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   Table of Contents - Current issue
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April-June 2019
Volume 25 | Issue 2
Page Nos. 49-107

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EDITORIAL  

Visual speech perception p. 49
MK Taneja
DOI:10.4103/indianjotol.INDIANJOTOL_67_19  
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ORIGINAL ARTICLES Top

Acoustic radiation: Relation with frequency and its impact on threshold estimation p. 53
Preeti Sahu, Debadatta Mahallik
DOI:10.4103/indianjotol.INDIANJOTOL_38_18  
Background: The most important diagnostic feature of the audiogram is the air-bone gap. Both false and missed air-bone gap lead to misdiagnosed. Acoustic radiation from the bone vibrator, especially at high frequency, causes hearing through the air-conduction reflects false air-bone gap. Materials and Methods: A total of 67 (134 ears) individuals with age ranged between 14 and 48 years (mean age: 36.1 years) were taken in this study. Who had external auditory canal clean and dry with intact tympanic membrane and the air-bone gap >10 dB in high frequencies (i.e., 2000 Hz, 3000 Hz, and 4000 Hz) were included in the study. All the clients who had air-bone gap >10 dB in the frequencies of 2000, 3000, and 4000 Hz were reassessed for their bone-conduction thresholds by closing the external ear canal with the patient's own index finger during testing. Study Design and Statistics: This was an experimental study where statistical analysis and ANOVA was done to compare between open ear canal and closed ear canal condition among frequencies. One-way repeated measure ANOVA along with Bonferroni comparison test was done separately for open ear canal and closed ear canal conditions. Results: Results revealed significant difference in air-bone gap (ABG) between two conditions which were increasingly more for higher frequencies, that is, 2000 Hz, 3000 Hz, and 4000 Hz compared to lower frequencies. Conclusion: Acoustic radiation is the sound energy that may be detected by air-conduction mechanisms which escape from a bone vibrator. When the external auditory meatus is occluded, the acoustic radiation phenomenon can be controlled or avoided, enabling bone measures at the higher frequencies, especially at 2000, 3000, and 4,000 Hz to be more accurate. Thus provides more accurate audiometric diagnosis which is most importantly based on ABG.
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Comparison of frequency-Specific hearing thresholds between pure-tone audiometry and auditory steady-state response p. 59
Himanshu Swami, Santosh Kumar
DOI:10.4103/indianjotol.INDIANJOTOL_97_18  
Introduction: Hearing assessment in difficult to assess persons gives inconsistent response in free field hearing and pure-tone audiometry (PTA). We have been performing brainstem evoked response audiometry (BERA) as an objective assessment in such cases. BERA has limitations that it is not frequency specific, measures thresholds in higher frequencies only, signal intensity levels cannot be higher than 90 dB and presents the data in waveform which needs to be interpreted by experienced audiologist to deduce correct information. All these limitations can be negated with use of auditory steady-state response (ASSR) which can present intensity levels till 120 dB, is frequency specific, even for lower frequencies and has automated response and deduction analysis. The aim of our study was to compare pure-tone thresholds with ASSR thresholds in normal hearing and hearing loss subjects with an objective to validate the ASSR as a tool for objective hearing assessment. Materials and Methods: In this prospective cross-sectional study of 70 adults (n = 140 ears) of both genders, with and without hearing complaints, Group 1 consisted of 24 individuals of normal hearing, Group 2 consisted of 25 individuals of sensorineural hearing loss, and 21 individuals with conductive hearing loss in Group 3. The patients were evaluated with PTA and ASSR test. The mean pure tone and ASSR thresholds for each frequency were calculated and analyzed using the SPSS IBM software. Results: The mean difference of ASSR with PTA was noted at 9.92 dB in the right ear and 10 dB in the left ear. A high significant correlation was noted between ASSR and PTA with P(0.0005) across all the three groups. The relationship between the PTA and ASSR measurement for measuring average hearing threshold levels is described by the equation: PTA = ASSR mean × 0.99–9.92. Conclusion: ASSR is an excellent tool to predict accurate level of frequency-specific hearing threshold. It has constant relationship with pure tone thresholds. ASSR can predict true hearing thresholds in “difficult to assess” patients such as children and malingerers. This can also be used in the prediction of disability assessment objectively.
