Clinical markers of cholestetoma

Objective: To evaluate the significance of clinical markers, predict underlying cholestetoma in chronic suppurative otitis media

Study Design: It is cross-sectional descriptive study

Place and Duration: This study conducted at ENT Department Liaquat National Hospital Karachi from June 2003 to July 2005

Material and Methods:Patients presented with history of chronic suppurative otitis media with clinical markers, suspicious of underlying cholestetoma irrespective of age and sex were evaluated by detailed history, otolaryngology examination, ear examination under microscope, hearing loss assessment primarily by tuning fork test and pure tone audiometry. All patients were operated for mastoid exploration by cortical mastoidectomy and then subsequently converted into modified or radical mastoidectomy according to nature and extent of disease. Tissue removed sent for histopathology to confirm the diagnosis

Results: Out of 100 patients 48 were females and 52 were males. Fifty-six of patients had nonspecific chronic inflammation and 44% had cholestetoma. Highest prevalence of cholestetoma observed in aural polyps [31.81%], followed by 27.27% in chronic discharging ear with central perforation not resolving with medical treatment, and 18.18% of cholestetoma in patients with attic perforation/retraction pocket, 15.90% in Granulation tissue and the lowest percentage of cholestetoma seen in posterior-superior marginal perforation [6.81%]

Conclusion: Chronic suppurative otitis media with clinical markers, suspicious for underlying cholestetoma, not resolving with medical treatment, have significant percentage of presence of underlying Cholestetoma. It is necessary to evaluate every patient of CSOM carefully for early recognition and treatment, to avoid intra and extra cranial complication

Comparison between dissection and bipolar diathermy method tonsillectomy

To compare dissection method and diathermy method tonsillectomy in terms of intraoperative mean blood loss, time taken for surgery and frequency of post operative bleeding. It was a grass experimental study carried out at Liaquat National Hospital, Karachi from January 2004 to January 2005. Patients of ages between 5 years and 25 years were selected from the out patient department. Sampling technique was convenient sampling. Sample was of 100 patient. First 50 patients were selected for dissection method [Group A] and the last 50 patients for bipolar method tonsillectomy [Group B]. Data collection procedure was interview and observational facts. Data was analyzed by using SPSSS version 10. For mean comparison, student's test was used. Significance of the test was taken at p<0.05. The difference in result between dissection method tonsillectomy and diathermy method tonsillectomy was statistically significant [P<0.001] in terms of intraoperative blood loss and time taken for surgery. Regarding postoperative hemorrhage, the difference between diathermy and ligation was insignificant. Tonsillectomy with bipolar diathermy was a better and safer technique as compared to ligation method especially in terms of intraoperative blood loss and time taken for surgery. The frequency of postoperative bleeding was similar in both methods

Role of fine needle aspiration cytology [FNAC] in the cervical lymphadenopathy

To evaluate the accuracy and efficacy of fine needle aspiration cytology [FNAC] in the cervical lymphadenopathy. The study was conducted at the department of ENT-Head and Neck Surgery, Liaquat National Hospital Karachi, from April 2001 to December 2002. 35 patients with enlarged cervical lymph nodes were selected from out patients department. All patients were evaluated through detailed history, general physical and otolaryngology examination. Pathologist performed all FNAC procedures and postoperative specimens were also examined at histopathology department. SPSS-10 was used for data analysis. Age was presented by mean standard deviation. Frequencies and percentages were computed to present FNAC and histological findings. Histopathology is considered as gold standard criteria and performed for its sensitivity, specificity and accuracy analysis. 35 patients were enrolled in study, out of which 10 were females and 25 were males, 20 cases showed benign disease and 15 were malignant. In 20 benign cases, 18 were true negative and 2 were false negative, while out of 15 were malignant. In 20 benign cases, 18 were true negative and 2 were false negative, while out of 15 malignant cases, 14 were true positive and 1 was false positive. Over all sensitivity were 87.5%, specificity 90.0% and accuracy 91.4%. FNAC is reliable, safe and accurate test as a first line of evaluation in cervical lymphadenopathy. It plays vital role in the management of cervical lymphadenopathy; it could differentiate the infective process from neoplastic one and avoids unnecessary surgeries

Role of fine needle aspiration cytology in thyroid diseases

To evaluate the accuracy and efficacy of fine needle aspiration cytology [FNAC] in thyroid gland diseases. Cross sectional study. Department of Otolaryngology / Head and Neck Surgery Liaquat National Hospital Karachi, from April 2001 to December 2005. Eighty nine patients with enlarged thyroid gland, of both sexes were selected from out patients department. All patients had preoperative FNAC, performed by pathologist at histopathology department and postoperative specimens were also examined and histopathological diagnosis made. All FNAC reports were correlated with histopathology diagnosis. Out of 89 patients 60 were female and 29 male. In 82 patients FNAC showed benign lesion, of which 80 were true negative and 2 false negative, which on hisopathology reported malignant. Remaining 9 cases were diagnosed as malignant on histopathology of which 7 were true positive. No case of false positive was detected in our study. Over all sensitivity was 77%, specificity of 100% and accuracy 97.7%. FNAC is reliable, safe and accurate method as a first line of evaluation in thyroid gland nodules before surgery. FNAC is more specific than sensitive in detecting thyroid gland malignancy and therefore its use as a reliable diagnostic test cannot be overemphasized