Otitis media with effusion: Accuracy of tympanometry in detecting fluid in the middle ears of children at myringotomies

Objective: [1] The diagnostic accuracy of tympanometry in detecting fluid in the middle ear space in children with otitis media with effusion by comparing its findings with those of myringotomies. [2] Identify the age group most commonly affected by OME

Methods: This prospective study was conducted at the Department of ENTand Head and Neck Surgery, Postgraduate Medical Institute Hayatabad Medical complex, Peshawar from July 1, 2012 to April 30, 2015. Patients with suspicion of OME underwent tympanometry and later myringotomies. Using Jerger's classification, Type B tympanogram with normal canal volume was considered as conclusive evidence of fluid in the middle ear space. Its findings were compared with those of the respective myringotomies. From the data collected, the accuracy, sensitivity, specificity, positive predictive value and negative predictive values were calculated

Results: A total 117 ears of 63 patients were operated. The age range was 3 to 12 years. The commonest age group [58.7%] affected by OME was 6-8 years. Type B tympanogram with flat curve and normal canal volume was obtained in 71.4% of the ears. Comparison with myringotomy findings showed TP 85, TN 13, FP 5 and FN 14. The diagnostic value of tympanometry was; Sensitivity 85.85%, Specificity 72.22%, PPV 94.44%, NPV 48.14% and Accuracy of 83.76%. P value calculated using chi square test showed that there was significant difference between tympanometry and myringotomy findings in OME [p < 0.05]

Conclusions: OME is common in age group 6-8 years. Tympanogram Type B with normal canal volume is fairly sensitive in diagnosing this condition. However for occurrence of false positive results, final decision regarding management should be made on clinical findings and other supportive audiological tests

Control of bleeding by silk ligation and diathermy coagulation during tonsillectomy: a comparison of efficacy of the two techniques in the first 24 hours after surgery

To assess and compare the relative efficacy of silk ligation and diathermy coagulation techniques in controlling bleeding during tonsillectomy in the first 24 hours. This prospective study was conducted at the Department of ENT, Khalifa Gul Nawaz Teaching Hospital, Bannu and this department related consultants' private clinics from January 1, 2012 to December 31, 2014. The study included 180 cases. All patients included were having history of recurrent, acute tonsillitis, with more than 6-7 episodes in one year, five episodes per year for two years, or three episodes per year for three years. All the surgeries were performed by dissection method. Haemostasis during the procedure was secured by either ligation with silk 1 or using diathermy. The results were analyzed using SPSS 16.0 for windows. A total of180 cases were included in the study. The ages of the patients ranged from 5 to 40 years with the mean age of 15.56 years and a std.deviation of +/- 8.24. The male to female ratio was 1.25:1. The number of hemorrhages occurring was greater in the 'diathermy coagulation' group as compared to the 'silk ligation' group. However, the observed difference was statistically insignificant [p >.05]. Primary haemorrhage occurring during tonsillectomy is a serious threat and control of bleeding during the procedure should therefore be meticulous. Both suture ligation and coagulation diathermy for control of bleeders during the procedure by dissection method are equally effective

Otomycosis; clinical features, predisposing factors and treatment implications

The aim of this study was to determine the frequency of Otomycosis, the clinical presentation, predisposing factors and treatment outcomes. This observational study was conducted at ENT department of Combined Military Hospital Attock, from October, 2010 to September, 2012. Convenient sample comprising 180 patients of both sexes and all age groups were selected from ENT OPD. The frequency, predisposing factors and most common symptoms of Otomycosis were recorded. The response to different antifungal agents was also observed. Results were recorded in percentages. There were 180 patients with documented diagnosis of Otomycosis. There were 107 [59%] males and 73 [41%] females. The age of patients ranged from V/i years to 75 years with a mean age of 38.5 years, Mean follow up time was 2 years. Most common presenting symptom was hearing loss [77.7%] followed by pruritis [68.8%] and otalgia [40%]. We prescribed 1% clotrimazole drops or lotion in 58% patients and 2% salicylic acid in 31% cases. Both of these agents are effective. Topical 1% clotrimazole drops yielded highest resolution rate with lowest recurrent rate. Overall 149 [83%] patients were improved with initial treatment and 31 [17%] did not respond to initial treatment. Eight [4.4%] patients had a history of otological procedures. Four [2.2%] patients had canal wall down procedures that resulted in mastoid cavity. To analyse the efficacy of 1% clotrimazole and 2% salicylic acid we applied Z-Test to calculate the difference between 2 proportions of patients before treatment with those patients who remained uncured after treatment. Otomycosisis commonly presented with decreased hearing, pruritis, otalgia and otorrhoea. It usually resolves with local toilet of ear and instillation of antifungal agents. Eradication of disease is difficult in presence of a mastoid cavity and metabolic diseases like diabetes mellitus

