Browsing by Author "Amatya, RCM"
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Publication Analysis of Ear, Nose and Throat Foreign Bodies in Dhulikhel Hospital(Kathmandu University, 2012) Shrestha, I; Shrestha, BL; Amatya, RCMABSTRACT Background Foreign body in ear nose and throat are commonly encountered by otolaryngologists, pediatricians and primary care physicians. Objective The aim of this study is to analyze different types of foreign bodies and socio- demographic correlates of self-inflicted foreign body insertion in ear–nose–throat. Method This was a two year hospital based cross sectional descriptive study performed in the Department of ear nose and throat (ENT), Dhulikhel Hospital - Kathmandu University from June 2009 to June 2011 after verification from the Institutional Review Committee. Using a predesigned questionnaire, socio-demographic data was collected prospectively by examining clinically all patients attending with foreign body and interviewing the caregivers of pediatric patients after removal of foreign body. The data collected from 312 patients was entered and analyzed by using descriptive and analytical statistical methods using SPSS version 16.0. Results The mean age was 21.26 years with majority between 0-10 years (50.6%). Male predominance was noted (58.97%). Most patients or caregivers were illiterate (35.1%) or literacy up to primary level(21.12%).Foreign body of the ear was found to be most frequent ( 47.4%) and mostly they were non-living (96.1%). Most patients presented late (80%) and had history of prior attempted removal (67%). Pearsons chi square test between education level and duration of time was significant (p value- 0.0000). One way ANOVA test between type of foreign body and age was significant (p value- 0.001). Conclusion Foreign bodies are common in adult and pediatric ear, nose and throat. They can potentially be associated with significant complications if not taken care of immediately. KEY WORDS Foreign body, inorganic, living, non- living, organicPublication Awareness and Knowledge of Oral Cancer among Medical Students in Kathmandu University School of Medical Sciences(Kathmandu University, 2017) Pokharel, M; Shrestha, I; Dhakal, A; Amatya, RCMABSTRACT Background Oral cancer is a major public health problem worldwide. It has high mortality rates and chances of survival is relatively superior when detected early. Lack of knowledge and awareness about oral cancer among medical students may contribute to delay in diagnosis and treatment. Objective To assess awareness and knowledge of oral cancer among medical students. Method A cross-sectional study conducted among 286 students by Department of Otorhinolaryngology and Head & Neck surgery, Kathmandu University School of Medical sciences between July to August 2016. A questionnaire with questions on socio-demographic profile, awareness and knowledge of oral cancer was used. Independent sample t test and Pearson Chi-square tests were used for statistical analysis. Result Out of 329 students approached, 286 participated in the study yielding a response rate of 86.9%. Symptoms of oral cancer as reported were ulceration in mouth (92.3%), oral bleeding (85.0%),whitish or reddish patch (84.3%), halitosis (75.5%) and swelling in neck (74.5%), trismus (69.2%), numbness (67.1%), loosening of teeth (49.3%) and tooth sensitivity (41.6%). The perceived risk factors were smoking (97.2%), tobacco chewing (96.5%), chronic irritation (86.7%), immunodeficiency (83.9%), poor oral hygiene (88.5%), human papilloma virus infection (82.5%), dietary factors (81.1%), alcohol (79.4%), ill-fitting dentures (72.4%), hot spicy food (65.4%) and hot beverages (58.0%). Significant differences were found between pre-clinical and clinical students for knowledge of risk factors, signs and symptoms of oral cancer (p<0.001). Conclusion There is deficiency of knowledge among medical students about some aspects of oral cancer. Active involvement while examining patients and taking biopsies of malignant and premalignant lesions may help in improving students’ knowledge about oral cancer. KEY WORDS Awareness, knowledge, oral cancer, risk factorsPublication Clinicoradiologic Evaluation of Eagle’s Syndrome and its Management(Kathmandu University, 2013) Pokharel, M; Karki, S; Shrestha, I; Shrestha, BL; Khanal, K; Amatya, RCMABSTRACT Background Eagle’s syndrome (Elongated