Unilateral Meniere's disease; intra tympanic injection of low dose gentamicin in the treatment

ABSTRACT: Meniere's disease is chronic progressive disease with unclear idiopathic etiology and symptomatic improvements with treatment

Objectives: To analyze the efficacy of low dose intratympanic injection of gentamicin for vertigo control in unilateral Meniere's disease. Study Design: Quasi experimental study. Settings: Department of ENT, PIMS, NESCOM and IMDC Islamabad

Materials and Methods: Gentamicin was used intra tympanically in this multicentre study of 75 patients over a period of 8.5 years between 1[st] January 2005 to 30[th] June 2013 in definite Meniere's disease according to the 1995 Document of American academy of otolaryngology- Head and Neck Surgery [AAO-HNS].All these centers followed same criteria and procedures. Single dose of 1 ml Gentamicin solution 40 mg/ml was instilled in the middle ear through the grommet under microscope and followed up for 3 months and two years. The staging of disease [hearing thresholds] the degree of disability [frequency of attacks per month] and the functional level were assessed before and after treatment

Results: Among 75 patients, 41 were female and 34 were males between age ranges of 25 to 70 years. Most of the patients in the study had stage 2 [23/75] and stage 3 [41/75] Meniere's disease. About 68[91%] patients were having good control of vertigo at the end of two year of intratympanic gentamicin without any loss of hearing

Conclusion: A single Low dose intratympanic gentamicin is effective in controlling vertigo in patients with Meniere's disease with no further deterioration in hearing for at least two years follow up

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

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