Comparison of Needle Aspiration With Incision and Drainage in the Management of Patients Presenting with Peritonsillar Abscess

To compare the efficacy of needle aspiration with incision and drainage in the management of Peritonsillar abscess. This study was carried out at Ear, Nose, Throat and Head and Neck Surgery Department of Tertiary Care Teaching Hospital at Rawalpindi from August 2007 to July 2009. Total of 60 patients with diagnosed Peritonsillar abscesses were included in the study. They were divided into two groups A and B, each consisting of 30 patients. Needle aspiration was done in group [A] whereas patinets in group B were treated with incision and drainage. All the patients received the same parenteral antibiotics and analgesics. Patients were observed for reoccurrence of disease, fever, pain, oral intake, duration of stay in hospital. The mean age of patients in both groups was 20.7 [SD +/- 7.3] years. Four [13%] patients developed reoccurrence in group A after needle aspiration and were subjected to incision and drainage. Two of them again developed reoccurrence and required interval tonsillectomy. In group B, 3 [10%] patients developed reoccurrence after incision and drainage and all of them needed interval tonsillectomy. Twenty six [86.6%] patients in group A were afebrile at 24 hrs after treatment whereas in group B, 29 [96.9%] patients had no fever. Twenty five [83.3%] patients in group A were pain free at 24 hours while in group B, the number of pain free patients were only 16 [53.3%]. Seventeen patients [56.6%] in group A began to take solid diet at 24 hours while none had taken solid diet in group B after that interval. The duration of hospital stay in group A was 27.6 hours [SD +/- 15.1] while it was 76.9 hours [SD +/- 116.3] in group B. Needle aspiration is as effective as Incision and drainage in the management of peritonsillar abscess

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

Effect of ear surgery on bone conduction thresholds of patients with chronic middle ear disease

To determine the effects of surgical treatment on bone conduction thresholds in patients with chronic middle ear disease. This prospective quasi experimental study included 83 patients of chronic middle ear disease, which were surgically treated at the department of otolaryngology of a tertiary care teaching hospital in Rawalpindi, between May 2007 to May 2010. The preoperative and postoperative bone conduction thresholds were obtained one day before and six months after the surgical procedure and the data was analyzed in various ways to determine any statistical difference by applying paired t test. Statistical significance was accepted if p value is <0.05. Statistically significant deterioration in mean bone conduction thresholds was found only with radical mastoidectomy at 4000 Htz. There was no change in mean bone conduction thresholds in 68 [82%] of patients. A total of 7 [8.4%] patients showed improvement whereas 8 [9.6%] patients showed worsening of postoperative bone conduction thresholds. Mean improvement in bone conduction thresholds was 16.25 db [range 10 to 22.5 dB] whereas mean deterioration of 14.68 dB [range 10 to 30 dB] were noted. The surgical treatment of chronic middle ear disease does not affect bone conduction thresholds in majority of the patients

Comparison of over-underlay and underlay techniques of myringoplasty

To compare the success rate of over-underlay and underlay techniques of myringoplasty regarding rate of graft acceptance, hearing improvement and complications. Quasi-experimental study This study was conducted at the Department of Otorhinolaryngology and Head and Neck Surgery, Foundation University Teaching Hospital, Rawalpindi from 1st January 2003 to 31st December 2005. Clinical records of patients who underwent myringoplasty by either over-underlay or underlay techniques in the past three years were analyzed. A total of 62 patients who had dry central tympanic membrane perforations of various sizes secondary to chronic tubotympanic suppurative otitis media were included in the study. These patients were divided into two groups. In group A [study group], 34 patients were included in which tympanic membrane was repaired by using over-underlay technique of myringoplasty whereas group B [control group] comprised of 28 cases of myringoplasty in which underlay technique was used. The results of two techniques were compared in terms of graft success rate i.e., full take or failure to takeup, medialization or lateralization of graft within 6 months of operation and improvement in hearing at the end of 6 months of follow up. In group A, graft success was noted in 32 [94.1%] cases compared to 26 [92.8%] in group B [p <0.05]. Medialization of graft was seen in only 1 [2.9%] case in group A whereas it was noted in 5 [17.8%] patients in group B [p >0.05]. Lateralization of graft was not observed in any case in either group. As far as hearing improvement is concerned, the mean air bone gap closure was 10.8 dB [SD+ 5.56] in group A compared to11.3 dB [SD+5.84] in group B [p < 0.05]. Over-underlay technique of myringoplasty is equally effective to more commonly practiced underlay technique in terms of graft take and hearing improvement. As far as complications are concerned, over-underlay technique is associated with less chances of graft medialization

Treatment of iatrogenic bilateral adductor vocal cord immobility by endoscopic posterior transverse cordotomy with cutting diathermy

