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Salem MA, Ghoneim M, Ahmed SS, Elsobki A, Elzhzahy AA, Hemdan A. Endoscopic transcanal coblation excision of glomus tympanicum: a novel technique. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08660-7. [PMID: 38689036 DOI: 10.1007/s00405-024-08660-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 04/03/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE To evaluate the feasibility of coblation in excision of glomus tympanicum tumors. PATIENTS AND METHODS A retrospective study carried out over 28 patients with types I and II glomus tympanicum tumors according to GLASSCOCK-JACKSON classification. Preoperative radiological and endocrinal evaluation were performed. All patients underwent endoscopic transcanal excision of their glomus tympanicum tumors using coblation. RESULTS None of the patients developed recurrence during the 1-year follow up period proved radiologically. None of the patients developed facial palsy postoperatively. Differences between preoperative and postoperative dizziness and taste disturbance were statistically non-significant. Tinnitus disappeared completely in 22 patients postoperatively. A statistically significant reduction in Tinnitus Handicap Inventory (THI) after surgery was found. Statistically significant reductions in postoperative air conduction (AC) threshold and air bone gap (ABG) were recorded while bone conduction (BC) threshold showed statistically non-significant change. CONCLUSION Coblation is an effective and safe tool in excision of glomus tympanicum tumors. Further studies comparing coblation with laser and piezosurgery are strongly recommended.
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Affiliation(s)
- Mohammed Abdelbadie Salem
- Department of Otorhinolaryngology, Faculty of Medicine, Mansoura University, El-Gomhoria Street, Mansoura, Egypt
| | - Mahitab Ghoneim
- Department of Diagnostic Radiology, Faculty of Medicine, Mansoura University, El-Gomhoria Street, Mansoura, Egypt
| | - Sally Sameh Ahmed
- Department of Endocrinology, Diabetes and Metabolism, Faculty of Medicine, Mansoura University, El-Gomhoria Street, Mansoura, Egypt
| | - Ahmed Elsobki
- Department of Otorhinolaryngology, Faculty of Medicine, Mansoura University, El-Gomhoria Street, Mansoura, Egypt
| | - Ahmed Abdoo Elzhzahy
- Department of Otorhinolaryngology, Faculty of Medicine, Mansoura University, El-Gomhoria Street, Mansoura, Egypt
| | - Ahmed Hemdan
- Department of Otorhinolaryngology, Faculty of Medicine, Mansoura University, El-Gomhoria Street, Mansoura, Egypt.
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Quer-Castells M, Sandoval M, Larrosa F. Blue laser for the exclusive endoscopic transcanal approach to middle ear paraganglioma. Eur Arch Otorhinolaryngol 2024; 281:2041-2045. [PMID: 38334782 PMCID: PMC10942876 DOI: 10.1007/s00405-024-08470-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/09/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND The management of glomus tympanicum tumours can be challenging. Blue laser coagulation may improve bleeding control thus facilitating an endoscopic transcanal excision. The objective of this presentation is to illustrate the authors' experience using this novel tool. METHODS Case report of a patient that underwent exclusive endoscopic transcanal blue laser surgery of a class A2 glomus tympanicum tumour in a tertiary referral center. CONCLUSION The present study provides evidence of the safety and efficacy of endoscopic blue laser surgery, for the minimally invasive treatment of early-stage glomus tympanicum tumours.
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Affiliation(s)
- Mireia Quer-Castells
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Clinic de Barcelona, C Villarroel 170, 08036, Barcelona, Spain
| | - Marta Sandoval
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Clinic de Barcelona, C Villarroel 170, 08036, Barcelona, Spain
- University of Barcelona Medical School, C Villarroel 170, 08036, Barcelona, Spain
| | - Francisco Larrosa
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Clinic de Barcelona, C Villarroel 170, 08036, Barcelona, Spain.
- University of Barcelona Medical School, C Villarroel 170, 08036, Barcelona, Spain.
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Jo HJ, Kim SH, Lee HM, Lee IW. Transcanal endoscopic ear surgery for glomus tympanicum removal: A case series on the necessity of preoperative embolization. Am J Otolaryngol 2024; 45:104193. [PMID: 38134848 DOI: 10.1016/j.amjoto.2023.104193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/09/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Transcanal endoscopic ear surgery (TEES) has become popular in recent years in the treatment of glomus tympanicum tumors (GTT). The most significant risk for TEES is bleeding. In some cases, preoperative vascular embolization is performed to mitigate bleeding during TEES. However, guidelines regarding the necessity and efficacy of preoperative vascular embolization have not been established yet. CASE PRESENTATION This report aimed to assess the necessity and usefulness of preoperative vascular embolization in TEES for GTT by comparing the surgical findings of TEES without preoperative vascular embolization (Case 1) and TEES with preoperative vascular embolization (Case 2). Compared to Case 1, Case 2 included less bleeding and a more convenient procedure. However, no significant difference was observed. CONCLUSIONS For GTT confined to the middle ear cavity (Glasscock-Jackson Grade II or less), when performed by a proficient otolaryngologist, TEES alone is sufficient without preoperative vascular embolization.
