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   Table of Contents - Current issue
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April-June 2018
Volume 24 | Issue 2
Page Nos. 75-134

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ORIGINAL ARTICLES  

Dysmorphic features and cochlear implantation outcome in children with sensorineural hearing loss; the headmost study Highly accessed article p. 75
Susan Amirsalari, Shahla Afsharpayman, Mohammad Ajalloueyan, Jaber Rasuli, Amin Saburi, Mohammad Torkaman
DOI:10.4103/indianjotol.INDIANJOTOL_103_16  
Introduction: Recently, treatment of children with severe-to-profound sensorineural hearing loss (SNHL) has been influenced by diagnostic improvements and technological treatment advances, specifically new cochlear implant prospects. Multiple handicaps children and children with syndromes and conditions resulting disabilities, such as dual sensory loss, cerebral palsy, somatic abnormalities, and autistic spectrum disorder, are now not routinely precluded from receiving a cochlear implant. The primary aim of this study was to determine the effects of dysmorphic feature on cochlear implant outcome. Materials and Methods: In this cohort study, we evaluated 336 cochlear implanted children from 2007 to 2009. The case group consists of 53 patients (15/7%) with dysmorphic features and control group consisted at 53 patients with normal features and without behavioral and developmental disorders. All patients received auditory and speech rehabilitation and we evaluated their speech and auditory outcome. One year after cochlear implantation, the patient was assessed by categories of auditory perception (CAP) and speech intelligibility rating (SIR) tests. Results: We included 106 out of 336 cochlear implanted children, with the mean age of 30.42 ± 12.16 (maximum 48 months), 52 cases (49.1%) were girls and 54 (50.9%) were boys. There was a significant difference in SIR between case and control groups (3.26 ± 0.98) versus (4.06 ± 0.94) (P < 0.001), and a significant difference in CAP (4.09 ± 1.26) versus (5.43 ± 1.23) as well (P < 0.001). Conclusion: In this study, the prevalence of dysmorphic feature in children with severe-to-profound SNHL is 15.7%. One year after cochlear implant SIR and categories of auditory perception in these patients are significantly lower than children without dysmorphic feature, but cochlear implant will help these children.
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A prospective, observational study of incidence of sensory neural hearing loss in diabetes mellitus patients p. 80
Swati Dadhich, Sushil G Jha, Vikas Sinha, TU Samanth
DOI:10.4103/indianjotol.INDIANJOTOL_135_16  
Aims and Objective: To find out the incidence of hearing loss among the type 2 diabetes mellitus patients. Materials and Methods: Study included 100 diabetic mellitus patients at least for 3 years. It is an observational study carried out for 1 year. Fasting blood sugar, PP2BS, random blood sugar, pure tone audiogram were done. Results: In this study, 100 diabetic patients were studied; out of them, 73 patients were having sensorineural hearing loss (SNHL). Out of 73 SNHL diabetic patients, 48 patients are having mild SNHL (65.75%), 21 patients are having moderate SNHL (28.76%), one patient of mod severe SNHL (1.37%), and three patients of severe SNHL (4.11%). Conclusion: The diabetic individuals had higher hearing threshold with bilateral mild to moderate degree SNHL. Gender of diabetic patient had no significant correlation with hearing loss. Duration of diabetes had significant correlation with hearing loss. Blood glucose level had strong association with SNHL.
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Determinants of holistic outcome in traumatic tympanic membrane perforation p. 83
Hemant Ahluwalia, Prem Narain, Arunabh Ahluwalia, Jaypal Singh, Ajay Singh
DOI:10.4103/indianjotol.INDIANJOTOL_138_17  
Objective: The goal of this study is to understand the perforation closure dynamics and to elucidate the factors playing vital role in closure of traumatic tympanic membrane perforation (TMP). Study Design: This was a prospective, sequential allocation, three armed, January 2015–June 2017 (30 months). Setting: This study was conducted at university teaching tertiary hospital. Sample Size: A sample size was 309 (291 patients and 294 ears). Results: The total number of patients included was 291 and the total ears were 294 being bilateral traumatic TMPs in three patients. The mean age of the patients was 27.9 years. Hearing loss and bleeding from ear were the most common presentation. In majority, the hearing loss was conductive. Slap being the most common etiology. Posteroinferior quadrant was the most common site of injury. The overall mean closure time of this study was 13.32 days. Three patients were lost to follow-up. Perforation healing rate in this study was 98.98% at 1 month, and there was a significant difference in healing rate for small and large perforations. We have studied all the three variables together, i.e., the impact of time of initiating treatment after injury, grade of perforation, and their closure time to understand the closure dynamics of traumatic TMPs which is unique and is first of its kind in literature. Conclusion: The carbolic acid to the edge and paper patch with soframycin is a noninvasive, patient-friendly and low-cost office procedure for traumatic TMP's and if performed within 72 h of injury gives 99%–100% closure rate.
