Objective: To assess the hearing loss among the subjects using excessive mobile phone. Methodology: 50 subjects were entered for this study with age ranging from 20 to 40 years using mobile phone for more than 5 years. 25 subjects who used mobile phone for less than (<) 60 min /day formed one group, while 25 subjects who used cell phone for more than (>) 60 min /day formed the second group. The hearing levels of all the subjects were tested using Pure Tone Audiometry (PTA). Duration of mobile phone usage was assessed by questionnaires. Results: There was a significant increase (p-value .00006) in the hearing thresholds at all frequencies in air conduction and bone conduction in right ear in test group compared with the control group. Similar result was found in the left ear except for bone conduction at frequency 4 and 6 (kilo hertz) kHz. Excessive use of mobile phone caused Sensory neural hearing loss and the prevalence was 84% in group who used mobile phone for > 60 min / day and 20% in group who used for < 60 min / day. Conclusion: Excessive use of mobile phone may cause increase in pure tone threshold associated with the duration of usage. The use for more than 5 years with more than 60 minutes daily can produce harmful effects on human hearing.

Background: Ludwig’s angina is a rapidly expanding cellulitis involving the floor of mouth and sub mandibular space predominantly due to dental / periodontal infections. Aim: To determine the management outcomes in the patients of Ludwig’s Angina. Place and duration of study: Department of Otorhinolaryngology Bahawal Victoria Hospital Bahawalpur. Duration was two years from August 2018 to July 2020. Study design: Hospital based cross sectional descriptive type of study Methodology: Patients of any age and gender who were clinically diagnosed as Ludwig angina and required hospitalization during the study duration were included in the study. Data regarding age, gender underlying cause, mode of presentation, treatment and complications were collected and analyzed. Patients with mild infection who did not require hospital admission were excluded from the study. Results: Out of total 32 cases, 20(62.5%) were males and 12(37.5%) were females. Age range was 10 to 70 years. In 28 (87.5%) cases, the cause was dental infection. All patients presented with pain and swelling of sub mandibular region. Four (12.5%) patients were improved with conservative treatment while 28(87.5%) underwent incision and drainage. Two (6.25%) patients needed tracheostomy. One (3.1%) patient developed complication (mediastinitis) and could not revive. Conclusion: Ludwig's angina is a disease of any age and gender commonly seen among the patients of preexisting dental infection. It can be life threatening if presented late with complication. Early diagnosis and aggressive treatment decrease morbidity and mortality. Key words: Angina, Ludwing, Cellulitis, Submandibular region.

Objective: To assess the indications of tracheostomy among patients requiring prolonged mechanical ventilation and to observe the relationship of the timings and outcome of tracheostomy with age and gender. Study Design and Setting: It was a descriptive study conducted at intensive care unit (ICU) of Department of Otorhinolaryngology at Bahawal Victoria Hospital from January 2017 to December 2018. Methodology: Secondary data was collected with the help of charts of ICU patients in which elective tracheostomy was done to replace orotracheal intubation for mechanical ventilation. Inclusion and exclusion criteria were designed. Clinical record was reviewed for the assessment of indications of the procedure (medical or surgical) along with age and gender distribution. The timing of tracheostomy in these patients with its outcome in terms of decannulation and weaning were recorded. Proforma was used to enter the findings. Finally results were obtained and assessed on SPSS Version 23. Results: Out of total 551 tracheostomies 42(7.6%) were indicated for the patients of ICU requiring prolonged mechanical ventilation. From the 42 mechanical ventilated patients majority had Guillain-Barre syndrome (GBS) 20(47.6%). Twenty six patients were adults (61.9%) and sixteen were children (38%).Twenty four were male patients (57.1%) and eighteen were females (42.8%). The timing of tracheostomy among majority of the patients (40) was from 7-10 days, with mean of 9th day with good outcome. Only two patients who underwent tracheostomy after two weeks had to face poor outcome (failed decannulation, late weaning) (4.7%). Conclusion: Neuroparalytic lesions were the common indication among the patients requiring prolonged mechanical ventilation with tracheostomy. Tracheostomy if performed earlier in such patients carries good outcome