Browsing by Author "Shrestha, BL"
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Publication Analysis of Ear, Nose and Throat Foreign Bodies in Dhulikhel Hospital(Kathmandu University, 2012) Shrestha, I; Shrestha, BL; Amatya, RCMABSTRACT Background Foreign body in ear nose and throat are commonly encountered by otolaryngologists, pediatricians and primary care physicians. Objective The aim of this study is to analyze different types of foreign bodies and socio- demographic correlates of self-inflicted foreign body insertion in ear–nose–throat. Method This was a two year hospital based cross sectional descriptive study performed in the Department of ear nose and throat (ENT), Dhulikhel Hospital - Kathmandu University from June 2009 to June 2011 after verification from the Institutional Review Committee. Using a predesigned questionnaire, socio-demographic data was collected prospectively by examining clinically all patients attending with foreign body and interviewing the caregivers of pediatric patients after removal of foreign body. The data collected from 312 patients was entered and analyzed by using descriptive and analytical statistical methods using SPSS version 16.0. Results The mean age was 21.26 years with majority between 0-10 years (50.6%). Male predominance was noted (58.97%). Most patients or caregivers were illiterate (35.1%) or literacy up to primary level(21.12%).Foreign body of the ear was found to be most frequent ( 47.4%) and mostly they were non-living (96.1%). Most patients presented late (80%) and had history of prior attempted removal (67%). Pearsons chi square test between education level and duration of time was significant (p value- 0.0000). One way ANOVA test between type of foreign body and age was significant (p value- 0.001). Conclusion Foreign bodies are common in adult and pediatric ear, nose and throat. They can potentially be associated with significant complications if not taken care of immediately. KEY WORDS Foreign body, inorganic, living, non- living, organicPublication Clinicoradiologic Evaluation of Eagle’s Syndrome and its Management(Kathmandu University, 2013) Pokharel, M; Karki, S; Shrestha, I; Shrestha, BL; Khanal, K; Amatya, RCMABSTRACT Background Eagle’s syndrome (Elongated styloid process) is often misdiagnosed due to its vague symptomatology. The diagnosis relies on detail history taking, palpation of styloid process in tonsillar fossa and imaging modalities. Objective To assess the length and medial angulation of elongated styloid process with the help of three dimensional computed tomography (3D CT) scan and to describe our clinical and surgical experience with patients suffering from Eagle’s syndrome. Method Prospective, analytical study conducted from August 2011 to August 2012 among 39 patients with Eagle’s syndrome. Detailed history taking, clinical examination and 3D CT scan was performed. Length and medial angulation was calculated. Patients with styloid process length longer than 2.50 cm underwent surgical excision via intraoral approach. Medial angulation of styloid process on both sides was correlated with each other using rank correlation coefficient. Wilcoxon Signed Rank test was applied to test significant difference between pre-operative and post- operative symptoms scores. Result Significant positive correlation was found between the medial angulation of styloid process on right side and left side (ρ =0.81, p<0.001). Significant difference was also observed between pre and post-operative symptoms scores (z=-5.16, p<0.001) . Conclusion Possibility of Eagle’s syndrome should always be considered while examining patients with vague neck pain. 3D CT reconstruction is a gold standard investigation which helps in studying the relation of styloid process with surrounding structures along with accurate measurement of its length and medial angulation. KEY WORDS Eagle’s syndrome, elongated styloid process, three dimensional computed tomographyPublication Comparison of clinical presentation between Chronic Otitis Media Mucosal with Squamous.