Prevalence and Risk Factors for Occupational Voice Disorders in Nepalese Teachers: A Cross-Sectional Study.

Introduction Teachers are a high-risk group for the development of vocal dysfunction, as they use voice extensively in their profession. Objective To know the prevalence and risk factors associated with voice strain in teachers. Methods A cross-sectional study was conducted among schoolteachers in Chitwan, Nepal. The Voice Handicap Index questionnaire was used as a survey tool. Result A total of 315 teachers were enrolled in the study. The mean age of the participants was of 36.7 years. Teachers from public schools, primary grade classes, > 50 pupils in the classroom, > 24 hours of classes per week, dust in class, and recurrent tonsil problems were associated with various degrees of vocal handicap. Conclusion There is a high prevalence of voice disorder among teachers. A holistic approach, which includes teacher education regarding voice care during their work and management of their voice handicap by taking into consideration different risk factors, must be adopted.

Sinonasal hemangiopericytoma: A rare sinonasal tumor.

Hemangiopericytoma is a rare vascular tumor arising from pericytes and occurs very rarely in sinonasal region. A 48-year-old man with sinonasal mass presented with nasal obstruction and occasional epistaxis. Nasal endoscopy showed a readily bleeding mass in the left nasal cavity. Endoscopic removal of the mass was done. The histopathology came out to be hemangiopericytoma. The patient was kept on follow-up, and no metastasis or recurrence was seen in last 1 year. Hemangiopericytoma is a very rare vascular tumor. Surgery is the mainstay treatment of choice. A long-term follow-up is needed after surgery to rule out recurrence and metastasis.

Role of Mesenchymal Stem Cells on Tonsillar Hypertrophy: An Unexplored Enigma.

Tonsillar or adenoid hypertrophy is a common childhood finding which can cause significant health problems like respiratory infections and sleep apnea. Though normal growth of children is also attributed to such enlargement, infection, environmental pollutants, allergens, and gastroesophageal reflux are proposed triggering factors for tonsillar hypertrophy. While tonsilar enlargement in adults is more associated with malignancy and chronic infections like the human immunodeficiency virus, the immunology of childhood adenotonsillar hypertrophy is less understood. We postulate that upon stimulation, mesenchymal stem cells are found to reduce the secretion of interferon-gamma but increase the secretion of interleukin-4 from activated T cells. Both of these factors inhibit apoptosis in the tonsillar tissue leading to its hypertrophy. Under the umbrella of evidence, it implicates the role of mesenchymal stem cells in tonsillar hypertrophy. However, further longitudinal large studies are needed to validate the proposition. Keywords: interleukin-4; mesenchymal stem cell; tonsillar hypertrophy.

Normative nasalance scores in Tamil-speaking Indian children.

OBJECTIVE: The aim of this study was to obtain normative nasalance scores for Indian Tamil-speaking children. METHODS: Mean nasalance scores were obtained from 175 consecutive Tamil-speaking normal children (95 males, 80 females) aged 5-16 years during the repetition of six standardized sentences: two oral, two oronasal, and two nasal sentences. The nasal view was used to obtain nasalance scores for the standardized sentences. RESULTS: Group mean and standard deviation (SD) nasalance scores of children for oral, oronasal, and nasal sentence were 35.65(SD 7.20), 44.42(SD 7.37), and 57.21(SD 8.15), respectively. The mean nasalance values of children aged 9-12 years were greater than children aged 5-8 years and 13-16 years for nasal sentences (p < .001). Males were found to have significantly higher nasalance scores for oral and oronasal sentences (p < .05) although these differences were within the range of normal variation. CONCLUSIONS: The present study provides normative nasalance scores for Tamil-speaking Indian children.

Olfactory Dysfunction: A Clinical Marker of COVID-19.

Due to the rapid spread of the SARS-CoV-2 virus, many health systems worldwide are overwhelmed, leading to the triggering of the scarcity of medical resources. The identification of indicators that require hospital admission help in the efficient allocation of medical resources. Olfactory impairment is also one of the indicators of COVID-19 infection. Many studies have analyzed olfactory dysfunction in COVID-19 with a variable prevalence rate but underreporting of this problem is very much likely as the problem is considered benign. Many scientific societies have stated that olfactory dysfunction is a frequent symptom of COVID-19 and have published recommendations for it.

