Extra nasal manifestations of fungal sinusitis in children

Objectives: To portray the extra nasal features of fungal sinusitis in children in southern Punjab [Pakistan]

Study design: A retrospective descriptive study

Place and duration: Conducted at two tertiary care hospitals Ibn-e-Sina Hospital Multan, teaching hospital affiliated with Multan Med and Dental College, CMH Multan and one private ENT hospital Javeria ENT hospital Mianchanu. Period of study was three years [Jan 2010-Dec 2012]

Methodology: Thirty children with age range of 5-12 years fulfilling the diagnostic criteria of fungal sinusitis treated within 3 years [Jan 2010 - Dec 2012] were evaluated retrospectively. Nineteen patients were referred from ophthalmology and pediatric units of different hospitals located in Multan region for otorhinological opinion. Eleven patients reported directly to ENT department with nasal symptoms. Clinical presentation, radiological, laboratory and operative findings were studied

Results: Mean age determined was 10.2. Males were affected more than female and majority of them belonged to underprivileged group. Most frequent extra nasal features were epiphora, proptosis, telecanthus and headache

Conclusion: Fungal sinusitis is misjudged in children. In absence of or minimal nasal symptoms diagnosis gets delayed leading to dreadful disease with poor outcome

Occupational noise induced heraing loss

Objective: To investigate hearing threshold of industrial workers and correlate between noise exposed and unexposed groups

Study design: An observational cross sectional study

Place and duration of study: Study was conducted at medical testing and research organization located at Islamabad from January 2010 to May 2010

Methodology: 50 industrial workers [Gp A] exposed to constant high level noise were integrated in study and compared with matched control group [Gp B]. Pure tone audiometry [subjective test] was carried out to measure the hearing threshold at various frequencies

Results: Hearing loss was more prevalent in group A. A characteristic dip of hearing threshold was noted at 4000 Hz in Gp A

Conclusion: Industrial workers are at higher risk of developing Sensor-neural hearing loss [SNHL] as compared to general population. These individuals can easily be picked in early stages by audiometry and appropriate protective measures advised to prevent or interrupt the silent progress of disease

Intramuscular ceftriaxone as single dose treatment of acute otitis media

To evaluate single dose intramuscular ceftriaxone as an option for the treatment of acute otitis media [AOM]. To compare efficacy of single dose intramuscular ceftriaxone to 10 days treatment with amoxicillin-clavulanate combination. Prospective, randomized, double blind control study. Combined Military Hospital Muzaffarabad, Azad Kashmir, over a period of 02 years from October 2006 to September 2008. A total of 148 freshly diagnosed cases of AOM between ages 03months to 6 years were recruited and divided randomly into two equal groups of 74 each using random numbers table. Group I was administered oral amoxicillin-clavulanate in a dose of 45mg/kg/day in three divided doses along with single intramuscular shot of placebo. Group II was given a single shot of intramuscular ceftriaxone in a dose of 50mg/kg along with placebo syrup thrice a day for 10 days. Patients were reassessed at day 03 and 11. Ninety four point five percent of patients responded to amoxicillin-clavulanate whereas 95.9% responded to single dose IM ceftriaxone. No significant difference was noted between the two types of treatments in term of disease outcome. Single dose intramuscular ceftriaxone can be another option for the treatment of AOM especially in children/parents with poor compliance

Reduced mouth opening following tonsillectomy in children: myth or reality

To evaluate whether tonsillectomy in children leads to subsequent reduction in mouth opening. Cohort study. Department of ENT/Head and Neck Surgery, Combined Military Hospital, Peshawar, from October 2005 to December 2006. A total of 42 children undergoing tonsillectomy [Group A = requiring insertion of a mouth gag] and 44 patients undergoing myringotomy or septoplasty [Group B = control group] were included in this cohort double blind study. Patients having pre-operative temporomandibular joint [TMJ] dysfunction, undergoing any other surgery in addition to tonsillectomy e.g. adenotonsillectomy, aged under 4 or above 15 years, and patients lost to follow-up were excluded. Painless, maximum interincisal distance [MID] was measured pre-operatively with a Vernier Calliper. Because of the inconsistency of mouth opening in children, three readings per individual were taken and the maximum recorded. Patients were followed up at 1, 2, 4, 12 and 26 weeks postoperatively in the ENT OPD and respective MID readings recorded. After a transient reduction in mouth opening, at the 26th week follow-up, 100% patients had reverted to their pre-operative MID measurements. Reduced mouth opening in children, after tonsillectomy is a transient finding returning to normal by about the 26th postoperative week

Post-tonsillectomy pain and bupivacaine, an intra individual design study

To compare whether an individual could appreciate the pain relief, if any, in either one of his/her tonsillar fossa topically suffused with a local anaesthetic [bupivacaine]. Randomized controlled trial. Department of ENT/Head and Neck Surgery, Combined Military Hospital, Peshawar, from January to June 2007. Forty-six patients of either gender, aged 10-42 years undergoing tonsillectomy for recurrent tonsillitis were enrolled for this study. At the end of surgery, having secured haemostasis, one tonsillar fossa was randomly packed with a gauze piece soaked in 3 ml of 0.5% bupivacaine for 5 minutes, while the other was not. Effects of postoperative analgesia were assessed using visual analogue scale [VAS] up to 8 hours. Majority of the patients [85%, n=39] failed to experience an appreciable pain relief on the side of local anaesthetic [bupivacaine] application [p=0.006]. Topical application of local anaesthetic [bupivacaine] confers no appreciable pain control in post-tonsillectomy patients

Efficacy of rifampicin in eradication of carrier state of staphylococcus aureus in anterior nares with recurrent furunculosis

To compare the frequency of detection of Staphylococcus aureus carrier state in anterior nares of the patients suffering from recurrent furunculosis with the normal population and to determine the efficacy of rifampicin in eradication of the carrier state. Quasi-experimental study. Skin Department of Combined Military Hospital, Peshawar and Multan, from March 2004 to December 2005. Patients and The study consisted of 80 individuals. They were placed in two groups. Group I comprised of 40 patients suffering from recurrent furuncles and group II included 40 healthy adults, kept as controls. Nasal swab was taken from the individuals belonging to both the groups, when they first reported to skin OPD. The patients who were suffering from furuncles were treated with co-amoxiclav 375 or 625 mg three times a day. The patients in whom S. aureus carrier state was detected were again divided into two groups. Group 1 was prescribed rifampicin 450-600 mg daily [depending on the body weight] for 10 days, while the group 2 was not offered any treatment. After this course, a second nasal swab was taken and submitted for cultures. Among the 40 patients belonging to group I, S. aureus carrier state was detected in 23 [57.5%], while in group II the carrier state was found in 8 [20%] individuals [p <0.001]. Among the 13 patients who received rifampicin, 10 got cured of carrier state, while in 3 patients nasal swab was still positive after a course of rifampicin. In 10 patients, who were not offered any treatment, the nasal swabs remained positive [p<0.001]. These patients were followed-up in skin OPD for another 3 months, and did not develop any recurrence of the infection. Nasal swab for detection of S. aureus carrier state should be done in all patients of recurrent furunculosis. If the nasal swab culture is positive, then as the infection gets cured, the patients should receive a course of rifampicin for 10 days. This may eradicate the carrier state in majority of cases and prevent the recurrence of the infection