RESUMEN
Late diagnosis, late intervention, inconsistent follow-ups, inadequate maintenance of hearing aids and not so good outcome is something nobody amongst service providers in the field of ENT, audiology and also psychiatry wishes to come across. The fact that many factors, elements, people and physicians are involved in the equation of service provision and results/outcome, therefore, it is very difficult to predict of contemplate what one does will bring good results. The element of myth, physicians dealing with deafness rarely getting help from psychiatrists and psychologists. The age of diagnosis is one of the key element in this process. It marks the beginning of a long term process and is therefore considered a parameter of concern. With a view to determine how much we take the hearing problem seriously, a study was conducted at ENT clinic of Lahore Medical and Dental College, Ghurki Trust Teaching Hospital. The objective was to find the mean age of diagnosis, type and amount of deafness, associated problems with emphasis on related psychiatric problems in particular the element of depression. Out of a total of 200 patients between the ages of 10 years to 80 years over a period of one year from Jun 2001 to Jun 2002 were evaluated and investigated. They represent the major ethnic group of central Punjab [central Pakistan]. Every patient under went a detailed clinical examination, any depressive symptoms and audiological investigations. The cause of hearing loss could be found in 82% cases. Main causes were infections [31%], trauma [19%], presbyacusis [8%] and genetic [5%]. The cause of hearing loss could not be established in 18% cases. It was higher in males [58%] than females but noticeably higher in uneducated Muslim patients. Late diagnosis was also related to financial background, family size and accessibility to the health facility. The findings of the study are a cause of concern because the element of psychiatric disturbance was unacceptably high [60%] and it raises the questions about the importance the patients give to hearing problems and how little importance ENT/audiologists give to associated psychiatric disturbance, in particular depressive episodes
RESUMEN
Maxillary sinus is the most commonly affected sinus. Complications arise due to spread of infection beyond the bony walls of sinus. It is rare to see a maxillary cutaneous fistula in the absence of dental disease in this modern era. This is a case report of a 40 years old female presenting as a I cm diameter open fistula on the cheek secondary to maxillary sinusitis along with osteomyelitis. Pus culture and sensitivity revealed resistant strains of staphylococcus aureus and pseudomonas aeruginosa. Once osteomyelitis was settled with antibiotics, diseased sinus mucosa was removed, inferior meatal antrostomy carried out, fistulous tract excised, anterior maxillary wall repaired with iliac crest bone graft and wound repaired in layers