Oral Corticosteroid Therapy For Sudden Sensorineural Hearing Loss And Factors Affecting Prognosis.

BACKGROUND: Sudden sensorineural hearing loss (SSNHL) is considered an otologic emergency globally. Aetiology is unknown in most cases but still the disease is believed to be caused by inflammation of the cochlea; therefore, steroids are considered beneficial due to their anti-inflammatory effect. METHODS: This study was conducted on 62 patients of sudden sensorineural hearing loss (SSNHL) in Ayub Medical Complex, Abbottabad. The patients were given prednisolone and their response to the therapy was monitored. Factors like age of the patient, gender, degree of hearing loss and duration of symptoms at initial presentation were recorded and their effect of response of the patient was also noted. RESULTS: The research subjects were 62 patients. Majority of the patients suffered from moderate to moderately severe hearing loss. Age and gender did not influence the response to the treatment. While the patients who presented earlier after the onset of disease and the patients who had milder degree of hearing loss at presentation had a better response to therapy. CONCLUSIONS: Oral corticosteroid therapy is a good therapeutic option for the treatment of sudden sensorineural hearing loss (SSHNL). The response to therapy is better in patients with milder hearing loss and those who present early to the otologist for treatment.

Pattern Of Presentation Of Nasal Foreign Bodies, An Experience With 155 Patients.

BACKGROUND: Children commonly present to outpatient department with foreign bodies in the nose. Sometimes the history is straightforward but not infrequently presentation is with a foul-smelling unilateral discharge and obstruction. Most of the foreign bodies are inert and do not cause any local tissue reaction but some of these can cause serious complications. The frequency of the different types of foreign bodies is not known in our setup. Our study aims to determine the types and frequencies of different foreign bodies in our catchment area so as to make the attending surgeon aware of the different possibilities he may have to encounter. Also, we aimed to make the general public aware of the hazards which the foreign bodies can create. METHODS: This descriptive cross-sectional study was carried out at Department of ENT of Ayub Teaching Hospital Abbottabad, from 1st June to 30th November 2017. During the period of study, patients presenting in outpatient department with nasal foreign bodies were included in the study. We recorded patients' age and gender. Types of foreign bodies recovered from the nose were documented and their frequency was calculated. RESULTS: A total of 155 patients were included in the study. 60% of the foreign objects were inserted in the nasal passage by male children. Children below the age of 4 years comprised more than 55% of the cases. Mean age 4.5±2.36 years. Right nostril was predominantly involved (58%). Various seeds were commonly retrieved (40%). Plastic beads were the second most common foreign bodies (21.2%). Other foreign bodies found were buttons (9%), dry batteries (1.2%), stones (9%), toy pieces (4.5%), and food particles (10%). CONCLUSIONS: The commonest nasal foreign objects in children were organic seeds followed by plastic beads.

Haemorrhoidal Artery Ligation Operation Without Doppler Guidance.

BACKGROUND: A range of surgical options from banding to open haemorrhoidectomy are available for the treatment of haemorrhoids. Haemorrhoidal artery ligation operation (HALO) with or without Doppler guidance is a newer option with claims of having better efficacy. We aimed to study the efficacy of HALO without Doppler guidance in terms of presence of postoperative complications including pain, bleeding, prolapse and overall patient satisfaction. METHODS: This interventional study was conducted in the Department of Surgery Combined Military Hospital Rawalpindi, from 1st September 2013 to 31st July 2015. Consenting patients with second degree haemorrhoids not responding to banding or sclera-therapy and those with third and fourth degree haemorrhoids were included in the study. They were followed up at 1 week, 6 weeks and then at 6 months. All of them were questioned regarding pain, bleeding, prolapse and overall satisfaction with the procedure. RESULTS: A total of 97 patients (n=97) were included in the study. At 1 week follow up after HALO, mean pain score was 1.76, at 6 weeks it was 0.4 and at 6 months none of the patients had any pain. Postoperative bleeding was seen in 1 patient at 1 week (1.03%). None of the patients had bleeding at 6 weeks (0%), and 2 patients reported mild occasional bleeding at 6 months' post op (2.06%). Four of our patients had persistent prolapse post-operatively (4.12%) which persisted throughout follow up. Ninety-four (96.91%) patients were overall satisfied with the procedure, whereas 3 patients (3.09%) were not satisfied. CONCLUSION: Haemorrhoidal artery ligation operation without Doppler guidance is an effective method to treat haemorrhoids in terms of post-operative pain, bleeding and patient satisfaction.

Recurrent Laryngeal Nerve Injury In Total Versus Subtotal Thyroidectomy.

BACKGROUND: Both Total and Subtotal Thyroidectomy are correct treatment options for symptomatic Euthyroid Multinodular Goitre. The choice depends upon surgeon's preference due to consideration of disadvantages like permanent hypothyroidism in Total Thyroidectomy and high chances of recurrence in Subtotal Thyroidectomy. Many surgeons believe that there is a higher incidence of Recurrent Laryngeal nerve injury in Total Thyroidectomy which affects their choice of surgery. This study aimed to compare the incidence of recurrent laryngeal nerve injury in total versus subtotal thyroidectomy. METHODS: This non randomized controlled trial was carried out at Department of Surgery and ENT of Ayub Teaching Hospital Abbottabad, and Combined Military Hospital Rawalpindi from 1st September 2013 to 30th August 2014. During the period of study, patients presenting in surgical outpatient department with euthyroid multinodular goitre having pressure symptoms requiring thyroidectomy were divided into two groups by convenience sampling with 87 patients in group 1 and 90 patients in group 2. Group-1 was subjected to total thyroidectomy and Group -2 underwent subtotal thyroidectomy. All the patients had preoperative Indirect Laryngoscopy examination and it was repeated postoperatively to check for injury to the recurrent laryngeal nerve. RESULTS: A total of 177 patients were included in the study. Out of these, 87 patients underwent total thyroidectomy (Group-1). Two of these patients developed recurrent laryngeal nerve injury (2.3%). In group-2 subjected to subtotal thyroidectomy, three of the patients developed recurrent laryngeal nerve injury (3.3%). The p-value was 0.678. The overall risk of injury to this nerve in both surgeries combined was 2.8%. CONCLUSIONS: There is no significant difference in the risk of recurrent laryngeal nerve damage in patients undergoing total versus subtotal thyroidectomy.