Browsing by Author "Rayamajhi, P"
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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 Defensible record keeping(Institute of Medicine, 2007) Rayamajhi, P; Guragain, RPSAbstract Background: This retrospective study was conducted by the department of ENT and Head & Neck Surgery, TU Teaching Hospital to evaluate the maintainance of records of the inpatients in TU Teaching Hospital. The rolling audit was performed to evaluate the implementation of the recommendations made. Material and Methods: Total of twenty files from each of the eight departments with the inpatient wards was reviewed retrospectively on January 2004. Similarly, other twenty files from each department were studied for the rolling audit on October 2006. The notes were reviewed for completeness and inclusion of the criteria as laid down in the protocol by the Royal College of Surgeon. Results: The admission notes were adequately filled in the department of Psychiatry. The progress notes were adequately filled in the department of Psychiatry and ENT-HNS. The investigation form filling was comparable in all the departments. The discharge summaries were complete and understandable in the department of Psychiatry followed by ENT-HNS. Significant improvement was seen in the department of Obstetrics and Gynecology during the rolling audit. Conclusion: The rolling audit can be done every 6 month to assess the maintainance of the records and the implementation of the recommendations. Keywords: Audit, Defensible record keeping, Royal College of SurgeonsPublication Short term hearing results in patients with otosclerosis after stapedotomy in a tertiary care center(Institute of Medicine, 2018) Rayamajhi, P; Rauniyar, NAbstract Introduction: Stapedotomy done for otosclerosis is one of the finest middle ear surgery and needs great expertise. The present study is done to evaluate the short-term hearing results in patients with otosclerosis and treated with primary stapedotomy. Methods: A retrospective chart review of patients after stapedotomy surgery was done from April 2011 to October 2016. Stapedotomy was performed under local anesthesiausing a Teflon piston under local anesthesia. The patients were followed up after 6 weeks for the assessment of the hearing status. The hearing assessment was done using the Air Bone gap improvement and Air Bone gap closure (AB gap closure) pre and postoperatively. Results: Total of 73 cases were retrieved from hospital database. 3 cases were excluded and analysis of only 70 cases was done. Among the total patients 85.71% of the patients had bilateral involvement of the disease. The overall mean pre-operative pure tone Air conduction average was 55.66 dB, SD 11.576 (95% CI; 52.57-59212), while the overall mean post -operative pure tone average was 17.63 dB, SD 11.958 (95% CI; 14.70-21.57). This difference was found to be statistically significant (p = 0.000). The overall mean pre-operative air bone gap was 37.65 dB and the overall mean post -operative air bone gap was 18.47dB. This difference was found to be statistically significant (p = 0.000). Conclusion:This study confirms that stapedotomy for clinical otosclerosis is a safe and successful treatment for short-term hearing improvement. Both the AC threshold and AB gap closure showed significant improvement postoperatively. Key Words:otosclerosis, stapedotomy, air-bone gap, air conduction threshold, air bone gap closure, pure tone audiogram