Aim: To determine the improvement of hearing after grommet insertion in patients with secretory otitis media. Study Design:A Quasi-Experimental study. Place and Duration: ENT, Head & Neck Surgery department of Lady Reading Hospital MTI, Peshawar and Azra Nahid Medical College, Lahore for duration of two years from February 2019 to February 2021. Methods: The study was performed on 48 ears with secretory otitis media. Before the operation,evaluation of both ears along with tympanmontometry and Pure Tone Audiometry were performed. Documentation ofhearing loss was done pre-operatively. During the operation accomplished under GA, a grommetwas placed in the anterior inferior quadrant of the tympanic membrane. After the surgery, PTA was repeated in the postoperative period before the patient was discharged from the hospital. Results:Our study included 28 patients with secretory otitis media and a total of 48 ears. Of the ears, 27 (56.25%) were male and 21 (43.75%) were female. Both ears were affected in 21 patients. Two patients had unilateral ear involvement. The right ear was affected in 26 cases (51.1%) and the left ear in 22 cases (48.9%). 7-55 years was the age range of the patients and 14.10 ± 9.11 years was the mean age. The degree of preoperative hearing loss was mild (20-40 dB) in 5 (10.41%) ears, moderate (40-60 dB) in 37 (77.1%) ears and severe (60-80 dB) in 6 (12.5%) ears. The degree of postoperative hearing loss was mild (20-40 dB) in 36 ears (75%), moderate (40-60 dB) in 11 ears (22.9%) and severe (60-80 dB) in one ear (2.1%). Hearing improvement was not seen in 8 (16.6%) ears, an improvement of 5-10 dB in 34 (70.8%) ears, and an improvement of 10-20 dB in 6 (12.5%) ears. There was a statistically significant difference between preoperative and postoperative hearing loss in the ears, the hearing loss was significantly less after grommet insertion; p = 0.017. Conclusion:The insertion of Grommet provides a significant improvement in hearing in patients with secretory otitis media. Keywords:Pure tone audiometry, Tympanometry, Middle ear, Secretory otitis Media and Grommets.

Background: Nasal obstruction is a common presenting problem which can lead to symptoms like sleep disturbances, mouth breathing, oral cavity dryness. Hypertrophied inferior turbinate is a common cause of nasal obstruction. Microdebrider assisted turbinoplasty and submucosal diathermy are widely used methods for patients who fail to respond to medical therapy to relieve obstruction. The aim of the study was to compare two methods in terms of relief of nasal obstruction, reduction in sneezing and post-operative complications. Material & Methods: This randomized clinical trial was conducted at ENT Department, Benazir Bhutto Hospital Rawalpindi, Pakistan for one year from 01-03-2018 to 28-02-2019. One hundred and twenty patients were randomized to into either MAT and SMD groups each with 60 patients. Nasal obstruction symptom evaluation score system (NOSE) was used to access relieve from obstruction and sneezing. SPSS 22, online chai square and fisher exact test calculators were used to analyze the data. Results: Two groups were comparable for age and gender. After 3 months of treatment, all patients in MAT group and 51 patients in SMD group were completely relieved from obstruction. At two weeks follow up 37(61.57%) patients in MAT group had grade 0 obstruction compared with 14 (23.33%) in SMD group and this difference was significant (p value .000). at one month follow up 55 (91.67%) patients in MAT while 46 (76.67%) had completely relieved obstruction and this difference was significant ( p value .024). Not all patients showed reduction in sneezing in both groups. 37 patients in MAT and 25 patients in SMD group had completely relieved from sneezing at third month follow up with MAT group showing significantly more patients with sneezing reduced at one month follow up. Crust formation was most seen complication in both groups, more with SMD group at two weeks follow up which responded to treatment alkaline nasal douches and crust removal.   Conclusion: MAT gives better in terms of nasal obstruction relieved, reduction in sneezing and less complications than SMD  procedure. KEYWORDS: Microdebrider; Diathermy; Turbinates; Nasal obstruction

