Efficacy of topical clotrimazole in treatment of otomycosis

Otomycosis is a common condition affecting external ear and ears with chronic suppurative otitis media, and has a tendency for recurrence. Objective of this study was to determine the efficacy of topical clotrimazole in the treatment of otomycosis. This descriptive study was conducted at the outpatient department of ENT, Ayub Teaching Hospital Abbottabad, from Jul 2012 to Dec 2012. A total of 101 patients were included in this study. The results were compared and analysed regarding age, gender, presenting complaints and efficacy of clotrimazole. A total of 101 patients of otomycosis were included in the study. Male to female ratio was 0.71:1. Patients of 15 years and above were included in the study. Adults were more affected by otomycosis than the younger age group. The efficacy of clotrimazole in treatment of otomycosis was observed in 89 [94.12%] while in 12 [5.88%] patients no efficacy was seen. Age and gender have no role in efficacy of Clotrimazole in treatment of Otomycosis. Topical clotrimazole is effective in the treatment of Otomycosis

Early complications of elective and emergency tracheostomy

Tracheostomy is a life saving procedure when it is performed for an appropriate indication and surgical technique. The aim of this study was to compare the early complications of elective and emergency tracheostomy in our setup. This comparative study was conducted at the ENT Department, Hayatabad Medical Complex [HMC] from March 2009 to March 2010. A total of 100 patients included in this study were divided in to two equal groups, group A undergoing elective tracheostomy and group B undergoing emergency tracheostomy. The results of hundred patients were compared and analysed from stand point of age, sex, disease pattern, operative procedure and postoperative complications associated with tracheostomy. A total of 100 patients were included with age ranging from 17 to 88 years. The average age was 35 years in elective cases and was 32 years in emergency cases. The male to female ratio was 2.9:1 in elective cases and 4.6:1 in emergency cases. The overall complications rates were 38% in elective cases and 56% in emergency cases. Early complications of emergency tracheostomy are more common than elective tracheostomy.

Medical versus surgical management of otitis media with effusion in children

Otitis media with effusion [OME] is a leading cause of hearing difficulty in children. OME must be detected early and managed properly to prevent hearing and speech impairment in children. This study was aimed to compare results of medical and surgical treatments in terms of hearing improvement, recurrence of Middle Ear Effusion [MEE], time to offer surgical intervention. The study was conducted from June 2008 to December 2011. A performa was used to collect data. Every child having hearing difficulty was examined with pneumatic otoscope for fluid level and tympanic membrane mobility. These children were investigated with pure tone audiometry for level of hearing loss and tympanometry to confirm the middle ear effusion. X-Ray nasopharynx lateral view was taken to see if there were adenoids. All patients were treated conservatively in the first phase. Those not responding to conservative treatment were treated with myringotomy and adenoidectomy with or without ventilation tubes. Patients were followed-up for up to 36 months. Middle ear effusion cleared in 80 [71.5%] out of 112 ears. No improvement was noted in 32 ears for 9 months. Resistant and recurrent cases were managed with adenoidectomy and myringotomy alone or with insertion of ventilation tubes [VT]. Recurrence was noted more common with myringotomy alone than with ventilation tubes. Medical treatment failed in 32 ears. MEE recurred in 9 ears. VT was put in 41 ears. The hearing level improved with VT by 10-15 dB after first 3 months. All children with OME should be treated conservatively. It is cost effective and relieves MEE in about 70% of patients. The ears with OME that fails to resolve or recur should be managed with myringotomy and VT insertion or adenoidectomy.

Complications of nose and paranasal sinus disease

Background: Diseases of nose and paranasal sinuses can complicate to involve the orbit and other surrounding structures because of their close proximity. These diseases are usually infective or can be neoplastic in origin. Method: All the patients presenting in ENT or Eye Departments of Ayub Teaching Hospital during the one year study period who had complicated nose or paranasal sinus disease were included in the study. A detailed history and examination followed by CT scanning and laboratory investigations to assess the type and extent of the disease, was carried out. Results: Infections were the most common cause of complicated sinus disease 11 [75%]. The rest of the 4 [25%] cases were tumours. 12 [80%] of the cases presented with proptosis. In 1 of these 12 cases, there was complete blindness. In 2 [13%] of the cases there was only orbital cellulitis. Two of these patients had facial swelling and 2 had nasal obstruction and presented as snoring. Two patients presented with history of weight loss and these patients had malignant tumour of the paranasal sinuses. One patient presented with early signs of meningitis. In 1 case subperiosteal scalp abscess [Pott's puffy tumour] was the only complication noted. Conclusion: Nose and paranasal sinus diseases can complicate to involve mostly the orbit, but sometimes brain, meninges and skull bones can also get involved

