Ear, Nose And Throat Department Research Articles

Pattern of Diseases Presenting in ENT Outpatient Department in a Postgraduate Teaching Hospital in S.I.T.E. Area Karachi

Ear, Nose and Throat (ENT) diseases are one of the public health problems and affect a huge number of the patient around the globe. Objective: To determine the pattern of ENT disorders or diseases in those patients who were attended outpatient department of ORL in a postgraduate teaching hospital of Karachi. Methods: Patients presenting at ENT OPD were selected randomly for the study. Data about ENT problems and information were collected through well structured questionnaire. After data collection, it was entered and analyzes by using software SPSS-23. Variables were age, sex, residence, socioeconomic status and different ENT diseases including wax, otitis media, allergic rhinitis, pharyngitis, tonsillitis, Deviated Nasal Septum (DNS) etc. Results: Male patients were 585 (46.8%) while female patients were 665 (53.2%) out of 1250 patients. Most of the patients were from industrial areas 775 (62%) and 475 (38%) were from city areas. 355 (28%) were suffering from wax followed by acute otitis media 300 (24%), acute tonsillitis and deviated nasal septum each in 225 (18%), otitis externa 150 (12%) and acute pharyngitis 145 (11%). In our study, a huge number of 72% of cases had ear disorders. 43.2% of patients had nasal issues, while 45.2% were related to laryngopharyngeal issues. Conclusions: Majority of the patients attending outpatient ENT department were related to ear wax followed by acute otitis media, acute tonsillitis, DNS, otitis externa, acute pharyngitis and many patients have multiple diseases.

Proximie in the operating theatre: evaluation of a virtual operating platform for medical student education.

Medical students often hesitate to enter the operating theatre because of poor visibility of the surgical field and anxiety about the theatre environment. In addition, ear, nose and throat (ENT) surgery is underrepresented in many medical curricula. Virtual systems like Proximie offer flexible viewing of surgeries with surgeon commentary, potentially addressing these issues. This descriptive survey study aimed to evaluate the use of Proximie as a surgical education tool for delivering ENT teaching to medical students. Live ENT procedures were recorded at the ENT Department of the John Radcliffe Hospital and shared with interested clinical medical students through Proximie accounts. Students were added to a private group chat to ask questions and provided feedback through structured forms, assessing procedural effectiveness and the platform's technology. Live-streaming and recording of procedures were facilitated by ENT surgeons providing commentary. Conducted over four virtual theatre days, the study gathered 52 responses: 96% of students rated Proximie's educational value as 4 of 5 or higher; 57% preferred the virtual experience over physical attendance because of its convenience and the improved view of the surgical field. Students valued the live commentary and showed interest in using Proximie for a broader range of surgeries. Suggested improvements included fixing technical issues, better communication of theatre lists, and expanding surgical specialty coverage. Proximie has been highly rated by medical students for its effective and engaging approach in the instruction of surgical skills, underscoring its value as an educational tool. Future research is needed to formally assess knowledge acquisition and retention across multiple surgical subspecialties. This work is the first step towards evaluating the utility of virtual operating theatre platforms for medical student education.

Management Challenges And Outcome Of Juvenile Onset Respiratory Papillomatosis In A Tertiary Hospital In North Central Nigeria: A Preliminary Study

Background/Aim: Juvenile Onset Recurrent Respiratory Papillomatosis (JoRRP) is a benign tumour attributed to human papillomavirus infection with a high propensity to recur despite appropriate treatment. It is relatively rare but the commonest benign tumour of the larynx in children. This study is aimed at evaluating its management challenges.
 Materials and methods: This was a retrospective review of patients with JoRRP at Ear, Nose and Throat (ENT) Department, University of Ilorin Teaching Hospital over a 7-year period. The patients' biodata, mode of presentations, surgical care, histopathological findings and management outcome were reviewed.
 Results: A total number of ten patients were diagnosed with JoRRP during the study period. Male to female ratio was 1:1. All the children were delivered per vaginal and sixty percent were first children of their mothers. Hoarseness, breathy voice and worsening difficulty in breathing were the presentation in 7 (70%) of cases, while 3 (30%) presented with only hoarseness and breathy voice. They all presented first to General Practitioners and Paediatricians before ENT Specialist assessment and six (60%) patients presented to ENT department 6 months or more after the onset of symptoms. They all had direct laryngoscopy and excisional biopsy of laryngeal papillomatous lesions. Thirty percent had tracheostomy done. There is a statistical significant relationship between tracheostomy rate and recurrence rate of JoRRP.
 Conclusion: JoRRP is a rare but potentially life-threatening benign tumor of the respiratory tract. Most of our patients presented late and were misdiagnosed at presentation. The key to good management outcome remains early diagnosis, adequate management and regular follow-up.