A Three Point Assessment Protocol for Tympanoplasty Outcomes: A Retrospective Analysis

Abstract Introduction The surgical outcome of chronic otitis media (COM) of the mucosal type in the pediatric population with high rates of recurrent tympanic membrane perforation is indeed a concern for the attending surgeon. Objective The present study was done to evaluate the outcome of tympanoplasty in children with chronic otitis media mucosal type. Methods A retrospective analysis of the medical records of all children, aged < 16 years old, who underwent tympanoplasty for COM of the mucosal type was performed. These patients were addressed by a three-point assessment, for predicting outcome of tympanoplasty, which included the age of the patient, addressing the nasal/pharyngeal issues, and the status of the COM (discharging or dry). Surgical success was assessed in terms of graft uptake and improvement of hearing. Factors affecting the surgical outcome were also analyzed. Results A total of 90 children underwent type 1 tympanoplasty; 7 were lost to follow-up and 10 had incomplete audiometric results. In the 73 tympanoplasties analyzed, graft uptake was seen in 91.7% of the patients. Children with longer duration of ear discharge (> 8 years) had greater hearing loss. Children aged > 8 years old showed statistically significant higher chance of graft uptake (p = 0.021). Five of the six children who had graft rejection had bilateral disease. Conclusion A three-point assessment in the management of pediatric COM of the mucosal type offers good outcomes with post-tympanoplasty graft uptake rates > 90%.

Comparison of Proton Pump Inhibitor and Triple Therapy Regimen for Laryngospharyngeal Reflux Disease.

BACKGROUND: Laryngopharyngeal reflux is retrograde flow of contents of the stomach to the larynx and the pharynx. The study aims to compare two regimens (proton pump inhibitor monotherapy versus triple therapy) on the outcome of Helicobactor pylori positive laryngopharyngeal reflux disease. METHODS: The presence of laryngopharyngeal reflux was determined by reflux symptom index and reflux finding score. The presence of Helicobactor pylori in the tissue was confirmed by rapid urease test. All urease test negative laryngopharyngeal reflux patients were given a course of proton pump inhibitors and results were evaluated. All urease test positive patients were divided into two groups. One group was given a course of proton pump inhibitors and another group was given a course of triple therapy and the results were compared. RESULTS: A total number of 704 laryngopharyngeal reflux patients were screened for urease test. Among them 138 patients (19.6 %) were urease test negative and were given proton pump inhibitor therapy. Improvement in both reflux finding score (average score 11.75) and reflux symptom index (average score 5.25) score was observed after 3 months with p-value<0.05. In urease test positive patients, improvement in scores was observed in both proton pump inhibitors and triple therapy group, however marked improvement in the clinical features was observed in triple therapy group with p-value<0.05. CONCLUSIONS: The study reveals association between laryngopharyngeal reflux and Helicobactor pylori. Proton pump inhibitor therapy is sufficient if no Helicobactor pylori is detected, however incase of presence of Helicobactor pylori, triple therapy gives better results.

A Three Point Assessment Protocol for Tympanoplasty Outcomes: A Retrospective Analysis.

Introduction The surgical outcome of chronic otitis media (COM) of the mucosal type in the pediatric population with high rates of recurrent tympanic membrane perforation is indeed a concern for the attending surgeon. Objective The present study was done to evaluate the outcome of tympanoplasty in children with chronic otitis media mucosal type. Methods A retrospective analysis of the medical records of all children, aged < 16 years old, who underwent tympanoplasty for COM of the mucosal type was performed. These patients were addressed by a three-point assessment, for predicting outcome of tympanoplasty, which included the age of the patient, addressing the nasal/pharyngeal issues, and the status of the COM (discharging or dry). Surgical success was assessed in terms of graft uptake and improvement of hearing. Factors affecting the surgical outcome were also analyzed. Results A total of 90 children underwent type 1 tympanoplasty; 7 were lost to follow-up and 10 had incomplete audiometric results. In the 73 tympanoplasties analyzed, graft uptake was seen in 91.7% of the patients. Children with longer duration of ear discharge (> 8 years) had greater hearing loss. Children aged > 8 years old showed statistically significant higher chance of graft uptake ( p = 0.021). Five of the six children who had graft rejection had bilateral disease. Conclusion A three-point assessment in the management of pediatric COM of the mucosal type offers good outcomes with post-tympanoplasty graft uptake rates > 90%.

Prevalence of Laryngomalacia among Young Children Presenting with Stridor in a Tertiary Care Hospital.

INTRODUCTION: Laryngomalacia is one of the most common causes of stridor in young children. It can be a serious concern to both parents and caregivers. The main objective of this study is to find the prevalence of laryngomalacia among young children presenting with stridor in a tertiary care hospital in central Nepal. METHODS: A descriptive cross-sectional study was carried out form 1st December 2017 to 1st May 2020 in children less than two years of age in a tertiary care hospital. Ethical approval was taken from the Institutional Review Committee of the hospital (reference number: 2020/23). Convenient sampling was done. Detailed demography, clinical examination, and video laryngoscopy findings were evaluated to find the prevalence of laryngomalacia among all children with stridor. Data were analyzed by using Statistical Package for the Social Sciences version 20. Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. RESULTS: Out of 430 participants who presented with stridor, the laryngomalacia was found in 234 (66%) (58.7-74.07) cases at a 95% confidence interval. The male: female ratio was 1.7:1. Most children, 192 (67.6%), presented with a milder form of laryngomalacia. The most common type was a mixed type of laryngomalacia in 159 (56%). Sleep-disordered breathing was seen in 113 (39.79%) of children diagnosed with laryngomalacia. CONCLUSIONS: Our study concluded that laryngomalacia was the most common cause of stridor in children less than two years of age. However, in most cases, the problem is not serious and a regular follow-up with weight monitoring is warranted.

