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   Table of Contents - Current issue
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October-December 2019
Volume 25 | Issue 4
Page Nos. 177-222

Online since Wednesday, December 4, 2019

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ORIGINAL ARTICLES  

Topical silver nitrate application during myringoplasty for large tympanic membrane perforation p. 177
Mohammad Waheed El-Anwar, Mohammad El-Sayed AbdElbary, Ibrahim Mohammad Saber, Mohamed El-Sayed Elshora, Sameh Mohamed Hosny
DOI:10.4103/indianjotol.INDIANJOTOL_89_18  
Objective: The aim of this study was to assess the topical application of silver nitrate during myringoplasty for large tympanic membrane (TM) perforation. Patients and Methods: This study was applied on 70 patients who had large dry central TM perforations. The patients were randomly divided into two groups: silver nitrate group for whom silver nitrate 50% was used during myringoplasty and control group that was managed traditionally without silver nitrate. The patients were evaluated on the basis of postoperative graft taking, hearing improvement, and complications. Results: Both groups were statistically matched with regard to age and sex. At 6 months postoperatively, success rate (graft taking) in silver nitrate group was 88.57% and 82.86% in control group with statistically nonsignificant difference (P = 0.49). Success in terms of hearing gain (≥10 dB) was achieved in 23 patients (65.6%) in the silver nitrate group and 12 patients (34.4%) in the control group with statistically nonsignificant difference (P = 0.079). Conclusion: Topical application of 50% silver nitrate during myringoplasty for large TM perforations is safe, provides refreshing the edges of the large TM perforation, and avoids losing any part of the precious remnants of the large TM perforation.
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A clinico-etiological study of aural myiasis p. 180
Pradip Mallik, Vikas Sinha, Sushil Jha, Jigna Swani, Naimish Maniya, Sandeep Yadav
DOI:10.4103/indianjotol.INDIANJOTOL_131_17  
Introduction: Human Myiasis is found among elderly and neglected patients. It occurs in skin and mucosa and causative agent maggot derived from families of Cuterbridae and Hypodermatidae. It otolaryngology it is found in ear nose and paranasal sinus and oral cavity and aural myiasis is found in patients with prolong systemic disease, otitis externa, otitis media, malignancy and other imunocompromised patients. Methodology: In this study we will discuss about aural Myiasis found in department of ENT for a period of 21 months. After taking proper history and examination all maggots were removed after putting turpentine oil soaked gauge piece and manually removing all by forceps. Regular dressing done under vision of endoscope and microscope. Results and Discussion: In this study it was found that females are more in numbers and geriatric age group is largely affected. People from slum areas were largely affected and mostly they were from lower socioeconomic background. Conclusion: Most of the aural myiasis found in external auditory canal however pre and post auricular regions also were affected. Most of the patients were anemic and also some patients were imunocompromised. So this study helps us to know the causative factors and how to treat the condition.
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Sigmoid sinus diverticulum and dehiscence: Diagnosis and management p. 184
H Shameer Ahamed, Ajay Philip, Aparna Irodi, Anjali Lepcha, Shyamkumar Nidugala Keshava
DOI:10.4103/indianjotol.INDIANJOTOL_106_18  
Introduction: Sigmoid sinus diverticulum (SSD) is a relatively rare vascular disorder characterized by a dilated sac in the sinus wall protruding into the mastoid cells. It may be associated with SSDe-Sigmoid sinus plate dehiscence (SSDe); however, SSDe can occur in isolation too. SSD may be associated with prediverticular venous sinus stenosis (SS) and commonly presents as pulsatile tinnitus (PT). Aim: This study aims to present a series of patients who were diagnosed and managed for SSD and SSDe and discuss their treatment options. Methods: A retrospective chart review was carried out between January 2016 and August 2018, and all patients presenting with PT and diagnosed with SSD and or SSDe were included in this study. Results: We had six patients who were diagnosed with SSD and SSDe during this time frame. High-resolution computed tomography and magnetic resonance venogram were used for the diagnosis. In addition, cerebral angiogram was done for 2 patients who had prediverticular stenosis of the sinus. Transmastoid decompression and repair of SSD gave excellent relief from tinnitus in one patient. Conclusion: SSD and SSDe are treatable causes of PT. SSD may be associated with a prediverticular venous SS. A prediverticular high-pressure gradient stenosis should be managed before decompression and repair of SSD.
