Nasal Hirudiniasis--an unusual cause of epistaxis.

BACKGROUND: Common causes for unilateral nasal bleeding in adults are benign or malignant tumours, deviated nasal septum, nasal trauma and foreign bodies. Nasal leech infestation has not been identified as a cause of nasal bleeding in most of the textbooks of Ear Nose and Throat. Over 3 years, at Combined Military Hospital Muzaffarabad, and Combined Military Hospital Abbottabad, we have dealt with 38 such cases presenting with epistaxis where the cause was found to be leech infestation. METHODS: A descriptive study was carried out at Combined Military Hospital Muzaffarabad and Combined Military Hospital Abbottabad over a period of 3 years. All patients whose epistaxis was due to leech infestation were included in the study regardless of age and sex. RESULTS: A total of 38 such cases presented with nasal Hirudiniasis as a cause of unilateral epistaxis. 29 were male and 09 female. All of the patients related their problem to the intake of fresh water of stream origin. The mean duration of symptoms was 12 weeks SD 3.0. CONCLUSION: It is concluded that nasal Hirudiniasis (nasal leech infestation) is a cause of unilateral epistaxis in areas like Muzaffarabad, Azad Kashmir and Abbottabad, where leeches are a common inhabitants of fresh water streams.

Total thyroidectomy as primary elective procedure in multinodular thyroid disease.

BACKGROUND: Multinodular goitre is one of the commonest thyroid diseases encountered in the practice of surgery. The most common surgery being performed for multinodular goitre is subtotal thyroidectomy. Total thyroidectomy is designed to remove all of the thyroid tissue. The objective of this study was to evaluate total thyroidectomy as a primary elective procedure for treatment of multinodular thyroid disease. This descriptive study was carried out at Combined Military Hospital Rawalpindi from June 2003 to September 2006. METHODS: 88 patients of multinodular thyroid disease were included. Patients having evidence of recurrent laryngeal nerve damage, recurrent goitre, evidence of altered parathyroid functions or evidence of malignancy were excluded. All patients underwent total thyroidectomy by the same team of surgeons and the patients were closely followed up for postoperative complications especially in terms of recurrent laryngeal nerve damage and hypocalcaemic tetany. RESULTS: No major postoperative complication was noted. Only 1 patient (1.14%) developed unilateral recurrent laryngeal nerve damage and 2 patients (2.27%) developed transient hypocalcaemia that recovered quickly. CONCLUSION: Total thyroidectomy as a primary elective procedure in multinodular thyroid disease is a safe option and it removes the disease process completely, lowers local recurrence rates and avoids the substantial risks of reoperative surgery.

Office management of benign paroxysmal positional vertigo with Epley's maneuver.

BACKGROUND: The underlying cause of benign paroxysmal positional vertigo is free floating endolymph particles (otoconia displaced from the otolithic membrane of the utricle) in the posterior semicircular canal. Particle repositioning techniques are one of the effective method of treatment. The purpose of the study was to determine the effectiveness of Epley's maneuver against expectant treatment and to find out if this treatment should be used more frequently than watchful waiting for the treatment of BPPV. METHODS: This study was carried out at outpatient clinic, departments of ENT, Combined Military hospital Rawalpindi and PNS Shifa hospital Karachi over a three years period from Jan, 2002 to Jan, 2005. Based upon history and Dix-hallpike testing 44 patients diagnosed as benign paroxysmal positional vertigo were collected by convenient sampling from these hospital's outpatient departments and divided by non probability convenience into two groups of 22 each. The control group (group A) was given placebo and the test group (group B) received single treatment by Epley's maneuver in the OPD. The results were analyzed at the end of one and two weeks by history taking and Dix-hallpike testing. Computer software SPSS version 10 was used. RESULTS: At the end of week one 14 (63.63%) patients of group B were symptom free and 2 (9.1%) patients was much better as compared to the control group where only 1 (4.5%) patient reported as symptom free and another 5 (22.7%) reported as much better. At the end of second week out of those treated by Epley's maneuver 16 (72.7%) reported as symptom free and another 2 (9.1%) as much better whereas 4 (18.2%) patients reported no improvement at all. In the control group only 4 (18.2%) patients reported as symptom free, 3 (13.6%) as much better, 6 (27.3%) as better and 9 (40.9%) reported no change in the symptoms. Chi square test was applied and the value of p came out to be 0.001 and 0.002 at week one and week two respectively. CONCLUSION: It was concluded that Epley's maneuver is a much better form of management for benign paroxysmal positional vertigo.

Acute epiglottic abscess in an adult.

A case of acute epiglottic abscess is reported in an adult female patient who presented with odynophagia and fever. Initial treatment with parenteral antibiotics was not much of a success until incision and drainage of abscess was carried out under general anaesthesia after securing airway with preliminary tracheostomy. Diagnostic difficulties due to different mode of presentation in adults are emphasized. The diagnostic workup and treatment options are discussed.