Hearing Status after Radical Mastoidectomy without Tympanoplasty.

OBJECTIVE: To find out the impairment of hearing associated with radical mastoidectomy by measuring the quantitative difference in the functional hearing level before and after radical mastoidectomy operation without tympanoplasty. STUDY DESIGN: Cross-sectional comparative study. PLACE AND DURATION OF STUDY: Department of Otorhinolaryngology and Head Neck Surgery, Bahawal Victoria Hospital, Bahawalpur and PNS Shifa Hospital, Karachi, from November 2009 to January 2013. METHODOLOGY: Eighty-five patients, diagnosed clinically as chronic suppurative otitis media with extensive cholesteatoma having history of ear discharge and hearing impairment for more than 6 weeks duration and requiring radical mastoidectomy for treatment, were included in this study. Pure tone audiogram was done before and after radical mastoidectomy. Hearing impairment was compared in each patient before and after the operation. RESULTS: Among the 85 patients, 54 (63.5%) were males and 31 (36.5%) were females, with the age ranged between 18 to 63 years, mean age being 42.31 4.8 years. The mean increase in hearing loss after radical mastoidectomy in air conduction was 7.19 dB, bone conduction was 4.16 dB, and air-bone gap was 3.75 dB (0.001). The ear became dry and safe in 82 patients (96.5%) out of a total of 85, and only 3 patients required revision surgery at a second stage. CONCLUSION: Radical mastoidectomy has a least negligible effect on hearing status and one should not limit this technique due to the concern of aggravated hearing in patients with extensive cholesteatoma at the cost of dry and safe ears, which should be of prime importance.

Application of mouth gag and temporomandibular joint pain and trismus in tonsillectomy.

OBJECTIVE: To determine the effect of duration of application of mouth gag on Temporomandibular (TM) joint pain and trismus after tonsillectomy. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of ENT and Head and Neck Surgery, Combined Military Hospital, Nowshera, from February to July 2012. METHODOLOGY: A total of 40 patients undergoing tonsillectomy, in mouth opening prior to surgery was measured as inter incisor distance in cms. A stop watch was used to calculate the time of application of mouth gag. Mouth opening was again measured 06 hours after the surgery. Difference between the two readings was considered as trismus score and categorized as mild (1 cm), moderate (2 cm) and severe (3 cm). Patient was asked to score pain on a visual analogue scale (0 - 9). Score 0 was categorized as no pain; 1 - 3 as mild pain; 4 - 6 as moderate pain; 7 - 9 as severe pain. Spearman's rank correlation was used for finding correlation between time of mouth gag application and study outcome (pain and trismus). RESULTS: Trismus as observed by difference in inter incisor distance was mild in 11 patients; moderate in 15 patients and severe in 14 patients 06 hours after the surgery. Eleven (27.5%) had mild pain over temporomandibular joint, 15 (37.5%) had moderate and 14 (35%) had severe pain 06 hours after the surgery. Direct relationship was observed between duration of application of mouth gag with postoperative pain and trismus. Significant strong correlation was observed between length of mouth opening to severity of pain and trismus (rs = 0.738; p < 0.001). CONCLUSION: Duration of mouth gag application should be reduced to cause less TM joint pain and trismus in early postoperative period in tonsillectomy.

Intraocular pressure measurement: Goldmann Applanation Tonometer vs non contact airpuff tonometer.

BACKGROUND: An accurate assessment of Intraocular pressure (IOP) is vital in establishing diagnosis of Glaucoma and decision making regarding various treatment modalities available. The purpose of this study is to compare Goldmann Applanation Tonometer (GAT) with Air puff tonometer. METHODS: Cross-sectional comparative study conducted. 73 eyes from 73 patients were included in this study and intraocular pressure (IOP) was measured by GAT and PT100 at Sheikh Khalifa Bin Zayed Hospital, Muzaffarabad, Benazir Shaheed Teaching Hospital, Abbottabad. RESULTS: Mean age of the patients was 53.17 +/- 13.80 years. Mean IOP measurements showed significant differences in measurements performed by the two tonometers (p < 0.05). Correlation revealed significant relation between PT100 and GAT (Pearson's correlation 0.715, p < 0.01). CONCLUSIONS: Compared to non-contact air-puff tonometer, the Goldmann applanation tonometer is a reliable and consistent technique for measurement of intraocular pressure.