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Affiliation(s)
- Hyun-Ju Jo
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 49241, Republic of Korea
| | - Seok-Hyun Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, 20, Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Republic of Korea
| | - Hyun-Min Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, 20, Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Republic of Korea
| | - Il-Woo Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, 20, Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Republic of Korea.
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Remacha J, Pujol L, Caballero-Borrego M, Sandoval M, Viza I, Codina A, Bernal-Sprekelsen M, Larrosa F. Transcanal endoscopic carbon dioxide laser resection of early-stage (A1-B1) glomus tympanicum tumours: single-centre case series. J Laryngol Otol 2024:1-5. [PMID: 38311335 DOI: 10.1017/s0022215124000288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
OBJECTIVE To report a single-centre experience in the endoscopic carbon dioxide laser-assisted approach to glomus tympanicum tumours. METHODS A retrospective case review was conducted of patients diagnosed with class A1 to B1 glomus tympanicum tumours who underwent exclusive transcanal endoscopic carbon dioxide laser surgery. RESULTS Seven patients fulfilled the inclusion criteria. All patients (100 per cent) were women, with a mean age of 65.4 years (standard deviation, 13.6). There were five A2 tumours, one A1 tumour and one B1 tumour. One patient presented with a delayed tympanic membrane perforation needing myringoplasty on follow up. There were no substantial post-operative complications. The mean hospitalisation time was 9.5 hours (standard deviation, 9.8). The mean follow-up period was 32.7 months (standard deviation, 13.1), with all cases having resolution of pulsatile tinnitus and no tumour recurrence. CONCLUSION The study provides further evidence on the safety and efficacy of endoscopic carbon dioxide laser surgery as a minimally invasive technique for treating early-stage glomus tympanicum tumours.
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Affiliation(s)
- Joan Remacha
- Department of Otorhinolaryngology - Head and Neck Surgery, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Laura Pujol
- Department of Otorhinolaryngology - Head and Neck Surgery, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Miguel Caballero-Borrego
- Department of Otorhinolaryngology - Head and Neck Surgery, Hospital Clinic de Barcelona, Barcelona, Spain
- University of Barcelona Medical School, Barcelona, Spain
| | - Marta Sandoval
- Department of Otorhinolaryngology - Head and Neck Surgery, Hospital Clinic de Barcelona, Barcelona, Spain
- University of Barcelona Medical School, Barcelona, Spain
| | - Ignacio Viza
- Department of Otorhinolaryngology - Head and Neck Surgery, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Alberto Codina
- Department of Otorhinolaryngology - Head and Neck Surgery, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Manuel Bernal-Sprekelsen
- Department of Otorhinolaryngology - Head and Neck Surgery, Hospital Clinic de Barcelona, Barcelona, Spain
- University of Barcelona Medical School, Barcelona, Spain
| | - Francisco Larrosa
- Department of Otorhinolaryngology - Head and Neck Surgery, Hospital Clinic de Barcelona, Barcelona, Spain
- University of Barcelona Medical School, Barcelona, Spain
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Panda NK, Nayak G. Postauricular Transcanal Posterior Tympanectomy (PT 2 ) Approach - A Modified Surgical Technique for Jugulotympanic Paragangliomas. Int Arch Otorhinolaryngol 2023; 27:e407-e411. [PMID: 37564478 PMCID: PMC10411173 DOI: 10.1055/s-0042-1742766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 11/16/2021] [Indexed: 08/12/2023] Open
Abstract
Introduction The surgical management of jugulotympanic paragangliomas has remained challenging. They are the second most common type of tumor of the temporal bone after acoustic neuroma. It has been noticed by the authors that the jugulotympanic paragangliomas may have extensions to the epitympanum and aditus in addition to the mesotympanum and hypotympanum. The modified technique could be an alternative to the conventional facial recess technique for complete removal of the tumors. Objective To highlight the modified surgical technique for the surgical treatment of jugulotympanic paragangliomas. Methods This is a retrospective review of 34 cases of jugulotympanic paragangliomas treated in a tertiary center with respect to clinical presentation, diagnosis, and surgical treatment. Tinnitus and hearing loss were predominant symptoms. A modified technique of postauricular transcanal posterior tympanectomy with extended hypotympanic access was performed in 29 patients. Only two cases were operated with a classical transcanal approach. A canal wall down the mastoidectomy was required in three patients. Results The patients operated on with the modified technique had complete excision evident by absence of any lesion in computed tomography and the disappearance of tinnitus. However, two patients had recurrence of symptoms and presence of tumor in the follow-up period. These two patients underwent revision surgery. None of the patients required postoperative radiotherapy or gamma knife therapy. Conclusions Jugulotympanic paragangliomas can be effectively managed with the modified technique to ensure complete removal of the lesions. This technique has not been reported earlier in the literature.
