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Dr Paulose - World Class ENT Surgeon

I’ve spent over 38 years treating and healing patients from around the world. I’m highly indebted to God for His mercy and compassion, in giving me the strength to continue my life’s call. Today, I’m happy to have this opportunity of expressing myself, sharing my knowledge and skills.

Thanks to my son Jose and through drpaulose.com – I’ll be posting topics related to medicine, surgery, preventive measures and occasional posts in my areas of interest – charity, spirituality, yoga, painting and  folk arts of kerala.

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I appreciate your readership and support. I will be updating the site with more posts . May God Bless, heal and comfort those who read this site.

Healthy and Happy Living!

Dr Paulose
Dr. K. O. Paulose, FRCS DLO
Consultant ENT & Laser Surgeon

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Tribute to a Missionary –Fr.Francis Kalampadan

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Witness through Suffering

It is amazing to know that God chooses and uses weak, ordinary men and women to accomplish his purposes for his kingdom. It’s not about great men and women of God but a Great God! He is never failing.

The life of a missionary is not glamorous, it’s full of hardship. I think that when it comes to serving Jesus it requires a lot of sacrifice. Some of these sacrifices are very easy. Some are much more difficult. Sometimes God will ask you to sacrifice your family and friends and that is a little bit more difficult. The term sacrifice seems so harsh and strong.

Fr.Francis.K.O. passed away unexpectedly on 24th May 2013at the age of 79 while he was in Palghat, northern part of Kerala South India. I believe, Fr.Francis is celebrating in heaven today with others who have gone before him.

He narrated his life story when he visited me on a holiday before he passed away.

I request all of my readers to offer a special prayer to God on behalf of all the missionaries you know, and the thousands you haven’t yet met. As it is written: “How beautiful are the feet of those who preach the gospel of peace, who bring glad tidings of good things!” (Romans 10:14-15)

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Life of “Fr K.O”

Fr.K.O.Francis (Fondly called Fr.K.O.) was a great missionary, who spent nearly 25 years in various north Indian states as a lay missionary-“brother” and 30 years spent as a priest in different parts of the subcontinent.

His life was full of hardship and misery, illness and poverty.

He was born in a middle class family on 22nd July 1934, last of the 10 siblings to his parents, in a village called Nedungapra. Our great grandparents, The Kalampadan (Kalambattu) family were migrant from the south, Arakkuzha and nearby places.

From very early days he was very prayerful, highly spiritual and used to serve in the village church as an altar boy. After completing matriculation and 2 year Latin study, he joined the OCD (Order of Discalced Carmelites) as a novitiate in 1954. But ill health did not allow him to complete the novitiate.

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Suffering with joy

Fr.Francis always found joy in his suffering, like St Paul said “Now I rejoice in my sufferings for your sake, and in my flesh I do my share on behalf of His body, which is the church, in filling up what is lacking in Christ’s afflictions.”( Is there any lacking in Christ suffering?-subject to debate)

There was no end of suffering in his life. He used to get very severe pain from stomach ulcer, and vomiting bile. He was taken to the Catherine Booth Hospital, in Nagercoil, Tamil Nadu, which is a Salvation Army Hospital. (It is named after Catherine Booth, the wife of William Booth, the founder of the Salvation Army.).

An American surgeon by name Dr Noble operated him under local anesthesia which took 5-6 hrs. But later found the operation was not successful, indeed done wrongly.

He went back to his village and recuperated and after one year went back to the OCD in Thakkala to repeat his novitiate again. Unfortunate, after 8 months he became ill again.

He was taken to Holy cross mission Hospital at kottyam near Quilon.The German doctors who examined him advised a redo surgery, meaning opening his abdominal wounds again. They gave only fifty percent chance of survival. So he was not keen to undergo the operation. Stayed in the hospital for 2 months and got better by medications. Dr Rogan, the German doctor treated him reassured him that he can get back to an active life, than a contemplative life.

Since he was rejected by OCD as he lost two chances of completing novitiate, he felt frustrated.

