Aetiological and predisposing factors of sinonasal - fungal infections in our setup

Objective: The aim of the study is to find out the aetiological and predisposing factors of sinonasal fungal infection, its comparison with other countries and its treatment in our set up

Study Design: It is a cross-sectional [observational study]

Methodology: This study was carried out in the Department of Ear Nose and Throat at Shaikh Zayed Postgraduate Medical Institute, Lahore from April 2011 to October 2012

Results: A total of 30 patients were included in this study with signs and symptoms suggestive of chronic sinusitis, chronic sinusitis with systemic diseases, with long term medication and with complications over a period of six months 30 patients were included in the study. Sixteen were male [53.3%] and 14 female [46.7%] patients. The age range was from 13 years to 60 years. Mean age was 35 years. Fungal cultures were positive in 94% of patients. Twelve patients had aspergillosis and 16 patients had mucormycosis. Common underlying systemic diseases included uncontrolled diabetes, hepatitis, renal failure and patients on long term steroids

Conclusion: Dust pollution, humidity and poor ventilation are the common predisposing factors for fungal sinusitis especially allergic and non-invasine types. Mucormycosis is the commonest agent in fulminant type

Comparison of timolol alone with fixed combination of latanoprost/ timolol to control intra-ocular pressure in primary open angle glaucoma

To evaluate the effectiveness of Timolol only and fixed combination Latanoprost- Timolol in lowering intraocular pressure in patients with primary open angle glaucoma. Comparative Randomized Controlled trial This study was conducted at Institute of Ophthalmology, Mayo Hospital, Lahore over a period of one year from January 2012 to December 2012. Total 80 patients were selected by Non-Probability Purposive Sampling technique after fulfilling inclusion and exclusion criteria. After informed consent these patients were divided into two groups by random number table. Group-I consisted of 40 patients which were put on topical Timolol therapy one drop in each eye twice daily. Group-II consisting of 40 patients was put on topical fixed combination Latanoprost-Timolol therapy, one drop once daily in both eyes. On each follow-up visit all patients were assessed by monitoring intraocular pressure with Goldmann Applanation Tonometer. The follow up examinations were scheduled at one week, one month, and three months from the start of therapy. Later on, all patients were followed for at least 6 months and according to requirement they underwent modification in medication or surgical procedure. At the end of study, mean reduction of intraocular pressure from baseline in Group- I [using 0.5% Timolol twice daily] was 6.7 mm of Hg [27.57%] and the mean reduction of intraocular pressure in Group-II [using Fixed Combination Timolol-Latanoprost once daily] was 7.9 mm of Hg [32.24%]. The effectiveness i.e. reduction of intraocular pressure by 30% from baseline was noted among 32.5% patients in Group-I and 70% patients in Group-II. Latanoprost-Timolol fixed combination is well tolerated, convenient and an effective ocular hypotensive agent than Timolol alone in lowering IOP in primary open angle glaucoma

Management of otitis media with effusion in children suffering from allergic rhinitis

Otitis media with effusion is a pathological condition of the middle ear in which sterile effusion is presented behind the non-perforated Tympanic Membrane. This prospective study was conducted during period from July 2007 to June 2011. One hundred and sixty children of age group between one to ten years were included in study. After starting the treatment for Allergic Rhinitis they were followed up at the intervals of 1, 2, 4, 12 weeks, 6 month and one year. Detailed ENT examination along with tuning fork tests, pure tone Audiometry and Tympanometry were performed on every visit. In suspected cases of having effusion we performed Myringotomy and Grommet insertion for confirmation of diagnosis and to resolve the effusion. We found that allergic rhinitis leading to upper respiratory tract infection was a prime factor as the cause for Otitis media with effusion. myringotomy and Grommet insertion causes aeration and drying of fluid

Unusual presentation of episodic inspiratory stridor "paradoxical vocal fold motion" its awareness and management

Back Ground: stridor is always terrifying entity and presentation of such patient in clinic is Dire emergency. Majority of these cases are dealt with empirical medicines like steroids and antihistamines, but sometimgs patients need surgical intervention like Tracheostomy or Endotracheal intubation to save the life. Paradoxical Vocal Fold motion is a relatively uncommon in routine Otolaryngological practice. So it can be easily confused with Bronchial Asthma or upper air way obstruction like Laryngeal oedema. Due to rare occyrrence and requirement of special diagnostic fiber optic instruments, the final diagnosis can be difficult. Management of paradoxical Vocal Fold Motion is discussed in this original article. Common mistake which is being done by many Otolaryngologists is treatment with Steroids which may worsen the disease. The aim of this study is to increase the awareness about Paradoxical Vocal Fold Motion regarding management with review of literature