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Affiliation(s)
- Naresh K. Panda
- Department of Otolaryngology Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Gyanranjan Nayak
- Department of Otolaryngology Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Alkheder A, Ghareeb A, Almasalmeh MS, Yousfan A. Effective surgical management of glomus tympanicum tumor using diode laser: A case report study. Int J Surg Case Rep 2023; 107:108356. [PMID: 37245374 DOI: 10.1016/j.ijscr.2023.108356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/20/2023] [Accepted: 05/22/2023] [Indexed: 05/30/2023] Open
Abstract
INTRODUCTION Glomus tympanicum is an extremely rare benign paraganglioma of the middle ear. The distinctive features of these tumors include their propensity for recurrence following treatment and their remarkably vascular nature, posing significant challenges to surgeons and necessitating the development of effective surgical techniques. CASE PRESENTATION A 56-year-old female presented with pulsatile tinnitus persisting for a year. Examination revealed a pulsating red mass in the lower section of the tympanic membrane. Computed tomography confirmed the presence of a mass occupying the middle ear, which was diagnosed as a glomus tympanicum tumor. The patient underwent surgical excision of the tumor, followed by diode laser application for coagulation at the site of the tumor. Histopathological examination confirmed the clinical diagnosis. DISCUSSION Glomus tympanicum tumors are rare neoplasms that arise in the middle ear. The surgical management of these tumors varies depending on the size and extent of the lesion. Various techniques are available for excision, including bipolar cautery and laser. Laser has emerged as an effective method for reducing tumor mass and controlling intraoperative bleeding, with positive indications after surgery. CONCLUSION Based on our case report, laser can be considered an effective and safe method for excision of glomus tympanicum, with positive indications for controlling intraoperative bleeding and reducing tumor mass.
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Affiliation(s)
- Ahmad Alkheder
- Department of Otorhinolaryngology, Al Mouwasat University Hospital, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Amjad Ghareeb
- Department of Otorhinolaryngology, Al Mouwasat University Hospital, Faculty of Medicine, Damascus University, Damascus, Syria.
| | - Mohammad Sadek Almasalmeh
- Department of Otorhinolaryngology, Al Mouwasat University Hospital, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Abdulmajeed Yousfan
- Department of Otorhinolaryngology, Al Mouwasat University Hospital, Faculty of Medicine, Damascus University, Damascus, Syria
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Dimakis C, Beka D, Papageorgiou E, Tsetsos N, Poutoglidis A, Gortsali A, Nomikos A, Karatzias G. A Case Report of Glomus Tympanicum Complicated With Facial Nerve Palsy. Iran J Otorhinolaryngol 2022; 34:327-331. [PMID: 36474487 PMCID: PMC9709390 DOI: 10.22038/ijorl.2022.64737.3217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/30/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Generally, glomus tumors are considered tumors of the autonomic system arising from chromaffin cells of the parasympathetic paraganglia of the skull base and neck. Glomus tympanicum is the most common primary tumor of the middle ear cavity and it arises from the paraganglia of the middle ear. CASE REPORT We present a case of glomus tympanicum presented in a 70-year-old woman, complicated with facial nerve palsy which at first sight was misdiagnosed as cholesteatoma. Patient presented in our clinic because of otorrhea, pulsatile tinnitus and hearing loss in the right ear. However, facial nerve function was good in the first examination (40 days before the surgery). Eventually, she treated successfully with a canal wall down mastoidectomy. Technique had been chosen because of the mass size and the involvement of external auditory canal, after a discussion with the patient. CONCLUSIONS Although histologically benign, glomus tympanicum is slow growing and destructs adjacent tissues potentially. The two most common complaints are hearing loss (conductive) and pulsatile tinnitus. These neoplasms are more common in women and they can be diagnosed by CT or MRI scan. It is of high importance physicians suspect a glomus tumor when patient 's clinical findings are hearing loss and pulsatile tinnitus and use an intravascular agent in imaging so that the differential diagnosis will be supported.
