From Place : Bellary

Dr. SHAMA HEGDE Date : /11/2010

Post Graduate Student in MS- ENT,

Department of ENT,

Vijayanagar Institute of Medical Sciences,

Bellary.

To,

The Principal,

Vijayanagar Institute of Medical Sciences,

Bellary.

Through Proper Channel

Respected Sir,

Subject: - Submission and forwarding of synopsis for

Registration of dissertation topic.

In accordance with above cited above, I the undersigned studying in PG Course in MS-ENT has been allotted the dissertation topic “COMPARISION BETWEEN MICRODEBRIDER ASSISTED SURGERY AND THE CONVENTIONAL METHODS IN THE SURGICAL TREATMENT OF NASAL POLYPS” under the guidance of DR.N MANJUNATH, Professor , Department of ENT, VIMS, Bellary.

I am requesting you to forward the dissertation topic in the prescribed form to the Registrar Rajiv University of Health Sciences, Bangalore, Karnataka, for approval.

Thanking you,

Yours faithfully,

Signature of the guide

DR. SHAMA HEGDE

DR.N MANJUNATH.

Professor, Dept. of ENT,

VIMS, Bellary.

From Place : Bellary

The Professor and HOD, Date : /11/2009

Department of ENT,

Vijayanagar Institute of Medical Sciences,

Bellary.

To,

The Registrar,

Rajiv Gandhi University of Health Sciences,

Bangalore.

Through Proper Channel

Respected Sir,

As per the regulations of the University for registration of Dissertation Topic, the following Post Graduate student in MS - ENT has been allotted the dissertation topic as follows by the official registration committee of all qualified and eligible guides of the department of ENT.

Name / Topic / Guide
DR. SHAMA HEGDE
Post Graduate Student in MS ENT, Dept of ENT, VIMS, Bellary. / “COMPARISION BETWEEN MICRODEBRIDER ASSISTED SURGERY AND CONVENTIONAL METHODS IN THE SURGICAL TREATMENT OF NASAL POLYPS” / DR.N MANJUNATH. Professor , Department of ENT, VIMS, Bellary.

Therefore, I kindly request you to communicate the acceptance of the dissertation topic allotted to PG student at an early date.

Thanking you,

Signature of the guide Yours faithfully,

DR.N MANJUNATH DR.SATYANANDA RAO

Professor, Dept. of ENT, Professor and HOD, Dept. of ENT,

VIMS, Bellary. VIMS, Bellary.

(RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE. KARNATAKA.