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Usefulness of modified Romberg test in screening persons with vestibular dysfunction p. 66
Amit Patil, Sharda Ajay Sarda
DOI:10.4103/indianjotol.INDIANJOTOL_56_18  
Introduction: Development of age-appropriate clinical norms is needed for modified Romberg test (MRT) in the Indian scenario. Hence, the present study was undertaken. Objectives: The specific objectives of the study were to investigate the age and gender effect on MRT, comparison of MRT in normal individuals and individuals with vestibular dysfunctions, and association of MRT with caloric and cervical vestibular evoked myogenic potential (cVEMP) test. Materials and Methods: The study involved two groups of participants: Group I had 90 healthy individuals (45 males and 45 females) and Group II had 30 individuals with vestibular dysfunction. MRT was administered on both the groups. Furthermore, participants of Group II underwent caloric and cVEMP test. Results: It was observed that scores of MRT reduced with increase in age among the participants of Group I. However, gender did not show any significant effect for MRT. On comparison, MRT revealed that healthy participants performed superior to individuals with vestibular dysfunction. Further, correlation analysis between MRT with caloric test and cVEMP showed poor association between them (P > 0.05). Conclusions: MRT is affected by age, and therefore, age-specific norms for MRT are required for each clinic.
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Development of dichotic digit test in Tulu p. 71
PG Bhargavi, Kanaka G
DOI:10.4103/indianjotol.INDIANJOTOL_119_18  
Introduction: Behavioral tests are widely used due to their ease of accessibility, simple instrumentation, less variability, and feasibility for interpretation. The use of these tests in regional languages such as Tulu will make the individuals comfortable. Tulu is spoken as mother tongue by over 2 million people in India which demands the need of development of test. Methodology: The study was done in two phases. In Phase 1 of the study, development of material was done which included two lists (List A and List B – each containing 20 digit pairs). In Phase 2 of the study, the recorded material was administered on normal population. Sixty-six native Tulu-speaking adults of age range18–55 years consented and participated in the study. These adults had no associated sensory-motor deficits or history of middle ear effusion and audiological evaluation showing pure tone average ≤15 dBHL; speech identification score (SIS) >90%. Statistical Analysis: Descriptive statistics was used to compile mean and standard deviation and paired sample t-test was used to check the statistical significance between the ears. Results: The present study revealed a significant difference between the right ear and left ear, indicating of greater right ear advantage in Tulu speakers. Conclusion: Language plays an important role in performance of behavioral tests used, even in central auditory test battery, which led to development of test in Tulu. The scores obtained from this test can be utilized in demarcating the normal population from peripheral loss, central auditory processing disorders, cortical/brainstem lesions, and dyslexic groups, in Tulu-speaking population.
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Fungi in the normal human external ear p. 76
Raudha Ezaty Ruslan, Raman Rajagopalan, Kee Peng Ng
DOI:10.4103/indianjotol.INDIANJOTOL_90_18  
Aim: The aim of this study is to determine the presence of fungi in the human external ear. Materials and Methods: A total of 84 specimens of skin scraping were taken from the external ear canals of 46 randomly selected adult ears with their consent. Patients were 15 males and 31 females, with a mean age of 51 years (22 years to 86 years). Of these, 38 patients were from both the ears, and 4 each from right or left ear, respectively, making it a total of 84. These samples were sent to the microbiology laboratory for potassium hydroxide staining for fungal elements and then cultured in sabouraud dextrose agar with olive oil. If fungus was detected on the agar after 2–4 weeks of incubation, the type of fungus was read and verified by a microbiologist. Results: Forty specimens were positive (47.6%) and 44 were negative for fungal culture. The positive culture was Malassezia furfur in 31 (77.5%) and other fungi (Candida albicans 1, Candida parapsilosis 6 and Aspergillus species 2) in 9 (22.5%). Conclusion: There are fungi as commensals in the external human ear, M. Furfur is the most common fungus.
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Illness behavior among patients with medically unexplained dizziness Highly accessed article p. 78
Geetha Desai, Jagdish Chaturvedi, Santosh K Chaturvedi
DOI:10.4103/indianjotol.INDIANJOTOL_116_18  
Background: Dizziness is a common symptom to which patients seek ENT consultations. It is a symptom for which the cause can be either medical or psychological factors or both. Dizziness can cause significant distress and lead to multiple consultations. This study aimed to assess patterns of illness behaviors among patients with chronic dizziness and understand the underlying patterns. Methodology: Illness behavior was assessed by illness behavior questionnaire (IBQ), somatic symptoms by Scale for Assessment of Somatic Symptoms and diagnosis by the Diagnostic Criteria for Psychosomatic Research (DCPR) and International Classification of Diseases 10. Results: Of the 301 individuals, 24 had dizziness, most of these individuals had another somatic symptom and majority met criteria for health anxiety on DCPR. On the four subscales of IBQ, health concerns scores were higher in patients with dizziness as compared to other somatic symptoms. There was no significant difference between bodily distress, affective distress, and affective inhibition. Conclusions: This study concluded that patients with dizziness can also have other physical symptoms and high health anxiety and hence it may be necessary to screen patients for the same.
