Browsing by Author "Rayamajhi, Pabina"
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Publication Comparison of Cognition between Elderly with Sensorineural Hearing Loss and Normal Hearing for Age(Institute of Medicine, 2022) Gurung, Bikash; Rayamajhi, Pabina; Dutta, Heempali DasABSTRACT Introduction: Age related hearing loss starts at mid to late adulthood. With ageing, cognitive ability also declines. The aims of this study were to assess, compare and correlate cognition of elderly people having bilateral moderate to profound sensorineural hearing loss with the population of normal hearing for age. Methods: This observational analytical study included 25 elderly participants between 55 to 75 years of age in each group; Hearing loss Group with moderate to profound sensorineural hearing loss and Normal hearing Group with normal hearing. Based on pure tone audiometry, hearing loss was classified into moderate (41-60 dB), severe (61-80 dB) and profound (81 and above). Cognition status was assessed using a Nepali version of Mini-mental state examination and classified into no cognitive impairment, mild cognitive impairment and severe cognitive impairment. Comparison and correlation of the cognitive impairment was done between the groups. Results: In Hearing loss Group, 8 (32%) participants and in Normal Hearing Group, 3 (12%) participants had mild cognitive impairment. Means of total Mini-mental state examination scores between the two groups had statistically significant difference (p=0.02) but no significant correlation (Kendall tau b =0.20) between age related hearing loss and cognitive impairment was found. Conclusion: Though cognitive impairment was found more in participants with age related hearing loss, there was no correlation between age related hearing loss and cognitive impairment. Keywords: Age-related hearing loss, cognitive impairment, mini-mental state examinationPublication Comparison of Graft Uptake and Postoperative Hearing Results between Butterfly-Cartilage and Temporalis-Fascia Myringoplasty(Institute of Medicine, 2020) Sah, Amiya K; Rayamajhi, Pabina; Bhattarai, HariABSTRACT Introduction: Myringoplasty is one of the commonest surgeries done in Otology for chronic otitis media- mucosal type (COM-mucosal type). The objective of this study was to compare the graft uptake and post-operative hearing status between butterfly-cartilage and temporalis-fascia myringoplasty. Methods: Patients of age ≥15 years with COM-mucosal type with dry, small to medium sized central perforation of pars tensa with clearly visible perforation margin were randomized into two groups of butterfly-cartilage myringoplasty and temporalis-fascia myringoplasty. Graft uptake and hearing results were assessed after six weeks and results were compared within and between the groups. Results: Thirty-one patients in butterfly cartilage group and twenty-nine patients in temporalis fascia group were analysed. Graft uptake rate was 93.5% (29/31) in butterfly group and it was 86.2% (25/29) in temporalis fascia group with no statistically significant difference (p= 0.34) between the two groups. The mean pre and post-operative air bone gap in butterfly cartilage group were 20.65dB±8.35 dB; 12.86dB±7.39dB and that in the temporalis fascia group were 19.72±6.14dB, 13.16dB±6.26dB respectively. The difference of preoperative and postoperative hearing status, obtained within the two groups was statistically highly significant (p< 0.001). However, there was no statistically significant difference in hearing results between the two groups (p= 0.54). Conclusion: The graft uptake rate and hearing results of butterfly-cartilage group and temporalis-fascia group were statistically significant within the group after myringoplasty but there was no statistically significant difference in between the two methods. Keywords: Air bone gap, air conduction threshold, butterfly cartilage, myringoplastyPublication 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, PabinaABSTRACT 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 windowPublication Congenital Cholesteatoma in a Case of Congenital Aural Atresia: A Case Report(Nepal Medical Association, 2020) Aggarwal, Poonam; Rayamajhi, PabinaAbstract: Congenital external canal atresia is one of the congenital ear anomalies that can occur in patients. Similarly, congenital cholesteatoma is also another congenital disease that is often diagnosed in early adulthood. Both the above-mentioned diseases can occur independently but the presence of both these entities is a rare occurrence and needs a high degree of suspicion aided by a computed tomography scan to make the diagnosis. We are presenting a case of a sixteen-year-old patient who presented with unilateral ear anomaly, earache, facial palsy, and postaural swelling and was diagnosed as a right sided congenital aural atresia with congenital cholesteatoma. He was surgically managed with right-sided modified radical mastoidectomy with canaloplasty and closure of mastoid fistula under general anesthesia.Publication Correlation of Status of Mastoid with Outcomes of Myringoplasty with Cortical Mastoidectomy in Mucosal