Comparison of auditory brainstem response and auditory steady state response audiometry by evaluating the hearing thresholds obtained in children with different severity of hearing loss.

OBJECTIVES: To compare the hearing thresholds obtained with auditory brainstem response (ABR) and auditory steady state response (ASSR) audiometry in children with hearing loss. METHODS: Hearing thresholds were obtained by ABR and ASSR in children who presented with suspicion of deafness at Ear, nose & throat department of Al-Nafees Medical College Hospital Islamabad, between January to August 2018. The mean hearing thresholds obtained by two tests were compared within each category of severity of deafness. Time taken by both tests was also compared. RESULTS: A total of 57 patients (114 ears) were included in the study. Among them 27 (47.4%) were male and 30 (52.6%) were female. The mean age of patients at presentation was 42 months (±30.9) with age range from one to 12 years. Mean hearing thresholds obtained by click ABR, chirp ABR, ASSR (1, 2, 4 kHz) & ASSR (0.5, 1, 2, 4 kHz) was 56.25 (±27.61), 58.88 (±27.44), 58.03 (±21.26) & 56.35 (±22.86) respectively. Mean thresholds were comparable between click ABR & ASSR (1, 2, 4 kHz) and between chirp ABR & ASSR (0.5, 1, 2, 4 kHz) in all degrees of hearing loss categories except in those patients with normal hearing thresholds. The mean time taken by clicks ABR, chirp ABR and ASSR were four minutes seven seconds, three minutes 15 seconds and 16 minutes and 7 seconds respectively. CONCLUSIONS: Hearing thresholds obtained by ABR and ASSR are comparable in all categories of severity of hearing loss. The time taken by ABR is less as compared to ASSR.

Results of endoscopic endonasal dacrocystorhinostomy.

OBJECTIVES: To analyse the results of Endonasal Endoscopic Dacrocystorhinostomy regarding complications and success rate. METHODS: The prospective quasi-experimental study was conducted at the Departments of Otolaryngology and Ophthalmology of Islamic International Medical College Teaching Hospital, Rawalpindi, from August 2008 to July 2012. Patients presenting with epiphora and diagnosed with chronic nasolacrimal duct obstruction were included in the study. Endonasal Endoscopic Dacrocystorhinostomy was performed under general anaesthesia. Patients were followed up for at least 6 months after the removal of dacrocystorhinostomy tube. Complications during and after the procedure were recorded. RESULTS: Of the 31 patients in the study, 27 (87%) were females and 4 (13%) were males with an overall mean age of 45.7 +/- 13.4 years (range: 21-70). The duration of symptoms ranged between 6 months and 13 years (Mean: 4.1 +/- 3.2). Average duration of endoscopic dacrocystorhinostomy was 40 +/- 17.5 minutes (range: 25-70). The tube was removed 6 months after operation in 27 (87%) patients and after 3 months in 4 (13%). Complications encountered were peroperative haemorrhage in 4 (13%), ecchymosis in 2 (6%), nasal adhesions in 3 (9.6%), granulations at osteotomy site in 1 (3.2%), retrograde tube displacement in 3 (9.6%) and symblepheron in 1 (3.2%) patient. Of the total, 26 (84%) patients were symptom-free 6 months after the removal of the tube. Two (6.4%) patients underwent revision surgery and were symptom-free 6 months after the removal of the tube. Overall success rate of the procedure was 28 (90%). CONCLUSIONS: Endonasal Endoscopic Dacryocystorhinostomy is an effective procedure with high success rate and minimal complications.

Over-under myringoplasty.

OBJECTIVE: To determine the success rate of over-under technique of myringoplasty regarding rate of graft take, complications and hearing improvement. DESIGN: Quasi-experimental study. PLACE AND DURATION OF STUDY: Department of Otorhinolaryngology and Head and Neck Surgery, Fauji Foundation Hospital, Rawalpindi from March 2003 to January 2005. PATIENTS AND METHODS: A total of 68 patients having dry central tympanic membrane perforations of various sizes secondary to chronic tubotympanic suppurative otitis media were included in the study. Over-under technique of myringoplasty was used to repair the tympanic membrane perforation. Outcome measures were graft success i.e., full or partial take, no perforation, atelactasis or lateralization within 6 months of operation and improvement in hearing. RESULTS: Sixtysix patients (97%) out of 68 had full graft take at six months of follow-up. Only one (1.5%) met with graft failure and another one (1.5%) had partial graft take. Delayed perforation was noted in two patients (3%), both of these were 10 months after surgery. Atelactasis was seen in only one patient (1.5%) eight months after operation. Lateralization did not occur in any patient. Hearing improvement was noticed in 67 (98.5%) patients. Average air bone gap decreased by 12.65 dB. CONCLUSION: Over-under myringoplasty is an effective technique of repairing the tympanic membrane perforation due to high rate of graft take, few complications and marked hearing improvement.

Microbiology and drug sensitivity patterns of chronic suppurative otitis media.

OBJECTIVE: To identify the commonest microorganisms associated with chronic discharging ears and their antimicrobial sensitivities. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: This study was carried out from August 2003 to February 2004 at the Department of Otorhinolaryngology and Head and Neck Surgery, Fauji Foundation Hospital, Rawalpindi. MATERIALS AND METHODS: A total of 124 patients with unilateral or bilateral active chronic suppurative otitis media attending the outpatient clinic were included in the study. All patients were evaluated through detailed history and clinical examination. Pus samples were collected from the discharging ear(s) and sent to the hospital laboratory where culture and sensitivity studies were done for aerobes, anaerobes and fungi and antibiotic sensitivity patterns. RESULTS: Overall microbiology of 142 samples was studied. Among them, 108 (76%) were pure cultures and 34 (23.9%) were mixed. There were 186 isolates including 182 (97.8%) aerobes, nil anaerobes and only 4 (2.1%) fungi. Pseudomonas aeruginosa 94(50.5%) was the most common isolate, followed by Staphylococcus aureus 44 (23.6%). Drug sensitivities pattern of Pseudomonas aeruginosa showed that ciprofloxacin was active against majority 95.8% of isolates followed by amikacin 83.3%, gentamicin and tobarmycin 60% and cefotaxime 41.6%. Staphylococcus aureus isolates were resistant to penicillin, ampicillin and amoxicillin in 77.2% whereas majority was sensitive to coamoxiclav 81.8% and cephradine 86.3%. CONCLUSION: Commonest organisms isolated from chronic discharging ears were Pseudomonas aeruginosa and Staphylococcus aureus. Majority of isolates of Pseudomonas aeruginosa were sensitive to ciprofloxacin. Majority of strains of Staphylococcus aureus were resistant to penicillin. Cephradine and coamoxiclav were effective against most of the isolates of Staphylococcus aureus.