styloid process) is often misdiagnosed due to its vague symptomatology. The diagnosis relies on detail history taking, palpation of styloid process in tonsillar fossa and imaging modalities. Objective To assess the length and medial angulation of elongated styloid process with the help of three dimensional computed tomography (3D CT) scan and to describe our clinical and surgical experience with patients suffering from Eagle’s syndrome. Method Prospective, analytical study conducted from August 2011 to August 2012 among 39 patients with Eagle’s syndrome. Detailed history taking, clinical examination and 3D CT scan was performed. Length and medial angulation was calculated. Patients with styloid process length longer than 2.50 cm underwent surgical excision via intraoral approach. Medial angulation of styloid process on both sides was correlated with each other using rank correlation coefficient. Wilcoxon Signed Rank test was applied to test significant difference between pre-operative and post- operative symptoms scores. Result Significant positive correlation was found between the medial angulation of styloid process on right side and left side (ρ =0.81, p<0.001). Significant difference was also observed between pre and post-operative symptoms scores (z=-5.16, p<0.001) . Conclusion Possibility of Eagle’s syndrome should always be considered while examining patients with vague neck pain. 3D CT reconstruction is a gold standard investigation which helps in studying the relation of styloid process with surrounding structures along with accurate measurement of its length and medial angulation. KEY WORDS Eagle’s syndrome, elongated styloid process, three dimensional computed tomographyPublication Correlations Between Symptoms, Nasal Endoscopy Computed Tomography and Surgical Findings in Patients with Chronic Rhinosinusitis(Kathmandu University, 2013) Pokharel, M; Karki, S; Shrestha, BL; Shrestha, I; Amatya, RCMABSTRACT Background Although Chronic rhinosinusitis (CRS) is increasing in prevalence and incidence, its diagnosis and treatment still pose a challenge. The Task Force on rhinosinusitis (TFR) advocates the use of symptom based criteria. However, many otorhinolaryngologists depend on diagnostic nasal endoscopy and computed tomography(CT) of paranasal sinuses for diagnosis of CRS. Computed tomography has been extensively relied upon in confirming the presence of CRS, in assessing severity of disease, surgical planning and management decisions. Despite its widespread use, several studies have failed to correlate findings on CT with symptom severity. Objective To determine the correlations between symptoms described at presentation, radiological findings, endoscopy and extensiveness of surgery. Methods Longitudinal, prospective, analytical study conducted from August 2011 to August 2012 among 87 patients diagnosed as CRS according to the TFR criteria. Symptom, endoscopic, radiological and surgical scoring was done by using Lund and Mackay staging system. Pearson correlation coefficients between scores for symptoms, endoscopy, sinus CT and surgery was determined. Results When overall symptom score was correlated with radiological score and endoscopy score, it was found to be statistically significant (p= <0.01). However, no significant relationship was found between Lund and Mackay symptom and surgery score. Conclusion The symptom criteria used by TFR for CRS diagnosis are not very specific for sinus disease. A detail assessment of the subjective and objective criteria (CT and endoscopy) is necessary for tailoring surgical plan but should not be relied upon for determining the extensiveness of surgical intervention. KEY WORDS Chronic rhinosinusitis, lund and mackay staging system, task force on rhinosinusitisPublication Evaluation of Etiology of Epistaxis and its Management in Dhulikhel Hospital(Kathmandu University, 2015) Shrestha, I; Pokharel, M; Shrestha, BL; Dhakal, A; Amatya, RCMABSTRACT Background Epistaxis is one of the most common and most difficult emergencies presenting in 7-14% of the general population each year. Although its lifetime incidence is about 60%, only 6% require formal medical intervention but they can be serious and even life threatening. Objective The main objectives are to study different etiology, types, modality of treatment of epistaxis. Specific objective is also to find out if the modality of treatment