Determinants of variable hearing loss in patients with chronic suppurative otitis media

To determine the impact of ear discharge, duration size and site of tympanic membrane perforation on hearing loss. Cross-Sectional prospective study. Baqai Medical College and Abbasi Shaheed Hospiatl, Department of Ear Nose and Throat and Head and Neck Surgery from December 2010 to November 2011. Sixty six patients of chronic suppurative otitits media [CSOM] aged between 09 to 60 years of age were included in the study. After history and examination, pure tone audiometry was done .Statistical analysis of the collected data is done using SPSS 16 program. Patients with 107 perforated tympanic membrane, 40 males and 26 females were included in the study. Bilateral tympanic membrane perforation were seen in 41 patients, right sided perforation in 10 and left sided in 15 patients respectively. Out of total 107 perforations, 58 were large central[54.2%]and 49 were small[45.8%]. 100 perforations [93.5%] were anteriorly located and 07 [6.5%] were posterior. The size of the perforation was not a determinant of hearing loss though the site of the perforation was associated with significant degree of hearing loss. Hearing loss increased with the chronicity of the disease. The location of perforation on the tympanic membrane and the duration of ear discharge have significant effect on the magnitude of hearing loss while the size of perforation does not affect the hearing level significantly

Retrosternal goitre, presentation and treatment outcome

To assess the clinical presentation, surgical out come and complications of retrosternal goitre [RSG]. A descriptive retrospective study. Departments of Ear Nose Throat and Head and Neck Surgery, Fatima Hospital Baqai Medical University and Civil Hospital Dow University of Health Sciences Karachi, between January 2002 to March 2008. Twenty seven patients of both gender and different ages of retrosternal goitre who under went for thyroidectomy between January 2002 to March 2008 were studied regarding their clinical presentation, and surgical outcome. Only two [7.4%] of our patients were presented with acute air way obstruction. Six [22.2%] patients were complained of dsypnoea only in supine posture, dysphagia and hoarseness were noticed in 3[11.1%] and 1 [3.7%] patients respectively while fifteen [51.5%] were asymptomatic apart from the obvious neck swelling. Total thyroidectomy was performed in twenty two [81.4%] cases and lobectomy with isthemectomy was done in five [18.1%] patients. CT scan was done in seven [25.9%] cases. Majority of our cases i.e. twenty five [92.6%] were benign while malignancy was noted in only two [7.4%] cases. Complications noted was haematoma formation in one [3.7%], recurrent laryngeal nerve injury in four [14.8%], hypoparathyroidism [transient] was recorded in three [11.1%] patients, and wound infection was observed in two [7.4%] patients. There was no mortality pre and post-operatively and no case of permanent hypoparathyroidism was noted where as only one patient had permanent unilateral recurrent laryngeal nerve injury. Retrosternal goitre is often asymptomatic and thyroidectomy is the treatment of choice with very low mortality and morbidity

Inverted papillomas of the nose and sinuses: clinical presentations, surgical treatment and outcome

To find the outcome of surgical management of inverted papillomas of the nose and paranasal sinuses. Case series. At Fatima Hospital Baqai Medical University and Usman Memorial Hospital Karachi, from June 2000 to July 2006. A total of 17 cases of inverted papillomas presented to us during the last six years, were managed and the outcome of their surgical treatment was reviewed retrospectively. Out of 17 cases 13 were male and 4 females. All the cases presented with unilateral nasal obstruction. Lateral rhinotomy and medial maxillectomy were the standard surgical procedure adopted for complete excision of the lesion. Two cases had wound infection, one with depressed ipsilateral facial deformity. In two cases recurrence occurred in the post-operative period. Wide surgical excision is the primary treatment modality of inverted papilloma to minimize the incidence of recurrence. Radiation therapy should only be considered in patients with incompletely respectable lesions, multiple recurrent lesions and tumours associated with malignancy

study of hearing levels in children of rural and urban setups

To assess the hearing levels of children belonging to two different environmental set ups. A Comparative analysis. ENT department Fatima Hospital, Baqai Medical University June 2006 to Nov. 2006. Study includes 100 students of Saleemullah Fahmi Primary School and equal number of Cadets of Baqai Cadet College Gadap. Hearing levels of these two groups of children were assessed and recorded with the help of pure tone audiometer [PTA]. It was found that the hearing levels of the students of Baqai cadet college were noticeably better i.e. 59/100 having normal hearing, hearing grade-I, and 41/100 having mild loss, hearing grade-Il, than the students of Saleemullah Fahmi primary school where 41/100 having mild loss i.e. hearing grade-I and 58/1 00 moderate loss hearing grade-Il and only 01/100 having severe bilateral loss i.e. hearing grade-III. The hearing assessments of 200 sample students from rural and urban background [divided into two equal groups] were found to have different levels of hearing without any detectable pathology in their hearing apparatus

Otogenic intracranial complication

Two patients one male of 25 years the other a girl of 10 years old presented to us with purulent ear discharge, severe hcadache and nausea/vomiting and amastoid abscess in one of them of few days duration. Otoscopy revealed purulent foul smell discharge filling the ipsilateral ears with X-ray mastoid showing a cavity due to bone erosion. Incision and drainage of mastoid abscess followed by radical mastoidectomy in one and radical mastoidectomy straight away in the other were performed with complete eradication of disease and chlesteatoma was achieved clinically. But within 16 hour in the young girl and after 12 days in the 25 years old male again both cases presented in emergency with sever headache, nausea/vomiting and disorientation. CT scan of both the cases revealed right temporal lobe abscess. The girl was already in ICU and the male was re- admitted for the drainage of abscesses under care of neurosurgeon and follow up was done in both the departments for four months

Transitional cell carcinoma of the nasal cavity

A 40 years old female presented with left nasal obstruction, sneezing and watery discharge for the last three months. Clinically left proptosis and widening of the nasal bridge was obvious while the left nasal cavity was full of multiple greyish grapes like polypoid masses which were painless and did not bleed on manipulation. CT scan revealed soft tissue mass occupying the left nasal cavity, maxilla, infra temporal fossa, ethmoid, sphenoid and the orbit. The mass was excised in toto through left Lateral Rhinology approach and histology examination revealed it to be a transitional cell carcinoma