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Affiliation(s)
- Christodoulos Dimakis
- Department of Otorhinolaryngology-Head and Neck Surgery, General Hospital Asklipιeio Voula, Athens, Greece.,Corresponding Author: Department of Otorhinolaryngology-Head and Neck Surgery "General Hospital Asklipιeio Voula", Athens, Greece. E-mail:
| | - Despoina Beka
- Department of Otorhinolaryngology-Head and Neck Surgery, General Hospital Asklipιeio Voula, Athens, Greece.
| | - Eustratios Papageorgiou
- Department of Otorhinolaryngology-Head and Neck Surgery, General Hospital Asklipιeio Voula, Athens, Greece.
| | - Nikolaos Tsetsos
- Department of Otorhinolaryngology-Head and Neck Surgery, G.PapanikolaouGeneral Hospital, Thessaloniki, Greece.
| | - Alexandros Poutoglidis
- Department of Otorhinolaryngology-Head and Neck Surgery, G.PapanikolaouGeneral Hospital, Thessaloniki, Greece.
| | - Athanasia Gortsali
- Department of Otorhinolaryngology-Head and Neck Surgery, General Hospital Asklipιeio Voula, Athens, Greece.
| | - Alexandros Nomikos
- Department of Pathology, General Hospital Asklipιeio Voula, Athens, Greece.
| | - Georgios Karatzias
- Department of Otorhinolaryngology-Head and Neck Surgery, General Hospital Asklipιeio Voula, Athens, Greece.
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Larrosa F, González-Sánchez N, Remacha J, Sandoval M, Bernal-Sprekelsen M. Nuances in transcanal endoscopic approach to benign middle ear tumours in adult patients. Acta Otorrinolaringol Esp (Engl Ed) 2022; 73:279-285. [PMID: 36031112 DOI: 10.1016/j.otoeng.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 05/12/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Minimally invasive surgery of benign middle ear tumours is possible by using the endoscope. The optimal lighting and the broadest vision it offers, allow a transcanal approach to these rare tumours. The objective of this work is to summarise its key points through a case series. MATERIALS AND METHODS Retrospective study of benign middle ear tumours that underwent exclusive endoscopic surgery in a third-level adult university hospital between June 2018 and June 2020. Postoperative follow-up was performed by otoendoscopy and audiometry. RESULTS Six patients underwent surgery during the study period. Five patients were female and one male, with an average age of 57.8 years (±21.9). Four tumours were in the left ear and 2 in the right ear. These included four tympanic paragangliomas (three type I and one type II), a chorda tympani neuroma, and a congenital cholesteatoma. There were no serious postoperative complications. At present, no tumour recurrence has been found in either case, with a minimum follow-up of 7 months. CONCLUSIONS The present study adds evidence on the safety and efficacy of endoscopic transcanal ear surgery, as a minimally invasive technique, for the treatment of benign middle ear tumours confined to the tympanic cavity.
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Affiliation(s)
- Francisco Larrosa
- Servicio de Otorrinolaringología, Hospital Clínic de Barcelona, Barcelona, Spain; Departamento de Especialidades Médico-Quirúrgicas, Facultad de Medicina, Universitat de Barcelona, Barcelona, Spain.
| | | | - Joan Remacha
- Servicio de Otorrinolaringología, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Marta Sandoval
- Servicio de Otorrinolaringología, Hospital Clínic de Barcelona, Barcelona, Spain; Departamento de Especialidades Médico-Quirúrgicas, Facultad de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Manuel Bernal-Sprekelsen
- Servicio de Otorrinolaringología, Hospital Clínic de Barcelona, Barcelona, Spain; Departamento de Especialidades Médico-Quirúrgicas, Facultad de Medicina, Universitat de Barcelona, Barcelona, Spain
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Abstract
PURPOSE OF REVIEW This paper will outline the clinical neurologic presentation and diagnostic evaluation of patients with paragangliomas of the head and neck. Contemporary management options will be outlined for these rare and complex tumors. RECENT FINDINGS The majority of recent publications and research on these tumors are dedicated to traditional and robotic image-guided radiosurgery in the treatment of head and neck paragangliomas. Paragangliomas are rare, slow-growing tumors of the head and neck which usually cause silent cranial nerve deficits or compensated mild speech or swallowing symptoms. While radiologic surveillance is often the best treatment option, subtotal resection with case-specific radiosurgery is commonly used in patients with large tumors.
