Analysis of patients in otolaryngology department at Muzaffarabad hospitals

Objective: To assess the work load of the department in terms of individual disease

Study Design: Descriptive study

Place and Duration of Study: This study was conducted at Ear, Nose and Throat [ENT] Department of Shaikh Khalifa Bin ZayedAl Nahyan, Hospital Combined Military Hospital [CMH] Muzaffarabad from Jan 2011 to Jan 2012

Material and Methods: Total of 710 patients was admitted in ENT ward in one-year duration for various pathologies. For easy analysis, they were divided into groups according to the region involved by disease

Results: Two hundred and eighty-five cases [40.14%] were admitted with pathologies of nose and para nasal sinuses making the highest percentage among the groups. The second major group was otology comprising of one hundred and fifty-six [21.97%] cases. One hundred and three [14.50%] cases were from pathologies in oral cavity. Thirty [4.22%] cases from skull base, thirty [4.22%] pathologies of larynx, trachea and bronchi, forty [5.63%] cases were from hypopharynx and esophagus, twenty-four [3.38%] cases were from salivary gland pathologies. Twenty-one [2.95%] cases were from neck region. Tumors were 4[0.56%] and neurological cases were 11 [1.54%] of the total number of cases

Conclusion: Self-analysis/ audit at departmental level greatly enhances the working efficiency of a department and is essential for betterment of the patient and education of trainees as one gets a fair idea about the prevalence of disease in a community and can thus direct the resources accordingly

Atorvastatin in the management of tinnitus with hyperlipidemias

To determine the role of atorvastatin in management of tinnitus in patients with hyperlipidemia. Quasi-experimental study. ENT Department, Combined Military Hospital, Rawalpindi, from July 2011 to August 2012. Ninety eight patients of tinnitus with sensorineural hearing loss having hyperlipidemia were included in the study. Their pre-therapy serum cholesterols were measured, and tinnitus scores were recorded on a 'Tinnitus handicap questionnaire'. They were administered tablet atorvastatin 40 mg once daily with low fat diet for 8 months. After 8 months of therapy, patients were purposefully divided into responsive and unresponsive group depending on serum cholesterol levels. Post therapy serum cholesterol levels and tinnitus scores were also recorded after 8 months and compared with pre-therapy records. Serum cholesterol came to within normal limits in 51 [52%] patients [responsive group], while it remained high in 47 [48%] patients [unresponsive group]. Improvement in tinnitus score in the responsive group was seen in 36 [70.5%] patients and in 2 [4.2%] patients of the unresponsive group. Improvement in tinnitus scores was compared in the two groups using Fisher's exact test and were found to be statistically better in the responsive group [p < 0.001]. Tinnitus, in patients having hyperlipidemia, can be successfully dealt with by treating hyperlipidemia with lipid lowering agent atorvastatin

Needle aspiration an equal to incision and drainage in management of peritonsillar abscess

To compare needle aspiration with incision and drainage in treatment of Peritonsillar abscess. Randomized Control Trails. Department of ENT CMH Peshawar from 28th October 2009 to 1st November 2010. Fifty patients of either gender presenting with peritonsillar abscess for the first time were randomly divided allocated into two groups A and B. Group A underwent aspiration of pus on day 0 followed by reaspiration on day 1 and 2 if required. Group B underwent incision and drainage and evacuation of pus on day 0 followed by repeat drainage on day 1 if required. In about 72% of cases single needle aspiration was curative while 24% required two and 4% required three aspirations in group A. While in group B 80% of patients were cured with single sitting of incision and drainage and 20% required second sitting of drainage. This difference was statically insignificant [p=0.550]. Needle aspiration is as an effective method as incision and drainage for management of peritonsillar abscess

Comparison of serum immunoglobulin levels before and after adenotonsillectomy

To compare the pre and post-operative serum immunoglobulin levels in patients undergoing tonsillectomy and adenotonsillectomy. Quasi-Experimental Study ENT Department, Combined Military Hospital, Rawalpindi from Febuary 2006 to December 2007 Study included 50 patients of adenotonsillectomy and tonsillectomy. Two patients were excluded, because they did not report to the hospital for postoperative investigations. Preoperative serum IgG and IgA levels were measured two weeks before surgery and post operative samples were taken two months after the surgery. Mean age of the patients was 8.8 years, with maximum patients of 12 years of age [35.4%]. There were 36 [75%] male and 12 [25%] female patients. Tonsillectomy was done in 30 [62.5%] patients and adenotonsillectomy in 18 [37.5%] patients. Mean age of patient in case of adenotonsillectomy was 7.17 year and for tonsillectomy 9.9 years. There was a significant rise in the post operative serum IgA level [p= 0.02] while it was insignificant in case of IgG [p= 0.44]. Our study shows a significant rise in the post operative serum IgA level [p= 0.02]

Emergency tracheostomy, an experience of 120 casses

The objective of this study is to compare short term complications in elective and emergency tracheostomy Qausi Experimental study Place and Duration of Study: Department of ENT, Head and Neck Surgery Combined Military Hospital Rawalpindi from Jun 2006 to Jun 2008. Patients and Method: In this study 120 patients undergoing tracheostomy were included. Patients were purposely divided into two groups of 60 each. Patients in Group A had elective tracheostomy where as group B included 60 patients who under went emergency tracheostomy. Short term complications including haemorrhage, surgical emphysema, cardiac arrest and stomal infection were noted in both groups. Chi-square test was applied as test of significance to compare the two groups. Emergency tracheostomy in our study is associated with significantly increased risk of haemorrhage and surgical emphysema [p value being <0.05]. There was no statistical difference in occurrence of stomal infection and cardiac arrest between the two groups. Emergency tracheostomy is associated with significantly increased risk of postoperative haemorrhage and surgical emphysema

