Browsing by Author "KC, Toran"
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Publication 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 Objective analysis of voice in normal young adults(Kathmandu University, 2009) KC, Toran; Lal, BKAbstract Background: Acoustic vocal parameters measure frequency, intensity (amplitude), perturbation (jitter and shimmer) and dynamic range of the voicing vocal folds. Studies have established that a normal standard data is necessary for acoustic analysis. Objective: The aim of the present study is to standardise Jitter, shimmer, harmonic to noise ratio (HNR) and fundamental frequency (F0) for young adults with normal voice. Materials and methods: Values for acoustic voice measurements were obtained from 50 normal individuals with equal number of sexes, without sign and symptoms of voice problems. The vocal data measurement was performed with Doctor Speech (DRS) Tiger Electronics, USA. Results: Voice analyses were performed with a sustained vowel //i//. The jitter and HNR values were same [1.6 %( ±0.47/±0.43) and 25.8dB (±2.62/±2.72)] for both the genders. For the males, the jitter was 0.14% (±0.02) and 0.16%(±0.04) for female gender. There was a significant difference in the HNR (P=0.000) with 170.05HZ (±32.78) and 246.45HZ (±39.73) respectively for male and female genders. Conclusion: Our results differ from the various literatures; therefore it is important to standardise the program that we use before applying the values for tests designed for a different kind of population. Key words: Acoustic analysis, Perturbation, harmonics to noise ratio, fundamental frequency, standardised voice.Publication Objective voice analysis for vocal polyps following microlaryngeal phonosurgery(Kathmandu University, 2010) KC, Toran; Lal, BKAbstract Background: Vocal polyps are the products of voice overuse, misuse and abuse as the most common causative factors. Treatment generally advised for them are voice therapy and Microlaryngeal Phonosurgery (MLPS). The improved or changed quality of voice is generally assessed perceptually and can cause intra rater variability. In this study we compared and analysed the acoustic characteristics before and after MLPS. Objective: The purpose of the study was to acoustically determine the changes in voice quality of a group of patients before and after the surgery. Material and methods: The following patients group were studied prior to and in between 3 and 4 weeks of surgery. Altogether there were 23 patients with either unilateral or bilateral vocal polyps. Voice recording and analysis were performed with Dr. Speech acoustic software (Tiger electronics, USA). The parameters analyzed were in terms of perturbation (Jitter and shimmer), harmonic-to-noise ratio (HNR) and fundamental frequency (F0 ). Results: The results showed that shimmer, HNR and F0 decreased significantly (p<0.05) following MLPS, but jitter though reduced, was not statistically significant (p=0.694). Conclusion: The acoustic output generally improved after MLPS as evidenced by decreased values of all the four acoustic parameters. The study also stress that voice quality can be improved through the phonosurgical procedures. This multidimensional voice analysis can be very helpful in our ability to provide objective clinical analysis of voices with vocal polyps, and following their surgical treatment. Key words: Acoustic analysis, Vocal polyps, Micro-laryngeal phonosurgeryPublication 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 Successes rate of endoscopic dacryocystorhinostomy at KMC(Kathmandu University, 2010) Shrestha, S; Kafle, PK; Pokhrel, S; Maharjan, M; KC, ToranAbstract Background: Nasolacrimal duct obstruction is a common problem which can be corrected by dacryocystorhinostomy (DCR). The gold standard treatment for this is DCR operation through an external approach. Development of endoscopic sinus surgery and endoscopic DCR performed through intranasal route is a major recent development in this field. Objectives: The aim of this study is to find out the success rate of endoscopic dacryocystorhinostomy without silicon stent intubation within the period of six month following surgery. Materials and methods: A prospective study was done on 26 patients with obstruction of the nasolacrimal duct referred from eye out-patient department to ENT OPD during one year period from 2008 to 2009. All the cases had undergone endoscopic DCR operation which was regularly followed up for a period of six months. Postoperative patency of ostium was checked by sac syringing and endoscopic visualisation of ostium in the nasal cavity. The success of surgery was categorised as: complete cure, partial cure and no improvement depending upon symptomatic relief and clinical examination such as sac syringing and endoscopic examination following surgery. Result: In six months’ follow-up, 22 (84.5%) out of 26 patients had achieved the complete cure and 4 patients (15.5%) continued to have persistent epiphora. Conclusion: Endoscopic DCR is a beneficial procedure for nasolacrimal duct obstruction with no external scar on face and less bleeding. The success rate is as good as external DCR. Key words: Nasolacrimal duct, Epiphora, Rigid nasal endoscope, Endoscopic DacryocystorhinostomyPublication 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