Introduction: Foreign body aspiration is a common problem in children with signifi cant mortality and morbidity. This study aims to determine the prevalence of foreign body aspiration in children in a tertiary care hospital of Nepal. Methods: A descriptive cross-sectional study was conducted at Tribhuvan University Teaching Hospital from April 2010 to March 2016 after obtaining ethical approval from Institutional Review Committee (Reference number- 08(6-11)E277/78). All children of age up to 15 years with suspected foreign body aspiration were included. The data was collected from the medical record section and entered in Microsoft Excel. The descriptive statistical analysis was performed. Results: A total of 26,294 patients were included in the study. The prevalence of foreign body aspiration in children was found to be 98 (0.37%). On rigid bronchoscopy, 82 patients (83.6%) were confirmed to have a foreign body in the airway. The peak incidence of foreign body aspiration was seen in patients of age group one to two years. The commonest foreign body in the airway was a peanut. Conclusions: The prevalence of foreign body aspiration in children was low, which is similar to other studies. Foreign body aspiration may lead to dreadful complications. Therefore, both the clinicians and the public need to be cautious about it.
Introduction External auditory canal cholesteatoma (EACC) is often misdiagnosed. Objectives To outline the clinical presentation of EACC, and to describe its radiological findings on high-resolution computed tomography (HRCT) of the temporal bone. Methods The clinical records of all patients diagnosed with EACC from April 2017 to March 2020 in a tertiary care center were retrospectively reviewed. The clinical presentation, the findings on the HRCT of the temporal bone, and the treatment provided were analyzed. Results A total of 9 patients, 7 males and 2 females, with a mean age of 30 years, were diagnosed with primary EACC. Six patients presented with otorrhoea, three, with otalgia, three. with hearing loss, and one with facial palsy. Some patients had multiple symptoms. The most common findings on otomicroscopy were destruction of the posterior and inferior canal walls, with cholesteatoma and intact tympanic membrane (six patients). Two patients had aural polyp, and one had a narrow ear canal due to sagging of the posterior canal wall. On HRCT, all nine patients showed soft-tissue density in the external auditory canal with erosion of the canal wall. The disease extended to the mastoid in eight cases, and to the cavity of the middle ear in one. There were three cases of dehiscence of the facial canal. Dehiscence of the dural and sinus plates was observed in two cases each. Eight patients underwent mastoidectomy, and one underwent debridement with canalplasty. Conclusion Review of the clinical and radiological findings is essential to reduce the rate of misdiagnosis.
Objective: The aim of this study was to report the incidence of complications in otitis media and to determine the frequencies of various extracranial and intracranial complications at a tertiary care hospital. Methods: We retrospectively reviewed the clinical records of patients of all ages and genders who were treated in a tertiary care hospital in Nepal from May 2015 to May 2020 for complications of acute and chronic otitis media. The complications were broadly classified as extracranial and intracranial. The details of patient profiles, histories, examination findings, investigations and treatments were reviewed from the charts. Results: The mean age of 164 patients with complications of otitis media was 47.44±18.58 years. There were 79 (48.2%) male and 85 (51.8%) female patients. The overall incidence of otitis media complications was 0.78%. The incidences of the complications from acute otitis media, chronic otitis media without cholesteatoma, and chronic otitis media with cholesteatoma were 0.5%, 0.06% and 5.6%, respectively. Extracranial complications, intracranial complications and combined extracranial and intracranial complications were seen in 80%, 11% and 9% of the patients, respectively. The most common extracranial and intracranial complications were subperiosteal abscesses and brain abscesses, respectively. There was one mortality due to complication. Conclusion:The incidences of complications and mortality from otitis media have declined with the availability of suitable antibiotics, improved imaging, and multidisciplinary management. Antibiotic resistance and masking of signs and symptoms, however, could pose challenges in the future.
Objective: Cancellations of elective surgical cases on the scheduled day in a tertiary referral hospital vary from 0.1% to 40% due to varied causes. Such cancellations result in financial loss, waste of resources of a health care facility with equally disappointing loss of time and money of the patients and the caretakers. The current study assesses the magnitude and causes of cancellation of cases on the same day of surgery in ENT department of a tertiary referral hospital and suggests measures to reduce the cancellation rate.
Introduction Antimicrobial resistance is an emerging issue resulting from the misuse of antibiotics in today’s world. As an effect of it, cases with persistent ear discharge not responding to the conventional oral antibiotics prescribed in ear pathologies are seen increasing in our day to-day practice. This study aims to review the microbiological growth and the pattern of their antibiotic sensitivity in this group of population. MethodsThis was a retrospective study which was conducted at the Department of ENT-HNS of Tribhuvan University Teaching Hospital. Record files of all cases who presented with persistently discharging ear for more than 2 weeks and not responding to oral antibiotics, between January 2017 to March 2020 were assessed. Cases of chronic otitis media (COM) squamous with persistent discharge were excluded as most of the times it is the disease process rather than type of organism which causes the persistence of ear discharge despite the use of antibiotics. ResultsCOM mucosal and cavity infection following modified radical mastoidectomy (MRM) were the commonest pathologies. Pseudomonas aeruginosa (PA) and Coagulase negative Staphylococcus (CoNS) were the commonest bacterial isolates. Pseudomonas aeruginosa showed a good sensitivity to antibiotics like Tazobactam and Piperacillin and resistance to conventionally used antibiotics like Ciprofloxacin and Levofloxacin. Similarly, CoNS had good sensitivity to antibiotics like Oxacillin and Levofloxacin and resistance to conventionally used antibiotics like Amoxicillin. ConclusionCOM mucosal and post MRM cavity infection are the commonest pathologies presenting with persistent ear discharge with PA and CoNS as the predominant isolates. Pseudomonas aeruginosa holds a good sensitivity to drugs like Tazobactam and Piperacillin; and CoNS to drugs like Oxacillin and Levofloxacin.
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