Background: Thyroid swelling can be benign or malignant. It is evaluated by clinical examination, Ultrasonography (USG) and Fine Needle Aspiration Cytology (FNAC). This study was conducted with the aim of comparing discrepancy of diagnosis by USG, considering FNAC as gold standard. Methods: A prospective observational study of thyroid swellings with convenient sampling was carried out over a year (20 October 2020 to 19 October 2021) at Outpatient department of Nobel Medical College, Biratnagar, eastern region of Nepal. Clinical, ultrasonological and cytological parameters were recorded. Sensitivity, Specificity, Positive predictive value (PPV) and negative predictive value (NPV) were calculated. Results: Out of 120 study population, with a mean age of 45.37 years, there was female preponderance, 110(91.66%). The commonest age group was 30-40 years, 28(23.33%). On Ultrasonography, non neoplastic lesions diagnosed were in 104 (86.7%) cases, as compared to FNAC, 113(94.2%). While, malignancy was diagnosed in 16 (13.7%) cases, by USG, only 7(5.8%) cases were malignant on FNAC. The Sensitivity of USG for malignancy detection was 100%, Specificity was 92 %, Positive predictive value (PPV) was 43.75 % and Negative Predictive value (NPV) was 100% as compared to FNAC. Accuracy was 92.5%. Conclusions: Ultrasonography has an excellent diagnostic sensitivity, specificity and accuracy compared to that of FNAC.
Epistaxis is a common ENT emergency. Various causes are mucosal trauma, anticoagulants and bleeding disorders. Vascular causes and trauma accounts for less than 5% causes. A 25-year-old man presented to emergency with intractable epistaxis. He had sustained road traffic accident 5 months back. His previous CT scan showed multiple facial bones fracture along with sinuses (frontal, maxillary and sphenoid sinus on right para clinoid area) fracture. Initial CT angiography showed no vascular defects. The latest episode of epistaxis was massive and he underwent nasal endoscopy and packing of nose. Pulsatile sphenoidal polyp was visualized, along with transmitted pulsations in the sphenoid sinus on the right side. Subsequent Magnetic Resonance Angiography (MRA) showed a 12x4 mm pseudoaneurysm of clinoidal portion of Internal Carotid Artery on the right side. Post-traumatic Pseudoaneurysm of the Internal Carotid Artery may be the differential diagnosis in traumatic epistaxis, especially the delayed type. If pseudoaneurysm is suspected, CT or MRI angiography should be performed immediately.
Background: Sino nasal outcome test (SNOT) is a subjective tool in which both nasal and health-related symptomatic improvements are assessed in cases of Chronic Rhinosinusitis (CRS). We aim to report the demography of CRS patients and magnitude of symptoms, along with its improvement over time after the surgery, using SNOT questionnaire. Methods: A hospital based prospective, descriptive study was done in 35 patients with medically refractory CRS cases who underwent Functional endoscopic sinus surgey (FESS), over one year. All patients were routinely examined the 1st week, the 4th week, and 3 months after surgery. The cases were assessed preoperatively and then after surgery, using the Sino-nasal Outcome Test-22 (SNOT-22) questionnaire, for a maximum of 3 months period. The results were expressed in number and percentage. Mean and standard deviation were used to describe the findings and compare the initial and follow up values. Association between preoperative and postoperative symptoms was analyzed using paired sample t-test and p value less than 0.05 were considered significant. Results: The age range was 14-64 years, with a mean age of 33.11 ± years. 12(34.28%) were male and 23(65.71%) were female. Polyps were present in 12 (34.28%). 23 (65.71%) cases were without polyp. The mean SNOT score overall preoperatively was 33.94±SD, while postoperative SNOT score was 19.05±SD. There was a significant improvement in nasal, ear and facial symptoms, quality of life symptoms and psychological symptoms. Conclusion: There was an overall improvement in all the symptoms postoperatively, though the Cough and dizziness improvement was not statistically significant.
Brain abscess, though not rare, is an uncommon complication of otitis media. We report a case of 12 years old male for chronic ear discharge, throbbing headache and post aural swelling for three weeks. A detailed history and physical examination of the child was performed and a Magnetic Resonance Imaging (MRI) scan was done. A diagnosis of an intracranial abscess, secondary to the chronic otitis media was made. An emergency craniotomy with drainage of brain abscess was planned and performed by the Neurosurgeon. Otolaryngolgoist performed mastoidectomy, in the same setting. After the surgery, post-operative manage- ment was done and the patient was discharged, uneventfully. The complete management in a single sitting of primary cause and resulting complication with no added expenses is the necessity of a poor country citizen.
Background: Tympanoplasty is done in cases of chronic otitis media. Middle Ear Risk Index (MERI) Scale is used to predict the outcome of tympanoplasty, based on various risk factors like otorrhoea, perforation, ossicular chain status, cholesteatoma, smoking and middle ear granuation/effusion. The objective of the study was to report the success rate of graft uptake, postoperative gain in hearing threshold and to find out the association of success to the different categories of MERI scale. Methods: A prospective study of 75 cases of chronic otitis media who underwent tympanoplasty, was done over one year. Convenience sampling method was done. Clinical and audiological evaluation was done pre- and post- operatively. Risk categorization based on MERI scale was done. Data were recorded and analyzed using SPSS 16. Results: Out of 75 cases, 39 (52%) cases were male and 36 (48%) were female. The mean age was 24.55 years±11.545. Overall, 53 (70.66%) cases had successful graft uptake. MERI 1-3 group had 82.6 % (38/46), MERI 4-7 group had 64.7 % (11/17) and MERI 8-12 group had only 33.33% (4/12) graft uptake, (p-value 0.003). Above-10-year age group had higher graft uptake rate and hearing gain. Graft acceptance was seen equal in dry or wet ear, and in unilateral or bilateral perforation. Conclusions: Tympanoplasty done in cases with lower MERI scale and more than 10 years age group was associated with higher graft acceptance. More than 10 years age group had better hearing gain. The status of middle ear, dry or wet and laterality of perforation had no association for graft acceptance.
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