Evaluation of anxiety during nasal pack removal in patients operated under local versus general anesthesia

Objective: To evaluate the anxiety experienced before, during and after conventional paraffin gauze nasal pack removal in patients operated under local versus general anesthesia

Study design: Comparative study

Place and duration of study: Department of ENT, Combined Military Hospital Sialkot and PAF Hospital Shorkot from July 2017 to June 2018

Material and methods: A total of 120 patients planned for Septoplasty were enrolled and divided into two groups. Sixty patients were to be operated under local anesthesia [Group A] while the other 60 were undergoing the same procedure under general anesthesia [Group B]. Conventional paraffin gauze nasal packing was done for 24 hours in all 120 patients. Hamilton Anxiety Rating Scale [HAM-A] was used to determine the patients' anxiety in both groups, 1 hour pre-operatively, immediately before and 1 hour after nasal pack removal

Results: The mean Hamilton Anxiety Scale assessment scores in both groups were of ‘mild' category. The highest scores in both groups were observed immediately before nasal pack removal, with a range of 15-18, while the lowest scores in both groups were documented one hour after pack removal with a range of 13-16. Anxiety level in patients operated under general anesthesia was slightly lower than patients administered local anesthesia mean score of 16.40 +/- 0.763 vs 17.21 +/- 0.666 [p<0.001]

Conclusion: Anxiety during nasal pack removal is mainly associated with prior pain experienced during nasal pack insertion. It is recommended that proper analgesia, adequate topical anesthesia, gentle insertion would make this process less distressing and will subsequently result in less anxiety at its removal

Effectiveness of transient evoked otoacoustic emission [TEOAE] test for neonatal auditory screening

Objective: The purpose of this study is to assess the efficacy of Transient Evoked Otoacoustic Emission [TEOAE] as screening test for auditory function in neonates

Study Design: A cross-sectional study

Place and Duration of Study: This study was conducted at United Medical and Dental College, Creek General Hospital, Karachi, from July 2106 to May 2017. A total number of 120 newborn babies were screened for hearing loss before discharge from hospital but 20 were lost for follow up and 100 cases were included in this study

Method: TEOAE was done in all neonates born during this period at 3rd day after birth. Those who were found to have hearing loss, TEOAE was repeated at the end of 1st week and again in 6th week after birth. BERA was done in those cases who showed hearing loss on TEOAE on all three occasions. All the 100 cases were followed up regularly for more than one year for appearance of any sign or symptom related with hearing loss or speech development failure

Result: Out of 100 cases included in this study, 96 were found to have no hearing loss on TEOAE and 1 on BERA test. Remaining three cases were found to have hearing loss on both TEOAE and BERA test. True negative cases where no hearing loss was found on TEOAE and subsequent follow up were 96. True positive cases were 3 where hearing loss was found on TEOAE and BERA and also on subsequent follow-up. False positive case was 1, where hearing loss was detected on TEOAE but BERA showed normal hearing and subsequent follow-up also showed normal hearing and false negative result was not detected in any case. Sensitivity of TEOAE was found to be 100%, specificity is 98.9%, accuracy is 99%, positive predictive value is 75% and negative predictive value is 100% in this study

Conclusion: TEOAE was found to be a cost-effective and practicable method of recognizing congenital hearing loss. It should be done in all newborns as routine screening for hearing loss

Hearing status after radical mastoidectomy without tympanoplasty

Objective: To find out the impairment of hearing associated with radical mastoidectomy by measuring the quantitative difference in the functional hearing level before and after radical mastoidectomy operation without tympanoplasty

Study Design: Cross-sectional comparative study

Place and Duration of Study: Department of Otorhinolaryngology and Head and Neck Surgery, Bahawal Victoria Hospital, Bahawalpur and PNS Shifa Hospital, Karachi, from November 2009 to January 2013

Methodology: Eighty-five patients, diagnosed clinically as chronic suppurative otitis media with extensive cholesteatoma having history of ear discharge and hearing impairment for more than 6 weeks' duration and requiring radical mastoidectomy for treatment, were included in this study. Pure tone audiogram was done before and after radical mastoidectomy. Hearing impairment was compared in each patient before and after the operation

Results: Among the 85 patients, 54 [63.5%] were males and 31 [36.5%] were females, with the age ranged between 18 to 63 years, mean age being 42.31 +/- 4.8 years. The mean increase in hearing loss after radical mastoidectomy in air conduction was 7.19 dB, bone conduction was 4.16 dB, and air-bone gap was 3.75 dB [<0.001]. The ear became dry and safe in 82 patients [96.5%] out of a total of 85, and only 3 patients required revision surgery at a second stage

Conclusion: Radical mastoidectomy has a least negligible effect on hearing status and one should not limit this technique due to the concern of aggravated hearing in patients with extensive cholesteatoma at the cost of dry and safe ears, which should be of prime importance

Comparison of finger glove and ribbon gauze nasal packing after septal surgery

Objective: To compare the efficacy of finger glove and ribbon gauze as nasal packing material after septal surgery by assessing the two parameters of bleeding and pain

Materials and Methods: This cross sectional comparative study was conducted at ENT Department of PNS SHIFA Hospital,Karachi, over a period of one and a half years fromAugust 2014 to January 2016.A total of 100 patients were included in this study. Inclusion criterion was all patients undergoing septal surgery requiring post-operative nasal packing. The right side of nose was packed with finger glove packing and left side of nose was packed with ribbon gauze in every patient. Pain and bleeding were assessed during 24 hour period of packing and on pack removal

Results: Mean blood loss during the packing period and at the time of pack removal was 6.60 ml and 2.31 ml respectively on the finger glove side and 11.40ml and 7.47 ml respectively on the ribbon gauze side [p = 0.001]. Similarly mean pain score on VAS during the packing period and at the time of removal was 2.62 and 3.65 respectively on the finger glove side while 3.37 and 4.41 on the ribbon gauze side[p = 0.001]. No complication from nasal packing was seen on either side

Conclusion: Finger glove is a better choice for packing after septal surgery than ribbon gauze because of less bleeding and pain

Suction cleaning of the external auditory canal in otomycosis: is it really helpful?

OBJECTIVE: This study was conducted with the objective to find out whether suction cleaning of the external auditory canal in cases of otomycosisis helpful or not

STUDY DESIGN: Prospective, randomized comparative study

PLACE AND DURATION OF STUDY: This multi-center study conducted at the departments of ENT, head and neck surgery of Liaquat University Hospital, Hyderabad, Sheikh Zayed Hospital, Rahim Yar Khan and Zubaida Medical Centre, Karachi. The study was conducted from March 2013 to February 2014 for a period of one year

PATIENT AND METHODS: A total of 200 patients were included in this study. These patients were serially divided into two groups A and B. Both groups received topical antifungal solution of 1% clotrimazole, 3 to 4 drops three time per day..In group A at the time of first consultation suction cleaning of the fungal debris was also done while in group B only above mentioned treatment was given without suction cleaning of the external auditory canal. All these patients were followed up regularly till the complete resolution of the disease

RESULTS: The minimum time duration for group A was 5 days and for group B was 9 days. The maximum time duration for group A was 18 days while for group B was 23 days. The mean time duration for complete resolution in group A was 9.6 days while in group B was 15.2 days [p<0.05]

CONCLUSION: Suction cleaning of the external auditory canal for removal of fungal debris is very helpful and it reduces the time duration for complete resolution. So it should be performed in every patient of otomycosis to remove fungal debris