Background and Objectives: Hoarseness of voice is a common laryngeal disorder in general population and the most cardinal symptom of the laryngeal disease. The aim of this study was to demonstrate and compare the benefit and importance of both flexible nasopharyngoscopy and laryngeal mirror in the evaluation of hoarseness as well as to identify the incidence of hoarseness and its main causes.
Methods: This prospective study carried out on 125 patients complaining from hoarseness of voice in the department of Otolaryngology in Sulaimani Teaching Hospital for a period from Jan.2006 to Feb.2007, using both nasopharyngoscopy and laryngeal mirror for all patients.
Results: This study showed that the diagnostic accuracy was 96.8% in case of flexible nasolaryngoscopy in comparison with indirect mirror examination which was 72.8%.Incidence of complications in this study was 5 out of 125 by using flexible nasolaryngoscopy in form of fainting and slight nasal bleeding, in spite of some difficulties in flexible nasolaryngoscopy all patient were successfully assessed in comparison with failure of assessment in 10 patients out of 125 for indirect mirror examination. The peak age incidence of hoarseness of voice was in the fifth decade of life, and the male 66(52.8%) to female 59 (47.2%), ratio was 1.1:1. Chronic non-specific laryngitis was the commonest pathological finding 47 (37.6%) followed by laryngeal carcinoma 17 (13.6%).
Conclusions: Flexible nasolaryngoscopic examination is safe and reliable mean of evaluation of hoarseness of voice.
Key words: hoarseness of voice, flexible nasopharyngoscopy, laryngeal mirror, Ca.Larynx, Chronic non-specific laryngitis.
Background and Objectives: Fistula -in- ano is one of the commonly encountered surgical problems. Most of these fistulae develop after drainage of an anorectal abscess. Many surgical procedures have been described in literature to treat high type fistula in ano and this reflects the lake of an ideal one, the one that is expected to carry the minimum rate of recurrence, sphincter incontinence in addition to patient's compliance and satisfaction.
Methods: This is a prospective study aimed to review the results of a modified surgical procedure adopted to treat high type fistula in ano, carried between Feb.1995 and Dec. 2005.
Results: Eighteen patients were included in this study, sixteen of them were males with two females, and the male to female ratio was 8:1. The incidence was low in both sexes below 20 years and above 50 years of age. Peak occurrence was noted between 20 to 40 years.
1. Kelli M. Bullard and David. A. Rothenberger, Colon, Rectum, and anus, Schwartz's principles of surgery, eighth edition, 2005, (P. 1055-1119).
2. Parks AG, Gardon PH, Hardcastle JD. A Classification of fistula-in-ano. Br J Surg 1976; 63: 1-12.
3. Marks CG, Ritchie JK. Anal fistula at St. Marks’s Hospital. Br J Surg 1977:64:84-91.
4. EU KW. Fistulotomy and marsupialization for simple fistula-in-ano. Singapore Med J 1992; 33(5):532.
5. Yang CY. Fistulotomy and marsupialization for fistula-in-ano. Singapore Med J 1992; 33(3): 268- 70.
6. Khubchandain. Comparison results of treatment of fistula-in-ano. J R Soc Med 1984; 77(5): 369- 71.
7. Williams JG, Mac Leod A, Rothenberger A, Goberg M. Seton treatment of high anal fistulae. Br J Surg 1991; 78: 1159-61.
8. Norman S. Williams, chapter The anus, and anal canal, Bailey& love's Short practice of surgery 24th Edition2004 (page 1242-1271)
9. Athanasiadis S, Lux N, Fischbach N, Meyer B.One stage surgery of high trans and supra-sphincteric anal fistulae using primary fistulectomy and occlusion of the internal ostium. A prospective study of 169 patients. Chirurg 1991; 68(8): 608-13.
10. Parkas S, Lakshmiratan V, Gajendran V. Fistula-in-ano; Treatment by fistulectomy, primary closure and re-construction. Aust NZ J Surg 1985; 55(1): 23-7.
11. Van-de-Stadt-J. Fistula-in-ano: the place of rectal advancement flap technique. Acta Chir Belg. 2000; 100(3): 123-7.
12. Miller GV, Finan PJ. Flap advancement and core fistulectomy for complex rectal fistula. Br J Surg 1998; 85(1): 108-10.
13. Jun-SH, Choi GS. Anocutaneous advancement flap closure of high anal fistula. Br J Surg 1999; 86(4): 490-2.
14. Nelson RL, Cintron J, Abcarian H. Dermal island-flap anoplasty for transphincteric fistula-in-ano: assessment of treatment failure. Dis Colon Rec tum 2000; 43(5): 681-4.
15. Cintron JR, Park JJ, Orsy CP, Pearl RK, Nelson RL, Sone JH, et al. Repair of fistula-in-ano using fibrin adhesive glue; long term follow-up. Dis Colon Rectum 2000; 43(7): 944-50.
16. Thomson JPS, Ross AHMcL. Can the internal sphincter be preserved in the treatment of trans-sphincteric fistula-in-ano? Int J Colorectal Dis 1989; 4:247-50.
17. Vainlevsky CA, Gordon PH. Results of treatment of fistula-in-ano. Dis Colon Rectum 1985; 28: 225-31.
18. Ramanujam PS, Parsad ML, Abecarin H. The role of Seton in fistulotomy of the anus. Surg Gynaecol Obstet 1983; 157: 419-22.
19. Mann CV, Clifton MA. Re-routing of the track of high anal and anorectal fistulae. Br J Surg 1985; 72: 134-7.
20. Jones IT, Fazio VW, Jagelman DG. The use of transanal advancement flaps in the management of fistulas involving anorectum. Dis Colon Rectum 1987; 30: 919-23.
21. Wedell J, Meir ZW, Fissen P, Danzhaf G, Klein L. Sliding flap advancement for the treatment of high level fistulae. Br J Surg 1987; 74: 390-1.
22. Culp CE. Use of Penrose drain to treat certain anal fistulae. A Primary operative seton. Mayo Clin Proc 1984; 579: 613-7.
23. J.Garcia-Aguilar,C. Belmonte,W. wong, D.W. Goldberg, R.D. Madoff, cutting seton versus two stage seton fistulotomy in the surgical management of high anal fisula,BJS, vol.85 I ssue 2,(1 Feb.1998).