Browsing by Author "Gurung, U"
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Publication Audit on elective surgery waiting list in the department of ENT- Head and Neck Surgery in a tertiary care center(Institute of Medicine, 2018) Tripathi, P; Gurung, U; Shrestha, AAbstract Introduction: Patients needing surgical treatment for benign conditions are listed on first come first served basis in the department of ENT- Head and Neck Surgery (ENT-HNS), Tribhuvan University Teaching Hospital, Kathmandu, Nepal. The objective of this audit was to determine the average waiting period for elective surgery in various subspecialty units of the department and the patient turn up rate on the scheduled date. Methods: This was a retrospective audit based on the elective surgical waiting list register of year 2073 B.S. of four subspecialties in the department; namely unit I-Otology, Unit II- Head & Neck surgery, Unit III - Pediatric ENT and Unit IV- Rhinology Results: The overall average waiting period for elective surgery was 10.6 weeks. For GA cases it was 10.4 weeks for unit I and II, 13.2 and 8.3 weeks for unit III and IV respectively. For LA cases, waiting period in unit I and IV was 16.9 and 2.5 weeks respectively. The overall turn up rate on the scheduled contact date was 40.8% (46% for GA cases and 31% for LA cases). For unit I, it was 50% for GA cases and 26.6% for LA cases. For unit II and unit III GA cases, turn up rate was 38.4% and 43.8% respectively. In unit IV, it was 53.3% for GA cases and 66% for LA cases. Conclusion: The patient turn up rate on contact date in general decreased with longer waiting period for elective surgery. Key Words: Elective surgery, ENT, waiting listPublication Changes in Clinical Practice amongst Nepalese Otolaryngologists during COVID-19 Pandemic(Kathmandu University, 2022) Tripathi, P; Gurung, U; Baidya, S; Thapa, NABSTRACT Background COVID-19 pandemic changed clinical practices more so for otolaryngologists due to inevitable risk of exposure. Objective To assess the changes in the clinical practice among Nepalese otolaryngologists during this pandemic. Method It was an observational study conducted as an online survey in the first two weeks of December 2020. A questionnaire pertaining to changes in clinical practice was mailed to 190 registered otolaryngologists working in various provinces of Nepal. Data were entered in Microsoft Excel 2007 and analysed in percentages. Result Out of the 77 (40.5%) who responded, nearly 50% resumed clinical practice after a month of national lockdown restarting everyday consultation by 64.9% mostly in hospital setting (81.8%) after screening patients via fever clinic by 87%. Modifications in clinical examinations was mostly done for neck (85.7%), oral cavity (44.2%) and nose (29.8%) examination with least with for ear examination (3.9%) Regular endoscopic evaluation was avoided by 19.4%. Only around 57% used adequate personal protective equipment. There was 93.5% reduction in elective operations. Mandatory COVID test was done by 89.6% mostly with reverse transcriptase polymerase chain reaction (95.9%) prior to semi-urgent case. Conclusion Changes in clinical practice were adapted to mitigate viral transmission. The changes were evident in the outpatient department where most patients were screened for fever and modifications made in the clinical examinations. Personal protective equipments were worn when available. Operative lists were limited to semi-urgent and urgent cases with covid testing customarily done for semi-urgent cases. KEY WORDS Aerosols, COVID-19, Otolaryngologists, PandemicPublication Chondrosarcoma of Posterior Nasal Septum(Kathmandu University, 2012) Gurung, U; Joy, L; Thapa, NM; Pradhan, BABSTRACT Chondrosarcoma is a rare non-epithelial tumor comprising of 10-20% of primary bone tumor. The nasal septum is a rare site for its occurrence. We present one such case of chondrosarcoma of the nasal septum who was treated with endoscopic removal followed by post operative radiotherapy and discuss the relevant clinical presentation, diagnosis and treatment and review the literature also. KEYWORDS chondrosarcoma, excision, nasal septumPublication Comparison of Outcomes of Conventional Septoplasty Versus Endoscopic Septoplasty using Freer’s Incision in Symptomatic Deviated Nasal Septum(Kathmandu University, 2021) Khadgi, S; Gurung, U; Pradhan, B; Tripathi, PABSTRACT Background Septoplasty techniques have evolved over the years with endoscopic septoplasty gaining popularity in the recent times. Objective To compare the outcomes of conventional septoplasty with endoscopic septoplasty using Freer’s incision in symptomatic deviated nasal septum. Method It was a prospective, randomized and comparative study done at Department of ENT- Head and Neck Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal from July 2018 to August 2019. A total of 70 patients with symptomatic deviated nasal septum were allocated randomly into two groups. Group A underwent conventional septoplasty whilst Group B underwent endoscopic septoplasty using Freer’s incision. Sino-nasal outcome test (SNOT-10) score was recorded pre-operatively and post -operatively between four to six weeks of surgery. Paired