Results of myringoplasty in chindren: a comparison with an adult population

To find out validity of myringoplasty in children by comparing its anatomical and functional results with adult myringoplasty. Adescriptive cross sectional study Department of Otolaryngology and Head and Neck Surgery at a tertiary care teaching hospital in Rawalpindi from January 2007 to December 2010. A total of 89 patients having dry central tympanic membrane perforation of various sizes secondary to chronic tubotympanic suppurative otitis media were included in the study. The patients were divided in two groups. First group comprised of children upto the age of 14 years whereas those above the age of 14 years were included in second group. Myringoplasty was performed in all patients with temporalis fascia utilizing underlay technique. The two groups were compared regarding graft success rate and hearing improvement at the end of 6 months of follow up. Out of 89 patients included in the study, 37 [41.6%] belonged to child group whereas 52 [58.4%] were included in adult group. Among 37 patients in child group, 34 [91.8%] had successful graft take at the end of 6 months of follow up whereas 47 [90.3%] patients out of 52 in adult group had successful graft. Average air bone gap closure of 13.5 dB was noted in child group whereas in adult group it was 12.5 dB. The difference between graft success rate and average air bone gap closure was found to be statistically insignificant [P>0.05]. Results of myringoplasty in paediatric and adult age group are comparable in terms of graft success rate and hearing improvement

Tinnitus matching

To study the pitch and loudness of tinnitus and to find minimal masking level. Descriptive analytical study. This study was conducted at Combined Military Hospital Rawalpindi, the tertiary referral center for Pakistan Armed Forces from 1998 to 2001. Patients with tinnitus were included in the study. Exclusion criterion was transient tinnitus settling on removal of offending agent like foreign body and not having tinnitus as major presenting feature. Patients were thoroughly interviewed and tinnitus card [questionnaire] was filled. Thorough general physical and Ear Nose Throat examination was carried out including relevant tests to elucidate any cochleovestibular pathology. All patients had pure tone audiometery and tinnitus testing and sophisticated investigations were carried out whenever indicated. Most patients of tinnitus were seen between age of 40 to 60 years and 76.6% patients were male. Hearing loss accompanied tinnitus in 90% patients and 53% patients had tinnitus of moderate intensity. Pitch match frequency of 4 kilohertz was seen in 25.3% while 29% patients had loudness match of tinnitus ranging from 55 to 70 decibel [dB]. In vast majority [24%] minimal masking level ranged from 41 to 55 dB. Seventy nine percent patients had pitch match frequency at or around frequency of maximum hearing loss. Tinnitus is seen predominantly among males and its frequency increases with age .It is usually of moderate intensity and is of high pitch which corresponds to frequency of maximum hearing loss. Pitch of tinnitus is not a good indicator of degree of annoyance while loudness match gives a good measure of annoyance. Minimal masking levels are at or around loudness match. Tinnitus in majority of patients is associated with mild to moderate degree of hearing loss

Transient ischaemic attacks due to a pulsating mass in the neck produced after incision and drainage of parapharyngal abscess

Carotid endarterectomy is the most commonly performed vascular surgical procedure. One of the complications of carotid endarterectomy is Pseudoaneurysm of the carotid artery frequently managed by endo-vascular technique. Pseudoaneurysm caused by other aetiological factors is rare entity. Penetrating trauma and neck surgery are known but very rare causes of pseudo aneurysm of the carotid artery. We have successfully managed a case of carotid artery pseudoaneurysm caused by incision and drainage of parapharyngeal abscess. This surgery also leads to the palsy of right vagus nerve causing complete hoarseness of voice. The patient presented with Transit Ischaemic Attacks [TIA] and amurosis fugos. Resection of aneurysm and reconstruction of right carotid artery lead to complete recovery. Vocal cord palsy was managed by Vox implant injection leading to full recovery

Dysphagia aetiology and incidence in young adults

The Study was conducted at Combined Military Hospital Rawalpindi, to identify cases of dysphagia in both genders, to see sex predominance, to find the aetiology in our population and to compare it with the literature. Study was conducted on 54 cases of dysphagia 32 male and 22 female, from outpatient department of CMH Rawalpindi. 31.45% were cases of foreign body esophagus, 16.66% were case of Carcinoma esophagus, 9.25% were of leiomyoma esophagus, 11.11% were of Carcinoma pyriform fossa hypopharynx, 7.40% were of peptic stricture esophagus, 3.7% were of globus pharyngeus, 3.7% were of Plummer Vinsons disease, 1.85% of Zenker's Diverticulum. All the esophageal pathologies have equal sex involvement. 14.81% were of postcricoid carcinoma female predominance. Our results were compared with the literature. Some esophageal pathology values were matched with the results and some were contrary what we saw in the literature

