Internal auditory canal duplication with facial and cochlear nerve dysfunction: A case report.

Internal auditory canal duplication is a rare anomaly of the temporal bone. The condition is diagnosed on performing High-Resolution Computed Tomography of the temporal bone and magnetic resonance imaging for sensorineural hearing loss. A bony septum divides the internal auditory canal into dual compartments. Duplication may be either unilateral or bilateral and vestibulocochlear nerve may be aplastic or hypoplastic. Rarely, patient may present with facial nerve palsy. A 26-year-old female presented with right grade IV lower motor neuron facial nerve palsy for 12 years and right-sided hearing loss for 9 years. Pure tone audiogram revealed 45 dB of moderate degree sensorineural hearing loss on the right ear. On High-Resolution Computed Tomography of the temporal bone, an incomplete bony septum was visualized in the right internal auditory canal, dividing it into two compartments. Internal auditory canal on the left side was normal. Other inner and middle ear structures were normal. On magnetic resonance imaging, both the vestibulocochlear and facial nerves were well visualized with normal calibers.

Mucormycosis of the Middle Ear and Neck Post COVID 19.

Mucormycosis is an opportunistic infection caused by fungi of order Mucorales and affect immunosuppressed patients. The cases of mucormycosis have surged during the COVID pandemic, especially in cases requiring steroids and mechanical ventilation. Here we present a case of a 40-year-old diabetic post COVID female patient. She presented with right earache, right facial paralysis (grade four) of two weeks duration and right sided neck swelling for ten days. Ultrasonography and computed tomography revealed multiple abscesses in the right side of the neck. Histopathological examination of tissue from the neck and middle ear confirmed the diagnosis of mucormycosis. This is a rare case of concurrent neck and middle ear mucormycosis in a post COVID patient. Keywords: Coronavirus; COVID 19; middle ear; mucormycosis; neck.

Tracheostomy among Children Admitted in the Pediatric Intensive Care Unit of a Tertiary Care Centre.

Introduction: Tracheostomy is commonly performed for upper airway obstruction, prolonged mechanical ventilation and tracheo-bronchial toileting. Pediatric tracheostomy differs from adult tracheostomy in terms of surgical procedure, post-operative care and recovery. The tracheostomized patients may either be decannulated, discharged with tube-in-situ or the patient may expire. The aim of this study was to find out the prevalence of tracheostomy in patients admitted to the Pediatric intensive care unit of a tertiary care centre. Methods: A descriptive cross-sectional study was performed among children admitted to the Pediatric intensive care unit of a tertiary care centre from 1 May 2017 to 31 August 2022 after obtaining ethical approval from the Institutional Review Committee. A convenience sampling method was used. The point estimate was calculated at 95% Confidence Interval. Results: Among 1472 patients, tracheostomy was done in 65 (4.41%) (3.37-5.47, 95% Confidence Interval). A total of 33 (50.76%) underwent tracheostomy for prolonged ventilation whereas 32 (49.23%) were tracheostomized for airway obstruction. Among them, 41 (63.07%) patients were successfully decannulated, 9 (13.84%) were discharged with tracheostomy tubes in situ whereas 15 (23.07%) patients deceased. The most common complication was tracheostomy tube blockage reported in 5 (7.69%). Conclusions: The prevalence of tracheostomy among the children of the pediatric intensive care unit was found to be lower than in other studies. Keywords: mechanical ventilation; complication; pediatric; tracheostomy.

Anatomical Variations, Surgical Difficulties, and Complications Associated with Cochlear Implantation in Different Age Groups of the Pediatric Population of Nepal: A Tertiary Level Hospital-Based Study.

Pediatric cases account for the major proportion of the population for whom cochlear implantation is indicated. This study aims to review the anatomical variations, surgical difficulties, and complications associated with cochlear implantation surgery in different age groups of the pediatric population of Nepal.This study was conducted at Tribhuvan University Teaching Hospital, Nepal. A prospectively set data of cases who underwent cochlear implantation between January 2015 and March 2020 were analyzed for details of surgical procedure, surgical difficulties, and intraoperative and postoperative complications. The anatomical variations encountered during surgery were classified as: developmental anomalies, round window niche variations and acquired abnormalities resulting from inflammation. Intraoperative surgical difficulties were defined based on the operating surgeon's perspective. Complications following cochlear implantation were classified as surgical and nonsurgical or device-related. We used SPSS version 25 for the analysis of our data. Chi-square test and Fisher's exact test were used to analyze the statistical association.The most commonly encountered difficulty was the requirement of an extended posterior tympanotomy approach due to poor visualization of round window niche. There was a statistically significant association of difficult insertion of electrodes with round window niche visibility. The common complications encountered were intraoperative facial nerve exposure, bleeding, electrode-related problems, cerebrospinal fluid gusher, and device failure.Cochlear implantation with an experienced surgeon in pediatric population is a relatively safe procedure. There is no association of the difficulties and complications related to surgery with the different age groups.

