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साइनस सर्जन
Verma Hospital , 11 Gujral Nagar , Jalandhar 144001
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चिकित्सा सुविधाएं:-
कान, नाक, गले की एन्डोस्कोपी एवं दुरबीन द्वारा जाँचे ।
कान के बहने / पस आने का व बहरेपन का अत्याधिक दूरबीन द्वारा ऑपरेशन (Microscopic Surgery )
आधुनिक दूरबीन द्वारा (Endoscopic) नाक की हड्डी साइनस व गले के ऑपरेशन,
टॉन्सिल व एडीनॉइड (Adenoid) के ऑपरेशन
थायराइड के ऑपरेशन (Thyroidectomy)
आवाज़ के लिए , स्वर यंत्र (लेरिंक्स) की माइक्रोसर्जरी
नाक की प्लास्टिक सर्जरी
लेज़र सर्जरी
बिना खून बहाए कोब्लेशन व Radiofreuency द्वारा ऑपरेशन
खुर्राटे व स्लीप एपीनिया का ऑपरेशन द्वारा इलाज

Oto acoustic emission (OAE) test done to know about the hearing status in new born (Pic 2)and BERA ( brain evoked response audiometery) done in older children to assess the hearing. All new born kept in NICU must undergo OAE Test

Mole removal with laser

Indian Journal of Otolaryngology and Head & Neck Surgery https://doi.org/10.1007/s12070-023-03525-7
OTHER ARTICLES
Sinonasal Irrigation After Endoscopic Sinus surgery – Past to Present and Future
Ravneet Ravinder Verma1 · Ravinder Verma2
Received: 22 November 2022 / Accepted: 21 January 2023 © Association of Otolaryngologists of India 2023
Abstract
Functional endoscopic sinus surgery (FESS) is the gold standard treatment for medically refractive chronic rhinosinusitis, aimed at removing diseased tissue and improving natural sinus drainage and aeration. Irrigation of the sinuses has been known to improve sinus mucosal health and is an essential adjunct to surgery. There are a number of methods, devices, and solutions available which are used for nasal irrigation. Neti Pot, squeeze bottle, syringe, rubber bulb and commercially available nasal sprays are some of the simpler used devices used for douching. Electric devices like flosser, Hydropulse and the Navage nasal irrigation systems are available but it’s not clear if they provide any advantage over the other methods. We use and propose a gravitational pressure-pulsed device which provides adequate volume and force without the need for external pressure. Salt with sodium bicarbonate is the most used solution base. Hypertonic saline has been described to be more efficacious compared to isotonic saline. Additives such as sodium hypochlorite, antibiotics, cortico- steroids, manuka honey and xylitol have proven to be beneficial. Large volume positive pressure irrigations have proven to be beneficial. Optimal position for irrigation varies for low or high-volume irrigation systems. Patient education regarding precautions and disinfection of the device is a must.
Keywords Sinusitis · Functional Endoscopic Sinus Surgery · Sinus Flush · Nasal do**he · Nasal lavage · Saline Sniffs · Nasal Irrigation · Nasal washout · Nasal toileting
Introduction
Chronic rhinosinusitis (CRS) with or without nasal polyps is a common disease-affecting people all over the world. Functional endoscopic sinus surgery (FESS) is considered the gold standard treatment for medically refractive disease. The role of sinus surgery is to remove diseased or obstruc- tive sinus tissue, creating an improved drainage pathway and aeration of the sinuses. Post-operative care is as impor- tant as sinus surgery to achieve the best surgical results. Post-FESS management includes antibiotics, analgesics and local corticosteroids spray and nasal irrigation.
Ravinder Verma [email protected]
Nasal irrigation clears mucus and allergens, blood clots, crusts and debris from the nose and sinuses and improves the healing process in post-operative FESS. The direct mucosal cleansing, the removal of antigens, biofilms or inflamma- tory mediators resolve inflammation and improved muco- ciliary function. It is safe and inexpensive, representing a non-pharmacological form of treatment. The aim of nasal irrigation is to carry out distribution of the irrigating solu- tion effectively and reliably to all sinuses. This depends upon the surgical state, delivery device, head position, tech- nique, nasal anatomy, respiratory cycle, and carrier vehicle [1].
Nasal irrigation has been practiced around the world since a long time, for a range of purposes. It is also known as saline sniffs, nasal do**he, nasal lavage, sinus flush, nasal irrigation, nasal washout, and nasal toileting. It is performed by instilling saline into one nostril and allowing it to drain out of the same or other nostril, bathing and cleaning the nasal cavity. Nasal irrigation can be done with low positive
1
Medical College and Hospital, Chandigarh, India
Department of ENT Head and Neck Surgery, Government
2
Jalandhar 144001, India
Verma Hospital and Research Centre, Gujral Nagar,
13