Otitis Media with High Risk Perforation(Institute of Medicine, 2021) Shrestha, Asmita; Bhattarai, Hari; Rayamajhi, Pabina; Pradhananga, Rabindra BABSTRACT Introduction: Chronic mucosal otitis media is one of the common disease prevalent in our society. This study was done to correlate the status of mastoid with outcomes of myringoplasty with cortical mastoidectomy in mucosal otitis media with high risk perforation. Methods: This prospective, observational study was done at Department of Otorhinolaryngology and Head and Neck Surgery, Tribhuvan University Teaching Hospital. Thirty-four patients of ag|e 15 and above with chronic mucosal otitis media having high-risk perforation undergoing cortical mastoidectomy with myringoplasty were included. The status of middle ear, aditus, and mastoid air cells were assessed. Post-operatively, patients were assessed for graft uptake and hearing after three months. The post-operative graft uptake and hearing results were correlated with the peroperative status. Four patients who had preoperative sensorineural hearing loss were studied in terms of graft uptake only. Results: The graft success rate in patients with normal mastoid air cells was 90% whereas in diseased cases was 71.4% which was statistically not significant with p value 0.20. The success rate in terms of hearing was 68.8% in normal mastoid whereas it was 64.3% in diseased mastoid which was statistically not significant with p-value of 1. Conclusion: In correlation with the status of mastoid air cells with graft uptake and hearing result, the observed differences were not statistically significant. However, averages of post-operative air conduction threshold and air-bone gap of all cases were better as compared to preoperative levels. Keywords: Chronic mucosal otitis media, cortical mastoidectomy, high-risk perforationPublication Outcome of Endoscopic Sphenopalatine Artery Cauterization for Posterior Epistaxis(Institute of Medicine, 2019) Kharel, Bijaya; Gurung, Urmila; Tripathi, Prashant; Rayamajhi, Pabina; Silwal, PriyanshaABSTRACT Introduction Epistaxis is a common otorhinolaryngology emergency condition. Majority of it is anterior epistaxis which usually improves with conservative management. However, for posterior epistaxis, apart from posterior nasal packing, endoscopic sphenopalatine artery cauterization (ESPAC) is considered an effective measure for its control. Hence, this study was conducted to evaluate the outcome of endoscopic sphenopalatine artery cauterization for posterior epistaxis. Methods Retrospective medical chart review of patients who underwent endoscopic sphenopalatine artery cauterization for posterior epistaxis from January to December 2018 at Ganesh Man Singh Memorial Academy of ENT-Head & Neck Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Results A total of 31 patients (21 males and 10 females) underwent ESPAC during the one-year period. Twenty-seven of them were unilateral whilst four were bilateral. Four of them rebled, of which two bled within 48 hours and the remaining two after two months. The overall success rate of ESPAC was 87.1% (27/31). Conclusion Endoscopic sphenopalatine artery cauterization is an effective measure to control posterior epistaxis. Keywords: Endoscopy, epistaxis, nasal packing, sphenopalatine artery cauterizationPublication Relationship Between Ossicular Chain Erosion and Facial Canal Dehiscence in Chronic Otitis Media Squamous(Institute of Medicine, 2020) Kharel, Bijaya; Shreepaili, Ashok; Tripathi,Prashant; Neupane, Yogesh; Gurung, Urmila; Pradhananga, Rabindra B; Rayamajhi, Pabina; Bhattarai, HariABSTRACT Introduction: Chronic otitis media squamous is a gradually expanding destructive lesion and leads to complications by eroding the adjacent structures. Facial canal and ossicles are in close proximity in the middle ear space and they share the same pathogenesis of the bony erosion. Ossicular chain erosion found intraoperatively due to cholesteatoma, may suggest the likelihood of facial canal dehiscence. This study was conducted to assess the relationship between ossicular chain erosion and facial canal dehiscence in chronic otitis media squamous. Methods: It is a retrospective chart review of patients who had mastoidectomy done for chronic otitis media squamous in Tribhuvan University Teaching Hospital from January 2014 to December 2018. The operative findings of facial canal dehiscence were correlated with ossicular chain status. Results: Among 158 cases, facial canal dehiscence was seen in 20 (12.7%), of which, 19/20 (95%) had ossicular erosion. Majority (90%) of dehiscence was in the horizontal segment. Incus was the most common ossicle to be eroded. Among the ossicles, stapes erosion was related to the facial canal dehiscence with odds ratio of 3.216 (1.235-8.374) and p-value 0.03. Conclusion: Among the ossicles, there is a relationship between the stapes erosion and the facial canal dehiscence in chronic otitis squamous. Erosion of ossicular chain especially stapes should alert surgeons towards the possibility of facial canal dehiscence. Keywords: Chronic otitis media squamous, facial canal, ossicular erosion