Diurnal influence to the onset of preterm Delivery

To analyse the onset of uterine contractions and preterm delivery in order to document any diurnal influence. Hospital records of the patients admitted with the diagnosis of preterm labor were retrieved from January 2003 to February 2007 from Sobhraj Maternity Hospital, Karachi. Time of onset of uterine contractions establishment of preterm labor parity and gender of the baby was noted. Data was analyzed by SPSS version 10 for descriptive and inferential statistics. During the study period, 632 preterm deliveries were recorded. Precise timing of onset of uterine contractions was available in 340 [38.33%] deliveries. Uterine contraction leading to labor started from 2:00AM to 5:00AM and 397 babies delivered during the night / early morning [8:00 PM to 8:00 AM] and 235 babies were delivered during day [8:00AM to 8:00PM] [chi2 = 7.908; p= 0.004]. Among all babies delivered during night / early morning 311 [49.2%] were born between 2:00AM to 8:00AM. Preterm labours demonstrate diurnal rhythm. In most of the women, contractions started between 2:00AM - 5:00AM and most of the deliveries occurred from 2:00AM - 8:00AM

Analysis of tracheobronchial foreign bodies with respect to sex, age, type and presentation

Foreign body inhalation is one of the life threatening emergencies. It may happen at any age, however, most of these accidents occur in children especially below the age of five. This prospective study was done at Department of Otolaryngology, Head and Neck Surgery, Ayub Teaching Hospital, Abbottabad, from 1 January 2003 to 30 June 2005. a total of Eighty one patients, referred from the casualty and Paediatric unit with suspicion of tracheobronchial foreign body were included in the study. Eighty one were studied. Fifty [61.7%] were male and thirty one [38.3%] were female. Sixty three [77.8%] were below five years, thirteen [16%] were between five and fifteen years and five [6.2%] were above fifteen years. Sixty seven patients [82.7%], presented mainly with chocking, while fifty nine patients [72.8%] had stridor and forty five patients [55.6%] had cough at initial presentation. Seventy two [88.9%] patients had decreased air entry and forty two [51.9%] had wheeze on auscultation, whereas cyanosis was noticed in five [6.2%] patients. Peanut was the commonest foreign body, retrieved in forty five patients [55.6%]. Other foreign bodies were whistle [18.5%], maize seed [13.6%], bean seed [6.2%], nuts [2.55], sewing needle with thread, dice and denture [1.2%] each. Foreign body inhalation is more common in male patients, mostly below five years of age. Chocking is the commonest symptom and decreased air entry on auscultation is the typical examination finding. Peanut has been found to be the commonest type of foreign body

Significance and cost effectiveness of pre-operative routine laboratory investigations in young healthy patients undergoing elective ear, nose and throat surgery

Pre-operative preparation is an important component of surgical workup. Adequate clinical assessment to determine fitness for anaesthesia and surgery and to outrule possibilities of existing disease or risk factors against the procedure would suffice in elective surgery on healthy young patients. Still routine investigations are carried out following a protocol, that does not offer added benefit and is not cost effective. We evaluated one hundred and fifty young healthy patients planned for elective surgery, to compare adequate clinical assessment with results of routine investigations in such patients, in terms of significance and cost effectiveness. Significant co-relation was demonstrated between clinical assessment and routine investigations. Only 03 abnormal results were reported following 600 laboratory investigations on 150 patients. Thorough clinical assessment is mandatory for successful outcome of surgery. There is significant co-relation with routine investigations in elective Ear, Nose and Throat [ENT] surgery. Investigations should be restricted to where indicated by clinical assessment. Such policy will significantly reduce the costs and workload, thereby improving quality of health care system

Foreign body inhalation - site of impaction and efficacy of rigid bronchoscopy

Foreign body inhalation is a relatively commonly encountered emergency in otolaryngology. Foreign body can get lodged at any site from the supraglottis to the terminal bronchioles. Rigid bronchoscopy is one of the well established methods of removing inhaled foreign body with fewer complications. This prospective study was conducted in the Department of ENT, Head and Neck Surgery, Ayub Teaching Hospital, Abbottabad, from January 2003 to June 2005. The total number of patients was eighty one. Patients in whom a foreign body was retrieved, were included in the study. Foreign body was found in the right main bronchus in sixty patients [74.1%], left main bronchus in seventeen patients [21%], terminal bronchioles in two patients [2.5%] and one patient [1.2%] each in trachea and laryngeal inlet. Foreign body was successfully removed in seventy-nine patients [97.5%]. Nineteen patients [23.5%] had postoperative airway edema, one [1.2%] had trauma to the false cord and laceration of the posterior pharyngeal wall. It was concluded that the right main bronchus is the most common site of impaction of inhaled foreign body. Rigid bronchoscopy is very effective procedure for inhaled foreign body removal with fewer complications

