Functional endoscopic sinus surgery as a primary modality of treatment for primary and recurrent nasal polyposis

Objectives: To describe the efficacy of Functional Endoscopic Sinus Surgery [FESS] in our set up in comparison with other published studies to treat primary and recurrent nasal polyposis

Method: This descriptive study was conducted in 02 years at Ear Nose Throat Department Combined Military Hospital [CMH] Multan from October 2013 to October 2015. Convenient sample comprising 116 patients of both sexes of age group from 18 to 60 years were selected from ENT Out Patient Department, with documented diagnosis of nasal polyposis that underwent functional endoscopic sinus surgery. Out of 116 patients, 15 [12.9%] had recurrent nasal polyposis while 101 [87.1%] had primary nasal polyposis. Patients were assessed clinically. Preoperative nasal endoscopy and CT scan of nose and paranasal sinuses were performed in every patient to assess the extent of disease and evaluate the surgical anatomy. Patients were followed up 03 monthly, 06 monthly and after 01 year. Clinical signs of nasal polyposis were evaluated by nasal endoscopy at each follow up visit

Results: There were 116 patients with documented diagnosis of nasal polyposis. Among these, 75 [64.7%] were male and 41 [35.3%] were female patients. Mean age of presentation in males was 39.1 years and that of females was 36.7 years. Only 15 patients [12.9%] developed recurrent disease within a year

Conclusion: Functional endoscopic sinus surgery is preferred as a primary treatment modality for primary and recurrent nasal polyposis. Mucosal polyps can be carefully debrided, the natural ostia enlarged, the ethmoid sinuses are unroofed, and sphenoid sinuses are opened in nasal cavity and sinus nasal mucosa is mostly preserved due to excellent visualization and surgical technique. Improvement in symptoms with minimal chance of recurrence may be expected in more than 90% patients

Patterns of nasal trauma during close combat training in military training institutions

Objective: To identify the patterns and optimum management of nasal trauma during close combat training in military training institutions. Study Design: Descriptive study

Place and Duration of Study: The study was conducted in ENT department, Combined Military Hospital Abbottabad from August 2007 to July 2010

Material and Methods: All patients who reported with nasal trauma during the training were included in the study. A total of 200 cases were studied. They were all males and their ages were between 16 to 24 years

Results: The most common presentation of nasal trauma was epistaxis [92.5%] while 7.5% of cases were having no nasal bleed. Nineteen percent cases had external deviation of nasal axis while only 17% revealed inferior turbinate injury after initial treatment. Septal hematoma was present in 15% and was drained immediately in all cases. Nasal bone fracture was present in 36.5%. Anterior nasal packing was sufficient to stop nasal bleed in 80% cases of episatxis while 20% cases of nasal bleed required post nasal packing

Conclusion: The close combat techniques in army training institutions have increased the risk of nasal trauma and many different patterns of this trauma have been identified. Addressing the epistaxis, septal heamatoma and fracture nasal bone reduces the chances of complications

Comparison of permeatal medial placement of graft without raising the tympanomeatal flaps to conventional methods of myringoplasty: an experience at tertiary care hospital in Pakistan

Objective: To compare the results of permeatal approach without raising the tympano-meatal flap to end-aural or post-aural approach in myringoplasty

Methods: This Quasi-experimental study was carried out in CMH [Combined Military Hospital] Peshawar, from August 2006 to July 2013. Three hundred fifty patients of chronic suppurative otitis media [CSOM] with dry central; small, medium and large perforations were selected

They were divided into two groups depending upon the type of approach. In Group-A [n-200]; permeatal approach without raising tympano-meatal flap was used; while in Group-B [n-150] end-aural or post-aural approach was used. Subjects were followed up for two years; graft take was checked regularly by examinations of ear under microscope. Data was collected on structured Performa and analysed by SPSS-17

Results: Male and female were 74% and 26% respectively; Age ranged from 15 to 46 Years. There was no significant difference in the graft success at the end of two years in Group-A [80%] and Group-B [85%] [p-0.261]. Type of approach had a significant impact on duration of surgery [p<0.001] and post-operative recovery time [p<0.001]

Conclusion: The permeatal approach and end-aural/post-aural approach had almost equal graft success rates, but former is more useful as it causes lesser morbidity, decreased post-operative hospital stay and reduced operative time. It is under-utilized and should be employed more frequently

Son preference in Pakistan: M Myth or reality

Objective: To analyze desire for sons/daughters among ladies of Peshawar, Pakistan, with a view to rule out son preference and to study impact of various demographic characteristics on the subject

Methods: Cross-sectional descriptive study conducted at Combined Military Hospital, Peshawar, from August 2015 - January 2016; sampling technique was random/probability/non-purposive. Self-designed questionnaire was utilized; carrying questions pertinent to desire for sons/daughters during marital life, and demographic details. Data analyzed via descriptive analysis [SPSS-21], expressed as frequencies/ percentages and mean +/- standard deviation [minimum/maximum]

