Comparison of efficacy of topical with oral ciprofloxacin in patients of tubotympanic type of chronic suppurative otitis media to obtain dry ear

Background: Chronic suppurative otitis media [CSOM] is one of the common diseases in routine ENT practice

Objective: To compare the efficacy of topical ciprofloxacin with oral ciprofloxacin 500mg twice daily in achieving dry ear [Medical cure] in Tubo-tympanic type of Chronic suppurative otitis media

Methodology: Study Design: Quasi-experimental study. Place and Duration of Study: The study was carried out at ENT department of Bahawal Victoria Hospital Bahawalpur from 01 January to 30 September 2015. One hundered patients, 11 to 60 years of age of either gender having Tubo-tympanic type of chronic supportive otitis media were included. Patients with previous antibiotic treatment, pregnant or lactating women, history of hypersensitivity to Quinolones [ciprofloxacin], chronic suppurative otitis media of Attico-antral type, known case of DM and hypertension were excluded. Selected patients were divided into two groups [Group A and Group B] by using lottery method. Group A [n=50] was given Ciprofloxacin ear drops and Group B [n=50] was given Oral Ciprofloxacin 500mg twice daily. The patients were followed up to 08 weeks after treatment [at least two follow up visits] and examined otoscopically and under microscope to assess the efficacy. The efficacy of drugs was graded into four grades depending upon the decrease in discharge amount [Poor/no response, satisfactory, good and excellent]. The data was entered and analyzed by using SPSS version 20

Results: The mean age of group Apatients was 27 +/- 5 and in group B was 30 +/- 5 years. Males were 67 [67%] and females were 33 [33%] with ratio of 2:1. Bilateral CSOM in 27 [27%] and Unilateral was found in 73 patients [73%]. Efficacy was excellent in 52%, good in 24%, satisfactory in 8% and poor/ no response in 11% patients of Group A while it was excellent in 36%, good in 24%, satisfactory in 1% and poor/no response in 30% patients of Group B

Conclusion: This study concluded that Topical ciprofloxacin is more effective than oral ciprofloxacin in the medical treatment of tubo-tympanic type of CSOM to obtain dry ear

Frequency of three complications [bleeding, laceration of external auditory canal and perforation of tympanic membrane] in patients with aural foreign bodies

To determine the frequency of three major complications of the foreign body in the external auditory canal i.e. the haemorrhage, the laceration and the perforation of the tympanic membrane. Cross sectional study. This study was conducted in the Department of ENT, Bahawal Victoria Hospital, Bahawalpur from 25-12-2012 to 24-09-2013. Total 284 cases that presented during nine months of duration were included in our study. General anaesthesia was used not only when initial attempt under direct visualization was unsuccessful, but also for those having history of previous attempts, and uncooperative patients. 25% of patients developed haemorrhage, 13.8% were having laceration while none of the patient presented with tympanic membrane perforation. Cotton bud was found to be the commonest foreign body [33.7%] and bleeding was associated with it. In this study, the cotton bud was found to be the commonest foreign body in external auditory canal. Use of cotton bud although is easy for cleaning of ears but if it is broken inside the external auditory canal, can cause serious complications like bleeding and laceration as found in this study. Public should be educated about this preventable medical emergency

Juvenile nasopharyngeal angiofibroma, experience of 35 cases with different surgical approaches

1] To study the clinical presentation. 2] To study the outcome regarding recurrence, prognosis and complications of different surgical approaches ofjuvenile nasopharyngeal angiofibroma. Observational study. The study was conducted at department of Ear, Nose, Throat. Head and Neck Surgery, Quaid-e-Azam Medical College and Bahawal Victoria Hospital Bahawal Pur, from March 2005 to February 2009. All young male patients presenting in ENT OPD/COD with complaint of recurrent nose bleeding, nasal obstruction and nasopharyngeal mass were admitted in ward. Detailed history was taken and thorough clinical examination done. Routine investigations and CT scan done in all cases. Staging done according to Fisch staging systems. Sufficient quantity of blood arranged and patient prepared for surgery. Specimen removed was sent for histopathological examination to confirm clinical diagnosis. Follow up was done for 12-18 months to see the recurrence and complications. Total 35 young male patients clinically diagnosed as JNA and postoperatively confirmed by histopathology were included in the study. Age range was between 10-25 years, majority were between 12-20 years [n-31]. All patients were male. All patients presented with epistaxis, nasal obstruction and nasopharyngeal mass. Other presenting symptoms were, anemia [n-29], nasal mass [n-27], ear blockage [n-27], nasal discharge [n-25], headache [n-22], snoring [n-15], speech defect [n-11] and proptosis [n-6]. All patients under went surgery. Seventeen patients were approached through lateral rhinotomy, 12 through transpalatal approach and 06 through Weber Furguson approach. In 05 patients recurrence occurred and in 11 patients postoperative complications occurred. Meticulous surgical approach depending on the stage of .TNA reduces the risk of recurrence and complications

