Otolaryngology Commons^™

Clinical Profile, Outcomes And Improvement In Symptoms And Productivity In Rhinitic Patients In Karachi, Pakistan., Taimur Saleem, Umair Khalid, Ubaid Ur Rehman Sherwani, Shehzad Ghaffar

Section of Otolaryngology, Head & Neck Surgery

Background:Rhinitis can cause a heavy toll on Patients because of its bothersome effects on productivity. This retrospective study was conducted to explore the clinical profile, outcomes and improvement in the symptoms and productivity resulting from treatment of allergic rhinitis in Pakistan.

Methods:

We carried out a retrospective file review of all allergic rhinitis Patients who presented to the Ear, Nose, Throat Consulting Clinic from January, 2006 to June, 2008 using a structured proforma especially designed for this Purpose. Data was entered and analyzed using SPSS v. 16.0.

Results:

The charts of 169 Patients were reviewed. The mean age of …

Two Cases Of Primary Laryngeal Amyloidosis, Taimur Saleem, Sanna Fatima, Shehzad Ghaffar, Kanwal Aftab, Sohail Awan

Section of Otolaryngology, Head & Neck Surgery

The larynx is a rare site of involvement of amyloidosis. We report two cases of laryngeal amyloidosis. Both patients were middle aged females with history of persistent hoarseness. Fibreoptic laryngoscopy used for diagnosis in both and debulking of the tumour was performed. Histopathological examination confirmed the diagnosis of amyloidosis. Appropriate follow up is an important part of the long-term management of the disease.

Adenoid Cystic Carcinoma Of The External Auditory Canal, Mohammad Hussham Arshad, Umair Khalid, Shehzad Ghaffar

Section of Otolaryngology, Head & Neck Surgery

This is a rare case of a young male with biopsy proven adenoid cystic carcinoma of the external auditory canal who underwent excision of the lesion with superficial parotidectomy sparing the facial nerve. Histopathology showed perineural invasion, which is a diagnostic hallmark of adenoid cystic carcinoma. Clinical examination, chest X-ray and CT scan showed no signs of recurrence or metastasis 2 years postoperatively.

Management Of Allergic Fungal Sinusitis With Postoperative Oral And Nasal Steroids: A Controlled Study., Mubasher Ikram, Akbar Abbas, Anwar Suhail, Maisam Abbas Onali, Shabbir Akhtar, Moghira Iqbal

Section of Otolaryngology, Head & Neck Surgery

In Patients with allergic fungal sinusitis, the mainstay of treatment remains surgical removal of allergic mucin and fungal debris. But as a single modality, surgery is associated with high rates of recurrence, so a number of adjunctive medical modalities have been tried, including postoperative corticosteroid therapy. We conducted a study of 63 Patients with allergic fungal sinusitis who underwent endoscopic sinus surgery with or without postoperative steroid therapy. A group of 30 Patients who had been treated prior to January 2000 had undergone surgery only, their cases were reviewed retrospectively, and they served as historical controls. Another 33 Patients who …

Estrogen Replacement Therapy Induces Functional Asymmetry On An Odor Memory/Discrimination Test, Richard L. Doty, Mehreen Kisat, Isabelle Tourbier

Section of Otolaryngology, Head & Neck Surgery

The secondary afferents of the olfactory system largely project to the ipsilateral cortex without synapsing in the thalamus, making unilateral olfactory testing a useful probe of ipsilateral hemispheric activity. In light of evidence that lateralized performance on some perceptual tasks may be influenced by estrogen, we assessed left:right nostril differences in two measures of olfactory function in 14 post-menopausal women receiving estrogen replacement therapy (ERT) and 48 post-menopausal women receiving no such therapy. Relative to women not taking ERT, those receiving ERT exhibited better performance in the left nostril and poorer performance in the right nostril on an odor memory/discrimination …

Laryngotracheal Trauma: Its Management And Sequelae, Shabbir Akhtar, Sohail Awan

Section of Otolaryngology, Head & Neck Surgery

OBJECTIVE: Laryngotracheal trauma is a rare but clinically important injury. Complications are frequent. Early recognition, accurate evaluation and proper treatment is vital. In order to learn from our past experience and refine our management, we reviewed our cases.

