Efficacy Of Prophylactic Antibiotics In Reducing Posttonsillectomy Haemorrhage.

BACKGROUND: This study aims toward establishing the impact of prophylactic pre-operative antimicrobial therapy on tonsillectomy related haemorrhage. METHODS: In this randomized controlled trial conducted at Combined Military Hospital, Abbottabad from January 2017 till August 2019, 121 children and adult patients who had consented and had undergone tonsillectomy were evaluated for procedure related haemorrhage. RESULTS: Incidence rate of secondary posttonsillectomy haemorrhage and need for re-hospitalization was significantly less in patients who had completed pre-operative prophylactic antibiotics. Patient-reported secondary haemorrhage was recorded in 4.59% (n=9) cases who did not receive pre-operative antibiotic prophylaxis, thereby increasing morbidity and prolonging hospital stay. Secondary post-operative bleeding only occurred in 1.18% (n=2) patients who received appropriate pre-operative anti-microbial prophylaxis. CONCLUSIONS: We strongly imply that prophylactic pre-operative antibiotics reduce procedure related complications in all patients undergoing tonsillectomy.

Diverse Anatomical Configuration Of Recurrent Laryngeal Nerve In Relation To Inferior Thyroid Artery, An Experience With 51 Thyroidectomies.

BACKGROUND: Objective of the study is to elaborate the anatomical variants of recurrent laryngeal nerve in relation to inferior thyroid artery, encountered during thyroidectomy operation. It is descriptive, case series, conducted at the Department of Ear Nose & Throat, Combined Military Hospital, Abbottabad. The study was conducted from January 2016 to September 2017. METHODS: Fifty-one patients underwent extra-capsular thyroidectomy in general anaesthesia. The dissection was carried out in a standard way in all patients. Recurrent laryngeal nerves were identified and exposed in every patient, and their anatomical relations were recorded in database. RESULTS: Recurrent laryngeal nerve was seen over riding the ramification of inferior thyroid artery in majority of left sided dissected specimen, however on the right side the principal nerve was found to be ascending through the branches of inferior thyroid artery.. CONCLUSIONS: Iatrogenic vocal cord paralysis has sinister implication on quality of life of the patient undergoing thyroidectomy. Anatomic variants of recurrent laryngeal nerve are well known and frequent. The disastrous outcome of inadvertent recurrent laryngeal nerve trauma can be adequately prevented by thoroughly knowing its anatomical variants, and intra-operatively identifying and exposing the principal nerves.

Ectopic Warthin's Tumour Masquerading As Infected Branchial Cyst.

Salivary gland tumours are relatively uncommon but they present globally regardless of age. Most of these tumours are benign and involve the parotid gland. Though strictly confined to the parotid gland, Warthin's tumours can exceptionally present at an ectopic site of head and neck. Of particular significance is its striking similarity with a lymph node, an inclusion cyst, branchial cyst or a malignant mass, especially when it presents in the upper cervical region.

Forgotten Post Operative Nasal Splint & Oro-Nasal Fistula.

of the oral cavity. It may develop as a congenital defect e.g. cleft palate, or rarely, consequent to an operative procedure like a sub muco-perichondrial resection surgery of the nasal septum. After nasal septal corrective surgery, follow up of the patient with meticulous nasal toilet and detailed examination is mandatory. In operated patients who do not report to follow up, and later on present with persisting nasal discharge, pain, nasal blockage and exsanguination must alert a clinician for any evidence of a possibly retained foreign object. Inadvertently retained nasal splints can cause long lasting morbidity due to a possible chronic sinusitis, toxic shock syndrome and palatal perforation.

Microbiological Profile From Middle Ear And Nasopharynx In Patients Suffering From Chronic Active Mucosal Otitis Media.

BACKGROUND: Chronic otitis media is described as a tympanic membrane perforation and ear discharge for more than six weeks duration. Ascending infection from the nasopharynx into the middle ear cleft has been attributed to prevent resolution of chronic otitis media. This research aims to determine the association between the microbiological flora of the nasopharynx with that of the middle ear in patients suffering from chronic (active) mucosal otitis media.. METHODS: Our study is a hospital-based cross-sectional survey. It was conducted from December 2015 to February 2017 at the Department of ENT, Combined Military Hospital, Abbottabad. Ear and nasopharyngeal swabs were obtained from 65 patients of chronic active mucosal otitis media and sent for microbiological analysis. Microbiological culture and sensitivity test was performed to identify the microbial spectrum of each specimen. Performa bearing the result of otoscopy, aspirate and swabs were completed for middle ear and the nasopharyngeal culture with reference to each patient. Descriptive statistics and Pearson's chi square analysis were performed using SPSS-22. RESULTS: Staphylococcus aureus and Pseudomonas aeruginosa are foremost microorganisms found in otorrhea culture isolated from patients of chronic active mucosal otitis media. Majority of the cultures from nasopharynx of these patients did not reveal any growth after incubation for 48 hours. CONCLUSIONS: A statistically insignificant association exists between the microbiological spectrum of the middle ear and the nasopharynx of patients suffering from chronic active mucosal otitis media. Micro organisms' exposure from a perforated tympanic membrane remains leading cause of persistent otorrhea, rather than ascending infection through the Eustachian tube.