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Ear anomalies (congenital) at referral hospital p. 188
Vikas Sinha, Sushil Jha, Jigna Savani
DOI:10.4103/indianjotol.INDIANJOTOL_123_18  
Background: In otorhinolaryngology region, about half of the malformation affects the ear. Congenital anomalies of the ear can affect the external ear, middle ear, and inner ear. The ear malformations can be unilateral or bilateral. In this study, we enrolled patients with preauricular cyst, tag, accessory tragus, preauricular sinus, pinna sinus, microtia, anotia, EAC atresia, and congenital sensorineural hearing loss (SNHL). Hearing loss may lead to delayed language development and poor school performance. Universal newborn hearing screening allows for earlier detection and intervention in infants with hearing loss, which may result in improved language development in affected children. Estimated rates of congenital SNHL range from 1/1000 to 3/1000 live births. Aim and Objective: Proper and early diagnosis can change the future of a child by providing hearing rehabilitation and speech therapy. Materials and Methods: It is a prospective study of 122 patients of ear-related anomalies, conducted at the Government Medical College and Sir T. Hospital, Bhavnagar, Gujarat, India, from January 2016 to July 2018. Results: we have observed patients with otological malformations which includes external, middle and inner ear malformations. Conclusion: This study contains 122 patients, of which more than half of the patients are male (54.91%). We obsereved patients with Congenital SNHL, pinna anomalies, congenital facial weakness. We have also obtained cases with Waardenburg syndrome and Goldenhar syndrome.
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A comparative study of visual attention in hearing impaired and normal schoolgoing children p. 192
Renu Thakur, Jaikishan Jayakumar, Sangeeta Pant
DOI:10.4103/indianjotol.INDIANJOTOL_19_19  
Background: Enhanced visual attention is one of the major documented effects in auditory deprivation. However, in parallel, it has been shown that the congenitally deaf show deficits in their temporal processing. Aim: In this study, we aimed to study the parameters of visual attention. Materials and Methods: The speed of processing of divided attention (using the symbol digit modality test [SDMT]) and the central attention with attentional blink (AB) using a commercially available App, the BrainBaseline App. We tested these parameters of visual attention in students who are congenitally hearing impaired and those with normal hearing. Results: The measure of visual attention (error scores) using the SDMT did not show any significant differences between the congenitally hearing impaired and the students with normal hearing. However, we report significant differences in the processing speeds of divided attention and the error rates in the AB test between the congenitally hearing impaired and the normal with the hearing impaired having slower speeds of processing but making less errors in AB test. Conclusion: This finding probably indicates the redistribution or allocation of available brain resources as a result of sensory deprivation.
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Outcome of gans repositioning maneuver in patients with posterior canal benign paroxysmal positional vertigo with cervical spondylosis p. 196
H Gayathri, Gurushekar Rose Preethi, Paul Mary P. Christina
DOI:10.4103/indianjotol.INDIANJOTOL_62_19  
Background and Objectives: Cervical spondylosis and BPPV often co-exist in older population. As GRM doesn't involve hyperextension of neck, which is better avoided among patients with cervical spine pathology, we decided to assess the outcome of GRM in patients with cervical spondylosis in terms of safety & efficacy. Methodology: Twenty patients with clinically proven posterior semicircular canal BPPV and radiologically evident cervical spondylosis without symptomatic spondylotic myelopathy or radiculopathy or severe restriction of neck or back movement were enrolled. GRM was done on the first day and repeated until resolution of nystagmus, for a maximum of four times. Lack of response to GRM even after fourth attempt was considered as failure. The manuever was repeated in the successful group on day two and after one week & these patients were followed up for one month. Results: Overall, 75% of the patients (50.9% to 91.3% - 95% C.I.) had a successful repositioning maneuver. Favourable parameters for better chances of cure were higher age (>55 years), male gender & higher grade of cervical spondylosis. 20% of patients had experienced temporary pain for few hours on the day of maneuver. None of the patients who had less than two attempts of GRM had post-procedure pain. Clinically, none of the patients had precipitation of cervical myelopathy or radiculopathy. Conclusion: GRM is a safe & effective particle repositioning maneuver for patients with posterior semicircular canal BPPV with co-existent cervical spondylosis.