(Kathmandu University, 2010) Shrestha, BL; Shrestha, I; Amatya, RCABSTRACT Background Chronic otitis media is a chronic inflammatory disease of the middle ear cleft which is manifested as deafness and ear discharge. It is a common condition affecting 0.5 – 30% of any community worldwide, and most common in developing countries. The prevalence mainly depends on age, low socio-economic status, overcrowding and limited medical facilities. Objective To compare the clinical presentation between chronic otitis media mucosal with squamous types. Methods A prospective, longitudinal and analytical study performed among 200 patients who have features of chronic otitis media and were attended to in the ear, nose and throat outpatient department of Dhulikhel Hospital - Kathmandu University Hospital, Dhulikhel, Nepal from January 2010 to January 2011. Patients who had already undergone surgery and came back to the hospital, with inadequate information were excluded from the study. Results The results showed that, out of 200 cases, 120 (60%) were chronic otitis media- mucosal and 80 (40%) were chronic otitis media – squamous. Patients < 30 years were affected in both groups. The male to female ratio in chronic otitis media mucosal was 1.14:1, whereas in chronic otitis media squamous, it was 1.96:1. Similarly in etiological factors, oil and water exposure (76%) was the most common cause in chronic otitis media mucosal, whereas in chronic otitis media squamous, oil and water exposure (62.5%) and recurrent upper respiratory tract infection (62.5%) were the most common causes. Of all the clinical features, ear discharge was the leading feature in both chronic otitis media mucosal (98%) and squamous (100%) cases. The complications were mainly seen in the chronic otitis media squamous and the most common complication was mastoid abscess (5%). Conclusions The frequency of chronic otitis media is higher in the younger age group and those lacking in health education. As a result, it is important to disseminate the health education regarding the ear disease which will help in decreasing the frequency of the disease in developing countries like ours. Key Words chronic otitis media, mastoid abscess, upper respiratory tract infectionPublication Comparison of Ketamine, Fentanyl and Clonidine as an Adjuvant During Bupivacaine Caudal Anaesthesia in Paediatric Patients(Kathmandu University, 2012) Singh, J; Shah, RS; Vaidya, N; Mahato, PK; Shrestha, S; Shrestha, BLABSTRACT Background Caudal epidural analgesia with bupivacaine is very popular in paediatric anaesthesia for providing intra- and postoperative analgesia. Several adjuvants have been used to prolong the action of bupivacaine. Objectives To compare the efficacy of ketamine, fentanyl and clonidine in terms of quality and duration of analgesia they produce when added with caudal bupivacaine by single shot technique in children. Methods Eighty children, age one to ten years, undergoing sub-umbilical surgery, were prospectively randomized to one of four groups: caudal analgesia with 0.75 ml/ kg of 0.25% bupivacaine in normal saline (Group B) or caudal analgesia with 0.75 ml/kg of 0.25% bupivacaine with 1 μg/kg of clonidine in normal saline (Group BC) or caudal analgesia with 0.75ml/kg of 0.25% bupivacaine with ketamine 0.5mg/kg (Group BK) or caudal analgesia with 0.75ml/kg of 0.25% bupivacaine with fentanyl 1mcg/kg (Group BF). Post-operative pain was assessed for 24 hours using the FLACC scale. Results The mean duration of analgesia was significantly longer in Group BC (629.06 ± 286.32 min) than other three groups P < 0.05. The pain score assessed using FLACC scale was compared between the four groups, and children in Group BC had lower pain scores, which was statistically significant. The requirement of rescue medicine was lesser in Group BC. Clonidine in a dose of 1 μg/kg added to 0.25% bupivacaine for caudal analgesia, during sub-umbilical surgeries, prolongs the duration of analgesia of bupivacaine, without any side effects in compare to fentanyl or ketamine. Conclusion We conclude that clonidine in a dose of 1 μg/kg, added to 0.25% bupivacaine for caudal analgesia and administered as a 0.75 ml/kg mixture in children, for sub- umbilical surgery, significantly prolongs the duration of post-operative analgesia when compared to 0.75 ml/kg of 0.25% bupivacaine in normal saline than 0.75 ml/kg of 0.25% bupivacaine with ketamine 0.5 mg/kg or 0.75 ml/kg of 0.25% bupivacaine with fentanyl 1 mcg/kg or 0.75 