Comparison of nasal patency following submucosal resection of inferior turbinate and total inferior turbinectomy

To compare the nasal obstruction following submucosal resection of inferior turbinate versus total inferior turbinectomy in patients with enlarged inferior turbinate. Randomized control trial CMH Rawalpindi from June 2007 to November 2007. Sixty patients of both gender clinically diagnosed to have inferior turbinate hypertrophy with history of nasal obstruction, not responding to medical treatment, having age >12 years with no history of previous nasal surgery were selected by convenience sampling. Thirty patients were treated by total inferior turbinectomy and thirty cases were treated by submucosal resection of inferior turbinate and results in terms of relief of nasal obstruction based on VAS [Visual Analogue Score] were observed with follow-up carried out at three weeks. Out of 30 cases managed by total inferior turbinectomy 83% cases showed marked improvement, and 17% had mild improvement in nasal obstruction 3 weeks after surgery. Among patients managed by submucosal resection 80% had marked, 17% had mild and 3% had no improvement of nasal obstruction. Submucosal resection of inferior turbinates and total inferior turbinectomy are almost equally effective for relief of nasal obstruction in patients with hypertrophic turbinate

Comparison between efficacy of 4% boric acid and 1% clotrimazole in treatment of otomycosis

To compare the efficacy of 4% boric acid solution in alcohol and 1% clotrimazole in treatment of otomycosis. Randomized control trial. ENT department, CMH Rawalpindi from 21 July 2007 to 20 January 2008. In this study, 252 patients of otomycosis were selected through random sampling technique. Selected patients were allocated into two equal groups; A and B. Group [A] was treated with topical 4% boric acid solution in alcohol ear drops and Group [B] was given 1% clotrimazole ear drops for control of otomycosis. Comparison of both the drugs was evaluating the variables; ear itching, and presence or absence of fungal debris on otoscopy at day 7. Out of 126 cases of group A, fungal debris was absent in 101 [80.2%] cases as compared to only 63 [50%] cases in group B at day 7[P value<0.05]. Itching control was gauged as marked, mild and no improvement at day 7. After 1 week of treatment, itching control in group A was following; marked improvement in 50[39.7%] cases, mild in 46[36.5%] and no improvement in 30[23.8%] cases. In group B, 20[15.9%] cases had marked improvement, 56[44.4%] mild improvement and 50 [39.7%] patients had no improvement after 1 week of treatment [P value<0.05]. 4% boric acid solution in alcohol is a better remedy in terms of alleviating symptoms of otomycosis

Effect of preoperative dexamethasone on postoperative pain, emesis and haemorrhage in tonsillectomy by dissection method

To compare the effect of single preoperative intravenous dose of dexamethasone on postoperative morbidity that is pain, episodes of emesis, and hemorrhage in patients undergoing tonsillectomy by dissection method with those who do not receive dexamethasone. Randomized control type. ENT Department Combined Military Hospital Rawalpindi, from Feb 2006 to Feb 2007. After getting informed consent a total of 60 patients who fulfilled the probability sampling. Group A received 0.25 mg/kg body weight [maximum 20 mg] of dexamethasone intravenously 10 minutes before start of operation while group B [control group] did not receive any steroid. Pain control had significant difference in both groups with better control rates in group A. Similarly, emesis control was significantly better in group A. There was no significant difference in secondary haemorrhage in the two groups. Single dose of dexamethasone given preoperatively significantly reduces the postoperative morbidity that is pain, episodes of emesis with no effect on secondary hemorrhage in patients undergoind tonsillectomy by dissection method