Evaluation of antibiotic prescription patterns using WHO AWaRe classification.

Antimicrobial resistance is a rising problem worldwide and it poses a serious risk to public health. In Pakistan, about 70.0% of the Acinetobacter group of bacteria were resistant to all antibiotics and were responsible for high mortality among neonates within the first week of life. To evaluate the pattern of antibiotic prescription in the Ear, Nose and Throat (ENT) Department of Shalamar Hospital, Lahore, Pakistan, using the WHO AWaRe 2021 classification. We collected prescription data from the ENT outpatient department of Shalamar Hospital from October to December 2021. We compared the quantitative analysis of antibiotics with the WHO AWaRe classification. We analysed the data using SPSS version 26 and discussed the results with the ENT Department for possible improvements. Some 862 (12.1%) of the total 7126 entries were assessed. Others were excluded because they had some missing data or had no antibiotic prescription. Of all the antibiotics prescribed, around 54.9% belonged to the access category. The WHO 13th General Programme of Work 2019-2023 recommends a country-level target of at least 60% of the total antibiotic consumption in the access group antibiotics. The outpatient department of the ENT did not prescribe any reserve or not recommended antibiotics. The use of watch antibiotics was higher than recommended by the WHO AWaRe classification. More efforts should be made to increase prescriptions from the AWaRe access group to achieve the 60% minimum target recommended by WHO for the country.

Ear, nose and throat disorders found in diabetic patients

Background: Diabetes, a non-communicable metabolic disease in perfect growth in the world, poses a problem of neurovascular dysfunction in the inner ear and the secondary immunodeficiency it causes gives a particular character to the clinical course of certain diseases of the ear, nose and throat (ENT) organs. Objective were to find out the prevalence of otorhinolaryngological disorders in patients with diabetes mellitus who presented themselves to the endocrinology and ENT departments of the Mali hospital, the diabetes center and the district hospital IV Bamako (Mali). Methods: The patients of the various departments concerned in our study, all benefited from screening consultations, we collected the data: socio-demographic, clinical and paraclinical, the management of the ENT disease and the ongoing treatment of diabetes. Results: ENT pathologies represented 2.08% of consultations of diabetic patients with a female predominance. The 46-55 age group represented 39.53%. Diabetes was type 2 in 91% of cases and fasting hyperglycemia was found in 65.12% of patients. Auditory neuropathy, influenzae rhinitis, otitis media were the common ENT diseases found in type 2 diabetics and in patients with a blood glucose greater than 1.80 gm/l. Conclusions: Diabetes, a non-communicable metabolic disease in perfect growth in the world, causes a problem of neurovascular dysfunction in the inner ear and the secondary immunodeficiency it causes gives a particular character to the clinical course of certain disorders of the ENT organs. Auditory neuropathy, influenzae rhinitis, otitis media were the common ENT diseases found in type 2 diabetics.

Drug Utilization Pattern and Adverse Drug Reaction Monitoring of Antibiotics use in Ear, Nose and Throat Infection at Tertiary Care Hospital, Lucknow, India

Objective: To investigate the ENT department's (OPD, IPD) antibiotic prescribing practices at a tertiary care hospital in Lucknow, India. Material and Methods: A prospective, cross-sectional, non-experimental (observational) study was performed in (OPD, IPD) department of Ear, Nose and Throat (ENT) over a period of 6 months. Result: In this study, 100 ENT patients (51 male, 49 female) were selected based on inclusion and exclusion criteria. Ear infections were the most common reason for visits (86 patients), followed by nose (7 patients) and throat infections (5 patients). The most commonly prescribed antibiotics were β-lactam antibiotics, with penicillin's (amoxicillin with clavulanic acid) and cephalosporin's (cefixime) being the most commonly used. Combination therapy was used in 100 patients, with an average of 1.9 antibiotics per patient per course. A total of 40 antibiotics were prescribed, with oral being the most common route of administration. Only one adverse drug reaction was reported, with a suspected link to cefixime causing an increase in rashes in one patient. The study population had comorbid conditions of anxiety, epilepsy, and anaemia. Conclusions: To conclude, our study in the university teaching hospital (IIMSR) highlighted lesser utilization of antibiotics in ENT infections, as some of the ENT infections are not due to bacteria. The majority of ENT patients admitted to the hospital appear to have bacterial infections, and most of them reacted favourably to antibiotic treatment. Majority of the patients used the regimen in accordance with the current guidelines.

