IntrOductIOnThyroiditis is defined as a disorder that involves inflammation of the thyroid gland. Thyroiditis is mainly divided into two broad categories: painless and painful. Among the category of painful types of thyroiditis is subacute (de Quervain's thyroiditis) which is the most common cause of acute painful thyroiditis [1]. The patients usually present to the otorhinologists with complaints of neck pain, swelling and odynophagia. On examination, there is tenderness at the region of thyroid gland. Although the exact aetiology is unknown, is thought to be a viral inflammatory disorder [2]. The disorder is usually selflimiting over months with a triphasic course of hyperthyroidism followed by hypothyroidism and ending with euthyroidism.Subacute thyroiditis has been treated with either nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids for years. The response to steroids is often more dramatic and quicker than the response to NSAIDs, but steroids are well known for their side effects over NSAIDs. As subacute thyroiditis is a self-limiting condition, high dose of steroids might be irrelevant to some people. The usual initial dose is 1 mg/kg of prednisolone per day and tapered over six weeks although the basis for this dose has not been established yet by prospective studies [3].The current study was carried out to study if prednisolone in lower initial dose (20 mg/day tapered over four weeks) is effective in patients with acute painful thyroiditis. Thyroid tenderness and Erythrocyte Sedimentation Rate (ESR) were taken as the guidelines to either continue or discontinue the drug. The patients were followed up carefully and data were analysed. MAterIAls And MethOdsThis study was a prospective, cross sectional, observational study carried out in the Department of ENT, Manipal Teaching Hospital, Pokhara, Nepal from 1 st August 2012 to 31 st March 2015. All the patients with acute anterior neck pain of less than or equal to seven days duration were included in the study. Diagnosis was made in the clinical grounds according to history of anterior neck pain, tenderness thyroid region, tender and swollen thyroid gland, ultrasound of the neck showing increased vascularity of the thyroid gland and raised Erythrocyte Sedimentation Rate (ESR).Patients with clinical signs suggestive of subacute thyroiditis and ESR of more than 30 mm/h were finally included in the treatment group.Patients in whom there was contraindication to the use of prednisolone (severe gastritis, Diabetes, hypertension) were excluded from the study.The patients were administered prednisolone in a starting dose of 20 mg/day (10 mg twice daily) tapered over four weeks. The dose was 10 mg twice daily for 2 weeks and 10 mg once daily day for next 2 weeks. They were also co-prescribed with pantoprazole 40 mg twice daily for 2 weeks to lessen the gastric irritation caused by prednisolone. A performa was made, initial findings of severity of pain and tenderness and ESR were noted, and patients were closely observed for 4 weeks. ESR was repeated ...

Background: Foreign body (FB) impaction in the esophagus is a common emergency in all age groups. In the children coins are the commonest foreign bodies while bones have been found as the commonest in adults. Methods: This is a retrospective study comparing FB in the esophagus in adult and pediatric population between June 2007 and May 2010 in Manipal Teaching Hospital, Pokhara, Nepal. Most of the patients underwent rigid esophagoscopy and FB removal; few were removed under anesthesia by the anesthesiologists. Comparison was done in terms of pattern of FB, their site of impaction and relative ease of removal. Data were collected from the case file available from the medical record department and analysed using SPSS 11.6. Results: A total of 63 cases were included in this study. Out of which 28 (44.4%) patients were children and 35 (55.5%) were adults. Coin was the most common foreign body in the pediatric population (82.1%) whereas bones were the commonest ones (91.4%) in adults. In the pediatric population the commonest site of impaction was upper esophagus (92.8%) whereas mid esophagus was the commonest site (65.7%) in adults. Conclusion:There are differences in various aspects of impacted foreign bodies in esophagus in adult and pediatric populations. Coins being the commonest foreign bodies in children are relatively easier to remove due to their higher location and less chances of trauma. Contrary in the adults, bones being the commonest foreign body are difficult to remove due to the lower location and chances of trauma. Keywords: Foreign body; esophagus; rigid bronchoscopy DOI: http://dx.doi.org/10.3126/njms.v1i1.5797   Nepal Journal of Medical Sciences. 2012; 1(1): 42-44

Background: Laryngeal malignancy is a common malignancy of the head and neck region. Affected patients usually present with features that are characteristic of certain subsites. The larynx is oncologically divided into three: supraglottis, glottis and subglottis. Studies from Western countries have shown that the glottis is the commonest subsite to harbour laryngeal malignancy. However, the supraglottis has been reported to be the commonest subsite in developing countries, including examples in the Indian subcontinent. To our knowledge, no study has been carried out in western Nepal about the epidemiology of laryngeal cancer to date. The purpose of this study was to analyse the epidemiology of laryngeal cancer in relation to its risk factors, age distribution,and preferred subsites and to see if there is any recent change in the subsite wise distribution of laryngeal malignancy in western Nepal. Materials and Methods: Patients of all ages and both sexes with suspected laryngeal malignancy were enrolled in the initial study. Detailed history taking and clinical examination was performed to find out the involved subsite in relation to the clinical features. Direct laryngoscopy was performed to further confirm the subsite and to take biopsy from the growth under general anesthesia. After confirmation of malignancy from the biopsy report, patients were finally included in the study. Data were analysed and observations were made to find out the distribution of laryngeal malignancy in different subsites. Results: The supraglottic larynx was the commonest subsite to harbor laryngeal malignancy. Smoking and alcohol were found to be the common risk factors. The mean age of the patients was in their sixties. Conclusions: Laryngeal malignancy is common in elderly individuals. Supraglottic laryngeal malignancy is the commonest laryngeal malignancy in people who smoke and drink alcohol in Nepal. Avoidance of alcohol use and smoking will be a milestone to reduce the incidence of laryngeal cancers and associated mortality.

