Ear Nose Throat & Head - Neck diseases

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Sunday, January 23, 2011

Review of the Book: Endoscopic Color Atlas of Ear Disease

Reviewer :

Dr. M P Manoj, MS

Managing Director and Consultant ENT Surgeon

Head of the Cochlear Implant Unit and Head & Neck Surgery, Calicut, kerala

In one word- commendable! Easy to read, lucid presentation, nice formatting ( not often seen in Indian books), no clutter and quite comprehensive in coverage.

The first chapter starts very well, a concise description of the tympanic membrane anatomy and many pictures, eleven in all. However one must remark that many of these pictures are similar and wonder whether a large single page high resolution color photograph with a line diagram on the next page, clearly labeled would have been a better idea. Figures 6,8,9 and 11 look like replicas.

A comment about the quality of the endoscopic photographs- great deal of improvement is possible. The only photograph in the whole book that is of really good quality came from the Causse clinic. I think we have the technology to do as good, if not better photographic documentation. The authors are luminaries in their own right and have the passion to produce a book that is a work of love, no doubt, but why cringe on quality? A Xenon/ LED light source, high res camera like the Storz HD, good image capturing software like provision or DIVA which aren't too expensive would have produced pictures that are stunning, given the amazing clinical material in the book.

These pictures are video caps from per operative videos taken with the free VLC media player. It is not even a professional recording. We need the second edition to come out with photos like these!

The varieties of external ear conditions shown are quite good, and are of special relevance and these are the cases that are more specific for our conditions. Quality of photographs apart, a great collection and learning material. Kudos.

The chapter on AOM has a small glitch to begin with. The stage of resolution should have mentioned, "Most cases of AOM tend to resolve without antibiotics". This is a documented, scientifically proven fact and needs to be highlighted.

Actual clinical photograph Ms. R, 7 years old presented with acute onset severe ear pain. Endoscopy showed bulging TM, and after analgesic use only, full resolution in three weeks. (Dr. MPM collection)

The lighthouse sign is a video sign and can never be actually demonstrated in serial photographs. For us who have seen this, the image is realistic, but for a GP, for whom I believe this book is a great diagnostic tool, it maybe perplexing.

The term Chronic Suppurative otitis media is too, I fear, rather archaic. The current terminology is Chronic Otitis media, mucosal or squamous type, active or inactive and should have been used throughout this book. So is the term adhesive otitis media- and is actually chronic ear disease, squamous type inactive. Is the use of decongestants recommended in Otitis media? I fear that there is a lot of evidence it does no good and in fact harm.

The various presentations of chronic ear diseases are very well documented and apart from a minor criticism of some apparently similar photographs that run the risk of repetition, are truly informative. Some technical terms like infected gel foam could have been avoided, and the lowered facial ridge do not appear lowered at all! It is probably a photographic illusion, but deserves mention.

The chapter on otitis media with effusion , ventilation tubes , granular myringitis and hemotympanum should technically have preceded the chronic ear chapters.

Though cartilage tympanoplasty is a fantastic technique and many surgeons including me use it from time to time, it is not the only option for creation of a neotympanum. A book on cartilage tympanoplasty can elaborate its advantages, not a endoscopic atlas, which could have included other grafts like temporalis fascia, perichondrium and fascia lata. Obviously a canal wall down procedure would require far more than a cartilage graft and this is not mentioned in the atlas. An audiometric follow up also would have added value to the pre and postoperative chapter.

Why has the exostosis been repeated in the tumors chapter when it already is mentioned in the external canal pages? A post treatment picture could have been included.

Just for completion, the Sade and Tos classification of retractions could have been acknowledged in a footnote as a tribute for those giants.

Notwithstanding these comments that should be taken as encouragement for improvisation rather than negative criticism, the authors deserve all praise for bringing out such a first-of-a-kind book of Otoendoscopy. You deserve a standing ovation. May god bless your passion to bring out another edition to shut big mouths like mine! Congratulations!

Dr M P Manoj

web : http://drmanojsent.com/

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