1958-He took a train to Raipur (MP) to join the Pallotine order (order est. by St Vincent Pallotine).It was early days of Pallotine missionary work in India, there were only 3 members when he joined.

Their missionary activity involved not only evangelization but also humanitarian work, especially among the poor and disadvantaged, promoting economic development, education, health care and in orphanages. Fr Francis was no stranger to hardship. Yet in the midst of hardship, he heard God’s call and continued his life’s call.

He lived a life of hunger, disappointment and frustration. A typical day for him combines a dizzy schedule of visiting villagers and the sick, to attend to parishioners’ needs, preparing people for baptisms, weddings, and funerals.

Six months after joining there, he became ill again, went back to Kottyam, the doctors again advised redo surgery, but he was not keen, got treated by medicines, and got better. Went back to Raipur, and continued his mission work for a long period of ten years under late Fr.Hunold. He was involved in mission work in 80 villages, traveling by foot or at time on some one’s bicycle back seat. Living among the poor, the oppressed and the overburdened low caste villagers.1968, Fr. Hunold had an accident and went back to Germany.

He always wanted to become a priest but his health prevented it, so what left is to become a” brother”. This was not what he wanted. He felt empty even though his health had become stable.

1968-He joined the CMI (Carmelites of Mary immaculate) fathers in Raigarh (MP) to continue the mission work. His missionary work involved traveling in rural villages, staying with the poor, teaching them about the good news, and prepares them for baptism- (mass baptism took place those days). He spent another eight years of the missionary work with CMI fathers. Most of villages were very poor and had no electricity and running water, most of the time he commuted on foot miles and miles sometimes thru jungles.

1973-Got typhoid and the stomach illness flared up. Taken to St.Johns Hospital Bangalore, they gave only 10% chance of survival after the operation. He didn’t get operated.

1974-He goes to Hazaribag in Bihar, meet Sr. Collet a matron in a government hospital, thru her contacts with Sr. Segrid, was then taken to Dr.Sr. Frederic in Holy Family Hospital in Ranchi. There he underwent the second major operation.

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Life of Missionary-Divine Providence

1975-He reaches Banaras (Varanasi), Bishop Patrick sent him to Nagpur seminary for completing his studies-2 year Philosophy, 4 years of Theology, which he completed.

1981-At last he becomes a Deacon, which last only one year. Priesthood was at hand, eventually.

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Coming home for Priestly Ceremony-

He comes back to his native village Nedungapra after 24 years (he left Nedungapra in 1958).All his family, brothers and sisters thought he was not alive.

But disaster struck him again, while he was in Kerala on a visit to prepare the priesthood ceremony. He had massive internal bleeding from a burst stomach ulcer and admitted unconscious in Little flower Hospital Angamaly.He was again, 3rd time undergone a major operation by Dr George Jacob and the surgeon removed 2/3 of his stomach and while in hospital he received 18 pints of blood transfusion. It was a miraculous escape from death.

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Ordination as a Priest

1982-15th April-Priesthood ceremony took place in the village church_Nedungapra.His ambition of life was fulfilled. He became Fr.K.O.Francis, fondly called “Fr K.O.”

1982-2000-Spent his life as priest in the Diocese of Varanasi, served as a diocesan, spiritual director in various parishes and seminaries in North India-Nagaland, Jaunpur (UP,) Andaman Islands etc.He built nearly 12 churches in different parts of north India.

2001-At the age of 66, because of his ill health ,he requested Bishop of Varanasi to come back to Kerala for better medical treatment and to lead a not so hectic life. The permission was granted and from year 2000 onwards, he served in various places in Kerala-Kanjoor,Chalil,Elavoor,Ettumannoor,Divine centre, Muringoor, Chalakkudy and a spiritual father in Palghat, where he died after a silent heart attack..

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“The biggest reward for me is the presence of God in my life as a Divine Word Missionary and in the lives of the people I served…” Fr Francis. His mission was endless and diverse.