ANNEXURE – II

SYNOPSIS FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 / Name of the candidate and address
( in block letters) / DR.SHAMA HEGDE
POST GRADUDATE STUDENT IN MS ENT
DEPT OF ENT,
VIMS, BELLARY, KARNATAKA
PIN : 583104
2 / Name of the Institution / VIJAYANAGARA INSTITUTE OF MEDICAL SCIENCES, BELLARY.
3 / Course of study and subject / MS IN ENT
4 / Date of Admission to course / 26-06-2010
5 / Title of topic / ‘COMPARISION BETWEEN MICRODEBRIDER ASSISTED SURGERY AND CONVENTIONAL METHODS IN THE SURGICAL TREATMENT OF NASAL POLYPS”
6
6.1
6.2 / Brief Resume of the Intended Work
NEED FOR STUDY
Nasal polyposis is regarded as one form of chronic inflammation in the nose and
sinuses, part of the spectrum of chronic sinusitis.1
The prevalence of nasal polyposis is about 2%, increasing with age reaching a peak in those aged 50 years and older. The male:female ratio is about 2:1.1
Primary treatment consists of intranasal corticosteroids in majority of cases which serves as medical polypectomy. In more severe cases surgery is required in the form of simple polypectomy or intranasal endoscopic surgery preceded by CT scan examination of nose and paranasal sinuses1
After the advent of endoscopic sinus surgery it has become the procedure of
choice for the treatment of sinonasal polyps.
With the advances in technology microdebrider , a powered instrument is becoming popular to treat nasal polyps by reducing reliance on traditional non
powered instruments like curettes and forceps. It is a rotator cutting device that provides atraumatic dissection by resecting tissue precisely,minimizing inadvertent mucosal trauma and stripping.7
This study is undertaken to evaluate the efficacy of microdebrider and to assess whether differences in efficacy exist between microdebrider assisted surgery and conventional endoscopic surgical techniques in treatment of sinonasal polyps.
REVIEW OF LITERATURE
Polyp is derived from Greek word meaning many footed (poly-many; pous-footed)1
Historicalreview:
It is a condition that was first recognized in India. Hippocrates developed 2 methods for nasal polypectomy-extraction by pulling a sponge through the nasal canal and by cauterization. Cato the Censor developed first known medical management of nasal polyp using local application of herbs. Deschemp in 18th century devised methods of treatment as local application of astringents, avulsion with forceps, knotted threads, chemical cautery , ligature with waxed wire or with wire of silver. In the 19th century Luc advocated middle turbinectomy followed by intranasal ethmoidectomy.4
Management:
Treatment of nasal polyp is a combination of medical and surgical modalities following assessment of the patient. Polyps are sensitive to corticosteroids and hence where polyps are not obstructing the nose completely a trial of corticosteroids pre-operatively is worthwhile. Surgery is a straight forward options in patients with pansinus polyps, those not responding to medical management or have subsequent relapses.5
Presently Endoscopic sinus surgery is the surgery recommended that involves anterior to posterior approach designed to achieve functional intact sinus with minimal surgical intervention necessary. The primary objective of this ‘Messerklinger approach’ championed by Stammberger is the removal of pathology in the ostiomeatal complex sufficient to achieve ventilation and drainage, thereby addressing the underlying pathophysiology by a conservative technique; hence the term ‘functional’ endorsed by Kennedy.1,2,3
But it may lead to major complications like
  1. Haemorrhage, the common site being septal branch of sphenopalatine artery
  2. Scarring causing synechiae and stenosis
  3. Epiphora caused by injury to nasolacrimal duct
  4. Orbital injury ranging from orbital fat exposure to retrobulbar haemorrhage.
  5. Intracranial injury causing CSF leakage and life threatening intracranial haemorrhage.5
Microdebrider is an instrument considered to be the most important innovation in the field of rhinology and endoscopic sinus surgery. Originally concept and design of microdebrider was patented by Urban in 1969 who called it ‘Vacuum rotator dissector’.It was initially used by House group to remove Acoustic neoroma during 1970’s. In 1994, Setliff and Parson started using this equipment for nasal surgeries.
Microdebrider can remove mucosa, neoplastic tissue, cartilage, thin bony septations, nasal debris and blood under continuous endoscopic visualization.It combines suction of tissue with amputation by hollow rotating cutter. It is hooked upto suction that removes excess blood and tissues and can be controlled by a foot pedal. Advantages of microdebrider are:
  1. It spares the adjacent mucosa.
  2. It is precise.
  3. Removes tissue real fast.
  4. Visualisation is good.
  5. Intraoperative bleeding is less.
  6. Can be used to cut tissue from inaccessible areas inside the nose.
Disadvantages of this instrument include
  1. It has slower rotation rates which makes it inefficient to drill bony structures.
  2. Tactile feedback is less while operating when compared to that of conventional instruments.
  3. It should be carefully used in confined spaces and close to vital structures to avoid damage.
  4. Cost of the equipment and expenses towards purchase of blades increase the cost of surgery.6

