Nasal packing with ventilated nasal packs; a comparison with traditional vaseline nasal pack

Objective: To compare the benefits of ventilated nasal packing with traditional vaseline guaze nasal packing

Study Design: Randomized controlled trial

Place and Duration of Study: This study was conducted at CMH Multan, from Jun 2014 to Dec 2014

Material and Methods: In this study, sample size of 80 patients was calculated using WHO calculator. Patients were divided in two groups using lottery method endotracheal tube and piece of surgical glove filled with ribbon guaze was utilized for fabricated ventilated nasal pack and compared with traditional nasal packs. Nasal obstruction and sleep disturbance were studied at eight hours and twenty-four hours following surgery using visual analog scale

Results: Mean nasal obstruction with ventilated nasal pack was 45.62 +/- 6.17 and with Vaseline nasal pack was 77.67 +/- 4.85 which was statistically significant [p=0.001] in both the groups. Mean sleep disturbance in both the groups was 46.32 +/- 5.23 and 68.75 +/- 2.70 respectively which was statistically significant [p=0.001] in both the groups

Conclusion: Patients with ventilated nasal packs were found to have better tolerance to nasal packs due to less nasal obstruction and sleep disturbance

Tonsillar surface micro flora: does it truly represent pathological tonsillar flora?

Objective: To determine the best method of identifying core tonsillar flora

Study Design: Quasi-experimental study

Place and Duration of Study: ENT Department, Combined Military Hospital, Lahore, from September 2013 to October 2015

Methodology: Eighty-seven patients of recurrent tonsillitis undergoing tonsillectomy were included. All the patients, after being anaesthetised, had surface swabs taken from the tonsillar surface followed by tonsillar aspiration with a 5cc syringe. Following tonsillectomy, the tonsils were sent for culture of core flora. All three specimens from each patient were cultured according to established criteria

Results: The patient population had 33 [37%] female and 54 [62%] male patients. Flora of 12 [13.8%] surface swabs and 68 [78.2%] tonsillar aspirates matched the flora cultured from core of the tonsils. Chi-square test showed this difference to be significant [p-value <0.001]

Conclusion: Tonsillar aspiration gave a much more realistic picture of the tonsillar core flora as compared to surface swabs

Correction of caudal septal deviations via closed rhinoplasty approach

Objective: To introduce the combined technique of nasal spine stitching and partial tongue-in-groove for the management of caudal septal deviation and to evaluate the surgical outcome and its efficacy

Study Design: Quasi-experimental study

Place and Duration of Study: Ear, nose and throat [ENT] Department Combined Military Hospital [CMH] Lahore from September 2013 to February 2015

Material and Methods: Ninety three patients with caudal deviation were included in the study. Caudal septal deviation was corrected employing both Modified Kriedel's and Pastorek's technique via endonasal approach. Nasal patency was determined using the alpha-version of "Nasal Obstruction Symptom Evaluation" [NOSE] Scale

Results: NOSE Scale scores were checked pre operatively and three weeks post surgery. Post operatively 88 [94.6%] patients had satisfactory nasal patency [NOSE Scale score fell by 15 points]. Five [5.4%] patients who did not have satisfactory score had revision surgery

Conclusion: Combination of Pastoreks's and Kriedel's technique gives accurate correction of caudal dislocation

Atorvastatin in the management of tinnitus with hyperlipidemias

To determine the role of atorvastatin in management of tinnitus in patients with hyperlipidemia. Quasi-experimental study. ENT Department, Combined Military Hospital, Rawalpindi, from July 2011 to August 2012. Ninety eight patients of tinnitus with sensorineural hearing loss having hyperlipidemia were included in the study. Their pre-therapy serum cholesterols were measured, and tinnitus scores were recorded on a 'Tinnitus handicap questionnaire'. They were administered tablet atorvastatin 40 mg once daily with low fat diet for 8 months. After 8 months of therapy, patients were purposefully divided into responsive and unresponsive group depending on serum cholesterol levels. Post therapy serum cholesterol levels and tinnitus scores were also recorded after 8 months and compared with pre-therapy records. Serum cholesterol came to within normal limits in 51 [52%] patients [responsive group], while it remained high in 47 [48%] patients [unresponsive group]. Improvement in tinnitus score in the responsive group was seen in 36 [70.5%] patients and in 2 [4.2%] patients of the unresponsive group. Improvement in tinnitus scores was compared in the two groups using Fisher's exact test and were found to be statistically better in the responsive group [p < 0.001]. Tinnitus, in patients having hyperlipidemia, can be successfully dealt with by treating hyperlipidemia with lipid lowering agent atorvastatin

