Background Hearing loss among neonates is one of the important health issue in pediatric population which may remain unnoticed until the child reaches a certain age. The importance of universal early screening, diagnosis and intervention in reducing the negative impact of congenital hearing loss has been described all over the world. Objective To observe the outcome of hearing screening by Automated Auditory Brainstem Response (AABR) in newborns delivered in Dhulikhel Hospital and neonates admitted in an intensive care unit (NICU) of Dhulikhel Hospital. Method A prospective study was done in neonates who were born at Dhulikhel Hospital, Kathmandu University Hospital from February 15th, 2017 to October 30th, 2019. AABR was used for their hearing assessment within 24 hours of birth and again at about 6 weeks of age in those neonates who failed the initial test. All the neonates admitted in NICU were studied regarding the risk factors based on Joint committee on Infant Hearing. Those who failed the test for the second time were referred for detailed audiological diagnostic work up. Result The screening rate was 92.6% of the total deliveries. A total of 5517 neonates comprising of 2800 males and 2717 females were screened from total deliveries of 5956 neonates in the study period. Among them, NICU (sick) babies were 422 (7.7%) and well babies were 5095 (92.3%). Out of them, 1675 failed the test in the first screening and 374 failed in the second screening. So, the total number of referred babies in second screening was 6.7% (374) out of 5517 screened. Amongst them, well babies were 6.59% (336), out of 5095 screened and sick babies were 9% (38) out of 422 screened. Low birth weight and prematurity were found to be the commonest risk factor present among them, followed by the use of ototoxic medications, hyperbilirubinemia and prolonged use of mechanical ventilation. Conclusion Automated Auditory Brainstem Response (AABR) is a very useful tool for hearing screening which should preferably be done in all the neonates where possible. It should be done within one month of life and those with confirmed hearing loss should receive early appropriate intervention for better hearing in future.

Introduction CSOM is defined as persistent or intermittent infected discharge of more than three months duration through the perforated or non intact tympanic membrane caused by bacteria, fungi and virus resulting in inflammation of mucosal lining that often results in partial or total loss of tympanic membrane and ossicles. The aim of study was to study the current bacteriological profile responsible for the disease. Methods This descriptive cross sectional study was carried out at the department of Ear , Nose and Throat (ENT) and Head and Neck Surgery (HNS) in a tertiary care centre from January 2019 to December 2020. Ethical approval was taken from Institutional Review Committee (Reference number 52/2021). A convenient sampling method was used and data analysis was done in Microsoft Excel . Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. Results There were a total of 324 patients included in the study. The age range was from five to sixty-eight years. Most patients were of the age group below 10 years. There were a total of 178 males and 146 females. The most common organism isolated were Staphylococcus aureus 145 (44.8%) and Psedomonas aeruginosa 86 (26.6%). Conclusions Staphylococcus aureus and Pseudomonas aeruginosa were the most common organisms responsible for chronic suppurative otitis media in our study.   Keywords: chronic suppurative otitis media, Staphyllococcus aureus.

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Background Thyroid cancer is associated with local and systemic inflammatory activities. Many systemic inflammatory markers including the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) had shown credible and independent prognostic biomarkers in different malignant conditions. These markers are easy to reproduce, measure and inexpensive also. So, the preoperative evaluation of NLR and PLR is helpful in evaluating tumor growth and prognosis of papillary carcinoma of thyroid. Objective To evaluate the association of pre-operative NLR and PLR with clinic-pathological characteristic in papillary carcinoma of thyroid. Method This was a retrospective study performed in thirty one patients with the diagnosis of papillary carcinoma of thyroid. Preoperative NLR and PLR values were correlated with the clinical parameters like age, gender, lymph node metastasis, tumor size and pathological features (e.g., multifocality, bilaterality, extrathyroidal spread). Result There were thirty one patients, amongst which 13 were male and 18 were female. Similarly, the age distribution ranges from 27-68 years. The value of NLR was 2.37±1.09, and the value of PLR was 96.69±49.53.The increase in NLR was associated with increase in tumor size with statistically significant results. Similarly, increase in PLR was associated with increase in tumor size and multifocality with statistically significant results. Conclusion Increase NLR and PLR is associated with lymph node metastasis, extra thyroidal extension, multifocality of tumor and also bilaterality, so the risk can be stratified beforehand with measurement of NLR and PLR.

Introduction: Computed tomogram (CT) of nose and paranasal sinuses provides the detailed knowledge of depth of olfactory fossa as per Keros' classification, which is important in endoscopic sinus surgery. Objective: To analyze the types and frequency of depth of olfactory fossa in Nepalese population. Methodology: This was a longitudinal study conducted from 1 May to 30 August 2018. Coronal CT scans of nose and paranasal sinuses were taken for analysis of olfactory fossa depth. The landmarks like infraorbital foramen, point of articulation of medial ethmoidal roof with lateral lamella of cribriform plate (MERP) and lowest point on the cribriform plate (CP) were taken. The lateral lamella of cribriform plate (LLCP) was calculated by subtracting CP height from MERP height (MERP-CP = LLCP). Results: There were total 101 patients included. The distribution of age was 33.72 ± 15.15 years. The keros' type I was the most common (86.1%). Regarding the olfactory fossa depth, right side was deeper in male whereas in females, the left side was deeper, but overall right side was deeper in 52(51.5%) patients. Conclusions: Type I Keros' was the most common whereas type III Keros' was the least common. A deep olfactory fossa is more common on right.