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Effectiveness of multitalker babble over speech noise and its implications: A comparative study p. 88
Archana Gundmi, P Himaja, Alisha Dhamani
DOI:10.4103/indianjotol.INDIANJOTOL_24_18  
Introduction: Speech perception is a complex process. Many variables can affect speech perception; among that, background noise is one of the important factors where maximum interference for the speech perception happens. Perception of speech varies also with types of noise the individual is encountering. Aim: The present study was concentrated on effect of multitalker babble over speech noise in perceiving speech signal. Method: Twenty-four normal-hearing individuals participated in the present study were tested in two different conditions in different signal-to-noise ratio ratios. Result and Conclusion: Results revealed multitalker babble is more effective than speech noise thus can be used more relevantly in clinical practice.
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Clinical features of preauricular sinus and recurrence rate of supra-auricular approach p. 91
O Song-Hwan, In-Kyo So, Jin-Ho Kim
DOI:10.4103/indianjotol.INDIANJOTOL_149_17  
Objective: The objective of this study was to analyze the clinical features of preauricular sinus and the recurrence rate of supra-auricular approach. Materials and Methods: A total of 87 patients (96 ears) treated for preauricular sinus at the Department of Otolaryngology-Head and Neck Surgery, Pyongyang Medical College Hospital, Kim Il Sung University, between January 2007 and December 2016 were enrolled in this study. Results: The prevalence of preauricular sinus was more common in teenage group (55.2%). Preauricular sinus occurred more frequently in male (1.4 times). The most common type of preauricular sinus was marginal helicine type with 86.5%. The recurrence rate with supra-auricular approach was found to be 3.3% whereas simple sinusectomy was 17.1%. Conclusion: The most common type in the preauricular sinus was marginal helicine type and supra-auricular approach was a reliable technique which had significantly less recurrence rate.
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Influence of mastoid drilling on otoacoustic emissions of the nonoperated ear p. 95
Sherien Badarudeen, Mubeena , Gangadhara Somayaji
DOI:10.4103/indianjotol.INDIANJOTOL_139_17  
Introduction: Drilling in mastoid surgeries can affect the nonoperated normal ear by transcranial transmission. This transient hearing loss can be assessed using distortion-product otoacoustic emissions (DPOAE). Objectives: To determine the effect of drilling on the DPOAE in the contralateral normal ear following mastoid surgeries and its relation with the duration of drilling. Study Design: This was a comparative, prospective, and case–control study. Materials and Methods: DPOAE was obtained for 20 patients who underwent mastoid surgery. DPOAE was measured at frequencies of 2, 3, 4, and 5 kHz with frequency ratio maintained at 1.22. DPOAE was recorded during the preoperative, immediate postoperative, 1st and 7th postoperative days. Twenty controls that underwent tympanoplasty were also analyzed pre- and post-operatively. Results: Significant deterioration in the DPOAE amplitudes was noticed during immediate postoperative period in all the four frequencies studied. No correlation was obtained between the duration of drilling and the change in amplitudes. Conclusion: A transient hearing loss is seen in the nonoperated ear following mastoid surgeries due to a drill-induced noise exposure.