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de Souza SNF, Pongeluppi RI, Cardoso RAM, Abud DG, Colli BO, Massuda ET, de Oliveira RS. Glomus jugulare in a pediatric patient: case report and literature review. Childs Nerv Syst 2022; 38:269-277. [PMID: 34698910 DOI: 10.1007/s00381-021-05397-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 10/14/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The jugular and tympanic glomus are rare neoplasms in the general population, being even more uncommon in the pediatric population. There is considerable morbidity associated with both disease and treatment. Treatment is essentially surgical, carried out in recent years in a multidisciplinary manner using preoperative embolization associated with microsurgery and eventually adjuvant radiotherapy. The outcome depends on the location of the lesion and its proximity to noble structures in addition to multidisciplinary monitoring in the postoperative period. METHODS In this article, a literature review was carried out in the PubMed database, finding reports from 17 patients diagnosed with the disease. Only articles in English were considered. RESULTS Moreover, we reported a case of a 14-year-old patient diagnosed with jugulotympanic glomus who underwent radical surgical treatment of the lesion. CONCLUSION This is a rare case of jugulotympanic glomus in a pediatric patient, who underwent surgical treatment associated with multidisciplinary therapy, with a favorable postoperative outcome.
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Affiliation(s)
- Stephanie Naomi Funo de Souza
- Division of Neurosurgery, Department of Surgery and Anatomy, University Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, 14049-900, Brazil
| | - Rodrigo Inácio Pongeluppi
- Division of Neurosurgery, Department of Surgery and Anatomy, University Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, 14049-900, Brazil
| | - Rodrigo Augusto Monteiro Cardoso
- Division of Neurosurgery, Department of Surgery and Anatomy, University Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, 14049-900, Brazil
| | - Daniel Giansante Abud
- Division of Interventional Radiology, University Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, 14049-900, Brazil
| | - Benedicto Oscar Colli
- Division of Neurosurgery, Department of Surgery and Anatomy, University Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, 14049-900, Brazil
| | - Eduardo Tanaka Massuda
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Sao Paulo, Brazil
| | - Ricardo Santos de Oliveira
- Division of Neurosurgery, Department of Surgery and Anatomy, University Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, 14049-900, Brazil
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Larrosa F, González-Sánchez N, Remacha J, Sandoval M, Bernal-Sprekelsen M. Nuances in transcanal endoscopic approach to benign middle ear tumours in adult patients. Acta Otorrinolaringol Esp (Engl Ed) 2021; 73:S0001-6519(21)00091-1. [PMID: 34404521 DOI: 10.1016/j.otorri.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 05/05/2021] [Accepted: 05/12/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Minimally invasive surgery of benign middle ear tumours is possible by using the endoscope. The optimal lighting and the broadest vision it offers, allow a transcanal approach to these rare tumours. The objective of this work is to summarize its key points through a case series. MATERIALS AND METHODS Retrospective study of benign middle ear tumours that underwent exclusive endoscopic surgery in a third-level adult university hospital between June 2018 and June 2020. Postoperative follow-up was performed by otoendoscopy and audiometry. RESULTS Six patients underwent surgery during the study period. Five patients were female and one male, with an average age of 57.8 years (± 21.9). Four tumours were in the left ear and 2 in the right ear. These included 4tympanic paragangliomas (3 type I and one type II), a chorda tympani neuroma, and a congenital cholesteatoma. There were no serious postoperative complications. At present, no tumour recurrence has been found in either case, with a minimum follow-up of 7 months. CONCLUSIONS The present study adds evidence on the safety and efficacy of endoscopic transcanal ear surgery, as a minimally invasive technique, for the treatment of benign middle ear tumours confined to the tympanic cavity.
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Affiliation(s)
- Francisco Larrosa
- Servicio de Otorrinolaringología, Hospital Clínic de Barcelona, Barcelona, España; Departamento de Especialidades Médico-Quirúrgicas, Facultad de Medicina, Universitat de Barcelona, Barcelona, España.
| | | | - Joan Remacha
- Servicio de Otorrinolaringología, Hospital Clínic de Barcelona, Barcelona, España
| | - Marta Sandoval
- Servicio de Otorrinolaringología, Hospital Clínic de Barcelona, Barcelona, España; Departamento de Especialidades Médico-Quirúrgicas, Facultad de Medicina, Universitat de Barcelona, Barcelona, España
| | - Manuel Bernal-Sprekelsen
- Servicio de Otorrinolaringología, Hospital Clínic de Barcelona, Barcelona, España; Departamento de Especialidades Médico-Quirúrgicas, Facultad de Medicina, Universitat de Barcelona, Barcelona, España
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12
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Pradhan S, Chappity P, Nayak A, Pradhan P, Parida PK. Exclusive endoscopic transcanal approach to lateral skull base lesions: Institutional experience of 3 cases. J Otol 2020; 16:55-60. [PMID: 33505451 PMCID: PMC7814085 DOI: 10.1016/j.joto.2020.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/20/2020] [Accepted: 08/27/2020] [Indexed: 10/29/2022] Open
Abstract
Introduction Majority of petrous bone and lateral skull base pathologies are benign in nature. The complex anatomy usually warrants an extensive approach with associated morbidity. Case summary Two cases of petrous bone cholesteatoma (1 congenital cholesteatoma with facial palsy and 1 acquired cholesteatoma) and a case of glomus tympanicum were treated with exclusive endoscopic transcanal approach. The cases of petrous cholesteatoma were addressed with trans-promontorial and infra-cochlear approaches. The mean operative time was approximately 140 min. No CSF otorrhoea was noticed in the post-operative period. The average period of hospital stay was 3.7 days. Conclusion In the subset of cases with limited benign disease an endoscopic trans-canal approach is a better alternative to an external approach. It decreases operative time, blood loss, chance of meningitis, morbidity and hospital stay. The lack of depth perception is a major hurdle which can be come over by experience in endoscopic middle ear surgery. This approach can create direct access to cochlea/petrous apex/internal auditory canal (IAC)/Supra-geniculate ganglion region.
