Schwannoma of nasal inferior turbinate in young male: a rare occurrence

A 12-year old boy presented to the ENT Department of Abbasi Shaheed Hospital, Karachi, with a one year history of progressively increasing unilateral right sided nasal obstruction. He denied any other symptoms like that of rhinorrhea, epistaxis, facial pain, headache and any history of nasal trauma. After routine clinical examination, CT scan nose/PNS with contrast was advised and subsequently biopsy was done that revealed the mass to be as schwannoma. This was then removed via a lateral rhinotomy approach and the postoperative specimen again revealed the same. The boy was followed for 1-year and no recurrence is seen. He is still in the follow-up phase

Fibrous dysplasia of mandible

An elderly male presented to the ENT, Outpatient Department at Abbasi Shaheed Hospital [ASH] with a mass on the left side of the face and lower jaw for 8-9 years. It was of a tennis ball size. No treatment was sought by him during those years. A diagnosis of benign fibro-osseous lesion of the mandible was made. Later the histopathology proved the same. The first occurrence in a male gender and involvement of the mandible is uncommon

Post tonsillectomy quality of life in adults

Objective: to determine the health related quality of life benefits derived from tonsillectomy in adult patients of chronic or recurrent tonsillitis

Patients and methods: a cross sectional study of 85 adult patients carried out in ENT department of Abbasi Shaheed Hospital, Karachi from January 2010 to February 2011 with the written and informed consent of patients. All were of age 18 years or greater and of either sex with the diagnosis of chronic tonsillitis or recurrent tonsillitis. There complete correspondence addresses with phone numbers were noted and they all were called back again after a lapse of 6-months post-operation to fill in the questionnaire, Glasgow Benefit Inventory [GBI]. Analysis of data was done by SPSS version 11.0

Result: good scores were noted on the Glasgow Benefit Inventory. Total score was +45.29 [p-value <0.0001]. The subscale scoring was general subscale score +44.10 [p-value <0.0001]; social subscale score, no change i.e. 0 and physical health subscale score +79.62 [p-value <0.0001]

Conclusion: the result thus proves that post-tonsillectomy the HRQOL is improved and the procedure of tonsillectomy is beneficial in terms of improved quality of life

Fine needle aspiration cytology: sensitivity and specificity in thyroid lesions

Thyroid enlargement is one of the common problems in patients presenting at outpatients department of ENT particularly in females. Thyroid nodules are common, thyroid cancer is uncommon and the most common way for it to present is as a solitary thyroid nodule. This study was conducted to evaluate the sensitivity and specificity of Fine Needle Aspiration Cytology [FNAC] in thyroid diseases. This prospective analytic study was conducted at ENT Department of Karachi Medical and Dental College/Abbasi Shaheed Hospital during year 2004-8. One hundred and five cases were enrolled who underwent thyroid surgery after complete evaluation by history, clinical examination, Thyroid profile, Thyroid Scintigraphy, Ultrasound neck and FNAC. In cases which were revealed malignant by FNAC, CT scan were done to see the extent of disease and neck node status. Surgery was done in all cases and specimens sent for histopathology. Male to female ratio of the patients was 1:8.5. Most common lesion was benign nodule [96]. Malignant lesions were 9 in FNAC. In histopathology, the benign nodules were 92, and malignant cases were 13. Sensitivity of FNAC was 61.53% and specificity was 98.9%. FNAC in Thyroid has high sensitivity and specificity

