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Abstract Introduction Neck space infection in the pediatric age group is common but can be life-threatening if not diagnosed properly. Since it is a polymicrobial disease, antibiotic usage should be guided by culture sensitivity pattern. Objectives To assess the microbiology, antibiotic resistance pattern and the outcome of the medical and surgical management of deep neck space infection in children. Methods This was a prospective study of children admitted for management of neck space infection from August 2017 to August 2018. The age, gender, organisms isolated, sensitivity and resistance to antibiotics, length of hospital stay, complications, and recurrence were noted. The descriptive data were analyzed. Results Out of 108 cases, there were 51 males (47.2%) and 57 females (52.8%) ranging from 1 month to 15 years, with a mean age of 5.32 +/- 4.35 years. The mean period of hospitalization was 6.98 days. Staphylococcus aureus was the most common organism isolated with less coagulase-negative staphylococci and streptococci. Clindamycin was the most sensitive drug (82.35%) followed by vancomycin and cloxcillin, while amoxicillin/ampicillin, a commonly used drug, was the least sensitive (20.58%). The abscess recurrence rate was 9.28%. The outcomes of either medical treatment or a combined medical or surgical treatment in properly selected cases were comparable. Conclusion Clindamycin or cloxacillin can be used as a first-line option for neck infection in children. Ampicillin/amoxicillin alone has a small role in neck abscess because of high resistance to this type of antibiotic.
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Abstract Introduction Fine needle aspiration cytopathology (FNAC) is widely used for the stratification of thyroid nodules. Objective The objective of the present study is to validate FNAC reporting based on The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) at our institution and to calculate the risk of malignancy in each category. Methods This was a descriptive cross-sectional study conducted jointly at the Department of Ear, Nose and Throat and at the Department of Pathology for a period of 1.5 years (May 2018 to November 2018). All cases presenting with thyroid swelling in the outpatient department were investigated with ultrasonography (USG) of the neck, thyroid function test, and FNAC. All FNAC reporting was done according to TBSRTC. Results A total of 134 thyroidectomies were performed during the study period. The female to male ratio was 5.3:1. The age ranged from 11 to 74 years old. with a mean age of 51 years old. The FNAC has a specificity of 84.9%, a sensitivity of 89.4%, a positive predictive value of 86.4%, a negative predictive value of 88.2%, and an accuracy of 87.3% in detecting thyroid cancer. The implied risk of malignancy (ROM) in Bethesda II, III, IV, V and VI is 11.7%, 25%,40%,76.6% & 96%, respectively. Conclusion The four studied categories had a ROM comparable to other studies, except for the Bethesda III category. Further studies with larger sample sizes and with the use of USG guidance for the aspiration from the thyroid swelling may give better results by reducing the number of false negative and false positive cases.
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Background:The revision myringoplasty surgery is done for the graft failure after myringoplasty. The surgeons’ make use of the temporalis fascia or cartilage as the graft material. Some surgeons opt for the revision myringoplasty with cortical mastoidectomy as well.Methods:This study is a retrospective, observational study done in the Department of ENT and Head and Neck Surgery, Tribhuvan University Teaching Hospital from December 2015 to 2019. Dataof all the patients undergoing revision myringoplasty with or without cortical mastoidectomy were collected from the record section and included in the study. Post-operatively, the patients were assessed for graft uptake and hearing assessment after six weeks of surgery. Total uptake of the graft was taken as the successful graft uptake. The hearing was assessed by air conduction threshold (AC threshold) and air-bone gap status postoperatively.Results:Total of 42 patients were analysed with the graft uptake of 86%. There was no significant difference in the graft uptake on using the temporalis fascia or tragal cartilage. Regarding the hearing assessment, the average pre-operative and post-operative AC threshold was 37.95±5.68 dB and 29.36±6.28dB. The average pre and postoperative AB gap was 29.97±8.16dB and 21.85±6.68dB. The improvement in the hearing threshold was significant (p value<0.05).Conclusions:The graft uptake rate for revision surgery in our centre was comparable to other studies in the literature. There was significant hearing improvement pre and postoperatively after revision myringoplasty.