Association of Allergic Rhinitis with Asthmatic Conditions: A Cross Sectional Study.

Allergic rhinitis is one of important risk factor for developing asthma and sometimes it appears before developing full-blown asthma in affected patients. This is a socially embarrassing condition for the patients. Current estimates are that allergy in one form or another affects some 30% or more of general population. Otolaryngologists may expect about 50% of patients encountered in their daily practice to have allergy as a major or at least a contributing cause of presenting problems. Allergy has been called "The great masquerader", because of its ability to mimic an immense variety of other conditions. Objective of the study is to determine the association of allergic rhinitis with asthma. This cross sectional study was conducted at Green Life Hospital, Dhaka, Bangladesh from January 2018 to July 2018. Ultimately 250 interested patients were enrolled in the study. 50.8% of the participants were male and 49.2% were female. Among the 250 allergic rhinitis patients 92% presented with nasal discharge, 64.8% presented with nasal blockade, 84% presented with bouts of sneezing, 27.6% presented with hyposmia, 8.8% presented with Ocular redness, 48.8% presented with headache, 18.0% presented with epistaxis. Among them 43.2% patients were previously diagnosed as asthma by competent physicians; 39.2% patients had previous history of breathlessness that relieved with asthma medication in last 12 months. At least more than one symptom like wheeze, shortness of breath, chest tightness and cough in last 12 months were experienced by 51.6% patients. Among the 250 patients 51.2% had Rhonchi on chest examination, 54.8% had some form of shortness of breath, 43.2% had chest tightness, 59.6% had dry cough during the time of history taking & physical examination. The current study found strong association between allergic rhinitis and asthma.

Microbiology of Chronic Suppurative Otitis Media in a Tertiary Care Hospital in Bangladesh.

This cross sectional prospective study was carried out in the Department of Otolaryngology-Head & Neck Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU) and Department of Microbiology, University of Dhaka from July 2012 to June 2013. The objectives of this study were to identify the common microorganisms involved and the antibiograms of chronic suppurative otitis media (CSOM) patients in this tertiary care hospital in Bangladesh. A total of 117 patients clinically diagnosed of CSOM were enrolled in the study. They had chronic ear discharge & had not received any topical or systemic antibiotics for the previous five days. Swabs was taken and cultured for bacteria. The standard of isolation and identification was followed. Antimicrobial susceptibility of all aerobic bacterial isolates was performed by using modified Kirby Bauer Disk diffusion method. There were 186 positive cultures for organism from 117 patients. The most common causal organisms isolated were S. aureus (47.30%) and Pseudomonas spp. (27.40%) followed by S. epidermidis (16.10%), Klebsiella spp. (8.10%) and Escherichia coli. (1.10%). Gentamicin showed the highest sensitivity (89.8%) to S. aureus whereas erythromycin showed the lowest sensitivity (14.8%) with highest resistance (67%) to S. aureus. Pseudomonas spp. showed highest sensitivity against ciprofloxacin (78.4%) and highest resistance against cloxacillin (96.1%). Novobiocin showed the highest sensitivity (100%) followed by chloram phenicol (94.1%) to S. epidermidis. Klebsiella spp. and E. coli showed highest sensitivity against chloram phenicol. This study suggests that Staphylococcus aureus and Pseudomonas are the commonest bacteria involved in CSOM in Bangladesh and Ciprofloxacin is an important tool in the management of active CSOM.

Role of Computed Tomography in the Evaluation of Nasopharyngeal Mass.

