Conventional curettage adenoidectomy misses a substantial amount of adenoid tissue. Rigid endoscopy-assisted adenoidectomy improves this result by enabling localisation of any residual adenoid tissue.

Introduction: The term ‘voice' is the acoustic energy generated from the vocal tract that are characterized by their dependence on vocal fold vibratory pattern. Teachers as professional voice users are afflicted with dysphonia and are discouraged with their jobs and seek alternative employment. Loud speaking and voice straining may lead to vocal fatigue and vocal fold tissue damage.  Methods: Sixty teachers from various schools, volunteered to participate in this study. Acoustic analysis Doctor Speech Tiger Electronics, USA was used to assess the voice quality of the school teachers before and after teaching practice. The data were collected and analyzed using Doctor Speech Tiger Electronics, USA. Analysis was performed in terms of perturbation (jitter and shimmer), fundamental frequency, harmonic to noise ratio and maximum phonation time. Results: We found statistically significant difference in all the four parameters except the Jitter value. The fundamental frequency and shimmer value has significantly increased (P<0.001) and (P=0.002) respectively after teaching practice. Unlikely, there was significant decrease in harmonic to noise ratio value (P<0.001) and maximum phonation time value (P<0.01) after teaching practice. Conclusions: Vocal abuse, overuse, or misuse in teaching practice over a long period of time can result in inadequate phonatory pattern due to vocal fold tissue damage, which ultimately results in vocal nodules or polyps. So voice evaluation is particularly important for professional voice users and for the people who are concerned about their quality of voice.

Background:The excellent visualization and minimally invasive approach employed in endoscopic endonasal procedures has now revolutionized the pituitary surgery, replacing the transnasal microscopic technique worldwide. However, it involves major shift in hand-eye co-ordination from static 3 dimensional images of microscope to 2 dimensional endoscopic images hence demands training and inter-disciplinary approach. Here we present our experiences in learning and developing a safe endonasal transsphenoidal endoscopic approach to resect pituitary adenomas.Methods: This prospective study was jointly conducted in the departments of ENT and Neurologicals surgery Kathmandu Medical College, Nepal, from September 2014 to August 2016. The endoscopic approach to the sphenoid sinus was performed by an Otolaryngologist and ablative surgery by Neurosurgeon. The ease of procedure, intra operative challenges, surgical cure, post-operative cerebro spinal fluid (CSF) leaks and postoperative complaints were analyzed.Results: Sixteen consecutive patients with pituitary adenoma (macro adenoma=13, micro adenoma =3) were analyzed. There were three intraoperative CSF leak, managed successfully. Two patients developed transient diabetes insipidus and surgical cure rate was 90%. No case had to be switched over to traditional microscopic route due to technical failure. There was no mortality. Conclusions:The endoscopic endonasal transsphenoidal approach to pituitary tumors is a safe and minimally invasive procedure, which can be employed safely in any of our centers in Nepal, equipped with endoscopic sinus surgery and endoscopically trained ENT and Neurosurgeons. A multi disciplinary approach provides good access, greater tumor excision and excellent postoperative follow up.

Background: Packs are placed following nasal surgeries to arrest haemorrhage, to prevent septal haematoma and synechie formation. Despite Merocel, a tampon constructed from a foam polymer of hydroxylated polyvinyl acetate, which is less abrasive and hence associated with the less pain, we still use Neosporine Impregnated Ribbon Gauze (NIRG). Objective: To compare Merocel and the Neosporine Impregnated Ribbon gauze (NIRG) packs in regards to the post-operative pain levels caused by them and their ability to prevent haemorrhage, crusting and synechie. Methods: The nose was packed after surgery either with the Merocel pack or Neosporin Impregnated Ribbon Gauze (NIRG) according to the randomisation. The pain score was noted on the Visual analog score while packs were in situ and again immediately after the pack removal. The haemorrhage, crusting and synechie were noted if present. Results: Among 106 patients, 61 were male and 45 were female. In Merocel group there were 51 patients and in NIRG group 55. The mean pain score for merocel was 4.15 while in situ and 3.66 immediately after removal where as mean pain score for NIRG was 6 while in situ and 3.78 immediately after removals. Post-operative crusting and synechie were seen relatively more in NIRG pack group. Conclusion: Merocel is superior in terms of both patient comfort and pain. DOI: http://dx.doi.org/10.3126/hren.v10i1.6004 HREN 2012; 10(1): 30-34