is associated with age, site, amount of bleeding and etiology. Method It is a prospective, cross sectional, longitudinal, analytical study done in Department of ENT, Dhulikhel hospital, Kathmandu University School of Medical Sciences (KUSMS) from Aug. 2010 to Aug. 2013. Data was collected. This study was cleared through institutional review committee of hospital. Statistical analysis was done using SPSS 16.0. Result 487 patients were studied during the period. There was significant association between age group with type of treatment (p value 0.002); and with admission (p value < 0.001). Significance in the study was also shown in the correlation between site of bleeding and the type of treatment and also with alcohol intake with site of bleeding (p value < 0.001).However there was no significance between hypertension and the type of treatment methods chosen (p value >0.01). Conclusion Management of epistaxis is challenging. Most are managed by non surgical means whereas some by surgical treatment. Non surgical treatment is still useful, safe and cost effective. Type of treatment and need for hospital stay is related to age and site of bleeding. KEY WORDS Age group, epistaxis, modality of treatment, site of bleedingPublication Prevalnace of Noise Induced Hearing Loss among Traffic Police Personnel of Kathmandu Metropolitan City(Kathmandu University, 2011) Shrestha, I; Shrestha, BL; Pokharel, M; Amatya, RCM; Karki, DRABSTRACT Background Noise induced hearing loss (NIHL) is a major preventable occupational health hazard. Objective To measure permanent threshold shift in traffic police personnel due to noise exposure and to examine whether it was associated with duration of noise exposure, years of work and risk factors. Methods Cross sectional, descriptive study conducted at Dhulikhel hospital, Kathmandu University Hospital in 110 responding traffic police personnel. Detailed history and clinical examination of ear, impedence audiometry and pure tone audiometry was performed. Results Mean age group was 29.82 years; 82(74.5%) were males and 28 (25.5%) were females. Mean duration of service is 11.86 years. Twenty six (23.6%) had tinnitus and 39(35.5%) had blocked sensation in ear. Sixty five (59.1%) worked between 10- 19 years. Alcohol and smoking shows positive impact on NIHL (p value =0.00). Odds ratio with 95% confidence interval were 4.481 (1.925-10.432) and 6.578 (2.306- 18.764) respectively. Among 73(66.4%) noise induced hearing loss positive cases, bilateral involvement was seen in 45 (40.9%) and unilateral in 28(25.4 %) cases. Among unilateral cases most were left sided. Hearing threshold at 4 kHz increased according to age and duration of service. Conclusion Traffic police personnel are in constant risk of noise induced hearing loss. Screening for hearing loss is recommended for people exposed to noise. KEY WORDS noise induced hearing loss, traffic police personnel, occupational hazardPublication Reflux Symptom Index and Reflux Finding Score in Diagnosis of Laryngopharyngeal Reflux(Kathmandu University, 2016) Pokharel, M; Shrestha, I; Dhakal, A; Purbey, B; Amatya, RCMABSTRACT Background Although laryngopharyngeal reflux is a common condition encountered in otolaryngological practice, its diagnosis is not very easy because of its indistinct symptoms Objective To assess the efficacy of proton pump inhibitors versus proton pump inhibitors with lifestyle modification in patients with laryngopharyngeal reflux. Method Prospective, analytical study conducted in Department of Otorhinolaryngology and Head and Neck Surgery at Dhulikhel Hospital, Kathmandu University Hospital between January 2015 to January 2016. Eighty two patients with laryngopharyngeal reflux having Reflux symptom index > 13 and Reflux finding score > 7 were included. Patients were divided into 2 groups. Group A comprised of patients treated with proton pump inhibitors alone and Group B with Proton pump inhibitors with lifestyle modification. Pre and post therapeutic reflux finding score and reflux symptom index were compared. Result The mean reflux symptom index score difference before and after treatment in group A was 16.70 and group B was 14.58. Similarly, mean reflux finding score difference before and after treatment in group A was 8.68 and group B was 9.92. Comparison of reflux finding score and reflux symptom index scores before and after treatment revealed