Browsing by Author "Sinha, BK"
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Publication Accuracy of otoscopy, tympanic membrance mobility and tympanometry in the diagnosis of otitis media with effusion(Institute of Medicine, 2007) KC, S; Guragain, RPS; Sinha, BKAbstract Background: To determine the accuracy of otoscopy, pneumatic otoscopy and tympanometry in the diagnosis of otitis media with effusion. Materials and Methods: A total of 71 patients (121 ears) suffering from Otitis Media with Effusion (OME) diagnosed clinically were subjected to myringotomy and ventilation tube insertion (VTI). The finding of presence of fluid in middle ear after myringotomy was correlated with Tympanic Membrane (TM) color, fluid level, air bubble, TM mobility and tympanometric curve recorded preoperatively. Results: Otoscopic findings revealed pink TM in 78.5%, prominent landmarks in 98.3%, generalized retraction 73.6%, fluid level in 14% and air bubble in 2.5% of cases. On pneumatic otoscopy, decreased or absent mobility was found in 85.1%. Tympanometry with ‘B’ curve was the most sensitive finding (98.9%), whereas pneumatic otoscopy was found to be the most specific amongst all the three tools. Combination of tympanometry with either otoscopy or pneumatic otoscopy or combination of all three modalities was found to be highly significant . Conclusion: Tympanometry is the most sensitive tool for the diagnosis of OME and combination of tympanometry with either otoscopy or pneumatic otoscopy is highly significant. Keywords: otitis media with effusion (OME), pneumatic otoscopy, tympanometryPublication Acute tuberculous mastoiditis(Institute of Medicine, 1998) Baskota, DK; Sinha, BKAbstract Tuberculosis is one of the commonest infectious diseases of developing countries including Nepal, affecting almost all the vital organs of human body. Here an unusual case of tuberculosis of temporal bone has been presented. A 26-year old lady presenting with features of acute mastoiditis was managed surgically. All the investigations including histopathological examination were negative for tuberculosis, but in the end she responded only to anti tuberculous therapy (ATT) with complete resolution of her symptoms. Keywords: Tuberculosis (TB), mastoiditis, granulations, antituberculous therapy, sequestra, mastoidectomyPublication Aetiology and management of epistaxis at TU Teaching Hospital(Institute of Medicine, 2006) Adhikari, P; Pradhananga, RB; Thapa, NM; Sinha, BKAbstract Background: Epistaxis is a common condition, as well as a frequent otolaryngologic emergency. Up to 60% of people experiencing one episode in their lifetime and 6% seeking medical attention. Methods: A retrospective study of records of 93 patients admitted in the department of ENT-Head and Neck Surgery of TU Teaching Hospital for the management of epistaxis in between March 2005 and February 2006. Results: The incidence of epistaxis was found to be in 6.0% of all the ENT patients admitted in the department in this time period. The most common cause / risk factors were hypertension followed by deviated nasal septum. In 24.7% of cases no cause could be found and was labeled as idiopathic. Regarding treatment, 9.7% treated with Chemical cautery, 34.4% anterior nasal packing, 25.8% posterior nasal packing and 2.2% required arterial ligation to control their epistaxis. Conclusion: Our study shows that epistaxis is also a common emergency. Etiology could be found nearly 75% of cases only which could be preventable. Anterior Nasal Packing was the most common treatment. We should manage a case of epistaxis in an orderly manner.Publication Analysis of tracheobronchial foreign bodies(Institute of Medicine, 2007) Adhikari, P; Shrestha, BL; Sinha, BK; Baskota, DK; Sharma, NRAbstract Background: To analyze the type and site of tracheo-bronchial foreign bodies in patients admitted in the department of ENT-Head and Neck surgery (ENT-HNS) of TU Teaching Hospital. Methods: Medical records of 41 cases admitted in the department of ENT-HNS, TU Teaching Hospital, Kathmandu between April 2004 to October 2006 for the management of suspected foreign bodies in tracheobronchial tree were analysed retrospectively. It was found that rigid bronchoscopy was performed in all 41 cases and foreign bodies were removed from 36 cases. In the five cases where foreign body was not found, were excluded from the study. Results: There were 83.3% children and 16.6% adults. Most common type of foreign body found in children were vegetative (63.3%) where as in adults beetle nut (50.0%) and metallic foreign bodies (50.0%) were found. Majority of foreign body was found to be lodged in the right main bronchus (56.7%) in children. Whereas, in adults foreign bodies (66.7%) were found in the left main bronchus. Radiological confirmation of the foreign body could be made only in 8 cases (22.2%). All patients had an uneventful postoperative period except two (5.5%) who died during postoperative period after removal of foreign bodies from trachea. Conclusion: In children, foreign body is more common in right bronchus where as in adults it is more common in left bronchus. Only 22.2% foreign bodies could be seen in plain X-ray. In unresolved pneumonia high index of suspicion of foreign body in tracheobronchial tree must be made and diagnostic bronchoscopy should be performed. Keywords: Vegetative foreign