pressure from a spray, pump or sq**rt bottle, with a nebu- lizer or with gravity-based pressure vessel, such as a neti pot [2].
Nasal irrigation has been found to be an effective and pop- ular mode of adjunct therapy in post-operative endoscopic sinus surgery [3,4,5,6]. It can also be used as a preparation for nasal and sinus surgery [7]. A Cochrane report found some benefit of daily, large-volume (150 ml) saline irriga- tion with a hypertonic solution when compared with placebo in CRS [2] It may play a role in reducing viral severity and further transmission. However, it is not yet clear whether it provides viral mitigation effects or conversely has a poten- tiating effect on viral transmission [8]. There are a variety of combinations of solutions and devices advocated by dif- ferent authors and institutions. There are different home recipes, commercially available powders or solutions and several devices used to perform nasal irrigations.
Sino-Nasal Irrigation
There are several devices used to perform nasal irrigation. Delivery of the nasal solution can be by positive- pres- sure (squeeze bottles, bulb syringes with or without nasal adaptors, mechanical), negative pressure (sniffing solution into nasal cavity), or nebulizers. Categorizing the devices according to the volume and the pressure of the solution used, three types of devices are available. (1) Low- volume, high pressure (nasal spray) (2) High-volume, Low-pressure using.
gravitational pressure (Neti pot, syringe, bulb). 3) High- volume, high-pressure (syringe with adapter, squeeze bot- tle). A High-volume device uses more than 100 ml of the solution to irrigate the nose [9]. Piromchai et al. 2019 col- lected information about 331 devices for nasal irrigation and found that syringes were the most commonly used device in more than 60% of patients [10]. A prospective single- blind randomized study compared postoperative efficacy of nasal irrigation devices after endonasal surgery and concluded that large-volume low-pressure irrigation was associated with better cavity cleansing on the Lund-Mackay postopera- tive endoscopy score than low-volume high- pressure irriga- tion [11]. It optimizes the distribution and cleansing power of the irrigation solution in the nasal cavity.
A study by Olson et al., using healthy adult volunteers analyzed the irrigation pattern and found that positive pres- sure and negative- pressure nasal irrigations were more effective than nebulizers in distributing solutions to the eth- moidal and maxillary sinuses. The distribution was more uniform using positive-pressure irrigation. The delivery with nebulization was poor and resulted in a significantly lower volume of retained solution [12]. Comparing metered
nasal sprays, nebulization, and nasal douching with the head on the floor position, Wormald et al. reported that douching was significantly more effective in penetrating the maxillary sinus and frontal recess. Both these studies concluded that the sphenoid and frontal sinuses were the least irrigated by all the techniques [13.
A study from Germany, comparing irrigation devices in nasal models concluded that compression systems deliv- ering ≥ 120 mbar pressure, a tight fit between nozzle and nostril and the possibility of inserting the nozzle into the vestibule and orienting it 45 degrees upward has were able to optimize cavity coverage [14].
History
The earliest use of nasal irrigation has been illustrated in Ayurveda. The nasal wash has been an integral part of the yoga tradition for more than 5,000 years. It was customary to perform jala- neti daily, as part of ‘saucha’ (cleanliness). It has been proposed to offer significant relief from nasal congestion and irritation and reduces their reliance on anti- biotics to combat sinus inflammation, leading to a sig

Sinonasal Irrigation After Endoscopic Sinus surgery – Past to Present and Future - Indian Journal of Otolaryngology and Head & Neck Surgery Functional endoscopic sinus surgery (FESS) is the gold standard treatment for medically refractive chronic rhinosinusitis, aimed at removing diseased tissue and improving natural sinus drainage and aeration. Irrigation of the sinuses has been known to improve sinus mucosal health and is an essential...

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