Oral Corticosteroid Therapy For Sudden Sensorineural Hearing Loss And Factors Affecting Prognosis.

BACKGROUND: Sudden sensorineural hearing loss (SSNHL) is considered an otologic emergency globally. Aetiology is unknown in most cases but still the disease is believed to be caused by inflammation of the cochlea; therefore, steroids are considered beneficial due to their anti-inflammatory effect. METHODS: This study was conducted on 62 patients of sudden sensorineural hearing loss (SSNHL) in Ayub Medical Complex, Abbottabad. The patients were given prednisolone and their response to the therapy was monitored. Factors like age of the patient, gender, degree of hearing loss and duration of symptoms at initial presentation were recorded and their effect of response of the patient was also noted. RESULTS: The research subjects were 62 patients. Majority of the patients suffered from moderate to moderately severe hearing loss. Age and gender did not influence the response to the treatment. While the patients who presented earlier after the onset of disease and the patients who had milder degree of hearing loss at presentation had a better response to therapy. CONCLUSIONS: Oral corticosteroid therapy is a good therapeutic option for the treatment of sudden sensorineural hearing loss (SSHNL). The response to therapy is better in patients with milder hearing loss and those who present early to the otologist for treatment.

Comparison of graft uptake by underlay and overlay technique in myringoplasty.

BACKGROUND: About 80% of tympanic membrane tears consequential of middle ear infections or trauma restore spontaneously. Myringoplasty is the procedure to fix the perforation which fails to heal. It is of two types; overlay and underlay techniques. In former technique graft is placed lateral to the fibrous sheet of the tympanic membrane while in underlay technique the graft is placed medial to the tympanic membrane remnant. The published success rates of underlay and overlay myringoplasty varied. This study was conducted to evaluate the effectiveness of graft uptake by underlay and overlay technique in patients undergoing myringoplasty. METHODS: This randomized control trial including 80 patients was carried out at Otorhinolaryngology department of Combined Military Hospital, Rawalpindi from April 2016 to September 2017. Patients going through myringoplasty for tympanic perforations were randomly allocated into two groups. Group-A underwent underlay while Group-B underwent overlay myringoplasty. RESULTS: The age of the patients ranged from 20 to 40 years with a mean of 29.58±5.92 years with a male to female ratio of 1.2:1. Hearing improvement was significantly higher (97.5% vs. 77.5%) in patients undergoing underlay versus overlay myringoplasty. The frequency of effectiveness in terms of graft uptake was significantly higher in patients undergoing underlay (95.0% vs. 57.5%) as compared to overlay myringoplasty. CONCLUSION: The underlay procedure is more effective in terms of graft uptake and lesser complications as compared to overlay myringoplasty.

Seasonal Variation Of Acute Otitis Externa Presenting To Ayub Teaching Hospital, Abbottabad.

BACKGROUND: Otitis Externa is a common inflammatory condition of external ear. It is more common in patients having predisposing conditions like trauma, swimming, patients using hearing aids, certain skin pathologies and immunocompromised patients. Increased humidity in rainy season increases the predisposition to otitis externa. METHODS: This descriptive study was carried over the duration of one year in ENT department of Ayub Teaching Hospital, Abbottabad. Patients of all ages and both genders suffering from acute otitis externa were included in the study after taking informed consent. All the information's were recorded in predesigned proforma and then finally evaluated by using SPSS program. RESULTS: The mean age of the patients presenting to us was 39.84±14.48 years (Range 1-78 Years) more commonly in male patients (54.14%). The disease was most commonly seen in rainy season, presenting unilaterally and affecting young adults of age ranging from 31-40 years. CONCLUSIONS: Prevalence of otitis externa is more common in humid climate. Precautionary measures should be taken in rainy and humid condition such as avoidance of self cleaning the ear.

Pattern Of Presentation Of Nasal Foreign Bodies, An Experience With 155 Patients.

BACKGROUND: Children commonly present to outpatient department with foreign bodies in the nose. Sometimes the history is straightforward but not infrequently presentation is with a foul-smelling unilateral discharge and obstruction. Most of the foreign bodies are inert and do not cause any local tissue reaction but some of these can cause serious complications. The frequency of the different types of foreign bodies is not known in our setup. Our study aims to determine the types and frequencies of different foreign bodies in our catchment area so as to make the attending surgeon aware of the different possibilities he may have to encounter. Also, we aimed to make the general public aware of the hazards which the foreign bodies can create. METHODS: This descriptive cross-sectional study was carried out at Department of ENT of Ayub Teaching Hospital Abbottabad, from 1st June to 30th November 2017. During the period of study, patients presenting in outpatient department with nasal foreign bodies were included in the study. We recorded patients' age and gender. Types of foreign bodies recovered from the nose were documented and their frequency was calculated. RESULTS: A total of 155 patients were included in the study. 60% of the foreign objects were inserted in the nasal passage by male children. Children below the age of 4 years comprised more than 55% of the cases. Mean age 4.5±2.36 years. Right nostril was predominantly involved (58%). Various seeds were commonly retrieved (40%). Plastic beads were the second most common foreign bodies (21.2%). Other foreign bodies found were buttons (9%), dry batteries (1.2%), stones (9%), toy pieces (4.5%), and food particles (10%). CONCLUSIONS: The commonest nasal foreign objects in children were organic seeds followed by plastic beads.