body, metallic foreign body, rigid bronchoscopyPublication 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 Comparison of core and surface cultures in recurrent tonsillitis(Institute of Medicine, 2005) Bista, M; Sinha, BK; Amatya, RCM; Tuladhar, NR; Pokharel, BMAbstract This prospective study was done to find out the most common organism affecting the tonsils in recurrent tonsillitis and to compare the microorganisms found in the core and surface of such tonsils. A total of 50 patients attending ENT Out patient Department of Tribhuvan University Teaching Hospital (TUTH) from February 2000 to August 2001 were included in the study. All these patients had undergone tonsillectomy under general anaesthesia by dissection method. Among these 39 patients had undergone tonsillectomy for recurrent tonsillitis and 11 had undergone tonsillectomy for reasons other than recurrent tonsillitis. The excised tonsils were kept in agar plates and transported to the microbiology laboratory within half an hour of surgery. The culture was taken from the surface and the core after cutting the tonsils into half by a sterile blade and with another sterile blade only core was extracted in a wedge shaped manner and was cultured in aerobic (5% sheep blood agar, Chocolate agar and McConkey’s agar and anaerobic (gas pack jar system) media for 24 - 48 hours. The most common microflora seen in recurrent tonsillitis was Streptococcus viridansfrom the surface, as well as the core. Other common micro organisms prevalent on the surface in recurrent tonsillitis were Staphylococcus aureus, and Brahmnella catarrhalis. Likewise other common micro organisms in the core in recurrent tronsillitis were Staphylococcus aureus, Klebsiella pneumonie, and Haemophillus influenzae. There was no statistical difference between the micro organisms found on the surface and the core except for Brahmnella catarrhalis which was significantly more on the surface. Anaerobes were isolated only from the core and there was no statistical difference between the micro organisms isolated from the non-infected tonsils and from recurrent tonsillitis.Publication Foreign body in the larynx for 13 years(Institute of Medicine, 1998) Pradhan, B; Sinha, BK; Amatya, RCM; Bhattarai, H; Prasad, R; Bhushal, CL; Baskota, DKAbstract This is a report of case of an old man of 67 years who was fortunate to survive a foreign body (denture) into the larynx for 13 years. Fibreoptic endoscopy showed a whitish mass in between the cords; on removal by direct laryngoscopy it was found to be a denture. Keywords: Foreign body, LarynxPublication Hearing results after myringoplasty(Kathmandu university, 2006) Shrestha, S; Sinha, BKBackground: Myringoplasty is one of the various surgical techniques for the management of chronic supurative otitis media of tubotympanic type (CSOM-TT). The presence of a perforation of tympanic membrane with intermittent discharge and hearing loss of conductive nature are the indications of myringoplasty. It is a beneficial procedure done for closing tympanic membrane perforation and improving hearing. Objective: The aim of this study was to assess hearing improvement after myringoplasty within ten weeks following surgery. Material and methods: The study population consisted of 50 patients who were suffering from CSOM-TT. Preoperative and postoperative examinations of the patients were conducted clinically as well as audiologically. Pre and postoperative air-bone (A-B) gap were calculated by taking the averages of bone conduction and air conduction at the frequencies of 500, 1000 and 2000 Hz. Myringoplasty was performed with underlay technique under local anaesthesia by either permeatal or endaural approach. Temporal muscle fascia was used as grafting material for reconstruction of the tympanic membrane. Results: Preoperatively, air-bone gap of 30 db or more was observed in 39 (76%) patients whereas post operatively A-B gap of 30 db or more was observed in only one patient. Using hearings gain exciding 15 dB as the criterion, thirty-nine (78%) patients had their hearing gain exceeding 15 dB. Using postoperative A-B gap within 20 dB as the criterion, 42 (84%) patients had their A-B gap within 20 dB. Conclusion: Myringoplasty is a beneficial procedure for hearing improvement. Using the proportion of patients with a postoperative A-B gap of 30 dB as the criterion, in this study, 98% of patients achieved their A-B gap closer within 30 dB. Using hearing gain exceeding 15 dB as the criterion, 78% patient had their hearing gain exceeding 15 dB. Key words: CSOM, myringoplastyPublication Lipoblastoma in head and neck – A rare childhood tumour(Kathmandu University, 2006) Sinha, BK; Thapa, N; Banskota, DKLipoblastoma is an uncommon benign mesenchymal tumour that occurs primarily in children younger than 3 yrs of age. Despite the lesions being benign, great difficulty can be encountered in its management because of its tendency to invade the different fascial planes. A rare case of huge lipoblastoma diagnosed in a 22 months old child, involving various spaces of face and skull base has been reported. This huge tumour was completely and successfully removed through cheek incision without any postoperative complications. Key words: Lipoblastoma, Benign Mesenchymal Tumour, Head & Neck, C.T., M.R.I., FNAC, Total excisionPublication OK-432: An effective sclerosing agent for the