Effect of postoperative dexamethasone on pain, emesis and haemorrhage in tonsillectomy by dissection method

To compare the effect of postoperative intravenous dose of dexamethasone on morbidity in patients undergoing tonsillectomy. Randomized control trial. This study was conducted in ENT Department Shaikh Khalifa Bin Zayed Al Nahyan Hospital [CMH] Muzaffarabadfrom 10[th] Jan 2010 to 15[th] Feb 2011. After getting informed consent, a total of 60 patients who fulfilled the inclusion criteria were selected and tonsillectomy by dissection method was carried out. They were divided into two groups of 30 eachusing a random numbers table. Group A received 0.25 mg/kg body weight [maximum 20 mg] of Dexamethasone postoperatively intravenously for 03 days while group B [control group] did not receive any steroid. In group A, 80% patients had mild pain, 16.7% had moderate pain and 3.3% had a severe pain while in group B, 30% patients had mild pain, 6.7% had moderate pain and 63.3% had severe pain [p< 0.05]. In group A, 76.7% patients had mild emesis while in group B, 86.7% had moderate emesis [p< 0.05]. There was an insignificant difference in secondary hemorrhage. Dexamethasone given postoperatively significantly reduces the morbidity that is pain, episodes of emesis thus early recovery to a normal lifestyle with no effect on secondary hemorrhage in patients undergoing Tonsillectomy by dissection method

Comparison between efficacy of 4% boric acid and 1% clotrimazole in treatment of otomycosis

To compare the efficacy of 4% boric acid solution in alcohol and 1% clotrimazole in treatment of otomycosis. Randomized control trial. ENT department, CMH Rawalpindi from 21 July 2007 to 20 January 2008. In this study, 252 patients of otomycosis were selected through random sampling technique. Selected patients were allocated into two equal groups; A and B. Group [A] was treated with topical 4% boric acid solution in alcohol ear drops and Group [B] was given 1% clotrimazole ear drops for control of otomycosis. Comparison of both the drugs was evaluating the variables; ear itching, and presence or absence of fungal debris on otoscopy at day 7. Out of 126 cases of group A, fungal debris was absent in 101 [80.2%] cases as compared to only 63 [50%] cases in group B at day 7[P value<0.05]. Itching control was gauged as marked, mild and no improvement at day 7. After 1 week of treatment, itching control in group A was following; marked improvement in 50[39.7%] cases, mild in 46[36.5%] and no improvement in 30[23.8%] cases. In group B, 20[15.9%] cases had marked improvement, 56[44.4%] mild improvement and 50 [39.7%] patients had no improvement after 1 week of treatment [P value<0.05]. 4% boric acid solution in alcohol is a better remedy in terms of alleviating symptoms of otomycosis

Effect of preoperative dexamethasone on postoperative pain, emesis and haemorrhage in tonsillectomy by dissection method

To compare the effect of single preoperative intravenous dose of dexamethasone on postoperative morbidity that is pain, episodes of emesis, and hemorrhage in patients undergoing tonsillectomy by dissection method with those who do not receive dexamethasone. Randomized control type. ENT Department Combined Military Hospital Rawalpindi, from Feb 2006 to Feb 2007. After getting informed consent a total of 60 patients who fulfilled the probability sampling. Group A received 0.25 mg/kg body weight [maximum 20 mg] of dexamethasone intravenously 10 minutes before start of operation while group B [control group] did not receive any steroid. Pain control had significant difference in both groups with better control rates in group A. Similarly, emesis control was significantly better in group A. There was no significant difference in secondary haemorrhage in the two groups. Single dose of dexamethasone given preoperatively significantly reduces the postoperative morbidity that is pain, episodes of emesis with no effect on secondary hemorrhage in patients undergoind tonsillectomy by dissection method

Comparison of serum immunoglobulin levels before and after adenotonsillectomy

To compare the pre and post-operative serum immunoglobulin levels in patients undergoing tonsillectomy and adenotonsillectomy. Quasi-Experimental Study ENT Department, Combined Military Hospital, Rawalpindi from Febuary 2006 to December 2007 Study included 50 patients of adenotonsillectomy and tonsillectomy. Two patients were excluded, because they did not report to the hospital for postoperative investigations. Preoperative serum IgG and IgA levels were measured two weeks before surgery and post operative samples were taken two months after the surgery. Mean age of the patients was 8.8 years, with maximum patients of 12 years of age [35.4%]. There were 36 [75%] male and 12 [25%] female patients. Tonsillectomy was done in 30 [62.5%] patients and adenotonsillectomy in 18 [37.5%] patients. Mean age of patient in case of adenotonsillectomy was 7.17 year and for tonsillectomy 9.9 years. There was a significant rise in the post operative serum IgA level [p= 0.02] while it was insignificant in case of IgG [p= 0.44]. Our study shows a significant rise in the post operative serum IgA level [p= 0.02]

Mucosal lichen planus simultaneously involving oral mucosa, conjunctiva and larynx

Lichen planus is an autoimmune disease that typically involves skin and the mucosa of the mouth and genitalia. The involvement of conjunctival and laryngeal is rare. A young patient presented with hoarseness of voice, oral ulcerative lesions and symblephron. Mucosal biopsies [buccal mucosa and supraglottic area] revealed the diagnosis of lichen planus and he was managed accordingly. Although oral lichen planus is frequently reported but simultaneous involvement of oral, ocular and laryngeal mucosa has not been reported earlier

comparison of oral and topical steroid therapy for recurrent apthous stomatitis

This study was carried out to compare the efficacy of oral and topical Steroids in the treatment of Recurrent Apthous Stomatitis [RAS]. It was a quasi-experimental interventional study conducted on 60 patients of Recurrent Oral Ulcers seen in ENT Department of the Combined Military Hospital, Peshawar and Quetta, and was carried out in these hospitals from 01 August 2008 to 31 May 2010. Sixty patients, age ranging from 20 to 40 years; both genders were selected for the study purpose. The patients were included on the basis, having experienced oral ulcers at least thrice during the last one year severe enough to cause significant discomfort leading to absence from work place and remained afebrile during the ailment. Patients suffering from Hypertension, Bronchial Asthma, Glaucoma or Acid Peptic Disease were excluded. People taking medicines of any kind were not included in the study. Children, lactating mothers and pregnant females were excluded. Patients fulfilling the criteria were divided into two groups. Group I were given tablet Prednisolone [45mg] in daily divided doses for three days. Group II were prescribed topical application of Steroid[Triamcinolone acetonide] for the same duration. The day on which the treatment was started was counted as Day 1, the patients were re-examined on Day 2, 4 and 7. 91% of the patients of group I were symptom free on Day 4. Rest of the patients though not fully recovered were able to resume normal pattern of life. Only 47% of the patients of group II had comparable outcome on Day 4.On Day 7 all the patients of group I were normal while 18% of group II had some residual symptoms. Short term therapy of oral steroids brings an early and significant improvement in clinical picture of patients with RAS

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