Day 1 :
Associate consultant in Hamad Medical Corporation
Time : 9:00-09:40
Dr. Ahmad Nasrat Al-juboori has completed his PhD since 1997. He was graduated from Iraqi Board of Otolaryngology (1997), and from European Board of Otorhinolaryngology, Head and Neck Surgery since 2015. He was former consultant ENT surgeon and professor in clinical otolaryngology in Al-Iraqia University, Iraq till 2015. Now he is working as Associate consultant in Hamad Medical Corporation, Al Wakra Hospital and Assistant Professor in Weil Cornell Medicine-Qatar. He has published more than 22 papers in reputed journals and has been serving as an editorial board member and reviewer in 5 of reputed journals.
Background: Extracranial intra-temporal complications of Chronic suppurative otitis media (CSOM) are extremely rare. Gradenigo’s syndrome is defined as a clinical trial of otitis media, severe pain originating from the trigeminal nerve, and ipsilateral sixth cranial nerve palsy.
Case report: A 61-years-old man presented with chronic left ear discharge, left side headache, diplopia associated with vertigo, tinnitus and hearing impairment. MRI with contrast showed asymmetrical signal changes in the bilateral petrous bone with reduced enhancement on the left with high suspicion of petrositis, in the context of chronic tympanomastoiditis, there was 10×4mm enhancing lesion in the left internal auditory meatus involving the 7th – 8th nerve complex. The patient treated conservatively with local and systemic antimicrobial agents, he had satisfactory response and improvement regarding symptoms of ear discharge, vertigo and diplopia but there is no remarkable response regarding hearing loss and tinnitus.
Conclusion: Although there is little evidence to support the use of conservative treatment in the treatment of Gradenigo’s syndrome resulting from chronic ear disease, we here demonstrate successful conservative treatment of Gradenigo’s syndrome.
Director professor & head ENT Department in University College of Medical Sciences & GTB Hospital
Time : 09:40-10:20
Dr LAKSHMI VAID has completed her MBBS MS ( ENT ) at the age of 26 years in 1982 from SMS Medical college, Jaipur, Rajasthan University. She is having work experience of more than 35 years and at present she is Director professor & head ENT Department in University College of Medical Sciences & GTB Hospital, Delhi -95 ,INDIA . She has published more than 45 papers in reputed journals.
Chronic rhinosinusitis is one of the most common reasons for physician office visit, lost productivity in the work force and antibiotic prescription. Recent researches on the pathogenesis of CRS have been focused on the potential role of biofilm in the recalcitrant nature of disease.
Anti inflammatory therapies favourably topical steroids with low dose macrolides have received an increasing interest in recent years. Studies have shown some influence on polyp size and patient symptoms also, on biofilm formation in many steps.
Our study group comprising of 48 patients, of which 24 were given macrolides along with steroidal spray and rest 24, steroidal spray alone for 4 weeks underwent FESS surgery.
We compared the pre-operative and post-operative SNOT-20,endoscopic score, CT,scores and biofilm presence and density in both groups. Significant improvement was seen in the SNOT-20 scores with p value of 0.011 and endoscopic scores with p value of 0.001 in group having macrolides along with steroids pre-operatively however the scores post surgery didn’t show any such significant change in both groups. The efficacy of macrolide with nasal steroidal spray or nasal spray alone showed no further benefit in the subjective outcome measures post operatively. Also no statistically significant eradication of biofilms or decrease in density could be appreciated in both groups. Furthermore there was no significant difference in recurrence rate.
Our result demonstrated the subjective improvement in patients of macrolide group post treatment which could be attributed to its anti inflammatory effect. However the in ability of the macrolide group to represent any change in density of biofilm refutes many available studies.
Eventhough macrolides in combination with nasal spray reflected some improvement in the secondary outcomes but the primary outcome of eradication of biofilms couldn’t be achieved. Hence more research is needed so as to answer this topic and confirm the effectiveness of clarithromycin on mucosal biofilms.