Frequency of major causes of left vocal cord paralysis

To determine the frequency of different causes of left vocal cord paralysis in patients reporting in a tertiary care set up. Descriptive cross sectional study. This study was conducted at Combined Military Hospital Rawalpindi from Jan 2008 till Jan 2013. A total of 74 diagnosed cases of left vocal cord paralysis who consented to participate and fulfilling the inclusion criteria were included in this study. All patients were diagnosed by indirect laryngoscopy supplemented by flexible nasopharyngosopy whenever required. After detailed history and physical examination every patient was investigated in a sequence till confirmation of any pathology or exclusion of any underlying factor. Sequence of investigations were X-ray chest PA view, Barium swallow, Ultrasound neck, CT scan with contrast from base of skull to diaphragm, FNAC whenever required, panendoscopy under general anesthesia and biopsy. The commonest cause identified was malignancy in 20 cases [27%], followed by iatrogenic trauma 18 cases [24.3%], idiopathic 14 [18.9%], non surgical trauma 13 [17.5%] and miscellaneous causes that accounted for 9 cases [12.1%]. Left vocal cord paralysis is a common entity in ENT practice with multiple etiologies. An extensive protocol for investigation is required. Protocol should include USG, CT scan from base of skull to diaphragm because malignancy is still the most frequent cause of left vocal cord paralysis

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

Streptomycin associated hearing loss in patients treated for multidrug resistant tuberculosis

OBJECTIVES: To determine the incidence, frequency and degree of hearing loss in patients treated with streptomycin for multidrug resistant tuberculosis

STUDY DESIGN: A prospective observational study

PLACE AND DURATION: This study was carried out at Combined Military Hospital Rawalpindi over two years time from 01 Jan 2008 to 31 December 2009

METHODOLOGY: 38 patients who were treated with streptomycin as part of antituberculous therapy meeting the inclusion and exclusion criteria were included in this study. Pure tone Audiometry [PTA] was done before starting the treatment, on complaint of hearing loss and after one month and two months of streptomycin therapy to determine the hearing loss

RESULTS: At the end of 2 months therapy with streptomycin 22 patients [57.9%] develop sensorineural hearing loss, amongst them 15[68.2%] were identified within 1 month of therapy. Out of 22 patients 12[54.5%] have mild, 7[31.9%] have moderate and 3[13.6%] have moderately severe hearing loss in speech frequencies

CONCLUSION: Streptomycin still has got important role in treatment of Multidrug Resistant Tuberculosis. It is potentially ototoxic specially in children and old age. Careful monitoring in the form of serial audiograms is advised to pick up individuals susceptible to hearing loss with its use