Modified palatal stiffening procedure for snoring

To evaluate the efficacy of a modified procedure of palatal stiffening for the treatment of snoring. A quasi-experimental study. ENT, and Head and Neck Surgery departments of Pakistan Air Force [PAF] Hospital Masroor, Combined Military Hospital [CMH] Rawalpindi and PAF Hospital Sargodha, from January 2000 to January 2005. Patients of either gender and above 20 years of age having snoring as their primary complaint were registered. Patients with an obvious cause of upper airway obstruction like oropharyngeal swelling, growths and obstructive sleep apnea were excluded. A grading system was designed to classify the patients according to severity and criteria for successful outcome defined; grades were equated with VAS. Palatal stiffening was achieved by using an insulated 22 gauge LP needle for infiltration cautery. Results were analyzed at 6 weeks post operatively on SPSS-16. Paired t-test was applied to compare the improvement in snoring and significance was tested at p-value less than 0.05. Forty four [44] patients underwent the palatal stiffening procedure. Male to female ratio was 42:2. Twenty eight [28] patients [63%] had complete resolution of symptoms after first surgery. Out of the remaining, ten more patients [22.72%] became symptom free after 1st revision surgery while six patients [12.5%] needed 2nd revision. Pain in throat was the main post operative complaint which settled in 10 to 14 days. Palatal stiffening procedure causing relatively less morbidity, simple and minimally invasive, but effective at the same time

Comparison of locally made phonating device versus oesophageal speech in postlaryngectomy speech rehabilitation

To compare the effectiveness of locally made phonating device with oesophageal speech as a communication method in a laryngectomized patient. Randomized Controlled Trial. Combined Military hospital Lahore from January 2004 to July 2007. Twenty five patients who had undergone total laryngectomy were divided in two groups by random sampling. 13 patients were placed in experimental group and provided with a locally made phonating device El [Electro-larynx, 'BM Talk'] and speech training with this device started between 20th to 30th post-operative day. The results were compared to a Control Group consisting of 12 laryngectomized patients who were provided instruction and training on oesophageal speech for communication. Speech assessment was made at the end of 2nd, 4th and 6th month post-operatively in both the groups. Assessment parameters were defined according to the patient's ability to communicate ten predetermined sentences of Urdu and Punjabi to a team of three speech assessors on each speech assessment day. Speech communication score was fixed at 100 if all the spoken sentences were fully understood by all the three assessors irrespective of character of speech, while it was 0 if none of the sentence spoken could be understood by any of the three assessors. In between the two were different percentages of speech communication scores depending on the number of sentences understood by the speech assessors. The character of voice was assessed by Visual Analogue Score where variation between robotic and normal speech character were divided into ten grades from 1 to 10. At the end of six months, speech communication score was 76.62 with SD 17.29 for EL [Electro-Larynx]; while for control group [oesophageal speech] it was 34.17 with standard deviation of 8.63. Those score was compared by using t test and was highly significant i.e. <0.001 in favor of EL. The character of voice was closer to normal in case of oesophageal speech compared to EL where it was closer to robotic. Locally made EL [Electro-larynx] 'BM Talk' is a useful device for speech rehabilitation in laryngectomised patient. It has added advantage of local availability and cost effectiveness. The character of voice may be robotic and monotonous, nevertheless full sentence can be communicated with relative ease to the listener, which is more important factor in our setup

Comparison of peri-operative haemorrhage and post-operative pain in endoscopic and conventional intranasal polypectomy

To compare endoscopic and conventional intranasal polypectomy in reference to peri-operative haemorrhage and post-operative pain. Randomized Control Trial [RCT]. This study was conducted in the department of ENT and Head and Neck Surgery, Combined Military Hospital Rawalpindi, from January 2007 to July 2008. After getting informed consent, 120 patients fulfilling the inclusion criteria reporting to ENT department during study period were selected. The patients were assigned to two groups A and B by random number table. Group 'A' underwent endoscopic assisted polypectomy using powered shavers and group 'B' underwent simple intranasal polypectomy using Tilley Henckle's forceps. Peri-operative haemorrhage and post-operative pain were studied for first 24 hours post-operatively. Peri-operative haemorrhage and post-operative pain had significant difference in both groups with less peri-operative haemorrhage and post-operative pain in group A. endoscopic assisted powered polypectomy significantly reduces the morbidity associated with this operation i.e. perio-operative haemorrhage and post-operative pain

