Frequency and causes of hearing impairment in tertiary care center.

OBJECTIVE: To determine the frequency and causes of hearing impairment in patients attending the out patient department of Civil Hospital Karachi. METHODS: This study was carried out at the ENT department of Civil Hospital Karachi from January 1998 to October 2000. Six hundred patients were randomly selected from the out patient department. Patients of all age groups and both genders were included, who complained of hearing impairment in one or both ears. Detailed history, complete E.N.T. examination and relevant audiological, radiological investigations were carried out. RESULTS: Frequency of conductive hearing loss was 50%, sensorineural hearing loss 20% and mixed hearing loss in 30%. CSOM remains the most common cause in this study. In majority of cases of sensorineural hearing loss, prenatal and perinatal factors predominate. Consanguinity was the most frequent factor in this study in sensorineural type of hearing loss. CONCLUSION: Conductive hearing loss is more prevalent than sensorineural hearing loss by a ratio of 2.5:1. Otitis media remains the commonest cause in this study i.e. 76%. Prevention of prenatal and postnatal factors can decrease the frequency of sensorineural hearing loss.

Fine needle aspiration cytology: sensitivity and specificity in thyroid lesions.

BACKGROUND: Thyroid enlargement is one of the common problems in patients presenting at outpatients department of ENT particularly in females. Thyroid nodules are common, thyroid cancer is uncommon and the most common way for it to present is as a solitary thyroid nodule. This study was conducted to evaluate the sensitivity and specificity of Fine Needle Aspiration Cytology (FNAC) in thyroid diseases. METHOD: This prospective analytic study was conducted at ENT Department of Karachi Medical and Dental College/Abbasi Shaheed Hospital during year 2004-8. One hundred and five cases were enrolled who underwent thyroid surgery after complete evaluation by history, clinical examination, Thyroid profile, Thyroid Scintigraphy, Ultrasound neck and FNAC. In cases which were revealed malignant by FNAC, CT scan were done to see the extent of disease and neck node status. Surgery was done in all cases and specimens sent for histopathology. RESULTS: Male to female ratio of the patients was 1:8.5. Most common lesion was benign nodule (96). Malignant lesions were 9 in FNAC. In histopathology, the benign nodules were 92, and malignant cases were 13. Sensitivity of FNAC was 61.53% and specificity was 98.9%. CONCLUSION: FNAC in Thyroid has high sensitivity and specificity.

Pseudomonas aeruginosa in chronic suppurative otitis media: sensitivity spectrum against various antibiotics in Karachi.

BACKGROUND: Chronic suppurative otitis media (CSOM) is a prevailing and notorious infection in developing countries causing serious local damage and threatening complications. Early and effective treatment based on the knowledge of causing micro organisms and their sensitivity results in good clinical recovery and prevents from damage and complications. Pseudomonas aeruginosa is most common pathogen causing CSOM in Pakistan. The objective of this study is to identify incidence of Pseudomonas aeruginosa involved in CSOM and sensitivity against commonly prescribed antibiotics. METHODS: A total of 263 patients with unilateral or bilateral chronic suppurative otitis media (CSOM) were enrolled in the study at Department of ENT, Karachi Medical and Dental College & Abbasi Shaheed Hospital, Karachi, Pakistan from December 2004 to May 2006. Sterile cotton swabs were used to collect pus from discharging ears and plated on Blood agar and MacConkey agar for 24 to 48 hours. Antibiotics susceptibility was tested by Minimum inhibitory concentrations (MIC) method using Mueller-Hinton agar. RESULTS: Overall microbiology of 267 samples from 263 patients was studied including 4 of bilateral discharge. Polymicrobial growth was present in 8 samples. A total of 275 bacterial isolates were studied. Pseudomonas aeruginosa (40%) and Staphylococcus aureus (30.9%) were the most common bacterial agents found in CSOM. MIC was done for Pseudomonas aeruginosa only as it was the commonest pathogen found in CSOM. Sensitivity pattern of Pseudomonas aeruginosa showed that amikacin was active against 96% of isolates followed by ceftazidime 89%, ciprofloxacin 85%, gentamicin 81%, imipenem 76%, aztreonam 42% and ceftriaxone 21%. CONCLUSIONS: Pseudomonas aeruginosa was the most common bacteria isolated from chronic discharging ears followed by Staphylococcus aureus. Amikacin was found to be the most suitable drug followed by ceftazidime and ciprofloxacin for Pseudomonas aeruginosa. The resistance against ceftriaxone and aztreonam was found to be very high.

Morphological pattern of parotid gland tumours.

OBJECTIVE: To determine the morphological pattern of parotid tumours. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: ENT Department of Karachi Medical and Dental College and Abbasi Shaheed Hospital, Karachi, from 1990 to 2004. PATIENTS AND METHODS: During this study, 204 patients with parotid tumours were registered. The patients of all ages and both gender were included in this study. All patients were evaluated by history, clinical examination, F.N.A.C. and ultrasound, C.T/MRI was done in selected cases. All patients were surgically managed and their tumour specimen was sent for histopathology. Classification of individual tumour was based on 1991 World Health Organization Classification. Discrete data was presented in percentage and proportions. RESULTS: Out of 204 cases, 152 (74.5%) were benign and 52 (25.5%) were malignant. Of these, 117 (57.35%) patients were females and 87 (42.65%) males. Benign tumours were more common in females whereas malignant tumours were common in males. The mean age of patients was 34 years and 42 years for benign and malignant tumours respectively. Pleomorphic adenoma was most common benign tumor (83.5%), followed by Warthins tumour. The most common malignant tumour was mucoepidermoid carcinoma (60%), followed by adenoid cystic carcinoma. Superficial lobe of parotid gland was the commonest site, 120 benign and all 52 malignant tumours arising from it while 32 benign tumours originated from deep lobe. Parotid swelling for years was main feature of benign tumours, whereas malignant tumours presented with pain, fixation to skin or underlying structure, cervical lymphadenopathy and facial palsy. CONCLUSION: Pleomorphic adenoma was the most common benign tumour and mucoepidermoid carcinoma was most common malignant tumour. The morphological patterns and distribution followed the known pattern.