treatment of lymphangiomas of head and neck(Kathmandu University, 2007) Baskota, DK; Singh, BB; Sinha, BKObjective: The basic objective of this study was to find out the efficacy of OK-432 for the conservative treatment of lymphangiomas of head and neck regions at the Department of ENT-Head & Neck Surgery of Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal. Methods: It was a hospital based prospective, cross-sectional, case series, conducted among the patients suffering from different lymphangiomas of head and neck regions and treated with intra-lesional injection of OK-432, from March, 2005 to September 2006. Altogether eleven patients were enrolled in this modality of treatment out of which one patient was excluded from the study, which was treated surgically due to very ugly scar at the site of lesion resulting from previous surgery for the same. The data were analyzed by using simple mathematical tools like percentage and frequency. Results: Out of ten patients treated with intralesional injection of OK-432, absolute response, i.e. total resolution of swelling was found in nine patients (90%) after the first dose. Remaining one patient also responded well on the treatment but some residual swelling was in situ for which second dose was given. After the second dose it was also totally resolved. In this way we achieved 100% response after the second dose of OK-432. Conclusion: The results of this study so far indicate that OK-432 is an effective and safe tool for the treatment of lymphangioma of head and neck region. As the procedure can be done in an out patient department, without hospitalization and has got minimal side effects, it can be proposed as the first line treatment of lymphangiomas of head and neck. Key words: Lymphangioma, OK-432, Sclerotherapy, Sclerosing agent, Head and Neck.Publication Outcome of thyroid surgery in the department of ENT- Head and Neck Surgery: three years experience(Institute of Medicine, 2006) Baskota, DK; Sinha, BK; Prasad, RAbstract Introduction: A retrospective, cross-sectional, analytical study, to find out overall outcome of thyroid surgeries and correlation of fine needle aspiration cytology (FNAC) with histopathology of different thyroid lesions was recently carried out at the Department of ENT-Head & Neck Surgery of TU Teaching Hospital, Kathmandu, Nepal. Altogether 114 charts of patients underwent different thyroid surgeries from July15, 2002 to July14, 2005 for different thyroid lesions were analyzed, out of which 11 patients were excluded from the study due to lack of adequate information. Results: Out of 103 analyzed cases female sex was found to be exclusively predominant 94(91%) and age group of 21-30 years was the most commonly affected group 36(35%). Clinically, solitary thyroid nodule was the commonest diagnosis 57(55.4%) made for these thyroid lesions and right lobe was commonly affected site 50(48.5%). Similarly, hemithyroidectomy was the most commonly performed surgery 63(61.2%) followed by lobectomy 18(17.5%) for the management of these lesions where as hypothyroidism 11(10.7%) and hypocalcaemia 9(8.7%) were the commonest observed postoperative complications respectively. Although 3 cases of malignancy were missed by FNAC, its diagnostic accuracy was still 97.09%. Conclusion: The results of this study so far indicate that although FNAC is a good diagnostic tool for thyroid lesions, USG guided FNAC would have better option for further accuracy of the diagnosis. Likewise cytologically reported, as solitary thyroid nodule with cystic changes and follicular neoplasm should be taken into consideration as malignancy might be missed particularly in these lesions. Therefore it is better to do hemithyroidectomy in solitary thyroid nodule irrespective of FNAC report.Publication Prevalence of chronic suppurative otitis media in school children of Kathmandu district(Institute of Medicine, 2007) Adhikari, P; Sinha, BK; Pokharel, NR; Kharel, B; Aryal, R; Ma, JAbstract Background: Chronic suppurative otitis media is a major health problem throughout the world in developing countries including Nepal. This study was carried out to find the prevalence of chronic suppurative otitis media (CSOM) among school going children of Kathmandu district. Methods: This is a prospective cross sectional study among 1070 school children aged between 5 - 12 years. Students were randomly selected from four different schools of Kathmandu district. All these students were interviewed and examined otoscopically from November 2006 to January 2007. Data were analyzed statistically. Results: Results showed that 5.4% of the children had CSOM. Unilateral disease was seen in 79.3% and 96.5% had a tubotympanic disease. Around 24.1% had active disease, 65.4% used unhygienicand risky materials to clean their ears. There were 10.3% students having CSOM who did not receive any treatment. More than half were treated by paramedics. Conclusion:The prevalence of CSOM among school children in Kathmandu district is lower as compared to rural areas of Nepal. This might be due to the improvement of health care facilities or due to increase in the use of antimicrobials in Kathmandu. Awareness for school children as well as parents through health education is in need to reduce the prevalence of CSOM. Keywords: Chronic suppurative otitis media (CSOM), tubotympanic disease, health educationPublication