The rationality of prescribing antibiotics after tonsillectomy.

OBJECTIVE: To compare the antibiotic therapy with the absence of antibiotic therapy in reducing post-tonsillectomy morbidities METHODS: The quasi-experimental study was conducted at the Aga Khan University Hospital, Karachi, from November 2006 to September 2007. It involved 60 patients fulfilling the criteria for recurrent tonsillitis who were divided in two groups based on the different practice of two sets of surgeons. In one group antibiotics were used, while in the other group, no antibiotic was given. Patients filled a questionnaire about pain, post-operative bleeding, day of normal diet intake, day of normal activity and any consultation received during the first postoperative week. The data collected was analyzed using SPSS version 16. RESULTS: There were 60 patients who were divided in two groups of 30 each on the basis of purposive sampling technique. Mean age was 21.43 +/- 8.3 years. Of the total, 55% were male and 45% were female. Post-operative pain was comparable between the two groups. Four patients had secondary haemorrhage--three in the antibiotic group, and one in the non-antibiotic group. Mean day of normal activities and normal diet intake was almost the same in both groups. Unscheduled hospital visits were 6.9% in the antibiotic group, and 3.3% in the non-antibiotic group. CONCLUSION: The study showed that antibiotics did not have any significant impact in reducing the post-tonsillectomy morbidities.

Daycare adeno-tonsillectomy: is it safe in developing countries?

OBJECTIVE: To determine the safety of daycare adeno-tonsillectomy in a tertiary care centre. METHOD: A retrospective chart review of 207 patients who had undergone tonsillectomy and/or adenoidectomy as daycare procedure in Aga Khan University Hospital, Karachi, between January 2008 to March 2009 was done. Demographic data as well as complications requiring unplanned admissions were recorded. Any emergency room visit in the first 24 hours was also noted. Telephonic calls were then made to collect the first 24-hour, postoperative data in order to know if there were any complications requiring visit to some nearby health facility. All data was analysed using SPS version 19, while Fisher's exact test was used to compare complications with respect to age groups. RESULTS: Of the total, 132 were males and 75 females. Only one (0.48%) patient developed bleeding soon after surgery which required a revisit to the operating room. Another 13 (6.2%) patients were admitted for reasons like post-operative vomiting, desaturation and raised blood pressure. There were no hospital visits within the first 24 hours after the patient was discharged. Besides, 172 (83%) patients preferred daycare surgical procedures if given an option again. CONCLUSION: Daycare adeno-tonsillectomy is a safe practice which can help to save resources in developing countries.

Gradenigo's syndrome--surgical management in a child.

Otits media is a common problem. Some of its complications that were seen frequently in the preantibiotic era are rare today. We report a case of an 8 year boy who presented with earache, retro-orbital pain and diplopia secondary to a sixth nerve palsy--Gradenigo's syndrome. In this syndrome infection from the middle ear spreads medially to the petrous apex of the temporal bone. Work-up includes CT scan of the temporal bones. Timely management with intravenous antibiotics (+ surgery) is needed to prevent intra-cranial complications.