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Affiliation(s)
- Sidharth Pradhan
- All India Institute of Medical Sciences, Bhubaneswar Department of Otorhinolaryngology and Head & Neck Surgery, 1 floor, AIIMS, Bhubaneswar, Sijua, Bhubaneswar, Odisha, 751019, India
| | - Preetam Chappity
- All India Institute of Medical Sciences, Bhubaneswar Department of Otorhinolaryngology and Head & Neck Surgery, 1 floor, AIIMS, Bhubaneswar, Sijua, Bhubaneswar, Odisha, 751019, India
| | - Anindya Nayak
- All India Institute of Medical Sciences, Bhubaneswar Department of Otorhinolaryngology and Head & Neck Surgery, 1 floor, AIIMS, Bhubaneswar, Sijua, Bhubaneswar, Odisha, 751019, India
| | - Pradeep Pradhan
- All India Institute of Medical Sciences, Bhubaneswar Department of Otorhinolaryngology and Head & Neck Surgery, 1 floor, AIIMS, Bhubaneswar, Sijua, Bhubaneswar, Odisha, 751019, India
| | - Pradipta K Parida
- All India Institute of Medical Sciences, Bhubaneswar Department of Otorhinolaryngology and Head & Neck Surgery, 1 floor, AIIMS, Bhubaneswar, Sijua, Bhubaneswar, Odisha, 751019, India
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Kaul VF, Filip P, Schwam ZG, Wanna GB. Nuances in transcanal endoscopic surgical technique for glomus tympanicum tumors. Am J Otolaryngol 2020; 41:102562. [PMID: 32563784 DOI: 10.1016/j.amjoto.2020.102562] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/24/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe the utility and nuances of transcanal endoscopic surgery (TCES) on glomus tympanicum tumors from a single surgeon's experience. PATIENTS/INTERVENTION Twelve patients, eight female and four males, diagnosed pre-operatively with glomus tympanicum tumors. They all underwent endoscopic resection by a single surgeon. MAIN OUTCOME MEASURES Feasibility of endoscopic resection of glomus tympanicum tumors without conversion to a microscopic approach. Secondary outcomes include tumor stage, pre and post-operative audiometry, vertigo, sensorineural hearing loss (SNHL) and integrity of the facial nerve, ossicles, chorda tympani and tympanic membrane. RESULTS Twelve patients underwent TCES, eight patient's pathology results were glomus tympanicum, ranging from Glasscock-Jackson grade I-III. Due to loss in follow up, 6/8 patients had complete audiometric data, which were analyzed. Average pre-operative air-bone-gap (ABG) was 5.41 compared to post-operative ABG of 5.08 (p > 0.89). No patients resulted in any, post-operative vertigo, tinnitus, SNHL, facial nerve injury or chorda tympani nerve injury. Two patients had intentional tympanic membrane perforations secondary to tumor adherence to the membrane. They were repaired with tragal perichondrium graft. No patients have had any recurrences. CONCLUSIONS Endoscopic resection of glomus tympanicum tumors is a feasible and effective, alternative visualization modality for the neurotologist. Surgical pearls are described herein.