frequency of malignancy in nodular goiter - a single center study

To find out the frequency of malignancy in nodular goiters. A total of 204 cases were studied in the department of ENT and Head and Neck surgery, Hayatabad Medical Complex, Peshawar. The duration of this descriptive study was from June 1, 2008 to May 31, 2010. After taking informed consent, a detailed history was obtained. Clinical and laboratory investigations were carried out as an aid to diagnosis and determine the patients' fitness for surgery. Patients with nodular goiters were categorized into two categories i.e., Solitary thyroid nodule and multinodular goiter. Surgically resected thyroid specimens were examined histopathologically. The data was analyzed using SPSS 16.0 for windows to determine the frequency of malignancy in nodular goiter. Ages of the patients ranged from 17 to 84 years with a mean age of 37 +/- 12.48 years. The male to female ratio was 1:3:5. 18.14% cases presented as solitary thyroid nodules [STN] and 81.86% as multinodular goiters [MNG]. Out of the total 83.82% cases were benign and 16.18% cases were malignant. The prevalence of malignancy in multinodular goiter was 14.37% and in the solitary thyroid nodules as 24.32%. Papillary carcinoma was the commonest malignancy followed by follicular carcinoma. The prevalence of cancer is significant in nodular goiters and these malignant tumours are usually of the papillary type. Solitary thyroid nodules have more chances of being malignant than multinodular goiter

Kochia Indica Wight - an unusual foreign body of the upper airways in children

To highlight the special features of an unusual foreign body of the larynx, the seed of kochia indica wight, and discuss its management. This prospective study was conducted at the Department of ENT, Khalifa Gul Nawaz Teaching Hospital Bannu, District Headquarter Teaching Hospital, Bannu and this department related consultants' private clinics from January 1, 2009 to December 31, 2011. The study included 32 cases. All the patients underwent direct laryngoscopy for removal of foreign body. The main indication for direct laryngoscopy was a definite history of foreign body inhalation and acute onset of hoarseness in predisposed children. The results were analyzed using SPSS 16.0 for windows. A total of 32 cases were included in the study. The age range was 5-15 years. There were 14 males and 18 females. All the patients presented with hoarseness of voice and dry irritating cough. Odynophagia was seen in 56.2% cases whereas breathing difficulty was present only in 9.4% of cases. The foreign body was lodged lateral to anterior 1/3rd of the cord in 62.5% followed by lateral to mid cord in 31.2% cases. Kochia indica wight seed is an unusual but a common foreign body of the larynx in the southern districts of Karak and Bannu. The diagnosis is easy in the predisposed children. Though it does not change its position in the larynx, yet urgent removal should be undertaken as foreign body in the larynx is potentially a life threatening condition.

diagnostic value of fine needle aspiration cytology in masses of the salivary glands

To determine the sensitivity and specificity of fine needle aspiration cytology in masses of the various salivary glands. The study included 49 cases. It was conducted at the Departments 0f ENT, Hayatabad Medical Complex, Peshawar and Saidu Teaching Hospital, Saidu Sharif, Swat from January 1, 2002 to December 31, 2009. Patients undergoing Fine Needle Aspiration Cytology followed by open biopsy were included in the study. The results obtained on FNAC were compared with those obtained on biopsy findings of the respective specimens and the specificity and sensitivity of FNAC were calculated from the data. The FNAC findings in salivary glands were; Benign 38, Malignant 7 and Suspicious 4. The biopsy findings were; Benign 33 and Malignant 16. Comparison of FNACs and biopsy in the salivary glands taken as True Negative, True positive, False Negative and False Positive respectively was; 32, 10, 6 and 1. The Sensitivity and Specificity for FNAC were calculated at 62.50% and 96.97% respectively. The results of this study show that FNA cytologic diagnoses in the salivary gland tumours are reliable and treatment can be planned on its basis. However, owing to a higher number of false negative cases occurring in this study, it is recommended that a negative cytology report should be viewed with suspicion. The diagnosis should be confirmed by open biopsy if clinical suspicion persists