Drug Utilization Pattern and Adverse Drug Reaction Monitoring of Antibiotics use in Ear, Nose and Throat Infection at Tertiary Care Hospital, Lucknow, India

Objective: To investigate the ENT department's (OPD, IPD) antibiotic prescribing practices at a tertiary care hospital in Lucknow, India. Material and Methods: A prospective, cross-sectional, non-experimental (observational) study was performed in (OPD, IPD) department of Ear, Nose and Throat (ENT) over a period of 6 months. Result: In this study, 100 ENT patients (51 male, 49 female) were selected based on inclusion and exclusion criteria. Ear infections were the most common reason for visits (86 patients), followed by nose (7 patients) and throat infections (5 patients). The most commonly prescribed antibiotics were β-lactam antibiotics, with penicillin's (amoxicillin with clavulanic acid) and cephalosporin's (cefixime) being the most commonly used. Combination therapy was used in 100 patients, with an average of 1.9 antibiotics per patient per course. A total of 40 antibiotics were prescribed, with oral being the most common route of administration. Only one adverse drug reaction was reported, with a suspected link to cefixime causing an increase in rashes in one patient. The study population had comorbid conditions of anxiety, epilepsy, and anaemia. Conclusions: To conclude, our study in the university teaching hospital (IIMSR) highlighted lesser utilization of antibiotics in ENT infections, as some of the ENT infections are not due to bacteria. The majority of ENT patients admitted to the hospital appear to have bacterial infections, and most of them reacted favourably to antibiotic treatment. Majority of the patients used the regimen in accordance with the current guidelines.

Drug Utilization Pattern and Adverse Drug Reaction Monitoring of Antibiotics use in Ear, Nose and Throat Infection at Tertiary Care Hospital, Lucknow, India

Objective: To investigate the ENT department's (OPD, IPD) antibiotic prescribing practices at a tertiary care hospital in Lucknow, India. Material and Methods: A prospective, cross-sectional, non-experimental (observational) study was performed in (OPD, IPD) department of Ear, Nose and Throat (ENT) over a period of 6 months. Result: In this study, 100 ENT patients (51 male, 49 female) were selected based on inclusion and exclusion criteria. Ear infections were the most common reason for visits (86 patients), followed by nose (7 patients) and throat infections (5 patients). The most commonly prescribed antibiotics were β-lactam antibiotics, with penicillin's (amoxicillin with clavulanic acid) and cephalosporin's (cefixime) being the most commonly used. Combination therapy was used in 100 patients, with an average of 1.9 antibiotics per patient per course. A total of 40 antibiotics were prescribed, with oral being the most common route of administration. Only one adverse drug reaction was reported, with a suspected link to cefixime causing an increase in rashes in one patient. The study population had comorbid conditions of anxiety, epilepsy, and anaemia. Conclusions: To conclude, our study in the university teaching hospital (IIMSR) highlighted lesser utilization of antibiotics in ENT infections, as some of the ENT infections are not due to bacteria. The majority of ENT patients admitted to the hospital appear to have bacterial infections, and most of them reacted favourably to antibiotic treatment. Majority of the patients used the regimen in accordance with the current guidelines.

ENT On-call Equipment Bag: Updated for COVID-19.

Otorhinolaryngology, or Ear Nose and throat (ENT), is a specialty requiring specific equipment for the management and treatment of patients. While most hospitals provide a 24/7 ENT procedure room, there is also a need for a mobile equipment bag with objects and instruments not readily available outside of the ENT department. We look to introduce a novel ENT equipment bag and checklist which has been updated to include a list of required equipment in the setting of the current COVID-19 pandemic. For the ENT equipment bag we use a high visibility multi-compartment bag. In addition to this, the bag contains four folders, labelled “Ear”, “Nose”, “Throat” and “Drugs”. The necessary ENT equipment is divided and included within these folders. The bag also contains a copy of the “ENT bag checklist”. This is a list, designed by the Whipps Cross ENT team, which specifies the required ENT equipment, including PPE in light of the current COVID-19 pandemic. The bag is stocked once a week using this list. Using this new system we developed a portable, practical and easy to use ENT on call equipment bag that included all of the relevant PPE to manage COVID-19 patients. We also implemented a new method of bag stocking to ensure that the bag is adequately stocked. In conclusion, we present a COVID-19 updated ENT bag and checklist. We hope this will help act as a reference for other ENT teams to compare and implement during the current COVID-19 pandemic.

