Comparison between epleys maneuvre and prochlorperazine maleate in treatment of benign paroxysmal positional vertigo

The objective is to compare the efficacy of Epley's maneuver and vestibular sedative, prochlorperazine maleate in the management of benign paroxysmal positional vertigo [BPPV]. Randomized Control Trial. ENT department, Combined Military Hospital, Rawalpindi from 1[st] May 2011 to 1[st] November 2011. After consent, 60 patients of BPPV fulfilling the inclusion criteria were randomly allotted two groups. Group A was treated with Epley's maneuver [n=30] while group B with prochlorperazine maleate [n=30]. Outcomes were analyzed on disappearance of vertigo at follow-up examination. 24 [80%] cases managed by Epley's maneuver showed relief of symptoms while only 14 [47%] treated by prochlorperazine maleate showed recovery after 15 days. Epley's maneuver was more effective than vestibular sedatives like prochlorperazine maleate in treating patients of BPPV

Tinnitus matching

To study the pitch and loudness of tinnitus and to find minimal masking level. Descriptive analytical study. This study was conducted at Combined Military Hospital Rawalpindi, the tertiary referral center for Pakistan Armed Forces from 1998 to 2001. Patients with tinnitus were included in the study. Exclusion criterion was transient tinnitus settling on removal of offending agent like foreign body and not having tinnitus as major presenting feature. Patients were thoroughly interviewed and tinnitus card [questionnaire] was filled. Thorough general physical and Ear Nose Throat examination was carried out including relevant tests to elucidate any cochleovestibular pathology. All patients had pure tone audiometery and tinnitus testing and sophisticated investigations were carried out whenever indicated. Most patients of tinnitus were seen between age of 40 to 60 years and 76.6% patients were male. Hearing loss accompanied tinnitus in 90% patients and 53% patients had tinnitus of moderate intensity. Pitch match frequency of 4 kilohertz was seen in 25.3% while 29% patients had loudness match of tinnitus ranging from 55 to 70 decibel [dB]. In vast majority [24%] minimal masking level ranged from 41 to 55 dB. Seventy nine percent patients had pitch match frequency at or around frequency of maximum hearing loss. Tinnitus is seen predominantly among males and its frequency increases with age .It is usually of moderate intensity and is of high pitch which corresponds to frequency of maximum hearing loss. Pitch of tinnitus is not a good indicator of degree of annoyance while loudness match gives a good measure of annoyance. Minimal masking levels are at or around loudness match. Tinnitus in majority of patients is associated with mild to moderate degree of hearing loss

Chronic maxillary sinusitis, an uncommon aetiological factor of headache

To emphasize that headache due to chronic sinusitis must be differentiated from all other forms of headache clearing the misconception of relating almost every headache with sinusitis. This is a descriptive study. The study was carried out at the department of ENT, PNS SHIFA Naval hospital Karachi from March 2002 to March 2004. This study was carried out on 100 patients who were selected from the OPD as convenient sampling. It included patients referred to otolaryngology department who were having radiological evidence of maxillary sinusitis on plain x-ray PNS and were being investigated for headache of more than one-month duration. All the patients underwent a detailed history, clinical and E.N.T. examinations. Bilateral antral washouts were performed. Patients were compared on the bases of various parameters for instance age, gender, duration, severity, type and location of headache, effects of treatment for chronic sinusitis in ameliorating headache. A follow up for a period of three months were carried out. After the study the collected data was processed, analyzed and the final results were made. Majority of the cases belonged to the age group of 21 to 35 years [70%]. A large majority of the patients were not sure about any aggravating conditions. 28% cases were unable to recognize any pain-relieving factor. Only 9% patients were severely affected. 23% patients were having structured problems e.g., deviated nasal septum, nasal polypi and enlarged turbinates. In 39% cases antral wash on one or both sides revealed mucoid discharge. 17% patients expressed that they were markedly improved with the treatment. 83% did not improve remarkably, revealing that chronic maxillary sinusitis was not the main cause of headache in those patients. It was concluded that although sinusitis is associated with headache in majority of the cases but headache is not a major symptom in chronic maxillary sinusitis. Patients primarily presenting with headache have chronic sinusitis in a few cases only. It is recommended that not all the patients of headache with hazy X-ray PNS should be subjected to only the treatment of chronic sinusitis to relieve headache