Pressure splintage by coat buttons versus simple pressure dressing in management of hematoma pinna

To compare pressure splintage by coat buttons versus simple pressure dressing in management of haematoma pinna in terms of re-accumulation, perichondritis and cosmetic deformity. Randomized clinical trial. Department of ENT, Combined Military Hospital, Rawalpindi from October 2007 to February 2009. Sixty patients of haematoma pinna, of less than one month duration, were selected and randomly allocated to the button splintage and the pressure dressing groups. There was significantly less re-accumulation of haematoma in patients in whom pressure splintage was performed by coat buttons [3.33%] as compared to simple pressure dressing [26.66%]. There was no difference in perichondritis [3.33%] in both the groups, while difference in cosmetic deformity [16.66%] in button group and [33.33%] in dressing group was not statistically significant. pressure splintage by coat buttons is more effective than simple pressure dressing in preventing re-accumulation of haematoma pinna

Emergency tracheostomy, an experience of 120 casses

The objective of this study is to compare short term complications in elective and emergency tracheostomy Qausi Experimental study Place and Duration of Study: Department of ENT, Head and Neck Surgery Combined Military Hospital Rawalpindi from Jun 2006 to Jun 2008. Patients and Method: In this study 120 patients undergoing tracheostomy were included. Patients were purposely divided into two groups of 60 each. Patients in Group A had elective tracheostomy where as group B included 60 patients who under went emergency tracheostomy. Short term complications including haemorrhage, surgical emphysema, cardiac arrest and stomal infection were noted in both groups. Chi-square test was applied as test of significance to compare the two groups. Emergency tracheostomy in our study is associated with significantly increased risk of haemorrhage and surgical emphysema [p value being <0.05]. There was no statistical difference in occurrence of stomal infection and cardiac arrest between the two groups. Emergency tracheostomy is associated with significantly increased risk of postoperative haemorrhage and surgical emphysema

Efficacy of topical nasal steroids and total inferior turbinectomy in hypertrophic rhinitis

To compare the efficacy of topical nasal steroids therapy with total inferior turbinectomy in relieving nasal obstruction caused by inferior turbinate hypertrophy. Randomized Controlled Trials [RCT]. The study was conducted in the ENT department, Combined Military Hospital Rawalpindi from October 2006 to July 2007. Sixty patients suffering from allergic rhinitis were divided in Two groups of thirty partients. Group A underwent total inferior turbinectomy where as Group B advised Betamethasone nasal drops for two months. Relief in terms of nasal obstruction was assessed on Visual analogue scale two months after commencement of treatment. Chi-square test was applied as test of statistical significance to compare the two groups. Total inferior turbinectomy was found to be clinically superior to topical betamethasone drops in relieving nasal obstruction caused by inferior turbinate hypertrophy [p<0.001]. Total inferior turbinectomy is a better method of relieving obstruction as compared to topical betamethasone drops in nasal obstruction due to hypertrophied inferior turbinates

Efficacy of betahistine hydrocholride in tinnitus due to noise-induced hearing loss

To determine efficacy of betahistine hydrochloride in treatment of tinnitus due to noise-induced hearing loss [NIHL] as compared to placebo. Randomized- controlled trail. This study was carried out at ENT department, CMH Rawalpindi from July 2006 to December 2006. A total of 70 patients of tinnitus due to NIHL, diagnosed on the basis of history, clinical examination and audiometric findings, were randomly divided into two groups of 35 each. Group I, was treated with betahistine hydrochloride 16 mg thrice a day for two months. Group II, the control or placebo group was prescribed a single tablet of Multivitamin thrice a day for the same duration; after taking informed consent. All the subjects were assessed using Visual Analogue Scale [VAS] scores thrice during the treatment i.e. on first visit, after one month [2nd visit] and then after two months [3rd visit]. No statistically significant difference was noted in the loudness of tinnitus, between the two groups from the start of treatment till the complication of therapy. It is concluded that Betahistine hydrochloride is 'not' better than a placebo in its efficacy for the treatment of tinnitus due to NIHL