improvement in both groups and the difference was statistically significant (p<0.001). However, comparison of pre and post therapeutic and scores between group A and B, showed no statistical significance. Conclusion The extent of symptomatic improvement correlated positively with both proton pump inhibitor therapy alone as well as with proton pump inhibitor therapy along with lifestyle modification. Although addition of lifestyle modification offered incremental benefit for treating laryngopharyngeal reflux, it was not found to be statistically significant. KEY WORDS Laryngopharyngeal reflux, reflux finding score, reflux symptom indexPublication Short duration anterior nasal packing after submucosal resection of nasal septum(Kathmandu University, 2008) Gyawali, KR; Amatya, RCM; Pokharel, MAbstract Objectives: To find out the shortest possible duration of nasal packing after submucosal resection (SMR) operation. To compare the outcome of the patients who underwent SMR operation and anterior nasal pack (ANP) removed after 24 hours with those who had ANP removed after 2 hours of operation. Materials and methods: A prospective randomized hospital based study was undertaken to compare the outcome of early removal of nasal packs after 2 hours of operation and after 48 hours. Seventy four patients undergoing SMR operation with ANP were divided in two groups. Group I: patients who underwent SMR and ANP removed after 24 hours to 48 hours (n= 37 patients). Group II: patients who underwent SMR and ANP removed after 2 hours (n= 37 patients). Results: There was no significant difference between the two groups in terms of age distribution (p = 0.244), sex (p = 0.76), synaechia formation (p = 0.615) and bruise in the upper lip (p = 1.000). There were no complications following early (2 hours) removal of ANP except synaechia, no significant post-operative bleeding occurred and no post operative septal hematoma were noted. In addition, patients reported less post-operative discomfort when the packs were removed early in Group II. This practice reduced the length of hospital stay and therefore reduced costs. Conclusion: Our study shows that there is no significant difference in the post operative events and recovery between removal of ANP after 48 hours and after 2 hours of operation. This supports that ANP removal can safely be done after two hours of operation. Key words: Sub mucosal resection of the nasal septum (SMR), anterior nasal packing (ANP)Publication Socio Demographic Predictors in Delayed Presentation of Head and Neck Cancer(Kathmandu University, 2016) Pokharel, M; Shrestha, I; Dhakal, A; Amatya, RCMABSTRACT Background Head and neck cancer is a major public health problem worldwide. In spite of the increase in incidence, there has been paucity of research on socio demographic factors influencing head and neck cancer. Objective To study the influence of various socio demographic factors on late presentation of head and neck cancer. Method Prospective, analytical study conducted in 69 patients with Head and neck malignancies in Department of Otorhinolaryngology and Head and Neck surgery, Kathmandu University School of Medical sciences between January 2015 to January 2016. Collected data were entered and analyzed using IBM SPSS statistical software 21.0. All the socio demographic variables were compared between the early and late presentation groups of patient using Chi-square test. A ‘p’ value of < 0.05 was considered statistically significant. Result Forty eight were male and 21 were female. The age of patients ranged from 34 to 70 years (mean age 52.03). Twenty patients were diagnosed in stage I, 13 in stage II, 20 in stage III and 16 in stage IV. Significant association was seen between stage of head and neck cancer and duration of illness (p=0.007), educational status of patient (p=0.003) and educational status of patient’s care taker (p=0.005). However, no statistical association was seen between stage at diagnosis of head and neck cancer and gender, type of family, previous consultation, systems of alternative medicine adopted before diagnosis, smoking habit, alcohol intake, tobacco chewing habit and occupation. Conclusion The results of this study suggest that educational status may influence the presentation of head and neck cancer. KEY WORDS Head and neck cancer, stage at diagnosisPublication Study of Microorganism Growth