Analysis of patients in otolaryngology department at Muzaffarabad hospitals

Objective: To assess the work load of the department in terms of individual disease

Study Design: Descriptive study

Place and Duration of Study: This study was conducted at Ear, Nose and Throat [ENT] Department of Shaikh Khalifa Bin ZayedAl Nahyan, Hospital Combined Military Hospital [CMH] Muzaffarabad from Jan 2011 to Jan 2012

Material and Methods: Total of 710 patients was admitted in ENT ward in one-year duration for various pathologies. For easy analysis, they were divided into groups according to the region involved by disease

Results: Two hundred and eighty-five cases [40.14%] were admitted with pathologies of nose and para nasal sinuses making the highest percentage among the groups. The second major group was otology comprising of one hundred and fifty-six [21.97%] cases. One hundred and three [14.50%] cases were from pathologies in oral cavity. Thirty [4.22%] cases from skull base, thirty [4.22%] pathologies of larynx, trachea and bronchi, forty [5.63%] cases were from hypopharynx and esophagus, twenty-four [3.38%] cases were from salivary gland pathologies. Twenty-one [2.95%] cases were from neck region. Tumors were 4[0.56%] and neurological cases were 11 [1.54%] of the total number of cases

Conclusion: Self-analysis/ audit at departmental level greatly enhances the working efficiency of a department and is essential for betterment of the patient and education of trainees as one gets a fair idea about the prevalence of disease in a community and can thus direct the resources accordingly

Comparison of efficacy of lignocaine anesthesia of vocal cords by [spray as you go] through a bronchoscope with lignocaine injection through the cricothyroid membrane

To assess and compare the efficacy of lignocaine anesthesia of vocal cords by [spray as you go] through a bronchoscope with lignocaine injection through the cricothyroid membrane. Quasi experimental study. This study was done in Combined Military Hospital Peshawar form May 2009 to June 2010. Thirty patients in each group were given local anesthesia to the vocal cords. With lignocaine either via intratracheal instillation through the cricothyroid membrane or through a fibreoptic bronchoscope [spray as you go]. A cough score was calculated by recording the number of coughs as the bronchoscope was advanced through the cords into the trachea. A twenty point unpleasantness score was marked by the patient 2 hours after the procedure. Cough score and unpleasantness score was compared among the two groups using SPSS version 19. Median unpleasantness score was 6 [Inter quartile range [IQR] 4-8] whereas median cough score was 2[IQR 0-3]. The difference was statistically significant among the two groups for both cough and unpleasant scores [p < 0.001 and p < 0.001 respectively]. Intratracheal injection of lignocaine is more comfortable for the patient. It induces much less cough and irritability to the patient than the [spray as you go] technique

Valsalva manouevre; efficacy in the treatment of eustachian catarrh

To assess the efficacy of Valsalva maneuver in the treatment of Eustachian catarrh. Quasi Experimental Study. Frontier corp Hospital [Quetta] and Sheikh Khalifa Bin Zayad Al Nahyan Hospital [Muzzafarabad] from December 2010 to May 2011. Total of sixty patients of Eustachian catarrh were randomly assigned to two treatment groups. Group A was given Antibiotics, Antihistamine, systemic and nasal decongestants and group B was advised Valsalva maneuver in addition to the above mention treatment. Relief in aural fullness [assessed through tympanometry] and hearing improvement [assessed through audiometry] were compared between these two groups at the end of three weeks of treatment. Audiogram done after three weeks of treatment showed statistically significant hearing and middle ear pressure improvement [assessed through audiogram and tympanogram respectively] in group B

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

To compare the effect of postoperative intravenous dose of dexamethasone on morbidity in patients undergoing tonsillectomy. Randomized control trial. This study was conducted in ENT Department Shaikh Khalifa Bin Zayed Al Nahyan Hospital [CMH] Muzaffarabadfrom 10[th] Jan 2010 to 15[th] Feb 2011. After getting informed consent, a total of 60 patients who fulfilled the inclusion criteria were selected and tonsillectomy by dissection method was carried out. They were divided into two groups of 30 eachusing a random numbers table. Group A received 0.25 mg/kg body weight [maximum 20 mg] of Dexamethasone postoperatively intravenously for 03 days while group B [control group] did not receive any steroid. In group A, 80% patients had mild pain, 16.7% had moderate pain and 3.3% had a severe pain while in group B, 30% patients had mild pain, 6.7% had moderate pain and 63.3% had severe pain [p< 0.05]. In group A, 76.7% patients had mild emesis while in group B, 86.7% had moderate emesis [p< 0.05]. There was an insignificant difference in secondary hemorrhage. Dexamethasone given postoperatively significantly reduces the morbidity that is pain, episodes of emesis thus early recovery to a normal lifestyle with no effect on secondary hemorrhage in patients undergoing Tonsillectomy by dissection method

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

Diagnostic yield of transbronchial needle aspiration analysis of 30 cases

In our clinical set up transbonchial needle aspiration of lymph node and parenchymal lesions is an underutilized technique. This study was done to highlight the usefulness of this technique in the pulmonologists armamentarium. Thirty procedures were performed on patients with intrathoracic lymphadenopathy or parenchymal lung lesions in this study from October, 2006 to April, 2007. Patients with an easily accessible peripheral lymph node, bleeding diathesis and an already confirmed diagnosis were excluded from the study as were patients with a well visualized biopsiable endobronchial lesion. Nineteen patients [63.3%] on whom transbonchial needle aspirations were performed had intrathoracic lymphadenopathy while 11 [36.6%] had parenchymal lesions without endobronchial lesions which could be biopsied. Adequate samples were obtained in 23 patients [76.6%] chronic granulomatous inflammations which was diagnosed as tuberculosis in corroboration with other clinical and laboratory evidence was seen in 3 cases [10%]. Carcinoma was diagnosed in 6 cases [20%]. Thirteen cases [43%] were reported as normal and inadequate samples were obtained in 7 cases [23%]. Transbronchial Needle Aspiration [TBNA] is an effective method of obtaining cytological material from intrathoracic lymph nodes and parenchymal lesions and can provide a safe alternative to invasive mediastinotomy/mediastinoscopy and open lung biopsya