Otitis media with effusion: Accuracy of tympanometry in detecting fluid in the middle ears of children at myringotomies

Objective: [1] The diagnostic accuracy of tympanometry in detecting fluid in the middle ear space in children with otitis media with effusion by comparing its findings with those of myringotomies. [2] Identify the age group most commonly affected by OME

Methods: This prospective study was conducted at the Department of ENTand Head and Neck Surgery, Postgraduate Medical Institute Hayatabad Medical complex, Peshawar from July 1, 2012 to April 30, 2015. Patients with suspicion of OME underwent tympanometry and later myringotomies. Using Jerger's classification, Type B tympanogram with normal canal volume was considered as conclusive evidence of fluid in the middle ear space. Its findings were compared with those of the respective myringotomies. From the data collected, the accuracy, sensitivity, specificity, positive predictive value and negative predictive values were calculated

Results: A total 117 ears of 63 patients were operated. The age range was 3 to 12 years. The commonest age group [58.7%] affected by OME was 6-8 years. Type B tympanogram with flat curve and normal canal volume was obtained in 71.4% of the ears. Comparison with myringotomy findings showed TP 85, TN 13, FP 5 and FN 14. The diagnostic value of tympanometry was; Sensitivity 85.85%, Specificity 72.22%, PPV 94.44%, NPV 48.14% and Accuracy of 83.76%. P value calculated using chi square test showed that there was significant difference between tympanometry and myringotomy findings in OME [p < 0.05]

Conclusions: OME is common in age group 6-8 years. Tympanogram Type B with normal canal volume is fairly sensitive in diagnosing this condition. However for occurrence of false positive results, final decision regarding management should be made on clinical findings and other supportive audiological tests

Intravenous urogram as a first line investigation in comparison with ultrasound

The objective of was to evaluate the usefulness and efficacy of intravenous urogram in patients with urinary tract pathology detected on ultrasound and X-ray KUB. The duration of the study was from September 2007 to August 2009 and a total of 250 patients were included in this cross-sectional study by non probability purposive sampling technique. Ultrasound scans and intravenous urograms were conducted by/under direct supervision of consultant radiologist. Out of 254 patients, four were unable to complete the intravenous urogram due to reaction to the contrast medium; hence a total of 250 patients were included in the final study. There were 66 male and 184 female patients. Calculi [renal, ureteric and vesical] were seen in 139 patients, pefviureteric Junction obstruction in 9, double collecting system and/or ureter in 6, neurogenic bladder in 13, horseshoe/pancake kidney in 2, ectopic kidney in 1, ureterocele in 2, cystocele in 1 and bladder mass in 7 patients. In 14 patients, the tests conducted were inconclusive and further investigations were advised. 28 patients had no detectable urinary tract pathology on any of the diagnostic modality. Intravenous urogram should not be performed routinely as a first line investigation in every patient presenting with flank pain. However, in congenital anomalies, intravenous urograms are needed and should be performed after a preliminary ultrasound

Effectiveness of trabeculectomy in primary open angle glaucoma

To analyze the change of intraocular pressure [IOP] brought about by trabeculectomy and to analyze any further changes in intraocular pressure after trabeculectomy during three months follow-up. Material and Patients who presented to eye department of Khyber Teaching Hospital Peshawar and were diagnosed as primary open angle glaucoma [POAG] and selected for trabeculectomy were included in the study, from 1998 to 2001. History, examination and relevant investigations were performed. All cases of trabeculectomy were analyzed and the follow up period was three months. The total number of patients included for trabeculectomy was 44 and the total trabeculectomies performed were 50 as in six cases, bilateral operations were done. Out of 44 patients, 34 [77.2%] were male and 10 [22.8%] were female. The age of the patients ranged from 43 to 80 years. The pre-operative infra ocular pressure ranged from 12 to 60 mm of mercury. The lower ranged intra ocular pressure was those cases of primary open angle glaucoma that were on maximum medical treatment. The post-operative intra ocular pressure was recorded on 1st and 15th post-operative days, one month after surgery and three months after trabeculectomy. The mean intra ocular pressure on 1st and 15th post-operative days, one month and 3 months after surgery was 10.2, 9.8, 12.55 and 10.7 mm of mercury respectively. Overall 92% cases were declared as complete success. Trabeculctomy is a safe and effective procedure for primary open angle glaucoma

Excision of juvenile nasopharyngeal angiofibroma through transpalatal approach

A retrospective study of 25 patients undergoing excision of nasopharyngeal angiofibroma was carried out from Jan. 1996 to April 1999. All patients were male with an age range between 13-22 years. Transpalatal route was used in all patients. In two patients with extension to infratemporal fossa and cheek, sublabial approach was combined with transpalatal route. All patients were evaluated post operatively for shortening of palate and hypernasality. The clinical presentation, radiological findings and post operative complications of transpalatal route are analysed