Combined Approach for Excision of Advanced Angiofibroma : A Study of 12 Cases

To determine effectiveness of combined skull base approach for excision of advanced angiofibroma.Materials and Methods: This study was conducted at the Department of Ear, Nose, Throat, Head and Neck Surgery and Neurosurgery, Post Graduate Medical Institute Lady Reading Hospital Peshawar. This was retrospective observational study. The duration of the study was 5 years from Jan., 2003 to Dec., 2008. This study included 12 cases with advanced (stage IIIA and IVB) of Nasopharyngeal angiofibroma. These cases were assessed in terms of detailed history, through examination and radiological investigations to stage according to the Fisch classification. The tumour was completely excised by combined approach of a team of Neurosurgeons and ENT surgeons. No recurrence found in 30 months post-op observation.Results: This study included 12 cases. All were male. Age of the patients was in range of 14 to 19 years with mean of 16.5 years. They belonged to lower and middle class of society. They presented with history of unilateral nasal obstruction (100%) while MRI where needed. The disease was involving nose, nasopharynx, sinuses and had Extracranial and intracranial extension. Nine cases (75%) were in stage IIIB and 3 cases (25%) in stage IVA according Fisch classification. The procedure time was average 7.5 hours and average 700 ml blood was transfused. Platal fistula formed in one case (8.3%) and no recurrence found on 18 months follow up.Conclusion: The cooperation of neurosurgeons and otorhinolaryngological doctors provides a good way to minimize invasiveness in skull base surgery. Sufficient preoperative preparation, well equipped theatre and surgical expertise are necessary for complete resection of benign tumor like angiofibroma

Attico-Antral vs. Tubo-Tympanic Chronic Suppurative Otitis Media

Background: To compare clinicopathological characteristics of attico-antral and tubotympanic types of chronic suppurative otitis media .Methods: In this comparative study 80 patients suffering from otitis media were enrolled. They were divided into group I, with attico-antral disease (perforation in pars flaccid of ear drum) and group II with tubo-tympanic disease (perforation in pars densa of ear drum). Otoscopy and pure tone audiometries were performed in all cases. Examination under microscope were performed, where indicated. Chi square test was applied taking P value of < 0.05 as significant.Results: Majority (72.5%) were male, with male: female ratio of 2.6:1. Age ranged from 7-35 years, with mean age of 19.47 + 4.38 years. Most of the patients presented in second decade of life. The commonest clinical feature observed in this study was discharging ear in 37 patients (46.25%) and in 25 patients (31.25%) in group I and II respectively which is statistically significant (p=0.021). Mild hearing loss was 28.75% and 21.25% in group I and II respectively which was significantly greater in group I (p=0.004)Conclusion: There was no significant difference between these two diseases regarding age, gender and socioeconomic status. Clinical features and impaired hearing are significantly common in attico-antral disease as compared to tubotympanic disease