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Affiliation(s)
- Vivian F Kaul
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
| | - Peter Filip
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Zachary G Schwam
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - George B Wanna
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
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Fatima N, Pollom E, Soltys S, Chang SD, Meola A. Stereotactic radiosurgery for head and neck paragangliomas: a systematic review and meta-analysis. Neurosurg Rev 2020; 44:741-752. [PMID: 32318920 DOI: 10.1007/s10143-020-01292-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/15/2020] [Accepted: 03/26/2020] [Indexed: 10/24/2022]
Abstract
Head and neck paragangliomas (HNPs) are rare, usually benign hyper vascularized neuroendocrine tumors that traditionally have been treated by surgery, with or without endovascular embolization, or, more recently stereotactic radiosurgery (SRS). The aim of our study is to determine the clinical and radiographic effectiveness of SRS for treatment of HNPs. A systematic search of electronic databases was performed, and 37 articles reporting 11,174 patients (1144 tumors) with glomus jugulare (GJT: 993, 86.9%), glomus tympanicum (GTT: 94, 8.2%), carotid body tumors (CBTs: 28, 2.4%), and glomus vagale (GVT: 16, 1.4%) treated with SRS definitively or adjuvantly were included. The local control (LC) was estimated from the pooled analysis of the series, and its association with SRS technique as well as demographic and clinical factors was analyzed. The median age was 56 years (44-69 years). With a median clinical and radiological follow-up of 44 months (9-161 months), LC was 94.2%. Majority of the patients (61.0%) underwent Gamma Knife Radiosurgery (GKS), but there was no statistically significant difference in LC depending upon the SRS technique (p = 0.9). Spearmen's correlation showed that LC was strongly and negatively correlated with multiple parameters, which included female gender (r = - 0.4, p = 0.001), right-sided tumor (r = - 0.3, p = 0.03), primary SRS (r = - 0.5, p ≤ 0.001), and initial clinical presentation of hearing loss (r = - 0.4, p = 0.001). To achieve a LC ≥ 90%, a median marginal dose (Gy) of 15 (range, 12-30 Gy) was required. The results corroborate that SRS in HNPs is associated with good clinical and radiological outcome.
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Affiliation(s)
- Nida Fatima
- Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Edwards Bldg, Stanford, CA, USA.
| | - Erqi Pollom
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Scott Soltys
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Steven D Chang
- Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Edwards Bldg, Stanford, CA, USA
| | - Antonio Meola
- Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Edwards Bldg, Stanford, CA, USA
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Abstract
Background Tympanomastoid paragangliomas are usually benign, slowly growing, painless tumors. The common presenting symptoms of this tumor are pulsatile tinnitus and conductive hearing loss. Vertigo as the cardinal or initial symptom is extremely are, especially in the early stages of the disease. Case presentation A 53-year-old female patient presented only with intermittent recurrent vertigo and was later found to have a tympanomastoid paraganglioma. Her symptoms disappeared completely after resection of the tumor. This is the first report in literature of a case of tympanomastoid paraganglioma with vertigo as the single symptom. Conclusion The tympanomastoid paraganglioma is rare and its clinical symptoms are nonspecific, so it is easy to be misdiagnosed or missed. It is worth noting that although clinically uncommon, vertigo can also be the first or sole symptom of tympanomastoid paraganglioma. Detailed physical examination and imaging examination of the ear are necessary and should be carried out meticulously.
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Affiliation(s)
- Xi-Xing Li
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wei-Na Cui
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Guo-Dong Gao
- Department of Medical Radiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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Appannan VR, Md Daud MK. Glomus tympanicum. Malays Fam Physician 2018; 13:45-48. [PMID: 29796211 PMCID: PMC5962235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Glomus tympanicum is a tumour classified under the group glomus tumours, and is also known as paragangliomas. It is thought to commonly occur in women in the fifth to sixth decades of life. Here, we report a case of a 77-year-old lady with multiple co-morbids and a diagnosis of glomus tympanicum presenting to us. Her symptoms included pulsatile tinnitus, and reduced hearing, and the management of the case was done with consideration for her underlying multiple co-morbidities. This paper also describes the best modality of treatment for this patient with regard to her background history. The treatment goal was to improve her quality of life and control the disease.
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Affiliation(s)
- V R Appannan
- MBBS(Manipal), Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan
| | - M K Md Daud
- MD(UKM) MMed-ORL -HNS (USM) Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan
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Daneshi A, Asghari A, Mohebbi S, Farhadi M, Farahani F, Mohseni M. Total Endoscopic Approach in Glomus Tympanicum Surgery. Iran J Otorhinolaryngol 2017; 29:305-311. [PMID: 29383310 PMCID: PMC5785109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Glomus tympanicum (GT) is a benign primary tumor of the middle ear. The evolution of endoscopic ear surgery has allowed for an alternative approach to managing this vascular tumor. The purpose of this study was to evaluate an endoscopic approach in GT surgery, and also to investigate its applicability and feasibility. MATERIALS AND METHODS Prospectively, 13 class I and II patients, according to the Glasscock-Jackson glomus classification, were candidates for management via a transcanal endoscopic approach. Patients were categorized into three groups according to the location of the tumor in the middle ear. Group A consisted of patients with tumors located anteriorly while occupying the Eustachian tube. Group B were patients with tumors located on the promontory with entirely visible tumor borders. Patients in Group C had tumors that occupied the entire middle ear. Under specially designed flap elevation and hemostasis, the tumors were completely removed using an endoscopic technique. RESULTS Based on the classification criteria, three patients fell into Group A (30%), six into Group B (46%), and three into Group C (23%). The principal chief complaint was pulsatile tinnitus that disappeared after surgery in most cases. Hearing status was mostly mixed hearing loss. No change was detected in bone conduction after surgery, but air conduction was improved in nine cases. No major complication or recurrence was observed over 30 months of follow up. CONCLUSION Improved exposure and access in the endoscopic transcanal approach to GT leads to safe, rapid, and reliable tumor removal, as well as allowing comfortable surgery for both the surgeon and most patients.
