Diagnostic accuracy of indirect laryngoscopy and x-ray neck in the diagnosis of fish bone impaction in upper aero digestive tract

This study was aimed at finding the validity of indirect laryngoscopy [IDL] and neck X-rays in the diagnosis of fish bone impaction. Validation study. CMH Nowshera from August 2012 to February 2013. A total of 50 patients were selected by consecutive sampling presenting with history of fishbone impaction in aerodigestive tract. IDL examination and neck X-rays were performed and findings were recorded. Those with no fishbone on both the investigations were discharged from hospital with follow up after 03 days. Those with fishbone detected on either of investigations underwent removal. Fishbone easily approachable were removed under local anaesthesia with foreceps and in others endoscopy [Direct laryngoscopy or Oesophagoscopy] was performed under General Anaesthesia. Sensitivities and specificities of bath the modalities were calculated using standard 2/2 Table. ROC curve analysis was carried out and significance level p<0.05 was taken as significant. In 2Q patients no fishbone was found, 26 patients were diagnosed on IDL and in 04 patients fishbone was detected by neck X-Rays. Most common site for fishbone impaction was pharyngeal tonsil. In 22 patients fishbone was removed with foreceps and in 08 patients endoscopy was performed. Diagnostic accuracy for IDL 86% and Neck X-Rays 48% was calculated. ROC curve analysis revealed AUC for IDL 0.933 and Significance level [P] as <0.0001. ROC curve analysis for X-ray gives AUC of 0.567 and Significance level [p] 0.4132. IDL shows higher diagnostic accuracy than neck X-Rays for detection of fishbone in upper aerodigestive tract. Neck X-rays are more useful for impacted foreign bodies in oesophagus

Duration of nasal packs in the management of epistaxis

To compare the efficacy of nasal packs for 12 and 24 hours in the management of epistaxis. Quasi experimental study. Combined Military Hospital, Nowshera and Heavy Industries Taxilla Hospital, from October 2012 to April 2013. A total of 60 patients presenting with epistaxis were selected and were divided into two groups of 30 patients each. Patients in both the groups were managed by nasal packs. In group-A packs were removed after 12 hours while in group-B after 24 hours. Symptoms of headache, lacrimation and recurrence of bleeding were recorded. SPSS 20 was used for data analysis and p-value less than 0.01 was considered significant. There was significant difference for headache between removal of nasal packs after 12 hours and 24 hours [p < 0.001]. There was significant difference for excessive lacrimation at 12 and 24 hours [p = 0.001]. No significant difference was observed for recurrence of bleed when nasal packs were removed at 12 and 24 hours [p = 0.317]. Duration in removal of nasal packs after 12 or 24 hours made a difference in the management of epistaxis. Symptoms of headache and excessive lacrimation were significantly higher when nasal packs were removed after 24 hours. It is recommended that patient could be managed with lesser duration of packs after episode of epistaxis to avoid inconvenience

Sensitivity and specificity of ultrasonography in diagnosis of maxillary sinusitis as compared to antral lavage

To compare the sensitivity and specificity of ultrasonography in the diagnosis of maxillary sinusitis as compared to antral lavage. Validation study. Otolaryngology Department Combined Military Hospital Rawalpindi from 1st march 07 to 28th February 2008. Consenting 60 patients diagnosed clinically as a case of sinusitis, presenting in ENT OPD during the study period fitting the inclusion criteria were selected. Ultrasonography of maxillary sinuses focusing on fluid level was done of all the patients. After ultrasonography all the patients had an antral lavage with isotonic saline to look for mucopurulent discharge. Sensitivity and specificity of ultrasonography was evaluated in diagnosis of maxillary sinusitis. The sensitivity of ultrasonography in diagnosis of maxillary sinusitis taking antral lavage as Gold Standard was very low 35.89%. The specificity of ultrasonography in diagnosis of maxillary sinusitis taking antral lavage as Gold Standard is good i.e. 80.95%.Ultrasonography has low sensitivity but high specificity in diagnosis of maxillary sinusitis.