R. C. M. Amatya’s research while affiliated with Tribhuvan University and other places

The main objective of this study was to find out the most common organism affecting the tonsils in recurrent tonsillitis. This was a prospective study consisting of total number of 50 patients, conducted in the ENT department of Dhulikhel Hospital, KUTH, Dhulikhel, Nepal. The study period was one year and three months (March 2004 to April 2005). Total numbers of 50 patients were selected, of which 32 were of acute tonsillitis and 18 were taken as control. Among these males were 32 and females were 18. The age group was from 3 years to 64 years. Throat swabs of patients were taken by aseptic method and were sent to the laboratory immediately. Among the infected tonsils the most common organism was Streptococcus viridans followed by Streptococcus pneumoniae and Moraxella catarrhalis. The third most common was Beta haemolytic streptococci whereas Micrococcus was not isolated in any of the infected samples. Likewise in non-infected tonsils, the most common organism isolated was again Streptococcus viridans followed by Micrococcus and Diptheroids. In these specimen no Beta haemolytic streptococci was isolated from the control group. Thus, the study is able to put forward the fact that most common organism affecting the tonsils in infected as well as non- infected state is Streptococcus viridans. Where as Beta haemolytic streptococci was not found in non-infected tonsils, likewise Micrococcus was not found in infected tonsils.

This prospective study was done to find out the most common organism affecting the tonsils in recurrent tonsillitis and to compare the microorganisms found in the core and surface of such tonsils. A total of 50 patients attending ENT Out patient Department of Tribhuvan University Teaching Hospital (TUTH) from February 2000 to August 2001 were included in the study. All these patientshad undergone tonsillectomy under general anaesthesia by dissection method. Among these 39 patients had undergone tonsillectomy for recurrent tonsillitis and 11 had undergone tonsillectomy for reasons other than recurrent tonsillitis. The excised tonsils were kept in agar plates and transported to the microbiology laboratory within half an hour of surgery. The culture was taken from the surface and the core after cutting the tonsils into half by a sterile blade and with another sterile blade only core was extracted in a wedge shaped manner and was cultured in aerobic (5% sheep blood agar, Chocolate agar and McConkey’s agar and anaerobic (gas pack jar system) media for 24 - 48 hours. The most common microflora seen in recurrent tonsillitis was Streptococcus viridansfrom the surface, as well as the core. Other common micro organisms prevalent on the surface in recurrent tonsillitis were Staphylococcus aureus, and Brahmnella catarrhalis. Likewise other common micro organisms in the core in recurrent tronsillitis were Staphylococcus aureus, Klebsiella pneumonie, and Haemophillus influenzae. There was no statistical difference between the micro organisms found on the surface and the core except for Brahmnella catarrhalis which was significantly more on the surface. Anaerobes were isolated only from the core and there was no statistical difference between the micro organisms isolated from the non-infected tonsils and from recurrent tonsillitis.

To investigate the frequency and effective treatment of ulcers and sinuses in cases of tuberculous cervical lymphadenitis (TCL). Observational cross-sectional study. Department of ENT, Head and Neck Surgery of Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal, during the period of two years from March, 2000 to February, 2002. A hundred cases of histopathologically confirmed cases of tuberculous cervical lymphadenitis of more than six weeks of duration were included in the study. Overall frequency of the complication as well as the efficacy of treatment regime was considered. Out of 100 patients, 8 (8%) were found to develop ulcers and/or sinuses during the process of development of TCL which were effectively treated (100% cure rate). Mode of treatment was surgical excision of ulcers/sinuses along with affected underlying lymph nodes, followed by short course of anti-tubercular chemotherapy. Not a single case recurred during their follow-up period. In this series there was a low frequency of formation of ulcers/sinuses during the process of development of TCL. Surgical excision of ulcers/sinuses along with affected underlying lymph nodes, followed by short course of anti-tubercular chemotherapy is the effective methods of their treatment.

To investigate the distribution of lymph nodes in the neck during the process of development of tuberculous cervical lymphadenitis (TCL) in patients attending an outpatient clinic over a 1-year period. This was a prospective, cross-sectional, observational study which included 100 cases of histopathologically confirmed TCL of >6 weeks duration. Lymph nodes in the posterior triangle (PT) were found to be commonest (51%), followed by those in the upper deep cervical (UDC; 48%) and submandibular (SM; 36%) regions. The supra-clavicular (SC; 3%), submental (Sment; 4%) and lower deep cervical (LDC; 9%) regions were found to be the least frequently affected. Uni- and bilateral disease were observed in 83% and 17% of patients, respectively. A single group of lymph nodes was involved in 68% of patients, 2 groups in 29% and >2 groups in 13% of patients. These results indicate that if unilateral, painless, enlarged and mated lymph nodes are found in either the PT or the UDC or SM areas, lymphadenitis of tuberculous origin should be suspected rather than lymphadenitis of any other etiology.

To investigate the outcome of surgically managed laryngeal carcinoma patients attending an outpatient clinic over a 5-year period. This was an analytical, retrospective, cross-sectional study. A total of 36 laryngeal carcinoma patients who were managed surgically with or without radiotherapy were analyzed. A total of 32 patients (89%) were found to be disease-free during follow-up for up to 5 years. Two patients (5.5%) died because of intercurrent infection and recurrence of the disease and two (5.5%) were lost to follow-up 5 and 7 months after surgery, respectively. The results indicate that the best disease-free rates can be achieved by managing laryngeal carcinoma surgically with or without radiotherapy depending on the advancement and aggressiveness of the disease.

Hearing impairment is the single largest disability in Nepal. In 1980, the Ministry of Health organized a national workshop, which recommended that mobile ear surgery camps (MESCs) should be held in rural areas to combat ear diseases (particularly otitis media) and deafness. Since 1988, several nongovernmental organizations (NGOs) such as the Britain Nepal Otology Service, Nepal Ear Foundation, and IMPACT Nepal have been conducting MESCs. Forty-two MESCs have been held and approximately 40,000 people have been treated and 2000 ear surgeries have been performed there. More than 4000 hearing aids have been distributed to people who had sensorineural hearing loss. This paper deals with 25 MESCs conducted by IMPACT Nepal in rural areas of Nepal since 1994. The different types of middle ear surgery performed in the 25 MESCs are as follows: 783 myringoplasties, with or without ossicular reconstruction; 79 modified radical mastoidectomies (MRMs), usually combined with tympanoplasty; 131 ventilation tube insertions; 70 stapedectomies; and 49 other ear procedures. Follow-up of the patients was started from November 2000 onwards. The result of both graft uptake and hearing improvement within 35 dB was more than about 80%.