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A comparative study of microscopic myringoplasty and endoscopic myringoplasty in patients with mucosal type of chronic otitis media p. 81
Vijaya Sundaram Sundararajan, Yedluri Satya Prabhakar Rao, Basimala Ratna Stephenson
DOI:10.4103/indianjotol.INDIANJOTOL_67_18  
Background: Conventionally, over the decades, myringoplasty had been done using an operating microscope. Earlier endoscopes were used mainly for diagnostic and documentation purposes only. Currently, they are becoming popular in otological surgeries. Hence, this study aims to compare the outcome of endoscopic myringoplasty and microscopic myringoplasty in patients with inactive mucosal type of chronic otitis media (COM). Methods: This is a prospective comparative study done in a rural tertiary health-care (NRI Medical College and General Hospital) center from March 2016 to March 2018 after obtaining clearance from the Institutional Human Ethics Committee. Eighty patients underwent myringoplasty; they were block randomized into forty each for microscope and endoscope assisted. The results of surgery were compared at the end of 6 months postsurgery. Results: The hearing gain between the two study groups was not statistically significant (P = 0.36). The average duration in microscopic myringoplasty was 82.25 ± 10.8 min and in endoscopic myringoplasty was 56.43 ± 8.6 min, and this difference was statistically significant (P = 0.00). The graft success rate in both the groups was the same. The postoperative complications in both groups was not statistically significant (P = 0.49). Conclusions: Endoscopic myringoplasty is more advantageous than microscopic myringoplasty in terms of duration of surgery, cost of the instrument, and better magnification. As it is a one-hand-held technique and requires experience, microscopic myringoplasty is still the most-accepted procedure performed. Hence, both microscopic myringoplasty and endoscopic myringoplasty are equally effective in the treatment of COM.
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Effects of radiological abnormalities in temporal bone and brain on auditory outcomes in cochlear implant recipient children p. 85
Vishal Gaurav, Renu Rajguru
DOI:10.4103/indianjotol.INDIANJOTOL_122_18  
Introduction: Cochlear implantation (CI) is used for rehabilitation of children with bilateral severe-to-profound sensorineural hearing loss. Recently, treatment of such children has been influenced by diagnostic technological advances. Multiple radiological abnormalities detected in temporal bone and brain are now increasingly included for CI. The primary aim of this study was to determine the effects of “radiological abnormalities in temporal bone or brain” on CI outcome. Aim: The primary aim of this study was to determine the effects of “radiological abnormalities in high-resolution computed tomography (HRCT) temporal bone or magnetic resonance imaging (MRI) brain” on CI outcome. Study Design: Prospective study. Setting: Tertiary care center. Materials and Methods: In this study, we evaluated fifty cochlear-implanted children from October 2011 to March 2013. The case group consisted of 15 (30%) children with radiological abnormalities and control group consisted of 35 (70%) children with no radiological abnormalities in HRCT temporal bone or MRI brain. All patients received auditory and speech rehabilitation, and their auditory perception outcomes 1 year after CI were evaluated. The children were assessed by categories of auditory perception (CAP) and Meaningful Auditory Integration Scale (MAIS) tests. Results: There was significant reduction in mean auditory perception outcomes (decreased 6.9% mean CAP and 5.4% mean MAIS scores) at 1 year post-CI in CI recipients who had radiological abnormalities, in comparison to those who had no radiological abnormalities in temporal bone or brain (P < 0.05). Conclusion: In this study, presence of radiological abnormalities in temporal bone or brain was found to have a significant deleterious effect on auditory perception outcome at 1 year after CI surgery in children. However, CI was still helpful in these children. Hence, knowledge of “radiological abnormalities in temporal bone or brain” can provide reasonable help in predicting the auditory perception outcome for CI candidates.
