Jubilee Memorial Hospital, Palayam, Trivandrum is the only Catholic Health Care Service provider in the capital city of Kerala, in south India with a mission of “Promotion of Life Though Health Care With Love”.

At present it is a 200-bedded multi-specialty hospital giving affordable quality health care for all kinds of people from in and out of Trivandrum district .

“A friendly, homely and affordable hospital” is what our patients and relatives say about Jubilee Memorial Hospital. Where as our staffs say that they feel a warm family atmosphere, and our doctors feel “Jubilee is place of ethical medical practice”.

The management is trying to make Jubilee Hospital a place of healing and comfort of Jesus. Life is the most precious gift and expression of God’s love, and Jubilee Memorial Hospital is committed to foster and promote it.

At present Jubilee is a 200-bedded multi-specialty hospital giving affordable quality health care. 24 hours casualty & ambulance service, Pharmacy,Lab, CT Scan, X-ray and ECG are available at Jubilee. Day time Jubilee has US Scan, echo and TMT services. Jubilee hospital has opend a Renal Dialysis center with the collaboration of DM foundation.

Jubilee Memorial Hospital

Meads Lane, Palayam

Thiruvananthapuram – 695034,

Kerala, India

Ph: 0471-2334561-4,6452020

Fax: 0471-2330925,

Email: jubileehospital@hotmail.com

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Jubilee Hospital, Trivandrum.

The sinuses are spaces filled with air in some of the bones of the skull. Air passes in and out of these spaces, and mucus drains through them and out of the nose. They also reduce the weight of the skull and give our voices a nicer sound.

There are four main pairs of sinus openings, sometimes called sinus cavities, in the face:

• Maxillary – in the cheekbones

• Ethmoid – between the eye sockets

• Frontal – in the forehead and above the eyebrows

• Sphenoid – deep in the head at the back of the nose

Endoscopic sinus surgery can correct chronic or severe blockages in one or more of the maxillary, ethmoid, frontal, or sphenoid sinuses.

FESS-Functional Endoscopic Sinus Surgery is a procedure used to remove blockages in the sinuses (the spaces filled with air in some of the bones of the skull). These blockages cause sinusitis, a condition in which the sinuses swell and become clogged, causing pain and impaired breathing.

An endoscope is inserted into the nose, like a telescope with a wide-angle camera lens, the endoscope beams light into different parts of the nose and sinuses, allowing the surgeon to see what is causing blockages. Surgical instruments can then be used along with the endoscope to remove the blockages and improve breathing.

Endoscopic sinus surgery is an effective procedure to correct:

• Sinusitis

• Deviated septum, in which the partition separating the left and right sides of the nose is crooked

• Polyps, a noncancerous water-filled swelling

• Tumors, a swelling caused by an uncontrolled growth of cells

For Appointment- call 0471-2334561/62/63/64, 6452020,407822 Fax-0471-2330925

Email: jubileehospital@hotmail.com, drpaulose@yahoo.com

Clinic hours: Mon-Wed-Friday (8AM -1 PM)

Operation Days: Tue-Thu-and Saturdays (8AM-4PM)

To reach Jubilee Hospital: jubileehospitaltrivandrum

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Surgical Treatment in Jubilee Hospital, Trivandrum.

Most patients suffering from sinusitis can be treated without surgery, but occasionally surgery must be done. Since part of the problem in sinusitis is an obstruction to the drainage of the sinuses, sometimes the blockage needs to be removed. In that case surgery may be the only means to do so.

Endoscopic sinus surgery – also called endoscopy or sinoscopy – is a procedure used to remove blockages in the sinuses (the spaces filled with air in some of the bones of the skull). These blockages cause sinusitis, a condition in which the sinuses swell and become clogged, causing pain and impaired breathing.

Functional Endoscopic Sinus Surgery (FESS) is the mainstay in the surgical treatment of sinusitis and nasal polyps, including bacterial, fungal, recurrent acute, and chronic sinus problems. Ample research supports its record of safety and success.

FESS is a relatively recent surgical procedure that uses nasal endoscopes through the nostrils to avoid cutting the skin. These endoscopes have diameters of 4mm (adult use) and 2.7mm (pediatric use) and come in varying angles of view from 0 degrees to 30, 45, 70, 90, and 120 degrees. They provide good illumination of the inside of the nasal cavity and sinuses.

For more information on surgery and after care , please search similar articles in this site

For Appointment- call 0471-2334561/62/63/64, 6452020,407822 Fax-0471-2330925

Email: jubileehospital@hotmail.com, drpaulose@yahoo.com

Clinic hours: Mon-Wed-Friday (8AM -1 PM)

Operation Days: Tue-Thu-and Saturdays (8AM-4PM)

To reach Jubilee Hospital: jubileehospitaltrivandrum

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Jubilee Hospital, Trivandrum.