FINAL FAREWELL

(Fr.Francis  passed away unexpectedly on 24th May 2013 at the age of 79 while he was in Palghat, northern part of Kerala South India. I believe, Fr.Francis is celebrating in heaven today with others who have gone before him.)

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“All Christians must follow God sends us all hardships

out of infinite love. Do not try to escape suffering”.

St.vincent pallotti

 

Tumors of the Middle Ear and Mastoid

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Malignant tumors in the middle ear and mastoid are very rare. Of these very uncommon tumors, the squamous cell cancers are the most common. Squamous cell cancer of the middle ear and mastoid is a fatal disease, if not treated properly. These cancers are usually found in individuals who have neglected chronic infection in the mastoid or middle ear. The exact relationship of the infection to the formation of the squamous cell cancer is unclear. Presumably, it is related to chronic inflammation.

Malignant tumors of the mastoid and middle ear accounts for 5 to 26% of all ear neoplasms. Of these neoplasms, squamous cell carcinoma is the most common, with an age-adjusted incidence of 1 case in 1 million and peak age of 60 years.

Squamous cell cancer of the middle ear is often quite advanced before a correct diagnosis is made. Pain is a significant feature of squamous cell cancer of the middle ear and mastoid. Intermittent hemorrhage, bleeding and drainage for long periods of time are also usual. Hearing loss is significant. Diagnosis depends upon a biopsy of the tissue.

The major etiological factor is chronic suppurative otitis media although irradiation and inverted papilloma of the middle ear have also been reported to be additional risk factors.

Human papilloma virus types 16 and 18 have been associated with squamous cell carcinoma of the middle ear at both tissue and molecular levels, thus providing a good model to explain the pathogenesis of chronic inflammation-related human malignancies.

An examination by the ear surgeon investigating a perforated eardrum which shows suspicious tissue in the middle ear or mastoid that does not heal after appropriate medical therapy would indicate a need for a biopsy. Suspicion should be aroused about any unusual tissue which is seen through a perforated eardrum or mastoid, particularly those that are painful. After topical or local anesthesia is placed into the ear, the tissue to be biopsied is sent off for analysis and a pathologist will be able to determine whether cancer is present in the tissues. During middle ear mastoid surgery any polyps or granulations seen must be sent for histopathology as routine.

CT scan and MRI are necessary in order to help determine the extent of surgery necessary. Even with early surgery and radiation therapy, cure may not be possible if the tumor is deeply invasive. Thus, it is imperative that diagnosis be made as early as possible. Once diagnosis is made, the patient must be prepared for radical surgery.

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Glomus Tumors

Glomus tumors are the most common benign tumors of the middle ear. They arise from glomus bodies. Glomus bodies are tiny, normal structures in the middle ear which serve as baro receptors. These baro receptors sense and help to regulate the oxygen pressure in the middle ear and mastoid.

Benign tumors of glomus bodies can occur within the middle ear or at other sites: the temporal bone and neck, or within the jugular vein (the large vein in the upper neck which drains the head toward the heart). Glomus tumors of the middle ear are more common than glomus tumors of the jugular vein. They can result from abnormal growth of a single glomus body.

Glomus tumors are highly vascular and are primarily composed of blood channels flowing through the tumor itself. They appear red on examination of the eardrum. Most glomus tumors are readily noted by an n ENT Surgeon’s routine examination of the ear. They appear as a red ball or mass behind the eardrum. The eardrum may pulsate, if the glomus tumor is touching the under surface of the intact eardrum.

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Diagnostic Imaging Studies

CT scan: CT scanning of the mastoid and middle ear determine the extent of bone involvement. As a tumor grows, it will invade and destroy bones. Cancers also appear on a CT scan, and an estimate of the extent of the disease can be obtained.

MRI scanning can demonstrate the infiltration of the tumor into soft tissue, specifically tissue in the front of the ear or parotid gland area. MRI will also help to determine if the tumor has invaded the dura, which is the capsule surrounding the brain. If the tumor has grown through the plate of bone that separates the middle ear and mastoid from the brain, then cure becomes quite difficult.