Background: Laryngeal malignancy is a common pathological entity. Size of the primary tumor and neck node metastasis both are bad prognostic features. Purpose of this retrospective study is to see if the tumor size of primary laryngeal squamous cell carcinoma correlates with the neck node metastasis. Methods: Patients of all ages and both sex with biopsy proven squamous cell carcinoma of larynx were included in the study. After detailed history taking and clinical examination to identify the size of the primary tumor and neck node metastasis, biopsy was taken from the primary site under general anesthesia. Fine Needle Aspiration Cytology (FNAC) of the palpable neck node(s) was also performed. Data were analyzed using SPSS software for windows. Results: Fifty seven new cases of laryngeal squamous cell carcinoma with mean age of 72.71 were included in the study. Supra glottic layrnx was the most common site affected. Neck node metastasis was more frequent in tumor of bigger size (higher T stage) and the difference was statistically significant (p=0.001). Conclusion: The size of primary laryngeal squamous cell carcinoma correlates with the neck node metastasis. This information can be used for the therapeutic implementation as well. Nepal Journal of Medical Sciences | Volume 02 | Number 01 | Jan-Jun 2013 | Page 48-51 DOI: http://dx.doi.org/10.3126/njms.v2i1.7652

Objective: To study the role of nasal decongestants in spontaneous healing of traumatic tympanic membrane perforation.Material and Methods: A prospective single blinded, randomized controlled study was carried out in the department of ENT, Manipal College of Medical Sciences, Pokhara, Nepal. Patients with traumatic tympanic membrane perforation were divided into two groups; those receiving nasal decongestants along with conservative measures (Group1) and those receiving conservative measures only (Group2). Healing of tympanic membrane was compared in between these groups at 1 and 3 months. Statistical analysis was done using SPSS 20.Results: There were 30 patients in group 1 and 28 patients in group 2. The mean age of the study population was 26.98 (SD= 7.53). The M: F ratio in group 1 was 0.58:1 and that in group 2 was 0.56:1. Complete healing was seen in 25 (83%) patients in group 1 and 16 (57.1%) patients in group 2 at the end of 1 month (P=0.029). Similarly, healing was seen in in 29 (96.7%) patients in group 1 and 21 (75%) patients in group 2 at the end of 3 months (P=0.023).Conclusion: Routine use of nasal decongestants increases the chances of spontaneous healing of traumatic tympanic membrane perforations.

Endoscopic sinus and skull base Surgery has gained significant improvement widely all over the world. A computerized tomography (CT) scan provides a detailed anatomy of the skull base especially the bone framework. This study aims to analyze the fixed anatomical bony landmarks of the anterior skull base through coronal and reconstructed CT in the context of the Nepalese population and guide the surgeon to perform endoscopic sinus and skull base surgery safely. This Prospective study includes 70 Computerized Tomography scans of Paranasal sinuses. The different measurement from nasal floor to skull base was taken in coronal and reformatted sagittal CT scan. Mean, standard deviation, minimum and maximum values were analyzed using descriptive statistics. Student T-test was applied to compare between right and left side. This study includes 75 patients between 18 to 77 years. The measurement from nasal floor to the cribriform plate and ethmoidal roof in right and left side were, mean± SD (47± 4.1, 45.3±4.3, 47.9±5.1, and 49±8.5 mm) respectively. Mean Take off angle at the cribriform plate was 43.9 ±10.9°on right side and 43 ± 9.4° on the left side. The distance from the nasal spine to the skull base (mean ± SD) at nasofrontal recess, bulla ethmoidalis, and the junction of sphenoethmoid levels at right sides were 51.5 ± 4.7, 52.9 ± 4.1, and 61.2 ±4.7 little higher at left side. This study provides a detailed analysis of the anterior skull base in coronal and sagittal CT scans which helps to reduces complications.

Nepalese Journal of ENT Head and Neck Surgery Vol.2 No.2 Issue 2 (July-Dec 2011) 10-12 DOI: http://dx.doi.org/10.3126/njenthns.v2i2.6795

Introduction: Otorhinolaryngological injuries in head injury are something which are very common but yet are overlooked, missed and at times forgotten. In this study, we tried to see the epidemiological characteristics, clinical presentations and management of these associated injuries in cases of head injuries in a tertiary care center in western Nepal. Methods: An analytical study was done in all cases of head injury admitted to neurosurgical ward and ICU in between January 2019 to December 2019. Various clinical and epidemiological details were collected from the patient’s records obtained from Medical Records Department and charted in a preformed performa. All the continuous data were presented in terms of mean and standard deviation and categorical data in terms of percentage. Statistical analysis was done using SPSS 22.0 software. Results: Soft Tissue lacerations were the commonest findings in all head injuries; nose and face lacerations (29.5%), ear lacerations (23.5%) followed by facial bone fractures (19.2%). There were 41(52.6%) cases with mild head injury, 23 (29.5%) cases with moderate head Injury and 17 (17.9%) cases with severe head injury in patients those had associated ENT findings. There was no any statistically significant difference in outcome or hospital stay in between the head injuries with and without ENT manifestations (p=0.187) and (p=0.219) respectively. Conclusion: Skull base tumors are treated based on findings of diagnostic nasal endoscopy and imaging results. CT scans and MRIs are becoming more significant in the diagnosis of diseases. Endoscopic techniques to the skull base were beneficial in treating the malignancy. Chemotherapy can be used as a gold standard first-line treatment with radiation and surgery for significant types of head and neck tumors. immunotherapy-like checkpoint inhibitors targeting PD1 are the second-line treatments of advanced HNSCC. Prospective research and trials will be required in the future.