Evaluation of aetiology and efficacy of management protocol of epistaxis

Epistaxis is one of the commonest medical emergencies. It affects all age groups and both sexes. The cause may be local or systemic but in majority it is spontaneous and idiopathic. Trauma is considered to be a major aetiological factor. Various treatment protocols are utilized to control epistaxis derpending upon the type, severity and cause of bleeding. This descriptive study was designed to evaluate the aetiology and efficacy of management protocol of epistaxis in a tertiary care setting. 313 patients underwent prospective evaluation by consultant and non-consultant doctors with considerable experience in Ear, Nose and Throat [ENT] emergencies management. Standard principles were followed in the management. This study demonstrated a bimodal distribution with incidence peaks in below 25 years and above 50 years of age. Males were affected twice more than the females [2.15:1.04]. Anterior nasal bleeding was noted in majority of the patients. Anterior nasal packing was the most effective method of controlling anterior epistaxis. While posterior bleeding was controlled by posterior nasal packing with Foley's catheter. The most common cause was found to be trauma, followed by hypertension. It may be concluded from this study that epistaxis is the most common ENT emergency, affecting all age groups. It has a bimodal age presentation and affects males twice more than females. Anterior bleeding is more common than posterior bleeding. Epistaxis may be controlled with chemical/electro-cautery if the bleeding point is visible. In case of failure to localize or access a bleeding point or profuse bleeding, anterior nasal packing can effectively control majority of epistaxis. Foley's catheter is a good option that can be used for posterior nasal packing. Gelfoam may be used for controlling epistaxis in cases of bleeding disorders, when there is mucosal ooze

experience of 42 cases of Bronchoscopy at Saidu Group of Teaching Hospitals, Swat

The objectives of our study were to find out the frequency in terms of age and sex of the patients, type and site of foreign bodies, clinical manifestations and management with rigid ventilating bronchoscope. It was a descriptive study carried out in the department of otolaryngology and head and neck surgery at Saidu Teaching Hospital swat, and was conducted from March 2005 to March 2006. A total of 42 cases collected from March 2005 to March 2006, admitted through casualty, OPD and referred by pediatric unit. All of them subjected to bronchoscopy as an emergency as well as an elective procedure. A total of 42 cases were included in the study. In 37 cases [88.09%] foreign bodies were removed successfully, while 4 cases [9.52%] were having no foreign body, only mucous plug was removed. One patient [2.32%] died due to cardiac arrest

Diathermy tonsillectomy vs conventional dissection tonsillectomy

To compare the conventional method of tonsillectomy, the dissection snare method with that of the newer procedure, bipolar electrodissection method. We studied 200 cases in two groups, hundred in each. In the first group the patients underwent tonsillectomy by dissection-snare method and in the second by electrodissection method. The results of the two groups were studied regarding the time taken in the procedure, blood loss during the procedure, postoperative analgesia required, reactionary hemorrhage, postoperative diet toleration and secondary hemorrhage. The average operation time was 14.2 minutes for diathermy group and 35 minutes for the dissection-snare group. Regarding the postoperative diet taken and reactionary heamorrhage the bipolar diathermy method is better, but there is no significant difference regarding the postoperative analgesia, postoperative pain and secondary hemorrhage. We concluded that bipolar electrodissection [diathermy] method is the superior method regarding the time taken during the procedure, the intra operative blood loss was lower and there was no need of ties [ligating the bleeding vessels] in the diathermy method