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Treatment

The classical treatment is combined surgery and radiotherapy, although either method may be used alone. Most authorities agree that a combination of surgery and radiotherapy as opposed to single modality treatment is likely to yield the best results.

Glomus tumors are not highly radiosensitive. However, in older patients, or those who should not undergo sugery, radiation therapy may help to arrest the growth of a glomus tumor. In the younger patient, complete surgical removal of the tumor after emobilzation is the preferred method of treatment.

 

Chronic Ear Disease-Cholesteatoma and its Complications

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Cholesteatoma is a benign growth of skin in the middle ear or mastoid that can lead to infection and more serious problems involving the brain and facial nerve. It is not a cancer condition but is important because it can lead to serious complications such as permanent deafness and life-threatening illnesses such as meningitis and brain abcesess.

The cause of the cholesteatoma is not fully understood. It is thought that skin cells from the lining of the ear canal get trapped in the middle ear. Skin cells, including those that line the ear canal, normally multiply regularly to replace those that have died. Usually these skin cells flake off. The dead cells are trapped too and build up. This build-up of dead skin cells over time is what forms the cholesteatoma.

Types of Cholesteatoma

Congenital cholesteatoma grows behind the eardrum from birth.

Acquired cholesteatoma develops later, usually in adults. This is often as a result of a chronic or recurring ear infection. The infection causes a blockage of the Eustachian tube. This is the tube that connects the middle ear to the back of the nose and throat. The blockage creates a negative pressure that draws the eardrum inwards. This can result in a small pocket forming, usually at the very top of the eardrum. In this pocket some skin cells collect, get trapped, but continue to multiply to form the cholesteatoma. The pocket is too deep to allow the dead skin cells to escape, so the cholesteatoma gradually expands.

Symptoms

Cholesteatoma is usually unilateral. The most common initial symptoms are a smelly discharge from the ear, and some hearing loss. You are also likely to have had previous problems with ear infections. Other symptoms that may occur include hearing loss and vertigo.

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Complications

Erosion of the ossicles (bones) behind the eardrum can lead to a conductive hearing loss. The bone over the facial nerve can also be destroyed, and a facial paralysis can result. The inner ear, composed of a bony labyrinth, can also be partially destroyed. This can lead to sensor neural hearing loss and dizziness. The infection can also spread into the veins carrying blood from the brain to the heart. The sigmoid sinus can get thrombosis. The infection can also spread to the covering of the brain and cause meningitis. In rare circumstances, a brain abscess can occur.

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Facial Nerve Paralysis with Ear Disease

Facial nerve paralysis can be seen in patients who suffer from acute and chronic ear infections (otitis media). Facial paralysis that occurs suddenly during an acute ear infection implies inflammation of the nerve. This tends to occur in infants and young children, because the bony canal surrounding the nerve is not as insulated from the middle ear space as it is in adults. Ordinarily, prompt treatment of the infection, that sometimes includes putting a hole in the ear drum (myringotomy) to remove the infected contents, leads to recovery of the nerve.

Sudden facial paralysis in the setting of chronic ear disease suggests damage caused by expanding cholesteatoma. When sudden facial paralysis occurs in the face of known chronic ear disease, prompt surgical exploration with evacuation of disease and nerve decompression usually results in good recovery of function.

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Diagnosis

Otoscopy and Microscopic examination

Audiometry (hearing tests) may show deafness or hearing loss and are usually performed in a hospital clinic.

Swabs of the ear discharge may also be taken. The discharge often contains a bacterium Pseudomonas which is responsible for the smell.

CT scans might be needed to see the extent of the damage caused by the cholesteatoma, and to plan further treatment.

Treatment-Surgery

Surgery removes all of the diseased areas, including the cholesteatoma itself. Virtually all cholesteatomas should be removed by surgery.

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Mastoidectomy

In the canal wall–down (open) procedure, the posterior canal wall is removed. A large meatoplasty is created to allow adequate air circulation into the cavity that arises from the operation. Canal wall–down operations have the highest probability of permanently ridding patients of cholesteatomas.