and independent ‘t’ test for mean was used as a statistical tool. Result Out of 70 patients, 57(81.43%) were males and 13(18.57%) females. The age group mostly affected was in the third and fourth decades with total 47 patients (67.14%). In the conventional group, the pre-op mean SNOT-10 score was 11.46 (SD±3.6) while post-op mean SNOT-10 score was 2.60 (SD±1.9), the difference being statistically significant (p value 0.00001). Similarly, in the endoscopic group, pre-op mean SNOT- 10 score was 12.06 (SD±4.88) and post-op mean SNOT- 10 score was 3.37 (SD±2.71) with the difference being statistically significant (p value 0.00001). Comparison of post-operative mean SNOT-10 score between two techniques was not statistically significant (p value 0.17). Conclusion Both conventional and endoscopic septoplasty techniques using Freer’s incision were equally effective in improving symptoms due to deviated nasal septum. KEY WORDS Conventional septoplasty, Deviated nasal septum, Endoscopic septoplasty, Freer’s incisionPublication Does stenting improve the surgical outcome of Endoscopic Dacryocystorhinostomy? A prospective randomized study(Institute of Medicine, 2018) Gurung, U; Rauniyar, N; Pradhan, B; Thapa, NAbstract Introduction: The objective of this study was to compare the surgical outcome of endoscopic dacyrocystorhinostomy with or without stenting. It was a prospective, randomized study conductedfrom October 2011 to September 2013. Ganesh Man Singh Memorial Academy for ENT-Head and Neck Studies,Tribhuvan University Teaching Hospital, Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal. Methods: Patients aged 15 years and above of all genders with primary acquired nasolacrimal duct obstruction (PANDO) were included in the study. Forty patients were randomly allocated into two groups, 20 each in Endoscopic Dacyrocystorhinostomy with stenting (EwS) and Endoscopic Dacyrocystorhinostomy without stenting (EoS). Post-operative assessment was done at 8 weeks. In the subjective assessment using with 5-point Likert Scale of degree of epiphora, a score of 1,2 or 3 was considered a success. Objective assessment with syringing and endoscopic evaluation of patency of rhinostome considered patent and partly patent lacrimal system on syringing and patent rhinostome as success. Results: Both the subjective and objectivesuccess rate was 95% in EwS and 90% in EoS.However, there was no significant statistical difference between the two groups (p value =1.00). Conclusion: The success rate of EwS was comparable to that of EoS with no added benefit in our study. In addition, EoS avoided the complications associated with stenting. So, we recommend EoS for PANDO. Keywords: Endoscopic Dacryocystorhinostomy, Primary acquired nasolacrimal duct obstruction, silicon stentPublication Meckel’s cave and bilateral internal auditory canal metastasis of adenocarcinoma of unknown primary(Institute of Medicine, 2017) Gurung, U; Tse, A; Corbridge, RAbstract Adenocarcinoma of unknown primary presenting as metastasis to Meckel’s cave and bilateral internal auditory canals is rare. We report a case of a 65-year-old chronic smoker presenting with ontological symptoms and trigeminal neuralgia who, on neuroimaging, revealed metastatic deposits to bilateral internal auditory meatus (IAM) and also Meckel’s cave.Publication Nasolabial cyst: Clinical presentation and surgical outcome of 14 cases with literature review(Institute of Medicine, 2017) Gurung, U; Tamang, N; Tripathi, PAbstract Introduction: Nasolabial cyst is a rare, developmental, non-odontogenic cyst in the nasal alar region. The study aimed to assess the clinical characteristics, intra-operative findings, complications and recurrence following sublabial excision of nasolabial cyst and review the related literature. Methods: It was a retrospective chart review of 14 cases of nasolabial cysts who underwent excision via sublabial approach in a tertiary center from December 2014 to May 2017. The data on clinical characteristics, intra-operative findings, complications and recurrence were assessed. Results: Fourteen patients consisted of 9 females and 5 males. The age ranged from 22 to 73 years. Alar fullness was common presentation for all while 3 patients had associated pain. Two patients noted nasal obstruction. The cyst was located on left in 8 and on right side in 6 patients. The size ranged from 1.5 x1.5 to 4 x 4 cm2. All patients had the cyst excised totally via sublabial approach. Post-operatively, 8 patients developed cheek swelling which subsided within 2 weeks. None of the patients had gingival or tooth numbness or wound gape. There was no recurrence noted in follow up ranging from 3 to 30 months. Conclusions: Nasolabial cyst is a slow growing, unilateral cyst in the nasal alar region, common in female in the fourth and fifth decade. Sublabial excision is the standard treatment with no recurrence however it has risk of intra-operative rupture of cyst and complications like cheek swelling, bruising, facial pain, facial numbness, numbness of teeth or gingiva. Transnasal endoscopic marsupialization is a new treatment modality. Keywords: Nasolabial cyst, rare, sublabial excision, transnasal endoscopic marsupialization