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Prevalence and pattern of hearing loss in patients with chronic kidney disease in Kaduna, Northwestern Nigeria p. 201
Mohammed Bello Fufore, Abdullahi Musa Kirfi, Abubakar Danjuma Salisu, Thomas Musa Samdi, Abdulhameed Bala Abubakar, Paul Adekunle Onakoya
DOI:10.4103/indianjotol.INDIANJOTOL_94_19  
Background: Chronic kidney disease (CKD) is considered a serious public health issue, may be associated with hearing loss. Aim: This study aimed to determine the prevalence and pattern of hearing loss among adult patients with CKD in Northwestern Nigeria. Participants and Methods: This was a cross-sectional study of patients with CKD in a tertiary hospital in Northwestern Nigeria. Non-CKD population matched for age and sex were enrolled as controls. Ethical approval was obtained from relevant bodies. Informed consent was obtained. Data were obtained from clinical interview and audiometric evaluation of the participants. The data were descriptively analyzed using SPSS version 20. The Chi-square test was used, and the level of significance was set at P < 0.05. Results: Sixty patients and sixty controls participated in this study. The mean age for patients and controls was 43.2 ± 13.4 and 41.2 ± 11.3, respectively. Sixty-nine of the 120 ears of patients had hearing loss, whereas 25 of the 120 ears of the controls had hearing loss, giving a prevalence of 57.5% and 20.8% among patients and controls, respectively. Of patients with hearing loss, 97.1% had sensorineural hearing loss and the remaining 2.9% had mixed hearing loss. The hearing loss was mostly mild (75.4%) and bilateral (91.7%) mainly affecting higher frequencies (63.8%). Conclusion: This study showed that hearing loss was more prevalent among patients with CKD. In majority of the patients, the hearing loss was mild, bilateral, sensorineural, and mostly affecting higher frequencies.
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Comparison of hearing thresholds using audiometric versus android-based application p. 206
T Prithivi, Chandan Kumar Nayak, GS Kavitha, Banoth Shoban, G Jeevan, SP Pruthvik, Chandni Jain
DOI:10.4103/indianjotol.INDIANJOTOL_70_19  
Background: Hearing loss is a highly widespread problem worldwide and early identification of hearing loss through screening is important to overcome the negative effects of untreated hearing impairment. Screening can be done using handheld device app technologies for the hearing assessments that would be easy to be used by any individual. Aims and Objectives: The aim of the present study was to compare the hearing thresholds with smartphone application and conventional audiometer. Materials and Methods: A total of 52 participants were included in the study. They were divided into two groups. Group 1 included 36 participants (72 ears) in the age range of 7 to 35 years with normal hearing sensitivity. Group 2 included 16 participants (32 ears) in the age range of 18-68 years with varying degree of hearing loss ranging from minimal hearing loss to severe hearing loss. Thus, a total of 104 ears were tested. Air Conduction thresholds were obtained at octave frequencies from 250 Hz to 4000 Hz using conventional audiometer in a sound treated room and through the android application (Hearing test version 1.1.) using a smart phone (Micromax Xpress Canvas) in a quiet room. The noise levels for hearing assessment through smart phone app ranged between 70-75 dB A, which was measured prior to the testing session. The thresholds were obtained for both right and left ear of the participants. The hearing thresholds obtained from both the measures was subjected to appropriate statistical analysis. Results: The results showed that there was a significant difference in the thresholds across the procedures for all the frequencies in Group 1. However, there was no significant difference in thresholds across the procedures for all the frequencies in Group 2. Conclusion: It can be concluded that hearing screening through mobile application is user-friendly and cost-effective, but it might lead into under referrals.
