Audiolgical results of type I tympanoplasty by underlay technique with temporalis fascia graft

To determine subjective hearing improvement experienced after closing perforation of various sizes with temporalis fascia grafts by underlay type I tympanoplasty. Prospective study. This study was conducted at the department of Ear, Nose, Throat, Head and Neck Surgery, Jinnah Postgraduate Medical Center Karachi from 01.04.2004 to 31.10.2006. 100 consecutive cases of either sex, age ranging from 18 to 40 years [mean age 31.2] of tubo-tympanic type of chronic suppurative otitis media, with dry central tympanic membrane perforation for last six weeks, having good cochlear reserve and air bone gap between 30dB to 40dB, admitted for tympanoplasty were included for this study. Patients with active ear discharge, frequently or recently discharging ear [history of ear discharge of less than 6 weeks] were excluded. Patients associated with upper respiratory tract pathologies including deviated nasal septum, sinusitis, chronic tonsillitis or pharyngitis and patients with only hearing ear were also omitted from the study. Out of the 100 patients tested, the mean air conduction threshold was 40dB preoperatively and 28dB post-operatively, while the mean bone conduction threshold remained the same pre and post-operatively i.e. 15dB. On post-operative audiometric analysis 51 ears had a post -operative air-bone gap of 10dB or less, air bone gap closed completely in 4 patients, reduced upto 15dB in 26 patients, while in the remaining 19 ears there was no improvement noted. Type-I tympanoplasty underlay technique using the temporalis fascia graft has good functional results in young patients with dry central perforation. For good hearing results, selection of cases has prime importance

Frequency, presentation and management of juvenile nasopharyngeal angiofibroma

To determine frequency, clinical presentation and management of juvenile nasopharyngeal angiofibroma [JNA] at Civil Hospital Karachi. A descriptive study. Department of Otorhinolaryngology - Head and Neck Surgery, Dow Medical College, Civil Hospital Karachi and Dow University of Health Sciences from, January 2002 to December 2008. This study included 54 cases of nasopharyngeal angiofibroma over a period of 7 years. Follow up period ranges from 1 month to 7years. All patients were male with an age range of 14 - 17yrs. Epistaxis and nasal obstruction were the two most common presenting symptoms. Majority of our patients 39 [72%] had stage III a disease, stage II disease as seen in 13 [24%] cases while 2 [4%] cases presented in stage I disease according to Fisch classification. Surgery was done in all patients. Tumor recurrence was seen in 4 [7%] of cases. Angiofibroma usually presents in adolescent males. The triads of nasal obstruction, nasopharyngeal mass and recurrent epistaxis indicate the presence of the neoplasm. Surgery is the treatment of choice. Lateral rhinotomy is the most common approach. The sublabial endoscopic assisted approach is cosmetically better than other approaches and has definite advantages. Long term outcome for our patients treated by endoscopic assisted sublabial technique is required to further strengthen our view

Juvenile nasopharyngeal angiofibroma: stage and surgical approach

Objective: to study various surgical approaches and the outcome of surgery in juvenile nasopharyngeal angiofibromas [JNA]

Design: a descriptive study

Setting: department of Otorhinolaryngology - Head and Neck Surgery, Civil Hospital Karachi

Method: this study included 40 consecutive cases of nasopharyngeal angiofibroma over a period of 4 years. Patients were regularly followed up for any recurrence up to 3 years

Results: majority of our patients had stage III [72.5%] disease [Chandlers staging] i.e. extension in pterygopalatine fossa, maxillary antrum, nose and sphenoid sinuses; and infratemporal fossa in 72.5% patients, tumor was removed through lateral rhinotomy approach while Weber Fergusson in 17.5% , mid facial degloving in 7.5% and only in 2.5% patient transpalatal approach was used. Tumour recurrence were seen only in 5% of cases

Conclusions: angiofibromas usually present at the late stage. Surgery is the treatment of choice. Most of the tumours are excisable by a lateral rhinotomy approach, with minimal chance of recurrence

clinic pathological study of laryngeal malignancies - an institutional experience

Objective: to determine the risk factors and clinic-pathological pattern of the laryngeal malignancies

Design: descriptive case-series

Setting: department of Otorhinolaryngology - Head and Neck Surgery, Dow Medical College, Civil Hospital Karachi and Dow University of Health Sciences from, March 1998 to March 2009

Methods: all patients of either gender having malignant lesion of larynx were included. Recurrent cases after surgery or chemo radiotherapy and benign Tumours of the larynx were excluded from the study. Patients were studied with particular importance to the risk factors, mode of presentation, topography and histopathology of the tumour

Results: out of 100 patients, 89 were males and 11 were females with male to female ratio of 8.1:1. Majority of the subjects was in 5th decade of their life. Tobacco intake in the form of smoking or chewing was present in 91% . Presenting symptoms were hoarseness, odynophagia, sore throat, dysphagia and dyspnea/stridor. Tran's glottic area was the commonest site [39%] for laryngeal cancer. Squamous cell carcinoma [SCC] found in 98% of patients. Well differentiated category seen in 57% of patients

Conclusions: SCC was the most frequent malignant lesion of larynx. Most of the patients presented in the late stages [stage III and IV]. Commonest presenting symptom was hoarseness. Smoked tobacco [cigarette smoking] was found to be the major risk factor