To access the efficacy, safety and complication rate of posterior transverse cordotomy with electrocautry in the treatment of iatrogenic bilateral vocal cord immobility. This prospective quasi-experimental study included 12 female patients with iatrogenic bilateral vocal cord immobility after thyroid surgery, which came to outpatient clinic of department of otolaryngology of a tertiary care teaching hospital in Rawalpindi, between January 2004 to December 2007. In all patients, endoscopic posterior transverse cordotomy was done with electrocautry under general anesthesia. These patients were followed up for six months and accessed for decannulation rate, postoperative voice and complications. Nine out of 12 patients [75%] had successful decannulation on 3rd postoperative day. Only two [16.6%] required revision surgery on opposite vocal cord and were decannulated making overall decannulation rate of 91.6%. Postoperative voice analysis showed that eight patients [66.6%] had 'better' voice, three [25%] had 'same' whereas only one patient [8.3%] had 'worse' voice. Postoperatively, six patients [50%] had no dyspnoea, five [41.6%] had mild and one [8.3%] patient had severe dyspnoea. None of the patients had aspiration or swallowing difficulty. The whole procedure took 8 to 19 minutes with mean duration of 10.6 minutes. Treatment of iatrogenic bilateral vocal cord immobility with electrocautry can produce adequate postoperative airway and voice. This procedure is safe and not associated with any significant complications

Effect of noise pollution on hearing of public transport drivers in Lahore city

To study the effects of noise pollution on hearing of public transport drivers of Lahore city. It was a cross-sectional, descriptive study carried out at ENT Department, Sir Ganga Ram Hospital, Lahore, from February 1st, 2003 to June 31st, 2003. One hundred drivers of public transport, driving in Lahore city for more than 8 - 10 years were included in the study. These included 25 autorickshaw drivers, 25 taxi car drivers, 25 wagon drivers, and 25 bus drivers. All subjects were questioned according to a Performa. After wards ENT examination was carried out, followed by Pure tone audiometery. The mean age of the drivers was 41.35 years. Most of them [51%] were driving from last 8 - 10 years. 65% of the subjects had noise induced hearing loss. [NIHL] 25% had normal hearing threshold and 10% had disabling hearing loss. Public transport drivers are exposed to excess noise on roads in Lahore and most of them are suffering from noise induced hearing loss

Paediatric tympanoplasty: anatomical and functional results

To analyse outcome of tympanoplasty in children is with regard to graft success rate and hearing improvement. Interventional and descriptive. ENT department of Fauji Foundation Hospital, Rawalpindi, from March 2003 to November 2005. Thirty three children between the ages of 8 to 14 years undergoing 37 tympanoplasties. All of them had dry central tympanic membrane perforations of various sizes secondary to chronic tubotympanic suppurative otitis media. Post auricular approach and underlay technique of tympanoplasty was used to repair the tympanic membrane perforation in all cases. They were then followed up at monthly interval for up to at least 6 months.During that period, they were observed for the development of complications like graft failure, lateralization of graft and atelactasis. At the end of 6 months of follow up, pure tone audiogram with air and bone conduction thresholds was repeated to evaluate the change in air bone gap i.e., the difference between the average pre- and postoperative air bone gap at 0.5, 1 and 2 kHtz. Results were statistically analyzed with paired sample t test using statistical soft ware package SPSS 10.0.Thirty four out of 37 operated ears had full graft take at 6 months of follow up resulting in graft success rate of 91.9%.Average air bone gap closure was 13.5 dB [range 5 to 33.3 dB]. The change in pre and post-operative air bone gap was found to be statistically significant [p< 0.05]. Tympanoplasty proved to be a useful intervention in children age 8 to 14 years. The procedure gave good anatomical and functional results

Microbiology and drug sensitivity patterns of chronic suppurative otitis media

To identify the commonest microorganisms associated with chronic discharging ears and their antimicrobial sensitivities. Design: Descriptive study. Place and Duration of Study: This study was carried out from August 2003 to February 2004 at the Department of Otorhinolaryngology and Head and Neck Surgery, Fauji Foundation Hospital, Rawalpindi. Materials and A total of 124 patients with unilateral or bilateral active chronic suppurative otitis media attending the outpatient clinic were included in the study. All patients were evaluated through detailed history and clinical examination. Pus samples were collected from the discharging ear[s] and sent to the hospital laboratory where culture and sensitivity studies were done for aerobes, anaerobes and fungi and antibiotic sensitivity patterns. Overall microbiology of 142 samples was studied. Among them, 108 [76%] were pure cultures and 34 [23.9%] were mixed. There were 186 isolates including 182 [97.8%] aerobes, nil anaerobes and only 4 [2.1%] fungi. Pseudomonas aeruginosa 94[50.5%] was the most common isolate, followed by Staphylococcus aureus 44 [23.6%]. Drug sensitivities pattern of Pseudomonas aeruginosa showed that ciprofloxacin was active against majority 95.8% of isolates followed by amikacin 83.3%, gentamicin and tobarmycin 60% and cefotaxime 41.6%. Staphylococcus aureus isolates were resistant to penicillin, ampicillin and amoxicillin in 77.2% whereas majority was sensitive to coamoxiclav 81.8% and cephradine 86.3%. Commonest organisms isolated from chronic discharging ears were Pseudomonas aeruginosa and Staphylococcus aureus. Majority of isolates of Pseudomonas aeruginosa were sensitive to ciprofloxacin. Majority of strains of Staphylococcus aureus were resistant to penicillin. Cephradine and coamoxiclav were effective against most of the isolates of Staphylococcus aureus