Evaluation of efficacy of management protocol in allergic rhinitis

Allergic rhinitis represents a global health issue affecting between 10% to 25% of the world population, with increasing prevalence, resulting in a significant impact on quality of life, multiple comorbidities and the considerable socio-economic burden. Majority of the patients are younger than 30 years and it may be inherited. Symptoms typically occur as a result of exposure to dust, dander or certain seasonal pollen. Lack of standardized management protocol is one of the major factors responsible for poor control of this condition. This study was designed to evaluate the patients suffering with allergic rhinitis and manage them with a protocol based on the pathogenesis of the condition. Method: This prospective study was conducted in the Department of Ear, Nose and Throat and Head and Neck Surgery, Ayub Teaching Hospital, Abbottabad, over a period of two years [2005-2006], to assess the efficacy of a standard protocol of treatment developed and followed in the department. 1167 patients, clinically diagnosed as suffering with allergic rhinitis, were evaluated and managed. Age ranged from 08 months to 64 years. All the patients were prescribed medical treatment, divided into initial phase of 10 days to two weeks duration followed by a maintenance phase, and a regular follow-up schedule was maintained upto two years. 634 [54.32%] patients were male and 533 [45.67%] were female. Age ranged from 08 months to 64 years, 85% being between 05 and 45 years. 91% of patients had symptom duration of 06 months to 03 years. 96% of the patients were getting treated on as required basis, whereas 98% had no educational sessions with the treating doctor, especially regarding preventive measures. Typical presentation in most of the patients was nasal obstruction, runny and itchy nose, post nasal drip and bouts of sneezing. 90.57% patients reported improvement in symptoms. 53.21% patients had a relapse of symptoms at some stage during the study period. 37.53% patients had surgery done for associated pathologies, mostly a DNS. Compliance regarding medication was more than 90% in the initial phase of treatment that dropped to 50% in the maintenance phase. 93% of the patients tolerated the treatment well. Allergic rhinitis is a growing problem worldwide. Optimal treatment protocol is still lacking especially in the developing countries. Patient's education on avoidance of allergens must be stressed. Associated problems that may need surgical treatment. Regular follow-up must be ensured to monitor the progress of treatment as well as to identify patients who might be candidates for immunotherapy. Newer modalities of treatment need to be further explored. A team approach is mandatory in the presence of symptoms related to lower respiratory tract

Management outcome of secretory otitis media

Secretory otitis media is a common otological manifestation, that most of the time is left undiagnosed on account of unawareness and negligence in seeking early medical attention for trivial ailments. Untreated, it might end up in serious consequences in the form of poor speech and intellectual development and permanent anatomical disabilities within middle ear cleft, The objectives of the study were to determine most affected age group, the common etiological factors, to access the efficacy of medical and surgical treatment and finally to find out the complication associated with the surgical procedures. This study was conducted in the ENT, Head and Neck Surgery department of the Ayub Teaching Hospital, Abbottabad from January 2001 to December 2003.Only the diagnosed cases of SOM were included in the study. After detailed history, clinical examination, routine investigations and special investigations such as pure tone audiogram and tympanometry were carried out to confirm the diagnosis of SOM. All patients were initially treated by medical therapy. In cases of failure, underwent myringotomy with or without ventilation tube insertion and where indication present adenotonsillectomy and antral lavage was done. Follow up of cases was carried out from 18-24 months. It included 87 patients, 58 were males [66.6%] and 29 females [33.3%]. Majority of the patients were between 5-8 years [62%]. The most common aetiological factor was rhinosinusitis [36.7%] followed by hypertrophic adenoids [34.5%]. All patients were initially given medical treatment. Out of 87 patients,30 patients [34.4%] improved and 57 patients [65.5%] had no response and underwent surgery. Surgical procedures included myringotomy with and without ventilation tube insertion, adenotonsillectomy and antral lavage. It is concluded from this study that conservative treatment has a definite role and should be tried before any surgical step is taken however surgery is the treatment of choice in more resistant cases