Bikash Lal Shrestha

Randomized crossover comparison of the laryngeal mask airway classic with i-gel laryngeal mask airway in the management of difficult airway in post burn neck contracture patients

Purpose: The objective of the study was to compare the performance of i-gel supraglottic airway with cLMA in difficult airway management in post burn neck contracture patients and assess the feasibility of i-gel use for emergency airway management in difficult airway situation with reduced neck movement and limited mouth opening. Methods: Prospective, crossover, randomized controlled trial was performed amongst forty eight post burn neck contracture patients with limited mouth opening and neck movement. i-gel and cLMA were placed in random order in each patient. Primary outcome was overall success rate. Other measurements were time to successful ventilation, airway leak pressure, fiberoptic glottic view, visualization of square wave pattern. Results: Success rate for the i-gel was 91.7% versus 79.2% for the cLMA. i-gel required shorter insertion time (19.3 seconds vs. 23.5 seconds, P=0.000). Airway leak pressure difference was statistically significant (i-gel 21.2 cm H20; cLMA 16.9 cm H20; P=0.00). Fiberoptic view through the i-gel showed there were less epiglottic downfolding and better fiberoptic view of the glottis than cLMA. Overall agreement in insertion outcome for i-gel was 22/24 (91.7%) successes and 2/24(8.3%) failure and for cLMA, 19/24 (79.16%) successes and 5/24 (16.7%) failure in the first attempt. Conclusion: The i-gel is cheap, effective airway device which is easier to insert and has better clinical performance in the difficult airway management of the airway in the post burn contracture of the neck. Our study shows that i-gel is feasible for emergency airway management in difficult airway situation with reduced neck movement and limited mouth opening in post burn neck.

Local Anesthesia Versus Placebo in Flexible Nasopharyngo-laryngoscopy

Abstract: Background: The flexible nasopharyngolaryngoscopy is the commonest procedure in both out patients and in patients for the diagnosis of diseases. Since this procedure is at best uncomfortable and at worst intolerable making the procedure difficult, so topical anesthesia is generally used prior the procedure. Objective: To analyze and compare the role of local anesthesia with placebo in flexible nasopharyngolaryngoscopy. Materials and Methodology: A prospective, longitudinal and analytical study conducted among 84 patients required flexible nasopharyngolaryngoscopy dividing in two groups of 4% xylocaine and normal saline spray each. The questionnaires about nasal pain, throat discomfort, bad taste, feeling of nausea and overall discomfort were filled up by using numeric rating scale. Data was analyzed using SPSS 11.5 software. Results: Regarding the nasal pain, throat pain, feeling of nausea and overall discomfort, they were statistically not significant in both groups. Whereas the bad taste score was less in normal saline spray group as compared to 4% xylocaine spray group showing statistically significant (p=0.000). Conclusion: Though we do use topical local anesthesia frequently for the flexible nasopharyngolaryngoscopy, there is no such extra benefit as compared to normal saline spray.

Analysis of etiological factors of tinnitus in patients attending Kathmandu University Hospital

Background: Because of the subjective nature of tinnitus, variation of causes, and diversity of patients, this subject is a complex topic to study and understand. The main aim of our study was to find the frequency of tinnitus and also analyze its etiological factors. Since this kind of study has not been performed previously in Nepal, we conducted this study to know the different etiological factors related to tinnitus. Materials and Methods: One hundred and fifty-two patients who came to outpatient at Department of Otorhinolaryngology from 1 August 2011 to 1 August 2012 with history of tinnitus were included after taking informed consent, except six patients who had a co-existing psychiatric problem. Detailed history, clinical examination, and all necessary investigations were done to reach diagnosis. Data were collected and analyzed using SPSS 16.0 software. Results: There were a total 13,598 outpatients who came to Department of Otorhinolaryngology from 1 August 2011 to 1 August 2012. Among them 158 had a history of tinnitus, but six patients were excluded from the study because of a co-existing psychiatric problem. So frequency was found to be 1.11%. Regarding age distribution, 60.6% of the patients were Conclusion: Tinnitus is a distressing symptom, which causes a decrease in the quality of life. So it is important to find the sociodemographic factors and also the main etiological factors related to tinnitus as these findings will help to find out remedial measures and improvement in quality of life.

Comparison of Pre and Post-Operative Hearing Results in Patients Undergone Modified Inlay Butterfly Cartilage Perichondrium Myringoplasty

Objective : The perichondrium cartilage graft has its advantage not only on hearing outcome but also in graft uptake rate. So, the main aims are to compare the pre and post-operative hearing results and to observe the graft uptake rate. Materials and methodology : This is a prospective, longitudinal and analytical study conducted in the department of otorhinolaryngology in Kathmandu university hospital from 1st January 2011 to 1st June 2012. There were 34 patients who underwent modified inlay butterfly cartilage perichondrium myringoplasty using tragal cartilage perichondrium in ≥13 years patients and with the diagnosis of Chronic otitis media (mucosal- inactive) with central perforation of >50% and those requiring revision surgeries for failed myringoplasties were included. The pre and post-operative PTA (pure tone audiogram) was performed and evaluated. The post-operative hearing was assessed in terms of average ABG (air bone gap) and size of ABG closure. Results : Among 34 patients, the 30 (88.2%) patients had graft uptaken. Other 4 patients had residual perforation because of infection. The post operative ABG was smaller than the pre operative ABG. (36.57+/-12.13dB and 26.41+/-8.47dB respectively) The mean ABG closure was 10.15+/-10.23dB. The ABG closure was smaller than 10dB in 15 (50%) patients. Conclusion : There was statistically significant improvement in postoperative ABG with ABG closure within 10dB in 50% of patients. So, it is useful to perform the procedure in subtotal to total perforation with good outcome.