METHODS: Fifteen patients with external laryngotracheal injuries were analyzed retrospectively. The outcome was assessed both in terms of voice and airway, on short term and long term basis.

RESULTS: Commonest cause of injury was cut throat injuries followed by road traffic accidents. The main presenting symptoms and signs were hoarseness, haemoptysis, odynophagia and stridor. Major laryngeal injuries (10 cases) outnumbered minor injuries …

Blindness In Children At The Ida Rieu School For The Blind And Deaf, Sadia Javed Khan, Afshan Hassan, Laila Khalid, Uzma Karim, Erum Hashmi, Fariha Gul, Imtiaz Jehan

Community Health Sciences

Objective: To identify the causes of blindness at the Ida Rieu school for the blind and deaf, Karachi, Pakistan.Methods: A cross sectional study was conducted at the Ida Rieu School for the blind and deaf. The data collected from medical record of students was entered into the WHO/PBL eye examination form for children with blindness and low vision.Results: Records of 144 pupils aged between 4-30 years were reviewed, including 67% males and 33% females. One third (31%) children had visual impairment (< 6/18-6/60) and 69% were blind (< 3/60-NPL). The commonest anatomical site was retina (41%) and whole globe (20%). The etiology was unknown in 49% cases. In 33% of cases, the data suggested hereditary cause as the etiology, 40% of cases were preventable and 13% treatable.CONCLUSION: Avoidable causes of blindness were seenin 53% of children, 58% of which were preventable and 19 were treatable.

Iatrogenic Insertion Of Impression Mould Into Middle Ear And Mastoid And Its Retrieval After 9 Years: A Case Report, Mohammad Sohail Awan, Moghira Iqbal, Zakariya Imam Sardar

Department of Surgery Docs

Abstract

The magnitude of hearing loss in Pakistan is enormous. One in twelve children of Pakistan suffers from some form of hearing impairment. Many of them are unable to afford surgical procedures and resort to the use of cheap hearing aids fitted by untrained individuals or people lacking the required expertise. This predisposes the patients to significant complications during a process that is otherwise considered safe.We report the case of a child, where the process of making the mould for a hearing aid led to the perforation of the tympanic membrane and pouring of mould material into the middle ear, …

Neck Recurrence In Early Carcinoma Tongue, Mubasher Ikram, Sadaf Fatima Jafferbhoy, Maisam Abbas Shiraz Onali

Section of Otolaryngology, Head & Neck Surgery

Objective: To study the efficacy of different locoregional treatment options for tongue cancer in determining the prognosis, with reference to recurrence of disease in neck.

Methods: This is a retrospective analysis of 80 patients with early (T1/T2) carcinoma tongue who had hemiglossectomy with or without neck surgery and radiotherapy for 14 years.

Results: Eighty patients were included in this study, 49 (61.3%) men and 31 (38.8%) women; 36 (45%) patients with T1 lesion and 44 (55%) with T2 lesion. Sixty two patients (77.5%) were staged cN0 and 18 patients had a clinically palpable neck nodes (cN+). Thirty seven patients were …

Incorporating Endoscope In Middle Ear Surgery, Shehzad Ghaffar, Mubasher Ikram, Ahsan Raza

Section of Otolaryngology, Head & Neck Surgery

We conducted a study to evaluate the use of a pediatric rigid otoendoscope for determining the extent of middle ear disease and for assessing ossicular integrity and mobility during tympanoplasty. Our study population was made up of 132 patients who were undergoing surgery for the treatment of chronic suppurative otitis media; of this group, 41 patients underwent otoendoscopy and 91 underwent scutum lowering for purposes of visualization. In the otoendoscopy group, the ossicles were successfully visualized and their mobility assessed in 34 patients; the remaining 7 patients subsequently underwent scutum lowering. A 30° endoscope allowed for complete visualization of the …

Acetabular Morphometry For Determining Hip Dysplasia In The Singaporean Population, Masood Umer, Thambyah A, Wtj Tan

Department of Surgery Docs

Abstract

PURPOSE:

To assess and evaluate the usefulness of 7 morphological measurements of the acetabulum in establishing the prevalence of acetabular dysplasia in the Singaporean population.

METHODS:

Standardised plain anteroposterior radiographs of 522 hip joints of 261 asymptomatic patients (mean age, 60 years; range, 16-99 years) were evaluated. The 7 morphological measurements were centre-edge angle, acetabular angle, depth-to-width ratio, roof obliquity, extrusion index, lateral subluxation, and peak-to-edge distance.

