Anatomical Positions of Superior Parathyroid Gland with regard to the Zuckerkandl Tubercle in Patients Undergoing Thyroidectomy in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

INTRODUCTION: Zuckerkandl tubercle is a prominent anatomical structure of the thyroid lobe. Identification and preservation of recurrent laryngeal nerve and parathyroid glands during thyroid surgery can be made easier through assessment of their relationship with the Zuckerkandl tubercle. This study aims to determine the anatomical relationship between Zuckerkandl tubercle and superior parathyroid in patients who underwent thyroidectomy in a tertiary care center. METHODS: This descriptive cross-sectional study was conducted at a tertiary care hospital of Nepal following ethical clearance from the Institutional Review Committee (Reference no: 0106201804) among patients who underwent thyroid surgery between July 2018 to February 2020. Convenience sampling was used for collecting data and was entered in Statistical Package for the Social Sciences version 20. Point estimate at 95% confidence interval was calculated along with frequency andproportion for binary data. RESULTS: Out of 59 cases, 27 (96.4%) of superior parathyroid on the left were at the 1-2 o'clock position, and 28 (90.3%) of superior parathyroid on the right were at 10-11 o'clock position. On the left side, the superior parathyroid was adhered to Zuckerkandl tubercle in 10 (35.7%), was within 5 mm in 16 (57.1%), and was >5 mm away from Zuckerkandl tubercle in 2 (7.14%). On the right side, the superior parathyroid was adhered to Zuckerkandl tubercle in 12 (38.7%), was within 5 mm in 13 (41.93%), and was >5 mm away from Zuckerkandl tubercle in 6 (19.3%). CONCLUSIONS: Zuckerkandl tubercle has a consistent relationship with the superior parathyroid and can be used as an important landmark for identifying superior parathyroid during thyroid surgery.

Septorhinoplasty among Patients who Visited the Outpatient Department of Otolaryngology-Head and Neck Surgery of a Tertiary Care Center: A Descriptive Cross-sectional Study.

INTRODUCTION: The nose is the central most part of the face, so any nasal deformities may cause a high level of psychological distress on one's quality of life. Septorhinoplasty is a surgical procedure used to correct both functional as well as aesthetic problems of the nose. It enhances facial harmony and increases self-confidence. The objective of this study is to find out the prevalence of out-patients who underwent septorhinoplasty in a tertiary care centre in Nepal. METHODS: A descriptive cross-sectional study among 5,760 patients who visited the outpatient department of Otolaryngology-Head and Neck Surgery of Kathmandu Medical College from April 2019 to September 2020. Ethical approval was taken from the Institutional Committee of Kathmandu Medical College. A convenient sampling technique was used. The preoperative and postoperative assessment was done with the help of a rhinoplasty outcome evaluation questionnaire. Statistical Package for the Social Sciences is used for analysis. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: The prevalence of septorhinoplasty was 117 (2.03%) during the study period (95% Confidence Interval= 1.66-2.40). Among 117 patients, 67 (57.3%) were males and 50 (42.7%) were females. Among 117 patients, 85 (72.6%) patients underwent an open approach, while 32 (27.4%) patients underwent closed approach rhinoplasty for the correction of both aesthetic and functional problems. CONCLUSIONS: This study concludes the prevalence of septorhinoplasty is low which may be due to the COVID-19 pandemic during the study period.

Mean Duration for Cessation of Pain following Tonsillectomy Operation among the Patients of Otolaryngology Department in a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: Tonsillectomy is one of the most common surgical procedures performed by Otolaryngologists world-wide. There are various techniques for tonsillectomy, but none of the techniques has been accepted as the best one universally. Despite the efforts of all the surgeon and use of recent techniques, some post-tonsillectomy morbidity is unavoidable. The main objective of our study is to find out the mean duration for cessation of pain among the patients following tonsillectomy operation in a tertiary care hospital. METHODS: This is a descriptive cross-sectional study of 104 patients who underwent tonsillectomy in department of otolaryngology of Kathmandu Medical College from 1st August 2020 to 31st July 2021. Convenient sampling technique was used. Ethical Approval was taken from Ethical Clearance Committee of hospital (Reference number: 2207202005). Proforma containing visual analog score was given to every patient for scoring the severity of postoperative pain. The scoring of pain was done from 1st postoperative day till 14th postoperative day. Descriptive statistical analysis was done. RESULTS: One hundred four patients had undergone tonsillectomy in our hospital. The mean duration for cessation of pain was 10 (9.75±1.97) days with mean duration of analgesia taken of 11 (10.84±2.15) days. The mean duration after tonsillectomy operation for cessation of pain on drinking was 8 (7.51±1.19) days and on eating solids 12 (11.59±2.56) days. Patients reported the first normal night of sleep at seven (6.90±1.41) days and return to normal daily activities 11 (11.18±2.53) days. CONCLUSIONS: From the study concluded that the mean duration for cessation of pain after tonsillectomy is slightly lower than other similar study.