Introduction: Glucose meters are gaining popularity in monitoring of blood glucose at household levels and in health care set-ups due to their portability, affordability and convenience of use over the laboratory based reference methods. Still they are not free of limitations. Operator’s technique, extreme temperatures, humidity, patients’ medication, hematocrit values can affect the reliability of glucose meter results. Hence, the accuracy of glucose meter has been the topic of concern since years. Therefore, present study aims to evaluate the analytical and clinical accuracy of glucose meter using International Organization for Standardization 15197 guideline. Methods: A community based descriptive cross-sectional study was conducted in Kapan, Kathmandu, Nepal in April 2018. Glucose levels were measured using glucose meter and reference laboratory method simultaneously among 203 adults ≥20 years, after an overnight fasting and two hours of ingestion of 75 grams glucose. Modified Bland-Altman plots were created by incorporating ISO 15197 guidelines to check the analytical accuracy and Park error grid was used to evaluate the clinical accuracy of the device. Results: Modified Bland-Altman plots showed>95% of the test results were beyond the acceptable analytical criteria of ISO 15197:2003 and 2013. Park Error Grid-Analysis showed 99% of the data within zones A and B of the consensus error grid. Conclusions: Glucose meter readings were within clinically acceptable parameters despite discrepancies on analytical merit. Possible sources of interferences must be avoided during the measurement to minimize the disparities and the values should be interpreted with caution.

Introduction: Turbinate reduction procedures are recommended for inferior turbinate hypertrophy in allergic rhinitis that fail to respond to medical therapy. Several modalities like turbinectomy, submucosal resection and tissue ablation are available for this purpose. The study aimed to evaluate the effectiveness of diode laser in the treatment of symptomatic inferior turbinate hypertrophy in allergic rhinitis and explore complications related to the procedure.Methods: This descriptive cross-sectional study was carried out in a tertiary care centre. The study enrolled 60 patients with inferior turbinate hypertrophy with failure of medical therapy. Inferior turbinate reduction was performed under local anaesthesia using diode laser. All the patients were evaluated subjectively for various nasal symptoms using visual analogue score scale preoperatively and during postoperative visit at three months.Results: The age ranged from 16 to 47 years with median age of 28 years. Twenty nine were male and thirty one were female. There was significant improvement in symptoms like nasal obstruction, nasal discharge, sneezing and decreased sense of smell. Immediate post-operative pain, crusting and persistent nasal discharge were observed as complications of the procedure. However, there was no incidence of mucosal oedema and synechiae formation in our study.Conclusions: Diode laser turbinate reduction procedure is safe, minimally invasive and effective in relieving the symptoms associated with inferior turbinate hypertrophy in allergic rhinitis resistant to medical therapy and can be performed on a day care basis under local anaesthesia.

Background: The option for dissection and haemostasis during thyroid surgery include either the modern ultrasonic technology (Harmonic Focus™) or the conventional technique using knot and ties, monopolar or bipolar electrocautery. Comparison between the surgical outcomes of open hemithyroidectomy using these two modalities was done.Objective: To compare the surgical outcomes of ultrasonic technique using Harmonic Focus™ (HS) with Conventional technique (CT) in open hemithyoidectomy.Method: Twenty consecutive patients undergoing open hemithyroidectomy for benign solitary thyroid nodule of ≤ 3 cm were randomly assigned into two groups; group HS (n=10) and group CT (n=10). Analysis of surgical outcomes performed by these two techniques, particularly: operative time, intra-operative blood loss, post operative pain, incision size, complications and hospital stay were done.Results: The age, sex and pathologies were comparable in both the groups. For the group HS, mean operative time was (mean ± SD=55 ± 5 min) 15 minutes shorter than group CT (mean ± SD= 70 ± 10 min) (P<0.01). Mean operative blood loss was (mean ± SD=20 ±10 ml) 16 ml less in group HS than CT (mean ± SD= 36 ±12 ml) (P<0.01). The group HS experienced less post operative pain (mean ± SD=4 ± 0.94 VAS) than CT (mean ± SD= 7 ± 0.81 VAS) (P<0.001). The incision size at the time of skin closure was 1.6 cm shorter in group HS ((mean ± SD= 3.95 ±0.61 vs. 5.5 ± 0.78cm) (P<0.01). Hospital stay (mean ± SD= 2.30 ± 0.48 vs. 4.20 ±0.42 days) was statistically significant (P<0.01) in group HS than CT. There were no major complications.Conclusion: In patients undergoing open hemithyroidectomy, HS is a faster, better cosmetic, safe and less morbid tool than CT. Its use reduces operative time, blood loss, post operative pain, scar size, along with hospital stay.DOI: http://dx.doi.org/10.3126/jkmc.v2i4.11774  Journal of Kathmandu Medical CollegeVol. 2, No. 4, Issue 6, Oct.-Dec., 2013Page: 175-180

No abstract