Correlation of numeric rating scale with pure tone audiogram for assessing hearing loss.

Objective: Hearing loss is the public health problem affecting all the age groups. For the assessment of hearing loss pure tone audiogram (PTA) is the gold standard but cannot be easily available in rural areas. So, the main aim of our study is to see the correlation of numeric rating scale with the pure tone audiogram for assessing the hearing loss. Materials and methods: This was the prospective, non randomized and longitudinal study performed in two hundred patients with unilateral hearing loss. For the study purpose, the numeric rating scale (NRS) was divided into 5 parts as that of degree of hearing loss and the PTAwas also divided into 5 parts to see the correlation with the NRS findings. The analysis was done using SPSS 16.0 Software. Results: The total frequency of unilateral hearing loss was 1.79%. 125(62.5%) patients fell within 16 – 25years.The mean age was 23.2+/-9.7.Females were affected more than males. Most of the patients who were in high school had unilateral hearing loss. Students and housewives accounted for 87.5%. 89% patients had conductive hearing loss, 10% had sensorineural hearing loss whereas only 1% patients had mixed hearing loss. The most of patients reported NRS2 and NRS3 which was 85.5%. Regarding the PTA analysis, 91% patients fell within mild and moderate hearing loss. There was high degree of correspondence in mild hearing loss between NRS and PTA. The Pearson’s correlation showed the statistically significant correlation between NRS and PTA with p=0.00 Conclusion: The NRS scale can be used as an optional measure for PTAin assessing the hearing loss mainly in rural areas for screening where there is lack of PTA.

Nocardia brasiliensis primary pulmonary nocardiosis with subcutaneous involvement in an immunocompetent patient.

This is a report of an unusual case of Nocardia brasiliensis causing primary pulmonary nocardiosis with disseminated subcutaneous lesions in an immunocompetent patient. This case highlights the importance of considering nocardiosis as a differential diagnosis in patients with pulmonary and cutaneous lesions and the need for vigorous management for complete cure.

Short duration anterior nasal packing after submucosal resection of nasal septum.

OBJECTIVES: To find out the shortest possible duration of nasal packing after submucosal resection (SMR) operation. To compare the outcome of the patients who underwent SMR operation and anterior nasal pack (ANP) removed after 24 hours with those who had ANP removed after 2 hours of operation. MATERIALS AND METHODS: A prospective randomized hospital based study was undertaken to compare the outcome of early removal of nasal packs after 2 hours of operation and after 48 hours. Seventy four patients undergoing SMR operation with ANP were divided in two groups. Group I: patients who underwent SMR and ANP removed after 24 hours to 48 hours (n= 37 patients). Group II: patients who underwent SMR and ANP removed after 2 hours (n= 37 patients). RESULTS: There was no significant difference between the two groups in terms of age distribution (p = 0.244), sex (p = 0.76), synaechia formation (p = 0.615) and bruise in the upper lip (p = 1.000). There were no complications following early (2 hours) removal of ANP except synaechia, no significant post-operative bleeding occurred and no post operative septal hematoma were noted. In addition, patients reported less post-operative discomfort when the packs were removed early in Group II. This practice reduced the length of hospital stay and therefore reduced costs. CONCLUSION: Our study shows that there is no significant difference in the post operative events and recovery between removal of ANP after 48 hours and after 2 hours of operation. This supports that ANP removal can safely be done after two hours of operation.

Iliopsoas abscess: analysis and perspectives from an endemic region of Eastern Nepal.

OBJECTIVE: To evaluate the clinical profile and outcome in patients with iliopsoas abscess. METHODS: A descriptive study was carried out in B.P. Koirala Institute of Health Science, Dharan, Nepal from February 2005 to March 2006. The medical records of all thirty six patients admitted in surgery ward with diagnosis of iliopsoas abscess during the study period were analyzed. RESULTS: Thirty six patients were included the study. There were 22 (61.1%) males and 14 (38.9%) females with a mean age of 24.33 +/-19.19 years. Demographic distribution of the patients revealed the highest number 13 (36.1%) from Sunsari district, eastern part of the country. Right sided unilateral involvement was the most common presentation and only 2 cases had bilateral involvement. In none of our patients the dorsolumbar spine radiograph revealed any involvement of the bone. The most common complaints were pain in lower abdomen and lump in iliac fossa with flexion deformity at hip joint. All the patients underwent open surgical drainage and their outcomes were analyzed in term of cure, morbidity and mortality. Staphylococcus aureus was the most common organism 24 (61.5%) isolated. Twenty two (91.66%) of Staphylococcus aureus samples were sensitive to ciprofloxacin. There was one mortality in the group who died of septicaemia secondary to necrotizing fascitis. Six patients had wound infection, which were cured by regular dressing. CONCLUSION: On the basis of our experience and review of available relevant literature, we can conclude that a high index of suspicion and awareness of the varying clinical picture are required to diagnose this condition properly. Ultrasonography should still be the preferred imaging modality as it is cheap, safe, cost effective and readily available. Ciprofloxacin should be used as a first line drug. Image guided aspiration may be practical in selected cases having little pus and traditional open drainage should be considered without hesitation.

Tonsillar microbial flora: a comparison of infected and non-infected tonsils.

OBJECTIVE: The main objective of this study was to find out the most common organism affecting the tonsils in recurrent tonsillitis. METHODOLOGY: This was a prospective study consisting of total number of 50 patients, conducted in the ENT department of Dhulikhel Hospital, KUTH, Dhulikhel, Nepal. The study period was one year and three months (March 2004 to April 2005). RESULTS: Total numbers of 50 patients were selected, of which 32 were of acute tonsillitis and 18 were taken as control. Among these males were 32 and females were 18. The age group was from 3 years to 64 years. Throat swabs of patients were taken by aseptic method and were sent to the laboratory immediately. Among the infected tonsils the most common organism was Streptococcus viridans followed by Streptococcus pneumoniae and Moraxella catarrhalis. The third most common was Beta haemolytic streptococci whereas Micrococcus was not isolated in any of the infected samples. Likewise in non-infected tonsils, the most common organism isolated was again Streptococcus viridans followed by Micrococcus and Diptheroids. In these specimen no Beta haemolytic streptococci was isolated from the control group. CONCLUSION: Thus, the study is able to put forward the fact that most common organism affecting the tonsils in infected as well as non- infected state is Streptococcus viridans. Where as Beta haemolytic streptococci was not found in non-infected tonsils, likewise Micrococcus was not found in infected tonsils.