Browsing by Author "Bhattarai, H"
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Publication Association of systemic diseases with sudden sensorineural hearing loss(Institute of Medicine, 2007) Nepal, MK; Rayamajhi, P; Thapa, N; Bhattarai, H; Shrivastav, RPAbstract Background: To find out the association of systemic diseases with sudden sensorineural hearing loss and to observe the effect of high dose intravenous steroid in its management. Methods: All patients admitted with sudden sensorineural hearing loss in the department of ENT & Head and Neck Surgery, T. U. Teaching hospital from January 2002 to January 2005 were studied prospectively. Association with any systemic illnesses were noted. High dose steroid intravenously was given for treatment and hearing improvement was assessed by pure tone audiometry. Results: A total of 46 patients were enrolled in the study, 21 of whom had systemic diseases. Predominant systemic disease was diabetes mellitus which was present in 16 patients. After steroid therapy, 13 patient is hearing returned to normal, 13 had improvement in hearing, 16 had no improvement and 4 had their hearing deteriorated. Conclusion: Approximately 45.7% of the patients with sudden sensorineural hearing loss had associated systemic diseases. Only 28.3% of the patient recovered to normal hearing though another 28.3% had improvement in hearing after the high dose steroid therapy. Keywords: pure tone audiometry (PTA), Sudden sensorineural hearing loss (SSNHL), Diabetes mellitusPublication Chronic Supurative Otitis Media in relation to dehiscent of facial canal(Institute of Medicine, 2008) Acharya, K; Nepal, MK; Rayamajhi, P; Bhattarai, H; Shrivastav, RP; Sharma, PAbstract Background: To observe the pathological findings in CSOM-AA along with, frequency of dehiscence of facial canal and to correlate the type of pathologies found with dehiscence of fallopian canal. Methods: It is the retrospective study conducted in the department of ENT-HNS at Tribhuvan University Teaching Hospital, Nepal of 2 yrs duration April 2004 to April 006. Patients undergoing mastoid surgeries for the CSOM-AA under general anesthesia were taken for the study. Pathological findings were divided into 3 groups which are granulation tissue, cholesteatoma or both. Special attention was given to identify the dehiscent of facial canal and its status was also followed up in postoperative period till 1 month. Results: The pathological finding commonly encountered were cholesteatoma with granulation 75.2% (94), whereas cholesteatoma alone was 18.4% (23)and granulation tissue only was 6.4%(8) The total incidence of facial canal dehiscence was 22 % (28/125) in our study. Horizontal part of the fallopian canal was most common site for dehiscence 50% (14/28) followed by vertical part 35 % (10/28) then both part was involved in 15% (4/28). There is no statistical significance between any type of pathology and dehiscence of facial canal. Conclusion: Cholesteatoma with granulation was the most common pathology found in CSOMAA. Irrespective of the pathologies in the middle ear cleft during mastoid surgeries for CSOM- AA, the facial canal was found to have dehiscence which was commonly occurring at horizontal part of the facial canal with higher incidence among cholesteatoma with granulation group. Keywords: Chronic supurative otitis media, cholesteatoma, granulations, facial canalPublication Comparison between the conventional methods and Glasgow Benefit Plot in evaluating subjective hearing results after myringoplasty(Institute of Medicine, 2007) Rayamajhi, P; Bhattarai, H; Sinha, BK; Shrivastav, RPAbstract Background: To compare the Conventional methods with Glasgow Benefit Plot in evaluating subjective hearing results after myringoplasty. Materials and Methods: Patients above 17 years of age with the diagnosis of Chronic Suppurative Otitis Media-tubotympanic type undergoing Myringoplasty at TU Teaching Hospital from January 2004 to July 2005 were included in the study. The pre and postoperative Pure Tone Audiometry (PTA) was performed and evaluated. The postoperative subjective hearing status of the patients was recorded as improved, same or worsened. Objectively, the postoperative hearing was assessed in terms of Air Bone Gap closure, Air Conduction Threshold improvement and Glasgow Benefit Plot. The objective methods were then compared with the postoperative subjective hearing status of the patients. Results: The association between the Air Bone gap closure and the postoperative subjective hearing status was not statistically significant. The association between the Air Conduction threshold improvement and the postoperative subjective hearing status was statistically significant. The association between the Glasgow Benefit Plot and the postoperative subjective hearing status was also statistically significant. Conclusion: The study showed that the Air Conduction threshold improvement and the Glasgow Benefit plot are better parameters for evaluating subjective hearing results after myringoplasty than the Air Bone gap closure. Keywords: Glasgow Benefit Plot, myringoplasty, Pure Tone Audiometry (PTA)Publication Comparison of hearing results between the averages of three and four speech frequencies in Type 3 Tympanoplasty(Institute of Medicine, 2011) Shrestha, BL; Gurung, U; Bhattarai, HAbstract Introduction: Hearing assessment after tympanoplasty is done by taking pure tone average. This study was performed to compare the hearing results obtained from the averages of three and four speech frequencies namely 0.5, 1,2KHz and 0.5,1,2,4 KHz in type III tympanoplasty. Methods: This study was conducted in Tribhuwan university teaching hospital and Kathmandu university hospital, Dhulikhel from October 2006 to November 2009. The pure