Comparison of postoperative pain and hemorrhage in children after tonsillectomy with bipolar diathermy technique versus tonsillectomy with cold steel dissection and silk ligature

Objective: To compare post operative pain and hemorrhage in children after tonsillectomy with bipolar diathermy versus tonsillectomy with cold steel dissection and silk ligation to secure hemostasis

Study Design: Randomized controlled trial

Place and Duration of Study: Combined Military Hospital [CMH] Kharian from June 2012 to June 2013

Material and Methods: A total of 126 patients were included in the study through non-probability convenience sampling and randomly divided in two groups of 63 each. In group A patients were treated by tonsillectomy with bipolar diathermy and in group B patients underwent tonsillectomy with cold steel dissection and silk ligation to secure hemostasis. Results in terms of postoperative hemorrhage and pain based on Facial Pain Scale were observed

Results: A total of 126 patients were included in the study and randomly divided in two groups of 63 each. Average age in group A was 6.60 years [SD +/- 2.46] and in group B it was 6.31 years [SD +/- 2.48]. There were 33 males [52.38%] in group A while 37 males [58.73%] in group B. Both the groups are comparable with respect to gender [p=0.473] and age [p=0.522]. In group A, there were 5 [7.93%] cases of mild pain as compared to 15 [23.80%] in group B. Similarly there were 32 [50.79%] cases of moderate pain in group A and 39 [61.90%] in group B. In group A 25 [39.68%] had severe pain as compared to 9 [14.28%] in group B. It indicates that patients who underwent tonsillectomy with bipolar diathermy had significantly high frequency of severe pain than group A [p=0.03]. In both groups there was no incidence of primary hemorrhage. In group A, 3 [4.76%] patients had secondary hemorrhage and in group B, 1 [1.58%] patient had secondary hemorrhage however this was insignificant [p = 0.310]

Conclusion: Cold steel tonsillectomy technique with silk ligation to secure hemostasis is a safe method. It has significantly less postoperative pain as compared to bipolar diathermy technique. However there is no significant difference in post operative hemorrhage between the two methods

Role of pre-operative assessment on the results of rhinoplasty in terms of patient satisfaction

The objectives of the study was to find out the importance of preoperative psychological assessment of patients in rhinoplasty and significance of excluding patients with psychiatric disorders, particularly Body dysmorphic disorder [BDD], on the overall results of surgery in terms of patient satisfaction. Randomized control trails [RCT]. This study was carried out at ENT out patients department [OPD], PNS Shifa and CMH Okara from January 2004 to Dec 2007. Patients complaining of nasal deformity with or without nasal obstruction were included in the study. A total of 85 [47 females and 38 males] patients were selected. After detailed history, examination and counseling 45 patients were selected by simple random method for psychological assessment and 40 patients not to have psychological assessment. The psychiatrist used DSM-IV TR criteria for psychological assessment and diagnosed 08 patients to be suffering from BDD and did not clear them for cosmetic surgery. Thirty seven patients being cleared for rhinoplasty [group A] and 40 patients [group B] not having psychological assessment, a total of 77 patients [42 females and 35 males] were offered cosmetic rhinoplasty. Patients were followed up for 01 year to check whether they were satisfied or not with postoperative results. The statistical data in the two groups was separately analyzed. Then by applying chi-square test the association in both the groups was calculated. Postoperatively 36/37 patients in group A were satisfied with their postoperative appearance and 32/40 patients in group B were satisfied. Chi-square test revealed the probability of <0.005, which is significant. Preoperative psychological assessment of patients has a significant role in patients undergoing cosmetic rhinoplasty as far as postoperative appearance is concerned

Glomus tumors

Glomus tumours of the temporal bone occur in the region of the jugular bulb middle ear. They are rare, highly vascular, slow growing tumours and most are benign. Tumours that originate from the jugular bulb and extend to involve the middle ear are referred to as glomus jugular tumours. Those that are found in the middle ear around the otic ganglia in the tympanic plexus are known as Glomus tympanicum. Yhese tumours occur predominantly in women in the fifth and sixth decades of life. Because of the insidious onset of symptoms, these tumours often go unnoticed and there is often a significant delay in diagnosis. Morbidity in these cases is determined by their size and position. 1. To study the age/sex incidence of patients suffering from glomus tumours of the temporal bone. 2. To see various clinical presentations with which these tumours present and their variation according to the age and sex. Our study design was non-inter-ventional descriptive. This study was performed at CMH Rawalpindi and Multan from January 2000 to June 2002. We included ten patients of glomus tumours of the temporal bone in our study. 8 out of these were females and two were males. Though most of the patients belonged to middle age group yet few were also from the younger and older groups. All the patients underwent CT scan with and without contrast, MRI of the requisite site and carotid angiography. We found that these tumours were predominantly present in females, mostly in the middle age group. Individual symptoms were studied in detail and their presence was found to be directly proportional to the increasing age of patients. It is concluded that due to the slow growth of this tumour the diagnosis is often delayed until it is extensive. Therefore clinicians should be more vigilant about this rare disease and must keep it in their differentials