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Affiliation(s)
- Ahmad Daneshi
- ENT Head and Neck Research Center and Department, Iran University of Medical Science, Tehran, Iran.
| | - Alimohamad Asghari
- ENT Head and Neck Research Center and Department, Iran University of Medical Science, Tehran, Iran.
| | - Saleh Mohebbi
- Skull Base Research Center, Iran University of Medical Science, Tehran, Iran.,Corresponding Author:Department of Otolaryngology, Hazrat-e Rasool General Hospital, Niyayesh St., Satarkhan St., Tehran, Iran, Tel: +982166511011, E-mail:
| | - Mohammad Farhadi
- ENT Head and Neck Research Center and Department, Iran University of Medical Science, Tehran, Iran.
| | - Farhad Farahani
- Department of Otolaryngology, Hamedan University of Medical Science, Hamedan, Iran.
| | - Mohammad Mohseni
- ENT Head and Neck Research Center and Department, Iran University of Medical Science, Tehran, Iran.
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Abstract
Tympanic paragangliomas are uncommon vascular tumors of neural crest origin. Classically these lesions have been surgically managed via a transcanal or transmastoid approach using binocular microscopy. We describe a case in which a tympanic paraganglioma was removed via a transcanal approach, using the endoscope exclusively. Endoscopic ear surgery enhances visualization, helping to ensure complete tumor removal, while reducing unnecessary dissection and its associated morbidity. For small middle ear neoplasms, a purely endoscopic approach is feasible, with excellent results. Resident education in ear surgery has also been enhanced by the use of endoscopes. The wide field of view provided by the endoscope helps trainees understand the intricate three-dimensional anatomy of the middle ear cleft.
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Affiliation(s)
- Natasha Pollak
- Department of Otolaryngology - Head & Neck Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Resha S Soni
- Department of Otolaryngology - Head & Neck Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
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Abstract
Tantamount to the management of temporal bone neoplasms is the ability to visualize the pathology and its relationship with the numerous critical structures housed therein. Transcanal endoscopic ear surgery provides the surgeon with an unparalleled view of the entire middle ear. This article presents the latest information on the usefulness of transcanal endoscopic ear surgery in the management of middle ear and temporal bone neoplasms.
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Affiliation(s)
- Brandon Isaacson
- Department of Otolaryngology - Head and Neck Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9035, USA.
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Abstract
Glomus tympanicum (GT) tumors are benign arising from paraganglion cells of the tympanic plexus in the middle ear. Although surgical resection remains the best option for definitive treatment of these tumors, the diagnostic and management algorithms have evolved considerably with the introduction of high-resolution computed tomography, MRI, and genetic testing.
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Abstract
Glomus tumours of temporal bone are rare and usually present with symptoms of hearing loss and tinnitus. Diagnosis is often delayed due to the slow growth of the tumour. Here we present a case report of a patient diagnosed as glomus tympanicum who presented only with unilateral progressive hearing loss for the past one year and rapidly detoriating hearing loss since two months who was managed successfully.
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Affiliation(s)
- P Subashini
- Department of Otolaryngology - Head and Neck Surgery, Sri Ramachandra Medical College and Research Institute, Chennai, Tamilnadu, India
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Abstract
Glomus tympanicum tumor (also known as paraganglioma or chemodectoma) is the most benign tumor of temporal bone. Treatment may be palliative or curative. Palliative therapy includes watchful observation or radiotherapy and curative treatment is surgical. During 1995 to 2005, 18 cases of glomus tympanicum were managed at Basavanagudi ENT Care Centre Bangalore. We review retrospectively the diagnosis and surgical management of these cases. Advances in the imaging and refinements in traditional surgery have made correct diagnosis and complete excision of these tumors possible in most of the cases.
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Affiliation(s)
| | - S Badhwar
- Classified Specialist (Otolaryngology/Head and Neck Oncosurgery), INHS Asvini, Colaba, Mumbai
| | - J D'Souza
- Classified Specialist (Radiodiagnosis and Interventional Radiology), INHS Asvini, Colaba, Mumbai
| | - I K Indrajit
- Classified Specialist (Radiodiagnosis and Imaging), INHS Asvini, Colaba, Mumbai
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