Background: Tonsillectomy is one of the most commonly performed operations in otolaryngology. There are many proven methods of tonsillectomy, including cold dissection and bipolar electrocautery. Objective: To compare bipolar elecrocautery tonsillectomy with cold dissection method in pediatric age groups. Methods: Single blind controlled study to compare bipolar technique against the conventional dissection/snare technique. Results: The average amount of bleeding on electrocautery side was 4.07ml and on the cold dissection side was 14.58 ml. The mean time of operation for electrocautery and cold dissection was 12.04 and 16.57 minutes respectively. On the second post operative day, 35% of the patients complained of pain on the cauterized side, 30% complained of more pain on the dissection side while 35 % experienced equal pain on both sides. Post-operative complication such as hemorrhage was not seen in both the techniques employed. Conclusion: In the present study, bipolar diathermy tonsillectomy had advantages in having less post-operative time and blood loss intraoperatively but patients experience slightly more pain than cold dissection.

Background

Introduction Otitis media (OM) and otitis media with effusion are commonly presenting conditions in an otolaryngology clinic. Exposure to passive smoking is thought to increase the risk of OM through an effect on mucociliary clearance, decreased ciliary beat frequency, or mucous hypersecretion. Awareness among parents plays a key role in the primary prevention of the disease. Objective We aimed to identify the association of passive smoking with OM among school-going children of the eastern region of Nepal. Methods A community-based cross-sectional study was done among 663 school-going children, selected by stratified random sampling using a questionnaire. Data regarding age, gender, type of school, otological symptoms, smoking status of parents and family members, otoscopic findings, pure tone audiometry, and impedance audiometry were recorded. Results Six-hundred and sixty-three students were included in the study. OM was confirmed in 103 students (15.5%). Smoking history was present in at least one of the family members in 177 out of 663 students (26.69%) and with positive smoking history in any member of the family, OM was seen in 65 (36.7%) students (p ≤ 0.001), which suggested significant association. OM was seen in 38 students (7.8%) when there was no exposure to passive smoking. Conclusions There is a high prevalence of OM (15.5%) in school-going children. The study shows significant association between passive smoking and OM in children.

Introduction: The management of Mooren's ulcer can be a challenge for clinicians. Objective: To report a case of Mooren's ulcer treated with amniotic membrane transplantation supplemented with autologous serum eye drops. Case report: A 22-year-old male presented with history of pain, redness, watering and diminution of vision of the right eye for one year. Examination of his eyes revealed the best corrected visual acuity ( BCVA) of 6\60 and 6\6 in his right and left eyes respectively. Slit -lamp examination of the right eye showed a peripheral ulcer extending from 2'0 to 11'0 clock positions with peripheral thinning and the features suggestive of Mooren's ulcer. The condition did not improve with topical steroids and cyclosporine A eye drops. Therefore, 360 degree conjunctival peritomy with cauterization of the base was performed. Since there was no obvious improvement, the amniotic membrane transplantation was done with supplementation of autologous serum eye drops 20% four times a day. The patient showed symptomatic improvement in a week. There was cessation of the progression of the ulcer and decreased vascularization. One month later, a small corneal perforation was noted and was managed well with cyanoacrylate glue and bandage contact lens application. At nine months of follow up, the patient was symptomatically better, the ulcer had healed, the vascularization had decreased and the anterior chamber was well formed. Conclusion: Amniotic membrane transplantation showed to be promising in treatment of Mooren's ulcer refractory to immunosuppressive therapy. Addition of autologous serum eye drops seems to be an effective supplementary therapy.

Thyroid surgery evolution is important with a lots of hurdles faced by many surgeons to reach the present stage. The complications from the olden days reduced with improvement in understanding the disease process, development of antibiotics, anaesthesia and now restricted mainly to hypoparathyroidism and recurrent laryngeal nerve injuries. A retrospective analysis of thyroid surgeries performed at BP Koirala Institute of Health Sciences centre from 2007 to 2011 Clinicopathological features and complications were analyzed. Among 203 patients who underwent surgery for thyroid operations, 53 were malignant and 150 were benign cases. Hemithyroidectomy was the most common procedure performed (118 cases). Papillary thyroid cancer was the most common malignant lesion and colloid goiter the most common benign lesion. Postoperative complications occurred in 12 patients-infection in two patients, bleeding requiring reexploration in one patient, hypocalcemia in 6 (5-transient and 1-permanent) and hoarseness of voice in three patients (2-temporary and 1-permanent). FNAC is an easy, cost effective, reliable investigation in experienced hands. Reoperation, primary stage of the tumor and central node dissection are associated with increased complication rates.