RESULTS:

19 (7.3%) patients were acetabular dysplastic (centre-edge angle of <20 >degrees). The mean centre-edge angle was 31.2 degrees (range, 5-52 degrees), acetabular angle 39.46 degrees (range, 10-58 degrees), depth-to-width ratio 0.32, roof …

Socio-Demographic Correlates Of Betel, Areca And Smokeless Tobacco Use As A High Risk Behavior For Head And Neck Cancers In A Squatter Settlement Of Karachi, Pakistan, Samia Mazahir, Rabia Malik, Maria Maqsood, Kanwal Aliraza Merchant, Farida Malik, Atif Majeed, Zafar Fatmi, Muhammad Rizwanulhaq Khawaja, Shehzad Ghaffar

Community Health Sciences

Background

Head and neck cancers are a major cancer burden in Pakistan. They share a common risk factor profile including regular consumption of products of betel, areca and tobacco. Use of paan, chaalia, gutka, niswar and tumbaku is acceptable in Pakistan and is considered a normal cultural practice. This cross-sectional study was carried out to understand the relation of socio-demographic factors for the consumption of paan, chaalia, gutka, niswar and tumbaku in Pakistani population. Through systematic sampling, 425 subjects from a squatter settlement in Karachi were interviewed using a structured questionnaire. High risk behavior was defined as Daily use of …

Migrating Foreign Body In The Thyroid Gland, An Unusual Case, Tatheer Zohra, Mubasher Ikram, Moghira Iqbal, Shabbir Akhtar, Seyed Akbar Abbas

Section of Otolaryngology, Head & Neck Surgery

In literature various cases have been described where foreign bodies ingested were lodged in the upper aero digestive tract, but only few of these foreign bodies perforate the oesophagus and an even fewer migrate extraluminally.1 If untreated, they may result in life threatening suppurative or vascular complications. Exploration of the neck via an external approach to remove the foreign body is the recommended treatment. The CT scan utilizing fine cuts is invaluable in localizing the foreign body for exploration. Oesophageal penetration and migration of oesophageal foreign bodies into the thyroid gland is extremely rare with only occasional case reports appearing …

Speech Results With Tracheoesophageal Voice Prosthesis After Total Laryngectomy, Mohammad Sohail Awan, Imtinan Ahmed, Yassar Iftikhar Ahmad, Daniyal Ahmad

Section of Otolaryngology, Head & Neck Surgery

Objective: To assess the success rate of tracheoesophageal voice prosthesis as the primary mode of voice rehabilitation in patients after total laryngectomy.Methods: Medical record files of 35 patients subjected to total laryngectomy were reviewed for determining success or failure of the voice prosthesis. The indicators used were quality of speech and utility of the device. Subsequent complications that developed were also assessed. In addition other factors taken into consideration were pharyngeal myotomy, use of radiation, and timing of replacement. All thirty five patients (n=35) had prosthesis placed at the time of laryngectomy.Results: The success rate at one month and four …

Surgical Emphysema In The Neck As A Result Of A Dental Procedure, Moghira Iqbal, Mubasher Ikram, Farhan Raza, Ninette Banday

Section of Otolaryngology, Head & Neck Surgery

We report the development of subcutaneous emphysema in a middle-aged woman that occurred several hours after she had undergone a dental restoration procedure. The patient presented to the emergency department, and she was admitted for observation and prophylactic antibiotic coverage. She recovered in 3 days without further intervention and was discharged.

Leiomyosarcoma Of Thelarynx: A Case Report, Akbar Abbas, Mubasher Ikram, Nausheen Yaqoob

Section of Otolaryngology, Head & Neck Surgery

Leiomyosarcoma of the larynx is an extremely rare neoplasm; only about 50 cases have been reported in the English-language literature. We report a new case of laryngeal leiomyosarcoma in a 65-year-old man. The metastatic work-up was negative, and the patient underwent total laryngectomy. He remained disease-free 12 months postoperatively.

