An experience of steroid in recurrent ethmoidal nasal polyps at tertiary care hospital

OBJECTIVE: To evaluate the effect of preoperative short course of oral steroids followed by postoperative topical nasal steroids sprays on nasal polyp recurrence after classical intranasal Polypectomy

METHODS: Fifty five patients of both genders with symptoms and signs of nasal polyps were included in this prospective study between January 2010 and December 2012. Their ages ranged between 20 and 65 years. The patients were divided into two groups. Group I constituted 30 patients treated by classical sinus surgery [simple nasal polypectomy and intra nasal ethmoidectomy] without oral and local steroid therapy. Group II consisted of 25 patients also treated by intranasal polypectomy but received preoperatively 60mg prednisolone tablets daily for one week and postoperatively topical nasal steroid spray [Mometasone furoate suspension] for three months. All patients were followed up for at least one year. Recurrence of nasal polyps was assessed endoscopically at three, six and twelve months after surgery. Any evidence of nasal polyp formation of whatever size was considered as recurrence

RESULTS: Fifty five patients [35 male and 20 female] with sinonasal polyposis were included in this study. Male to female ratio was 1.75:1. The patients' age ranged from 20 to 65 years and median age was 45 years; median age was 43 years. Recurrence rates at three; six and twelve months after surgery for the first group of patients were 8.33% [2 patients], 25% [6 patients] and 41.6% [10 patients] accordingly, while the recurrence rates for the second group were 4.1% [1 patient], 8.3% [2 patients] and 12.5% [3 patients] accordingly

CONCLUSIONS: Preoperative short course of oral steroid followed by postoperative nasal steroid spray show significant reduction in the recurrence rate of nasal polyps after intranasal polypectomy

Assessment of hearing loss in tympanic membrane perforation at tertiary care hospitals

OBJECTIVE: To evaluate and analyze the degree of deafness in tympanic membrane perforation based on size, site and duration of perforation

METHODS: 90 patients of both sex were selected randomly for this study with age 20 years and above randomly. Size of tympanic membrane perforation was evaluated under operating microscope

Patients were divided into three groups according to size; group I [small], Group II [medium], Group III [large]. Hearing loss was measured in each case with pure tone audiometry

RESULTS: Deafness increased as the perforation size increased [I vs. II [t - 3.23,p <0.01], II vs. III [t - 7.19, p < 0.001], I vs. III [t - 10.88, p < 0.001]]. The degree of deafness was more in posterior quadrant perforation than anterior quadrant perforation but difference was not significant statistically [t - 1.25, p [0.05]. The degree of deafness was more in malleolar perforation [t - 4.64, p < 0.01]. Deafness increased as the duration of disease increased [A vs. B [t - 3.01, p < 0.03], A vs. C [t - 6.49, p < 0.001], B vs. C

Microbiological spectrum in tubotympanic type of chronic suppurative otitis media

OBJECTIVE: The objective of this study was to determine the local pattern of bacterial involvement in tubotympanic type of Chronic Suppurative Otitis Media

STUDY DESIGN: Descriptive, Cross sectional study

SETTING and DURATION: Department of ENT, Liaquat University Hospital Hyderabad. Two years from January 2012 to December 2013

METHODOLOGY: A total of 150 cases presenting with ear discharge for last six months were included in this study, irrespective of age and gender. Operated cases and disease of external ear were excluded from this study. Ear discharge sample [Pus Swab] was taken from deeper part of external auditory canal with sterile cotton swab on stick and sent for bacterial culture and sensitivity to the diagnostic and research laboratory. Statistical analysis carried out using SPSS 16

RESULTS: This study includes 150 patients of Chronic Suppurative otitis media. Males outnumbered females [M: F = 1.4:1]. Result of swab sensitivity for aerobic organism showed growth of single organism in 65%; while 25% showed mixed growth and 10% did not grow any organism. Pseudomonas aeruginosa[42%] was the commonest organism isolated, followed by staphylococcus aureus[24%], less common organism isolated includes Proteus mirabilis 8.7%, Klebsiella pneumonia 6.7%, E. Coli 5.3% and Coagulase negative Staphylococci 3.3%.Sensitivity of P. aeruginosa was good to Imipenem [97%], followed by ceftazidime [95%], ciprofloxacin [90%] and tobramycin [90%]

CONCLUSION: It is concluded that gram negative aerobic bacteria especially pseudomonas aeruginosa is the most common isolate organism significantly associated with tubotympanic type of CSOM followed by Staphylococcus aureus. Periodic monitoring of the microbiological profile along with their sensitivity pattern is essential for formulating an effective antibiotic policy for CSOM

Epistaxis - a study of etiologies and management at a tertiary care hospital of urban sindh

OBJECTIVE: To highlight different etiologies of epistaxis and their management at the setup of a tertiary care level hospital of urban Sindh

STUDY DESIGN: Descriptive Study

SETTING: Department of E.N.T. and Head and Neck Surgery, Liaquat University Hospital Hyderabad from June 2011 to May 2013

METHODOLOGY: A prospective study of 437 patients presented with epistaxis due to different etiologies and its management at the department of E.N.T. and Head and Neck Surgery, Liaquat University Hospital Hyderabad. The patients of all age groups of both the genders were enrolled. All the data was collected on a pre-designed Performa equipped with all the relevant details. Finally all the collected data was then fed into SPSS VER. 16 to have statistical assistance and to construct different graphs and tables

RESULTS: Spanning over two years period, this study comprised 437 cases. 263[60.2%] were male and 174[39.8%] were female. The age range was 3-77 years with mean age to be 31.66 years. The commonest cause in this study was trauma which affected 155[35.6%] patients. Most of the patients i.e. 324[74.1%] reached us through emergency department. Site of bleeding was anterior in most of the patients, accounting 229[52.4%] patients. Maximum numbers of patients i.e. 163 [37.3%] were managed successfully by anterior nasal packing

CONCLUSION: Epistaxis constitutes the main bulk of emergency cases attending the E.N.T. department. This study observed trauma to be the commonest cause of epistaxis in our set up. Maximum number of cases required anterior nasal packing as the only measure to be effective and successful from management point of view