ABSTRACT
Background: Sensorineural hearing loss may be one of the outcome of chronic suppurative otitis media
Objective: To evaluate the association of chronic suppurative otitis media with sensorineural hearing loss and also to find out whether the disease duration had any impact on hearing
Methodology: This was a cross sectional study conducted at Aga Khan University Hospital. Charts of all patients who underwent surgery for chronic suppurative otitis media from 1stJanuary 2004 to 31stDecember 2009 were reviewed. One hundred and fifty five patients out of 562 met our inclusion criteria and were included in the study. The contralateral ear was taken as control. History record and audiograms were reviewed from the patient charts for the duration of disease and evidence of SNHL at three speech frequencies [[500, 1000, and 2000 Hz]. The data was entered and analyzed by SPSS version 16
Results: Of 155 patients, 46 [29.6%] had SNHL. In a group of patients with epithelial disease[cholesteatoma] 16 out of 45 patients had SNHL whereas in the group of patients with mucosal disease [formerly known as tubotympanic type] 30 out of 110 patients had SNHL. This hearing loss found to be worsening with the duration of disease in both groups [p=0.000]
Conclusion: A significant association of SNHL was found with CSOM and disease duration. Early surgicaltreatment should be offered in order to prevent irreversible SNHL
ABSTRACT
To compare outcome of patients with advanced laryngeal hypopharyngeal squamous cell carcinoma treated surgically or with chemotherapy and/or radiotherapy. Observational study. The Aga Khan University Hospital, Karachi, from January 2000 to December 2005. Medical records of already treated stage-Ill and IV squamous cell carcinoma of larynx/hypopharynx patients were reviewed. Group-A comprised of patients treated with surgery +/- adjuvant therapy whereas non-surgically managed patients were labeled as group-B. One hundred and nineteen out of 275 met the inclusion criteria. Kaplan Meier technique was used to estimate mean recurrence time with standard errors. Cox proportional hazard regression was used to estimate the hazard ratio with 95 percent confidence interval for gender, age and tumour location. Sixty two percent of group-A and 49% patients of group-B were stage-Ill. In group-A, 40% patients received postoperative adjuvant therapy while in group-B, 45% received concomitant chemoradiation. Mean follow-up duration was 18.3 months. Mean recurrence time was 1369 +/- 193 days. In group-A, mean recurrence time was 2097 +/- 277 days. It was 399 +/- 68 days for group-B patients [p <0.001]. The hazard ratio of recurrence in hypopharyngeal tumours was 1.5 times [95% CI 0.68, 3.30] as compared to tumours of larynx. The hazard ratio of recurrence was 1.98 times [95% CI 0.99, 3.95] when both larynx and hypopharynx were involved as compared to when tumour was localized to larynx only. No residual disease was noted at the completion of treatment in surgical group-A while 62% patients of the group-B had residual disease at the completion of treatment. Larynx was retained in only 25% patients in group-B. Statistically significant difference was noted in disease free outcome when stage-Ill and IV larynx hypopharynx cancer was managed surgically as compared to non-surgical management. Chances of retaining larynx are only 25% when managed non-surgically