Carotid body paraganglioma

Carotid body tumours are benign neoplasms. This case report describes two patients with this rare tumour with diagnostic workup and treatment options. The first case was a 36-year-old gentleman who presented with 6 months history of painless swelling on the left side of neck. The second patient was 60 years old man who presented with slowly growing swelling on the right side of neck for the last 20 years. Both patients had transmitted pulsations over the swelling. On suspicion of a vascular lesion, a contrast enhanced CT scan and Doppler's ultrasound of neck was advised which suggested the diagnosis of a carotid body tumour. Magnetic Resonance Angiography [MRA] confirmed the diagnosis. Excision in collaboration with vascular surgeon was planned for the first case. The second case was subjected to radiation therapy due to the large size of tumour and the patient's age

Evaluation of mastoid cavities after canal wall down mastoidectomy

To evaluate mastoid cavities after canal wall down procedures in terms of achieving a dry mastoid cavity, presence of residual or recurrent disease [Granulations and cholesteatoma]. Quasi-experimental study. The study was done in the ENT Department, CMH Rawalpindi Study was done in fourteen months from Nov 2006 to Jan 2008. Fifty patients undergoing canal wall down mastoidectomy were included. Their mastoid cavities were evaluated for persistence of discharge and recurrence of granulations and cholesteatoma after the surgery. After follow up period of 3 months, 8% patients had mild discharge, 12% had granulation and 2% patients had recurrence of cholesteatoma. Canal wall down mastoidectomies are very effective in controlling the recurrence of cholesteatoma, granulations formation and otorrhoea to a greater extent

Clinicopathological evaluation of nasal biopsy specimens- and afip experience

To evaluate the presence and frequency of clinically significant microscopic diagnosis in cases under going nasal polypectomy/biopsy. Cases of nasal polypectomy/biopsy reported from department of histopathology during last five years [2004-2008] were retrieved from records and evaluated microscopically for detailed histological diagnosis. A total of 383 cases were reviewed. Most frequent age was 5[th] decade. Nasal polepectomy comprised 54.73% [n=214]. Nasal Biopsy not otherwise specified comprised 21.99% [n=86]. Suspicious of growth was indicated in 23.27% [n=84] cases. Among all types of biopsy, 60.04% [n=230] were inflammatory nasal polyps, 10.44% [n=40] malignant neoplasm, 5.48% [n=21] were inverted papilloma. Rest of the cases [24.03%] showed benign inflammatory changes and benign neoplastic lesions. Although frequency of neoplastic lesion in routine polypectomy specimen as mentioned in literature is low. Our study reveals significant number of malignant cases. Considering the prognostic significant of early histological diagnosis and appropriate post considered essential. Large scale studies are required to evaluate clinicopathological correction of nasal biopsy specimens in our setup

Comparison of efficacy of ciprofloxacin versus gentamicin ear drops in chronic suppurative otitis media [tubo-tympanic type]

To compare the efficacy of ciprofloxacin versus gentamicin ear drops in the treatment of chronic suppurative otitis media [tubo-tympanic type]. Quasi experimental study. This study was conducted in ENT department of Combined Military Hospital Quetta, from 17[th] March 2007 to 16[th] September 2007. Total number of 80 patients were included and divided into two groups of 40 each. Group A received ciprofloxacin ear drops [5 drops, two times in a day] while group B received gentamicin ear drops [5 drops, two times in a day] after aural toilet and than patient called on 3[rd] and 10[th] day of starting treatment for examination and response to treatment observed and documented. Control of ear discharge was significantly better in group A as compared to group B. Efficacy was measured in terms of control of ear discharge and achieving dry ear by comparing both groups on 3[rd], 6[th] and 10 day of starting of treatment. Ciprofloxacin ear drops are significantly better than gentamicin ear drops in controlling ear discharge in chronic suppurative otitis media [CSOM] [tubo-tympanic type]

