NepMed Repository :: Browsing by Author "Gyawali, Bigyan R"

Browsing by Author "Gyawali, Bigyan R"

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Comparison of Round Window Anatomy between Pediatric and Adult Population: A Perspective from Cochlear Implantation Surgery
(Institute of Medicine, 2020) Pradhananga, Rabindra B; Gyawali, Bigyan R; Rayamajhi, Pabina
ABSTRACT Introduction: The round window is thought to be an ideal port for inserting electrodes during cochlear implantation. Considering its complex anatomy with an individual variation, this study aims to review the anatomy of round window based on the visibility of round window niche and round window membrane via posterior tympanotomy in pediatric and adult population who underwent cochlear implantation. Methods: This was a retrospective observational study conducted at the Department of ENT-HNS, Institute of Medicine, Kathmandu, Nepal. Surgical notes of adult (>15 years) and pediatric cases (<15years) who underwent primary cochlear implantation from January 2015 to January 2018 were assessed for different grading of round window niche and round window membrane visibility via posterior tympanotomy. Cases with revision surgery and with incomplete documentation of intra-operative findings were excluded from the study. Statistical analysis was done using SPSS software version 25. We used Chi-square and Fisher’s exact tests to analyze the statistical association. Results: Type B round window niche (partially visible) was the most common variant seen in the pediatric group while in adults, both Type B (partially visible) and Type C (fully visible) round window niche were common. Compared to the adults, the pediatric group had good visibility of RWM. However, there was no statistical association between these observations. Conclusion: The round window has a wide range of anatomical variations with different levels of visibility of RWN and RWM in the different age groups. Although statistically insignificant, RWM visibility seemed to be better in pediatric cases compared to adults. Keywords: Anatomical variation, cochlear implantation, round window
Microbiological Profile and Drug Sensitivity Pattern in Persistently Discharging Ears: A Tertiary Level Hospital Based Retrospective Study
(Institute of Medicine, 2020) Gyawali, Bigyan R; Pradhanaga, Rabindra B; Rayamjhi, Pabina; Dongol, Kripa; Gupta, Mudit; Shrestha, Lava; Acharya, Kunjan
ABSTRACT Introduction: Antimicrobial resistance is an emerging issue resulting from the misuse of antibiotics in today’s world. As an effect of it, cases with persistent ear discharge not responding to the conventional oral antibiotics prescribed in ear pathologies are seen increasing in our day to-day practice. This study aims to review the microbiological growth and the pattern of their antibiotic sensitivity in this group of population. Methods: This was a retrospective study which was conducted at the Department of ENT-HNS of Tribhuvan University Teaching Hospital. Record files of all cases who presented with persistently discharging ear for more than 2 weeks and not responding to oral antibiotics, between January 2017 to March 2020 were assessed. Cases of chronic otitis media (COM) squamous with persistent discharge were excluded as most of the times it is the disease process rather than type of organism which causes the persistence of ear discharge despite the use of antibiotics. Results: COM mucosal and cavity infection following modified radical mastoidectomy (MRM) were the commonest pathologies. Pseudomonas aeruginosa (PA) and Coagulase negative Staphylococcus (CoNS) were the commonest bacterial isolates. Pseudomonas aeruginosa showed a good sensitivity to antibiotics like Tazobactam and Piperacillin and resistance to conventionally used antibiotics like Ciprofloxacin and Levofloxacin. Similarly, CoNS had good sensitivity to antibiotics like Oxacillin and Levofloxacin and resistance to conventionally used antibiotics like Amoxicillin. Conclusion: COM mucosal and post MRM cavity infection are the commonest pathologies presenting with persistent ear discharge with PA and CoNS as the predominant isolates. Pseudomonas aeruginosa holds a good sensitivity to drugs like Tazobactam and Piperacillin; and CoNS to drugs like Oxacillin and Levofloxacin. Keywords: Drug sensitivity, ear discharge, microbiological, persistent
Outcomes of Children Presenting with Button Battery in Esophagus: A Retrospective Review
(Institute of Medicine, 2020) Gyawali, Bigyan R; Guragain, Rajendra P Sharma; Neupane, Yogesh; Dutta, Heempali; Shrestha, Lava; Pradhananga, Rabindra B
ABSTRACT Introduction: Foreign body in esophagus is a common ENT emergency. Button batteries tend to have more grievous outcomes due to caustic mucosal injury to the esophagus. The objective of our study was to review the clinical profile and outcomes of the paediatric population in our center who presented with button battery in esophagus following accidental ingestion. Methods: This was a retrospective study conducted in Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Hospital records of all the patients who presented with button battery esophagus and underwent rigid oesophagoscopic removal from January 2013 to January 2019 were reviewed and analyzed for patient demographics, time interval between ingestion and presentation, site of impaction, status of oesophageal mucosa at the time of rigid oesophagoscopic removal of the battery, early post-operative complications, outcomes at the time of discharge and on follow-up. Results: Our final sample size was 11 and all cases were <15 years. The average duration from time of ingestion to presentation to our hospital ranged from 1 day to 2 months. Variable oesophageal mucosal findings such as superficial mucosal erosion, superficial ulcer with slough and granulations with deep discrete ulcer were seen at the site of impaction of the button battery. One case was diagnosed with bilateral abductor palsy on 10th post-operative day following rigid oesophagoscopic removal of the battery. All other cases didn’t develop any significant complications. Conclusion: Button battery in esophagus results in oesophageal ulceration and thus warrants an early endoscopic removal. Delayed removal can also cause bilateral abductor palsy from the caustic damage to recurrent laryngeal nerve. Keywords: Alkaline button battery, esophagus, rigid oesophagoscopy
Thyroglossal Duct Fistula with an Unusual Presentation: A Case Report
(Institute of Medicine, 2019) Gyawali, Bigyan R; Dutta, Heempali; Tripathi, Prashant
ABSTRACT Thyroglossal duct anomaly is one of the commonest congenital anomalies with midline neck manifestation. Though commonest location mentioned in the literature is thyrohyoid, several rare presentations have also been described. Here, we present a very rare case of thyroglossal fistula manifesting in submental region. Keywords:Fistula, submental, thyroglossal duct

Browsing by Author "Gyawali, Bigyan R"

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