Objectives: To study treatment outcome of positional vertigo in adult patients of 15-40 years of age. Place and duration of study: This study was conducted at ENT department of Chaudhary Muhammad Akram Teaching & Research Hospital, Lahore and Kuwait Teaching Hospital, Peshawar from June 2019 to June 2020. Material and Methods: 50 patients with diagnosis of benign positional vertigo were included in the study. Patients were treated and their outcomes were analyzed. Results: 50 patients of age between 15-40 years were included in the study. The analysis of treatment outcome showed that 35 patients (70%) showed maximum improvement in vertigo with medical treatment, 10 patients (20%) showed improvement in their symptoms with positional exercises and 5 patients (10%) showed improvement by combined treatment. Conclusion: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder and presents as brief, episodic, positional provoked vertigo. The diagnosis can be made through clinical history along with diagnostic maneuvers and it can have a considerable impact on the quality of life. The medical treatment with vestibular dilators and vestibular suppressant is best option, with particle repositioning maneuver (Epley maneuver) for resistant and recurrent patients. Key words: Vestibular exercises, Dizziness, Positional vertigo, Dis equilibrium

Objective: To understand the frequency, causes, and treatment of post-tracheostomy hemorrhage. Study Design: A prospective study of tracheostomy cases. Place and duration: ENT, Head & Neck Surgery department of Lady Reading Hospital MTI, Peshawar and Azra Nahid Medical College, Lahore for duration of one year from July 2019 to June 2020. Methodology: All hospitalized patients who underwent tracheostomy and had bleeding during this period were included. The parameters specified were demographics, time since surgery, degree of bleeding, causes of bleeding, and treatment. A total of 208 patients who have done with tracheostomy were selected. Results: Tracheostomy was performed in a total of 208 patients, 142 men and 66 women. Their ages ranged from 20 to 70 years old. 22 patients (10.6%) had postoperative bleeding, most of them have oozingfrom or around the stoma, but 5 patients were taken to the operating room for hemostasis. Three of them had Tracheo- innominate artery fistula and two died before undergoing surgery. One of the three trachea-innominatefistulae were successfully treated by a cardiac surgeon. The remaining cases required diathermy, transfixing thyroid isthmus or vein descent or relegation of veins. Conclusions: Hemorrhage after tracheostomy is not uncommon in intensive practice, bleeding occurred in 10.5% of our cases. Hemorrhage occurs because of inadequate hemostasis, aspiration trauma, infection, coagulopathy and granulation. Rarely, there may be massive and life-threatening bleeding from tracheo-innominate fistula that requires aggressive and urgent exploration. In such a situation, an experienced cardiac surgeon and anesthesiologist is very important and can lead to a better result. Key words: Tracheostomy, post-tracheostomy hemorrhage, Tracheo-innominate artery fistula (TIF)

Aim: The main objective of this study was to determine the effect of bilateral nasal packing on systemic blood pressure in patients treated with septoplasty surgical procedure. Study Design: Retrospective study. Place and Duration: This study was conducted at the department of ENT/ Head & Neck Surgery, Lady Reading Hospital MTI, Peshawar and Chaudhary Muhammad Akram Teaching and Research Hospital, Lahore for duration of one year from October 2020 to September 2021. Methods: One hundred and two men and women who had undergone nasal septoplasty following a clinical assessment were included in this research. From 18 to 48 years of age, the patients comprised this group. Detailed information about each patient, such as age, gender, and place of residence, was gathered after informed consent was obtained from each patient. Group C had no nasal packing placed, whereas typical anterior nasal packing was used in Group D. Both groups were evenly split. A 24-hour ambulatory monitoring of blood pressure was performed on all patients before to and during septoplasty. SPSS 23.0 was used to do statistical analysis on all of the data. Results: 60 (58.8%) of the 102 patients were male, and 42 (41.2%) of the patients were female. A total of 41 (40.2 percent) patients were under the age of 30, 35 (34.3 percent) were between the ages of 31 and 40, and 26 (25.5 percent) were above the age of 40. Rural residents comprised 52% of the patients. Study participants in Group D were found to have higher mean blood pressure (p-Value 0.05) following septoplasty therapy than those in Group C (P-Value >0.05). Group D patients had bleeding, vestibulitis, and septal perforations as a result of their nasal packing procedure. Conclusion: It is determined that bilateral nasal packing was associated with an elevation in either systolic or diastolic blood pressure in individuals who had septoplasty treatment. Patient who did not get nasal packing showed no statistically significant change from the rest of the group. Keywords: Septoplasty, Bilateral Nasal Packing, Systemic blood pressure