Facial nerve morbidity following surgery for benign parotid tumours

To determine the frequency and severity of facial nerve dysfunction following surgery for benign parotid gland tumours. A case series. ENT Department, Karachi Medical and Dental College and Abbasi Shaheed Hospital and Ziauddin University Hospital, from 1990 to 2010. Data was collected of all patients who were surgically managed for benign parotid tumours from 1990 to 2010. Data was reviewed for presentation of tumour, age and gender of the patient, site of tumour, nature and morphology of the tumour, primary or recurrent, surgical procedure adopted and the complications of the surgery especially the facial nerve dysfunction, its severity, complete or partial paresis and transient or permanent and time of recovery. Results were described as frequency percentages. Out of 235 patients, 159 [67.65%] were female and 76 [32.35%] were male. Age ranged from 18 to 70 years. Pleomorphic adenoma was the most common tumour [n=194, 82.6%], followed by Warthin's tumour. Superficial parotidectomy was done in 188 cases and extended parotidectomy in 47 cases. In the immediate postoperative period facial nerve function was normal in 169 [72%] patients and nerve dysfunction was observed in 66 [28%] patients. Complete paresis involving all the branches of facial nerve was seen in 25 [10.6%] patients and 41 [17.4%] patients were having incomplete dysfunction. Of these, 62 [26.3%] recovered and 04 [1.7%] had permanent facial nerve dysfunction. Marginal mandibular branch of facial nerve was involved in 57 [86.3%] cases. The frequency of temporary and permanent facial nerve dysfunction was 26.3% and 1.7% respectively in 235 consecutive parotidectomies for benign parotid gland tumours. Higher frequency of facial nerve dysfunction was found in recurrent and deep lobe tumours

Prevalence of torus mandibularis among various ethnic groups in Karachi City: a cross sectional study

The aim of this study was to determine the prevalence of torus mandibularis in dental patients with regard to ethnic population in Karachi city. This study was undertaken at a dentistry teaching hospital of Karachi. Eight hundred subjects were clinically examined, presenting for their common dental health issues with the diagnosis of torus mandibularis [TM]. This study was conducted from January 2011 to March 2012. The location, position and clinical presentation of torus mandibularis were recorded, related to age and sex of various ethnic populations. Subjects participated in the study were 365[45.6%] males and 435[54.3%] females. Its overall prevalence in the study subjects was 8.6%. The mean age of patient was 41.79 and STD +/- 16.61. Torus mandibularis was observed in both genders with females having predominance. Urdu speaking population showed higher frequency of TM as compared to other ethnic sample

Pathological findings of chronic supparative otitis media in tertiary care hospital

Objectives: To see the clinico-pathological pattern of findings in the chronic supparative otitis media [CSOM] during surgery

Study Design: A prospective observational study

Place And Duration: This study was conducted in Karachi Medical and Dental College and Abbasi Shaheed Hospital during the period of October 2006 to October 2010

Methodology: For this study, 288 patients were selected. After complete history, examination and relevant investigations surgery was performed and intra-operative findings of middle ear cleft were noted

Results: Total number of patients selected were 288, in which female were dominating slightly with 54.1%. Maximum incidence was noted between the ages of 16-30 years of age in 180 patients [62.5%]. 140 cases [48.61%] had no ossicles damage while 148 cases[51.38%] had one or more ossicles damage. Granulation tissue found in 99 patients [34.37%], while cholesteatoma found in 77 patients [26.73%]

Conclusion: Pathological changes varies from simple mucosal edema to extensive destruction of the middle ear cleft

Pattern of ossicular damage in chronic supparative otitis media

The aim of this study is to determine pattern of ossicular damage in chronic supparative otitis media. Prospective study. This study and was conducted in Karachi and Medical and Dental College and Abbasi Shaheed Hospital during the period of October 2006 to October 2010. 288 patients were selected in this study and intra-operative findings of ossicles were noted. Total numbers of patients was 288, in which female was slight domination with 54.1%. Maximum incidence was noted between the ages of 16-30 years of age which was 180 patients. 209 patients presented with central perforation. 140 cases had no ossicles damages of ossicles damage. Ossicles damage can be prevented by early diagnosis and proper management

