Valsalva manouevre; efficacy in the treatment of eustachian catarrh

To assess the efficacy of Valsalva maneuver in the treatment of Eustachian catarrh. Quasi Experimental Study. Frontier corp Hospital [Quetta] and Sheikh Khalifa Bin Zayad Al Nahyan Hospital [Muzzafarabad] from December 2010 to May 2011. Total of sixty patients of Eustachian catarrh were randomly assigned to two treatment groups. Group A was given Antibiotics, Antihistamine, systemic and nasal decongestants and group B was advised Valsalva maneuver in addition to the above mention treatment. Relief in aural fullness [assessed through tympanometry] and hearing improvement [assessed through audiometry] were compared between these two groups at the end of three weeks of treatment. Audiogram done after three weeks of treatment showed statistically significant hearing and middle ear pressure improvement [assessed through audiogram and tympanogram respectively] in group B

Delayed radionecrosis of the larynx: case series and literature review

Radionecrosis of larynx is a rare complication of radiotherapy in this era of mega voltage radiotherapy. We report two cases of post radiotherapy delayed radionecrosis of larynx. The data was collected from medical record, surgical record, imaging and histopathological results of two patients discussed. The radionecrosis developed between 9 to 18 months after completion of radiotherapy. Both patients ultimately required total laryngectomy

Myofibroblastoma: an unusual rapidly growing benign tumour in a male breast

Myofibroblastoma is an unusual benign tumour of the breast predominantly seen in men in their sixth to seventh decade. The gross appearance is that of a well circumscribed nodule, characteristically small, seldom exceeding 3 cm. We present a case of an unusually large myofibroblastoma, which mimicked a malignant breast tumour. A 40 years old male, known case of tetralogy of Fallot, was operated in infancy in abroad, presented with a rapid enlargement of right breast over 5 - 6 weeks. Examination revealed a firm 10 cm hemispherical lump occupying the whole of the right breast with normal overlying skin. Since core biopsy was inconclusive, a subcutaneous mastectomy was performed to remove the tumour, which weighed 500 gms. Histopathology and immunocytochemistry revealed a mixed classical and collagenised type of myofibroblastoma. The patient is well with no evidence of recurrence.

Culture sensitivity pattern in patients of chronic suppurative ottitis media

To compare the nasal obstruction following submucosal resection of inferior turbinate versus total inferior turbinectomy in patients with enlarged inferior turbinate. Randomized control trial CMH Rawalpindi from June 2007 to November 2007. Sixty patients of both gender clinically diagnosed to have inferior turbinate hypertrophy with history of nasal obstruction, not responding to medical treatment, having age >12 years with no history of previous nasal surgery were selected by convenience sampling. Thirty patients were treated by total inferior turbinectomy and thirty cases were treated by submucosal resection of inferior turbinate and results in terms of relief of nasal obstruction based on VAS [Visual Analogue Score] were observed with follow-up carried out at three weeks. Out of 30 cases managed by total inferior turbinectomy 83% cases showed marked improvement, and 17% had mild improvement in nasal obstruction 3 weeks after surgery. Among patients managed by submucosal resection 80% had marked, 17% had mild and 3% had no improvement of nasal obstruction. Submucosal resection of inferior turbinates and total inferior turbinectomy are almost equally effective for relief of nasal obstruction in patients with hypertrophic turbinate

Streptomycin associated hearing loss in patients treated for multidrug resistant tuberculosis

OBJECTIVES: To determine the incidence, frequency and degree of hearing loss in patients treated with streptomycin for multidrug resistant tuberculosis

STUDY DESIGN: A prospective observational study

PLACE AND DURATION: This study was carried out at Combined Military Hospital Rawalpindi over two years time from 01 Jan 2008 to 31 December 2009

METHODOLOGY: 38 patients who were treated with streptomycin as part of antituberculous therapy meeting the inclusion and exclusion criteria were included in this study. Pure tone Audiometry [PTA] was done before starting the treatment, on complaint of hearing loss and after one month and two months of streptomycin therapy to determine the hearing loss

RESULTS: At the end of 2 months therapy with streptomycin 22 patients [57.9%] develop sensorineural hearing loss, amongst them 15[68.2%] were identified within 1 month of therapy. Out of 22 patients 12[54.5%] have mild, 7[31.9%] have moderate and 3[13.6%] have moderately severe hearing loss in speech frequencies

CONCLUSION: Streptomycin still has got important role in treatment of Multidrug Resistant Tuberculosis. It is potentially ototoxic specially in children and old age. Careful monitoring in the form of serial audiograms is advised to pick up individuals susceptible to hearing loss with its use

To Study the Type and Severity of Ear Injuries in Blast Victims

OBJECTIVE: To study the type and severity of ear injuries in blast victims

STUDY DESIGN: An observational study conducted in the department of ENT, Combined Military Hospital, Rawalpindi from January 2007 to September 2009

PATIENTS AND METHODS: 62 blast victims who were brought to ENT department CMH Rawalpindi without previous history of ear disease in this duration were studied for type and severity of ear injuries. All cases underwent clinical examination of ear including otoscopy. Pure tone audiometry [PTA] was performed in all the cases