Allergic fungal sinusitis (AFS) now is believed to be an allergic reaction to fungi and most patients with allergic fungal sinusitis have a history of allergic rhinitis.

The common causative fungi in allergic fungal sinusitis are by Aspergillus.

Symptoms

Symptoms of nasal airway obstruction, allergic rhinitis, or chronic sinusitis that includes nasal congestion, purulent rhinorrhea, postnasal drainage, or headaches are common. Pain is uncommon among patients with allergic fungal sinusitis and suggests the concomitant presence of a bacterial rhinosinusitis.

Patients with allergic fungal sinusitis are atopic, but generally their symptoms have been unresponsive to antihistamines, corticosteroids, antibiotics and prior immunotherapy. Use of systemic corticosteroids may produce some relief of symptoms, but relapse is typical following completion of therapy. In contrast to patients who have invasive fungal sinusitis, patients with allergic fungal sinusitis always are immunocompetent.

The range of physical findings on examination is typically of nasal airway obstruction resulting from intranasal inflammation and polyposis, facial dysmorphism, consisting of proptosis. Proptosis usually occurs over long period of time hence no diplopia or visual loss is seen. Visual loss from allergic fungal sinusitis caused by compression of the ophthalmic nerve,

Diagnosis

Flexible or Rigid Endoscopy

CT/MRI imaging

Accumulation of allergic fungal mucin eventually leads to the increasingly well-recognized radiographic findings characteristic of allergic fungal sinusitis. Heterogeneous areas of signal intensity within Para nasal sinuses filled with allergic fungal mucin are frequently seen.

Treatment

Medical treatment of the disease has made use of various combinations of antifungal medications, corticosteroids, antihistamines and immunotherapy.

This comprehensive approach to management depends on complete removal of all fungal mucin usually requiring radical surgery and long-term prevention of recurrence through both corticosteroids and antifungal therapy

Systemic antifungal therapy often was used in an attempt to provide some degree of control over recurrence of allergic fungal sinusitis e.g. ketoconazole, itraconazole, and fluconazole. Topical application of antifungal agents may hold some benefit in the control of postoperative recurrence.

Itraconazole and fluconazole offer a slightly safer form of antifungal therapy but still may give rise to drug-induced cardiac dysrhythmias, hepatic dysfunction, urticaria, and agranulocytosis.

Surgical Therapy

FESS

Caldwell Luc

Lateral Rhinotomy

These surgical goals can be accomplished through a number of approaches and techniques, the choice of which ultimately is influenced by the experience and training of the surgeon. Endoscopic powered instrumentation has demonstrated its effectiveness; this technique allows for removal of soft tissue and thin bone while maintaining superb visibility. Exercise great care when using powered instrumentation because the well-recognized bone dissolution associated with allergic fungal sinusitis (AFS) increases the potential risk of inadvertent orbital and/or intracranial penetration.

Postoperative care begins immediately following surgery with nasal saline irrigation. Weekly clinic visits for about a month initially are required to allow regular inspection of the operative site and debridement of crusts and retained fungal debris.

Systemic corticosteroids, which were initiated before surgery, are continued during the postoperative period and slowly tapered during the process of healing. The length of corticosteroid treatment and the form of postoperative adjunctive medical management used to further control the disease are at the discretion of the managing physician. I treat the patients with 3-4 weeks of steroids postoperatively, starting with a similar dose of steroids received preoperatively for 10-14 days. The steroids then are tapered over the next 10-14 days.

Recurrence is not uncommon once the disease is removed. Anti-inflammatory medical therapy and immunotherapy are being employed to help prevent recurrence.

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Jubilee Hospital, Trivandrum.

Allergic Fungal Sinusitis is not uncommon in children. They are usually silent and come to the clinician very late.

Allergic fungal sinusitis (AFS) now is believed to be an allergic reaction to fungi and most patients with allergic fungal sinusitis have a history of allergic rhinitis.

The common causative fungi in allergic fungal sinusitis are by Aspergillus.

Symptoms

Symptoms of nasal airway obstruction, allergic rhinitis, or chronic sinusitis that includes nasal congestion, purulent rhinorrhea, postnasal drainage, or headaches are common. Pain is uncommon among patients with allergic fungal sinusitis and suggests the concomitant presence of a bacterial rhinosinusitis.

Patients with allergic fungal sinusitis are atopic, but generally their symptoms have been unresponsive to antihistamines, corticosteroids, antibiotics and prior immunotherapy. Use of systemic corticosteroids may produce some relief of symptoms, but relapse is typical following completion of therapy. In contrast to patients who have invasive fungal sinusitis, patients with allergic fungal sinusitis always are immunocompetent.