Fine needle aspiration cytology: sensitivity and specificity in thyroid lesions

Thyroid enlargement is one of the common problems in patients presenting at outpatients department of ENT particularly in females. Thyroid nodules are common, thyroid cancer is uncommon and the most common way for it to present is as a solitary thyroid nodule. This study was conducted to evaluate the sensitivity and specificity of Fine Needle Aspiration Cytology [FNAC] in thyroid diseases. This prospective analytic study was conducted at ENT Department of Karachi Medical and Dental College/Abbasi Shaheed Hospital during year 2004-8. One hundred and five cases were enrolled who underwent thyroid surgery after complete evaluation by history, clinical examination, Thyroid profile, Thyroid Scintigraphy, Ultrasound neck and FNAC. In cases which were revealed malignant by FNAC, CT scan were done to see the extent of disease and neck node status. Surgery was done in all cases and specimens sent for histopathology. Male to female ratio of the patients was 1:8.5. Most common lesion was benign nodule [96]. Malignant lesions were 9 in FNAC. In histopathology, the benign nodules were 92, and malignant cases were 13. Sensitivity of FNAC was 61.53% and specificity was 98.9%. FNAC in Thyroid has high sensitivity and specificity

unusual foreign body in trachea

We report a very unusual case of foreign body [FB] in the tracheo-bronchial tract of a male child, who presented to us in the emergency department at our tertiary care centre with the complaint of FB in throat, cough bouts and choking sensation with pain and difficulty in breathing for whom an emergency rigid endoscopy was carried out after appropriate investigations

Clinical profile of patients with presenting hoarseness

To describe the causes of voice disorder [hoarseness] among general population attending E.N.T department in Abbasi Shaheed Hospital. It is the descriptive study of 100 patients, who enrolled from out patient department and admitted in E.N.T department of Abbasi Shaheed Hospital. The data was collected as per the specially designed Performa. This study was done in Abbasi Shaheed Hospital, Karachi. Most of the patient with hoarseness 38 [38%] were observed between 5-15 years followed by 16-24 years old 26 [26%] patients. The most common cause of hoarseness was vocal cord nodules 35 patients [35%] followed by acute laryngitis, 22 patients [22%] and chronic non specific laryngitis 14 patients [14%]. Hoarseness due to carcinoma of larynx, 13 patients [13%]

Synovial cell sarcoma: rare presentation in head and neck area

We report a case of a 17 years young male who presented to us with a huge neck swelling on the left side of the neck that has been present for about 2 years. He presented to us with the complains of mild pain and disfiguring swelling

Comparison between dissection and bipolar diathermy method tonsillectomy

To compare dissection method and diathermy method tonsillectomy in terms of intraoperative mean blood loss, time taken for surgery and frequency of post operative bleeding. It was a grass experimental study carried out at Liaquat National Hospital, Karachi from January 2004 to January 2005. Patients of ages between 5 years and 25 years were selected from the out patient department. Sampling technique was convenient sampling. Sample was of 100 patient. First 50 patients were selected for dissection method [Group A] and the last 50 patients for bipolar method tonsillectomy [Group B]. Data collection procedure was interview and observational facts. Data was analyzed by using SPSSS version 10. For mean comparison, student's test was used. Significance of the test was taken at p<0.05. The difference in result between dissection method tonsillectomy and diathermy method tonsillectomy was statistically significant [P<0.001] in terms of intraoperative blood loss and time taken for surgery. Regarding postoperative hemorrhage, the difference between diathermy and ligation was insignificant. Tonsillectomy with bipolar diathermy was a better and safer technique as compared to ligation method especially in terms of intraoperative blood loss and time taken for surgery. The frequency of postoperative bleeding was similar in both methods

Role of tracheostomy [early VS late] in intubated cases of neurosurgical patients in surgical intensive care unit [SICU] setting

To study the role of early vs. late tracheostomy, in neurosurgical intubated cases admitted in surgical intensive care unit, on recovery from pneumonia during ventilation, length of intensive care unit stay and duration of ventilatory support and weaning. The Study was conducted in the Department of Anaesthesia and Surgical Intensive Care Unit with collaboration of ENT Department, Abbasi Shaheed Hospital, Karachi from Jan 2007-Dec 2008. A retrospective analysis of the case file records of the intubated neurosurgical patients admitted in surgical intensive care unit for whom elective tracheostomy was performed, for prolonged ventilation, was made from 2007-2008 of 50 cases. Early tracheostomy was consider, when it was performed within 3 - 7 days of intubation and late was after that or 8- 14 days. Data collected include the information regarding the patient's name, age, sex, etiology and Glasgow coma score [GCS] on admission, time duration of patients' stay in surgical intensive care unit, time period of weaning from mechanical support and recovery from pneumonia during ventilation, along with chest x-ray's, culture and sensitivity reports. Depending on the time of tracheostomy performed two groups were made: Group- I in which tracheostomy was performed early within 3-7 days of intubation and Group- II in which tracheostomy were performed after an interval of more than 7 days or 8-14 days [late tracheostomy]. For group I the early tracheostomy was done at the median of 4th day vs. that of 10th day for the group II. The number of cases that developed pneumonia in group- I was 45.45% versus Group- II 54.54%, [odd ratio 0.27]. Duration of mechanical ventilation was significant with early tracheostomy [mean, standard deviation] 11.95 days +/- 3.14 versus late tracheostomy 21.79 days +/- 6.06. Intensive care unit stay was shorter in group- I [mean, standard deviation] 15.09 days +/- 3.49 versus in group- II 26.71days +/- 7.00. Recovery from pneumonia was shorter in group- I [mean, standard deviation] 9.0 days +/- 1.63 versus in group- II 14.23 days +/- 1.81. Our study shows that early tracheostomy has a positive role in reducing the risk of pneumonia, because of easier access to lower airway for clearance but not statistically significant, decreased the overall time period of surgical intensive unit stay and patients were weaned off earlier from mechanical support, in comparison to those in which tracheostomy was performed late. Therefore early tracheostomy in selected patients may help in reducing unnecessary resource utilization