Rationalising requests for preoperative sleep studies and postoperative HDU beds: a quality improvement project in paediatric ENT patients undergoing elective surgery

BackgroundSleep disordered breathing represents a spectrum of upper airway obstruction including snoring, increased respiratory effort and obstructive sleep apnoea. An increasing demand for paediatric preoperative sleep studies and postoperative high...

1539 Flexible Nasoendoscopy – Is It Clean? Can You Prove It?

Abstract Aim Flexible Nasoendoscope (FNE) is an essential device routinely used to assess patients who present acutely to the Ear, Nose and Throat (ENT) department with signs and symptoms of ENT pathologies that may compromise the patient’s airway. It is imperative the scope is decontaminated before and after each use. The “Tristel Trio Wipe” decontamination methodology is employed by most ENT departments in UK and the process utilises an audit logbook to correctly document the sterilisation process as well as allowing accurate patient traceability. The audit aim was to conduct a review of documentation of patient traceability and FNE sterilisation after each use on ENT patients in the acute setting. Method Retrospective audit over one-month periods 11/10/2019 –10/11/2019 (Audit 1) and 26/12/2019 – 21/01/2020 (audit 2). Tristel audit logbook and electronic patient note on PPM+ were used for data collection. Data was analysed using Microsoft excel. Results 100% of FNE decontaminations used correct Tristel Trio Wipes. However, audit one demonstrated 54.5% compliance with correct documentation of FNE sterilisation process and 0% had recorded all traceability information. Following intervention of easier identification of FNE scopes and their storage; as well teaching ENT Senior House Officers and registrar about the correct documentation of decontamination process, compliance improved to 81%, while traceability increased to 39% during the re-audit. Conclusions As a department, we have significantly improved our compliance with both correct documentation of FNE sterilisation and patient traceability information following the intervention above. A further 3rd audit cycle is planned.

Comparison of Endoscopic Sinus Surgery and Continued Medical Treatment Therapy for Refractory Chronic Rhinosinusitis

Aim: To compare endoscopic sinus surgery and continued medical treatment in refractory refractory chronic rhinosinusitis (CRS) patients regarding diseases specific quality of life measurement Study design: RCT (Randomized controlled trial) Place and duration of study: Study was conducted at ENT (Ear, nose and throat) department, Railway Hospital Rawalpindi. Study duration was one year (January 2018-Deecember 2018) Methods: A sample size of 22 patients was calculated using WHO calculator. Non probability consecutive sampling was used. A prior ethical approval and consent form was taken. Patients were randomly divided into two groups; Group A was given medical therapy while Group B comprised contain patients in whom medical therapy failed and had undergone endoscopic sinus surgery. Patients were followed for disease specific quality of life scores. Data was analyzed using SPSS version22. Chi-square and t test was applied. P value ≤ 0.05 was considered significant. Results: Total of 22 refractory CRS patients were included in study. There were 10(45.5%) males and 12(54.5%) females. Mean age of refractory CRS patients was 33.4 years±6.2SD. Group A (continued medical therapy) N=11, had significantly high SNOTT -22 scores 60.6±7.1SD as compared to endoscopic sinus surgery 21±3.9SD (p=0.000). Group B (endoscopic sinus surgery) had significantly low endoscopic scores 2.7±0.3SD as compared to group A (continued medical therapy) 7.14±0.53SD (p=0.000). Endoscopic sinus surgery group showed significant reduction in work days lost 17.4±4.9SD as compared to continued medical therapy (Group A) 30.1±2.5SD (p=0.000). Conclusion: Endoscopic sinus surgery is an effective treatment option as compared to continued medical therapy with improved quality of life in refractory CRS patients (with reduced baseline disease specific quality of life). Keywords: Refractory chronic rhinosinusitis, endoscopic sinus surgery, quality of life

An Overview of Emergencies in Otorhinolaryngology at a Tertiary Care Centre, Telangana.