Aim: aim of study is to document the etiological factors and treatment modalities of patients presenting with inspiratory stridor in Paradoxical vocal card motion

Setting and design: retrospective study in two teaching Hospitals

Material and methods: records of patients presenting with inspiratory stridor at outpatient and in emergency between 2007 and 2010 were analyzed

Results: paradoxical vocal fold motion constitutes 77% of inspiratory stridors. Male to female ratio was 1:2.4. Among the etiological factors were sinusitits, allergic Rhinitis, Gastro esophageal reflux disease, Psychogenic and exposure to irritants. Conservative treatment was sufficient in all of these cases, none of these patients required intubation or tracheostomy

Unusual oropharyngeal foreign body

We present an unusual case of foreign body [sewing needle] in a young man, who swallowed it with bolus of food. It penetrated through soft palate into parapharyngeal space, detected with image intensifier and removed successfully. Postoperative course remained uneventful

Management of deviated nasal septum by septoplasty

This is a prospective study for the management of deviated nasal septum by septoplasty. Fifty patients in age group 4-40 years were selected for this study. There were 34 male 68% and 10 females 32%. All cases had deviated nasal septum with or without external cartilaginous deformity of nose. Major etiological factor causing deviated nasal septum was idiopathic or developmental in our study. After thorough preoperative and peroperative assessment all patients were operated upon by septplasty under general anesthesia at Shaikh Zayed Hospital Lahore. The success rate in 50 patients was evaluated with minimum follow up period of 8 weeks. The present study showed improvement in nasal obstruction 84%, post nasal drip 73%, headache 70% hyposomia in 58% and external nasal deformity of nose with deviated nasal septum 83% by septoplasty. The results were obtained by comparing the pre and post operative complaints with rhino logical examination. Regarding post operative complications septal adhesions were noted in 8 p atients [16%] septal perforation [1%] secondary hemorrhage in 2 patients [4%] and 6 patients had residual deviated nasal septum [12%]. From this study it was concluded that conservation at the septal frame work rather than resection is much better as it gives lesser complications, allows concomitant rhinoplasty or revision surgery and conservative surgery can be safely performed in children without fear of poor development of midface. The objective of this study was to assess the results and complications of the septoplasty

Treatment of allergic rhinitis by 25% silver nitrate cauterization

A series of 50 patients were closely assessed prospectively to determine the effectiveness, untoward effects and patient acceptance of new method of treatment of allergic rhinitis by 25% silvernitrate application. Age range was 14-45 years except one who was 55 years old. This study describes the technique, uses and results obtained following the application of 25% silvernitrate on the inferior turbinate in patients with allergic rhinitis. Each patient was evaluated regularly which based on both subjective response and clinical examination. We selected only patients having complain of nasal obstruction [92%], rhinorrhoea [82%] and sneezing [88%]. Silvernitrate 25% was used after topical anaesthesia 4% xylocaine with adrenaline and three applications were used after interval of one week. Successful relief was obtained with improvement in nasal obstruction [86%] sneezing [84%] and rhinorrhoea [68%]. Regarding complications no major complication were noted except, mild to moderate pain, nasal congestion and inc reased rhinorrhoea and all were temporary for one or two days and relieved by taking analgesics. In this study we found in follow up 4 patients still had nasal obstruction [8%], 7 patients with rhinorrhoea [14%] and sneezing in 2 patients [4%]. This new method was found to be simple, easy and effective. It is based on the astringent effect of local application of silvernitrate solution

Rhinocerebral mucormycosis - an uncommon but deadly disease

Mucormycosis is caused by fungi of the order Mucorales and is one of the most rapidly fatal fungal infections known to man. Rhinocerebral mucormycosis is the most common type and its extension to the orbit and brain is quite usual. Location of mucormycosis on the palate is a rare and late occurrence. Rhinocerebral mucormycosis is an invasive fungal infection initiated in the paranasal sinuses that frequently progresses to orbital and brain involvement. If recognized early, involvement is limited to the nasal cavity and paranasal sinuses. Diabetics in poor control are at greatest risk, however, any immunocompromised individual may be infected. We present here two cases of mucormycosis with different presentation and outcome. By presenting these case reports we would like to point out that mucormycosis should be included in the differential diagnosis of hard palate ulcers and orbital cellulitis. They also illustrate the clinical course of this unusual, but potentially fatal, fungal infection. Taxonomy, clinical presentation, diagnosis, and management of mucormycosis of the paranasal sinuses are reviewed in detail