Congenital meatal atresia

This interventional study was carried out in ENT Department of Combined Military Hospital Rawalpindi, a tertiary care hospital, from January 1993 to December 2000, to determine the sex incidence, laterality and type of congenital meatal atresia, and possible etiological factors; and secondly to determine the results of surgery in terms of hearing gain and incidence of complications while comparing trans-mastoid approach with the anterior approach. 42 patients of both sexes with congenital meatal atresia, up to the age of 25 years were selected by non-probability sampling. A detailed history and a detailed physical examination showed consanguinity as the biggest possible etiological factor [40.4%], male to female ratio of 2.5:1, unilateral to bilateral ratio of 1.6:1, type II atresia in 50%, type I atresia in 35.7% and type III atresia in 14.2%. X-ray mastoids and CT scan showed favourable anatomy in 36 patients who were selected for surgery. Canalplasty with tympanoplasty was carried out in them, via trans-mastoid approach in ten and direct anterior approach in 26 patients. Pre and post-operative Audiological Brainstem Response and Pure Tone Audiometry [over 4 years of age] showed successful surgery in 19 [52.7%] patients having post-operative hearing thresholds of up to 25-30 dB. Success rate was 61.3% with the anterior approach as compared to 30% with the trans-mastoid approach. Post-operative complications as re-stenosis [16.6%], otorrhoea [11.1%] and facial paralysis [2.7%] occurred in 11 [30.55%] patients. Complication rate was 50% with trans-mastoid approach and 27% with anterior approach. Consanguinity must be studied in greater detail as an important possible etiological factor

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

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

Blunt, external laryngeal trauma, clinincal analysis and management, experience at combined military hospital, Rawalpindi

18 cases of external laryngeal trauma are being analyzed retrospectively. Main etiological factors were road traffic accidents 11 cases [61.11%] accidental strangulation 3 cases [16.66%], blunt trauma due to fall 1 case [5.5%] during fight 2 cases [11.11%] and suiccidal attempt 1 case [5.55%]. Most of the patients presented with hoarseness or aphonia 8 cases [44.44%], pain and tenderness of neck 6 cases [33.33%], odynophagia 6 cases [33.33%] and swelling of the neck one case [5.55%]. After careful history, meticulous examination and detailed investigations patients were grouped according to clinical findings. Group one had 4 patients having supraglottic swelling, edema, ore stenosis occurs as a squalal of lalpferl trauma ad occurs after sometime, not immediatily after trauma hamatoma [22.22%], group two had six patients having supraglottic stenosis [33.33%] group three had subglottic stenosis. Number of patients was again 6 [33.33%]. Group four had two patients having subglottic stenosis and tracheal stenosis [11.11%]. Treatment was varied depending upon the severity of the injuries. Fourpatients [22.22%] were managed by tracheostomy and conservative measures i.e., voice rest, humidification and bed rest. Fourpatients [22.22%] underwent laryngotracheal reconstruction with hyoid descent, three patients [16.66%] had suprahyoid release, resection and reanastomosis of stenotic segment. Two patients [11.11%] had laser ablation, two patients [11.11%] had laser ablation and serial dilations and one patient [5.55%] had laryngotracheal reconstruction with hyoid descent and augmentation with septal cartilage. Three patients [16.66%] underwent more than one operation. Fifteen patients out of eighteen [83.33%] recovered un-eventfully having stable air way, voice capable of verbal communication, decannulation and swallowing without aspiration, two patients [11.11%] are still not decannulated and are declared unsuccessful, one patient [5.55%] has got left vocal cord paralysis. A delay in early detection of external laryngeal trauma may precipitate life threatening airway compromise later on, therefore prompt and accurate diagnosis should immediately be followed by skillful air way management

Complications of tracheostomy

A study of 44 tracheostomies was conducted at Combined Military Hospital Rawalpindi to see the complications. All tracheostomies were performed under general or local anaesthesia in operation theatre. Portex cuffed tracheostomy tube was used in 83.6%, Vygon [PVC] tracheostomy tube in 9% and Chevalier-Jackson tracheostomy tube in 4.5% cases. The rate of complications was 27.2%. The intermediate complications included surgical emphysema and infection of the wound. There was no death related to tracheostomy however, deaths not related to tracheostomy were 20.35%

Fungal Sinusitis

Fungal sinusitis is a relatively uncommon disease.Eleven patients were diagnosed between July 1996 to June 1998. Apart from the nasal symptoms, orbital complaints were commonly encountered. There was a predilection of females in our study, while the commonest infection was Aspergillosis. In contrast to the medical literature most of the patients were healthy individuals. This study highlights the vast variety of presentation of fungal sinusitis. A high index of suspicion in unilateral chronic resistant sinusitis helps in diagnosing such cases.Adequate surgical clearance of the disease and appropriate anti fungal medication give favourable results

Hearing results of mastoidectomy

Pre-operative and post-operative hearing levels of 105 patients, who underwent radical or modified radical mastoidectomy due to chronic supportive otitis media, were evaluated. Findings in the ear at the time of operation and condition of cavity after six months of operation were recorded. Post operative hearing was assessed at least after six months of surgery. Hearing improved in 29.5% of cases. There was no significant difference in Preoperative and post-operative hearing in 50.5% of cases and hearing worsened in 20% cases. Hearing loss was more in high frequencies. Mean hearing gain was only 4.2 dB