Otorhinolaryngology emergencies are a common complaint in the emergency department. These emergencies can occur in all the age groups and can present as a result of infection, trauma, foreign bodies, etc. The most common Ear, Nose and Throat (ENT) emergencies are epistaxis, foreign bodies in ear, nose and throat, stridor, trauma, facial bone fractures etc. Prompt assessment and immediate intervention can save lives and reduce the suffering arising out of these emergencies.The present study focusses on determining the magnitude and pattern, demographic characteristics and outcome of patients with ENT emergencies. A cross sectional study was carried out in the casualty and ENT department of Gandhi Hospital, which is a tertiary care center in Secunderabad, Telangana. The data was collected from June 2014 to May 2018. 2901 patients reported to casualty with ENT emergencies. Around 46.12% of emergencies were of Ear, 34.33% were related to nose and 19.54% were related to throat, neck and others. The most common ENT emergency among pediatric age group was foreign body in ear, nose, throat and aero digestive tract, while the most common ENT emergency in geriatric age group was Stridor. ENT emergencies are increasing in incidence due to increasing burden of road traffic accidents and early detection and institution of appropriate and adequate treatment may be important in preventing the progression of disease and minimizing complications.

Extended scope of practice audiology in the ENT outpatient clinic – a pilot study

Objective To investigate the feasibility of using an extended scope (ES) audiology service to provide care to non-urgent adult patients waiting for an Ear Nose and Throat (ENT) appointment. Design Based on suitability criteria developed by the Audiology and ENT departments, an internal review of the ENT wait list identified patients who would be suitable for an ES audiology clinic. Study sample 220 non-urgent patients on the ENT wait list with hearing loss and/or tinnitus. Results A total of 220 patients were transferred from the ENT wait list to the ES audiology clinic: 200 (90.9%) were seen by the ES Audiologist and 20 (9.1%) patients self-discharged or did not attend the appointment. Out of the 200 patients seen, 175 (87.5%) were assessed, managed and discharged without the need for input from an Otologist. The remaining 25 (12.5%) patients needed an Otologist’s input. Conclusion This study has demonstrated the feasibility of an ES audiology clinic in a tertiary teaching hospital. Of those seen by ES audiologist, 87.5% were discharged from the ENT wait list without medical intervention. This model may represent an effective alternative pathway for lengthy outpatient waiting list management whilst providing patients with timely access to care.

The first experiences of implementation of the Swedish tonsil register in Denmark

Background: Tonsil surgery is a daily procedure at Ear, Nose and Throat (ENT) departments as well as ENT practices. Despite national tonsil guidelines in Denmark, no national survey has been introduced.Objectives: To display the process of implementing a Danish version of the Swedish tonsil register including a presentation and validation of the first year’s results.Methods: The Swedish tonsil register was translated into Danish. Minor modifications were executed and the register was implemented at the ENT department, Region Hospital West Jutland, Denmark. All patients undergoing surgery due to benign tonsil and/or adenoid diseases were eligible. Written informed consent was obtained. Indication for surgery, comorbidity, surgical and haemostasis techniques, and complications were registered by the surgeon.Results: Several obstacles were encountered due to legal procedures, daily work, IT organisation, and discontinuous information. 58% of eligible patients were registered. The incidence of post-tonsillectomy haemorrhage requiring secondary surgery was 6.4%. The potential underlying risk factors were easily retrieved from the register.Conclusions and significance: The Danish version of the national Swedish tonsil database is a useful, easily accessible, and informative tool for monitoring and validation of tonsil/adenoid surgery. We recommend a nationwide register with a central steering committee.