External Auditory Canal Cholesteatoma: Clinical and Radiological Features

Abstract Introduction External auditory canal cholesteatoma (EACC) is often misdiagnosed. Objectives To outline the clinical presentation of EACC, and to describe its radiological findings on high-resolution computed tomography (HRCT) of the temporal bone. Methods The clinical records of all patients diagnosed with EACC from April 2017 to March 2020 in a tertiary care center were retrospectively reviewed. The clinical presentation, the findings on the HRCT of the temporal bone, and the treatment provided were analyzed. Results A total of 9 patients, 7 males and 2 females, with a mean age of 30 years, were diagnosed with primary EACC. Six patients presented with otorrhoea, three, with otalgia, three. with hearing loss, and one with facial palsy. Some patients had multiple symptoms. The most common findings on otomicroscopy were destruction of the posterior and inferior canal walls, with cholesteatoma and intact tympanic membrane (six patients). Two patients had aural polyp, and one had a narrow ear canal due to sagging of the posterior canal wall. On HRCT, all nine patients showed soft-tissue density in the external auditory canal with erosion of the canal wall. The disease extended to the mastoid in eight cases, and to the cavity of the middle ear in one. There were three cases of dehiscence of the facial canal. Dehiscence of the dural and sinus plates was observed in two cases each. Eight patients underwent mastoidectomy, and one underwent debridement with canalplasty. Conclusion Review of the clinical and radiological findings is essential to reduce the rate of misdiagnosis.

External Auditory Canal Cholesteatoma: Clinical and Radiological Features.

Introduction External auditory canal cholesteatoma (EACC) is often misdiagnosed. Objectives To outline the clinical presentation of EACC, and to describe its radiological findings on high-resolution computed tomography (HRCT) of the temporal bone. Methods The clinical records of all patients diagnosed with EACC from April 2017 to March 2020 in a tertiary care center were retrospectively reviewed. The clinical presentation, the findings on the HRCT of the temporal bone, and the treatment provided were analyzed. Results A total of 9 patients, 7 males and 2 females, with a mean age of 30 years, were diagnosed with primary EACC. Six patients presented with otorrhoea, three, with otalgia, three. with hearing loss, and one with facial palsy. Some patients had multiple symptoms. The most common findings on otomicroscopy were destruction of the posterior and inferior canal walls, with cholesteatoma and intact tympanic membrane (six patients). Two patients had aural polyp, and one had a narrow ear canal due to sagging of the posterior canal wall. On HRCT, all nine patients showed soft-tissue density in the external auditory canal with erosion of the canal wall. The disease extended to the mastoid in eight cases, and to the cavity of the middle ear in one. There were three cases of dehiscence of the facial canal. Dehiscence of the dural and sinus plates was observed in two cases each. Eight patients underwent mastoidectomy, and one underwent debridement with canalplasty. Conclusion Review of the clinical and radiological findings is essential to reduce the rate of misdiagnosis.

Pleomorphic adenoma in the external auditory canal: Arising at an atypical location.

Pleomorphic adenoma is a common, benign neoplasm typically located in the major salivary glands. The external auditory canal is an atypical location for a pleomorphic adenoma to originate. Wide surgical excision is essential in cases of pleomorphic adenoma due to its tendency to recur and change into malignancy. We report a case of pleomorphic adenoma emerging in the external auditory canal, which is an atypical location for it to originate. A 23-year-old male presented with swelling and decreased hearing in the left ear for 2 months. On examination, there was a smooth, pink, firm swelling in the cartilaginous part of external auditory canal. Pure tone audiogram and computed tomography of temporal bone were performed. The patient underwent excision biopsy and the diagnosis of pleomorphic adenoma was confirmed after histopathology. Long-term follow-up is recommended as pleomorphic adenoma has the potentiality to recur or transform into malignancy.