Comparison of Improvised Ventilating Nasal Packs with Vaseline Gauze Packs in Nasal Surgery

To study the outcome of using Improvised ventilating nasal packs compared with Vaseline gauze packs in nasal surgery. A comparative study. Department of ENT, Combined Military Hospital Rawalpindi, from July 2011 to December 2012. One hundred and twenty patients undergoing nasal surgery were divided into two groups of sixty each. After surgery, Group A was packed with Improvised Ventilating nasal packs and Group B with Vaseline gauze nasal packs. Effects of nasal packs in both the groups were studied and compared in terms of control of bleeding, comfort level while in place, and discomfort level while packs were being removed. Patient comfort level was significantly better in Group A as compared to Group B, while there was no significant difference in post operative bleeding control among the two groups. Discomfort level while packs were being removed, was also similar among the two groups. Ventilating nasal packs provide a better alternative to conventional nasal packs in terms of patient comfort after nasal surgery, while they are as good in providing bleeding control

Bipolar versus unipolar diathermy for per-operative haemorrhage control during tonsillectomy

To compare per operative haemorrhage control, and post operative pain during tonsillectomy using bipolar and monopolar diathermy. This retrospective study was conducted at Department of ENT CMH Rawalpindi. Data were collected from hospital admission and discharge register from March 2011 to June 2012. One hundred and twelve patients undergoing tonsillectomy were divided into two groups of fifty six each. All patients underwent tonsillectomy with bipolar diathermy being used in Group A and monopolar diathermy in Group B for haemorrhage control. No statistical difference was found among two groups regarding per operative haemorrhage control. While post operative pain control was significantly better in Group A. Bipolar as well as unipolar diathermy effectively control haemorrhage in tonsillectomy and bipolar diathermy is more effective controlling post operative pain

Oral cavity tumours, a clinical experience in a tertiary care center

To determine the age range, gender distribution, histological types, sites, neck node involvement, and surgery as modality of treatment in diagnosed cases of oral cavity tumours in a tertiary care centre. Descriptive Study. The study was carried out in ENT Department, CMH Rawalpindi for the duration from Dec 2008- Dec 2011. Data of 113 biopsy proven cases of oral cavity tumors who underwent surgery at CMH Rawalpindi, were retrieved from Armed Forces Institute of Pathology's Tumour Registry and from Head and Neck Oncology Forum Registry, and were evaluated. Out of 113 patients with oral cavity tumours, 87 [77%] were male, while 26 [23%] were female, the male: female ratio being 3:1. The mean age of the patients was 59.4 years, ranging from 40 to 75 years. Site distribution of the tumours was: Tongue: 61[54%], buccal mucosa 24 [21%], floor of mouth 18 [16%], and hard palate 10 [9%]. The histology of tumours showed Squamous cell carcinoma in 102 [90%] and tumours of Salivary gland origin in 11 [10%]. Sixty four [56%] of these patients had N0 disease, 10 [9%] had N1 disease, 8 [7%] had N[2s] disease, 27 [25%] had N[2b] disease, 3 [2%] had N[2c] disease, while 1 patient [1%] had N[3] disease. Resection of the tumour along with Supra-omohyoid neck dissection was carried out in 64 [56%] patients, while resection with radical neck dissection was done in 49 [44%] patients. Primary closure was carried out in 62 [55%] patients, while secondary reconstruction was done in 51 [45%] patients. Presentation of oral cavity tumours occur at an advanced age with male preponderance in our population. Early presentation results in lesser local spread, leading to less aggressive surgical approach with selective neck dissection

Needle aspiration an equal to incision and drainage in management of peritonsillar abscess

To compare needle aspiration with incision and drainage in treatment of Peritonsillar abscess. Randomized Control Trails. Department of ENT CMH Peshawar from 28th October 2009 to 1st November 2010. Fifty patients of either gender presenting with peritonsillar abscess for the first time were randomly divided allocated into two groups A and B. Group A underwent aspiration of pus on day 0 followed by reaspiration on day 1 and 2 if required. Group B underwent incision and drainage and evacuation of pus on day 0 followed by repeat drainage on day 1 if required. In about 72% of cases single needle aspiration was curative while 24% required two and 4% required three aspirations in group A. While in group B 80% of patients were cured with single sitting of incision and drainage and 20% required second sitting of drainage. This difference was statically insignificant [p=0.550]. Needle aspiration is as an effective method as incision and drainage for management of peritonsillar abscess