ml/kg of 0.25% bupivacaine alone, without any side effects. KEY WORDS Bupivacaine, caudal analgesia, clonidine, fentanyl, ketamine, post-operative analgesia, sub-umbilical surgeryPublication Correlations Between Symptoms, Nasal Endoscopy Computed Tomography and Surgical Findings in Patients with Chronic Rhinosinusitis(Kathmandu University, 2013) Pokharel, M; Karki, S; Shrestha, BL; Shrestha, I; Amatya, RCMABSTRACT Background Although Chronic rhinosinusitis (CRS) is increasing in prevalence and incidence, its diagnosis and treatment still pose a challenge. The Task Force on rhinosinusitis (TFR) advocates the use of symptom based criteria. However, many otorhinolaryngologists depend on diagnostic nasal endoscopy and computed tomography(CT) of paranasal sinuses for diagnosis of CRS. Computed tomography has been extensively relied upon in confirming the presence of CRS, in assessing severity of disease, surgical planning and management decisions. Despite its widespread use, several studies have failed to correlate findings on CT with symptom severity. Objective To determine the correlations between symptoms described at presentation, radiological findings, endoscopy and extensiveness of surgery. Methods Longitudinal, prospective, analytical study conducted from August 2011 to August 2012 among 87 patients diagnosed as CRS according to the TFR criteria. Symptom, endoscopic, radiological and surgical scoring was done by using Lund and Mackay staging system. Pearson correlation coefficients between scores for symptoms, endoscopy, sinus CT and surgery was determined. Results When overall symptom score was correlated with radiological score and endoscopy score, it was found to be statistically significant (p= <0.01). However, no significant relationship was found between Lund and Mackay symptom and surgery score. Conclusion The symptom criteria used by TFR for CRS diagnosis are not very specific for sinus disease. A detail assessment of the subjective and objective criteria (CT and endoscopy) is necessary for tailoring surgical plan but should not be relied upon for determining the extensiveness of surgical intervention. KEY WORDS Chronic rhinosinusitis, lund and mackay staging system, task force on rhinosinusitisPublication Endoscopic Sphenopalatine Artery Cauterization in Recurrent Posterior Epistaxis: An Experience at Dhulikhel Hospital, Kathmandu University Hospital(Kathmandu University, 2014) Shrestha, BLNAPublication How I Do It? Endoscopic Modified Inlay Butterfly Cartilage Perichondrium Myringoplasty(Kathmandu University, 2013) Shrestha, BLNAPublication Prevalnace of Noise Induced Hearing Loss among Traffic Police Personnel of Kathmandu Metropolitan City(Kathmandu University, 2011) Shrestha, I; Shrestha, BL; Pokharel, M; Amatya, RCM; Karki, DRABSTRACT Background Noise induced hearing loss (NIHL) is a major preventable occupational health hazard. Objective To measure permanent threshold shift in traffic police personnel due to noise exposure and to examine whether it was associated with duration of noise exposure, years of work and risk factors. Methods Cross sectional, descriptive study conducted at Dhulikhel hospital, Kathmandu University Hospital in 110 responding traffic police personnel. Detailed history and clinical examination of ear, impedence audiometry and pure tone audiometry was performed. Results Mean age group was 29.82 years; 82(74.5%) were males and 28 (25.5%) were females. Mean duration of service is 11.86 years. Twenty six (23.6%) had tinnitus and 39(35.5%) had blocked sensation in ear. Sixty five (59.1%) worked between 10- 19 years. Alcohol and smoking shows positive impact on NIHL (p value =0.00). Odds ratio with 95% confidence interval were 4.481 (1.925-10.432) and 6.578 (2.306- 18.764) respectively. Among 73(66.4%) noise induced hearing loss positive cases, bilateral involvement was seen in 45 (40.9%) and unilateral in 28(25.4 %) cases. Among unilateral cases most were left sided. Hearing threshold at 4 kHz increased according to age and duration of service. Conclusion Traffic police personnel are in constant risk of noise induced hearing loss. Screening for hearing loss is recommended for people exposed to noise. KEY WORDS noise induced hearing loss, traffic police personnel, occupational hazard