Unilateral Meniere's disease; intra tympanic injection of low dose gentamicin in the treatment

ABSTRACT: Meniere's disease is chronic progressive disease with unclear idiopathic etiology and symptomatic improvements with treatment

Objectives: To analyze the efficacy of low dose intratympanic injection of gentamicin for vertigo control in unilateral Meniere's disease. Study Design: Quasi experimental study. Settings: Department of ENT, PIMS, NESCOM and IMDC Islamabad

Materials and Methods: Gentamicin was used intra tympanically in this multicentre study of 75 patients over a period of 8.5 years between 1[st] January 2005 to 30[th] June 2013 in definite Meniere's disease according to the 1995 Document of American academy of otolaryngology- Head and Neck Surgery [AAO-HNS].All these centers followed same criteria and procedures. Single dose of 1 ml Gentamicin solution 40 mg/ml was instilled in the middle ear through the grommet under microscope and followed up for 3 months and two years. The staging of disease [hearing thresholds] the degree of disability [frequency of attacks per month] and the functional level were assessed before and after treatment

Results: Among 75 patients, 41 were female and 34 were males between age ranges of 25 to 70 years. Most of the patients in the study had stage 2 [23/75] and stage 3 [41/75] Meniere's disease. About 68[91%] patients were having good control of vertigo at the end of two year of intratympanic gentamicin without any loss of hearing

Conclusion: A single Low dose intratympanic gentamicin is effective in controlling vertigo in patients with Meniere's disease with no further deterioration in hearing for at least two years follow up

Comparison of over-underlay and underlay techniques of myringoplasty

To compare the success rate of over-underlay and underlay techniques of myringoplasty regarding rate of graft acceptance, hearing improvement and complications. Quasi-experimental study This study was conducted at the Department of Otorhinolaryngology and Head and Neck Surgery, Foundation University Teaching Hospital, Rawalpindi from 1st January 2003 to 31st December 2005. Clinical records of patients who underwent myringoplasty by either over-underlay or underlay techniques in the past three years were analyzed. A total of 62 patients who had dry central tympanic membrane perforations of various sizes secondary to chronic tubotympanic suppurative otitis media were included in the study. These patients were divided into two groups. In group A [study group], 34 patients were included in which tympanic membrane was repaired by using over-underlay technique of myringoplasty whereas group B [control group] comprised of 28 cases of myringoplasty in which underlay technique was used. The results of two techniques were compared in terms of graft success rate i.e., full take or failure to takeup, medialization or lateralization of graft within 6 months of operation and improvement in hearing at the end of 6 months of follow up. In group A, graft success was noted in 32 [94.1%] cases compared to 26 [92.8%] in group B [p <0.05]. Medialization of graft was seen in only 1 [2.9%] case in group A whereas it was noted in 5 [17.8%] patients in group B [p >0.05]. Lateralization of graft was not observed in any case in either group. As far as hearing improvement is concerned, the mean air bone gap closure was 10.8 dB [SD+ 5.56] in group A compared to11.3 dB [SD+5.84] in group B [p < 0.05]. Over-underlay technique of myringoplasty is equally effective to more commonly practiced underlay technique in terms of graft take and hearing improvement. As far as complications are concerned, over-underlay technique is associated with less chances of graft medialization

Effect of noise pollution on hearing of public transport drivers in Lahore city

To study the effects of noise pollution on hearing of public transport drivers of Lahore city. It was a cross-sectional, descriptive study carried out at ENT Department, Sir Ganga Ram Hospital, Lahore, from February 1st, 2003 to June 31st, 2003. One hundred drivers of public transport, driving in Lahore city for more than 8 - 10 years were included in the study. These included 25 autorickshaw drivers, 25 taxi car drivers, 25 wagon drivers, and 25 bus drivers. All subjects were questioned according to a Performa. After wards ENT examination was carried out, followed by Pure tone audiometery. The mean age of the drivers was 41.35 years. Most of them [51%] were driving from last 8 - 10 years. 65% of the subjects had noise induced hearing loss. [NIHL] 25% had normal hearing threshold and 10% had disabling hearing loss. Public transport drivers are exposed to excess noise on roads in Lahore and most of them are suffering from noise induced hearing loss

Precipitating factors of hepatic encephalopathy: experience at Pakistan Institute of Medical Sciences Islamabad

Hepatic encephalopathy is an extra hepatic complication of impaired liver function and is manifested as neuropsychiatric signs and symptoms associated with acute or chronic liver disease in the absence of other neurological disorders. There are numerous factors of hepatic encephalopathy. The main objective of this study was to analyse the precipitating factors of hepatic encephalopathy in cases seen in Pakistan Institute of Medical Sciences Islamabad. Fifty admitted patients with acute or chronic liver diseases complicating to hepatic encephalopathy were probed into for precipitating factors, based on history, clinical examination and laboratory methods from September 2005 to December 2005. The associated biochemical laboratory data analysis and prognostic stratification through Child's Pugh classification was also done. Infection [44%], gastrointestinal bleeding [38%] and constipation [38%], stood out as the most common factors. Usage of drugs with ammonium salts, tranquilizers and large volume paracentesis were least common factors. Most patients were in grade III [52%], and grade IV [22%], of hepatic encephalopathy. Other common associations were ascites [64%], Child's class C [62%], hyponatremia [50%], low haemoglobin [70%], hepatitis C [62%], and high mortality rate [30%]. Infection, gastrointestinal bleeding and constipation being the most important precipitating factors must be prevented and hospital funds, medicines and human efforts should lay emphasis, on these factors to decrease the incidence of hepatic encephalopathy. This also includes effective control measures against rising cases of hepatitis C, as it is the leading cause of liver cirrhosis in Pakistan