Background Obstructive sleep apnea is a highly prevalent yet largely under-diagnosed disease that poses a significant burden on the healthcare system. Objective To determine the role of predictors for Obstructive sleep apnea syndrome and its severity in Nepalese population. Method Prospective and analytical study conducted in the Department of Otorhinolaryngology and Head and Neck surgery at Kathmandu University Hospital between March 2018 and June 2020. A total of 85 adult patients with Obstructive sleep apnea with an Epworth sleepiness score greater than 10 were included. Overnight polysomnography was done and scoring of sleep associated events were done according to the American Academy of Sleep Medicine criteria. Participants were classified as simple snoring and mild, moderate or severe Obstructive sleep apnea syndrome groups depending on the Apnea Hypopnea Index values. Relationship of Apnea hypopnea index was analyzed with age, neck circumference, body mass index and Epworth Sleepiness score. Result Simple snoring was seen in 18(21.17%) patients, 14(16.47%) had mild Obstructive sleep apnea, 13(15.29%) had moderate Obstructive sleep apnea, whereas the severe group consisted of 40(47.05%) patients. The minimum Epworth Sleepiness Score was 10 and the maximum was 25. The Apnea hypopnea index correlated positively with Body mass index (p=.010) and Epworth sleepiness score (p<.001). However, Apnea hypopnea index had no association with age (p=.437) and neck circumference (p=.118). Conclusion Health professionals need to be extremely vigilant while examining patients presenting with Obstructive Sleep Apnea. Polysomnography is the investigation of choice in the early identification of this treatable disease.

Background There are different methods to repair the perforation of the tympanic membrane. Recently cartilage has been used for the repair and results are comparable to temporalis fascia. For surgical procedure endoscope had added good assistance in middle ear surgery. Though the one hand technique the image quality and results are on par with the use of a microscope. Objective To compare the graft uptake rate and hearing results between temporalis fascia and tragal cartilage in endoscopic myringoplasty. Method This is a prospective, longitudinal study conducted among 50 patients who underwent endoscopic myringoplasty using temporalis fascia and tragal cartilage with 25 patients in each group. The hearing was assessed by comparing pre with post-operative ABG (Air bone gap) and ABG closure in speech frequencies (500Hz, 1 KHz, 2 KHz, 4 KHz). The status of graft and hearing results was evaluated on 6 months of follow up in both the groups. Result Out of total 25 patients enrolled for study in both (temporalis fascia and cartilage) groups, 23 (92%) patients in each group had graft uptaken. The audiological gain in the temporalis fascia group was 11.37±0.32 dB whereas in the tragal cartilage group it was 14.56±1.22dB. The audiological gain between the two groups did not show any statistically significant (p = 0.765). However, the pre and post-operative hearing difference was statistically significant in both temporalis fascia and tragal cartilage group. Conclusion Tragal cartilage has similar graft uptake rate and hearing gain when compared with temporalis fascia in endoscopic myringoplasty. Hence, tragal cartilage can be used for myringoplasty whenever required without any fear of deterioration in hearing.

Background: Tonsillectomy is one of the commonest surgical procedure carried out by ENT surgeon. In the post-operative period, rate of life-threatening post-operative bleeding varies between 0 and 20 % of the patients. The use of magnifying devices like microscopes or magnifying glasses is still in the focus of clinical investigation as it is hypothesized that precise vision of vessels during surgery allows precise coagulation and therefore reduces post-operative bleeding. Furthermore, precise coagulation should reduce post-operative pain too. The study aims to compare the surgical outcome between microscopic assisted tonsillectomy and traditional cold dissection tonsillectomy. Methods: This prospective study was conducted on 32 patients who had undergone tonsillectomy from March 2020 to December 2021. The patients included in the study underwent cold dissection tonsillectomy where one tonsil was removed with Microscopic assistance and other with traditional cold dissection method with unsupported vision. Intraoperative blood loss was calculated. Post-operative pain score was measured with Wong- Baker FACES® Pain rating scale till 7th post-operative day. Post-operative complications if present were noted. Results: Total of 32 patients were enrolled in the study with age ranging from 16-42 years. There were total 18 male (56.3%) and 14 females (43.8%) in the study. Intraoperative time for Microscopic assisted cold dissection (16.44 ± 3.46 minutes) was longer than Conventional dissection technique (13.94 ± 2.86 minutes) (p=0.04). Amount of blood loss during MCD technique was 16.47 ± 4.58 ml whereas in CD group it was 18.22 ± 4.54 ml (p=0.02). Pain score in both methods were higher during early post-operative period and gradually decreased with time. During rest, there was no statistically significant difference in pain between the two methods during first three post-operative days, after which pain was significantly reduced in MCD through day 4-7 (p <0.05). None of the patient had post- operative hemorrhage requiring intervention in operation room. Conclusions: Microscopic assisted cold dissection showed statistically significant results for reduced intraoperative blood loss and post-operative pain score than Conventional dissection method.