Objective: To apply the St Thomas’ Hospital (STH) classification of round window type, in a Pakistani pediatric population undergoing cochlear implantation, and rate the inter observer variability of applying this classification. Study Design: Cross sectional study. Place and Duration of Study: Combined Military Hospital Rawalpindi, from Apr 2019 to Dec 2020. Methodology: Patients were examined per-operatively by a panel of four surgeons after "optimal" posterior tympanotomy for round window variations, as per STH classification of approachability of RWM. The observations of the four surgeons were recorded and interobserver variation was assessed and analyzed. Results: A total of 100 patients were operated, 45 females and 55 males. Mean age was 3.8 years. There was minimal inter observer variability with regards to round window type and extent of "optimal" posterior tympanotomy. Three patients had type I, 76 had type IIA, 15 had type IIB and 6 patients had type III. Round window insertion/membranous cochleostomy was possible in 70 patients, whereas the rest require extended round window approach or bony cochleostomy. Conclusion: The STH classification is a useful predictor of route of CI electrode insertion and most patients can undergo RW insertion with confidence based on minimal variation between surgeons when applying the STH classification as well as when deciding the extent of surgical exposure.
Objective: Pharyngocutaneous fistula (PCF) is a complication of post radiotherapy total laryngectomy. Early post operative feeding is a risk factor for development of PCF. Delayed oral feeding (DOF) and inserting a nasogastric tube has been considered a safe practice among head and neck surgeons, and there is no general agreement on the timing of initiation of the oral intake. This study compared the effect of EOF and DOF on PCF formation. Study Design: Prospective case-controlled trial. Place and Duration of Study: Combined Military Hospital Rawalpindi, from Apr 2019 to Jul 2020. Methodology: Non-probability convenience sampling was done for both groups. The patients were not matched and were assigned to either EOF or DOF alternately. EOF was defined as feeding at seventh post operative day and DOF criterion was feeding on fourteenth post operative day. The primary outcome was development of PCF within the 30th post operative day. A total of 20 patients with prior radiotherapy for laryngeal cancer who presented with recurrence of carcinoma were included in the study. Same technique closure of neopharynx was done in all cases of laryngectomy. Results: Overall PCF frequency was 20% (4/20). In EOF group, 30% (3/10) of patients developed PCF whereas 10% (1/10) of patients in DOF developed PCF. However, the difference in outcome of two groups was not statistically significant. Conclusion: DOF in cases of Salvage total laryngectomy is a safe practice and it might help to reduce the frequency of pharyngocutaneous fistula.
Background: Patients come in the head and neck clinic most of the time with no obvious symptoms and most of the time with no visible lesion in the head and neck area. The nasopharynx is the area that is hidden from examination as it lies very deep in the skull base. It has a very high blood supply and a very metastatic rate. Study design: Prospective study Place and duration of study: Department of ENT, Pakistan Institute of Medical Sciences, Islamabad from 1st March 2021 to 28th February 2022. Methodology: Eighty six patients with FNAC proven neck masses showing squamous cell carcinoma were included. Pan endoscopy was done in all the patients after thorough clinical examination and CT scan. The patients with visible lesion were biopsied from the lesion site and the patients that had no visible lesion were biopsied from three sites i.e. nasopharynx, oropharynx and hypopharynx. The biopsies were sent to the PIMS histopathology laboratory. Results: There were 52 males and 34 females. The nasopharynx was the common site in the patients with visible lesion in 18 patients. In patients with non-obvious lesions again nasopharynx was the most frequent site in 9 out of 28. Conclusion: The nasopharynx is a very common site for carcinoma and has a very high metastatic rate, so every patient coming to head and neck should be thoroughly examined in the clinic in reference to nasopharynx and any suspicious are should be biopsied. Keywords: Frequency, Nasopharyngal carcinoma, Neck mass
Aim: To see the prevalence of fungal rhino sinusitis in patients presenting with nasal polyposis. Study design: Cross-sectional study. Place and duration of study: Department of Otorhinolaryngology and Head and Neck surgery, PIMS, Islamabad from 1st October 2021 to 31st March 2022. Methodology: Patients presenting with nasal polyps fulfilling our inclusion criterion in ENT Department in PIMS. Eighty patients presenting with nasal polyps for surgery after admitting them and the specimen was sent for fungal culture. Results: Sixty nine patients showed positive culture for fungal rhino sinusitis and only 11 patients were negative for fungal growth. Among 69 patients 51 patients were males and 18 were females. Eighty five percent male patients showed fungal growth while 90% females showed fungal growth. Conclusion: The nasal polyps is closely related to fungal infection, so all patients presenting with nasal polyps are suggested to undergo fungal culture and work-up should be done for fungal rhino sinusitis to rule fungal infection is suggested, so that early diagnosis is made and earliest treatment is started for the disease. Key words: Nasal polyps, Fungal culture, Fungal rhino sinusitis
Objective: To compare the graft uptake in permeatal versus postaural approaches in myringoplasty. Study design: Cross sectional comparative Place and Duration of Study: Department of ENT, Head and Neck Surgery, Pakistan Institute of Medical Sciences/Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad Pakistan from 1st March 2018 to 31st December 2018. Methodology: Seventy two patients were classified into two equal groups. Thirty six patients underwent myringoplasty by permeatal approach and thirty six patients underwent postaural approach. Those patients were included who had mucosal type moderate central perforation with inactive disease with age 15-42 years and those patients were excluded who had small, subtotal, total, squamosal type atticoantral tympanic membrane perforation, with comorbidities and pregnancy. Results: Thirty seven were (51.4 %) males and 35 (48.6%) were females. In both the groups the success of graft uptake was 52 (72.2%) patients and graft rejection in 20 (27.8%) patients. In each group there were 36 patients. The graft uptake in permeatal approach was 30 patients (83.3%), while the graft uptake in postaural approach was 22 (61.1%) patients. The overall graft uptake in permeatal approach is more as compared to postaural approach (p=0.035). Conclusion: The permeatal approach is better than the postaural approach in terms of graft uptake in medium sized central perforations in myringoplasty. Key words: Myringoplasty, Tympanoplasty, Permeatal, Postauricular
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