Noise induced hearing loss among artillery soldiers

To determine whether there is a significant difference in hearing threshold of artillery soldiers and non artillery soldiers. A cross sectional comparative study. This study was done at Khyber Rifles Hospital Landikotal over four months time from 10th September 2009 to 31st December 2009. Study group comprised sixty males thirty of whom were engaged in firing of artillery guns and thirty with sedentary jobs. Pure tone Audiometry [PTA] was done for all sixty individuals. Average hearing loss in speech frequencies was statistically more in individuals who were actively involved in firing of artillery guns. [P<0.001] Adequate protection and training should be imparted to individuals involved in firing of artillery guns

Transpalatal approach- a cosmetically acceptable route for removal of small juvenile nasopharyngeal angiofibroma

To determine frequency of employment of transpalatal route for a cosmetically acceptable outcome in surgically addressing small juvenile nasopharyngeal angiofibroma. Descriptive Study. The study was carried out in department of ENT and Head and Neck surgery Combined Military Hospital Rawalpindi and Combined Military Hospital Lahore from January 2005 - January 2008. Patients age less than 18 years with small juvenile nasopharyngeal angiofibroma [Radkowskis Stage I] were included in the study. These patients were managed surgically. A total of twenty four cases were included in this study, nine [37.5%] were managed by transpalatal route. Four patients had stage la and five had Stage Ib disease. Patients were studied in terms of facial appearance six months post operatively. None of the patients showed any facial deformity. Transpalatal route is novel approach to deal cosmetically with small juvenile nasopharyngeal angiofibroma

Evaluation of mastoid cavities after canal wall down mastoidectomy

To evaluate mastoid cavities after canal wall down procedures in terms of achieving a dry mastoid cavity, presence of residual or recurrent disease [Granulations and cholesteatoma]. Quasi-experimental study. The study was done in the ENT Department, CMH Rawalpindi Study was done in fourteen months from Nov 2006 to Jan 2008. Fifty patients undergoing canal wall down mastoidectomy were included. Their mastoid cavities were evaluated for persistence of discharge and recurrence of granulations and cholesteatoma after the surgery. After follow up period of 3 months, 8% patients had mild discharge, 12% had granulation and 2% patients had recurrence of cholesteatoma. Canal wall down mastoidectomies are very effective in controlling the recurrence of cholesteatoma, granulations formation and otorrhoea to a greater extent

Carotid body paraganglioma

Carotid body tumours are benign neoplasms. This case report describes two patients with this rare tumour with diagnostic workup and treatment options. The first case was a 36-year-old gentleman who presented with 6 months history of painless swelling on the left side of neck. The second patient was 60 years old man who presented with slowly growing swelling on the right side of neck for the last 20 years. Both patients had transmitted pulsations over the swelling. On suspicion of a vascular lesion, a contrast enhanced CT scan and Doppler's ultrasound of neck was advised which suggested the diagnosis of a carotid body tumour. Magnetic Resonance Angiography [MRA] confirmed the diagnosis. Excision in collaboration with vascular surgeon was planned for the first case. The second case was subjected to radiation therapy due to the large size of tumour and the patient's age

Monopolar diathermy as compared to silk ligatures for per operative haemorrhage control during tonsillectomy

To determine whether monopolar diathermy is a better tool for haemostasis compared to tying of silk ligatures. Quasi-experimental study. The study was done in ENT department of Combined Military Hospital Rawalpindi from July 2006 to March 2007. Seventy patients were included in this study and were divided into two groups of thirty-five each; one group underwent tonsillectomy with monopolar diathermy for haemorrhage control and tying of silk ligatures for hemostasis in second group. Chi square test was used as the test of significance. Monopolar diathermy is shown to be a better method of haemorrhage control as compared to tying of silk ligatures [p - value <0.05]. These results demonstrate the effectiveness of monopolar diathermy as a coagulation tool

Actinomycosis larynx: a rare entity

Our patient, a fifty five year old poultry farmer presented with two years history of throat discomfort, for which he had taken steam inhalation. For the last two months he noticed a change in his voice. On examination he was found to be hoarse. His Indirect Laryngoscopy [IDL] showed oedematous cords. He underwent DL, which revealed oedematous cords with yellowish spots. Histopathology report received showed actinomycosis larynx. Final diagnosis of Actinomycosis larynx was made because of presence of Sulphur granules [yellow spots] on naked eye examination of vocal cords during DL, and a positive hitopathology report. The patient was started on Injection Benzyl Penicillin one million unit international units intravenous four times a day. This dose was continued for four weeks after which patient were shifted on tablet ciprofloxacin 500 mg twice daily due to unavailability of oral penicillin V. The oral therapy was continued for 3-6 months depending upon the response. During the treatment the hoarseness settl ed and IDL showed reduction in odema of the vocal cords