Correlation of operative findings with pre-operative clinical signs and analysis of x-rays in patients with airway foreign bodies

Foreign body aspiration is one of the commonly encountered emergencies in ENT and still it remains a significant cause of mortality and morbidity. However with the development of modern endoscopic techniques and controlled anaesthesia, most foreign bodies can be removed safely with a bronchoscope. This study was carried out at Department of ENT, Head and Neck Surgery, Ayub Medical College, Abbottabad from 1[st] Jan 2003 to 30[th] June 2005. Total 81 patients were registered in the study. Two patients, in whom the foreign body could not be removed, were excluded from the study. The most consistent finding was decreased air entry on chest auscultation on the side of impacted foreign body which was present in 72 [91.1%] patients. The second most consistent finding was audible wheeze on the side of impacted foreign body found in 42 [53.2%] patients. The most common finding on Chest X-ray was emphysema found in 19 [61.3%] patient, followed by atelactasis in 9 [28%] patients while 3 [9.7%] patients had normal Chest x-ray. The pre-operative clinical signs in patient with aspirated foreign body give an idea about the site of foreign body in an airway. Although chest x-ray gives an idea about the pathological changes in respiratory tract it has little impact in the management of a patient with aspirated foreign body

Evaluation of safety of bipolar diathermy tonsillectomy

Tonsillectomy is a common operation in both children as well as adults, performed by a variety of techniques that have evolved over the years to ensure the safety of the procedure. Cold dissection and electrodissection are the two mostly used techniques. Bipolar diathermy tonsillectomy was evaluated for its safety and postoperative morbidity. This study was conducted over a period of two years, in the Department of Ear, Nose Throat and Head and Neck Surgery at Ayub Teaching Hospital, Abbottabad, Pakistan. Two hundred and forty-six were enrolled; however, 238 patients completed the full evaluation as the technique had to be modified in 8 patients. All the procedures were performed by the first author thereby ensuring the same expertise level. Operating time, intraoperative blood loss, postoperative algesia, feeding status and time taken getting back to school/work and episodes of secondary bleeding were recorded. Time taken by the procedure ranged from 10 to 20 minutes. Intraoperative blood loss ranged between 2 to 5 ml. Postoperative pain averaged around 3-5 on a 1-10 point scale in 75% of patients. 80% of patients were back to normal diet by day 3 postoperative. Nine [3.6%] patients had a secondary haemorrhage that was managed conservatively and did not need surgical intervention. Bipolar diathermy tonsillectomy is an effective and safe technique, especially in children population. Adequate experience with the technique is mandatory to achieve the desired goals

Analysis of tracheobronchial foreign bodies with respect to sex, age, type and presentation

Foreign body inhalation is one of the life threatening emergencies. It may happen at any age, however, most of these accidents occur in children especially below the age of five. This prospective study was done at Department of Otolaryngology, Head and Neck Surgery, Ayub Teaching Hospital, Abbottabad, from 1 January 2003 to 30 June 2005. a total of Eighty one patients, referred from the casualty and Paediatric unit with suspicion of tracheobronchial foreign body were included in the study. Eighty one were studied. Fifty [61.7%] were male and thirty one [38.3%] were female. Sixty three [77.8%] were below five years, thirteen [16%] were between five and fifteen years and five [6.2%] were above fifteen years. Sixty seven patients [82.7%], presented mainly with chocking, while fifty nine patients [72.8%] had stridor and forty five patients [55.6%] had cough at initial presentation. Seventy two [88.9%] patients had decreased air entry and forty two [51.9%] had wheeze on auscultation, whereas cyanosis was noticed in five [6.2%] patients. Peanut was the commonest foreign body, retrieved in forty five patients [55.6%]. Other foreign bodies were whistle [18.5%], maize seed [13.6%], bean seed [6.2%], nuts [2.55], sewing needle with thread, dice and denture [1.2%] each. Foreign body inhalation is more common in male patients, mostly below five years of age. Chocking is the commonest symptom and decreased air entry on auscultation is the typical examination finding. Peanut has been found to be the commonest type of foreign body