RESULTS: Out of 62 patients, 80.6 %[ 50] were male and 19.4 %[ 12] female. Age group varied from 13 to 60 years

Tympanic membrane rupture was the commonest finding present in 64.5%[40] individuals,17.7% [11] had perforation of right TM and 22.6%[14] had left TM perforation. Bilateral TM perforation was present in 24.2% [15] cases. Laceration of pinna was found in 11.2 %[ 7] patients and hemotympanum was present in 9.65% [6] cases [Fig: 1]. 79% [49] patients had hearing loss greater than 25 dB, out of which 22 were bilateral and 27 cases had unilateral involvement. So total of 71 ears were having hearing loss. 73.2% [52] had mixed hearing loss, 15.5% [11] pure conductive and 11.3% [8] pure sensorineural losses [Fig: 2]

CONCLUSION: Tympanic membrane perforation was the commonest injury followed by laceration pinna and hemotympanum. Hearing loss was seen in 79% patients of whom mixed type of loss was the commonest

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

Comparison of efficacies of 10% ichthammol glycerine and 3% ciprofloxacin - 1% dexamethasone by means of sustained release of drug by wick method in treatment of otitis externa

Objective: to compare the efficacies of 10% Icthammol glycerine and 3% Ciprofloxacin - 1% Dexamethasone by means of sustained release of drug by wick method in treatment of otitis externa

Study design: quasi experimental study

Place and duration of study: department of ENT CMH, Rawalpindi from Jan 2007 to Jan 2008

Methodology: 100 patients who met the inclusion criteria were included in study divided into two equal groups of 50 each by random sampling technique. The patients in group A were given 3% Ciprofloxacin - 1% Dexamethasone and patients in group B were given 10% Icthammol glycerine wick. Both groups of patients were analyzed on third day for reduction in pain by Visual Analogue Scale [VAS] and visible reduction of edema by degree of opening of External Auditory Canal [EAC]

Results: out of 50 patients in group A 76 %[ 38] were males and 24 %[ 12] females.66 %[ 33] patients in group B were males and 34 %[ 17] females. On third day in group A, 76 %[ 38] patients had marked reduction of pain whereas14 %[ 7] had moderate and 10 %[ 5] had mild reduction. In group B, on third day 38% [19] patients had marked pain reduction, 30% [15] had moderate and 32% [16] had mild pain reduction. 86%[ 43] patients in group A had visible reduction of external canal edema as compared to 60%[30]patients in group B

Conclusion: 3% Ciprofloxacin - 1% Dexamethasone wick is more effective in treating patients of otitis externa as compared to 10% Icthammol glycerine wick

Gender difference in metacarpal descent of fifth metacarpal

To determine the difference in metacarpal descent of fifth metacarpal between men and women. Descriptive study. The outpatient department of plastic, reconstructive and hand surgery at Liaquat National Hospital, Karachi, from August 2005 to February 2006. Skyline of the 2nd and 3rd metacarpals were used as reference line, from which the descent of the 5th metacarpal head was measured. The position of 5th metacarpal head was documented as angle X. Metacarpal descent was defined as the difference between angle "X" in relaxed and clenched fist position. The relaxed position was standardized by placing the forearm, wrist and palm on a shaped woodblock such that the wrist would be held in 25 - 30 degree in extension by a triangular spur, supported the 3rd metacarpal only. It was ensured that the movement of 4th and 5th metacarpals were not impaired. Analysis of variance was performed to compare the significance of means between genders at p < 0.05 level of significance. Metacarpal descent of the 5th metacarpal of both hands was significantly greater for women, with a mean of 7 degree as compared with a mean of 4 degree for the men. This decrease in angle "X" was significant for the right 5th metacarpal relaxed and fist position and the fist position on the left. In contrast, women showed no significant differences between the various age groups for any of the variables tested.There was no relationship between metacarpal descent and hand dominance. Difference in metacarpal descent between men and women is significant and must be kept in mind when hand function is evaluated in both genders to assess the outcome of treatment and rehabilitation

Kirschner wire pin tract infection rates between percutaneous and buried wires in treating metacarpal and phalangeal fractures

To compare pin tract infection rate between percutaneous and buried placement of Kirschner [K-] wiring for hand fractures. Quasi ' experimental study. Place and Duration: Plastic, Reconstructive, Hand and Burn Surgery Unit, Liaquat National Hospital, Karachi, from September 2005 ' February 2006. Patients and Patients with fractures of metacarpals and phalanges of hand were selected by non-probability purposive method. Assessment of pin tract infection by clinical examination and pin tract scoring was done by modification of Oppenheim classification. Statistical analysis was done using Chi-square test. Ten out of 55 percutaneous and 2 out of 45 buried wires were infected. The difference in infection rates of two groups was statistically significant at p < 0.05. Three percutaneous, but not buried Kirschner wires, had to be removed before 4 weeks because of failure to respond to local wound care and oral antibiotics. Percutaneous K- wires had significantly greater infection rate than wires which were buried deep to the skin