Prevalence of Post Tonsillectomy Haemorrhage at a Tertiary Care Centre in Nepal.

INTRODUCTION: Tonsillectomy is one of the common ENT surgical procedures. Post-tonsillectomy haemorrhage remains a frequent complication which can be potentially life-threatening. The objective of the present study was to calculate the prevalence of haemorrhage following a tonsillectomy at a tertiary care centre. METHODS: It was a descriptive cross-sectional study performed by medical chart review of the patients who underwent tonsillectomy from January 2018 to December 2019 at the department of ENT- Head and Neck Surgery of Tribhuvan University Teaching Hospital. Ethical approval was obtained from the institutional review committee (Ref:-282(6-11) E2 076/077). Convenient sampling method was used. All patients of any age who had tonsillectomy for recurrent tonsillitis or tonsillar hypertrophy with or without obstructive sleep apnoea and no missing information on chart review were included in the study. Data were entered in MS-Excel 2007 and analyzed in rate and percentage. RESULTS: Ten (5.18%) out of a total of 193 patients who underwent tonsillectomy had a post tonsillectomy haemorrhage. All 10 (100%) were adults patients, operated for recurrent tonsillitis, and used electrocautery. It was common in male patients 7 (70%). All of the haemorrhages was between a third and sixth postoperative day and were mild in severity. CONCLUSIONS: The prevalence of post-tonsillectomy haemorrhage was high at our centre during the study period of two years. It was common in adults, males and surgery done for recurrent tonsillitis using electrocauterization.

Prevalence of Foreign Body Aspiration in Children in a Tertiary Care Hospital.

INTRODUCTION: Foreign body aspiration is a common problem in children with signifi cant mortality and morbidity. This study aims to determine the prevalence of foreign body aspiration in children in a tertiary care hospital of Nepal. METHODS: A descriptive cross-sectional study was conducted at Tribhuvan University Teaching Hospital from April 2010 to March 2016 after obtaining ethical approval from Institutional Review Committee (Reference number- 08(6-11)E277/78). All children of age up to 15 years with suspected foreign body aspiration were included. The data was collected from the medical record section and entered in Microsoft Excel. The descriptive statistical analysis was performed. RESULTS: A total of 26,294 patients were included in the study. The prevalence of foreign body aspiration in children was found to be 98 (0.37%). On rigid bronchoscopy, 82 patients (83.6%) were confirmed to have a foreign body in the airway. The peak incidence of foreign body aspiration was seen in patients of age group one to two years. The commonest foreign body in the airway was a peanut. CONCLUSIONS: The prevalence of foreign body aspiration in children was low, which is similar to other studies. Foreign body aspiration may lead to dreadful complications. Therefore, both the clinicians and the public need to be cautious about it.

Complications of Acute and Chronic Otitis Media in a Tertiary Referral Center in Nepal.

OBJECTIVE: The aim of this study was to report the incidence of complications in otitis media and to determine the frequencies of various extracranial and intracranial complications at a tertiary care hospital. METHODS: We retrospectively reviewed the clinical records of patients of all ages and genders who were treated in a tertiary care hospital in Nepal from May 2015 to May 2020 for complications of acute and chronic otitis media. The complications were broadly classified as extracranial and intracranial. The details of patient profiles, histories, examination findings, investigations and treatments were reviewed from the charts. RESULTS: The mean age of 164 patients with complications of otitis media was 47.44±18.58 years. There were 79 (48.2%) male and 85 (51.8%) female patients. The overall incidence of otitis media complications was 0.78%. The incidences of the complications from acute otitis media, chronic otitis media without cholesteatoma, and chronic otitis media with cholesteatoma were 0.5%, 0.06% and 5.6%, respectively. Extracranial complications, intracranial complications and combined extracranial and intracranial complications were seen in 80%, 11% and 9% of the patients, respectively. The most common extracranial and intracranial complications were subperiosteal abscesses and brain abscesses, respectively. There was one mortality due to complication. CONCLUSION: The incidences of complications and mortality from otitis media have declined with the availability of suitable antibiotics, improved imaging, and multidisciplinary management. Antibiotic resistance and masking of signs and symptoms, however, could pose challenges in the future.