Comparison of post-operative complications in total Inferior turbinectomy versus submucous resection of inferior turbinate

To compare post-operative complications of total inferior turbinectomy and submucous resection of inferior turbinate. Randomized control trial [RCT]. This study was conducted in the department of ENT-Head and Neck surgery, Combined Military Hospital Rawalpindi, from 14[th] April 2007 to 13[th] October 2007. After getting informed consent 60 patients, fulfilling the inclusion criteria, reporting to ENT department during study period were selected. The patients were assigned to two groups A and B by random number table. Group A underwent submucous resection of inferior turbinate and group B underwent total inferior turbinectomy. Periorbital ecchymosis, bleeding and nasal crusting were studied on 1[st], 2[nd], 7[th] and 14[th] post-op day. Submucous resection of turbinates is associated with less bleeding and crusting as compared to total inferior turbinectomy. Submucous resection is a safer method of turbinate reduction as compared to total inferior turbinectomy

Partial inferior turbinectomy; a better management option for hypertrophied inferior turbinates

To assess the effectiveness of partial inferior turbinectomy in relieving the symptoms of nasal obstruction in cases of inferior turbinate hypertrophy and to compare the results in terms of relief from nasal obstruction in response to total inferior turbinectomy. Department of Otorhinolaryngology and Head and neck surgery, CMH Rawalpindi, From January 2004 to November 2004. A total of 60 patients with inferior turbinate hypertrophy were selected by convenient sampling. 30 patients were treated by partial inferior turbinectomy and 30 by total inferior turbinectomy and result in terms of relief of nasal obstruction based on VAS [Visual Analogue Score] was observed with follow up carried out at interval of one week and then two months. All cases of both the groups showed complete relief of nasal obstruction after 02 months, showing 100% out of 30 cases managed by total inferior turbinectomy 4 cases [13%] developed atrophic rhinitis. Partial inferior turbinectomy is as good as total inferior turbinectomy in relieving nasal obstruction with an edge of avoiding complications like atrophic rhinitis

Actinomycosis larynx: a rare entity

Our patient, a fifty five year old poultry farmer presented with two years history of throat discomfort, for which he had taken steam inhalation. For the last two months he noticed a change in his voice. On examination he was found to be hoarse. His Indirect Laryngoscopy [IDL] showed oedematous cords. He underwent DL, which revealed oedematous cords with yellowish spots. Histopathology report received showed actinomycosis larynx. Final diagnosis of Actinomycosis larynx was made because of presence of Sulphur granules [yellow spots] on naked eye examination of vocal cords during DL, and a positive hitopathology report. The patient was started on Injection Benzyl Penicillin one million unit international units intravenous four times a day. This dose was continued for four weeks after which patient were shifted on tablet ciprofloxacin 500 mg twice daily due to unavailability of oral penicillin V. The oral therapy was continued for 3-6 months depending upon the response. During the treatment the hoarseness settl ed and IDL showed reduction in odema of the vocal cords

Complications of tracheostomy

A study of 44 tracheostomies was conducted at Combined Military Hospital Rawalpindi to see the complications. All tracheostomies were performed under general or local anaesthesia in operation theatre. Portex cuffed tracheostomy tube was used in 83.6%, Vygon [PVC] tracheostomy tube in 9% and Chevalier-Jackson tracheostomy tube in 4.5% cases. The rate of complications was 27.2%. The intermediate complications included surgical emphysema and infection of the wound. There was no death related to tracheostomy however, deaths not related to tracheostomy were 20.35%