Type-I Tympanoplasty By Underlay Technique - Factors Affecting Outcome.

BACKGROUND: Type-I Tympanoplasty is an operation which is widely done to close a persistent tympanic membrane perforation after clearing the disease from the middle ear. It is very safe and effective procedure. The success rate varies in different setups and there are some confounding factors which affect the result of Type-I tympanoplasty like the size, type and location of perforation. By conducting this study, we aimed to calculate the success rate of Type-I Tympanoplasty in Ayub Teaching Hospital and assess which confounding factors affect the success rate. METHODS: This case series study was conducted at Ayub teaching hospital from 1st January 2014 to 31st December 2015. All the patients who presented with dry ears, no nasal disease and persistent tympanic membrane perforations during this period were operated upon and overall success rate was calculated. In addition, the relationship between the site of perforation, size of perforation and the type of perforation and the success rate of Type-I Tympanoplasty was also calculated. RESULTS: One hundred and thirteen patients were included in this study. Out of these 91 (80.5%) showed complete healing after surgery. Anterior perforations were found to fail the procedure in 41.7% of the cases, while central perforation failed in only 5.4% of the cases. In cases of marginal perforations healing was significantly decreased, i.e., only 47.1% while it was 94.9% in cases where annulus was not involved. Larger perforations also showed poor surgical outcome. 100% of the small perforation healed completely while only 58.3% of the large perforations showed successful result after surgery. When p-value was calculated all of these findings were more than 95% significant. CONCLUSIONS: There is a significant association between the healing of tympanic membrane after Type-I Tympanoplasty and site, size and type of perforation. Anterior perforations, marginal perforation and large perforations reduce the chances of successful outcome of Type-I Tympanoplasty.

Recurrent Laryngeal Nerve Injury In Total Versus Subtotal Thyroidectomy.

BACKGROUND: Both Total and Subtotal Thyroidectomy are correct treatment options for symptomatic Euthyroid Multinodular Goitre. The choice depends upon surgeon's preference due to consideration of disadvantages like permanent hypothyroidism in Total Thyroidectomy and high chances of recurrence in Subtotal Thyroidectomy. Many surgeons believe that there is a higher incidence of Recurrent Laryngeal nerve injury in Total Thyroidectomy which affects their choice of surgery. This study aimed to compare the incidence of recurrent laryngeal nerve injury in total versus subtotal thyroidectomy. METHODS: This non randomized controlled trial was carried out at Department of Surgery and ENT of Ayub Teaching Hospital Abbottabad, and Combined Military Hospital Rawalpindi from 1st September 2013 to 30th August 2014. During the period of study, patients presenting in surgical outpatient department with euthyroid multinodular goitre having pressure symptoms requiring thyroidectomy were divided into two groups by convenience sampling with 87 patients in group 1 and 90 patients in group 2. Group-1 was subjected to total thyroidectomy and Group -2 underwent subtotal thyroidectomy. All the patients had preoperative Indirect Laryngoscopy examination and it was repeated postoperatively to check for injury to the recurrent laryngeal nerve. RESULTS: A total of 177 patients were included in the study. Out of these, 87 patients underwent total thyroidectomy (Group-1). Two of these patients developed recurrent laryngeal nerve injury (2.3%). In group-2 subjected to subtotal thyroidectomy, three of the patients developed recurrent laryngeal nerve injury (3.3%). The p-value was 0.678. The overall risk of injury to this nerve in both surgeries combined was 2.8%. CONCLUSIONS: There is no significant difference in the risk of recurrent laryngeal nerve damage in patients undergoing total versus subtotal thyroidectomy.

Complications of nose and paranasal sinus disease.

BACKGROUND: Diseases of nose and paranasal sinuses can complicate to involve the orbit and other surrounding structures because of their close proximity. These diseases are usually infective or can be neoplastic in origin. METHOD: All the patients presenting in ENT or Eye Departments of Ayub Teaching Hospital during the one year study period who had complicated nose or paranasal sinus disease were included in the study. A detailed history and examination followed by CT scanning and laboratory investigations to assess the type and extent of the disease, was carried out. RESULTS: Infections were the most common cause of complicated sinus disease 11 (75%). The rest of the 4 (25%) cases were tumours. 12 (80%) of the cases presented with proptosis. In I of these 12 cases. there was complete blindness. In 2 (13%) of the cases there was only orbital cellulitis. Two of these patients had facial swelling and 2 had nasal obstruction and presented as snoring. Two patients presented with history of weight loss and these patients had malignant tumour of the paranasal sinuses. One patient presented with early signs of meningitis. In 1 case subperiosteal scalp abscess (Pott's puffy tumour) was the only complication noted. CONCLUSION: Nose and paranasal sinus diseases can complicate to involve mostly the orbit, but sometimes brain, meninges and skull bones can also get involved.

Evaluation of efficacy of management protocol in allergic rhinitis.