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CASE REPORTS Top

Postauricular abscess: An uncommon presentation of keratosis obturans p. 210
Srinidhi Govindarajan, Haneesh Amit Domah, S Vijendra Shenoy, Athulya Sreenivas, Rigzing Chophell Dadul
DOI:10.4103/indianjotol.INDIANJOTOL_104_18  
Keratosis obturans (KO) is a rare disease involving the bony external auditory canal due to hyperkeratosis of epidermis and disturbance in the epithelial migration process resulting in deafness, otalgia, and inflammation of the ear canal skin. Complications are extremely rare. Here, we present a case of KO in an elderly female presenting as a postauricular abscess, an unreported occurrence first of its kind in the literature. A 67-year-old female patient presented with complaints of dull aching pain and decreased hearing in the left ear for 1 month and swelling behind and above the left ear for 2 weeks. On examination, there was impacted wax in the left external auditory canal and the tympanic membrane was not visualized. A high-resolution computed tomography of the temporal bone reported left otitis externa with soft-tissue density with fat strands in the left postauricular region. The patient underwent examination under microscope, followed by debridement and a subsequent cortical mastoidectomy. Histopathology confirmed the diagnosis of KO. KO is an uncommon condition caused due to occlusion of external auditory canal by desquamated keratinous plug. It is important to differentiate it with other common conditions, including necrotizing otitis externa, canal cholesteatoma, osteoradionecrosis of the external auditory meatus, and tumors of the external auditory meatus. Extracranial complications are rare, including extensive bony erosion and automastoidectomy with no intracranial complications reported till date. KO is a relatively rare condition more commonly seen in the younger age group, and postauricular abscess as a complication of KO has not been reported till date. We thus highlight the importance of awareness of such rare conditions of the external auditory canal, promoting early diagnosis, prompt treatment, and successful prevention of complications.
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A rare entity in a child: Unilateral sensorineural hearing loss with an ipsilateral vascular loop – Is there any correlation? A case report and literature review p. 213
Ramaprabah Kandiah, Nik Adilah Nik Othman
DOI:10.4103/indianjotol.INDIANJOTOL_69_18  
Unilateral sensorineural hearing loss (USNHL) in children is multifactorial, which includes the inner ear malformations, cochlear nerve deficiency, perinatal cytomegalovirus infections, and Waardenburg syndromes. The exact cause of unexplained sensorineural hearing loss (SNHL) in children is explained via findings from imaging such as high-resolution computer tomography and magnetic resonance imaging (MRI). There are some evidence reported showing correlation between vascular loop and unilateral hearing loss in adults. Association between vascular loop and USNHL in children is yet to be published. A 12-year-old girl presented to otorhinolaryngology clinic with left ear reduced hearing since the age of 6 years. Pure tone audiometry yielded unilateral severe-to-profound SNHL. MRI of brain revealed ipsilateral second-degree vascular loop which projected into porus acusticus (medial end) of the internal auditory canal. She was counseled for hearing aid to improve her hearing. As there was no other possible abnormality noted, we are correlating the hearing loss with the presence of vascular loop in the MRI.
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Malignant external otitis with facial nerve paralysis p. 216
Giancarlo Tirelli, Annalisa Gatto, Silvia Brancatelli, Alice Piccinato
DOI:10.4103/indianjotol.INDIANJOTOL_25_19  
Malignant external otitis (MOE) is a severe infection of the external auditory canal and the skull base that is often seen in elderly diabetic patients with a high mortality and morbidity rate. in >98% of cases, the causative pathogen is Pseudomonas aeruginosa. Here, we describe a case of MOE associated with facial nerve paralysis in a patient hospitalized. A 62-year-old man was referred to our department experiencing right otalgia, purulent otorrhea, ear loss, and a Grade III right facial nerve palsy according to the House–Brackmann scale. He was affected by uncompensated insulin-dependent type 2 diabetes. The patient had a history of noncholesteatomatous ipsilateral chronic otitis treated with tympanomastoid surgery 10 years before, without any sign of recurrence. After 10 days of specific antibiotic and corticosteroid therapy, symptoms were reduced and the paralysis of the superior branches of the facial nerve had improved, but the persisting swell of the ear canal did not allow a thorough evaluation of the tympanic membrane. Therefore, an explorative tympanotomy was performed, and few days after surgery, the marginalis branch paralysis of the facial nerve had improved according toelectroneurography (ENG) results, and the culture swab showed a polymicrobial flora.
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Lateral temporal lobe meningoencephalocele: Transmastoid repair with surgicel and temporalis graft p. 219
K N Lorna Ting, Yew Toong Liew, Narayanan Prepageran
DOI:10.4103/indianjotol.INDIANJOTOL_77_19  
Temporal lobe meningoencephalocele is a rare entity and the acquired etiology is commoner especially from iatrogenic injury to the tegmen during mastoidectomy. Non-specificity of its clinical presentations often lead to delay in diagnosis and its neurological sequalae can be devastating. Hence, both clinical suspicion and imaging are both complementary. Various approaches have been described in meningoencephalocele repair. Here, we described a successful repair of the disease via transmastoid method for a huge tegmen defect, with simple materials, included surgicel and temporalis fascia graft.
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