Transurethral electrovaporization vs transuretheral resection of prostate for the management of benign prostatic hyperplasia: a comparative study at pims, Islamabad, Pakistan

To compare and determine the safety and efficacy of transurethral electrovaporization of prostate [TUVP] over transurethral resection of prostate [TUR.P] for management of benign prostatic hyperplasia [BPH]. This comparative randomized clinical study was carried out in Pakistan Institute of Medical Sciences [PIMS] Islamabad, Pakistan from May 1997 to April 1998. One hundred patients with signs and symptoms of benign prostatic hyperplasia were selected from Urology out patient department of Pakistan Institute of Medical Sciences [PIMS] Islamabad, Pakistan. They were divided into two groups of fifty each; one group underwent TURP and other TUVP. Post operative follow ups to assess the results of both the procedures were carried out at 2, 12 and 24 weeks. For approximately the same size of prostate, the mean operation time [39.7 mins] was longer for TURP as compared to TUVP [25.22 mins]. The hemorrhage was more with TURP. Clot retention incidences were five in TURP as compared to none in TUVP. The mean volume of irrigation fluid used during operation [7.5 liters] was far less in TUVP as compared with what was required in TURP [12.0 liters]. The changes in sodium and hematocrit were monitored by taking pre and post operative blood samples. The variations in the levels before and after TUVP were negligible, while TURP group patients were noted to have post operative hyponatremia. The maximum post operative stay was 3 days in TUVP [mean 2 days] compared to 7 days in TURP [mean 6 days]. As far as post operative complications were concerned, infection and perforation incidences were more in TURF compared to TUVP. Although TURP is much effective gold standard for treating BPH, it is a bit costly with higher morbidity and complication rate as compared to TUVP which is a minimal invasive technique suitable for smaller sized prostate in high surgical risk patients

Diagnostic value of fine needle aspiration cytology [FNAC] in cervical lymphadenopathy

The aim of this study was to evaluate the diagnostic value of fine needle aspiration cytology [FNAC] in head and neck lymph nodes and in differentiating malignant from benign diseases. This prospective study was conducted in the ENT Department of PGMI HMC and LRH Peshawar from 1st April 2003 to 30th March 2004. A total of 42 patients were studied. After thorough history and examination, FNA biopsy was obtained with the help of experienced cytopathologist using 21G needle and the results compared with final histopathological diagnosis. FNAC findings in this series were metastatic [42.85%], tuberculosis adenitis [26.19%], reactive hyperplasia [16.66%], lymphoproliferative disorder [9.52%] and lymphoma [4.76%]. In terms of differentiating malignant from non-malignant lesions; diagnostic accuracy, sensitivity, speciflcity, positive predictive value and negative predictive value of FNAC were 95.23%, 95.83%, 94.44%, 95.85% and 94.44% respectively. FNAC has been found to be a useful diagnostic tool in the evaluation of patients presenting with neck nodes and should be considered before performing open biopsy

Infection of human papillomavirus [HPV] and p53 over-expression in human female genital tract carcinoma

Inactivation of p53 gene products either by mutation or by complex formation with E6 oncoprotein encoded by high risk HPV appears to be a common event in cervical carcinogenesis. This study was designed to clarify this association in 41 primary cervical, 15 endometrial, 3 ovarian and one rectal carcinomas. Polymerase chain reaction analysis revealed presence of high risk HPV in 36[88%] cervical, 5 [33%] endometrial and none of ovarian and rectal carcinomas. HPV 16 was found in 14 cervical carcinomas, HPV 18 in 19 cervical and 2 endometrial carcinomas and HPV 33 in 28 cervical and 5 endometrial carcinomas. Expression of tumor suppressor protein p53 by using polyclonal antibody CM-I, was detected in 28 [68%]cervical, 7[47%] endometrial, 2 [66%] ovarian and one [100%] rectal carcinoma. Twenty six cervical and 3 endometrial carcinoma cases were positive for both high risk HPV and p53. We conclude that beside cervical carcinoma HPV infection is not uncommon in endometrial carcinoma and in our experimental design there is no inverse correlation between HPV infection and p53 over-expression in a variety of the tumors analysed in the present study