Pattern in Nasal Pack of Patients Visiting the Department of ENT, Head and Neck Surgery(Kathmandu University, 2015) Shrestha, I; Pokharel, M; Dhakal, A; Amatya, RCM; Madhup, S; Sherchan, JBABSTRACT Background Nasal packs are utilized nearly by otorhinolaryngologists for controlling epistaxis and post nasal procedures. Complications have been reported due to them; therefore the use of antibiotics is a common practice among otorhinolaryngologists. Objective To detect microbiological flora associated with nasal packing and find evidence to support the benefit of systemic antibiotics with it. Method A prospective, analytical study was conducted on 51 patients presenting to the Department of ENT, KUSMS from June to September 2015 who required nasal packing. Approval of the local Institutional review committee (IRC) was taken. The mid part of the pack was collected in a sterile bottle under aseptic technique and sent to microbiology department. Specimen collection, culture, identification tests were done according to the guidelines by American Society for Microbiology. Data were collected using the individual patient records and Microsoft Office Excel 2007. Statistical analysis was performed with SPSS 16.0. Result Among the 51 cultures; 33 (64.7%) were positive. In 18 (35.3%) cultures no organism was grown. Statistical analysis did not show significance between duration of pack kept with microbial growth (p=0.051) or the type of pack kept (p=0.212) .It showed significance with foul smell of the pack to the growth (p=<0.001). Conclusion Microbiological flora was associated with nasal pack. Antibiotic soaked nasal packs have lesser incidence of positive bacterial growth when compared with plain nasal packs. Nasal packs kept for less than 48 hours have lesser incidence of positive bacterial growth when compared with nasal packs kept for more than 48 hours. Therefore, administering systemic antibiotics in cases when we plan to keep the pack for longer duration is recommended. KEY WORDS Epistaxis, microbiology, nasal packPublication Study to Compare and Evaluate Traditional vs. Endoscopic Septoplasty(Kathmandu University, 2015) Shrestha, I; Pokharel, M; Dhakal, A; Amatya, RCMABSTRACT Background Surgery on a deviated septum has seen several modifications since its inception starting from radical septal resection to preservation of the possible septal framework. Objective To compare the efficacies of “Endoscope Septoplasty” over “Traditional Septoplasty” in treating pathological septum and turbinates, in terms of their outcome. Method Prospective descriptive study conducted on 60 patients who presented to the Department of ENT, Kathmandu University School of Medical sciences during a period of two years. The severity of the symptoms of the patients was scored using a visual analogue scale which was compared post operatively to subjectively evaluate the efficacy of either surgery. Objective assessment was done by nasal endoscopy. P value in case of subjective and objective evaluation was done by applying Z- test. Result The mean age ± SD was 29.5±1.2 .Maximum patients fell into age group of 21-30 with 31.7 % followed by 11-20 with 28.3% and then 31-40 with 25 %. There were total 35 males (58.3%) and 25 females (41.7%). Among the symptoms, nasal obstruction seems to be dominating with total of 83.3%, followed by postnasal drip with 66.6% and then headache with 60%. The types of dislocation was compared, there were 66.7% cases with DNS and Spur whereas only 10 % with isolated spur. C shaped deformity was seen in 30% and S shaped in 26.6 % cases. Significance in Z test, is seen in subjective assessment post surgery for nasal obstruction, headache and rhinorrhea and for objective assessment post surgery for persistent contact with turbinates. (p value set to 0.01) Conclusion Endoscopic surgery is an evolutionary step towards solving the problems related to deviated nasal septum. It is safe, effective and conservative alternative to conventional septal surgery. KEY WORDS Endoscopic approach, septoplasty.Publication Study to Compare and Evaluate Traditional vs. Endoscopic Septoplasty(Kathmandu University, 2015) Shrestha, I; Pokharel, M; Dhakal, A; Amatya, RCMABSTRACT Background Surgery on a deviated septum has seen several modifications since its inception starting from radical septal resection to preservation of the possible septal framework. Objective