Post SMR intranasal packing - do we really need it?

Sub mucous resection [SMR] for the deflected nasal septum [DNS] is the commonest nasal surgery all over the world. The unpleasant part of the whole event is postoperative nasal packing for 24 to 48 hours. Handsome numbers of patients delay the operation just to avoid the horrible experience of nasal packs by close friends or relatives. Many a times there is no bleeding at all on termination of operation but we still do nasal packing for the sake of doing it perhaps a fear of reactionary or primary bleed on the back of our mind. A variety of packing materials are being used most of which are not evidence based. This study was conducted at combined military hospital, Lahore over a period of one and half year from June 2006 to December 2007. A total of 72 patients were included in the study having moderate to marked deflection of nasal septum. All patients underwent classical SMR operation under local anesthesia. Only 04 patients were given nasal packs on termination of opearation. All patients were closely monitored for in 02 to 03 hours post operatively. All patients were seen on 2[nd], 5[th] and 15[th] day. 65 [90.27%] patients had no problem. 02 [2.7%] patients reported back with 24 in hours with septal haematoma. The operation was terminated in 01 [1.3%] patient just at the time of incision

Efficacy of epley maneuver in BPPV

Benign paroxysmal positional vertigo [BPPV] is one of the most common causes of vertigo. The diagnosis is confirmed by observing a classical response during the Dix-Halipike maneuver. The cause of BPPV is usually idiopathic. There are two popular hypotheses described regarding the pathogenesis i.e. cupulolithiasis and canalithiasis. The clinical course of BPPV is spontaneous recovery in weeks or months. Treatments for BPPV have ranged from no intervention to surgical treatment. The new treatment, "Canal it h-repositioning procedure [CRP]" which was introduced by Epley in 1992 produces a very high rate of success. This treatment has caused interest and has been modified and studied worldwide in recent years. To determine the efficacy of Epley maneuver in BPPV. We recruited 100 patients with a history of positional vertigo and unilateral positional nystagmus on physical examination [Dix-Halipike maneuver]. Patients were randomized to either the Epley [n=50] or a prochlorperazine [n=50]. Measured outcomes included resolution of vertigo and positional nystagmus at follow-up examination. RESULTS: The mean duration of follow-up was 14 days for both groups. In Epley's group resolution of symptoms was reported by 36[72%] of the patients after first visit on single maneuver treatment and by 46 [92%] patients on second visit on repeating maneuver, while 4 patients had minimal symptomatic improvement and were offer other treatment options. While in prochlorperazine group, 11 [22%] patients reported improvement in symptoms on first visit and 17[34%] on second visit and 19 [38%] had improved by 14th day. The Epley's maneuver is safe, economical and effective treatment of benign paroxysmal positional vertigo and this procedure can be performed by general internists on outpatients with this disorder