Presentation, management and outcome of surgery PF thyroid swellings by ENT and head and neck surgeons at civil hospital Karachi

Objective: to assess the presentation, management and outcome of surgery of thyroid swellings

Design: retrospective study

Place and duration of study: department of Otorhinolaryngology-Head and Neck Surgery, Dow Medical College and Civil Hospital Karachi [CHK], from Jan 2004 to June 2010

Patients and methods: retrospective review of 184 consecutive cases of thyroid swellings admitted and operated, irrespective of age, sex and socioeconomic status. Physiological goiter and previously operated thyroid swellings were excluded from the study. Demographic data, clinical features, investigations, surgical management details and complications were assessed

Result: among 184 cases of thyroid swellings 62.5% were between 21 to 40 years of age, with female preponderance [79.9%]. Majority [71.7%] cases belonged to lower socioeconomic status. Right lobe was involved in 32.60%, left in 15.7% while both lobes were involved in 51.5% cases. Multinodular goiter was seen in 54.8% cases while 39.1% cases had solitary nodule. Total thyroidectomy was performed in 23.3% cases, near total thyroidectomy in 9.8%, subtotal thyroidectomy in 31% and lobectomy [with isthemectomy] in 35.9% cases. In postoperative period, hoarseness was seen in 0.5% cases; while other complications like bleeding due to slipping of ligature, wound infection and hypoparathyroidism was seen in 1.6%, 2.2% and 2.2% cases respectively

Conclusion: with female preponderance and low socioeconomic status, thyroid swellings are mostly seen between the ages of 21 to 40 years. Solitary nodule and multinodular goiter are common findings. Surgical management performed by ENT - Head and Neck surgeon's ranges from total thyroidectomy to lobectomy, gives good results and few complications

presentation of carcinoma of larynx at civil hospital Karachi

To determine the frequency of different presenting clinical features and the most common stage of presentation in patients of laryngeal carcinoma. Descriptive study. This study was conducted at ENT department, Dow University of Health Sciences and Civil Hospital Karachi, from April 2006 to March 2007. All the patients of biopsy proven laryngeal carcinoma of any age and sex were included in the study. Demographic data, presenting complain like change in voice, difficulty in breathing, difficulty in swallowing, pain, smoked and unsmoked tobacco use, clinical examination findings, DL findings, neck examination with respect to levels of lymph nodes involvement, presence or absence of metastasis recorded in performed proforma. Histopathological reports and findings of imaging studies like X-ray chest, CT scan, and ultrasound abdomen [if needed], stage of carcinoma larynx were also recorded on proforma. In this study out of 34 cases, 32 [94.1%] were males and only 2 [5.88%] were females. Mean age was 55.23 years [SD +/- 12.09]. Most common symptom was hoarseness in 32 [94.1%] cases, 27 [79.4%] presented at advanced stage [stage III and IV] while commonest site was glottic region 50%. This study concluded that the most common stage of laryngeal carcinoma patients in our setup was late stage and commonest presenting symptom was hoarseness while commonest site was glottic region

Juvenile nasopharyngeal angiofibroma: stage and surgical approach

Objective: to study various surgical approaches and the outcome of surgery in juvenile nasopharyngeal angiofibromas [JNA]

Design: a descriptive study

Setting: department of Otorhinolaryngology - Head and Neck Surgery, Civil Hospital Karachi

Method: this study included 40 consecutive cases of nasopharyngeal angiofibroma over a period of 4 years. Patients were regularly followed up for any recurrence up to 3 years

Results: majority of our patients had stage III [72.5%] disease [Chandlers staging] i.e. extension in pterygopalatine fossa, maxillary antrum, nose and sphenoid sinuses; and infratemporal fossa in 72.5% patients, tumor was removed through lateral rhinotomy approach while Weber Fergusson in 17.5% , mid facial degloving in 7.5% and only in 2.5% patient transpalatal approach was used. Tumour recurrence were seen only in 5% of cases

Conclusions: angiofibromas usually present at the late stage. Surgery is the treatment of choice. Most of the tumours are excisable by a lateral rhinotomy approach, with minimal chance of recurrence

clinic pathological study of laryngeal malignancies - an institutional experience

Objective: to determine the risk factors and clinic-pathological pattern of the laryngeal malignancies

Design: descriptive case-series

Setting: department of Otorhinolaryngology - Head and Neck Surgery, Dow Medical College, Civil Hospital Karachi and Dow University of Health Sciences from, March 1998 to March 2009

Methods: all patients of either gender having malignant lesion of larynx were included. Recurrent cases after surgery or chemo radiotherapy and benign Tumours of the larynx were excluded from the study. Patients were studied with particular importance to the risk factors, mode of presentation, topography and histopathology of the tumour

Results: out of 100 patients, 89 were males and 11 were females with male to female ratio of 8.1:1. Majority of the subjects was in 5th decade of their life. Tobacco intake in the form of smoking or chewing was present in 91% . Presenting symptoms were hoarseness, odynophagia, sore throat, dysphagia and dyspnea/stridor. Tran's glottic area was the commonest site [39%] for laryngeal cancer. Squamous cell carcinoma [SCC] found in 98% of patients. Well differentiated category seen in 57% of patients

Conclusions: SCC was the most frequent malignant lesion of larynx. Most of the patients presented in the late stages [stage III and IV]. Commonest presenting symptom was hoarseness. Smoked tobacco [cigarette smoking] was found to be the major risk factor

Frequency of un-safe chronic suppurative otitis media in patients with discharging ear

Objective: To determine the frequency of un-safe chronic suppurative otitis media and its complications in patients with chronic discharging ear

Methods: This study was carried out in the Department of Otorhinolaryngology, Civil Hospital Karachi, Sindh - Pakistan between January 2004 and June 2006. This study included 390 cases of chronic discharging ears attending out patient department. All were examined according to protocol, and relevant investigations were carried out. 107 cases underwent mastoid exploration and were observed for cholesteatoma, granulations, aural polyps and their complications. A structured questionnaire was designed to record all information which was later analyzed

Results: Majority of patients was belonging to poor families. Female-male ratio was 1.2:1. Age range was between 6 months and 70 years. Most of the patients presented with discharging ears. Central perforation was seen in 89% cases. One hundred seven cases [27.5%] underwent mastoid exploration, in which cholesteatoma was found in 11.5% cases. Ossicular damage was the commonest complication in all cases having cholesteatoma, while 1% cases presented with mastoid abscess, 1.5% with exposed facial nerve, 1.2% with exposed sigmoid sinus and 0.25% with Bezold abscess. Intracranial complications were seen in nine patients

Conclusion: Cholesteatoma was found to be associated with most of the complications in cases of un-safe type of C.S.O.M. The complication rate in this study is lesser than that observed in our neighboring countries like Bangladesh, but still higher as compared to the developed countries. Cholesteatoma was also found in two cases having central perforation which is unusual presentation