Browsing by Author "Bista, M"
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Publication Incidence of tuberculosis in enlarged neck nodes, our experience(Kathmandu University, 2009) Maharjan, M; Hirachan, S; Kafle, PK; Bista, M; Shrestha, S; KC, Toran; Lakhey, MAbstract Objectives: To determine the incidence of tuberculous lymphadenitis in enlarged neck nodes. Materials and methods: Continuous prospective study is carried out in the department of otorhinolaryngology head & neck surgery, Kathmandu Medical College, Kathmandu, during two years, from January 2006 to January 2008. The study included a group of 155 patients with cervical lymphadenopathy. Each patient underwent a detail clinical Ear, Nose and Throat (ENT) examination and a battery of investigations which included Fine Needle Aspiration Cytology (FNAC) of the nodes, Montoux’s test, blood Erythrocyte Sedimentation Rate (ESR) and chest X-ray. Those patients with tubercular lymphadenitis were referred to Directly Observed Therapy System (DOTS) clinic for anti-tubercular therapy. Others with reactive lymphadenitis were treated with antibiotic and those with metastatic neck nodes were treated accordingly. Results: Of the 155 cases with enlarged neck nodes, 83 (54%) had tubercular lymphadenitis. Fifty two (33%) cases had reactive lymphadenitis and 17 (11%) cases were diagnosed with metastatic neck nodes. Fine needle aspiration cytology was found to be highly effective in the diagnosis of tubercular lymphadenitis with 94% accuracy. Majority of patients were otherwise healthy adults, aged between 8 – 71 years. No difference was observed between male and female in this study. Posterior triangle (PT) nodes were most commonly affected group of nodes accounting for 35 (42%) cases and preauricular region 1 (1%) case being the least commonly affected site. Fifteen (18%) cases presented with abscess formation. Only 42 (50%) cases had family history of tuberculosis but 8 (9%) patients had previous history of various forms of tuberculosis. Twelve (14%) patients had positive chest X-ray findings suggesting of concurrent pulmonary tuberculosis. All the patients were referred to DOTS clinic and were treated with category (CAT) - III anti tubercular therapy (ATT). Others with concurrent pulmonary tuberculosis were treated with CAT I regime. None of the patients required surgical treatment. Conclusion: There is high incidence of tubercular cervical lymphadenitis in patients with enlarged neck nodes in developing countries like Nepal. Involvement of cervical lymphnodes are the most commonly affected group of nodes. Therefore, it is important that otolaryngologists are aware of tuberculosis in the head and neck region. Key words: Tuberculosis, Lymph node, Fine needle aspiration cytology, LymphadenitisPublication Observation of hearing loss in patients with chronic suppurative otitis media tubotympanic type(Kathmandu University, 2009) Maharjan, M; Kafle, P; Bista, M; Shrestha, S; KC, ToranAbstract Background: It is acknowledged that size and site of tympanic membrane perforation is proportional to degree of hearing loss but there are many studies which suggests otherwise. Persistent ear discharge is also supposed to deteriorate hearing level with passage of time. This study is carried out to find out the relation between size and site of tympanic membrane perforation and duration of ear discharge on hearing loss. Objectives: The objective of this study is to study the effect of size and site of tympanic membrane perforation and duration of ear discharge on hearing loss. Materials and methods: This is a cross-sectional prospective study conducted at Kathmandu Medical College, department of ear nose and throat from January till July 2009. One hundred patients aged between 8 to 60 years with pars-tensa perforations were included in the study. Detail clinical examination and history was carried out followed by hearing evaluation by audiometry was done in all cases. All the data is collected, statistical analysis is done using SPSS program and documented for study. Results: One hundred patients with 119 perforated tympanic membrane, age ranged between 8 to 60 years, 44 males and 56 females were studied. Bilateral tympanic membrane perforation were seen in 19 patients, right sided perforation in 39 and left sided in 42 patients respectively. Large central perforation involving all four quadrants was the most common otologic findings seen in 72 ears (60.50%) whereas perforation in posterosuperior quadrant was the least common finding seen in 3 patients (2.52%). Significant relation is observed between site of perforation and degree of hearing loss; posterior placed perforations seem to have larger hearing loss. Ninety-five perforations (79.83%) showed more loss in low frequencies with larger air bone gap at low frequencies. The longer the duration of ear discharge, the more the hearing loss. Conclusion: The larger the perforation, the greater the decibel loss in sound perception. The location of perforation on the tympanic membrane and the duration of ear discharge have significant effect on the magnitude of hearing loss. Key words: chronic suppurative otitis media, tympanic membrane perforation, hearing lossPublication Surgery for recurrent lower lip carcinoma(Kathmandu University, 2008) Maharjan, S; Bista, M; KC, Toran; Joshi, KDAbstract A 38 year old gentleman presented with recurrent Squamos cell carcinoma of lower lip. He had earlier undergone previous surgeries and radiotherapy. At the time that he presented in KMCTH his lower lip area was much scarred and the tongue was shrunk and unavailable for vermilion reconstruction. This case report is an account of the various treatment carried out to reconstruct the lip. It was done with co-operation of the ENT department. Key words: Recurrent squamous cell carcinoma, Gillies fan ap, Deltopectoral ap, Delay of apsPublication 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, microfloraPublication Use of double-balloon catheter in the management of epistaxis: A boon for the periphery(Kathmandu University, 2010) Bista, M; Baranwal, C; Maharjan, M; Kafle, P; Shrestha, S; KC, ToranAbstract Background: Epistaxis is one of the most commonly encountered emergencies in ENT practise. It has been reported that almost 60% of general population experience epistaxis of small or large quantity in his /her lifetime1. Objective: The objective of this study was to compare the outcome of double ballon catheter to normal packing method for epistaxis. Materials and methods: An interventional study of 30 patients admitted in Kathmandu Medical College, Sinamangal, Kathmandu, Nepal from mid April 2008 to mid April 2009 with bleeding from the nose were taken into study. These patients were analysed on the basis of duration of hospital stay, any related cause for epistaxis, modalities of treatment, success of balloon catheter etc. Result: Results with double-balloon catheter showed less hospital stay and better compliance by the patient. Conclusion: This study highlights that double-balloon catheter has a higher chance of acceptance by the patient and is better in the treatment of epistaxis. This method can be undertaken without anaesthetic assistance thus it is very feasible even in the most remote areas of our nation. Key words: Epistaxis, Double-balloon catheter, Anterior nasal packing, Posterior nasal packing