Endoscopic Septoturbinoplasty among Patients Undergoing Surgery in the Department of Otolaryngology-Head and Neck of a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: Septoplasty without turbinoplasty is one of the main reasons for failure of procedure in case of deviated nasal septum with inferior turbinate hypertrophy. Septoturbinoplasty is the procedure of choice for complete treatment. The main objective is to find out the prevalence of endoscopic septoturbinoplasty among patients undergoing surgery in Department of Otolaryngology-Head and Neck of a tertiary care hospital. METHODS: This was a descriptive cross-sectional study in Department of Otolaryngology-Head and Neck Surgery done over a period of 1 year duration from 1st August 2020 to 31st July 2021 among 1248 patients who underwent surgery in the department. Ethical Approval was taken from Institutional Review Committee of Kathmandu Medical College and Teaching Hospital (Reference number: 2207202004). A convenience sampling technique was used. Two different techniques, Microdebrider Assisted Turbinoplasty and Outfracture with Submucosal Diathermy were used in surgery. Nasal Obstruction and Symptom Evaluation Scale questionnaire was used pre and postoperatively for data collection. Data were analyzed in Statistical Package for the Social Sciences version 16. Point estimate at 95% Confidence Interval was calculated, with frequency, percentage, mean and standard deviations. RESULTS: Out of 1248 patients, about 92 (7.37%) patients (4.95-10.14 at 95% Confidence Interval) underwent septoturbinoplasty. The mean Nasal Obstruction and Symptom Evaluation Scale before surgery was 75.21±6.19. CONCLUSIONS: The prevalence of septoturbinoplasty in our study is similar to other studies done in similar settings. We found almost complete resolution of breathing problems following endoscopic septoturbinoplasty, hence improving quality of life.

Innovative Method of Using Endoscope in Postoperative Canal Wall Down Mastoid Cavity.

INTRODUCTION: Poor access to the difficult areas in the middle ear and mastoid cavity is considered as the major reason for failure in mastoid surgery. Wide field visibility, visualization of nooks and corners by an endoscope could contribute to better clinical control of the disease in these patients that cannot be accessed by the operating microscope. The study was done to assess and clean postoperative canal wall down mastoidectomy cavities with endoscope and compare with oto-microscopy. METHODS: This was a descriptive cross-sectional study, done in Kathmandu Medical College from January to June 2017. Thirty two patients were included in the study. Data collection was done by convenient sampling. Statistical analysis was done by Chi square test and Fisher Exact test, P value of <0.005 was considered statistically significant. RESULTS: The study revealed that exposure benefit with an endoscope in canal wall down mastoid surgery was significantly better than with a microscope (P value of 0.034). The level of complete clearance and level of difficulty in cleaning with the help of a microscope compared to endoscope did not show a significant difference with P value of 0.288 and 0.652 obtained by Fisher extract test respectively. After microscopic removal of materials from the mastoid cavity, 22 (68.8%) which is more than half of cases had remaining materials in the cavity which was removed by endoscope completely. CONCLUSIONS: Outcome will make the ENT surgeons aware of use of endoscopy in post mastoid follow up cases to give better results and make the surgeon much more successful in his/her endeavor to eradicate the disease.

Acoustic Analysis of Voice in School Teachers.

INTRODUCTION: The term 'voice' is the acoustic energy generated from the vocal tract that are characterized by their dependence on vocal fold vibratory pattern. Teachers as professional voice users are afflicted with dysphonia and are discouraged with their jobs and seek alternative employment. Loud speaking and voice straining may lead to vocal fatigue and vocal fold tissue damage. The objective of the study is to assess the quality of voice of school teachers before and after teaching practice. METHODS: Sixty teachers from various schools, volunteered to participate in this study. Acoustic analysis Doctor Speech Tiger Electronics, USA was used to assess the voice quality of the school teachers before and after teaching practice. The data were collected and analyzed using Doctor Speech Tiger Electronics, USA. Analysis was performed in terms of perturbation (jitter and shimmer), fundamental frequency, harmonic to noise ratio and maximum phonation time. RESULTS: We found statistically significant difference in all the four parameters except the Jitter value. The fundamental frequency and shimmer value has significantly increased (P<0.001) and (P=0.002) respectively after teaching practice. Unlikely, there was significant decrease in harmonic to noise ratio value (P<0.001) and maximum phonation time value (P<0.01) after teaching practice. CONCLUSIONS: Vocal abuse, overuse, or misuse in teaching practice over a long period of time can result in inadequate phonatory pattern due to vocal fold tissue damage, which ultimately results in vocal nodules or polyps. So voice evaluation is particularly important for professional voice users and for the people who are concerned about their quality of voice.

Diode Laser Reduction of Symptomatic Inferior Turbinate Hypertrophy.

INTRODUCTION: Inferior turbinate hypertrophy refractory to medical management is one of the commonest problems encountered by ENT surgeons all over the world. Diode Laser turbinate reduction is a safe, minimally invasive, cost-effective procedure that helps in relieving the symptoms associated with it and can be performed on a day care basis under local anesthesia. The objective of this study is to measure the effectiveness of Diode laser in treatment of symptomatic ITH. METHODS: Fifty patients with symptomatic inferior turbinate hypertrophy, age ranging between 15-45 years were enrolled in the study. Symptom assessment was done with the visual analogue scale. Portable Diode laser was used. Patients were followed up after 1 week and 1 month of surgery. During each postoperative visit, symptoms were reassessed using VAS and postoperative morbidity were noted. RESULTS: Out of fifty patients, all the patients had nasal obstruction and 42 had nasal discharge and by the end of 1 month 43 (86%) and 37 (88%) patients had relief of symptoms respectively. Excessive sneezing was found in 45 patients, 39 (86.6%) patients got benefitted. Out of 18 patients, 15 (83.3%) patients had decreased snoring at 1 month post-op. Similarly, 24 patients had headache, 20 (83.3%) patients had decrease in severity. Hyposmia was seen in 19 patients, 10 (52.6%) patients had improvement in olfaction. CONCLUSIONS: Diode laser turbinate reduction for symptomatic inferior turbinate hypertrophy is one of the safest procedures that can be done under local anesthesia on OPD basis with significant relief of symptoms and with minimal complications.