Management of parapharyngeal space tumours

To determine the role of clinical features, fine needle aspiration cytology [FNAC] and computed tomography [CT] scan in diagnosing parapharyngeal space [PPS] tumors and treatment options. A descriptive study. From July 2000 to July 2002 at Pakistan Institute of Medical Sciences, Islamabad. Patients diagnosed as having PPS tumors were studied. The medical record of patients was reviewed for their age, gender, clinical features, investigations [FNAC and CT scan] and treatment. The mean age, percentage of different clinical features and the sensitivity and specificity of FNAC was determined. The mean age of patients presenting with PPS tumours was 33.6 years. The most common clinical features were neck mass [93%] and bulge in lateral pharyngeal wall [80%]. The CT scan showed exact location and extent of tumour in 11 out of 15 cases. The sensitivity and specificity of FNAC was 70% and 85% respectively. The most common tumours were neurogenic tumours [6] and salivary gland tumours [4]. Surgery was performed in all except 2 patients with lymphoma in whom radiation and chemotherapy was recommended. This study indicates that PPS tumours are usually benign neurogenous and salivary gland tumours presenting with neck mass and bulge in oropharynx. FNAC and CT scan are important in diagnostic work up and treatment planning. Surgery has the best results in most cases

Paediatric tympanoplasty: anatomical and functional results

To analyse outcome of tympanoplasty in children is with regard to graft success rate and hearing improvement. Interventional and descriptive. ENT department of Fauji Foundation Hospital, Rawalpindi, from March 2003 to November 2005. Thirty three children between the ages of 8 to 14 years undergoing 37 tympanoplasties. All of them had dry central tympanic membrane perforations of various sizes secondary to chronic tubotympanic suppurative otitis media. Post auricular approach and underlay technique of tympanoplasty was used to repair the tympanic membrane perforation in all cases. They were then followed up at monthly interval for up to at least 6 months.During that period, they were observed for the development of complications like graft failure, lateralization of graft and atelactasis. At the end of 6 months of follow up, pure tone audiogram with air and bone conduction thresholds was repeated to evaluate the change in air bone gap i.e., the difference between the average pre- and postoperative air bone gap at 0.5, 1 and 2 kHtz. Results were statistically analyzed with paired sample t test using statistical soft ware package SPSS 10.0.Thirty four out of 37 operated ears had full graft take at 6 months of follow up resulting in graft success rate of 91.9%.Average air bone gap closure was 13.5 dB [range 5 to 33.3 dB]. The change in pre and post-operative air bone gap was found to be statistically significant [p< 0.05]. Tympanoplasty proved to be a useful intervention in children age 8 to 14 years. The procedure gave good anatomical and functional results

Complications of total laryngectomy

To find out various complications after total laryngectomy, with reference to their presentation, diagnosis, and management. It was a prospective descriptive study. Otolaryngology, Head and Neck Surgery department, Pakistan Institute of Medical Sciences Islamabad, from 1st July 1999 to 31st June 2001. 25 patients undergoing total laryngectomy for proven carcinoma larynx [Ca larynx] were included in this study. Patients were reviewed after surgery and any complication that occurred was recorded. The presentation, diagnosis, and management of these complications are discussed, along with voice rehabilitation after total laryngectomy. There were 23 males and 2 females. Age of patients ranged from 40 - 65 years. Complications included wound infection [06], pharyngocutaneous fistula [03], pharyngeal stenosis [03], and nodal metastasis [02]. Wound infection and pharyngocutaneous fistula are most common complications after total laryngectomy. Preoperative radiotherapy and low postoperative haemoglobin level are important risk factors for development of pharyngocutaneous fistula in total laryngectomy patients. Postoperative radiotherapy to the neck reduces the risk of nodal metastasis after total laryngectomy

Clinical study on the use of nozovent in a tertiary care setting

To assess the effectiveness of the Nozovent device in Pakistani subjects at Aga Khan University Hospital, Karachi and Sir Ganga Ram Hospital, Lahore from 15 January 2001 to 15 January 2002. Sixty males and 40 females were selected by non probability purposive sampling, from OPD of ENT Department, complaining of nasal obstruction due to various reasons, e.g. vasomotor rhinitis, allergic rhinitis, congestion during pregnancy and menstruation, common cold, traumatic nose and nasal valve problem. All patients benefited subjectively but the degree of relief varied in individuals. The Nozovent provides a unique method to relieve nasal obstruction with no side effects

Topical antibodies for prophylaxis against umbilical wound infection in laparoscopic cholecystectomy

In order to assess the role of topical antibiotics in the prevention of umbilical wound infection in laparoscopic cholecystectomy, 61 patients undergoing laparoscopic cholecystectomy from December 1996 to January 1998 were studied. The patients were randomized in two groups. The umbilical wound of 31 patients in group A were irrigated with 200 ml of isotonic saline whereas the wounds of 30 patients in group B were irrigated with 1200 mg of lincomycin dissolved in 200 ml of isotonic saline. Significant difference in the rate of wound infection was found in both the groups [3/31 vs 0/30, p<0.05]. The difference in hospital stay was not found to be statistically significant [2.3 vs 1.9]