MASTOIDECTOMY IN NONCHOLESTEATOMATOUS CHRONIC SUPPTATIVE OTITIS MEDIA

Clinical outcome comparisons across diverse medical procedures are challenging and require considering several variables,including patient characteristics, research design, methodology, and accessible data. In your situation, you’re interested incontrasting the clinical outcomes of patients who had percutaneous transluminal angioplasty (POBA) and percutaneouscoronary intervention (PCI) with stent insertion and had substantial thrombosis burdens. Here are the main pointsof comparison broken down:Objective: to evaluate the effectiveness of the graft after mastoidectomy in non-cholesteatomatous chronic supportiveotitis media and the functional hearing result.Material And Methods: The research was conducted at the ENT (Ear, Nose, and Throat) department of theMardan Medical Complex Teaching Hospital. Study Duration: The study was conducted between June [2015] andJune [2016]. Follow-Up Period: A [24-month] (2-year) follow-up was established as the standard duration to monitorpatient outcomes after the surgery Patient Characteristics: Patient Age: The age range of the patients included in thestudy was between [20] and [50] years. Mean Age: The patients’ average (mean) age was [26.2] years. Gender Distribution Out of the total patients [25] patients (41.66%) were female [35] patients (58%) were male Ear Condition atSurgery Leaking Ears: [15] patients (25%) had ears that were leaking Dry Ears: [45] patients (75%) had dry ears.Results: Graft failure rates in the first and second groups were [30%] and [15%]. At the most recent follow-up,there was a statistically significant difference in the success rates of groups 1 and 2, where four perforations eitherhealed independently or were treated locally.Conclusion: According to this study, mastoidectomy increases the likelihood that the transplant will be effective andthe patient will have functional hearing. However, it also requires more work and comes with risks.Keywords: (Non-cholesteatomatous chronic supportive otitis media), (two tympanoplasties without mastoidectomy),(two mastoidectomies, may signify air-bone gap)

Cost and Value of Routine Histopathologic Analysis after Adenoidectomy and Tonsillectomy.

Introduction Tonsillectomy and adenoidectomy are common procedures. Most surgeries in children and young adults are recommended due to recurring infections or obstructive constraints. However, occult malignant findings are reported in the literature. The clinical guidelines still refrain from recommending routine histopathologic analyses when discussing these procedures. Objective The present study aims to define the value of a routine histopathologic analysis after tonsillectomy, adenoidectomy and tonsillotomy. Methods We conducted a prospective survey including all German ear, nose and throat (ENT) departments, asking physicians about their current clinical practice and opinion. Furthermore, we reviewed all patients attending our department for tonsillectomy/adenoidectomy/tonsillotomy or a combination of these procedures between 2011 and 2016. In addition to this, a cost analysis was conducted to assess the financial burden of a routine histopathologic analysis. Results Most German ENT departments perform a routine histopathologic analysis after tonsillectomy/adenoidectomy/tonsillotomy. Despite this, only a minority deemed this approach necessary. Our retrospective review of the histopathologic analysis after tonsillectomy/adenoidectomy/tonsillotomy in our department rendered a cohort size of 2,157 patients. Within this group, there were no occult malignant findings. We found a yearly burden of 2,509,401€ for routine histopathologic analyses in patients under the age of 15 years in Germany in 2016. Conclusion We found a divergence between the physicians opinions and their current clinical practice concerning the question of whether to conduct routine histopathologic analyses. Even though there was no occult malignant finding in our cohort, unsuspected malignant findings are reported in the literature. Therefore, we call for a discussion on clinical practice guidelines.

Prevalence of ear, nose and throat disorders in children at government district hospital Vizianagaram

<p class="abstract"><strong>Background:</strong> Ear, nose and throat (ENT) problems are very common among the children, there is a lack of data on paediatric otorhinolaryngology from various Indian populations. This study was conducted to determine the hospital based prevalence of ENT disorders in paediatric population.</p><p class="abstract"><strong>Methods:</strong> A record based, retrospective study conducted at government district Hospital, Vizianagaram, Andhra Pradesh, India. 1818 children between the ages of 0-15, attending the ENT department in our hospital were included in the study. General demographic details taken, and examination for common ENT complaints and disorders was taken for all patients. Otoscopy for ear examination for ear perforation and ear discharges. Anterior rhinoscopy for nasal discharge and airway obstruction. Throat examination was performed for any sign of tonsillitis or pharyngitis and adenoids. </p><p class="abstract"><strong>Results:</strong> ENT diseases in our study population were found to be more common among male children (57.97%). Majority of the paediatric patients belonged to age group 5-14 years (65.7%), were from lower socioeconomic status (57.53%), living in nuclear family (62.81%) and had illiterate mothers (68.5%). Diseases of ear system (44%) were the most common group of ENT problems among the paediatric population, followed by nasal (30.9%) and throat (25.1%) disorders. The most common ENT disorders were otitis media (22.1%), tonsillitis (11.66%).</p><p class="abstract"><strong>Conclusions:</strong> Our study provides basic information of the prevalent disorders in ENT in our area suggests that otitis media, tonsillitis and rhinitis are the most common otorhinolaryngological problems in paediatric population visiting the ENT Department of this hospital and contribute significantly to paediatric morbidity.</p>

Perioperative Management in Patients With Cleft Lip and Palate.