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Effect of below-damage-risk criteria environmental noise on auditory perception and working memory p. 98
Sandeep Maruthy, G Nike Gnanateja, Preethi C Chengappa, Sam A Publius, Varsha M Athreya
DOI:10.4103/indianjotol.INDIANJOTOL_25_18  
Background: The current research finding is the first in reporting impaired auditory and cognitive abilities consequent to chronic exposure to below-damage-risk criteria (DRC) environmental noise in humans. Objective: The objective of this study is to assess the chronic effects of occupational noise below DRC on auditory and cognitive abilities. Methods: A static-group comparison design was used, with three groups with varying levels of noise exposure below DRC. Shopkeepers working in busy areas exposed daily to environmental noise below DRC and shopkeepers working in quiet residential areas and college students in quiet environments. Speech perception in noise, acceptable noise levels, and concurrent vowel identification were used to assess auditory abilities, while Operation SPAN and Backward Digit Span were used to assess cognitive abilities. The data were analyzed using multivariate analysis of variance, Pearson's product-moment correlation, discriminant function analysis, and mediation analysis. Results: The results showed significantly poor auditory stream segregation abilities and working memory abilities in the shopkeepers exposed to environmental noise below DRC when compared to the other two groups with very low levels of occupational noise. The findings of the study are discussed in light of the deleterious effect of the supposedly safe (below DRC) levels of environmental noise on auditory and cognitive abilities. Conclusions: The novel results of affected auditory and cognitive abilities resulting from below-DRC occupational noise exposure as observed in the current study will have a great impact on the applicability to the general populace and also open up new avenues of research in ecological acoustics.
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Role of cervical vestibular-evoked myogenic potentials in evaluating vestibular dysfunction in patients with Type II diabetes mellitus: A prospective institutional study p. 105
Sitaramaraju Kanumuri, Krishna Vemuru Chaitanya, Janardhan Nara, K Vasu Kumar Reddy
DOI:10.4103/indianjotol.INDIANJOTOL_117_17  
Introduction: Cervical Vestibular Evoked Myogenic Potentials (C VEMP) is new dimension of non-invasive investigation to evaluate integrity of Saccule and inferior vestibular nerve by means of sacculo-collic reflex. In this study, we intend to use cervical vestibular evoked Myogenic potential as tool to investigate prevalence of vestibular dysfunction in patients with type II diabetes mellitus. Objectives: To study the prevalence of vestibular dysfunction as measured by cervical Vestibular Evoked Myogenic Potentials in patients with type 2 diabetes mellitus. Results: Prospective study performed on patients presenting in Otorhinolaryngology department during 2013-2016. Patients in study with type 2 diabetes mellitus of greater than 5 years underwent vestibular assessment by using Cervical Vestibular Evoked Myogenic Potentials. It was observed that 4 (10.0%) patients had absent bilateral Cervical Vestibular Evoked Myogenic Potentials responses, 8(20.0%) patients had delayed Cervical Vestibular Evoked Myogenic Potentials responses with delayed p1 and n1 latencies. Discussion and Conclusion: In diabetic individuals who are asymptomatic in patients who never complained of giddiness, Cervical Vestibular Evoked Myogenic Potentials identified vestibular dysfunction in 25% of patients. In symptomatic diabetic mellitus individuals, Cervical Vestibular Evoked Myogenic Potentials was able to identify 33.3% of vestibular dysfunction, however in another 33.3% of patients where Cervical Vestibular Evoked Myogenic Potentials failed to identify.
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Measurement of speech in noise abilities in laboratory and real-world noise p. 109
Bhanu Shukla, B Srinivasa Rao, Udit Saxena, Himanshu Verma
DOI:10.4103/indianjotol.INDIANJOTOL_134_17  
Aim: The present study aimed to investigate speech in noise perception abilities in normal-hearing adults using different types of noise (i.e., speech babble, traffic noise, and speech spectrum noise) and at different signal-to-noise ratios (SNRs) (i.e., +5 dB, 0 dB, −5 dB, and −10 dB). Methods: A total of 109 individuals with mean age of 23 years were participated in the study. All participants had English as second language and Telugu as native and first language. English disyllabic words (Hrish et al.) were used as speech stimuli under different noises and different SNRs. Results: Results have shown that for any type of noise the speech perception scores changed with the variance in SNRs, the scores have decreased when the SNRs were decreased from 0 dB to −10 dB SNR, and the scores have increased when SNRs increased from 0 dB to +5 dB SNR. Conclusion: From this study, it can be concluded that speech perception score in noise depends on the type of noise used in testing the speech in noise abilities. This factor is very important in the selection of the noise type when measuring speech perception in the presence of noise. It was also seen that change in noise level also had a different impact on speech perception in noise abilities.
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CASE REPORTS Top

Osteomyelitis of temporal bone: A case report of a rare disease p. 114
Bigyan Raj Gyawali, Pabina Rayamajhi
DOI:10.4103/indianjotol.INDIANJOTOL_11_18  
Osteomyelitis of temporal bone affecting the squamous portion is a very rare entity. We present here a case of osteomyelitis affecting the squamous portion of temporal bone following blunt trauma to the head.