Management of recurrence in nasal polypi

To investigate the incidence of recurrence in nasal polypi and assess the efficacy of various modalities of the treatment currently available to prevent the recurrence. This study was carried out in the ENT and Head and Neck Surgery Department, B.V. Hospital Bahawalpur from January 2006 to December 2007. A total of 160 cases were included in the study. Most of the cases were between the ages 11-30 years. The youngest patient was of 5 years age while the eldest was of 70 years. Mean age was 24 years. The disease is most prominent in males. Out of 160, male patients were 98 and female were 62. Male to female ratio is 1.6:1. Nasal polypi are mostly bilateral [75%] while 25% were unilateral. 14% were right sided and 11% were left sided. About 60% of the patients were having symptoms for less than one year, 26% presented in 1-3 years period and only 16% presented after 3.years. Out of 160 cases, 56 [35%] patients were recurrent i.e. they had undergone already operative procedures, mostly nasal polypectomy. Nasal polypectomy was performed in 67.5% of the cases and ethmoidectomy in 32.5%. Ethoidectomy is better than nasal polypectomy and has lesser recurrence rate but a great care must be observed as the ethmoid is very close to the orbit and brain. External erthmoidectomy is the best of all surgical procedure to prevent the recurrence. Use of topical steroids after nasal polypectomy also prevents the patient from recurrence of nasal polypi

Superficial cervical swelling in children; role of fnac in diagnosis - experience at Bahawalpur

Fine needle aspiration cytology [FNAC] is commonly used first line diagnostic test for palpable cervical swelling by ENT and Head and Neck surgeon. To analyze the diagnostic importance of FNAC by knowing its sensitivity and specificity in children having palpable cervical swelling. Prospective study. Department of ENT and Head Neck Surgery QAMC, Bahawalpur. July 2006 to June 2007. 82 cases of superficial cervical swelling with ages between 5 and 12 years were selected. Most of them were of poor socioeconomic class. All underwent FNAC for diagnosis and results were analyzed after comparing with histopathology examinations. Out of 432 total patients [of all ages] who attended the ENT department during the study period, only 82 were selected for the research which fulfilled the inclusion criteria. These were 5-12 years old, both sexes, 47 boys [57.3%] and 35 girls [42.75%]. Sixty eight [83%] patients had benign diseases while 14 patients [17%] had malignant lesions. Out of the 68 benign lesion [44.11%] were reaction hyperplasia [non specific inflammation], followed by tuberculous lymphadenitis [38.23%], cystic masses [5.88%], benign tumours [4.4%] and nodular goiter [7.35%]. Out of 14 malignant lesions, 6 [42.85%] had Hodgkin's Lymphoma, 2 [14.28%] had Non Hodgkin's Lymphoma, 3 [21.42%] patients had squamous cell carcinoma and 1 [7.14%] patient each of rhabdomyosarcoma, undifferentiated carcinoma and pleomorphic adenoma. In our study sensitivity and specificity of FNAC to diagnose the malignant lesion was 85.7% and 89.7% respectively. Accuracy of FNAC in our study was 89.0%. FNAC is highly helpful to diagnose the pathology of cervical swelling in children. It has high rate of sensitivity, specificity and accuracy to diagnose the malignancy in these lesions. Proper and specific sampling needs complete cooperation of the child and sedation may be necessary for this. Expertise is required for FNAC reporting