Evaluation of efficacy of management protocol in allergic rhinitis

Allergic rhinitis represents a global health issue affecting between 10% to 25% of the world population, with increasing prevalence, resulting in a significant impact on quality of life, multiple comorbidities and the considerable socio-economic burden. Majority of the patients are younger than 30 years and it may be inherited. Symptoms typically occur as a result of exposure to dust, dander or certain seasonal pollen. Lack of standardized management protocol is one of the major factors responsible for poor control of this condition. This study was designed to evaluate the patients suffering with allergic rhinitis and manage them with a protocol based on the pathogenesis of the condition. Method: This prospective study was conducted in the Department of Ear, Nose and Throat and Head and Neck Surgery, Ayub Teaching Hospital, Abbottabad, over a period of two years [2005-2006], to assess the efficacy of a standard protocol of treatment developed and followed in the department. 1167 patients, clinically diagnosed as suffering with allergic rhinitis, were evaluated and managed. Age ranged from 08 months to 64 years. All the patients were prescribed medical treatment, divided into initial phase of 10 days to two weeks duration followed by a maintenance phase, and a regular follow-up schedule was maintained upto two years. 634 [54.32%] patients were male and 533 [45.67%] were female. Age ranged from 08 months to 64 years, 85% being between 05 and 45 years. 91% of patients had symptom duration of 06 months to 03 years. 96% of the patients were getting treated on as required basis, whereas 98% had no educational sessions with the treating doctor, especially regarding preventive measures. Typical presentation in most of the patients was nasal obstruction, runny and itchy nose, post nasal drip and bouts of sneezing. 90.57% patients reported improvement in symptoms. 53.21% patients had a relapse of symptoms at some stage during the study period. 37.53% patients had surgery done for associated pathologies, mostly a DNS. Compliance regarding medication was more than 90% in the initial phase of treatment that dropped to 50% in the maintenance phase. 93% of the patients tolerated the treatment well. Allergic rhinitis is a growing problem worldwide. Optimal treatment protocol is still lacking especially in the developing countries. Patient's education on avoidance of allergens must be stressed. Associated problems that may need surgical treatment. Regular follow-up must be ensured to monitor the progress of treatment as well as to identify patients who might be candidates for immunotherapy. Newer modalities of treatment need to be further explored. A team approach is mandatory in the presence of symptoms related to lower respiratory tract

Significance and cost effectiveness of pre-operative routine laboratory investigations in young healthy patients undergoing elective ear, nose and throat surgery

Pre-operative preparation is an important component of surgical workup. Adequate clinical assessment to determine fitness for anaesthesia and surgery and to outrule possibilities of existing disease or risk factors against the procedure would suffice in elective surgery on healthy young patients. Still routine investigations are carried out following a protocol, that does not offer added benefit and is not cost effective. We evaluated one hundred and fifty young healthy patients planned for elective surgery, to compare adequate clinical assessment with results of routine investigations in such patients, in terms of significance and cost effectiveness. Significant co-relation was demonstrated between clinical assessment and routine investigations. Only 03 abnormal results were reported following 600 laboratory investigations on 150 patients. Thorough clinical assessment is mandatory for successful outcome of surgery. There is significant co-relation with routine investigations in elective Ear, Nose and Throat [ENT] surgery. Investigations should be restricted to where indicated by clinical assessment. Such policy will significantly reduce the costs and workload, thereby improving quality of health care system

