Diagnosis of nasopharyngeal carcinoma on fine needle aspiration cytology of cervical lymph nodes

This study was carried out to see the sensitivity of Fine needle aspiration cytology [FNAC] in cervical lymph nodes in patients of carcinoma of the nasopharynx. This Study was carried at the Department of ENT and Head Neck Surgery of Khyber Teaching Hospital, Peshawar Pakistan from June 2003 to May 2005. Patients between the age of 30 and 70 years were included in the study. 25 patients having cervical lymphadenopathy were selected and divided into two groups A and B. Group A includes 20 patients which were undiagnosed cases of nasopharyngeal carcinoma. Out of them 17 patients have ENT Symptoms and 03 patients have only Cervical lymphadenopathy. Group B includes 05 patients who were post irradiated cases of Nasopharyngeal Carcinoma having detectable cervical lymphadenopathy. Fine needle aspiration was performed with 21 gauge needle attached with 20 ml syringe and smears were prepared. The cellularity in most of the smears was high 96%. Single scattered malignant cells were present in 92% of cases. The oval shaped vesicular neuclei were present in 92% of cases. In group B who had undergone radiotherapy showed one to three prominent nucleoli. FNAC of Cervical lymphnodes is an important diagnostic tool for the diagnosis of NPC, especially in those patients who have no ENT symptoms. It is also helpful in the follow up of post-irradiated patients

Frequency of allergic fungal aetiology of chronic rhinosinusitis

The aim of this study was to find out the frequency of intranasal fungal sinusitis in patients attending a tertiary care hospital in North West Frontier Province [NWFP] of Pakistan. This study was conducted in the ENT department of Khyber Teaching Hospital Peshawar Pakistan from November 2004 to May 2006. One hundred patients with chronic rhinosinusitis [CRS] and 50 healthy subjects as a control group were included in this prospective study. Nasal lavage samples were investigated for the presence of fungus, using new culture technique and histological examination. Epidermal and intradermal hyper sensitivity tests were used to find out fungal atopy. Levels of serum eosinophils, total IgE were estimated in the blood samples. Allergic fungal sinusitis was diagnosed in 13 [13%] patients. Clinical and laboratory parameters of CRS were not significantly different in the groups with and without intranasal fungi. In this study frequency of fungal sinusitis was not as high as expected in patients living in NWFP with CRS. Furthermore, no significant correlation could be found between presence of intranasal fungus and type- I hyper sensitivity in patients with CRS

Frequency of intra cranialcomplications in chronic otitis media

Chronic Otitis Media can lead to intracranial complications, which were more common in pre-antibiotic era as compared to the present antibiotic era. Patients of Chronic Otitis Media with intrracranial complications usually present very late due to ignorance and lack of primary health care. The aim of this study was to investigate, the frequency, mortality and morbidity of intracranial complications of chronic otitis media admitted in Far Nose and Throat Unit of Lady Reading Hospital Peshawar. This study was conducted in Government Lady Reading Hospital Peshawar for a period of two years front October 2001 to October 2003. All the patients diagnosed as intracranial complications of chronic otitis media were included in the study. Result: The total number of patients reporting with intracranial complication due to chronic Otitis media [Unsafe ear] was 20. Meningitis and brain abscess were present in 8 cases each [40%]. In 3 cases [15%] extradural abscess was found while 1 [5%] had lateral sinus thrombosis. Chronic Otitis media is a common disease in our part of the world

Actinomycosis in neck glands

A middle aged women presented with right submandibular swelling, fever off and on and anemia. Excisional biopsy of the gland showed Actinomycosis. It is a rare disease in the neck. Patient was treated with high doses of parenteral pencillins followed by three months course of oral Doxycyclines. The patient was followed upto six months and she was symptoms free. In this case report the disease is elaborated and literature is reviewed

Management of whistle as a foreign body trachebronchial tree

To assess the management of whistle as a foreign body tracheobronchial tree and to know the measures for its avoidance. This is a descriptive study carried out prospectively at the department of ENT, Head and Neck Surgery PGMI, LRH Peshawar for a period of three years. Those patients having any other foreign body except metallic whistle in tracheobronchial tree were excluded from the study. In all patients the foreign bodies were removed using Karl Storz bronchoscope. This study included two hundred and twenty cases, mostly the young adults belonging to average socio-economic class. Out of 220 cases 150 [68.18%], were male with the mean age of 6 years and 70 [31.8%] were female with the mean age of 5 years. Male to female ration was 2.1 Eldest patient was of 15 years with whistle in trachea and the youngest was of three years. Maximum number of cases i.e 169 [76.8%] had foreign body in right main bronchus followed by trachea in 27 [12.2%] left main bronchus in 15 [6.8%] glottis in 7 [3.1%] and supra glottis 2 [0.9%]. The whistle were taken out successfully using different sizes of rigid bronchoscopes. None of the patients had any postoperative complications. It is concluded that mostly foreign bodies lodge in right main bronchus. Awareness of hazards of inhaled foreign body may reduce the incidence

Management of subglottic foreign body, a therapeutic challenge

To assess the effects of subglottic foreign bodies, and to know the measures for its avoidance. This is a descriptive analytical study, which was carried out at the department of ENT, Head and Neck Surgery, Khyber Teaching Hospital Peshawar, from January 2000 to December 2003. This study comprised twelve patients having foreign bodies in subglottic region; Mostly the patients were young, and belonged to average socio-economic class. Out of one hundred and ten patients presented to the ENT Unit, twelve patients had subglottic foreign body. The eight cases [66.6%] were boys and 4 [33.3%] were girls. The age ranged from 7 months to 4 years, and majority of sufferers were 3 years of age. Eight patients [66.6%] presented with respiratory distress alone, whereas 2 [16.6%] patients had distress with stridor. In 6 [50%] of patients 'betel nut' was the foreign body, followed by popcorn 4 [33.3%] It is concluded that although the foreign bodies in laryngotracheal region is a rare occurrence but it can result in fatal outcome. Awareness of inhaled foreign bodies should be encouraged

Outcome of myringoplasty

The out come of graft acceptance and rejection in myringoplasty were evaluated in patient of 16-45 year of age, having dry central perforation. Admitted patients in ENT unit Post-Graduate Medical Institute Lady Reading Hospital, Peshawar. Myringoplasty was done in 60 patient admitted in ENT unit with dry central perforation. Age limit was 16 - 45 years. All patients were admitted in door a night before. All the relevant investigation including clinical examination, pure tone audio gram, x-ray mastoid and para nasal sinuses were done. Examination under microscope was carried out a day before admission. Operations were done under local anaesthesia graft was taken from temporalis fascia. After weeks the tympanic membrane were evaluated under Microscope, to assess the result of Myringoplasty. Myringoplasty was successful in 35 patients [60%] and in 24 patients [40%] graft was rejected due to infection. Myringoplasty is a beneficial procedure to protect the middle ear and inner ear for future hearing deterioration. The improvement of hearing is an added benefit. Overall 2/3rd of patients get their graft accepted. In absence of meddle ear cleft infection, the reason of high graft rejection is due to improper sterilization of instruments and environment