Postembolization infarction in juvenile nasopharyngeal angiofibroma

We report the occurrence of cerebro-vascular accident, following selective embolization of internal maxillary artery [IMA] in a young male patient aged 18 years admitted at ENT Department, Abbasi Shaheed Hospital [ASH] with diagnosis of recurrent juvenile nasophayrngeal angiofibroma [JNA]. Angiography and selective trans-femoral embolization was done as an adjunctive measure before the definite surgical removal of this benign tumourous condition. The child developed weakness of the right half of body with slurred speech and drowsiness. CT scan of brain revealed the diagnosis of postembolization infarction. The patient recovered with no obvious signs of clinical residual weakness. Surgical excision after ligation of feeding vessel has been planned

unusual foreign body in trachea

We report a very unusual case of foreign body [FB] in the tracheo-bronchial tract of a male child, who presented to us in the emergency department at our tertiary care centre with the complaint of FB in throat, cough bouts and choking sensation with pain and difficulty in breathing for whom an emergency rigid endoscopy was carried out after appropriate investigations

Brown tumor of maxilla - a rare occurrence

We report a case of a middle age male patient who presented in our outpatient department at Abbasi Shaheed Hosptial [ASH] with a swelling at [L] half of face and [L] half of hard palate that histologically proved to be a Brown tumor of Maxilla with normal parathyroid hormone [PTH] levels and an elevated serum Ca[++] levels. The site of brown tumor in our case is a rarity. Our aim for presenting this case report is to highlight the rare site of presentation and to emphasize t he multidisciplinary approach incorporating the maxillofacial surgeons, endocrinologists and radiologists for the optimum patient care and management

Role of tracheostomy [early VS late] in intubated cases of neurosurgical patients in surgical intensive care unit [SICU] setting

To study the role of early vs. late tracheostomy, in neurosurgical intubated cases admitted in surgical intensive care unit, on recovery from pneumonia during ventilation, length of intensive care unit stay and duration of ventilatory support and weaning. The Study was conducted in the Department of Anaesthesia and Surgical Intensive Care Unit with collaboration of ENT Department, Abbasi Shaheed Hospital, Karachi from Jan 2007-Dec 2008. A retrospective analysis of the case file records of the intubated neurosurgical patients admitted in surgical intensive care unit for whom elective tracheostomy was performed, for prolonged ventilation, was made from 2007-2008 of 50 cases. Early tracheostomy was consider, when it was performed within 3 - 7 days of intubation and late was after that or 8- 14 days. Data collected include the information regarding the patient's name, age, sex, etiology and Glasgow coma score [GCS] on admission, time duration of patients' stay in surgical intensive care unit, time period of weaning from mechanical support and recovery from pneumonia during ventilation, along with chest x-ray's, culture and sensitivity reports. Depending on the time of tracheostomy performed two groups were made: Group- I in which tracheostomy was performed early within 3-7 days of intubation and Group- II in which tracheostomy were performed after an interval of more than 7 days or 8-14 days [late tracheostomy]. For group I the early tracheostomy was done at the median of 4th day vs. that of 10th day for the group II. The number of cases that developed pneumonia in group- I was 45.45% versus Group- II 54.54%, [odd ratio 0.27]. Duration of mechanical ventilation was significant with early tracheostomy [mean, standard deviation] 11.95 days +/- 3.14 versus late tracheostomy 21.79 days +/- 6.06. Intensive care unit stay was shorter in group- I [mean, standard deviation] 15.09 days +/- 3.49 versus in group- II 26.71days +/- 7.00. Recovery from pneumonia was shorter in group- I [mean, standard deviation] 9.0 days +/- 1.63 versus in group- II 14.23 days +/- 1.81. Our study shows that early tracheostomy has a positive role in reducing the risk of pneumonia, because of easier access to lower airway for clearance but not statistically significant, decreased the overall time period of surgical intensive unit stay and patients were weaned off earlier from mechanical support, in comparison to those in which tracheostomy was performed late. Therefore early tracheostomy in selected patients may help in reducing unnecessary resource utilization

Role of antibiotics in the pre and post tonsillectomy period in reducing the morbidity associated with tonsillectomy