Role of antibiotics in the pre and post tonsillectomy period in reducing the morbidity associated with tonsillectomy

The aim of the study is to see the role of pre and post operative antibiotic used in the cases for which tonsillectomy was planned as a primary surgical procedure with or without adenoidectomy, for effects on peroperative blood loss, ease of surgery, postoperative fever and pain, incidence of secondary heamorrhage and return to activities of daily living [ADL]. Department of ENT and Head and Neck Surgery, Abbasi Shaheed hospital, Karachi, from June 2006 - December 2006. Prospective, double blind study. The cases which were selected for tonsillectomy were included in this study. Their full informed and written consent was obtained prior to their inclusion in the study. Two groups were made each consisting of 50 patients. In group I [intervention group] preoperatively antibiotic was used for a period of 3 days and continued for another 5 days postoperatively. The antibiotic used was Amoxicillin-Clavulanic acid according to the weight of the patients [50mg/kg/day]. In the group II [control group] no preoperative or postoperative antibiotic was used. Analgesia was given on the need and demand basis in both the groups. Pain for adult was categorized by using a pain rating scale by the British Pain Society and pediatric age group the modified Toddlers Preschooler Postoperative Pain Scale [mTPPPS]' was used. The questionnaires were given on daily basis to them for 5 days postoperatively, results recorded and then compared. Both of these groups were not aware of each other. The parameters monitored were amount of peroperative blood loss, ease of surgery, whether or not the patients had postoperative fever, secondary heamorrhage rate, pain status and return to activities of daily living. The method for tonsillectomy used was dissection method [cold steel dissection method with ties for hemostasis]. There was a significant reduction in the amount of peroperative blood loss and early return to daily activities in group land also there was an ease of surgery because of less friability of tissue and less infection and bleeding as compared to group II where the patients had a significant amount of bleeding peroperatively and delayed return to activities of daily living with a bit difficulty experienced in dissection. The incidence of post tonsillectomy [secondary] heamorrhage was not found to be of significance suggesting that there might be some other factors that may lead to this complication despite the fact that antibiotics was used in group I in comparison to group II. The level of pain experienced post operatively was not affected in either group suggesting that antibiotics do not help in decreasing or alleviating it, Fever occurred in 3 in group I while 6 had fever in group II. Seeing the results of this study we would recommend the use of pre and post operative antibiotics for the tonsillectomy patients

Morphological pattern of parotid gland tumors

To determine the morphological pattern of parotid tumours. Case series. ENT Department of Karachi Medical and Dental College and Abbasi Shaheed Hospital, Karachi, from 1990 to 2004. During this study, 204 patients with parotid tumours were registered. The patients of all ages and both gender were included in this study. All patients were evaluated by history, clinical examination, F.N.A.C. and ultrasound, C.T/MRI was done in selected cases. All patients were surgically managed and their tumour specimen was sent for histopathology. Classification of individual tumour was based on 1991 World Health Organization Classification. Discrete data was presented in percentage and proportions. Out of 204 cases, 152 [74.5%] were benign and 52 [25.5%] were malignant. Of these, 117 [57.35%] patients were females and 87 [42.65%] males. Benign tumours were more common in females whereas malignant tumours were common in males. The mean age of patients was 34 years and 42 years for benign and malignant tumours respectively. Pleomorphic adenoma was most common benign tumor [83.5%], followed by Warthins tumour. The most common malignant tumour was mucoepidermoid carcinoma [60%], followed by adenoid cystic carcinoma. Superficial lobe of parotid gland was the commonest site, 120 benign and all 52 malignant tumours arising from it while 32 benign tumours originated from deep lobe. Parotid swelling for years was main feature of benign tumours, whereas malignant tumours presented with pain, fixation to skin or underlying structure, cervical lymphadenopathy and facial palsy. Pleomorphic adenoma was the most common benign tumour and mucoepidermoid carcinoma was most common malignant tumour. The morphological patterns and distribution followed the known pattern