Olfactory Neuroblastoma: A Case Report And Review Of The Literature, Shehzad Ghaffar, Iftikhar Salahuddin

Section of Otolaryngology, Head & Neck Surgery

Malignant tumors of the nasal cavity are rare. We report the case of an elderly woman who consulted us with a 4-year history of progressive nasal obstruction, occasional epistaxis, facial pain, and watering of the eyes. A diagnosis of olfactory neuroblastoma was established by histopathology and confirmed by immunohistochemistry. On staging, the mass was classified as a Kadish stage B tumor. The mass was excised via a lateral rhinotomy approach, and the tumor was peeled away completely from the cribriform plate with endoscopes. The patient underwent postoperative radiation, and she was free of recurrence at follow-up 15 months later.

Clinical Study On The Use Of Nozovent In A Tertiary Care Setting, M Sohail Awan, M Mubarik Ali, Manzoor Ahmed, Asim Iqbal, M Javed Aslam

Section of Otolaryngology, Head & Neck Surgery

Objective: To assess the effectiveness of the Nozovent device in Pakistani subjects at Aga Khan University Hospital, Karachi and Sir Ganga Ram Hospital, Lahore from 15 January 2001 to 15 January 2002.Methods: Sixty males and 40 females were selected by non probability purposive sampling, from OPD of ENT Department, complaining of nasal obstruction due to various reasons, e.g. vasomotor rhinitis, allergic rhinitis, congestion during pregnancy and menstruation, common cold, traumatic nose and nasal valve problem.Results: All patients benefited subjectively but the degree of relief varied in individuals.CONCLUSION: The Nozovent provides a unique method to relieve nasal obstruction with no side …

Reversible Obstructive Sleep Apnea And Right Heart Failure Due To Massive Tonsillar Hypertrophy, Mehnaz Atiq, Fatima Masood, Mubasher Ikram, Raana Haqqee

Section of Otolaryngology, Head & Neck Surgery

Obstructive sleep apnea is a relatively common but under diagnosed clinical entity in children. Adenotonsillar hypertrophy is the most common cause for upper airway obstruction in pediatric patients. If the obstruction to upper airways is not relieved, then the child can develop obstructive sleep apnea and its consequences. Treatment is simply to remove the obstruction thereby restoring patency of upper airways

Prevalence Of Smokers Among Air-Conditioned Coaches, Pakistan, R Mal, N Rizvi, S Rathi

Section of Otolaryngology, Head & Neck Surgery

Objective: To estimate the proportion of smokers among passengers of air-conditioned (A/C) coaches running between Karachi and Hyderabad. Pakistan.METHOD: A cross-sectional survey was done on passengers and staff members of 20 air-conditioned coaches.Results: Of 847 passengers interviewed, 17.3% were smokers and 11.7% passengers smoked during travel while rest of them remained passive smokers. Out of 147 smokers 91.2% were literate persons. Among staff members 59.3% were smokers. Approximately 56% of smokers among passengers were in the age range of 14-40 years. In 95% of A/C coaches there were no anti-smoking warning signs or written words present.CONCLUSION: In this study majority …

Vestibular Schwannomas: Clinical Presentation, Management And Outcome, M S. Awan, H U. Qureshi, A A. Sheikh, M M. Ali

Section of Neurosurgery

Objective: To review the demographic trends clinical spectrum, diagnosis, management and outcome of patients with vestibular Schwannoma and to identify areas where improvements are needed.
Methods: All patients with vestibular schwannoma admitted to the Aga Khan University Hospital over the past 11 years were reviewed retrospectively.
Results: The age range of majority of 22 patients analyzed, was 41-50 years (23%). Hearing loss was the most common presenting symptom (96%). Other clinical features included cranial nerve palsies (59%) and headache (55%). Fifty percent had signs of raised intracranial pressure. Neuroimaging revealed "Stage IV b" (tumor distorting the brainstem and compressing the …

A Comparison Of Dissection-Method And Diathermy Tonsillectomies, Muneeb Ahmed, Adil Abbas Khan, Tanya Siddiqi, Mubasher Ikram, M Yousuf Mian

Section of Otolaryngology, Head & Neck Surgery

Objective: To compare the dissection and diathermy methds of tonsillectomy and evaluate their advantages and disadvantages during surgery and convalescence.
Methods and Setting: Patients who had tonsillectomy at Aga Khan University Hospital, between January 1994-December 1997.
Results: Four year retrospective analysis was done of 200 patients who underwent tonsillectomy by either electrocautery or dissection method. One hundred and eleven underwent tonsillectomy by electrocautery and the other 79 had their tonsils removed by dissection-method and 2 had a combination of both. The average intra­operative blood loss was 10 ml with cautery and 65 ml with dissection method. The average operative time …