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Central auditory function in multiple sclerosis patients p. 90
Reem Elbeltagy, Nahla Hassan Gad, Mohamed Hamdy Ismail
DOI:10.4103/indianjotol.INDIANJOTOL_80_18  
Objectives: To evaluate central auditory functions in multiple sclerosis (MS) patients. Subjects and Methods: Twenty Egyptian MS patients involved in the study and 20 healthy controls who were matched to MS group in age, gender, and literacy. They ranged in age from 30 to 50 years with a mean age 37.6 ± 5 in the study group versus 37.3 ± 4.2 in the control group. In this study, four screening tests were conducted for the assessment of central auditory processing: Gaps In Noise test (GIN), Arabic dichotic digits test (DDT), Pitch Pattern Sequence test (PPS), and last Arabic Speech In Noise test (SPIN). Results: The study showed elevated GIN test approximate threshold and depressed total score in MS patients compared to the control group, with no significant difference between both right and left ears. There was statistical significant depressed scores in study groups at PPS, speech intelligibility in noise, and DDTs. Conclusion The findings of the current study add more evidence to the involvement of central auditory processing abilities in patients with MS. The assessment of central auditory function is highly recommended for all MS patients as a routine examination and can be used for monitoring the effectiveness of medication and related therapies for these patients.
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Mutation analysis of GJB2 and GJB6 genes and screening of nine common dfnb loci in iranian pedigrees with autosomal recessive nonsyndromic hearing loss p. 97
Fatemeh Azadegan-Dehkordi, Mahbobeh Koohiyan, Maryam Shirzad, Tayyeb Bahrami, Nasrin Yazdanpanahi, Mohammad Amin Tabatabaiefar, Reza Pourpaknia, Effat Farrokhi, Morteza Hashemzadeh-Chaleshtori
DOI:10.4103/indianjotol.INDIANJOTOL_113_18  
Background: Hearing loss (HL) is one of the most common sensory disorders (1/1000). Various studies have shown that a large proportion of autosomal recessive nonsyndromic HL (ARNSHL) in Iranian populations is caused by defects in a certain number of genes; new detection methods such as sequencing of the exome (exome-sequencing) can increase the frequency identification of responsible mutations for HL. The aim of this study was to screen for ARNSHL pedigrees and to find the responsible genes. Materials and Methods: Fifty big ARNSHL pedigrees including 130 Iranian patients with ARNSHL took part in this study. Direct sequencing and multiplex polymerase chain reaction were, respectively, used for the presence of GJB2 and GJB6 (del D13S1830 and del D13S1854) mutations in all of the families. The negative pedigrees for these genes were tested to homozygosity mapping for the linkage to nine known loci, then the negative pedigrees for them were sent for exome-sequencing. Results: Nine of 50 pedigrees had GJB2 ( 18%) mutations. No GJB6 mutation was found. Totally, 11 of 50 pedigrees (22%) showed linkage to 6 known loci DFNB, including 2 pedigrees to DFNB2, 2 pedigrees to DFNB3, 2 pedigrees to DFNB4, 2 pedigrees to DFNB7/11, 3 pedigrees to DFNB12, and 2 pedigrees to DFNB104. An individual from a large pedigree was examined by exome-sequencing and was observed no changes. Conclusion: In this study, DFNB1 and DFNB12 are the main causes of ARNSHL. GJB6 mutations, DFNB6, and DFNB59 were absent. Therefore, 40% of the ARNSHL etiology was found in this study.
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P300 as a measure of auditory memory in cochlear implant recipients: A preliminary report p. 103
CS Vanaja, Sharada Sarda
DOI:10.4103/indianjotol.INDIANJOTOL_118_18  
Objectives: This study aimed to check the feasibility of recording autiory P300 in children with cochlear implants using commercially available auditory evoked potential system. The present study also investigated if there is an association between auditory memory and auditory P300. Methods: The participants of the study included 10 children with monaural cochlear implant attending auditory verbal therapy. The age of the children ranged from 2 years to 7 years 8 months years. Audiotry P300 was recorded using Biologic Navigator Pro Auditory Evoked Potential System. Auditory memory was measured using 4-digit sequences. Results: Cortical auditory evoked potential could be recorded from 9 out of 10 children. The latency and amplitude of P300 showed a significant correlation with memory for 4-digit sequences. Discussion: The results of the present study highlights that auditory P300 can be recorded for the passive task from children using cochlear implants. It has been reported in the literature that cognitive and memory abilities are crucial for the development of auditory discrimination and hence can be a factor affecting the outcome of cochlear implants. The results suggest that P300 can probably be used to assess memory and cognitive abilities of children using cochlear implants. Conclusions: The results suggest that P300 can be recorded in clinical setup and probably will help in the objective assessment of memory abilities in children with cochlear implants.
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