Laryndeal Cancer Surgery Techniques, Management and Complications

Management of laryngeal cancer experienced a vital change during the last few decades. Indeed laryngeal cancer is a significant malignancy as it also has high cure rate. Surgery is an effective economical mode of treatment in our country, where facilities of time duration of study other modalities such as radiotherapy and chemotherapy are not uniformly available. This study evaluates the different surgical techniques, management and post operative complications of 50 cases of laryngeal carcinoma. Total laryngectomy was the commonest operation i.e. in 31 cases [62 percent]. The commonest complication was found to be pharyngocutaneous fistula [18 percent]. 72 percent patients were living disease free, 20 percent patients were living with disease and 8 percent patients expired in follow up period, of 3 years. It was concluded that radical surgery is still the most suitable modality of treatment in our environment where we deal advanced pathology

Glue ear at the highlands of Himalayas

Otitis media with effusion [OME] is common clinical entity in children. Adult onset glue ear is not uncommon in our country. This study was carried out while providing primary ear care and conducting epidemiological survey in the northern territories of Baltistan in the Himalayan range of mountain terrain. Total of 503 subjects, having the strong clinical evidence of glue ear were included in the study during 07 ENT camps in 1998. 295 [58.64%] were males and 208 [41.35%] were females between the age range of 05 to 85 years. 364 [72.36%] cases were bilateral and 139 [27.63%] were unilateral. Tympanometry was performed in 353 selected subjects. Type B tympanograms were found in 296 [83.85%]. Type C in 41[11.61%] and in 16 [4.53%] subjects, normal type A tympanograms were obtained. Increased number of glue ear were encountered with increasing height from sea level

Acquisition and recall of cognitive knowledge: effect of active learning

This is a prospective study carried out on a cohort of 110 pre-clinical students randomly selected from Dow medical college. The objective of the study was to observe the impact of both the active learning [Method I] and conventional teaching [Method II] techniques on acquisition, retention and recall of cognitive knowledge in our students. The study population was taught similar subject by two different techniques. Base line knowledge was determined using a set of MCQs as Pre-test. Immediate knowledge gain was assessed at the completion of lecture using the same set of MCQs [Post test]. Retention of knowledge was determined through a term test scheduled after three months. The rise in mean scores was significantly greater in post test taken by the study group in method I [65.4%] as compared to that in method II [48.8%] [p<0.001] showing early concept clearance. Similarly the mean scores in term test were higher in students exposed to method I [65.9%] than those in method II [56.6%] [p<0.001]. Among students taught by method II, the term test scores [56.6%] were significantly better in comparison to the post test scores [48.8%] [p<0.05]. Greater proportion of high scorers [scoring > 75% marks] were seen in the group taught by method I[38%] in contrast to those taught by method II [14.5%] [p<0.001]. This pilot study for DMC campus therefore concluded that the interactive mode of teaching leads to improved acquisition retention and recall of knowledge

Neonatal Hearing Screening

Hearing screening was first done over 100 years ago using a whispered voice test. Sweep testing with pure tone audiometer was other method employed in the fifties. Search for neonatal hearing screening methodologies was prompted by the fact that early intervention in cases of hearing impairment will reduce later disability. The concept of targeted screening of "at risk" babies became popular as it was more cost-efficient. The proponent of universal neonatal screening argue that the high risk register misses 50% of loss. Ironically 90% of the infants with hearing impairment are born to parent with normal hearing and his fact goes in favours of universal screening. Screening should be done by trained personnel. Hearing loss is expressed in the early years and therefore the optimal age for screening is first 3 years. School age screening may be used to detect progressive hearing impairment only. Automatic BSER, traditional BSER and Oto-acoustic emission have emerged as reliable screening methods. Screening tests for hearing should have a sensitively and specificity of 90%. Follow-up is vital to pick-up progressive hearing loss. Availability of ancillary facilities like audiological services speech language pathologist, ENT specialist, paediatrician and teachers for the deaf are equally important Benefits of screening include prevention, maintenance of adequate audition and habilitation

Current status and future trends of deafness and hearing impairment in the tropics

