Otitis media with effusion: Accuracy of tympanometry in detecting fluid in the middle ears of children at myringotomies

Objective: [1] The diagnostic accuracy of tympanometry in detecting fluid in the middle ear space in children with otitis media with effusion by comparing its findings with those of myringotomies. [2] Identify the age group most commonly affected by OME

Methods: This prospective study was conducted at the Department of ENTand Head and Neck Surgery, Postgraduate Medical Institute Hayatabad Medical complex, Peshawar from July 1, 2012 to April 30, 2015. Patients with suspicion of OME underwent tympanometry and later myringotomies. Using Jerger's classification, Type B tympanogram with normal canal volume was considered as conclusive evidence of fluid in the middle ear space. Its findings were compared with those of the respective myringotomies. From the data collected, the accuracy, sensitivity, specificity, positive predictive value and negative predictive values were calculated

Results: A total 117 ears of 63 patients were operated. The age range was 3 to 12 years. The commonest age group [58.7%] affected by OME was 6-8 years. Type B tympanogram with flat curve and normal canal volume was obtained in 71.4% of the ears. Comparison with myringotomy findings showed TP 85, TN 13, FP 5 and FN 14. The diagnostic value of tympanometry was; Sensitivity 85.85%, Specificity 72.22%, PPV 94.44%, NPV 48.14% and Accuracy of 83.76%. P value calculated using chi square test showed that there was significant difference between tympanometry and myringotomy findings in OME [p < 0.05]

Conclusions: OME is common in age group 6-8 years. Tympanogram Type B with normal canal volume is fairly sensitive in diagnosing this condition. However for occurrence of false positive results, final decision regarding management should be made on clinical findings and other supportive audiological tests

frequency of malignancy in nodular goiter - a single center study

To find out the frequency of malignancy in nodular goiters. A total of 204 cases were studied in the department of ENT and Head and Neck surgery, Hayatabad Medical Complex, Peshawar. The duration of this descriptive study was from June 1, 2008 to May 31, 2010. After taking informed consent, a detailed history was obtained. Clinical and laboratory investigations were carried out as an aid to diagnosis and determine the patients' fitness for surgery. Patients with nodular goiters were categorized into two categories i.e., Solitary thyroid nodule and multinodular goiter. Surgically resected thyroid specimens were examined histopathologically. The data was analyzed using SPSS 16.0 for windows to determine the frequency of malignancy in nodular goiter. Ages of the patients ranged from 17 to 84 years with a mean age of 37 +/- 12.48 years. The male to female ratio was 1:3:5. 18.14% cases presented as solitary thyroid nodules [STN] and 81.86% as multinodular goiters [MNG]. Out of the total 83.82% cases were benign and 16.18% cases were malignant. The prevalence of malignancy in multinodular goiter was 14.37% and in the solitary thyroid nodules as 24.32%. Papillary carcinoma was the commonest malignancy followed by follicular carcinoma. The prevalence of cancer is significant in nodular goiters and these malignant tumours are usually of the papillary type. Solitary thyroid nodules have more chances of being malignant than multinodular goiter

Intracranial complications of chronic suppurative otitis media

To study the presentations of various intra cranial complications of chronic suppurative otitis media [SOM]. This prospective and descriptive study was conducted in the department of ENT, Lady Reading Hospital Peshawar from April 2006 to march 2007. All the cases with suspected intra cranial complications were admitted to the department and assessed clinically and radiologically. Audiological, and laboratory investigations were done as well. Out of 50 cases 36 were male and 14 female ranging from 10-40years in age. Complications like meningitis and brain abscesses were more common in males in the 2[nd] and 3[rd] decade of life [72%]. Most of the complications were from atticoantral diseases. The main presenting features were foul smelling otorrhea, headache, and fever, neck stiffness, chloestosteatoma and granulations in the ear. Meningitis [46%], temporal lobe abscess [36%] and extra dural abscess [14%] were the commonest complications. Burr hole aspiration, for intra cranial abscess and radical/modified radical mastoidecomy for SOM were the main surgical procedure carried out for these patients. Otogenic intra cranial complications like meningitis and brain abscesses are still common in spite of advances in the medical sciences. Complications are common in 2[nd] and 3[rd] decade of life. Meningitis is the commonest complication followed by brain abscess Burr whole aspiration with modified, radical mastoidectomy is the main stay of treatment along with parenteral antibiotics

Complications of conventional tracheostomy

To study the various complications associated with conventional tracheostomy. Material and It is a descriptive study, conducted in the department of E.N.T and Head and Neck Surgery P.G.M.I Hayat Abad Medical Complex Peshawar from 1st June 2003 to 31 May 2004. Fifty patients of both genders and all age groups on whom tracheostomy was performed were included in the study. All patients were assessed pre-operatively. They were observed for complications during the procedure, in the recovery room and in the ward. They were followed for 3 months after the procedure. Complications arising during that period were recorded on the proforma. Fifty patients, comprising of thirty-eight male and twelve female patients, underwent tracheostomy, with male to female ratio of 3:1 and average age of 35 years. Out of 50 patients, 70% [n=35] underwent emergency tracheostomy and only 30% [n=15] had elective procedure. Immediate complications included primary haemorrhage [6%] and apnoea [2%]. Intermediate complications were surgical emphysema [4%], stomal infection [4%], tube obstruction [4%] and dislodgement of tube [2%]. Late complications seen at 3 months follow up included difficult decannulation, tracheal stenosis and hypertrophired scar [2% each]. Mortality due to procedure itself was nil. Tracheostomy is a commonly performed life saving operation. It is associated with certain complications that are more in cases of emergency procedures and in children. However mortality associated with the procedure is largely due to the primary disease and not due to the procedure itself

Removal of a large frontal sinus osteoma with unilateral osteoplastic flap

A Seventeen years old male presented with right unilateral proptosis and supra-orbital swelling. Routine x-rays sinuses and CT Scan showed opacified mass of the right frontal sinus mainly occupying the lateral part of the sinus extending into the orbit. Excision of the lesion was carried out under general anaesthesia utilizing unilateral osteoplastic flap. The procedure was devised to ensure complete excision of osteoma through frontal sinus, direct examination of the frontonasal duct opening, and to achieve a good post operative cosmesis

interesting and difficult foreign body trachea in an adult female

Foreign body in tracheobronchial tree though commonly seen in paedriatic age group is not so frequent in adults. With different age groups nature of the foreign bodies and their clinical presentation differ and hence the management too. We report a case of an adult female with an interesting and problematic foreign body trachea to emphasize the fact that foreign bodies, though inhaled by chance, may be troublesome to deal with