Diagnostic Accuracy Of Plain X-Ray Lateral Neck In The Diagnosis Of Cervical Esophageal Foreign Bodies Keeping Oesophagoscopy As Gold Standard.

BACKGROUND: Detection of foreign body oesophagus has always been a challenge for the otolaryngologists. Among different investigations available X -ray is valuable for detection of foreign bodies as it is readily available, inexpensive and easy to operate. However, this still remains to be decided that how accurate it is? The objective of the study is to determine the diagnostic accuracy of plain X ray lateral neck in the diagnosis of foreign bodies in cervical oesophagus keeping esophagoscopy as the gold standard. METHODS: This descriptive study was conducted at department of ENT, Ayub Medical Institute (AMI) Abbottabad, from Mar to Sep 2016. A total of 290 patients were included in this study and all the patients had X-ray lateral view of neck, followed by oesophagoscopy (gold standard). Diagnostic accuracy of plain X-ray lateral view of neck was detected by determining sensitivity, specificity and accuracy. RESULTS: The sensitivity, specificity and accuracy of plain X-ray lateral view of neck was 91.7%, 80%, and 89.7%, respectively. CONCLUSIONS: X-Ray lateral view of neck is a reliable investigation and should be advised among all the patients with history of foreign body ingestion.

Frequency Of Congenital Hearing Loss In Neonates.

BACKGROUND: Congenital deafness is commonest birth defect and it affects 2-4 neonates among 1000 live births. Detection and intervention especially before 6 months of age prevents severe linguistic, educational and psychosocial repercussions and helps the deaf child in the development of normal speech and language. Children who are identified after 6 months of age experience great difficulties in attaining speech and language.. METHODS: To find out the frequency of hearing loss in neonates, a hospital based observational study was conducted in Combined Military Hospital Abbottabad from June-to December 2014. One thousand new-borns selected by consecutive sampling within a specified period of time were subjected to Otoacoustic Emission (OAE) testing. Brain Evoked Response Audiometry (BERA) evaluation was performed in all those who failed OAE testing to confirm the hearing loss. Children born with microtia, meatal stenosis, cleft palate, craniofacial abnormalities and syndromic illnesses were excluded from the study. RESULTS: Of 1000 new-borns screened, 465 were males and 535 were females whereas 632 (63.2%) were delivered through C-section and 368 (36.8%) were born via SVD. Four hundred and ninety-one (49%) babies had a positive history of consanguinity among the parents. Out of 1000 infants 13 were having hearing loss which was later on confirmed on BERA evaluation. Among them 7 were males and 6 females, 9 (69%) were born through SVD and 4 (31%) through C-section and 8 (61.5%) new-borns had a positive history of consanguinity among their parents. In all these 13 patients only 2 (15%) patients had profound while the remaining 11 (85%) had moderate to severe hearing loss. CONCLUSIONS: Frequency of hearing loss in neonates is much higher in our study (13 per 1000) as compared to other parts of the world and demands that more studies should be undertaken on this subject to confirm this.

Effectiveness of conservative treatment in the management of secretory otitis media.

BACKGROUND: Secretory otitis media is a very important and common ENT disease, especially in the children. The aetiology of Secretory otitis media is multifocal, and the treatment is initially medical or conservative and if it fails then surgery is indicated. The objective of the study was to determine the efficacy of medical treatment in the management of Secretory otitis media. METHODS: This cross sectional descriptive study was conducted at the outpatient department of ENT, Ayub Medical Institute (AMI) Abbottabad, from Mar to Sep 2013. A total of 40 patients were included in this study and standard medical treatment of secretory otitis media was given. The patients were followed up at 2nd and then 4th week and results were analysed. RESULTS: Both clinical and audiological diagnosis of secretory otitis media was made and patients were followed up at 2nd and 4th week to see the effect of treatment. Among 40 patients, 26 (65%) completely recovered from the disease while 14 patients (35%) did not improve. CONCLUSION: Conservative treatment is effective in the management of Secretory otitis media.

Anatomical relationship between recurrent laryngeal nerve and inferior thyroid artery in thyroidectomy patients.

BACKGROUND: Thyroid surgery is performed very frequently now a day. Previously it was used to be associated with high morbidity especially hoarseness. This complication is now almost negligible as most of the surgeons are well acquainted with the anatomical knowledge of the nerves in relation to the gland. The objective of this study was to find out variable anatomical relationships between Recurrent Laryngeal Nerve and Inferior Thyroid Artery in patients undergoing thyroid surgery. METHODS: This cross-sectional retrospective study was conducted in Government Lady Reading Hospital Peshawar and Abasyn Hospital (Private) Peshawar from May 2010 to June 2014. Patients undergoing surgery for benign goiters, T1, T2 well differentiated thyroid cancers without lymph node involvement was included. Data on various types of relationships between RLN and ITA were recorded. RESULTS: In total 271 patients operated and included in the study, 117 were male and 154 were female. Total of 398 RLNs were identified in 416 sides operated. In 55.27% cases the nerve was found to be anterior to inferior thyroid artery while it was posterior to the artery in 34.67% cases. In the remaining 10.05% cases the nerve was observed passing within the branches of inferior thyroid artery. CONCLUSIONS: The anatomical relationship between Recurrent Laryngeal Nerve RLN and Inferior Thyroid Artery ITA is highly variable. For all head and neck surgeons to perform safe surgery on thyroid, it is necessary to have sound anatomical knowledge of these variable relationships between recurrent laryngeal nerve and inferior thyroid artery.

Laser and incisional myringotomy in otitis media with effusion-a comparative study.

BACKGROUND: Otitis media with effusion (OME) or middle ear effusion (MEE) is a common cause of hearing difficulty in children. MEE must be detected early and managed properly to prevent conductive hearing loss in children. It was aimed to compare results of laser myringotomy and conventional myringotomy in terms of hearing improvement, recurrence of MEE and time to put ventilation tube. METHODS: This randomized control trial was conducted from February 2012 to April 2014. Children of 4 years age or older with MEE were included in the study. These children were investigated with Pure tone audiometry (PTA) and tympanometry to confirm conductive hearing loss. X-Ray nasopharynx lateral view was performed for adenoids. Sixty-six patients were randomly assigned in to 2 groups, (1) treated with laser myringotomy and (2) treated with classical myringotomy. The ears were evaluated for MEE, for presence of perforation and level of hearing. RESULTS: A total of 98 ears in 66 patients underwent intervention. Middle ear effusion cleared in 44 out of 48 ears with laser myringotomy (LM) as compared to34 out of 50 ears with incisional myringotomy. The perforation was still patent in 36 ears treated with LM while it was found closed in all 50 ears with conventional myringotomy after 2 weeks. The hearing level improved with LM by 10-15 dB after first 3 months. CONCLUSION: The aim of management in otitis media with effusion is ventilation of tympanic cavity. Laser myringotomy is a best alternative to conventional one. It also has comparable results with ventilation tubes (VT). The ears with refractory or recurrent MEE should have VT insertion.