Comparison of sub mucosal diathermy and partial resection of Inferior turbinate in the treatment of symptomatic nasal valve blockage.

OBJECTIVES: to evaluate the efficacy of sub mucosal diathermy (SMD) and partial resection of inferior turbinate (PRIT) in the treatment of symptomatic enlarged inferior turbinates. STUDY DESIGN: prospective. METHODS: Forty patients of age group 18 -56 yrs with symptomatic enlarged inferior turbinates had given choices for SMD and PRIT. All the patients had history of failed medical treatment. RESULTS: Each twenty patients underwent SMD (group I), PRIT (group II), five pt of gr. I had to have anterior nasal packing after surgery for bleeding. Three pt complained of excessive rhinorrhoea for first 2 weeks while 3 pt of Group 1 complained of nasal blockage for 1 week even after intervention. In group 2, 5 pt had to have re-anterior nasal packing after pack removal. Both groups followed up for 6 months. Nine patients were lost in follow up, so excluded from the study. Following 6 months of follow up, 6 patient of gr. I had recurrence with nasal blockage and in gr. II none had recurrence. CONCLUSION: PRIT is better than SMD in long course; nevertheless it should be reserved for failed SMD, not as a primary option.

Comparison of chemical cautery (AgNo3) and steroid spray against SMD (submucosal diathermy) in the treatment of symptomatic inferior turbinate hypertrophy (ITH).

OBJECTIVE: To compare the efficacy of chemical cautery (AgNo3) and steroid nasal spray against SMD (submucosal diathermy) in the treatment of symptomatic Inferior Turbinate Hypertrophy (ITH). MATERIALS AND METHODS: Patients attending OPD in the department of ENT &HNS at KMCTH with symptomatic Inferior turbinate Hypertrophy were taken with their approval included for the study. Patients were divided into 2 Groups: in the first Group 25 patients were included and treated with chemical cautery (AgNo3) under Local Anaesthesia (LA), followed by steroid nasal spray for 3 months; in the second Group 25 patients were included and were treated with SMD (submucosal diathermy) under General Anaesthesia (GA).They all had history of use of topical nasal decongestant for different time period. Patients were followed up for 6 months. RESULTS: In Group 1, 16 patients complain of burning sensation for first week and 8 patients complain of continuous nasal blockage for 6 weeks.1 patient complain about inosmia for 2 weeks. In Group 2, nasal pain was complained by 17 patient for 2 weeks. 3 patients complain of persistent nasal blockage for 4 weeks. 3 patients complain of anosmia for 4 weeks. After completion of 6 months in Group 1, 20 patient has recurrent nasal blockage, whereas in Group 2, 10 patient has recurrent nasal blockage. Besides these, other symptoms noticed during initial phase did not appear. CONCLUSION: Chemical cautery (AgNo3) and steroid nasal spray is easy to follow, has less complication ,but failure rate is high, whereas SMD is procedure with less failure rate, but has to carried out under GA and has more discomfort postoperatively. For symptomatic inferior turbinate hypertrophy, where topical nasal decongestant has little role SMD is the choice of treatment for longer relief.

Waardenburg syndrome Type II.

Two rare cases of Waardenburg type II are reported. First case had three main features of WS--profound SN hearing loss, hetrochromia iris and white forelock of hair. Second case had moderate SNHL and depigmentation of hair.

Prevalence of otitis media in school going children in Eastern Nepal.

OBJECTIVES: To find out the prevalence of otitis media in school going children from lower socio-economic strata. MATERIAL AND METHODS: This study was carried out in a government school, Shree Naragram Secondary School in Morang district, eastern Nepal, and included 1050 children aged between 5-15 years. RESULTS: Of the 1050 school children, 346 children were found to have various ENT related problems. Hearing assessment revealed a conductive hearing loss on one or both sides in 114 cases (87%). Various middle ear pathologies were detected in these children, out of which chronic suppurative otitis media "Tubotympanic type" was the most common, followed by otitis media with effusion. The prevalence of otitis media in these children was found to be13.2% and those with hearing loss comprised 12.47%. Prevalence of otitis media is found to be much higher in school going children as compared to adults, and is even higher amongst children belonging to the lower socio-economic strata. Conditions complicating otitis media are more common and severe in children as compared to adults. CONCLUSION: Primary ear care education to teachers, students and guardians can prevent these vulnerable children from developing hearing impairment. School based study could be one of the useful and cost-effective modality aimed at community oriented program.

Effect of adenotonsillitis on peak exploratory flow rate in children.

Peak Exploratory Flow Rate (PEFR) is a simple, economical, reproducible, non-invasive test, which can be quickly performed with ease. PEFR was assessed in 36 children with adenotonsillar enlargement with mean age 10.75 years and equal number of age and sex matched normal children who acted as controls. PEFR was found to be 250. 61 +/- 66.92 lt/min in controls and 216.85 +/- 59.76 lt/min in children with adenotonsillar enlargement signifying impairment of PEFR in children in the second group.

Controlling Taenia solium in Nepal using the PRECEDE-PROCEED model.

Taenia solium is a predominant food-borne parasitic zoonosis (FBPZ) in Nepal. Using the PRECEDE framework, as defined by Green and Kreuter, we can identify the factors behind the high incidence of this disease. Armed with this information, we can define the actions necessary to control T. solium. In accordance with the first step of PRECEDE, social assessment, we set the goal of decreasing the potential for T. solium transmission in Nepal by the year 2003. This goal has yet to be endorsed by policy makers. However, an epidemiological assessment based on hospital data alone showed that T. solium is an endemic problem in urban Nepal that must be addressed. Based on behavioral and environmental assessments (Steps 1 and 2 of PRECEDE-PROCEED), we defined the following action objectives to be achieved by 2003: 1) Train meat producers and sellers to detect contaminated pork and avoid selling it, 2) Improve pig husbandry to limit the animals' access to human feces, 3) Construct hygienic model slaughterhouses. These improvements could control the meat-producing environment, thus limiting the potential for cross-carcass contamination and other hygiene deficiencies associated with the spread of T. solium. An educational and ecological assessment shows all predisposing, reinforcing and enabling factors are present in Nepal, consistent with PRECEDE requirements. While T. solium is clearly defined as a health problem according to PRECEDE, there remain significant hurdles to controlling it. These hurdles lie in administration and policy, where standardized law-enforcement and meat inspection practices are needed. Finally, the government of Nepal must assign high priority to T. solium control, as it is a preventable, yet prevalent disease.