BACKGROUND: Allergic rhinitis represents a global health issue affecting between 10% to 25% of the world population, with increasing prevalence, resulting in a significant impact on quality of life, multiple comorbidities and the considerable socio-economic burden. Majority of the patients are younger than 30 years and it may be inherited. Symptoms typically occur as a result of exposure to dust, dander or certain seasonal pollen. Lack of standardized management protocol is one of the major factors responsible for poor control of this condition. This study was designed to evaluate the patients suffering with allergic rhinitis and manage them with a protocol based on the pathogenesis of the condition. METHOD: This prospective study was conducted in the Department of Ear, Nose & Throat and Head & Neck Surgery, Ayub Teaching Hospital, Abbottabad, over a period of two years (2005 - 2006), to assess the efficacy of a standard protocol of treatment developed and followed in the department. 1167 patients, clinically diagnosed as suffering with allergic rhinitis, were evaluated and managed. Age ranged from 08 months to 64 years. All the patients were prescribed medical treatment, divided into initial phase of 10 days to two weeks duration followed by a maintenance phase, and a regular follow-up schedule was maintained upto two years. RESULTS: 634 (54.32%) patients were male and 533 (45.67%) were female. Age ranged from 08 months to 64 years, 85% being between 05 and 45 years. 91% of patients had symptom duration of 06 months to 03 years. 96% of the patients were getting treated on as required basis, whereas 98% had no educational sessions with the treating doctor, especially regarding preventive measures. Typical presentation in most of the patients was nasal obstruction, runny & itchy nose, post nasal drip and bouts of sneezing. 90.57% patients reported improvement in symptoms. 53.21% patients had a relapse of symptoms at some stage during the study period. 37.53% patients had surgery done for associated pathologies, mostly a DNS. Compliance regarding medication was more than 90% in the initial phase of treatment that dropped to 50% in the maintenance phase. 93% of the patients tolerated the treatment well. CONCLUSION: Allergic rhinitis is a growing problem worldwide. Optimal treatment protocol is still lacking especially in the developing countries. Patient's education on avoidance of allergens must be stressed. Associated problems that may need surgical treatment. Regular follow-up must be ensured to monitor the progress of treatment as well as to identify patients who might be candidates for immunotherapy. Newer modalities of treatment need to be further explored. A team approach is mandatory in the presence of symptoms related to lower respiratory tract.

Significance and cost effectiveness of pre-operative routine laboratory investigations in young healthy patients undergoing elective ear, nose & throat surgery.

BACKGROUND: Pre-operative preparation is an important component of surgical workup. Adequate clinical assessment to determine fitness for anaesthesia and surgery and to outrule possibilities of existing disease or risk factors against the procedure would suffice in elective surgery on healthy young patients. Still routine investigations are carried out following a protocol, that does not offer added benefit and is not cost effective. METHOD: We evaluated one hundred and fifty young healthy patients planned for elective surgery, to compare adequate clinical assessment with results of routine investigations in such patients, in terms of significance and cost effectiveness. RESULTS: Significant co-relation was demonstrated between clinical assessment and routine investigations. Only 03 abnormal results were reported following 600 laboratory investigations on 150 patients. CONCLUSION: Thorough clinical assessment is mandatory for successful outcome of surgery. There is significant co-relation with routine investigations in elective Ear, Nose & Throat (ENT) surgery. Investigations should be restricted to where indicated by clinical assessment. Such policy will significantly reduce the costs and workload, thereby improving quality of health care system.

Management outcome of secretory otitis media.

BACKGROUND: Secretory otitis media is a common otological manifestation, that most of the time is left undiagnosed on account of unawarenes s and negligence in seeking early medical attention for trivial ailments. Untreated, it might end up in serious consequences in the form of poor speech and intellectual development and permanent anatomical disabilities within middle ear cleft. The objectives of the study were to determine most affected age group, the common etiological factors. to access the efficacy of medical and surgical treatment and finally to find out the coumplication associated with the surgical procedures. METHODS: This study was conducted in the ENT, Head and Neck Surgery department of the Ayub Teaching Hospital, Abbottabad from January 2001 to December 2003. Only the diagnosed cases of SOM were included in the study. After detailed history, clinical examination, routine investigations and special investigations such as pure tone audiogram and tympanometry were carried out to confirm the diagnosis of SOM . All patients were initially treated by medical therapy. In cases of failure, underwent myringotomy with or without ventilation tube insertion and where indication present adenotonsillectomy and antial lavage was done. Follow up of cases was carried out from 18-24 months. RESULTS: It included 87 patients, 58 were males (66.6%) and 29 females (33.3%). Majority of the patients were between 5-8 years (62%). The most common aetiological factor was rhinosinusitis (36.7%) followed by hypertrophic adenoids (34.5%). All patients were initially given medical treatment. Out of 87 patients,30 patients (34.4%) improved and 57 patients (65.5%) had no response and underwent surgery. Surgical procedures included myringotomy with and without ventilation tube insertion., adenotonsillectomy and antral lavage. CONCLUSION: lt is concluded from this study that conservative treatment has a definite role and should be tried before any surgical step is taken however surgery is the treatment of choice in more resistant cases.