Hearing is the sense upon which human communication depends and deafness and hearing impairment are preventable disabilities. These scourges are on the rise in the tropical countries. Until 1985, even the W.H.O. did not take notice of these handicaps. Following the resolution passed by the 38th world health assembly in 1985, and then by the 48th assembly in 1995, combined with the remarkable endeavour of the E.N.T. fraternity, a permanent office was established in Geneva. This office instantly began a war against the hearing handicap under the title of 'PDH'. The Manchester symposium of 1995 must be called a watershed in this field, bringing many otologists and audiologists on one platform. However much needs to be done. The global estimates inform us that 2.2% of the world hearing handicapped. In the developing world the mangnitude of the problem is much more than the developed world. According to the world bank 70% of the burden of sickness is produced by communicable infections in Sub-Saharan Africa. The figures may match in the Indian subcontinent, where typhoid, meningitis and tuberculosis are significant contributors to human misery. In Latin America these communicable infections affect about 40% of the population. In sharp contrast to these figures only 15% are affected in the developed world. Even that figure is much too high, as the world's economic resources continue to shrink. The prevalence of hearing impairment varies between the countries in the developing world. For instance it is 10% in India, 9.3% in Myanamar, 6.5% in Nepal, 6% in Thailand and roughly 11% in Pakistan. In Africa the prevalence varies between 7% -10%. No data is totally reliable, as the standardization of methodology, and sensitivity as well as specificity of the data remain to be validated by the global community. While it is the young population that seems to bear the brunt of the problem in the developing world, it is the ageing population that is mostly affected in the west, even the causes are significantly variable. For instance, Muslims of the Arabo-African region and many Asian countries are allowed, indeed encouraged to customarily marry within the tribes, preferably cousins. The Hindus are not allowed to do so thus, consanguinity is an important cause of congenital deafness in the Muslim population stretching from the Mediterranean Libya through most of Africa, the entire Middle East, Indo-Pakistan subcontinent, the Asia-Pacific countries like Indonesia, Malaysia, Bangladesh, a part of the Philippines and the distant rich Sultanate of Brunei. The genes are autosomal recessive and not dominant as was proved in a study conducted in Pakistan while maternal rubella is a prominent cause in the west, it may not be so in the Indo-Pak subcontinent. Ototoxicity, on the other hand, is a universal problem, but its causes vary from country to country. For instance aminoglycosides and loop diuretics are the major causes in the Asian region, while 'Cassawa' seems to be the major culprit in Africa. The common causes established uniformally in the developing world are:1. communicable infections, 2. Otitis Media 3. Ototoxicity 4. Consanguinity 5. Malnutrition, and 6. Noise what is needed is [A] Population based surveys to establish the true nature of the problem [B] Awareness of the health personnel, NGOs and the community, [C] Early Intervention [D] Primary Ear Care [D] Prevention from complications [E] Rehabilitation and Rechannelization into the normal human pool. But all these objectives are not easy to attain. Population explosion, illiteracy, poverty, economic constraints and worst of all lock motivation are some of the crippling obstacles. This presentation looks at the epidemiology in some of the countries in the developing world, highlights the salient causes of hearing handicap and evaluates the strategies desired to combat the menace of deafness and hearing impairment in the tropics

Noise induced hearing loss [nihl] in Pakistan

Noise induced Hearing loss [NIHL] is a universal phenomenon currently it is receiving long overdue attention at the global level. It is now considered to be one of the main causes of hearing impairment, in both the developed and the developing world. Initially recognized as a 'Boiler makers deafness 'at the turn of the century as it mainly afflicted the industrial workers, the conditions has now grown to cover a much wider canvass in today's world. Social and leisure noise are the other significant causes, besides the industrial and road traffic noise. In Pakistan, the workmen's compensation Act of 1923 includes only a 100% loss of hearing due to noise injury worthy of compensation. Any loss less than total deafness is not even considered. There is an urgent need to bring about public awareness, improve legislation and join the global community in the campaign against noise induced hearing loss

Socio-cultural factors in the aetiology of otitis media-an anthropological study in Pakistan

Innumerable factors have been proclaimed to be associated with the pathogenesis of otitis media in the literature. The controversies shrouding the theories are a true reflection of the state of conflict in the mind. No truly satisfying hypothesis has so far come forward to satisfy the academician as well as the clinician. Hence, in order to comprehend the matters of clinico-pathological process involved, it is essential that one should try and look at the problem tangentially. Obviously it would mean looking at the problem beyond the established norms of clinical medicine, and delve into the paramedical fields of biomedicine and anthropology. This work is based upon the study carried out on the physical and cultural aspects of anthropology in Pakistani natives-to learn the intricacies of an extremely common problem called otitis media

Elective tracheostomy, an essential prerequisite for radical head and neck surgery

Elective tracheotomy in all major Head and Neck Surgeries has been a routine practice in this department since 1988. This is a report of 131 tracheotomies performed during the last 18 months. The rate of associated complications has been 15.23% which is statistically insignificant [P< 0.05]. Because it minimizes the chances of postoperative fatality due to respiratory obstruction, and the fact that elective Tracheotomy is associated with a very low incidence complications caused per se, its benefits far outweigh its demerits. Therefore, in our opinion, it should be performed whenever postoperative upper respiratory obstruction is anticipated

Unilateral proptosis in ENT practice

Seventeen cases of unilateral proptosis aged 11 -54 years are presented. The proptosis was due to mucormycosis in 7, ethmoid polyposis in 4, malignancy in 4, and one each due to Ringert's tumour and fibrous dysplasia. Surgery was performed in all cases with the aim of total extirpation of disease and orbital repositioning. The surgical approaches included transverse maxillary osteotomy, transantral ethmoidectomy, modified lateral rhinotomy, and orbital decompression. There was one fatality, and two recurrences. Three cases showed satisfactory and eleven excellent results

Repeated U.R.T.I. and mastoid pneumatization

Anthropological study of mastoid process in Pakistan Caucasian population has shown that the average mastoid process is at least 19% smaller in size and volume than an European average Caucasian mastoid. This is mainly due to genetically determined, hereditary factors. Besides, the overall diminuitive size of Pakistan mastoid is also the result of frequent and often repeated U.R.T.I., which contribute towards the development of sclerotic or poorly pneumatized mastoids, thus explaining the low lying dura, a forward placed lateral sinus and a narrow mastoid cavity. Access into the Facial recess or sinus Tympani may be quite difficult if not impossible, in surgical treatment of discharging ear