Oesophageal Foreign Bodies in Children

Foreign body ingestion is a common occurrence and carries significant morbidity and mortality. Failure to treat foreign bodies immediately can lead to various serious complications. This study was done to identify the types as well as site of foreign body ingested and its complication in children. A retrospective study of 122 cases of suspected foreign body ingestion in patients admitted in ENT and Head and Neck Surgery of TU Teaching Hospital, Kathmandu were done in between April 2004 to July 2008. Ages less than 12 years were included. In all cases x-ray soft tissue neck lateral and chest x-ray posterio-anterior views were done along with other preoperative investigations. Rigid oesophagoscopy or hypopharyngoscopy were done under general anesthesia to remove foreign bodies. There were 64.7% male and 35.3% female children. Foreign bodies were common in 0-4 year age group. Most common foreign body were coin (64.0%) followed by meat bone (14.0%). No foreign bodies were found in 2.4% patients as they were passed in stomach. No complications were noted during the entire period of this study. Most common foreign bodies in children are coin. Though complications with these foreign bodies are rare, these do occur due to delay in presentation and removal. No complications were noted in our series. Eventhough children who swallow foreign bodies are asymptomatic; we must maintain a high index of suspicion and undergo diagnostic procedure, if there is a positive history. Key words: foreign bodies, oesophagus, rigid oesophagoscop

Comparison of Pre and Post-operative Hearing Results in Canal Wall Down Mastoidectomy with Type III Tympanoplasty

This study was done to compare the pre and post-operative hearing results in patients undergoing canal wall down mastoidectomy with classical type III tympanoplasty using temporalis fascia alone. Patients of ≥5 years age with the diagnosis of Chronic otitis media (squamous) with conductive or mixed hearing loss, needing canal wall down mastoidectomy and with intact and mobile stapes suprastructure at surgery who underwent classical type III tympanoplasty were included in the study. The pre and post-operative PTA was performed and evaluated. The post-operative hearing was assessed in terms of average ABG and size of ABG closure. Mean pre and post-operative air bone gap in classical type III tympanoplasty were 37.8 dB and 29.8 dB respectively and these differences were statistically significant. The postoperative PTA-ABG ranged from 15-61.2 dB. Hearing results after type III tympanoplasty varied widely showing statistically significant improvement in mean post-operative PTA-ABG but there was a great variation. Key words: air bone gap, chronic otitis media, mastoidectomy, tympanoplast

Role of Foley’s Catheter in Removing Foreign Body of Oesophagus

Oesophageal foreign bodies are commonly removed with rigid oesophagoscopy under general anaesthesia, but spherical foreign bodies can also be removed using a foley's catheter under fluoroscopic control without anaesthesia. We present a case of successful removal of a spherical marble from the oesophagus in a four years old girl by a foley's catheter under general anaesthesia Keywords:Keywords:Foreign body, oesophagus, foley’s cathete

Looking beyond supply: a systematic literature review of demand-side barriers to health service utilization in the mountains of Nepal

Significant disparities in reproductive, maternal, newborn, and child health (RMNCH) outcomes and intervention coverage exist between the Mountains and other ecoregions of Nepal. Delivery of essential health services to remote mountainous areas is challenging and access is a known barrier to utilization. However, the contribution of demand-side barriers is poorly understood. Consequently, policies and programs cannot strategically target constraints to increase coverage. This systematic review identifies demand-side barriers to utilization of RMNCH services in the Mountain districts of Nepal. Research was drawn from MEDLINE, Web of Science, Scopus, Google Scholar, Eldis, and unpublished literature. Beyond inaccessibility, utilization is undermined by costs of care-seeking, traditional attitudes and practices, low status of women, limited health knowledge, dissatisfaction with service quality, and low and inequitable care by community health workers. The intensity and repercussions of these barriers are of greater magnitude in the Mountains where delayed care-seeking combines with long distances for critical health consequences