Nepalese Journal of ENT Head & Neck Surgery

Transition in Leadership

2026-06-19T03:32:26+00:00

Parotid duct sialolithiasis: A case report

2026-06-19T06:55:22+00:00

Parotid sialolithiasis, though uncommon salivary gland sialolithiasis, can present as unilateral painful or painless swelling of the gland. Often the stone is situated in the ductal system rather than gland itself. We are presenting a case of 32 years female with right parotid duct sialolithiasis. She presented with intra-oral swelling at parotid duct opening. The sialolith was removed under local anaesthesia by placing incision directly over the sialolith parallel to the course of salivary duct exposing the stone via intra-oral approach.
Keywords: local anaesthesia, salivary duct, sialolithiasis

Traumatic perilymphatic fistula; a rare entity

2026-06-19T07:00:10+00:00

Perilymph fistula is an abnormal communication between inner ear and middle ear cavity or mastoid causing perilymph leakage. The symptoms are vertigo, hearing loss, tinnitus, and aural fullness. Its management varies with variable outcome of hearing and vestibular function. A 32-year female with penetrating injury to the right ear causing dizziness and hearing loss presented with findings of bruise in external auditory canal along with dry central perforation and horizontal nystagmus in positional test. She had profound hearing loss and pneumolabyrinth. Successful surgical repair of perilymphatic fistula was performed with improved hearing and resolution of vestibular symptom. A high index of clinical suspicion is required for good outcome possible with early treatment. The surgical management with exploratory tympanotomy and fistula repair is advocated in patients with progressive hearing loss and non-resolving vertigo.
Keywords: Nystagmus, penetrating injury, perilymphatic fistula, tympanotomy, vertigo

Anomalous Intratympanic Facial Nerve Encountered During Stapes Surgery and Its Surgical Implications

2025-07-19T04:57:11+00:00

Aims and Objectives: Identifying the facial nerve in any middle ear surgery is of utmost importance. This study aimed to find the frequency of intratympanic facial nerve anomalies encountered during stapes surgery and note any modifications made in the surgical procedure.
Methods: The study was conducted in the department of ENT-Head and Neck Surgery in a tertiary referral hospital in Nepal. A retrospective review of medical records of stapes surgery performed between January 2020 and December 2024 was conducted.
Results: A total of 121 stapes surgeries were performed in 121 patients (51 males and 70 females). The age ranged from 18 to 65 (mean 34.7 ± 9.2) years. Anomalous facial nerves were found in 10 (8.3%) cases. Partial prolapse of intact fallopian canal and dehiscent facial nerve without prolapse were observed in four (3.3%) cases each. Total prolapse of the facial nerve over the stapes footplate was noted in two (1.6%) cases. Almost all patients underwent standard stapes surgery. However, in the two cases with total prolapse, fenestration was created in the promontory in one, while the procedure had to be abandoned in the other. The facial nerve function was normal post-operatively in all the cases.
Conclusion: Anomalous intratympanic facial nerves encountered during stapes surgeries are not uncommon. Being vigilant about the possibilities of anomalous facial nerve and tailoring the surgical technique accordingly is crucial for ensuring a safe and successful outcome.
Keywords: Facial nerve, stapes surgery, Stapes

Skin Prick Test Profile in Patients with Allergic Rhinitis: A Cross-Sectional Study in Western Nepal

2026-06-19T03:54:19+00:00

Aims and Objectives: Allergic rhinitis (AR) is a common health problem in Western Nepal, often underdiagnosed and mismanaged due to limited allergen identification. This study aimed to determine the common allergens causing sensitization among patients with clinically diagnosed allergic rhinitis using Skin Prick Test (SPT).
Methods: A hospital-based cross-sectional study was conducted from Feb 2014 to Feb 2020 at Nepalgunj Medical College, Nepalgunj, Banke, Nepal. Patients with symptoms suggestive of AR underwent SPT using a panel of 48 common allergens. The patients with wheal on at least one allergen during the test were included. Patients having no wheal on all tested allergens were excluded and advised for workup to rule out other diseases simulating allergic rhinitis. Results were interpreted according to standard wheal size criteria.
Results: Out of 132 patients, 79 (59.8%) were male and 53 (40.1%) were female patients. The age ranges from 14 to 54 years with average being 28.54years. The most common allergens were house dust mite (Dermatophagoidespteronyssinus) (72%), cockroach extract (42%), Parthenium hysterophorus pollen (18%), wheat (17.4%), Candida albicans (15%) and peanut (14%). Multiple allergen sensitization was seen in 103 (78.0%) of the above patients with positive result in SPT.
Conclusion: House dust mite, cockroach and Parthenium pollen are the leading allergens among AR patients in the Western region of Nepal.
Keywords: allergen, allergic rhinitis, hypersensitivity, skin prick test

