls get in touch in person with the patient with radiological investigations.

Dr. Ajay Jain

---

Date: Wed, 16 Feb 2011 12:47:12 +0530
Subject: Urgent help needed regarding Hemangioma tongue

Hi, my sister is diagnosed recently as Hemangioma of tongue, spread to submandibular area, possibly fed by ECA as confirmed by MRI done few days back. She lives in Mohali and Fortis, Mohali doctor has refused the surgery. Now what is the best management as per your expert advice...kindly suggest any higher centers in foreign also in your knowledge as it would be great help. Im a doctor myself and hope gets an urgent reply with proper advice.

Tinnitus both ears

Dear R....,

Any cause which results in hearing loss  can produce ringing sounds in ear. So if we can improve hearing with any modality (Surgery, Medicine or hearing aid), then it should result in diminished ringing sensation.

I need to see your audiometry report and scans to tell you what best can be done for you. You can send the same via email or meet in my clinic with prior appointment. 


with Best Regards,

Dr. Ajay Jain

30 Jan, 2011

Dear Dr. Ajay Jain,

Medical Guide Ad Response

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Steam Vs Nebulization

How should I take steam?

Steam can be taken by either the convenient Steamer or from the boiling water on a heater. The second option is dangerous especially with kids.

It's not necessary to keep the face too close to container. Even a chair close to the steamer is enough. You can leave the steamer on and do your table work.

Should I put something into boiling water like vicks or karvol?

Steam is a pure form of water. Water evaporates after boiling and when it condenses into air passage, then it leaves moisture there. This moisture helps moving dried up small hairs which ultimately moves the mucus. Putting these things may increase the pleasant experience like smell but as such they do not have an additional function and may not be necessary to use.

Can I take Nebulizer instead of steam?

Nebulizer is no substitute of steam. It has different function which can not be done by steam either.
Nebulizer is for lungs whereas steam is both for lungs and nose. Nebulizer is way of delivering drungs for local action in lungs while steam delivers moisture both to lungs and nose.

Some viruses like Rhinovirus which causes common cold are susceptible to heat. So taking steam helps in eliminating such viruses.

Question-Answer

Dear Sunny,

Any hearing loss whatever may be the cause, can result in ringing sensation in the ear.

You have not told your age, I guess you are young.

So first get an ENT consultation followed by pure tone audiometry and if needed impedance audiometery. If the cause of hearing loss is found, then treatment would be easy.

With regards

Dr. Ajay Jain

21 Jan, 2011

Dear Dr. Ajay Jain,

Medical Guide Ad Response

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Who heals the patient's suffering?

I am of the firm opinion that apart from good surgery, it's the faith of the patient in doctor that heals the patient's suffering. Sometimes I was not happy with the surgery but patient's longanimity and faith of him in me that he is happy with the outcome. At other times, I have done a wonderful job surgically but still patient is not happy. So TRUST is the key issue for good outcome.

There are instances where I had to revise my cases with revision surgery. I even offered the patient that someone else might do the same surgery whom I think is better than myself yet patient insisted me only to do the job. Fortunately results were satisfying.

Those patients who have happy-go-attitude towards life do very well after surgery and those are emotional kind, have unrealistic expectations towards life do worst despite surgeon's best job.

Extrasinus Mucocoele of right Maxillary sinus invading the orbit

Thanks Dr. Shivram Gopal Iyer for entrusting this case to me.

The case was operated upon by right infraorbital incision, right sublabial incision and right FESS to marsupialize the cyst which drained into right nose. the patient is doing fine in postoperative period with slight diplopia in certain eye movements.

Transpalatal incision for excision of Angiofibroma

 

This case was unusual in that here the boy presented at the age of 33 years with a history of left side nasal bleed for last one years. To prove it to be a case of Angiofibroma, I took biopsy under local anesthesia. luckily, since the tumour mass was occluding the choanea, it did not bleed into oropharynx. Biopsy showed thick angiod element with final inference of benign vascular growth. DSA showed it to be getting supply from both internal maxillary artery and left ascending pharyngeal artery which were embolized by PVA particle.

The case was operated upon by team of Dr. Atul Jain, Dr. Ajay Jain and Dr. Poonam Gautam at Pushpanjali Crosslay Hospital. A Transpalatal approach was used as shown in first figure. It bled a lot but no transfusion was required. The final histopathological examination of specimen confirmed it to be Angiofibroma.

Haemostasis during Tonsillectomy

Haemostasis during Tonsillectomy is an extremely important step and different surgeons have different preference for securing it. Some like suturing the bleeder which may be technically challenging at times or some like diathermy. Diathermy may be unipolar or bipolar.

Recently I did a paediatric tonsillectomy where I was comfortable with sutures and an adult tonsillectomy where sutures did not work and bleeding could be secured by bipolar cautery only. The apparent reason could be the larger and deeper tonsillar bed in adults where its difficult to secure sutures and because of too much fibrosis, it bleeds a lot.

In my opinion, suturing is best method with vicryl provided you can secure the knots at right place otherwise bipolar cautery is good. Radio-frequency is an excellent substitute for cautery and of late coblation has come. The adverse effect of using diathermy (cautery, radio-frequency or coblation) is increased postoperative pain and long term chances of developing neuralgic pain (Acquired Eagle's Syndrome).