Lemierre Syndrome. A Forgotten Disease. Case Report and Review of Literature.

INTRODUCTION: Lemierre syndrome is a serious condition that associates oropharyngeal infection and thrombosis of the internal jugular vein (IJV) with subsequent distant septic emboli, most frequently in the lungs. CASE PRESENTATION: A 70-year-old female with retropharyngeal abscess developed features of Lemierre syndrome. The condition was managed with serial aspiration of the abscess and prolonged usage of intravenous antibiotics. DISCUSSION: Lemierre syndrome is most frequently caused by the anaerobic bacterium, Fusobacterium necrophorum. Although rare, there is evidence of a resurgence in the condition in recent years, most probably due to reduced use of antibiotic therapy for sore throats. Although there is a characteristic clinical picture, many clinicians are unaware of this condition, leading to delayed diagnosis with potentially fatal consequences. CONCLUSION: Early diagnosis of this condition and prompt treatment with intravenous broad spectrum antibiotics results in a complete resolution of this condition. Surgery is indicated in the case of abscess formation.

Bilateral Adductor Nerve Palsy Following Total Thyroidectomy: A Case Report.

Recurrent Laryngeal Nerve palsy following thyroidectomy is usually attributed to surgery whereas sometimes the cause can be non-surgical and can result in adductor palsy. Bilateral Recurrent Laryngeal Nerve paralysis is a rare complication of thyroidectomy. We present a case of a 35 years old female who developed dysphonia following thyroidectomy. The clinical findings and recovery were suggestive of a non-surgical cause for palsy. The management of these patients differs and the knowledge in this regard is very important for the surgeons. The non-surgical and surgical cause of adductor palsy differs in presentation and management. Tracheostomy is not required, and recovery of the nerve occurs in most cases. Keywords: palsy; recurrent laryngeal nerve; total thyroidectomy.

Extradural cervical spinal schwannoma in a child: a case report and review of the literature.

INTRODUCTION: Extradural schwannoma arising from high cervical spinal root is a rare entity in children. We report a case of extradural cervical schwannoma in a 14-year-old boy. CASE PRESENTATION: Our patient is a 14-year-old Madhesi boy presenting with swelling in the posterior triangle of his neck. The radiological features suggested solitary extradural cervical schwannoma which was confirmed later by histopathological findings. There were no postoperative neurological complications in our patient. CONCLUSION: Extradural spinal schwannoma is a benign tumor. Gross total resection with good clinical outcome can be achieved with minimal risks.

Paediatric tracheostomy: A modified technique and its outcomes, results from a South Indian tertiary care.

STUDY OBJECTIVES: To review the key parameters related to the proposed modified pediatric tracheostomy technique with to determine the efficacy, safety and outcomes in a tertiary hospital in south India. Patients and Methods A retrospective chart review of all children aged below 16 years who underwent tracheostomy at a tertiary hospital in south India during the period of August 2014 to August 2016. Data on age, gender, indication for tracheostomy, primary disease condition, duration of intubation, complications and decannulation rate were recorded. RESULTS: Fifty children aged below 16 years underwent tracheostomy between August 2014 and August 2016. The average of the children was 5.35 years. (Range14 days to 14 years). The male female ratio was 1.6:1. In our study prolonged intubation was the most common indication (62%). None of the children had early post-operative complications such as bleeding, pneumothorax, surgical emphysema or accidental decannulation. Peristomal granulations (24%) was the most common complication although none was severe to warrant operative intervention. One child had a lifethreatening tube block requiring cardiopulmonary resuscitation. None of the children had accidental decannulation during the period of the study. Tracheocutaneous fistula was seen in 2 children (4%) and was the only long-term complication. These children required surgical decannulation. There was no clinical evidence of tracheal stenosis or tracheomalacia in any child. CONCLUSION: Pediatric tracheostomy is challenging for both the surgeon and the care-giver specially in the early post-operative period. Our proposed modified technique addresses these concerns and without any significant complications.

Evaluation of hearing level in patients on long term aspirin therapy.

Introduction: Aspirin is a routinely prescribed drug, most notably for cardiovascular diseases, such as myocardial ischemia. This cross sectional, comparative study study aims to explore differences in hearing status between the cardiovascular disease patients on aspirin therapy and age matched controls. Methods: The study population consisted of 182 patients with heart disease taking long term aspirin (i.e., for more than one year). The control population consisted of 221 age matched controls who were not taking aspirin. Results: It was found that age of patient, not aspirin intake, was more important risk factor contributing to hearing loss.  Conclusions: When confounding factors like age of the patient, hypertension and diabetes were taken into account, aspirin in its antiplatelet dose was not found to be the cause of any audiological problems like tinnitus and hearing loss.