Objective: To compare efficacy of Peritonsillar Dexamethasone with Peritonsillar Bupivacaine in managing post-tonsillectomy pain in children. Study design: Randomized Controlled Trial Setting & Period: ENT Department Fauji Foundation Hospital (FFH) Rawalpindi from 01-06-2019 to 31-11-2020. Material &Methods: A total of sixty patients of both genders between ages of 5-15 years fulfilling the recognized criteria for tonsillectomy were selected. They were equally divided into two groups; Group A received peritonsillar Bupivacaine while Group B received peritonsillar Dexamethasone. Mean post-tonsillectomy Visual Analogue Score (VAS) at 1st, 2nd and 7th day were recorded in both groups and compared using independent sample ‘t’ test. Results: In group A Mean post-tonsillectomy VAS at 24 hours was 6.73±1.44 SD while in group B it was 5.93±1.26 SD (p-value 0.025). Mean post-tonsillectomy VAS at 48 hours was 5.60±1.25 SD and 4.37±1.03 SD (p-value 0.000) respectively in groups A and B. At 7th post operative day, Mean VAS was noted as 3.27±0.74 SD and 2.30±0.79 SD (p-value 0.000) respectively in group A and B.  Conclusion: Peritonsillar Dexamethasone is more effective than peritonsillar Bupivacaine in controlling post-tonsillectomy pain in children. Statistically significant difference was noted for mean post-tonsillectomy VAS at 1st, 2nd and 7th day. Key Words: Tonsillectomy, visual analogue score, postoperative pain, dexamethasone, bupivacaine.

Isolated sphenoid sinus mucocoeles are rare; whereas, benign lesions usually discovered incidentally. These may present with headache, diplopia, visual loss or ocular motor nerve palsies, due to slow expansion and mass effects. Prompt endoscopic removal is the key to prevent permanent sequelae. We present the case of a 63-year femele, who presented with sudden loss of vision of the left eye, along with periorbital and retrobulbar pain for the last one month. She was found to have "no light perception" vision in the left eye and optic atrophy. Neuroimaging was performed, which revealed a sphenoid sinus mucocoele, impinging on the left optic nerve. Our ENT Department performed endoscopic sinus surgery and removed it, but her vision did not return at 6-month follow-up. Although very rare, sphenoid sinus mucocoeles should be considered in the differential diagnosis of any patient, who presents with sudden visual loss.

Objective: To observe the success rate of Over-underlay technique of myringoplasty in patients with inactive tubo-tympanic type of CSOM. Study Design: Descriptive, Observational study. Setting: ENT Department Fauji Foundation Hospital Rawalpindi. Period: December 2018 to December 2019. Material & Methods: A total of 80 patients with inactive tubo-tympanic type of CSOM, from both genders, within age range of 15-45 years, having pure conductive hearing loss with an Air-Bone gap of not less than 15 dB were selected by convenient sampling technique. Patients having an active ear disease or previous history of ear surgery, an active sinus or URT disease, or any comorbidity were excluded from the study. Complete general and head-neck examination was done after taking history. Patients’ affected ears were examined under surgical microscope to see the drum perforation, condition of middle ear mucosa and the status of the ossicles. Hearing assessment was done by Pure Tone Audiometry through both air and bone conduction. Temporalis fascia graft myringoplasty was done in all these patients by over-underlay technique, and they were discharged on 5th post-operative day, and were followed up in ENT OPD after 3 weeks. Status of graft was seen under surgical microscope after removing the BIPP. After three months the patients were reviewed for graft status and hearing assessment. Successful outcome was taken as those patients in whom graft uptake was successful with complete closure of perforation, and secondly, closure of the Air-Bone gap by at least 10 dB. Data was analyzed by SPSS 19. Results: Mean age of the patients (n = 80) was found to be 30.8 Years. Gender distribution showed 57 (71.25%) Males and 23 (28.75%) Females with a M:F ratio of 2.5:1. Success rate was found significantly better among younger aged males. Graft uptake was successful in 74 (92.5%) of the patients. With respect to closure of A-B gap, post-operative mean difference in Air-Bone gap was found to be 9.6 dB ± 3.9 SD as compared to preoperative mean A-B gap of 28.5 dB ± 4.2 SD, thus a closure of A-B gap by 18.9 dB ± 2.4 SD. Conclusion: Over-underlay technique is found to be a successful technique for myringoplasty in terms of graft uptake and improvement in hearing thresholds in the patients with inactive tubo-tympanic type of CSOM.

Objective: To compare the effectiveness of beclomethasone dipropionate with flunisolide given twice daily in terms of improvement in symptom score after 14 days of treatment in allergic rhinitis patients.Study Design: Quasi-Experimental Study.Place and Duration of Study: The study was carried out at the Department of ENT, PAF Hospital E-9 Islamabad, Pakistan, from January 2021 to July 2021.Materials and Methods: All patients of age 20-60 years of either gender having allergic rhinitis were included in the study. Allergic rhinitis was defined as any patient with a history of running nose with seasonal changes or exposure to allergens diagnosed by a consultant ENT surgeon. Patients with a history of smoking, asthma, having deviated nasal septum and inferior turbinate hypertrophy, patients already treated with Beclomethasone dipropionate or flunisolide, patients having an acute upper respiratory infection, and pregnant females were excluded from the study. A consecutive sampling technique was applied for the selection of participants. Patients were randomly divided into two groups: Group-A was given beclomethasone dipropionate, and Group-B Group-B was given flunisolide. The daily dose during treatment was 0.1 mg of beclomethasone dipropionate (50 ugs per puff) two-time each medicine daily. And dose of flunisolide nasal solution (flunisolide nasal spray 0.025%) flunisolide 50 micrograms in each nostril twice daily were 2 sprays (50 ugs) in each nostril 2 times a day: Treatment was continued for two weeks in each group. The symptoms score was estimated at baseline and after two weeks of intervention. Data were analyzed with the help of SPSS version 20.Results: The mean age of the study participants was 41.17+8.58 years in beclomethasone dipropionate and 41.85+8.52 years in flunisolide. Efficacy of flunisolide was significantly higher in terms of improvement in symptom score after 14 days of treatment in patients of allergic rhinitis compared to beclomethasone dipropionate (85% vs 79.58, p=0.035).Conclusion: Flunisolide inhaler is more effective when compared with beclomethasone dipropionate for treating allergic rhinitis.