Facial Nerve Palsy Unusual Complication Of Percutaneous Angiography And Emoblization For Juvenile Angiofibroma, Mubasher Ikram, Kamaluddin Khan, Moazzam Murad, Tanveer Ui Haq

Section of Otolaryngology, Head & Neck Surgery

Juvenile angiofibrorna is a locally invasive, vascular and non-encapsulated neoplasm occurring almost exclusively in adolescent males. Although histologically benign, these tumors are highly aggressive and are associated with significant morbidity and occasional mortality. It has marked tendency to recur if not completely removed1 . As the tumor is highly vascular, surgely is frequently accompanied by significant intraoperative hemorrhage, which may contribute to incomplete removal and additional morbidity and mortality2 . Roberson (1972) was first to advocate pre-operative angiography and embolization of major feeding vessels as an adjunct therapeutic method in addition to surgery, to facilitate complete excision of the tumOr …

Fine Needle Aspiration Cytology (Fnac) In The Management Of Thyroid Pathology - The Aga Khan University Hospital Experience, Mubasher Ikram, Jamil Hyder, Sohail Muzaffar, Sheema H. Hasan

Section of Otolaryngology, Head & Neck Surgery

Objective: To report the efficacy of FNAC in patients with thyroid disease.
Methods: Between January 1990 and December 1994 the records of all patients treated surgically for thyroid disease at ENT Head and Neck Surgery of Aga Khan University were reviewed. All the patients had pre­operative FNAC as the first line of evaluation and the histopathologist examined post-operative thyroid specimen.
Results: Forty-five patients (36 female and 9 male) had thyroid surgery. In 26 patients out of 45, FNAC was conclusive in diagnosing the nature of disease, while in 19 patients the FNAC was inconclusive because of the presence of follicular …

Aspergillosis Of The Sphenoid Sinus With The Involvement Of The Clivus, Mubasher Ikram, S.S.M. Hussain, R Ahmad

Section of Otolaryngology, Head & Neck Surgery

Introduction: Fungal infections of the nose and paranasal sinuses are frequent in this part of the world. One aspect of the increased frequency is the improved clinical, radiological and pathological diagnostic methods that are now available. Aspergillus is the commonest infecting fungus of the nose and the paranasal sinus1 . It is mainly a saprophytic spore producing fungus and can cause invasive and non-invasive infections. The initial report of fungal paranasal infection largely dealt with immunocompromised individuals as distinct from the allergic fungal infection. Aspergillosis confined to the sphenoid sinus is uncommon with only 34 cases having been reported in …

Ossifying Fibroma Of Nasal Cavity, Abbas Zafar Abbas Zafar, Muhammad Shafi Muhammad Shafi, Shaukat Malik Shaukat Malik, Shahid Pervez

Department of Pathology and Laboratory Medicine

No abstract provided.

Fine Needle Aspiration Cytology In Parotid Lumps, A Zafar, M Shafi, S H. Hassan, S Malik

Section of Otolaryngology, Head & Neck Surgery

Over a period of two years, Fine Needle Aspiration Cytology (FNAC) was performed on 33 patients presenting with a parotid lump. Five patients were excluded as they were treated medically after FNAC report. The FNAC results of 28 cases were compared with histopathological diagnoses of surgically resected specimens. There were 8 true positive, 17 true negative, 1 false positive and 2 false negative cases. Sensitivity was 80%, specificity 94.4% and diagnostic accuracy 89.3%. FNAC is a simple quick, accurate and virtually complications free investigative modality. It is also helpful adjunct to assess preoperatively the suitability and extent of the surgical …

Churg-Strauss Syndrome With Intestinal Perforation, Javaid A. Khan, Imran Hassan, Shahid Pervez, Wasim Jafri, Shaista Khan

Department of Pathology and Laboratory Medicine

No abstract provided.

Vocal Cord Paralysis Following Endotracheal Intubation, S Akhtar, Tanveer Janjua, Jameel Hyder

Section of Otolaryngology, Head & Neck Surgery

No abstract provided.