Foreign body inhalation - site of impaction and efficacy of rigid bronchoscopy

Foreign body inhalation is a relatively commonly encountered emergency in otolaryngology. Foreign body can get lodged at any site from the supraglottis to the terminal bronchioles. Rigid bronchoscopy is one of the well established methods of removing inhaled foreign body with fewer complications. This prospective study was conducted in the Department of ENT, Head and Neck Surgery, Ayub Teaching Hospital, Abbottabad, from January 2003 to June 2005. The total number of patients was eighty one. Patients in whom a foreign body was retrieved, were included in the study. Foreign body was found in the right main bronchus in sixty patients [74.1%], left main bronchus in seventeen patients [21%], terminal bronchioles in two patients [2.5%] and one patient [1.2%] each in trachea and laryngeal inlet. Foreign body was successfully removed in seventy-nine patients [97.5%]. Nineteen patients [23.5%] had postoperative airway edema, one [1.2%] had trauma to the false cord and laceration of the posterior pharyngeal wall. It was concluded that the right main bronchus is the most common site of impaction of inhaled foreign body. Rigid bronchoscopy is very effective procedure for inhaled foreign body removal with fewer complications

Management outcome of secretory otitis media

Secretory otitis media is a common otological manifestation, that most of the time is left undiagnosed on account of unawareness and negligence in seeking early medical attention for trivial ailments. Untreated, it might end up in serious consequences in the form of poor speech and intellectual development and permanent anatomical disabilities within middle ear cleft, The objectives of the study were to determine most affected age group, the common etiological factors, to access the efficacy of medical and surgical treatment and finally to find out the complication associated with the surgical procedures. This study was conducted in the ENT, Head and Neck Surgery department of the Ayub Teaching Hospital, Abbottabad from January 2001 to December 2003.Only the diagnosed cases of SOM were included in the study. After detailed history, clinical examination, routine investigations and special investigations such as pure tone audiogram and tympanometry were carried out to confirm the diagnosis of SOM. All patients were initially treated by medical therapy. In cases of failure, underwent myringotomy with or without ventilation tube insertion and where indication present adenotonsillectomy and antral lavage was done. Follow up of cases was carried out from 18-24 months. It included 87 patients, 58 were males [66.6%] and 29 females [33.3%]. Majority of the patients were between 5-8 years [62%]. The most common aetiological factor was rhinosinusitis [36.7%] followed by hypertrophic adenoids [34.5%]. All patients were initially given medical treatment. Out of 87 patients,30 patients [34.4%] improved and 57 patients [65.5%] had no response and underwent surgery. Surgical procedures included myringotomy with and without ventilation tube insertion, adenotonsillectomy and antral lavage. It is concluded from this study that conservative treatment has a definite role and should be tried before any surgical step is taken however surgery is the treatment of choice in more resistant cases

Lemierre's syndrome: a forgotten complication of oropharyngeal infection

Lemierre's syndrome [postanginal sepsis] usually complicates an oropharyngeal infection as septicemia. septic thrombophlebitis of the internal jugular vein, and metastatic lesions, most frequently in the lungs. Fusobacterium necrophorum is the usual etiologic agent. Lemierre's syndrome is not widely known by clinicians. This study aims at creating awareness amongst the clinicians of existence of this potentially fatal but curable clinical entity. All the patients admitted in the ENT department of Ayub Teaching Hospital, during the period of January 2000 to December 2002, for the treatment of acute oropharyngeal infection, were critically assessed by consultants, for features of Lemierre's syndrome, and investigated further. accordingly. 156 patients were admitted with acute oropharyngeal infection. Two patients [1.28%] had features suggestive of Lemierre's syndrome. A male and a female, 25 and 28 years old respectively, had a history of a preceding sore throat for a variable duration followed by complications. Attempts were made to make the diagnosis of Lemierre's syndrome and they were treated appropriately, as per recommendations, to a successful outcome. Conclusions: Widespread use of antibiotics for pharyngeal infections has significantly reduced the incidence. Rare and a forgotten complication, Lemierre's syndrome is potentially fatal. Early diagnosis and prolonged treatment with appropriate antibiotics are usually curative. A high degree of clinical suspicion is necessary for diagnosis. Modern day clinician should be aware of this potentially life threatening clinical entity that may complicate a trivial oropharyngeal infection

critical analysis of the management protocols for idiopathic sudden sensori-neural hearing loss