6.3 / OBJECTIVES OF THE STUDY
The present study is undertaken to study and compare the microdebrider assisted endoscopic surgery and conventional methods using sinus endoscopes in the surgical management of nasal polyps at VIMS Hospital, Bellary.
7
7.1 / MATERIALS AND METHODS
Source of Data :
This study will be conducted on 30 patients visiting ENT OPD at VIMS Hospital, Bellary prospectively during the time period of 1 year i.e., from December 2010 to December 2011.
7.2 / Method of collection of data (including sampling procedure if any)
  1. All patients diagnosed with nasal polyp will be included in the study. A detailed clinical evaluation (history and examination) and relevant laboratory investigations will be done for all patients as per the proforma.
  2. After initial management with intranasal and systemic steroids patients requiring surgery will be randomly selected for treatment with microdebrider assisted surgery and FESS.
  3. Postoperatively patient will be followed up at 1 week,6weeks ,3 months and 6 months for improvement in symptoms, complications or recurrence.
INCLUSION CRITERIA:
Patients diagnosed with nasal polyps between the age group of 5-60 years are included in the study.
EXCLUSION CRITERIA
Patients presenting with unilateral nasal masses that mimic nasal polyps like Encephalocoele, Nasolacrimal duct cyst, Glioma, Dermoid tumour, Haemangioma, Papilloma, Juvenile nasopharyngeal angiofibroma, Rhabdomyosarcoma, Lymphoma, Neuroblastoma, Sarcoma, Chordoma, Nasopharyngeal carcinoma, Inverted papilloma.
Investigations to be done

Mandatory investigations

  1. Complete haemogram
  2. Random blood sugar, Serum Urea, Serum creatinine
  3. Absolute eosinophil count
  4. X Ray- PNS
  5. CT PNS
  6. Histopathological examination of the biopsied specimen.
Optional investigations
  1. MRI - PNS
  2. Allergic tests

7.3 / Does the study require any investigations or interventions or interventions to be conducted on patients or other humans or animals ? If so please describe briefly.
Yes the above investigation are done routinely in our hospital, no animal interventions are required.
7.4 /

Has Ethical Clearance Obtained from Your Institution Case Of 7.3?

Yes ethical clearance has been obtained from the VIMS Institutional ethics Committee, Bellary.
8. / LIST OF REFERENCES
1.Mygind N,Lund J V, Jones R J. Nasal polyposis and Surgical management of rhinosinusitis. In: Gleeson M, Browning G G,Burton J M et al.Scott andBrown’s Otorhinolaryngology, head and neck surgery,Edward Arnold publishers Ltd 2008, 7th edition, volume 2,pp: 1549-50,1556,1480-81
2.Stammberger H. Endoscopic endonasal surgery - concepts in treatment of recurring rhinosinusitis. Part 1. Anatomic and pathophysiologic considerations. Otolaryngol Head Neck Surg 1986; 94: 143-46. (s)
3.Stammberger H Endoscopic endonasal surgery. - concepts in treatment of recurring rhinosinusitis. Part II - Surgical technique. Otolaryngol Head Neck Surg 1986; 94: 147-56. (s)
4.Settipane G.A and Settipane R.A.Nasal polyposis Clinical spectrum and treatment approaches. In:Gershwin M.E. and Incando G.A. Diseases of sinuses, A comprehensive textbook of diagnosis and treatment. Humana press Inc 1996
5.Marks.S.C, Endoscopic sinus surgery. In: Marks S.C.Textbook on nasal and sinus surgery,W.B.Saunders Company 2000 pp: 119,125-26,140-141
6. E book on Role of microdebriders in otolaryngological surgery, by Dr.T. Balasubramanian

7.Citation: Duvvi .S, Khattab.A, Khalil H.S et al. A National survey of the use of Powered instruments in Functional Endoscopic Sinus Surgery: UK Otolaryngology trainee perspective . The Internet Journal of Otorhinolaryngology. 2006 Volume 4 Number 2 pp: 312

9 / SIGNATURE OF THE CANDIDATE
10 / REMARKS OF THE GUIDE / RECOMMENDED AND FORWARDED
11 / NAME OF THE DESIGNATION OF
11.1 GUIDE / DR. N MANJUNATH
PROFESSOR,
DEPT. OF ENT,
VIMS, BELLARY.
11.2 SIGNATURE
11.3 CO-GUIDE (IF ANY)
11.4 SIGNATURE
11.5 HEAD OF THE DEPARTMENT / DR. SATYANANDA RAO,
PROFESSOR AND HOD,
DEPT OF ENT,
VIMS, BELLARY.
11.6 SIGNATURE
12 / 12.1 REMARKS OF THE CHAIRMAN AND PRINCIPAL / RECOMMENDED AND FORWARDED FOR NEEDFUL.
12.2 SIGNATURE