In Indian subcontinent, all types of nasopharyngeal masses are rare. However, Nasopharyngeal carcinoma is not uncommon in Bangladesh. It is very important to differentiate malignant from benign lesions early in the disease process. In recent years, CT is the primary diagnostic screening modality for the detection of nasopharyngeal pathology. This cross sectional study was carried out in the Department of Radiology & Imaging, BSMMU in collaboration with Department of otolaryngology of the same hospital from July 2012 to June 2014. Sensitivity of CT scan in diagnosis of nasopharyngeal carcinoma was 100%, specificity was 93.10%, positive predictive value (PPV) was 93.94%, negative predictive value (NPV) was 100% and accuracy was 96.67%. Sensitivity of CT scan in diagnosis of benign angiofibroma was 78.26 %, specificity was 89.19%, positive predictive value (PPV) was 81.82%, negative predictive value (NPV) was 86.84% and accuracy was 85% of CT scan. CT scan findings of the present study correlated well in most of the cases with the histopathological evaluations. Considering the high validity parameter it can come to a conclusion that CT scan is as highly effective as histopathology in diagnosis of nasopharyngeal mass.

Disabling hearing impairment in the Bangladeshi population.

OBJECTIVE: This study aimed to determine the prevalence of hearing impairment in Bangladeshi people of all ages. METHODS: A nationally representative cross-sectional survey was carried out in 2013. A total of 4260 subjects (1774 males and 2486 females), with a mean age of 32 years, participated. Hearing impairment was determined by pure tone audiometry and otoacoustic emissions testing. RESULTS: Disabling hearing loss (greater than 40 dB loss in adults, and greater than 30 dB loss in children younger than 15 years, in their better hearing ears) was present in 9.6 per cent (95 per cent confidence interval, 8.5-10.8 per cent) of the respondents. Hearing loss was more prevalent in socio-economically deprived people and in those older than 60 years. Multiple logistic regression analysis identified age, socio-economic deprivation, family history, impacted ear wax, chronic suppurative otitis media, otitis media with effusion, and otitis externa as the significant predictors of disabling hearing loss. CONCLUSION: Deafness prevention should focus mainly on chronic suppurative otitis media, otitis media with effusion, and impacted ear wax prevention, integrated within the primary healthcare system and addressing the equity issue.

Parathyroid failure following thyroid surgery.

This cross-sectional study was done to see the association of post thyroidectomy parathyroid failure with thyroid disease and type of surgery. It was carried out in the Department of Otolaryngology-Head and Neck Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka during the period of July 2008 to June 2010. Total 50 cases of thyroid malignancy and multinodular goiter who had undergone total or near total thyroidectomy with or without neck dissection were studied. In this study highest number of cases were found in 3rd decade of age (28%) and there was female predominance (M:F=1:3.54). Overall frequency of post operative hypocalcaemia was 30% (26% was temporary hypocalcaemia and 4% was permanent). Hypocalcaemia revealed clinically in 20% cases and remained subclinical in 10% cases. Hypocalcaemia developed in 42.30% cases of malignant thyroid disease and 16.66% cases of benign thyroid disease (p<0.05). It was found in 54.54% cases with neck dissection and 23.07% cases without neck dissection (p<0.05). Hypocalcaemia developed in 62.5% cases where parathyroid gland were not identified and 23.8% cases where parathyroid gland was identified. Hypocalcaemia developed most commonly on the 2nd post operative day (73.33%). There is a significance difference with development of parathyroid failure after thyroid surgery between benign and malignant thyroid disease and also between thyroid surgery with or without neck dissection.

Effect of tonsillectomy on humoral immunity.

Tonsils are one of the important secondary lymphoid organ in immune system. It remains controversial whether tonsillectomy results in decreased serum immunoglobulin level. The purpose of this study was to observe the effect of tonsillectomy on humoral immunity parameters among the patients with tonsillar disease. Total group A 70 patients up to the age of 18 years, who were enrolled for tonsillectomy and 30 age matched children group B were included for comparative study. Serum IgG, IgM and IgA levels were measured in all 70 patients before tonsillectomy and in 56 patients who came for 1st follow-up after one month and 30 patients who came for 2nd follow up after three months of tonsillectomy. Serum IgG, IgM and IgA levels were also measured in group B children. Serum IgG, IgM and IgA levels in patients of group A did not show any significant difference in comparison to group B. One month after tonsillectomy the level of IgG was slightly decreased and IgM and IgA were increased compared to preoperative value but not statistically significant. All IgG, IgM and IgA were also not significantly altered in comparison to group B. Three months after tonsillectomy serum IgG, IgM and IgA level were found decreased in comparison to pre operative value and group B, among which difference of only IgG was significant. After tonsillectomy humoral parameters were found reduced but overall impact on humoral immune status was not significantly altered.