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Double-Peak tympanometry in keratosis obturans p. 117
Azliana Aziz, Mohd Khairi Md Daud
DOI:10.4103/indianjotol.INDIANJOTOL_97_17  
Tympanometry is an effective objective tool used to identify problems in the middle ear. Keratosis obturans (KO) is a rare condition but may cause bony erosion and gradual expansion of the bony external auditory canal (EAC). We report a case of 32-year-old woman with KO who presented with bilateral hearing loss for a few years and right ear pain and discharge for 3 months before visit to an otorhinolaryngology clinic. She was treated by ear drops antibiotic and repeated ear toilet. Tympanometry done revealed a large EAC volume with a double-peak admittance. Double-peak tympanometry with an intact tympanic membrane may indicate diseases causing severe erosion in the EAC.
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Papular mycosis fungoides: Three case reports and a comprehensive literature review p. 120
Jingcheng Zhang, Mingzhe Zhao, Huixian Hu
DOI:10.4103/indianjotol.INDIANJOTOL_133_17  
This study was to investigate the clinicopathological characteristics, treatments, and prognoses of papillary mycosis fungus (PMF). From May 2004 to September 2015, three cases of papular mycosis fungoides were analyzed at Jinhua Municipal Central Hospital. Diagnostic criteria refer to the World Health Organization 2005 Classification of Cutaneous Lymphoma. Factors that influenced patient survival and prognoses were analyzed. Skin papules were reduced, and skin color was lightened in three patients after a short treatment regimen. Follow-up for 4–7 years revealed few changes in pigmentation, no increase in skin papules, and neither organ nor lymph node involvement. Skin papular mycosis fungal disease can heal itself, and there is no need for excessive intervention.
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The inferior “transposition flap” in meatal nevus p. 123
Manish Munjal, Archana Arora, Amanjeet Singh, Porshia Rishi
DOI:10.4103/indianjotol.INDIANJOTOL_111_17  
Nevi and benign lesions of the epithelium of the cartilaginous meatus and refractory to multiple sessions of laser resections are ideal candidates for composite resection with transposition flap reconstitution, retaining thereby the esthetic appearance and dimensional configuration of the cartilaginous meatus. An inferiorly based flap transposed anteriorly and utilized in nevus of the floor and posterior wall gave excellent results.
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A therapeutic approach of isolated suppurative labyrinthitis complicated by meningitis p. 125
Erika Celis-Aguilar, Lucero Escobar-Aispuro, Jose M Alarid-Coronel, Alan Burgos-Paez
DOI:10.4103/indianjotol.INDIANJOTOL_94_17  
Suppurative labyrinthitis (SL), a major complication of otitis media, results from a bacterial infection spread through the round window to the inner ear. The most frequent symptoms are hearing loss, vertigo, nystagmus, nausea, and vomiting. This infection poses a significant risk of meningitis due to direct communication of the perilymph to the cerebrospinal fluid through the cochlear aqueduct. There are scarce data in the literature documenting isolated SL as the only cause of meningitis. There are no data describing which treatment is more effective, how often this complication occurs, or when to expect this fatal outcome. We report a case that developed from a labyrinthine suppurative infection to a late-onset meningeal infective disease. This case highlights the importance of correct and timely treatment of SL with early mastoidectomy. The indications of mastoidectomy in these cases are discussed, with a brief review of the literature.
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Management of unsafe type of chronic suppurative otitis media with extracranial complications at a tertiary care center p. 129
Vinod Tukaram Kandakure, Pradipkumar Digambarrao Khokle, Udit Rohit Shah
DOI:10.4103/indianjotol.INDIANJOTOL_15_18  
Chronic suppurative otitis media (CSOM) is a common disease in the developing countries and the complications associated with it still pose a major problem. Despite the reduction in the incidence of CSOM-related complications with the introduction of antibiotics, Gradenigo's syndrome, mastoid abscess, labyrinthine fistula, and other complications still do occur. Computed tomography scan is an inevitable part of diagnostic algorithm rendered when a patient with CSOM presents with complications. Otitis media although a common pathology,complications are rare and should be suspected when the picture is of torpid evolution with clinical worsening and manifestation of neurological signs. There is a need to emphasize the importance of accurate and early diagnosis followed by adequate surgical therapy with a multidisciplinary approach. Here, we look at such cases encountered at our institute and their management.
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