Introduction: Epistaxis is a common otolaryngological emergency condition. It occurs due to local and systemic cause. Local cause lies within the nose bleeding either anterior or posterior. Commonest site of bleeding anterior epistaxis is kiesselbach’s plexus. In posterior epistaxis, it is difficult to locate bleeding site. Epistaxis is controlled by simply pinching of nose, decongested nasal drop and abgel packing. Some cases become more challenging required nasal packing and arterial ligation. Objectives: To study the epidemiological pattern and management of epistaxis. Methods: This was a retrospective study on pattern of epistaxis man­aged at Gandaki Medical College Teaching Hospital over a period from April 2015 to April 2016. Information regarding demographic profile, presentation and management of epistaxis was obtained from the Hospital records, ENT Outpatient clinic, Emergency Department, ENT ward and operation theatre. Results: A total of 78 cases were managed during study period. There was a significant male preponderance with male to female ratio 1.78:1. Patients’ age varied from eight to 80 years with mean age 40.7 years. The peak age of incidence was 21 - 30 years group. Idiopathic nasal bleeding 27 (34.6%) was commonest followed by nasal trauma 23 (29.5%) cases and hypertension 16 (20.5%) cases. Seventeen (21.8%) cases managed in day care basis with decongested nasal drop, chemi­cal cautery and abgel packing. Remaining cases required nasal packing and bipolar cautery and other specific form of treatment. Five (6.4%) cases required sphenopalatine artery ligation with no recurrence of bleeding. Conclusions: Epistaxis is common ENT emergency. Most common causes are idiopathic followed by nasal trauma and hypertension. Prompt management is instituted according to cases. Most of the cas­es are managed by non-surgical method.

Introduction: Acute tonsillitis is caused by either viruses or bacteria and is characterized by a sore throat and painful swallowing. About 49% of cases are thought to be caused by Group A beta-hemolytic streptococci. Penicillin should be given empirically after the diagnosis of acute tonsillitis. This study was carried out to find out the prescription pattern of antibiotics among the admitted cases of acute tonsillitis. Materials and Methods: This study was conducted in the Department of Otorhinolaryngology and Head and Neck Surgery, Gandaki Medical College Teaching Hospital and Research Centre (GMCTH), Pokhara. All the patients who were admitted for acute tonsillitis in the ENT ward were enrolled in this study. Age, gender, the average number of drugs per prescription, and the most commonly prescribed drug was recorded. Results: There were 320 patients with acute tonsillitis and the mean age was 27.44 ± 11.1 years. Most of the cases were in their twenties. The average number of drugs per prescription was four while the total number of antibiotics used was 520. The single antibiotic was used in 170 (53%) cases and a two-drug combination was used in 91(28.4%) cases. Ceftriaxone was the most commonly prescribed drug. There were 78 (24.3%) cases under monotherapy and 69 (21%) in multitherapy. Conclusion: Among the various effective antimicrobials, ceftriaxone was the most commonly prescribed antimicrobial. The injectable route of antibiotics administration was a widely used method in hospitalized patients in our setting.

Female, 66 years old with a chief complain of shortness of breath and lump over her neck since 6 month. Neck USG showed enlarged right lobe of thyroid gland with hyperechoic nodules. FNAC confirmed anaplastic carcinoma of thyroid. patient underwent chemotherapy using doxorubicin as agent of choice. She had difficulty in breathing and she kept on high flow of oxygen, even after she had stridor and planned for tracheostomy. MRI revealed heterogeneously enhancing mass (9.6*6.5*10.5 cm) replacing right lobe of thyroid, and extending superiorly till the level carotid bifurcation and inferiorly superior mediastinum. Lesion is partially encasing trachea and laryngeal airway, posteriorly extending into prevertebral space and anteriorly invading strap muscles and sternocleidomastoid muscle. Now it become very difficult stage. She transfers to ICU. intubation tried but failed. As mass was just anterior to trachea and difficult to do tracheostomy without intubation. all hope failed and she put continue to high flow of oxygen.

Background: Preservation of the external branch of the superior laryngeal nerve (EBSLN) during thyroidectomy is important because its injury may lead to frequent occurrence of vocal fatigue and the inability to perform phonation. The objective of the study was to identify and classify the nerve as per Cernea's classification using operating microscope during thyroidectomy Method: Between January 2017 to December 2019, we evaluated 50 patients for the position of external branch of superior laryngeal nerve, who underwent microscopic thyroid surgeries in the department of ENT- head and neck surgery at Gandaki Medical College. Results: In our study, we dissected a total 59 superior poles of thyroid from 50 patients and identified the nerve in all the cases. Of the total superior poles, 36 (61.01%) had type IIa EBSLN among which 24 was on the right side and 12 on the left followed by 19 (32.20%) patients with type IIb EBSLN among which 8 on right and 11 on left side. There were only 4 poles (6.77%) of type I with 3 on the right and 1 on the left side. Conclusion: The EBSLN can be very efficaciously identified during a microscope assisted thyroidectomy. Cernea type 2a and 2b EBSLNs are in position to be at high risk of injury during ligation of the superior vascular pedicle, which can be avoided by prompt identification through a microscope and a meticulous extra capsular dissection technique.

Introduction: Atopic disorder is very common globally and in Nepal which has affected quality of life resulting into loss of working and school days. Change in lifestyle is one of the important recommendations for fighting back with allergy, which suggests for avoidance of allergens developing allergic rhinitis. The objectives of the study were to find out common allergic conditions in Pokhara, Nepal and to identify the allergens, which induced IgE mediated disorder. Methods: A retrospective study was done among the patients with different allergic disorders who were referred from different specialist clinic attending Pokhara ENT Center at Pokhara from January 2011 to December 2017. The study sample included 1810 patients to find the distribution of various allergic disorders among them. Further, a sample of 430 patients of allergic rhinitis who had undergone skin prick test according to international guidelines were included in order to find out the common allergens among them. Set of allergens included in this study were mites, pollen, fungus, insects, dusts, epithelia-danders, feather & fabric, non-juicy foods, and juicy foods. These nine allergen types further included several allergens. Data were analyzed using descriptive statistics using Stata 15.1. The study was done from after taking ethical clearance from the institutional ethical committee of Gandaki medical college. Results: Among various types of allergic diseases, allergic rhinitis accounted for one fourth (23.8%) of the cases. The patients with allergic rhinitis who underwent skin prick test against various allergens were evaluated. Skin prick test positive test result were seen for non-juicy foods (96%), pollens (95%) and then juicy foods (93%). On the contrary, least percentage (13.72%) of people were found positive against feather & fabrics. Radish (7.7%) and snake gourd (6.99%) were only two juicy vegetables against which people were found positive in skin prick test. Among non-juicy foods, tobacco was the commonest allergens which was reported positive in skin prick test of 16% people. Pollen of Zea mays, Azadirachta indica, Mangifera indica and Prosopis juliflora were top allergens diagnosed positive among 12.65%, 10.95%, 7.79%, and 7.54% of people respectively. The mite Dermatophagoides pteronyssinus yielded highest prevalence (69.36%) of positive test. Conclusions: Based upon the findings of our study, allergic rhinitis is one of the most common allergic diseases in Gandaki province, Nepal. Patients of allergic rhinitis should be tested for certain allergens which are locally present and they need to modify lifestyle and avoid allergens which can induce IgE-mediated disorder. Further research is needed to establish causation.