Tubercular lymphadenitis - diagnostic evaluation.

Tuberculosis is one the commonest disease affecting peripheral lymph node and cervical tubercular lymphadenitis are frequently encountered in Otolaryngological practice. Three hundred fifty six (356) cases of Fine Needle Aspiration for Cytology (FNAC) positive tubercular lymphadenitis were studied from January 2006 to December 2008. FNAC positive but histopathologically negative cases were excluded from the study. Among 356 cases of FNAC positive cervical lymphadenopathy 300 cases (84.27%) were confirmed tuberculosis on histopathological examination. Remaining 50 cases (15.73%) were diagnosed as nontubercular lymphadenitis where nonspecific lymphadenitis was the commonest finding 34(9.55%) followed by metastatic carcinoma 7(1.97%), lymphoma 6(1.08%), Kikuchiz's disease 6(1.08%), Kala-Azar 2(0.56%) & Leukemia 1(0.28%). Most of the patients presented with only multiple lymph node swelling with other symptoms, such as fever 18(5.06%), pain (15.7%), tenderness 53(14.88%), weight loss 29(8.14%), anorexia 33(9.26%). Following observations are evident from this study: i) Disease is comparatively common between 12-35 years ii) Multiple matted/discrete lymph nodes are the earliest presentation iii) Multiple lymph node is the most consistent finding for clinical diagnosis. iv) Very few patients have constitutional symptoms v) Suppuration with or without abscess formation although confirms the diagnosis even then certainty is very essential. Though the evidence of cervical tuberculosis was thought to be decreasing in developing countries the real picture seems to be different. Random survey among the whole population was not done in any country rather hospital based laboratory research was made.

Screening--a unique way of better health care delivery for ENT patients.

A few Ear Camps were carried out amongst 25 schools and madrashas of Dhaka City having 10,102 pupils, to see the prevalence of ENT diseases and hearing impairment. A primary screening was done by the Bangladesh Council for Child Welfare (BCCW) with the possibilities of suffering from ear, nose & throat diseases with the help of questionnaire and clinical examination by qualified doctor. The word "Screening" is used in this paper not in the epidemiological sense but to imply primary selection. 1,403 (13.89%) were issued registration card for ENT consultation. Five otolaryngologist, one audiometrician, two ancillary staffs, BCCW workers, local volunteers and school teachers conducted the 3 days long camp. Secondary screening by the otolaryngologists revealed pathology in 1,101 students (10.89%). 26 children (0.26%) were attending schools with severe hearing loss. ENT diseases appeared to be common in urban school children and screened proved to be an efficient method for health care delivery.

Ewing's sarcoma of maxilla--a case report.

This paper reports the case of an adolescent girl who was admitted in the ENT ward, IPGMR in February '88 with the complaints of nasal obstruction, nasal discharge associated with progressive swelling of the right side of her face for 1 year. She had an operation at Chittagong Medical College Hospital 1 year back for some problem in the right side of the nose. No history of pain, nasal bleeding or visual disturbance were present. The nasal mass was mobile, insensitive and did not bleed on touch, but the facial swelling was red, soft and cystic. Clinically diagnosed as an Antral growth with Ethmoidal involvement. Radiologically revealed soft tissue swelling, obliteration of nasal fossa and opacification of sinuses. After surgical resection the facial mass was diagnosed as Ewing's sarcoma histopathologically. The patient needed radiotherapy but did not follow it.