Reduced mouth opening following tonsillectomy in children: myth or reality

To evaluate whether tonsillectomy in children leads to subsequent reduction in mouth opening. Cohort study. Department of ENT/Head and Neck Surgery, Combined Military Hospital, Peshawar, from October 2005 to December 2006. A total of 42 children undergoing tonsillectomy [Group A = requiring insertion of a mouth gag] and 44 patients undergoing myringotomy or septoplasty [Group B = control group] were included in this cohort double blind study. Patients having pre-operative temporomandibular joint [TMJ] dysfunction, undergoing any other surgery in addition to tonsillectomy e.g. adenotonsillectomy, aged under 4 or above 15 years, and patients lost to follow-up were excluded. Painless, maximum interincisal distance [MID] was measured pre-operatively with a Vernier Calliper. Because of the inconsistency of mouth opening in children, three readings per individual were taken and the maximum recorded. Patients were followed up at 1, 2, 4, 12 and 26 weeks postoperatively in the ENT OPD and respective MID readings recorded. After a transient reduction in mouth opening, at the 26th week follow-up, 100% patients had reverted to their pre-operative MID measurements. Reduced mouth opening in children, after tonsillectomy is a transient finding returning to normal by about the 26th postoperative week

Post-tonsillectomy pain and bupivacaine, an intra individual design study

To compare whether an individual could appreciate the pain relief, if any, in either one of his/her tonsillar fossa topically suffused with a local anaesthetic [bupivacaine]. Randomized controlled trial. Department of ENT/Head and Neck Surgery, Combined Military Hospital, Peshawar, from January to June 2007. Forty-six patients of either gender, aged 10-42 years undergoing tonsillectomy for recurrent tonsillitis were enrolled for this study. At the end of surgery, having secured haemostasis, one tonsillar fossa was randomly packed with a gauze piece soaked in 3 ml of 0.5% bupivacaine for 5 minutes, while the other was not. Effects of postoperative analgesia were assessed using visual analogue scale [VAS] up to 8 hours. Majority of the patients [85%, n=39] failed to experience an appreciable pain relief on the side of local anaesthetic [bupivacaine] application [p=0.006]. Topical application of local anaesthetic [bupivacaine] confers no appreciable pain control in post-tonsillectomy patients

Microflora and antibiograms of discharging ears in a cross - section of population in Quetta, Balochistan

To study the micro flora and the antibiograms of patients with discharging ears due to Otitis externa / Otitis media in Quetta, Balochistan and to analyse and compare the results with other domestic and international studies. Prospective, descriptive study. Department of ENT, Combined Military Hospital, FC Hospital, Saleem Medical Complex and Mideast Hospital Quetta, from January 2003 to June 2005. The ear swabs of 1105 patients with otorrhoea were prospectively analyzed. Antibiotic testing was done using modified Kirby Bauer disc diffusion method. In addition to the usual antibiotics, the two most common topically available antibiotics [gentamicin and Ofloxacin] were also tested. There were 1057 positive cultures for organisms from the 1105 patients with 1125 isolates. The most common causal organisms isolated were staphylococcus aureus [40%] with 10.29% Methicillin resistant staphylococcus aureus [MRSA] positive followed by pseudomonas aeruginosa [38.4%]. Fungi accounted for 3.7% of isolates. Out of the two antibiotics commonly available as topical eardrops, Ofloxacin has a very high overall susceptibility rate [97.3%] to all organisms cultured. Staphylococcus aureus is the commonest organism, replacing pseudomonas aeruginosa in discharging ears. All the isolates cultured were highly sensitive to Ofloxacin / Ciprofloxacin. Thus apart from fungal infection of the ear Ofloxacin eardrops should be the mainstay of treatment

Headache: sino-nasal or migrainous?

To outline the clinical features which help to differentiate patients presenting primarily with headache either due to migraine or un-complicated chronic rhino sinusitis. Prospective, comparative study. The study was carried out at the Department of ENT and Head and Neck Surgery, Combined Military Hospital Rawalpindi, a tertiary care hospital. Sept. 2001 to Mar 2003. 60 patients of common migraine [migraine without aura] and 60 patients of uncomplicated acute rhino sinusitis were selected and their headache patterns were compared. Migraine was 3 times more common in young healthy females. The important diagnostic clinical features of common migraine were unilateral cephalic location [76%], pulsatile nature [78%]. Moderate to severe intensity [88%] and association with nausea/ vomiting [58%] and photophobia/ phonophobia [78%]. 10% patients however showed symptoms mimicking sino-nasal disease due to autonomic dysfunction. Patients of acute rhino sinusitis on the other hand had a male predominance with diffuse [75%], mild to moderate headache [83%], nasal mucosal congestion [100%], postnasal dripping [98%], nasal discharge [88%] and nasal obstruction [68%]. Despite the development of rapid, noninvasive radiographic studies, history and physical examination are the comer stones in differentiating headache due to migraine or sino-nasal disease

Massive Rhinolith

Rhinolithiasis, a known yet uncommon clinical entity, usually presents as an incidental finding either in the otolaryngologist's office or on radiography performed for other reasons. A patient with left sided nasal obstruction and foul smelling discharge was diagnosed as having a massive rhinolith and because o f the sheer size o f stone it had to be partly delivered per orally under general anaesthesia

Role of plain radiology in chronic maxillary sinusitis.

To determine the specificity and specificality of X-rays paranasal sinuses [water's view] in patients of chronic maxillary sinusitis. A prospective, comparative study between radiological findings and lavage of the maxillary sinuses. ENT department Combined Military Hospital Quetta over a period of 6 months. A total of 110 patients with suspected chronic maxillary sinusitis were selected for the study from general population; mostly defence personnel and few civilians reporting to ENT department of Combined Military Hospital Quetta, which is the only tertiary referral Military Hospital in Baluchistan. Provisional diagnosis of maxillary sinusitis was made on history and clinical examination. X-ray paranasal sinuses [water's view] was carried out in all cases. Radiological findings were classified as clear, mucosal thickening, opaque or fluid level. Antral lavage was also carried out in all cases and fluid return was classified as clear, mucoid or mucopurulent. X-ray PNS [water's view] had a sensitivity of 77% and specificity of 37% in chronic maxillary sinusitis when compared with the findings of lavage of the maxillary sinuses. Despite the fact that affluent countries have adopted CT scan as the diagnostic tool of choice in diagnosing sinusitis', it is fair to conclude that plain X-rays remain the preferential investigation in diagnosing chronic maxillary sinusitis in third world countries like ours

Ductal piglottic cyst

A 28 years old female presented with a feeling of something sticking in her throat. Indirect laryngoscopy revealed a cystic mass lying on the left pyriform fossa. Direct laryngoscopy revealed a benign looking mass arising from the epiglottis and following excision histopathology revealed a ductal cyst of the epiglottis. A brief review of the literature accompanies the case report