The range of physical findings on examination is typically of nasal airway obstruction resulting from intranasal inflammation and polyposis, facial dysmorphism, consisting of proptosis. Proptosis usually occurs over long period of time hence no diplopia or visual loss is seen. Visual loss from allergic fungal sinusitis caused by compression of the ophthalmic nerve,

Diagnosis

Flexible or Rigid Endoscopy

CT/MRI imaging

Accumulation of allergic fungal mucin eventually leads to the increasingly well-recognized radiographic findings characteristic of allergic fungal sinusitis. Heterogeneous areas of signal intensity within Para nasal sinuses filled with allergic fungal mucin are frequently seen.

Treatment

Medical treatment of the disease has made use of various combinations of antifungal medications, corticosteroids, antihistamines and immunotherapy.

This comprehensive approach to management depends on complete removal of all fungal mucin usually requiring radical surgery and long-term prevention of recurrence through both corticosteroids and antifungal therapy

Systemic antifungal therapy often was used in an attempt to provide some degree of control over recurrence of allergic fungal sinusitis e.g. ketoconazole, itraconazole, and fluconazole. Topical application of antifungal agents may hold some benefit in the control of postoperative recurrence.

Itraconazole and fluconazole offer a slightly safer form of antifungal therapy but still may give rise to drug-induced cardiac dysrhythmias, hepatic dysfunction, urticaria, and agranulocytosis.

Surgical Therapy

FESS

Caldwell Luc

Lateral Rhinotomy

These surgical goals can be accomplished through a number of approaches and techniques, the choice of which ultimately is influenced by the experience and training of the surgeon. Endoscopic powered instrumentation has demonstrated its effectiveness; this technique allows for removal of soft tissue and thin bone while maintaining superb visibility. Exercise great care when using powered instrumentation because the well-recognized bone dissolution associated with allergic fungal sinusitis (AFS) increases the potential risk of inadvertent orbital and/or intracranial penetration.

Postoperative care begins immediately following surgery with nasal saline irrigation. Weekly clinic visits for about a month initially are required to allow regular inspection of the operative site and debridement of crusts and retained fungal debris.

Systemic corticosteroids, which were initiated before surgery, are continued during the postoperative period and slowly tapered during the process of healing. The length of corticosteroid treatment and the form of postoperative adjunctive medical management used to further control the disease are at the discretion of the managing physician. I treat the patients with 3-4 weeks of steroids postoperatively, starting with a similar dose of steroids received preoperatively for 10-14 days. The steroids then are tapered over the next 10-14 days.

Recurrence is not uncommon once the disease is removed. Anti-inflammatory medical therapy and immunotherapy are being employed to help prevent recurrence.

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Maxillary Antral Lavage – Sinus Washout

When I was an ENT trainee, the Antral lavage followed by systemic antibiotic was very common form of treatment in acute sinusitis. At times the Sinus washout was repeated every week till patient returned to normality. Some how the hype in FESS surgery, this old fashioned minor procedures were ignored and it is time to revisit the good old time tested minor procedure once again for the sake of patient.

Definitions:

Irrigation of the maxillary sinus through its natural ostium or through a puncture of the inferior meatus under local infiltration and surface anesthesia-Lidocaine.

Introduction:

The cheek bone or maxilla is hollow. This keeps the bones of the face nice and light. The space inside any face bone is called a sinus. The sinus in the maxilla is sometimes called the antrum and is very large. The bone between the sinus and the inside of the nose is thin like an egg shell. The sinus in the cheek bone has a little drain hole which leads into the upper part of the inside of your nose. Normally the hole lets in air. Infection may drain from the sinus into your nose…..

Diagnosis

Examination of Nasal passage-Rhinoscopy

Nasal Endoscopy

CT Scan Sinus

The Procedure

Maxillary Antral lavage involves piercing the wall between the nose and maxillary sinus with an Antral lavage needle and rinsing out the pus in the sinus cavity with fluid; the tiny hole heals quickly.

I use local anesthetic lidocaine spray and infiltrate the inferior meatus with a drop of lidocaine 4% using a fine needle.

A fine metal tube-Trocar and Canula- will be pushed into the nose and through the thin bone of the maxilla into the sinus. Salty water will be flushed through the tube into the sinus. The salty water will come out of the little drain hole in the sinus, and drain into the nose…..

Possible surgical complications of Maxillary antral lavage is rare, may include: pain, and numbness of upper teeth for few minutes. Rarly little blood stained discharge.

Post operative care

A course of broad spectrum antibiotic, Nasal decongestant drops, Antihistamines and Pain killers(if needed) should be given for a week. If any pus obtained it should be sent for Culture and see the result and give appropriate antibiotic.

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