Noise induced hearing loss in industrial workers of Karachi

Noise induced hearing loss [NIHL] sustained during work is detrimental to hearing. Workers involved in a number of industries operating in Karachi are victim to this hazardous occupational disease. International Labour Organisation [ILO] and World Health Organization [WHO] recognise NIHL as occupational disease that deserves compensation and they have set up industrial standards for noise level with current standard limiting noise exposure of 95 dB for 2 hours daily. Workmens Compensation Act 1923 and Social Security Ordinance 1965 do not include acoustic trauma as an occupational disease for percentage compensation. A conservative estimate afer this study suggest that 14,441 workers out of a total number of 173,300 registered with Sindh Social Security Institution in 1992 have noise induced hearing loss. This provokes an urgent need to persuade the workers, employers and the Government to realise the gravity of the situation so as to bring legislative measures, that can be employed to reduce noise at work and to provide compensation for the occupational deaf

Zingiber officinale and cholesteatoma

Cholesteatoma is a potentially dangerous chronic inflammatory ear disease characterized by discharge, deafness and is liable to produce severe complications like facial paralysis labyrinthitis and brain abscess. Ginger is a vegetable which is known to have medicinal uses since ancient of times Recent researches have proved it to be an anti-inflammatory agent which inhibits enzymatic pathways of inflammation in chronic inflammatory diseases. When Ginger was used in 25 patients who have recurrence of cholesteatoma after surgery, locally by insufflation of powder or drops it was found effective in drying up the cholesteatoma and making it loose so that it can be removed easily thus making the cavity dry. There was eradication of cholesteatoma in 15 patients [P<0.001] and reductions of cholesteatoma in 10 patients. There was recurrence of cholesteatoma in four patients within a follow up period of 3 months. The usage has definite indication in those patients who are medically unfit for anaesthesia Further analysis of this drug with clinical and experimental studies are needed in cholesteatomatous disease of middle ear for which no medicinal treatment is known

displaced laryngeal FB

A 35 year old man inhaled a F.B. [air gun pellet] which could not be located endoscopically. Repeated radiological examinations continued to reveal the F.B. in the neck. Tomograms showed the F.B. within the confines of thyroid cartilagenous frame work. Repeated endoscopic and microlaryngeal approaches failed, thus Laryngfissure was used to remove the F.B. from soft tissues of the Larynx with much difficulty

Sultamicillin in the treatment of upper respiratory tract infections

Forty nine patients, aged 12 years and above, were included in an open non-comparative trial to evaluate the efficacy and safety of sultamicillin in RTI including acute otitis media, acute tonsillitis, acute sinusitis and acute pharyngitis. Each patient received oral sultamicillin, a beta-lactamase inhibitor antibiotic 375mg twice a day in tablet form for 7-12 days. At the end of the study, 47 [96%] paients were clinically cured or improved with bacteria eradicated in 80% of patients, culture-positive at pre-treatment. Signs and symptoms of infection were rapidly resolved particularly temperature which came to normal in 80% of patients on day 3 of the treatment Side effects seen in four patients were mild and did not warrant discontinuation of treatment. Results indicate that sultamicillin is worth-while addition to existing range of oral antibiotics and has the promise to be considered as the antibiotic of choice in upper respiratory tract infections

Free field distraction test of hearing for assessment of deafness in hearing and speech impaired children

This is a retrospective study of 216 patients with hearing and speech impairment between 1982-1991. Free field hearing test has been found a useful convenient and simple investigation in the assessment of deaf children. Beside determining the degree of hearing loss an effort was also made in this study to establish the possible causative factors of deafness primarily based on history. On assessment 62 children were found to have normal hearing but had speech impairment. Among 154 deaf patients, 65 had mild to moderate loss, 63 were profoundly deaf where as 26 had shown total hearing loss. There were more who acquired the deafness than those who were born congenitally deaf. It is emphasized to employ this test in routine otological practice to establish the handicaps at an early age to achieve better rehabilitation results, rather than depriving patients of assessment and diagnosis for want of advanced and audiological test

Whistling foreign body in bronchial tree

A ten year old boy with a history of inhalation of F.B., also complained of whistling sound on respiration. On bronchoscopy a whistle of plastic and metal was removed thus indicating a rare symptom of F.B., in air passages

Double blind group comparative study of 2 sodium cromoglycate and placebo in treatment of perennial rhinitis in Karachi

Double blind group comparative study was done of 2% Sodium Cromoglycate solution four times a day and placebo in the management of perennial rhinitis in 45 patients. Duration of treatment was six weeks following a two week baseline. Five patients were excluded from the trial when they failed to return. Analysis of 20 patients in each group showed 8 patients [40%] in both treatment groups felt that the treatment made the symptoms completely or much better. The clinicians considered 13 patients [65%] in Sodium cromoglycate group and 11 patients [55%] in placebo group completely or much better. Statistically no significant difference was found between treatment groups for opinion of treatment, speed of onset of activity or acceptability of treatment. Improvement in symptoms assessed at the clinic were seen in both treatment groups

Foreign body in the nasopharynx

A case is reported of a long standing, ignored, Foreign Body, a large piece of wood which entered after penetrating injury in a road traffic accident near the medial canthus of right eye and was lodged in Nasopharynx. Nasopharynx is a site which is rarely mentioned in books and literature, a brief review of the subject is included

Ear, nose and throat emergencies

Emergencies in Ear, Nose and Throat forms an important component of Emergency Medicine. Though routine emergencies like Epistaxis, Foreign bodies and Otalgia are satisfactory described in ENT books there remain many emergencies in this speciality which need more care of emergency medical care team so that patients who present in emergency department with Vertigo, Headache, faceache, Facial palsy, Tinnitus, Sudden deafness, Voice disorders and amputations of Nose or Ear should be examined more thoroughly and satisfactorily directed to the speciality for investigation and treatment without loss of time

Vertigo

One hundred and four patients suffering from vertigo were assesed by clinical audiological and vestibular examination during 1983 and 1984. A detailed and critical history taking is one of the important contribution in understanding the pathology. A battery of audiological and vestibular tests should be performed to deduct help in localising pathology in sensory or neural areas and a single test cannot solely be relied upon. In this study a significant role has also been played by bithermal caloric stimulation of vestibular organs. This test is simple and quick, whether it is normal or abnormal it contributes towards understanding the site of lesion. Electronystagmography cannot be depended for diagnosis and is only supportive. The role of radiology and haematology cannot be ignored in assesing these patients. The commonest pathology in this series has been Menier's disease to be followed by Vertebrobasilar and Psychosomatic problems. Streptomycin toxicity should be kept in mind in our practice