Browsing by Author "Shrivastav, RP"
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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 Correlation of hearing impairment with site of tympanic membrane perforation(Institute of Medicine, 2005) Bhusal, CL; Guragain, RPS; Shrivastav, RPAbstract Objective: This prospective study was done to assess the level of preoperative hearing impairment in different sites of pars tensa perforation in patients with chronic suppurative otitis media (CSOM) tubo-tympanic type undergoing myringoplasty. Materials and Methods: A total of 50 patients were recruited from the outpatient Department of Otorhinolaryngology and Head and Neck Surgery from June 2003 to May 2004. Cases of CSOM tubo-tympanic type with dry central perforation, with conductive type of hearing loss were subjected to myringoplasty. Preoperative audiometric evaluations were done. Just prior to operation, examination under microscope was performed. Exact site of perforation was noted. During operation, those found to have ossicular discontinuity or fixation were excluded from this study. Results: It was observed that the greatest hearing loss was found in big central (45dB) and posterior central (43dB); whereas least in those of anterior central (31dB) and central malleolar (34dB) perforations. The average hearing loss at 500Hz, 1000Hz and 2000Hz was 46.40 dB, 30.90 dB and 31.9 dB respectively. This showed that the hearing loss is maximum at the lowest frequencies and minimum as the frequencies increase. Conclusion: This study shows that the posterior-central perforations cause more hearing loss than anterior-central ones. The hearing loss is maximum at the lowest frequencies and minimum as the frequencies increase.Publication Taste disturbances following middle ear surgery(Institute of Medicine, 2010) Gurung, U; Bhattarai, H; Shrivastav, RPAbstract Introduction: Iatrogenic chorda tympani nerve (CTN) injury during middle ear surgery is quite common. The objective of ours study is to observe frequency & types of CTN injury during middle ear surgery and assess types of post-operative taste disturbances and their functional recovery. Methods: Patients who underwent middle ear surgery from 1st October 2005 to 1st January 2007 in Tribhuvan University Teaching Hospital were divided into 6 groups according to intraoperative CTN manipulation as; seen but not handled, handled but not stretched, stretched but intact, cut while stretching, cut while using burr and clean cut with scissors. Subjective assessment of taste disturbance was done after 2days & 2, 4 & 6 months post-operatively and categorized as altered taste sensation/metallic taste, tongue numbness and dry mouth. Results: Amongst 260 patients, CTN was seen but not handled in 52/260 (20%), handled but not stretched in 54/260 (20.75%), stretched but intact in 66/260 (25.38%), cut while stretching in 17/260(6.5%), cut while using burr in 29/260 (11.15%) and clean cut with scissors in 42/260 (16.15%) patients. Eleven out of 260 patients (4.2%) symptomatic amongst which 6/11 (54.5%) had altered taste sensation,4/11 (36.3%) had tongue numbness and 1/11 (9%) had dry mouth. Complete recovery occurred in 9/11 (81.8%) patients by 6 months. Conclusion: Though iatrogenic CTN injury was common during middle ear surgery, frequency of taste disturbance was comparatively less, commonest type of CTN injury being stretched but intact. The most common post-operative taste disturbance was altered taste sensation/metallic taste. Most patients recovered completely by 6 months. Functional recovery was earlier when CTN was preserved than when sectioned. Keywords: CTN, middle ear surgery, taste disturbance