Hardip Singh Gendeh

By Hardip Singh Gendeh and Balwant Singh Gendeh

Anatomical variations of the sinuses are common and may lead to obstruction to the ventilation and drainage of the sinuses. This may lead to osteomeatal complex disease refractory to medications. A preoperative CT of the paranasal sinuses acts as road map guide to identify vital anatomical variations and its relationship to the orbit, skull base, neurological and vascular structures, to prevent iatrogenic injuries. To control intraoperative bleeding, it is critical to identify the anterior and posterior ethmoidal artery indentations and sphenopalatine artery in the anterior and lateral nasal walls. It is essential for the surgeon to familiarize with the anatomy of the ethmoid region, lateral nasal wall, sphenoid sinus, sella and parasellar region and pterygopalatine/infratemporal fossa before embarking on these approaches. The advent of CT scans and state-of-the-art FESS instrumentation has made surgery of the paranasal sinuses less of a mystery for the surgeon. Therefore, identifying and addressing these anatomical variations during FESS is crucial in restoring ventilation and drainage.

Part of the book: Paranasal Sinuses Anatomy and Conditions

By Hardip Singh Gendeh and Balwant Singh Gendeh

Laryngo-pharyngeal reflux (LPR); esophageal reflux; pharyngolaryngeal reflux; or reflux laryngitis refers to the backflow of acid from the stomach to the upper aerodigestive tract of the larynx and pharynx. Repetitive reflux of these contents may lead to LPR. It has been estimated that half of the otolaryngology patients with laryngeal and voice disorders have LPR. The pattern of reflux is different in LPR and gastroesophageal reflux. LPR usually occurs during the daytime in the upright position, whereas gastroesophageal reflux disease more often occurs in the supine position at nighttime or during sleep. Laryngeal edema is an important indicator of LPR that is most often neglected. LPR was previously deemed a controversial topic in laryngology but is now clearer with a better understanding of the pathogenesis. Diagnosis is made based on symptoms, and laryngoscopy aided with investigations and confirmed the response to treatment.

Part of the book: Updates on Laryngology

By Hardip Singh Gendeh and Balwant Singh Gendeh

Peritonsillar and intratonsillar abscesses are one of the not too frequent emergencies encountered by the ENT fraternity. Tonsillitis refers to inflammation of the tonsils, whereas peritonsillitis refers to cellulitis with or without an abscess collection within the surrounding soft tissue of the tonsils. Peritonsillar abscess is often unilateral, while peritonsillitis may be bilateral in 20% of cases, whereas intratonsillar abscess is rare with an incidence of 7%. The shared symptoms of peritonsillitis and intratonsillar abscess include fever, trismus, deviation of uvula and referred pain. These shared symptoms have placed many physicians in a dilemma, resulting in an intratonsillar abscess to be missed. The medical therapy consists of intravenous antibiotics and intravenous fluids. A needle aspiration is useful when a diagnosis is uncertain. Aspiration of pus is diagnostic confirming a peritonsillar abscess from a peritonsillar cellulitis. Incision and drainage can be performed for intratonsillar abscess not responding to treatment or a failed needle aspiration, which is preferably performed under general anesthesia for children. Elective tonsillectomy should be indicated for patients with recurrent peritonsillar abscess. CT contrast is useful to identify complications arising mainly in retropharyngeal or parapharyngeal abscess and to know its extension, spread and drainage approaches.

Part of the book: Tonsils and Adenoids