Oesophageal foreign bodies in children.

Foreign body ingestion is a common occurrence and carries significant morbidity and mortality. Failure to treat foreign bodies immediately can lead to various serious complications. This study was done to identify the types as well as site of foreign body ingested and its complication in children. A retrospective study of 122 cases of suspected foreign body ingestion in patients admitted in ENT and Head and Neck Surgery of TU Teaching Hospital, Kathmandu were done in between April 2004 to July 2008. Ages less than 12 years were included. In all cases x-ray soft tissue neck lateral and chest x-ray posterio-anterior views were done along with other preoperative investigations. Rigid oesophagoscopy or hypopharyngoscopy were done under general anesthesia to remove foreign bodies. There were 64.7% male and 35.3% female children. Foreign bodies were common in 0-4 year age group. Most common foreign body were coin (64.0%) followed by meat bone (14.0%). No foreign bodies were found in 2.4% patients as they were passed in stomach. No complications were noted during the entire period of this study. Most common foreign bodies in children are coin. Though complications with these foreign bodies are rare, these do occur due to delay in presentation and removal. No complications were noted in our series. Eventhough children who swallow foreign bodies are asymptomatic; we must maintain a high index of suspicion and undergo diagnostic procedure, if there is a positive history.

Size of typmanic membrane perforation and hearing loss.

This prospective study was done to assess the level of preoperative hearing impairment in different sizes of pars tensa perforation in patients with chronic suppurative otitis media (CSOM) tubo-tympanic type undergoing myringoplasty. A total of 50 patients were recruited from the outpatient Department of Otorhinolaryngology - Head and Neck Surgery from June 2003 to May 2004. Cases of CSOM tubo-tympanic type with dry central perforation, conductive type of hearing loss were subjected to myringoplasty. Preoperative audiometric evaluations were done. While operating under microscope diameter of perforations were measured and perforations were grouped according to the size. It was observed that greater hearing loss was reported in group D perforation (44 dB), where as in group A, it was 31 dBHL. The average hearing loss at 500 Hz was 46.40 dB, at 1000 Hz was 30.90 dB and at 2000 Hz it was 31.9 dB. This shows that the hearing loss is more at lower frequencies and less as the frequencies increase. This study shows that as the size of perforation is increased, the hearing loss also increases. The hearing loss is more marked at lower frequencies as compared to higher frequencies.