tone audiogram was performed by Hugson and Westlake method. The audiometry results were reported as per American Academy of Otolaryngology – Head and Neck surgery guidelines. The comparison between the averages of 3 and 4 speech frequencies that are 0.5, 1,2KHz and 0.5,1,2,4 KHz were performed with regard to bone conduction threshold(BCT), air conduction threshold(ACT),air bone gap (ABG) and air bone gap closure. Data analysis was performed using SPSS 13 software. Results: Comparison between the averages of 3 and 4 speech frequencies between the preoperative BCT and ACT showed difference of 1.5dB and 0.8dB which were statistically significant whereas the difference in ABG was 1dB which was statistically not significant. Similarly post-operative BCT, ACT, ABG showed the difference of 0.3dB, 0.5dB and 0.2dB respectively which were also statistically not significant. Conclusions: The difference between 3 and 4 speech frequencies averages are small and are statistically not significant but it is still worth to include 4 KHz as this is a high frequency which is likely to be affected by tympanoplsty. Keywords: tympanoplasty, bone conduction threshold, air conduction threshold, air bone gapPublication Foreign body in the larynx for 13 years(Institute of Medicine, 1998) Pradhan, B; Sinha, BK; Amatya, RCM; Bhattarai, H; Prasad, R; Bhushal, CL; Baskota, DKAbstract This is a report of case of an old man of 67 years who was fortunate to survive a foreign body (denture) into the larynx for 13 years. Fibreoptic endoscopy showed a whitish mass in between the cords; on removal by direct laryngoscopy it was found to be a denture. Keywords: Foreign body, LarynxPublication Hearing results of type III tympanoplasty with or without cartilage augmentation after Canal Wall Down mastoidectomy(Institute of Medicine, 2009) Shrestha, BL; Bhattarai, H; Bhusal, CLAbstract Background: To assess and compare the hearing results in patients undergoing canal wall down mastoidectomy with classical type III tympanoplasty using temporalis fascia alone and with cartilage augmented type III tympanoplasty. Methods: Patients of 5 years of age or more with the diagnosis of Chronic otitis media (squamous) with conductive or mixed hearing loss, needing canal wall down mastoidectomy and with intact and mobile stapes suprastructure at surgery who underwent classical type III tympanoplasty with or without cartilage augmentation were included in the study. Pure tone audiometry (PTA) was performed and evaluated. Post- operative hearing was assessed in terms of average air bone gap (ABG) and size of ABG closure. Post-operative hearing results were compared in between classical type III and cartilage augmented type III tympanoplasty groups. Results: Postoperative PTA–ABG ranged from 15–61.2 dB in classical type III tympanoplasty while the postoperative PTA–ABG ranged from 15–47.5 dB in cartilage augmented type III tympanoplasty. When comparing average post-operative ABG and size of ABG closure between classical and cartilage augmented type III tympanoplasty, cartilage augmented group showed marginally better results but this difference was statistically not significant. Conclusions: Hearing results after type III tympanoplasty varied widely. There was no statistically significant improvement in post-operative hearing results in cartilage augmented when compared to classical type III tympanoplasty, suggesting possibility of the effects of multiple other factors. Keywords: Air bone gap, air bone gap closure, canal wall down (CWD) mastoidectomy, , cartilage augmented type III tympanoplasty, classical type III tympanoplasty, chronic otitis media (squamous)Publication Influence of Tympanosclerosis on Grant Uptake and Hearing Status in Patients Undergoing Underlay Myringoplasty(Nepal Health Research Council, 2009-10) Bhattarai, H; Prasad, P LPublication Taste disturbances following middle ear surgery(Institute of Medicine, 2010) Gurung, U; Bhattarai, H; Shrivastav, RPAbstract Introduction: Iatrogenic chorda tympani nerve (CTN) injury during middle ear surgery is quite common. The objective of ours study is to observe frequency & types of CTN injury during middle ear surgery and assess types of post-operative taste disturbances and their functional recovery. Methods: Patients who underwent middle ear surgery from 1st October 2005 to 1st January 2007 in Tribhuvan University Teaching Hospital were divided into 6 groups according to intraoperative CTN manipulation as; seen but not handled, handled but not stretched, stretched but intact, cut while stretching, cut while using burr and clean cut with scissors. Subjective assessment of taste disturbance was done after 2days & 2, 4 & 6 months post-operatively and categorized as altered taste sensation/metallic taste, tongue numbness and dry mouth. Results: Amongst 260 patients, CTN was seen but not handled in 52/260 (20%), handled but not stretched in 54/260 (20.75%), stretched but intact in 66/260 (25.38%), cut while stretching in 17/260(6.5%), cut while using burr in 29/260 (11.15%) and clean cut with scissors in 42/260 (16.15%) patients. Eleven out of 260 patients (4.2%) symptomatic amongst which 6/11 (54.5%) had altered taste sensation,4/11 (36.3%) had tongue numbness and 1/11 (9%) had dry mouth. Complete recovery occurred in 9/11 (81.8%) patients by 6 months. Conclusion: Though iatrogenic CTN injury was common during middle ear surgery, frequency of taste disturbance was comparatively less, commonest type of CTN injury being stretched but intact. The most common post-operative taste disturbance was altered taste sensation/metallic taste. Most patients recovered completely by 6 months. Functional recovery was earlier when CTN was preserved than when sectioned. Keywords: CTN, middle ear surgery, taste disturbance