Nepalese Journal of ENT Head & Neck Surgery

The Art of Ossiculoplasty

Rabindra B Pradhananga — Mon, 01 Jun 2026 00:00:00 +0000

Chicken Bone Aspiration Masquerading as Malignancy: A Case Report of Diagnostic Dilemma

Niraj Bam, Prashanna Karki, Milan Pokharel, Bibek Shrestha, Sonam Dhenga — Mon, 01 Jun 2026 00:00:00 +0000

Foreign body (FB) aspiration is rare in adults but may mimic malignancy or tuberculosis, leading to delayed diagnosis.
We report a 52-year-old chronic smoker who presented with persistent fever, cough, weight loss, and progressive dyspnoea. Clinical examination revealed signs of left lung collapse, initially suspected as endobronchial malignancy or tuberculosis. Chest CT confirmed complete collapse of the left lung with a hyperdense lesion in the main bronchus. Unexpectedly, bronchoscopy identified and removed a chicken bone lodged in the left main bronchus, leading to complete symptom resolution.
Physicians should consider FB aspiration in adults with unexplained respiratory symptoms mimicking lung cancer or tuberculosis.
Keywords: Aspiration, bronchoscopy, foreign bodies

Association of Allergic Rhinitis and Thyroid Dysfunction: A cross-sectional observational study in a tertiary care center

Sudin Kayastha, Rupa Maharjan, Arun K.C. — Mon, 01 Jun 2026 00:00:00 +0000

Aims and Objectives: Allergic rhinitis can be a presenting symptom of underlying thyroid dysfunction. This study aims to assess thyroid function status and to explore prevalence of underlying thyroid dysfunction in allergic rhinitis patients.
Methods: This was a cross-sectional observational study carried out from July 2021 to June 2022 at Department of Otorhinolaryngology, Bir Hospital, Kathmandu, Nepal. A total of 91 allergic rhinitis patients without known thyroid disorders were included in this study. Severity and type of allergic rhinitis was categorized according to ARIA classification and their thyroid function status was assessed.
Results: Out of 91 total cases, there were 47 (51.6%) males and 44 (48.4%) females. Most patients (39.56%) were in the age group 21-30 years with mean age of 30.55 years. By ARIA classification, 30.76% had mild intermittent, 19.78% had mild persistent, 30.76% had moderate-severe intermittent type and 18.68% had moderate-severe persistent type of allergic rhinitis. Thyroid function assessment revealed mean TSH value 3.57mIU/L and median TSH 2.50 mIU/L. Out of total 91 cases, 82.4% (n=75) had normal TSH, 13.2% (n=12) had high TSH, 4.4% (n=4) had low TSH. Total 16 (17.58%) patients had undiagnosed underlying thyroid dysfunction. Out of 16 cases with thyroid dysfunction, 81.25% (n=13) had moderate to severe type of allergic rhinitis. The prevalence of underlying thyroid dysfunction in allergic rhinitis patients was statistically significant (p=<0.05).
Conclusion: There is some association between allergic rhinitis and underlying thyroid dysfunction. Thyroid dysfunction is more common in moderate/severe type of allergic rhinitis. Serum TSH could be a screening tool to identify underlying thyroid dysfunction in allergic rhinitis patients.
Keywords: allergic rhinitis, thyroid disease, thyroid function test

Skin Prick Test reactivity to common aeroallergens among patients of Allergic Rhinitis

Anita GC, Bijaya Kharel, Prakash Bahadur Thapa, Shailendra BK — Mon, 01 Jun 2026 00:00:00 +0000

Aims and Objectives: This study aims to investigate the pattern of skin prick test reactivity to various aeroallergens among patients presenting with allergic rhinitis symptoms.
Method: A cross-sectional study was conducted among 145 patients in the Department of ENT-HNS of a tertiary centre from December 2021 to January 2023. It included patients above six years of age diagnosed with allergic rhinitis based on the ARIA guidelines (2019). Exclusion criteria included chronic rhinosinusitis, nasal polyposis, tumours of the nose or sinuses, pregnancy, drug-induced rhinitis, and patients on antihistamines, steroids, or antileukotrienes within 7 days before the study.
Result: The skin prick test reactivity to aeroallergens was assessed in 145 patients aged 11 to 70 years (mean age: 31.98 years). Eye symptoms occurred in 59%, skin symptoms in 31%, and airway symptoms in 41% of the patients with allergic rhinitis. Frequent allergens were D. pteronyssinus, D. farinae, Blomia, wheat dust, and rice grain dust. Among all the patients, 8.96% had no positive skin test reactions.
Conclusion: Eye, skin and airway symptoms are the common symptoms in patients with allergic rhinitis. Majority of patients have polysensitization, house dust mites being the most common allergen.
Keywords: Allergic rhinitis, dust mites, skin prick test

Otoscopic Findings Among School-aged Nepalese Children: Evidence from School-based Ear Screening Programs