To compare the efficacies of “Endoscope Septoplasty” over “Traditional Septoplasty” in treating pathological septum and turbinates, in terms of their outcome. Method Prospective descriptive study conducted on 60 patients who presented to the Department of ENT, Kathmandu University School of Medical sciences during a period of two years. The severity of the symptoms of the patients was scored using a visual analogue scale which was compared post operatively to subjectively evaluate the efficacy of either surgery. Objective assessment was done by nasal endoscopy. P value in case of subjective and objective evaluation was done by applying Z- test. Result The mean age ± SD was 29.5±1.2 .Maximum patients fell into age group of 21-30 with 31.7 % followed by 11-20 with 28.3% and then 31-40 with 25 %. There were total 35 males (58.3%) and 25 females (41.7%). Among the symptoms, nasal obstruction seems to be dominating with total of 83.3%, followed by postnasal drip with 66.6% and then headache with 60%. The types of dislocation was compared, there were 66.7% cases with DNS and Spur whereas only 10 % with isolated spur. C shaped deformity was seen in 30% and S shaped in 26.6 % cases. Significance in Z test, is seen in subjective assessment post surgery for nasal obstruction, headache and rhinorrhea and for objective assessment post surgery for persistent contact with turbinates. (p value set to 0.01) Conclusion Endoscopic surgery is an evolutionary step towards solving the problems related to deviated nasal septum. It is safe, effective and conservative alternative to conventional septal surgery. KEY WORDS Endoscopic approach, septoplasty.Publication Thyroid Isthmus Agenesis in a Patient with Papillary Carcinoma of Thyroid(Kathmandu University, 2016) Rajbhandari, P; Shrestha, BL; Dhakal, A; Amatya, RCMABSTRACT Thyroid gland is the largest of all endocrine glands. It is composed of two lobes. These two lobes are joined by an isthmus and this resemble the letter “H”. A wide range of morphological variations and developmental anomalies of the thyroid gland like hypoplasia, ectopy, hemiagenesis, and agenesis have been reported in literature. Out of these, the incidence of agenesis of the thyroid isthmus is rare, and very few cases have been reported. In our report, 28 year old male patient was found with agenesis of thyroid isthmus with papillary carcinoma in the right lobe of thyroid. During the operation it was seen that the right and left thyroid lobes were independent from each other and isthmus was absent. We will present a case of thyroid isthmus agenesis and discuss the clinical importance and the incidence of this case. KEY WORDS Agenesis, papillary carcinoma, thyroid glandPublication Tonsillar microbial flora: A comparison of infected and non- infected tonsils(Kathmandu University, 2006) Bista, M; Amatya, RCM; Basnet, PObjective: The main objective of this study was to find out the most common organism affecting the tonsils in recurrent tonsillitis. Methodology: This was a prospective study consisting of total number of 50 patients, conducted in the ENT department of Dhulikhel Hospital, KUTH, Dhulikhel, Nepal. The study period was of one year and three months (March 2004 to April 2005). Results: Total numbers of 50 patients were selected, of which 32 were of acute tonsillitis and 18 were taken as control. Among these males were 32 and females were 18. The age group was from 3 years to 64 years. Throat swabs of patients were taken by aseptic method and were sent to the laboratory immediately. Among the infected tonsils the most common organism was Streptococcus viridans followed by Streptococcus pneumoneae and Morexella catarrhalis. The third most common was Beta haemolytic streptococci whereas Micrococcus was not isolated in any of the infected samples. Likewise in non-infected tonsils, the most common organism isolated was again Streptococcus viridans followed by Micrococcus and Diptheroids. In these specimen no Beta haemolytic streptococci was isolated from the control group. Conclusion: Thus, the study is able to put forward the fact that most common organism affecting the tonsils in infected as well as non- infected state is Streptococcus viridans. Where as Beta haemolytic streptococci was not found in non- infected tonsils, like wise Micrococcus was not found in infected tonsils. Key words: Recurrent tonsillitis, microflora