In cleft care, perioperative treatment strategies like ear nose and throat (ENT) diagnostics as well as postoperative antibiotics, feeding, and duration of inpatient stay are nonstandardized procedures varying between different centers. Likewise, intraoperative choice of suture materials and time of suture removal are performed inconsistently. Therefore, we wanted to collect information on protocols focusing on these topics to summarize and subsume currently approved treatment strategies of centers around the world. We ask members of international cleft centers for their respective treatment strategies and performed descriptive statistics.Absorbable suture material is used for reconstruction of the outer lip skin in 20 of 70 centers. Removal of skin sutures is conducted after 7.0 ± 1.5 days. Suturing of the orbicularis oris muscle, the enoral and nasal mucosa, as well as the palatal musculature is predominantly performed with absorbable suture materials. Intraoperative antibiotic prophylaxis is applied in 82.9% of the participating centers. In contrast, 31.9% of the departments do not apply any antibiotic postoperatively. Postoperative feeding is performed in 27 centers via a nasogastric tube for 4.6 ± 2.3 days on average. Mean length of postoperative inpatient stay is 4.1 ± 2.6 days in children after cleft lip surgery and 4.5 ± 2.7 days after cleft palate surgery. ENT consultation before surgery is routinely conducted in 52.8% of the centers and 82.9% of ENT colleagues investigate middle ear pathologies in the same operation in which cleft repair is performed.Closure of the lip skin is predominantly performed with nonabsorbable suture material followed by a suture removal after 1 week. Intraoperative antibiotic prophylaxis as well as inpatient hospital stay of 4 to 5 days in combination with oral feeding and a preoperative consultation and intraoperative cooperation with the ENT department seems to be well-proven concepts in cleft lip palate patient care. However, this analysis illustrated the variations and differing approaches in perioperative care emphasizing the need to verify perioperative management concepts in cleft surgery-preferably in the context of multicenter studies.

Uncontrolled systemic hypertension and haemolacria.

Haemolacria is a condition caused by a group of disorders resulting in production of tears that are partly composed of blood. It can be unilateral or bilateral. The etiology includes ocular, systemic, psychological, pharmacological, and idiopathic.[123] We present an unusual case scenario of unilateral hemolacria in a 62-year-old previously fit and well gentleman who presented to ER (emergency consultation room) with sudden onset epistaxis from the right nostril. Immediate evaluation included local examination by an ENT (Ear Nose and Throat department) colleague and systemic evaluation by the physician. The Physician diagnosed severe hypertension (BP recorded was 190/110 mm hg) and antihypertensive therapy was initiated. The source of the nasal bleed was identified as the Little's area (Kiesselbach's plexus). An attempt to cauterize the bleed under local anesthesia was made by the ENT colleague, following which anterior nasal packing was done. Within a few minutes of packing the nose, patient started shedding blood mixed tears from the right eye (Haemolacria) [Fig. 1]. The BP continued to stay high at 160/100 mm of Hg. Following this the antihypertensive measures were intensified resulting in complete resolution of the symptoms within the next 6 hours.Figure 1: Shows blood mixed tears coming out of right eye of the patient. It shows right haemolacria and the free end/thread of the anterior nasal pack in the right nostrilPreliminary ophthalmic evaluation revealed no local ocular causes of haemolacria, no previous trauma or lacrimal surgeries. We suspect retrograde blood flow through the Nasolacrimal duct to the conjunctival cul de sac following mechanical attempts at stopping the epistaxis, which alone was apparently ineffective as the underlying primary pathology was uncontrolled systemic hypertension. The authors also suspect a possible congenital absence of the valve of Hasner[4] or iatrogenic damage to the valve of Hasner at the inferior meatus at the time of primary mechanical attempts at haemostasis[5] that resulted in the above presentation. The patient was lost to further follow up thus preventing a further lacrimal outflow reassessment and a formal nasal endoscopic re-assessment. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Acknowledgement Dr. Sujay Siddharthan, TMS Eye hospital.