Milan Maharjan, Mana Shrestha, Rosy Bajracharya — Mon, 01 Jun 2026 00:00:00 +0000

Aims and Objectives: The objective of this study is to determine the common ear pathologies in Nepalese school aged children.
Methods: This was a retrospective study carried out by reviewing the medical records of the school-based ear health screening programs conducted in 2015 through 2019. The demographic data like age and gender along with clinical data like findings of ear examination were obtained and analyzed. Statistical analysis of the data was done using frequency and percentage.
Results: Records of 79,340 children were analyzed. 61.70% (n=48,947) of children had normal otoscopic findings whereas 38.30% (n=30,393) had various ear pathologies. Of those children with ear pathologies, 50.40% (n=15,321) were male and 49.60% (n=15,072) were female. Impacted wax was the most common otoscopic finding affecting 28.41% (n=22,539) children, followed by middle ear pathologies in 9.31% (n=7,393) and external ear pathologies in 0.58% (n=461) children.
Conclusion: This study shows high prevalence of ear pathologies in school age Nepalese children. It also highlights that the implementation of initiatives for screening of ear disease and hearing status using tools like otoscope and audiometer at the time of enrollment of children into school is beneficial. This would be an effective measure for early detection and treatment of ear diseases and to prevent avoidable hearing loss in Nepal.
Keywords: Children, ear disease, otitis media

Whole Word Phonological Measures in Typically Developing Native Nepali Speaking Children: A Cross-sectional Comparative Study

Sabin Sharma Duwadi, N Sreedevi Sreedevi — Mon, 01 Jun 2026 00:00:00 +0000

Aims and Objectives: To establish preliminary normative reference data for Phonological Mean Length of Utterance, Proportion of Word Proximity, and Percentage of Words Correct in native Nepali-speaking children aged 2 to 3 years and examine developmental differences between age groups.
Methods: Twenty-four typically developing children (12 males, 12 females) were recruited from a Kathmandu preschool, divided into two groups ≥2.0 to <2.6 years (n=12) and ≥2.6 to <3.0 years (n=12). Participants completed a picture-naming task using 50 familiar stimuli. Speech samples were audio-recorded and phonetically transcribed. Phonological Mean Length of Utterance, Proportion of Word Proximity, and Percentage of Words Correct were calculated following established protocols.
Results: Significant age-related improvements were observed across all whole-word phonological measures. Children aged 2.5–3.0 years demonstrated higher Phonological Mean Length of Utterance, Proportion of Word Proximity, and Percentage of Words Correct scores than those aged 2.0–2.5 years (p < 0.05). Strong positive correlations were found between chronological age and Phonological Mean Length of Utterance (r = 0.76) and Percentage of Words Correct (r = 0.79), while Proportion of Word Proximity showed a moderate positive correlation (r = 0.58). These findings indicate progressive improvement in phonological complexity and accuracy with age in Nepali-speaking children.
Conclusion: Results demonstrated developmental progression in phonological complexity and accuracy between 2 and 3 years in Nepali-speaking children. These preliminary normative reference values provided valuable reference data for clinical assessment and research in this understudied population.
Keywords: Nepali language, phonological development, speech assessment, whole-word measures, phonological mean length of utterance, percentage of words correct, proportion of whole-word proximity

Quality of Discharge Summary in Various Departments of a Tertiary Care Hospital: A Roll-On Audit

Manish Neupane, Sajish Khadgi — Mon, 01 Jun 2026 00:00:00 +0000

Aims and Objectives: Discharge summaries are essential communication tools between hospital-based and community-based healthcare providers. A previous audit at Tribhuvan University Teaching Hospital (TUTH) in 2016 assessed the quality of discharge summaries across departments using the modified Van Walraven criteria. This roll-on audit aims to re-evaluate the quality and completeness of discharge summaries and assess improvements since the last audit. To determine whether discharge summaries across various departments at TUTH in 2023-24 meet the standards outlined by the modified Van Walraven et al. (1999) criteria, and to assess the completeness of documentation.
Methods: This audit was conducted at TU Teaching Hospital, Kathmandu, Nepal, between April 2023 and March 2024. Seven departments were included: Medicine, Surgery, Gynecology, Pediatrics, ENT-HNS, Orthopedics and Psychiatry. A total of 168 discharge summaries (24 from each department) were selected through random sampling. Each summary was evaluated based on the ten-point modified Van Walraven criteria and compared with results from the 2016 audit.
Results: The Department of ENT-HNS demonstrated the highest level of completeness, with 99.5% of discharge summaries fully filled, while the Medicine department had the lowest completion rate at 94.0%. Frequently omitted components across all departments included physical examination findings and laboratory investigation results.
Conclusion: The roll-on audit demonstrates positive trends in discharge summary quality at TUTH. However, variability persists across departments. Regular audits, staff training, and standardized templates are recommended to further improve documentation practices and ensure high-quality patient care transitions.
Keywords: Audit, Discharge Summary, Modified Van Walraven Criteria