The aim of the study is to see the role of pre and post operative antibiotic used in the cases for which tonsillectomy was planned as a primary surgical procedure with or without adenoidectomy, for effects on peroperative blood loss, ease of surgery, postoperative fever and pain, incidence of secondary heamorrhage and return to activities of daily living [ADL]. Department of ENT and Head and Neck Surgery, Abbasi Shaheed hospital, Karachi, from June 2006 - December 2006. Prospective, double blind study. The cases which were selected for tonsillectomy were included in this study. Their full informed and written consent was obtained prior to their inclusion in the study. Two groups were made each consisting of 50 patients. In group I [intervention group] preoperatively antibiotic was used for a period of 3 days and continued for another 5 days postoperatively. The antibiotic used was Amoxicillin-Clavulanic acid according to the weight of the patients [50mg/kg/day]. In the group II [control group] no preoperative or postoperative antibiotic was used. Analgesia was given on the need and demand basis in both the groups. Pain for adult was categorized by using a pain rating scale by the British Pain Society and pediatric age group the modified Toddlers Preschooler Postoperative Pain Scale [mTPPPS]' was used. The questionnaires were given on daily basis to them for 5 days postoperatively, results recorded and then compared. Both of these groups were not aware of each other. The parameters monitored were amount of peroperative blood loss, ease of surgery, whether or not the patients had postoperative fever, secondary heamorrhage rate, pain status and return to activities of daily living. The method for tonsillectomy used was dissection method [cold steel dissection method with ties for hemostasis]. There was a significant reduction in the amount of peroperative blood loss and early return to daily activities in group land also there was an ease of surgery because of less friability of tissue and less infection and bleeding as compared to group II where the patients had a significant amount of bleeding peroperatively and delayed return to activities of daily living with a bit difficulty experienced in dissection. The incidence of post tonsillectomy [secondary] heamorrhage was not found to be of significance suggesting that there might be some other factors that may lead to this complication despite the fact that antibiotics was used in group I in comparison to group II. The level of pain experienced post operatively was not affected in either group suggesting that antibiotics do not help in decreasing or alleviating it, Fever occurred in 3 in group I while 6 had fever in group II. Seeing the results of this study we would recommend the use of pre and post operative antibiotics for the tonsillectomy patients

Synovial cell sarcoma: rare presentation in head and neck area

We report a case of a 17 years young male who presented to us with a huge neck swelling on the left side of the neck that has been present for about 2 years. He presented to us with the complains of mild pain and disfiguring swelling

Correlation between traffic noise induced hearing loss [NIHL] and occupation

To examine the subjects who are more prone to traffic noise exposure such as auto rickshaw drivers, traffic constables and shop keepers in central business area in Karachi [Pakistan]. This was hospital based prospective study comprising of 200 subjects. The results were obtained by testing the subjects which were investigated on the basis of interviews by [a] completing performa [b] Pure tone audiometry [PTA]. Correlation between traffic NIHL and occupation was found statistically significant with P<0.001 distributed as 15 [34.1%] in auto rickshaw drivers, 34 [40%] in shopkeepers and 29 [34.1%] in traffic constables. The fact that road traffic is the most significant source of noise pollution in Karachi was established by investigating our subjects. They had significant degree of hearing impairment i.e. 42%

Fractured tracheostomy tube in the tracheo-bronchial tract: a rare occurrence. Case report

We report a very rare occurrence of fracture of a metallic tracheostomy tube that lodged in the tracheo-bronchial tract of our male patient and caused him a great deal of distress, anxiety with minimal of respiratory embarrassment, if any. The tracheostomy was done earlier as the patient presented in the emergency department with stridor and was found to have a supraglottic growth! After the emergency tracheostomy, admission was offered with subsequent direct laryngoscopy and biopsy he was discharged with a metallic bivalve tracheostomy tube in place to return with the histopathology report but he never returned becoming a treatment defaulter only to present with the broken tracheostomy tube in the airway, later

Cystic hygroma: an unusual presentation in adult

We report a case of a 22 years old male patient suffering from cystic hygroma [CH] probably post-traumatic in origin. He presented with an asymptomatic, cosmetically disfiguring and a painless swelling involving the right side of the neck