Sons and daughters desired [dependent variables] were cross-tabulated with independent variables

Results: Response rate was 63.25% [n-506]

Data revealed following: Sons desired 3.05 +/- 2.061[1/12]; Daughters desired 1.15 +/- 0.767[0/4]; 6.1%[n-31] and 0.6%[n-3] desired infinite number of sons and daughters respectively, 18.2%[n-92] did not desire to have even one daughter, while 2.2%[n-11] considered it immaterial to have daughters or sons

There was a significant relation between sons desired and client's education [p<0.001], husband's education [p<0.001] and socioeconomic class [p<0.001]. There was no significant impact of religion [p-0.142] on desire for sons. Impact of independent variables on daughters desired was similar but less pronounced

Conclusion: There was candid son preference among the respondents. Gender discrimination can be attenuated by adequately addressing son preference at all tiers

Trends of contraception among ladies of local population in Pakistan; why, how, when and what?

Objective: To analyze trends of use of methods of contraception along with study of impact of various demographic and social factors on contraception in Peshawar, Pakistan

Methods: A cross-sectional descriptive study with random purposive sampling was conducted at Combined Military Hospital Peshawar, from Mar 2015-Nov 2015. Self-designed questionnaire with demographic details and questions pertinent to contraceptive practices was utilized as study instrument. Females reporting to concerned hospital for contraceptive advice and prescription were distributed with questionnaire and written informed consent form. Formal approval was taken from ethical committee of hospital. Data was analyzed via descriptive analysis [SPSS-21], qualitative data was expressed as frequencies and percentages; quantitative as mean +/- standard deviation [SD]. Main outcome variable i-e contraceptive device used; was cross-tabulated with independent variables

Results: Response rate was 53.2% [n-426]. Usage of contraceptive device was as follows; 51.2% Nil, 9.4% barriers, 22.3% oral/injectable hormones, 13.4% IUCDs, 3.8% sterilization. There was a strong relationship between type of contraceptives used and age [p<0.001], client's education [p<0.001], husband's education [p<0.001], number of children [p<0.001], religion [p0.013], socioeconomic class [p<0.001], and religious beliefs about use of contraceptives [p<0.001]. More Muslims considered contraception irreligious than non-Muslims [p 0.02]. There was no significant impact of husbands' pressure to not to use contraceptives on type of contraception practised [p 0.114]

Conclusion: Contraceptive devices are under-utilized in the study participants. Multidisciplinary approach should be applied to enhance client education, awareness and counseling to utilize these devices more appropriately and regularly

Pharyngeal Pouch co-existing with Thyroid Mass: a rare presentation

A 60-year male presented with a 4-year history of a mass in the lower third of the neck, which had gradually increased in size. On initial examination, it was considered a thyroid mass. On detailed examination, another mass was found in the upper neck which was doughy in consistency and reducible in size. With available investigations, he was diagnosed as a thyroid mass associated with pharyngeal pouch. On exploration of the neck, the whole mass revealed to be a pharyngeal pouch. We have discussed the patho-physiology of the pharyngeal pouch and reviewed the literature in detail

Role of pre-operative assessment on the results of rhinoplasty in terms of patient satisfaction

The objectives of the study was to find out the importance of preoperative psychological assessment of patients in rhinoplasty and significance of excluding patients with psychiatric disorders, particularly Body dysmorphic disorder [BDD], on the overall results of surgery in terms of patient satisfaction. Randomized control trails [RCT]. This study was carried out at ENT out patients department [OPD], PNS Shifa and CMH Okara from January 2004 to Dec 2007. Patients complaining of nasal deformity with or without nasal obstruction were included in the study. A total of 85 [47 females and 38 males] patients were selected. After detailed history, examination and counseling 45 patients were selected by simple random method for psychological assessment and 40 patients not to have psychological assessment. The psychiatrist used DSM-IV TR criteria for psychological assessment and diagnosed 08 patients to be suffering from BDD and did not clear them for cosmetic surgery. Thirty seven patients being cleared for rhinoplasty [group A] and 40 patients [group B] not having psychological assessment, a total of 77 patients [42 females and 35 males] were offered cosmetic rhinoplasty. Patients were followed up for 01 year to check whether they were satisfied or not with postoperative results. The statistical data in the two groups was separately analyzed. Then by applying chi-square test the association in both the groups was calculated. Postoperatively 36/37 patients in group A were satisfied with their postoperative appearance and 32/40 patients in group B were satisfied. Chi-square test revealed the probability of <0.005, which is significant. Preoperative psychological assessment of patients has a significant role in patients undergoing cosmetic rhinoplasty as far as postoperative appearance is concerned