Pattern of hearing loss on pure tone audiogram in heavy industrial workers

Background: Hearing loss in industrial worker may be devastating for the workers, with poor quality of life

Objective: This study was conducted to find out the degree of hearing loss and audiometric pattern of hearing loss in local industrial workers

Patients and method: This cross sectional study was conducted at department of ENT, head and neck surgery, Kulsoom Bai Valika Social Security Hospital, SITE, affiliated hospital of Hamdard University, Karachi, from 1[st] January, 2010 to 31[st] December, 2010. A total of 100 persons were included in this study who were industrial workers for more than 15 years and came to hospital for some reasons other than hearing loss or any ENT problem. The data was entered and analyzed by using SPSS version 15

Results: Majority of the subjects were male [96%] while only 4% were females. 18 patients were below the age of 35 years, 29 were between 36-45 years, 32 were between 46-55 years and 21 were above the age of 55 years. 74% of the workers were not using any protective device or method against loud machinery noises. Mean hearing threshold of all the subjects was above 25 dB in all frequencies tested i.e. from 250 to 8000 Hz. Mean hearing loss was maximum at the frequency of 4000 Hz

Conclusion: All of the workers included in this study has some degree of hearing loss at least in some frequencies [more pronounced at 4000 Hz], although majority were not aware of this hearing loss

Clinical versus intra-operative staging of T status in the laryngeal cancer: a comparative study

One hundred cases of proven squamous cell carcinoma of the larynx were analysed regarding their pre and post-surgical staging. Clinical underestimation was picked up in 9 cases of advanced lesions which staged as T3 but intra-operatively found to be T4. Clinical over estimation was not recorded in any of the case. In earlier lesions [T1 and T2] no clinical under or over estimation was recorded. Deep extension of the tumour with involvement of thyroid cartilage and extra-laryngeal structures are the commonest cause of clinical under estimation. We suggest that all T3 lesions must be treated by widefield total laryngectomy

Saw-blade: an unusual foreign body in the facial tissue

A 32 year old man was accidentally hit by a broken saw blade on the face. The blade caused a lacerated wound of entry on the cheek. Its impaction was not recognized initially when the wound was sutured. Subsequent cheek swelling and epistaxis prompted him for an ENT consultation. X-rays showed the saw blade lying in the soft tissue of the cheek. Under general anaesthesia, external manipulation showed the edge of the foreign body visible in the nasal cavity below the inferior turbinate. Intranasal removal was successful

Laryngo tracheal stenosis-diagnosis and management at civil hospital Karachi

Over a period of seven years, 8 patients of chronic laryngotracheal stenosis presented at Civil Hospital Karachi. Road traffic accident was the commonest cause in our series [5 cases]. Various modalities were employed for the diagnosis and treatment. For diagnosis we recommend MRI in preference to conventional X-rays and CT scan. In six cases open surgical method with stenting was used. Good patency and acceptable voice were achieved. Successful decannulation of tracheostomy tube was obtained in all these cases

Pharynogocutaneous fistula following laryngectomy

Sixty-eight cases of stage III and IV laryngeal cancer were analysed to determine the frequency and management of post - operative pharyngocutaneous fistula [PCF]. The overall incidence in our series is 8.9% [6 cases]. In five patients PCF healed spontaneously without any surgical intervention while one patient expired due to concomitant other medical illness. The longest time taken by the fistula to heal by conservative treatment was 7 weeks. Retaining the NG tube for a longer period [14-16 days] and adequate and appropriate antibiotic cover reduces the incidence of fistula formation

Current options in the treatment of laryngeal carcinoma

The incidence rate of carcinoma of larynx varies globally. This malignancy is significant as it has a high rate of cure. Beside other factors topography and the clinical stage of the disease is important to decide the modality of treatment. Supraglottic carcinoma is amenable to treatment either by surgery, radiotherapy or by combining both. Radiotherapy is effective in supragloltic carcinoma in superficial growths only. T1 glottic carcinoma can be treated by radiotherapy, excision, laser evaporation with equivocal results. T2 lesions may be treated by either radiotherapy or hemilaryngectomy with similar outcome. T3 glottic lesion is treatable with radiotherapy and salvage surgery for recurrence. Conservation surgery is also possible for T3 lesions in the recent years. In selected cases partial laryngectomy and radiotherapy may permit preservation of laryngeal function. Total laryngectomy is the mainstay of treatment for T4 lesions along with resection of adnexal areas. Subglotlic cancers are only treatable by total laryngectomy. For transglottic growths partial laryngectomy is only feasible when cartilages are spared. Radiorecurrent growths are now considered amenable to conservation surgery. Induction chemotherapy is useful for tumour regression only in advanced cases. For the nodal disease prophylactic neck dissection has no value now in No status. Radical neck dissection is mandatary once the node figures out. For the relief of airway in advanced disease emergency laryngectomy should be avoided for the danger of stomal recurrence. Among the voice restoration procedures oesophageal speech is the most cost affective

Pathological profile in chronic suppurative otitis media-the regional experience

Peroperative findings in 145 consecutive cases of chronic suppurative otitis media, operated at Civil Hospital, Karachi were recorded. The mean age was 24 years. More than half of the patients [51%] had subtotal perforations and majority had damage of more than one ossicle. Involvement of all the three ossicles was seen in 30 [40%] cases. The frequency of damaged malleus alongwith incus was higher than other series. Granulations and subtotal perforations were commoner and could account for it. Extensive cholesteatoma was present in 30 cases

Nodal relapse in laryngeal cancer after laryngectomy

Forty five patients of laryngeal carcinoma with NoMo stage were treated surgically and followed up. Patients with T4 lesions and transglottic lesions were given post-operative elective radiotherapy. Overall nodal relapse occurred in 17.7% of the cases. Relapse rate was more pronounced in supraglottic carcinomata [36.4%] than in transglottic carcinomata [25%]. Seventy five percent of the relapses occurred within six months. The shortest time interval between the primary surgery and the nodal relapse was 3 weeks. Post-operative elective radiotherapy curtails nodal relapse

Angiokeratoma tongue

A 4 year old girl from Swat presented with large protruding tongue which has gradually grown in 3 years. The exposed surface was swollen, congested and non tender. A punch biopsy was non diagnostic. Tracheostomy and partial glossectomy was done and revealed it to be a Angiokeratoma;a vascular lesion with hyperkeratosis. Angiokeratoma may be localised or generalised, and may presented in skin, cornea, gingiva and soft palate

Retropharyngeal abscess in adults

Retropharyngeal or prevertebral abscesses are less common in adults than in children. Acute variety is mostly seen in children, while the chronic variety, essentially prevertebral collection of pus resulting from tuberculosis of cervical spine, is seen in adults. Four cases of retropharyngeal or prevertebral abscess in adults are presented. The first one is an acute retropharyngeal abscess due to Staphylococcus aureus, the other case is due to a perforating foreign body while the remaining two cases are due to tuberculosis of cervical spine

Oesophagea speech

Twenty eight laryngectomees received oesophageal speech therapy. The overall success rate was 68%. The methodology and results of oesophageal speech therapy are discussed. It is a cheap method of speech rehabilitation without any costly devices, any further surgery and without complication of aspiration