Sudden sensori-neural hearing loss [SSNHL] is a clinical dilemma with great diversity in presentation and poorly understood pathogenesis and hence no definitive treatment protocol as yet. Both sexes are affected, middle age to elderly being the commonest age group. A variety of causes have been implicated as responsible for this condition, but most of the times it is difficult to isolate one, and hence most of the times a battery of investigations proves to be a clinical exercise. A number of treatment protocols have been suggested and used over the years, based on presumed etiological theories, claiming varying degrees of success. Relevant literature available on the net regarding the management and the efficacy of various treatment regimens for ISSNHL was critically analyzed by the authors [who are professorial staff of a medical college and consultants of a teaching hospital] to develop a consensus and recommendations on the most appropriate protocol. It was asserted that various treatment regimens have not proved beyond doubt to be superior to one another or spontaneous recovery rates. SSNHL is a medical emergency that entails thorough investigations to search for a possible cause and institution of appropriate therapy. Failing identifying a cause, i.e idiopathic group, combination therapy with steroids and antiviral drugs could prove beneficial provided treatment is instituted early. A number of placebo controlled trials consuming various modalities are needed to determine an optimal treatment of ISSNHL. Psychological and psychiatric assistance has a certain role and so has the rehabilitation in the management of these patients

Retropharyngeal abscess: a clinical study

Retropharyngeal abscesses are more common in children than the adult population. This is a potentially lethal infection in the paediatric population under the age of five years. Abscesses in this group are secondary to upper respiratory tract infection. In the adult group they are usually secondary to trauma, foreign bodies or as a complication of dental infections. We have treated 12 cases of Retropharyngeal Abscesses between 1990 to 1998 in our department. Factors such as age, sex, aetiology, presenting signs and symptoms, methods of diagnosis, treatment and complications are reviewed. A lateral neck film showing widening of the prevertebral space was the most diagnostic tool. Ten cases required surgical drainage. The other two were completely cured with parenteral broad spectrum Antibiotics. The most commonly isolated pathogen was streptococcus pyogenes. There were no deaths and only one recurrence required repeated surgical drainage

Management of tracheo-bronchial foreign bodies in children

This is a study of 32 cases of foreign body tracheobronchial tree in children, spread over two years period. More than 65% of patients were of two years and below. The male to female ratio was 2:1. More than 70% of foreign bodies were vegetable in nature. Foreign bodies were located more often in the right main bronchus as compared to the left [3:2]. In all cases, foreign bodies were removed under G.A., with the help of rigid pediatric bronchoscopes. There was no mortality. In 04 cases no history of foreign body inhalation was forthcoming and bronchoscopy was done because the child had persistent cough and episodes of dysphonia. There was a delay of 1-10 days before presentation in the majority of patients. Majority of the patients presented 24 -hours after the inhalation of foreign body. Removal of foreign body tracheobronchial tree through rigid bronchoscope under GA is a safe and life saving procedure with good results

Rare lethal midline granuloma of the nasopharynx Stewards's granuloma

We report a case of lethal midline Granuloma of the Nasopharynx. Lethal midline Granuloma of the nose is a rare tumor and its occurrence in the Nasopharynx is still more rare

Achalasia of the cardia

Achalasia of the cardia is an uncommon neuromuscular disorder originally described by Willis in 1972. Ernst Hellar performed the 1st successful cardiomyotomy for this condition on 14th April, 1913 by performing only anterior myotomy. Zaaijer modification of Hellers procedure is most often performed today. The results of cardiomyotomy are generally satisfactory but patient might have persistent or recurrent difficulty in swallowing or develop new symptoms of reflex oesophagitis and stricture. We have case reports of two cases where this operation was performed without any of these complication so far

Carcinoma of the middle ear

Cancer of the middle ear is an uncommon disease. It has been described in patients with long standing history of discharging ears. Two additional cases of carcinoma of middle ear are described