Objective: The  objective  of  this  study was to review the cases of epistaxis and audit its management at Patan Hospital. Materials and Methods: This was a retrospective study and an audit carried out in patients admitted for epistaxis in Patan Hospital from August 2012 to August 2014. All the patients with primary epistaxis were included. The data were analyzed in terms of the specific defined parameters and were compared with that of Guy’s Hospital, United Kingdom, of year 2011.Results: Out of 146 patients, 111 had primary epistaxis. Ninety-three patients (83.78%) with primary epistaxis had anterior bleeding and 18 patients (16.21%) had posterior bleeding. The majority of the patients (31.53%) were treated with chemical cautery, followed by anterior nasal packing (27.02%). Eleven patients (10%) underwent sphenopalatine artery cauterization. The data of our hospital were optimal or near optimal in some aspects like documented initial nasal examination, and initial cautery attempt whereas, parameters like re-bleeding rate, surgical intervention and endoscopic nasal examination after cessation of bleeding were found to be sub-optimal.Conclusion: The improvements are required in some aspects of management of epistaxis like decreasing the re-bleeding rate, increasing the timely surgical intervention and compulsory endoscopic evaluation of nasal cavity after cessation of bleeding. This can be attained with adherence to the protocol as proposed. A multi-center audit would be required to develop a common consensus regarding its management.Nepalese Journal of ENT Head and Neck Surgery, Vol. 5, No. 2, 2014, Page: 26-30

Objective: To assess the outcome of thyroid surgeries at Patan HospitalMaterials and Methods: It is a retrospective study of in-patient records of patients undergoing thyroid surgeries for various indications from April 2013 to January 2015 at Patan Hospital, Lalitpur.Results: During the period of 21 months, 75 patients underwent thyroid surgeries. Majority of patients underwent hemithyroidectomy (35) followed by total thyroidectomy (28), subtotal thyroidectomy (7) and completion thyroidectomy (5). Out of 28 patients undergoing total thyroidectomy (TT), 11 underwent central compartment clearance (CCC), 5 underwent CCC and lateral neck dissection. Among 5 patients undergoing completion thyroidectomy, CCC was performed in all cases and in one patient lateral neck dissection was also performed.  A total of 13 patients developed unilateral recurrent laryngeal nerve palsy (RLN), among them 5 had permanent palsy. Tracheostomy had to be done in immediate postoperative period for stridor following total thyroidectomy (TT) in one case. Temporary hypocalcaemia was observed in 10 (10/28) cases following TT, out of which 8 had undergone CCC. Permanent hypocalcaemia was observed in 7 (7/28) cases following TT out of which 3 had undergone CCC. Chylous leak occurred in one of the patient undergoing left level II-IV neck dissection which was managed conservatively. None of the patient had to be transfused postoperatively.Conclusion: Complications to thyroid surgery are not uncommon. Visualization of recurrent laryngeal nerve alone in our context is adequate in experienced hands. Identification of parathyroid during thyroidectomy is recommended to avoid hypocalcaemia. Meticulous dissection can reduce the complications.Nepalese Journal of ENT Head and Neck Surgery, Vol. 6, No. 1, 2015

Introduction: Parathyroid adenoma is the single most common cause of hyperparathyroidism. Reported incidence of parathyroid adenoma varies widely and is 30- 90%. Approximately 80% to 85% of patients with primary hyperparathyroidism were found to have solitary parathyroid adenoma.The hyperparathyroidism due to parathyroid adenoma may progress insidiously over several years and eventually presents as renal colic or symptoms may manifest over a considerably shorter period of time. Greater than 50% of patients present with nephrolithiasis or nephrocalcinosis. The present case report describes a 48 year old male patient with symptoms of abdominal pain.Nepalese Journal of ENT Head and Neck Surgery, Vol. 6, No. 1, 2015

Objective: To find out the prevalence of various types of head and neck trauma.Material and Methods: This retrospective study was done in the department of ENT and HNS, Patan Hospital, PAHS. Charts were retrospectively reviewed for total 61 inpatients with a diagnosis suggestive of head and neck trauma from August 2013 to January 2015. Data was collected for  age, sex, address, type of admission (emergency/OPD), mechanism of injury, site of injury , imaging including X-rays/CT scan wherever applicable and results, surgical therapy, type of anesthesia, hospital admission duration, complications, and follow-up and analyzed.Result: Males were common than females (62.3% vs. 37.7%).  Fall was the most common mode of injury (100%) in both pediatric and elderly population and in adults RTA (42.10%) was the most common mode. In the type of injury most common in pediatrics was oral cavity and oropharyngeal injury (47.60%), in adults facial soft tissue injury (STI) and facial fractures (42.10%) were equally common and in geriatrics  it was (100%).Conclusion: Adult males were prone to head and neck trauma mostly sustaining soft tissue injury (STI)  and fractures due to RTA and physical assult. Injury to oral cavity and oropharynx and STI due to fall is common in extreme of ages. Though the management out comes were good and no grave complications were reported in this study.Nepalese Journal of ENT Head and Neck Surgery, Vol. 6, No. 1, 2015