Background: Chronic otitis media is otological challenge in the developing countries it is particularly single most common cause of hearing impairement. Objective: The objective of this study was to observe the impact of prognostic factor middle ear risk index on hearing of patients undergoing tympanoplasty for chronic otitis media. Methods: This was a prospective analytical study conducted in 50 patients planned for tympanoplasty for chronic otitis media and evaluation done by MERI (Middle Ear Risk Index) and pure tone audiometry. Results: This study shows that most of the patients had mild MERI (64%), followed by severe MERI (20%) and then moderate MERI (16%). The mean preoperative PTA average was 44.34 dB (SD 8.01 dB) for patient with mild MERI, 44.75 dB (SD 5.87 dB) for patient with moderate MERI, and 54.9 dB (SD 14.05 dB) for patient with severe MERI and the mean preoperative A-B gap was 37.36 dB (SD 5.73 dB). Post operatively for mild MERI mean hearing gain is 12-14dB, for moderate MERI mean hearing gain is 10-13dB and for severe MERI mean hearing gain is 10-13dB and post operative mean A-B gap was improved by 10-11dB. There is a statistically significant hearing improvement in A-B gap with different types of MERI. Conclusion: MERI scoring is useful for predicating the outcome of hearing after tympanoplasty.
Introduction: Chronic otitis media is one of the most common ear diseases in developing countries like Nepal and is important cause of the hearing loss. Chronic otitis media is rarely an isolated entity, because the responsible factors for its development in one ear in similar way will impact the contralateral ear, since both ears have a common “nasopharyngeal” drainage. Contralateral ear is defined as asymptomatic ear in cases of unilateral chronic otitis media. Aims: To evaluate the audiological profile of Contralateral ear in post-operative subjects of unilateral otorrhoea. Methods: Patients fulfilling criteria underwent Otoscopic examination, tuning fork test and pure tone audiometry. The findings of contralateral ear like retraction, tympanosclerotic patch (TS patch), thin, dull and atrophied tympanic membrane were noted. The final diagnosis with the type of surgery of diseased ear, as well as status of contralateral ear were entered into the proforma. All the patients were followed till three months in relation to anatomy of Tympanic membrane onotomicroscopy and pure tone audiometry respectively. Results: In postoperative cases of mucosal disease, the cases with abnormality in the contralateral ear reduced from 17 to 10 patients (30.3%) and the normal patients increased from 16 to 23 cases (69.7%). Likewise, in postoperative squamous disease, the cases with abnormality in the contralateral ear reduced from 14 to 11 patients (64.7%) and the normal patients increased from 3 to 6 cases (35.3%). Out of 50 cases, 14 cases (28%) had defective hearing while 36 cases (72%) had normal hearing in the contralateral ear respectively. Conclusion: The high incidence of occurrence of abnormality in contralateral ear indicate that both ears should be regarded as a pair. Unilateral Chronic otitis media should not be taken as a static phenomenon but as a continuous process in the other ear too.
Objectives: To assess the reliability of paper-patch test in predicting the intra-operative ossicular status of patients with tympanic th membrane perforation from small to medium size. Methods: This is a hospital based prospective study conducted from 30 April, st 2016 to 1 May, 2017 in the Department of Otorhinolaryngology of Nepalgunj Medical College Teaching Hospital. The patients of chronic otitis media with small to medium sized central perforation were subjected to complete history taking and thorough examination. Audiological evaluation was done before patching, then after patching the perforation with cigarette paper. The result was recorded to predict the ossicular status. Result: The most common age group affected by the disease was 20-30 years with 21(42%) patients. Most of them were females 28(56%). Left ear was affected more 19(38%) than right ear 16(32%) and bilateral 15(30%). All the patients had conductive type of hearing loss out of which moderate degree of hearing loss was present in 36(72%) and mild degree of hearing was present in 14(28%). Following patch test, the hearing improved and in 7(14%) of patients the hearing came to normalcy. Majority of patients had mild degree of hearing loss, i.e., 36(72%) and moderate degree of hearing loss was seen in 7(14%). It was found that in those patients in whom there was less improvement in hearing that i.e. less than 10 dB, the mobility of the ossicles was restricted intra-operatively. Conclusion: The type of hearing loss was conductive hearing loss out of which most common was moderate degree of hearing loss in 36(72%) followed by mild degree of hearing present in 14(28%). Following patch test, it was found that in those patients in whom there was less improvement in hearing i.e., less than 10 dB,ossicular discontinuity was noted intra-operatively and thus ossicular reconstruction by tympanoplasty procedures had to be undertaken.
Objective: To investigate the spectrum of parotid pathologies on neck ultrasound and correlation with pathological findings. Materials and methods: A total of 41 patients with parotid swelling who had undergone neck ultrasound were included in this prospective study. Patients with history of previous neck ultrasound, recent surgery, bleeding diathesis or trauma, equivocal pathological findings were excluded from the study between June 2016 to May 2018. On-site fine needle aspiration cytology was performed by a pathologist who was blinded to the ultrasound findings. Results: Among the 41 patients, 41.5 % were males and58.5 % were females with age ranging from 1 to 76 years with a mean age of 37.31 years. Ultrasound was able to categorize lesions into benign and malignant with a sensitivity of 97.3 %, specificity of 50%. Pleomorphic adenoma was the most common pathology (46.3 %) followed by inflammatory conditions. Mucoepidermoid carcinoma was the most common malignant tumor constituting 7.3 % of the total cases. Conclusion: High resolution ultrasound can categorize parotid lesions with high degree of confidence in the hands of skilled radiologist. In equivocal cases, onsite fine needle aspiration by cytopathologist increases the diagnostic yield.
Introduction: Tonsillitis is inflammation of tonsils which is characterized by various signs and symptoms with sore throat being the most consistent symptom. The condition is mostly caused by bacterial infection with Streptococci being the most common bacteria. McIssac scoring technique is clinical symptoms based scoring method designed for diagnosing streptococcal tonsillitis. Aims: To find out the association between McIssac Score and beta hemolytic streptococcal infection in acute tonsillitis. Methods: This hospital based, prospective study was carried out in the Department of ENT, Nepalgunj Medical College from July 2020 to June 2021. Patients were scored as per McIssac score. The specimens were collected from the tonsillar surface using sterile cotton swabs and subjected for culture and sensitivity. Results:The most common affected age group was 21 to 30 years (46%). Females were affected more commonly (57%). The most common organism isolated in the study was Group A beta hemolyticn Streptococcus (48%), followed by Pseudomonas (10%), Enterococcus (9%) and Klebsiella (8%) and no organisms were isolated in 25% of the patients. It was observed that high McIssac score was associated with higher chance of having positive beta hemolytic streptococcal infection. Out of 48 group A beta hemolytic streptococci culture positive patients 18(37.5%) patients scored 3, 9 (18.75%) patients scored 4 and 7(14.5%) patients scored 5.The most common antibiotic effective against group A beta hemolytic srtreptococci was ceftriaxone in 25(72.9%), followed by amoxyclavulinic acid in 20 isolates (41.6%) and amikacin in seventeen (35.4%) isolates. Conclusion: The correlation between throat swab culture and McIssac score emphasized that this clinical scoring system aid in early diagnosis of group A beta hemolytic streptococci tonsillitis.
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