Polysyllabic Word Productions as a Screening Tool for Speech Sound Disorders in Native Nepali-Speaking Children: A Pilot Study

2026-06-19T06:38:29+00:00

Aims and Objectives: Speech sound disorders (SSD) affect children’s communication, learning, and social participation, yet culturally adapted screeners are scarce in Nepal. Polysyllabic words (≥3 syllables) place higher demands on speech planning and phonotactics, making them useful for detecting SSD. This study aimed to develop and pilot a brief Nepali polysyllable screener for three to five years, preschool children.
Methods: A cross-sectional, known-groups validation design was employed. Twenty native Nepali-speaking children out of whom 10 were SSD and 10 were typically developing (TD) were matched for age and sex. They were assessed using a 10-item picturable polysyllable word list. Responses were audio-recorded, scored dichotomously, and analyzed for group differences, internal consistency, and diagnostic accuracy.
Results: TD children obtained significantly higher scores (mean score=9.1) than SSD peers (mean scoe = 5.2), with a large effect size (Cohen’s d = 3.5). Item-level analyses showed adequate discrimination (corrected item–total correlations 0.41–0.74). Internal consistency was good (KR-20 = 0.82). Receiver operating characteristic (ROC) analysis demonstrated excellent diagnostic accuracy (AUC = 0.94, 95% CI 0.83–1.00). An optimal cutoff of ≤7 yielded sensitivity of 0.90 and specificity of 0.95.
Conclusion: The Nepali 10-item polysyllable screener reliably distinguished SSD from TD speech in preschool children. Although limited by small sample size, findings highlight its potential as a clinically valid, rapid triage tool for early identification of SSD in Nepalese schools and clinics.

Aspiration Risk: Clinical Swallow Evaluation and Fiberoptic Endoscopic Evaluation of Swallowing – A Comparative Study

2026-06-19T06:44:28+00:00

Aims and Objectives: Stroke is the most common neurological disorder leading to dysphagia. Aspiration is a frequent and serious complication in patients with dysphagia. Early identification and management of aspiration risk in stroke patients is crucial, as it helps prevent aspiration during oral feeding and reduces associated morbidity and mortality. This study aimed to identify aspiration risk using Clinical Swallow Evaluation (CSE) and compare the results with Fibreoptic Endoscopic Evaluation of Swallowing (FEES), considered the gold standard.
Methods: A total of 49 stroke patients were included. Bedside CSE was performed for each patient, assessing drooling, delayed swallow initiation, abnormal volitional cough, and dysphonia. Cough after swallowing and voice change after swallowing were evaluated using the single water swallow test, scored as present or absent. Delayed swallow initiation was assessed using Logemann’s four-finger method. The CSE scores were then compared with FEES findings for aspiration risk.
Results: The CSE demonstrated a sensitivity of 89.28% and a specificity of 59.09%. The positive predictive value (PPV) was 73.52%, and the negative predictive value (NPV) was 81.25%. The overall accuracy of the CSE was 76%. Among the clinical indicators, cough after swallow showed significant correlation with FEES outcomes.
Conclusion: Clinical evaluation using the six clinical indicators assessed in this study provides a safe and highly sensitive method for identifying aspiration risk at the bedside. While FEES remains the gold standard for objective assessment, CSE offers a fairly accurate alternative when FEES is unavailable. A combined approach using both CSE and FEES may improve diagnostic sensitivity and enhance clinical decision-making.
Keywords: Aspiration Risk, Clinical Swallow Evaluation, Fiberoptic Endoscopic Evaluation of Swallowing

Outcome of Intralesional Steroid Injection for Benign Vocal Cord Lesions

2026-06-19T06:50:24+00:00

Aims and Objectives: The study aims to find out the outcome of intralesional steroid injection in benign lesions of vocal cords.
Methods: This prospective, longitudinal, interventional comparative hospital-based study was conducted at Otorhinolaryngology and Head & Neck Surgery Department of Bir hospital, National Academy of Medical Sciences, Kathmandu, Nepal from March 2022 to March 2023. The pre and post treatment status documented and compared with videolaryngoscopy, voice handicap index (VHI)-10 and maximum phonation (MPT)time after 1 month. Thirty patients fulfilled the inclusion criteria.
Results: Sixteen out of 30 patients showed improvement on videolaryngoscopy, mean VHI-10 reduced and mean MPT increased. The results were statistically not significant(P>0.05).
Conclusion: In selected patients, those who are resistant to conventional voice therapy and those who are unfit for general anaesthesia, intralesional steroid injection is a good alternative non-surgical for the management of patients with benign vocal cord lesion.
Keywords: Benign vocal cord lesion, intralesional steroid, Maximum Phonation Time, Voice Handicap Index-10