Efficacy of topical nasal steroids and total inferior turbinectomy in hypertrophic rhinitis

To compare the efficacy of topical nasal steroids therapy with total inferior turbinectomy in relieving nasal obstruction caused by inferior turbinate hypertrophy. Randomized Controlled Trials [RCT]. The study was conducted in the ENT department, Combined Military Hospital Rawalpindi from October 2006 to July 2007. Sixty patients suffering from allergic rhinitis were divided in Two groups of thirty partients. Group A underwent total inferior turbinectomy where as Group B advised Betamethasone nasal drops for two months. Relief in terms of nasal obstruction was assessed on Visual analogue scale two months after commencement of treatment. Chi-square test was applied as test of statistical significance to compare the two groups. Total inferior turbinectomy was found to be clinically superior to topical betamethasone drops in relieving nasal obstruction caused by inferior turbinate hypertrophy [p<0.001]. Total inferior turbinectomy is a better method of relieving obstruction as compared to topical betamethasone drops in nasal obstruction due to hypertrophied inferior turbinates

comparison of oral and topical steroid therapy for recurrent apthous stomatitis

This study was carried out to compare the efficacy of oral and topical Steroids in the treatment of Recurrent Apthous Stomatitis [RAS]. It was a quasi-experimental interventional study conducted on 60 patients of Recurrent Oral Ulcers seen in ENT Department of the Combined Military Hospital, Peshawar and Quetta, and was carried out in these hospitals from 01 August 2008 to 31 May 2010. Sixty patients, age ranging from 20 to 40 years; both genders were selected for the study purpose. The patients were included on the basis, having experienced oral ulcers at least thrice during the last one year severe enough to cause significant discomfort leading to absence from work place and remained afebrile during the ailment. Patients suffering from Hypertension, Bronchial Asthma, Glaucoma or Acid Peptic Disease were excluded. People taking medicines of any kind were not included in the study. Children, lactating mothers and pregnant females were excluded. Patients fulfilling the criteria were divided into two groups. Group I were given tablet Prednisolone [45mg] in daily divided doses for three days. Group II were prescribed topical application of Steroid[Triamcinolone acetonide] for the same duration. The day on which the treatment was started was counted as Day 1, the patients were re-examined on Day 2, 4 and 7. 91% of the patients of group I were symptom free on Day 4. Rest of the patients though not fully recovered were able to resume normal pattern of life. Only 47% of the patients of group II had comparable outcome on Day 4.On Day 7 all the patients of group I were normal while 18% of group II had some residual symptoms. Short term therapy of oral steroids brings an early and significant improvement in clinical picture of patients with RAS

Comparison of post-operative complications in total Inferior turbinectomy versus submucous resection of inferior turbinate

To compare post-operative complications of total inferior turbinectomy and submucous resection of inferior turbinate. Randomized control trial [RCT]. This study was conducted in the department of ENT-Head and Neck surgery, Combined Military Hospital Rawalpindi, from 14[th] April 2007 to 13[th] October 2007. After getting informed consent 60 patients, fulfilling the inclusion criteria, reporting to ENT department during study period were selected. The patients were assigned to two groups A and B by random number table. Group A underwent submucous resection of inferior turbinate and group B underwent total inferior turbinectomy. Periorbital ecchymosis, bleeding and nasal crusting were studied on 1[st], 2[nd], 7[th] and 14[th] post-op day. Submucous resection of turbinates is associated with less bleeding and crusting as compared to total inferior turbinectomy. Submucous resection is a safer method of turbinate reduction as compared to total inferior turbinectomy

Carotid body paraganglioma

Carotid body tumours are benign neoplasms. This case report describes two patients with this rare tumour with diagnostic workup and treatment options. The first case was a 36-year-old gentleman who presented with 6 months history of painless swelling on the left side of neck. The second patient was 60 years old man who presented with slowly growing swelling on the right side of neck for the last 20 years. Both patients had transmitted pulsations over the swelling. On suspicion of a vascular lesion, a contrast enhanced CT scan and Doppler's ultrasound of neck was advised which suggested the diagnosis of a carotid body tumour. Magnetic Resonance Angiography [MRA] confirmed the diagnosis. Excision in collaboration with vascular surgeon was planned for the first case. The second case was subjected to radiation therapy due to the large size of tumour and the patient's age

Actinomycosis larynx: a rare entity

Our patient, a fifty five year old poultry farmer presented with two years history of throat discomfort, for which he had taken steam inhalation. For the last two months he noticed a change in his voice. On examination he was found to be hoarse. His Indirect Laryngoscopy [IDL] showed oedematous cords. He underwent DL, which revealed oedematous cords with yellowish spots. Histopathology report received showed actinomycosis larynx. Final diagnosis of Actinomycosis larynx was made because of presence of Sulphur granules [yellow spots] on naked eye examination of vocal cords during DL, and a positive hitopathology report. The patient was started on Injection Benzyl Penicillin one million unit international units intravenous four times a day. This dose was continued for four weeks after which patient were shifted on tablet ciprofloxacin 500 mg twice daily due to unavailability of oral penicillin V. The oral therapy was continued for 3-6 months depending upon the response. During the treatment the hoarseness settl ed and IDL showed reduction in odema of the vocal cords