Correlation between traffic noise induced hearing loss [NIHL] and occupation

To examine the subjects who are more prone to traffic noise exposure such as auto rickshaw drivers, traffic constables and shop keepers in central business area in Karachi [Pakistan]. This was hospital based prospective study comprising of 200 subjects. The results were obtained by testing the subjects which were investigated on the basis of interviews by [a] completing performa [b] Pure tone audiometry [PTA]. Correlation between traffic NIHL and occupation was found statistically significant with P<0.001 distributed as 15 [34.1%] in auto rickshaw drivers, 34 [40%] in shopkeepers and 29 [34.1%] in traffic constables. The fact that road traffic is the most significant source of noise pollution in Karachi was established by investigating our subjects. They had significant degree of hearing impairment i.e. 42%

Fractured tracheostomy tube in the tracheo-bronchial tract: a rare occurrence. Case report

We report a very rare occurrence of fracture of a metallic tracheostomy tube that lodged in the tracheo-bronchial tract of our male patient and caused him a great deal of distress, anxiety with minimal of respiratory embarrassment, if any. The tracheostomy was done earlier as the patient presented in the emergency department with stridor and was found to have a supraglottic growth! After the emergency tracheostomy, admission was offered with subsequent direct laryngoscopy and biopsy he was discharged with a metallic bivalve tracheostomy tube in place to return with the histopathology report but he never returned becoming a treatment defaulter only to present with the broken tracheostomy tube in the airway, later

Cystic hygroma: an unusual presentation in adult

We report a case of a 22 years old male patient suffering from cystic hygroma [CH] probably post-traumatic in origin. He presented with an asymptomatic, cosmetically disfiguring and a painless swelling involving the right side of the neck

Micropathogens in chronic suppurative otitis media an experience of 208 pus cultures at Abbasi Shaheed Hospital

To determine the causative pathogens of chronic suppurative otitis media and their antimicrobial sensitivity. Prospective analytic study. Two hundreds patients were enrolled for the study attending the ENT out patient department of Karachi Medical and Dental College and Abbasi Shaheed Hospital. Majority of the patients were children and young adult, with male predilection. 208 Pus cultures were taken from the ears of the 175 selected patients and Gram staining and antibiotic sensitivity was done on all of them. Staphlococcus aureus and Pseudomonas aeruginosa were responsible for most of infections in this study about 68%. Proteus spp., Klebsiella spp. and E.coli were also found in the cultures but in very low figure. Quinolones and aminoglycosides were found extremely effective against the two major pathogens, i.e., Staph.aureus and Pseudomonas aeruginosa with sensitivity index of 91% and 98% respectively. Macrolides and cephalosporins were also highly effective with 80-88% sensitivity whereas both Staph.aureue and Pseudomonas were quite resistant to Ampicillin and Amoxicillin. Chronic suppurative otitis media is primarily the disease of children and young adults, and incidence in adult and old population being very less. Staphylococcus aureus and Pseudomonas aeruginosa are most frequent causative organism and extremely sensitive to quinolones and aminoglycosides

Role of azithromycin in acute sinusitis and acute otitis media

To investigate the efficacy of Azithromycin 250 mg in acute sinusitis and acute otitis media. It is an observational study carried out on sixty patients, 30 each from acute sinusitis and acute otitis media were selected from E.NT OPD department of Karachi Meddical and Dental College and Abasi Shaheed Hospital. These all patients were treated with azithromycin 250 mg b.i.d for 3-7 day according to the severity of disease and response of the patients. Out of 30 patients with acute otitis media, 08 were having ear discharge at the time of presentation. All patients were followed for a period of 02 months to evaluate the efficacy, failure and complication of treatment. Out of 60 patients pain and fever subsided within 03 days in 40 patients[67%] and within 05 days in further 12 patients[20%]. The remaining 08 patients i.e. 13% [2 with acute sinusitis and 06 with acute otitis media] did not responded to the treatment at the end of 07 days, requiring surgical intervention. Nasal discharge and obstruction was improved on 4th day in 28 patients with acute sinusitis. Ear discharge disappeared in all 08 patients with discharging ears and hearing improved on 10th day in 24 patients. No serious complication was observed in any patient regarding the disease or antibiotic therapy. Azithromycin 250 mg b.i.d for 3-7 days was found highly effective in patients with acute sinusitis and acute otitis media. It has excellent antimicrobial activity against H.Influenza, Strep.Pneumonia and M.Catarrhalis. The overall clinical success rate was 87% within 05 days with failure rate of 13%