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Objective: To review the literature systematically on tonsillectomy by harmonic scalpel with a view of comparing its postoperative hemorrhagic rate with the conventional methods for tonsillectomy. Data Sources: Cochrane Library, Medline, Embase, CINAHL, INAHTA, CRD (Centre for Review and Dissemination, York, UK), and related databases. papers were considered irrespective of language of publication. Review Methods: Inclusion and exclusion criteria were applied independently by two reviewers with a third reviewer available for adjudication. The papers were quality assessed using Chalmers' criteria. Eleven randomized controlled trials (RCT) were included in the final review with 5 RCTs comparing harmonic scalpel tonsillectomy with "cold steel" tonsillectomy and 6 RCTs comparing harmonic scalpel with "hot" tonsillectomy techniques. Results: All studies were underpowered to detect a significant difference in the postoperative hemorrhagic complication between harmonic scalpel and the comparator tonsillectomy techniques. The heterogeneity of studies made quantitative combination of results impossible. Conclusion: The evidence reviewed is of low quality and does not support any significant difference in postoperative hemorrhage rates when harmonic scalpel is compared with other tonsillectomy techniques. As studies have numerous methodological flaws and incorporate biases and confounding factors, these results need to be interpreted with caution. Larger and better-conducted studies would be needed in order to compare the safety of harmonic against conventional tonsillectomy methods. The need for a large sample size might make an RCT impractical; therefore a large, well-controlled cohort study could be more suitable. [ABSTRACT FROM AUTHOR]

Objectives: To compare efficacy of mometasone furoate topical intranasal therapy alone and combination of oral anti-histamine and anti-leukotriene therapy in seasonal allergic rhinitis. Methods: A randomized control trial at Department of Otorhinolaryngology, Head and Neck surgery, Pakistan Institute of Medical Sciences, Islamabad, and Khyber Teaching Hospital, Peshawar-Pakistan, was done in 1 year, from 25th Oct 2016 to 24th Oct 2017. A total of 146 patients were selected and divided into group A & group B (each group have 73 patients). The treatment given was topical Steroid (Mometasone) to Group A and oral antihistamine (loratadine 10mg), antileukotriene (Montelukast 10mg) to Group B. All patients who were included in our study were examined on three consecutive occasions, i.e. at zero presentation day, at 2 weeks and 4 weeks. Patient nasal symptom score was recorded and improvement noticed. Results: All146 patients were selected and were divided into two groups with each group consists of 73 (50%) patients. Male to female ratio was 1:1.8 and mean age was 27.93+7.8. Out of all patients 124 (84.9%) were responders and 22 (15%) were non-responders. 69 (94.5%) patients of group A were responders while 4 (5.5%) were non-responders. On the other hand, in group B, 55 (75.3%) were responders and 18(24.7%) were non-responders Conclusion: Intranasal Mometasone furoate spray as a first line therapy was more effective than combined oral anti-histamines and leukotriene receptor antagonistsin allergic rhinitis. [ABSTRACT FROM AUTHOR]

Objectives: To compare the operative time and postoperative outcomes in thyroid surgeries using ultrasonic cutting with conventional diathermy dissection. Material and Methods: This prospective study was conducted in Abaseen Hospital, Peshawar, Pakistan from April 2018 to December 2018. Ethical approval was taken from the hospital administration. After taking informed consents from the patients, these were divided into two groups by lottery system. The patients operated with Ultrasonic Cutting device (UCD) were labelled as Group A and Conventional Diathermy dissection (CDD) as Group B. The operative time and outcome of thyroid surgeries were assessed and compared between the two groups. Results: Total of 4 males and 15 females underwent thyroid surgeries during the study period with age ranging from 25 to 70 years, the operative time in Ultrasonic Cutting device (UCD)was less than Conventional Diathermy dissection (CDD) group (100.15 minutes vs 150 minutes p=0.06).The cumulative mean amount of drain was found to be less in UCD group, the difference was statistically significant (80.5 ml vs 133.05 ml p=0.00018).The drain was removed earlier in UCD group, this comparison was also statistically significant (2.5 days in UCD group vs 3.02 days in CDD group, p=0.00007).The mean pain score was fond to be statistically significant on all the postoperative days in UCD group. Conclusion: Less operative time, reduce postoperative pain and minimal complications were recorded in patients who undergone thyroid surgery by Ultrasonic Cutting Scalpel than Conventional method. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the presentation and types of foreign bodies in tracheobronchial tree and difficulties encountered in their removal at a Tertiary Care Hospital. Material and methods: This retrospective, descriptive study was carried out at the department of ENT and Head & Neck surgery Khyber Teaching Hospital Peshawar-Pakistan from July 2015 to June 2017. A total of 142 confirmed or suspected cases of foreign body tracheobronchial tree were included in the study from OPD, accident & emergency department (A&E) and referred from pediatric department. Detailed history and clinical examination was performed, X-Ray chest and base line investigation were done in all cases. Rigid bronchoscopy was done under general anesthesia in all cases, and different types of foreign bodies were removed. Difficulties encountered during bronchoscopy were bleeding, slip of foreign body and difficult to remove foreign body. Results: Out of 142 cases 94 (66.2%) were males and 48 (33.8%) were female in the age range of 01 year to 10 years. The duration between inhalation and hospital arrival was 12 hours to 2 weeks. In 90 (63.3%) cases vegetative foreign bodies were retrieved followed by plastic 30 (21.12%) and metallic 20 (14%). In 4 cases removal was difficult due to bleeding and oedema and were refered to thoracic department after tracheotomy. Conclusion: Early diagnosis and proper management along with awareness regarding pediatric home care is stressed upon to reduce morbidity and mortality. [ABSTRACT FROM AUTHOR]