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   Table of Contents - Current issue
October-December 2018
Volume 24 | Issue 4
Page Nos. 209-276

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Frequency-modulated Bhramari Pranayam in tinnitus and deafness Highly accessed article p. 209
Mahendra Kumar Taneja
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Bacteriology and antibiotic sensitivity of chronic suppurative otitis media in a government hospital p. 214
Ashok Sharma, Madhurima Banerjee, Meenakshi Mehra, Pulkit Khandelwal, Vivek Taneja
Background: Chronic Suppurative Otitis Media (CSOM) is a disease well known for its persistence and recurrence, inspite of giving treatment. The microbiology cultures show the growth of a lot of organisms, frequently multiple and these differ based on patient population, climate, and whether or not antibiotics have been recently used. Objectives: To identify the commonest causative organism of CSOM in a government hospital of northern India and identify the sensitivity to antibiotics so as to achieve early dry ear for surgical intervention. Methodology: This study was done, from March 2018 to September 2018 on 100 patients with complaints of ear discharge. Pus samples were collected from the discharging ears, subjected to culture and sensitivity and the organisms isolated were identified by morphological, cultural and biochemical characteristics. Results: Most common organism causing CSOM in our study Staphylococcus aureus, followed by Pseudomonas aeruginosa. Most patients with Staphylococcus infection were sensitive to Vancomycin followed by Linezolid and Gentamycin whereas patients with Pseudomonas aeruginosa were sensitive to Amikacin and Ciprofloxacin. Conclusion: Early and effective intervention using appropriate topical as well as systemic antibiotics can decrease the chronicity of CSOM and prevent long term complications.
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Auditory & verbal outcomes following cochlear implant in patients with demyelinating diseases of brain p. 219
Ankur Barot, Rajesh Vishwakarma, Nisarg Mehta, Kalpesh Patel, Dipesh Darji, Chandrakant Vishwakarma
Objective: The objective of the study was to evaluate early auditory and verbal outcomes following cochlear implant (CI) in patients with radiological findings suggestive of demyelinating lesions in the brain. Methods: The study was conducted in the Department of ENT, Civil Hospital, Ahmedabad, Gujarat. We studied and evaluated early auditory and verbal outcome following CI in 30 patients who had demyelinating lesions in the brain on magnetic resonance imaging, of 1- to 5-year age group. Hearing and speech ability was recorded on categories of auditory performance (CAP) scale and speech intelligibility rating scale and was compared to patients with normal cerebral myelination. Results: Patients in case group showed comparable scores on CAP scale and speech intelligibility scale compared to the patients who did not have demyelinating disease in the same time frame. Conclusion: Patients with demyelinating lesions showed similar auditory and verbal responses compared to normal implant patients who show that demyelinating diseases do not pose limitations in the early outcome of auditory response in such patients.
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Prevalence of chronic suppurative otitis media in schoolgoing children p. 223
Sandip M Parmar, Abhey Sood, Hamjol Singh Chakkal
Introduction: Chronic suppurative otitis media (CSOM) is a major health problem throughout the world in underdeveloped and developing countries including India. The high prevalence of CSOM in school children in India has led us to undertake this study in schoolgoing children of rural and urban areas of Muzaffarnagar, Uttar Pradesh and to find out the various predisposing factors for the development of CSOM. Objectives: The objective is to find out the prevalence of CSOM in schoolgoing children of the rural and urban population about age, sex, and socioeconomic status. Materials and Methods: Students were randomly selected from primary schools in rural and urban areas of Muzaffarnagar, Uttar Pradesh. Cases selected was categorized in relation to age, sex, socioeconomic status, and prevalence of the safe and unsafe type of CSOM. Observations: In the present study, a cross-sectional survey was conducted in 2158 school children between the age group of 5 and 15 years. A total of 1161 children belonged to urban school whereas 997 children were from three adjacent rural government schools. A total of 78 children were found to be suffering from either unilateral or bilateral CSOM. Conclusion: The prevalence of CSOM in urban school children was 2.32%, while for rural children, it was 5.11%. 42.10% of cases of CSOM belonged to upper-lower socioeconomic group followed by lower middle group (31.57%). The tubotympanic disease was present in 87.18% of CSOM cases while 12.82% had atticoantral disease. Active CSOM was found amongst 37.18% while 62.82% had inactive disease. 42.10% had smoking father, 36.84% had indoor cooking with kerosene oil exposure, and 34.21% used unhygienic ear cleaning methods. 31.58% had a history of recurrent URI, 28.95% had chronic tonsillitis, and 21.05% of children had domain name system as associated findings with CSOM.
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The results of tympanoplasty for chronic suppurative medial otitis: Our experience for 10 years p. 227
Chol-Ung Sin, Tae-Myong Kim, Hea-Sun Cheo
Object: The aim is to analyze the results of the tympanoplasty (TP) for the chronic suppurative medial otitis and some factors which influence to the results of the TP. Materials and Methods: A total of 133 patients (148 ears) with chronic suppurative medial otitis (CSMO) undergone TP at our hospital for 10 years, were reviewed and the rates of the tympanic membrane perforation closure and the improvement of hearing loss by type of CSMO and operation, were retrospectively evaluated. Results: The success rates of the perforation and hearing loss were 29 ears (85.2%) and 22 ears (75.9%) in myringoplasty, 77 ears (82.8%) and 54 ears (70.1%) in TP, and 17 ears (80.9%) and 11 ears (64.7%) in TP with mastoidectomy. Conclusion: The rates of the tympanic membrane perforation closure and improvement of the hearing loss were 123 ears (83.1%) and 87 ears (70.7%). Some factors influence on the success of TP for CSMO, such as choosing the operation, eradication of focus, processing fascia, and management the effusion, should be considered.
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Efficacy of vestibular rehabilitation on quality of life of patients with unilateral vestibular dysfunction p. 231
Reem Elbeltagy, Marwa Abd El-Hafeez
Objective: The aim of this study is to determine the efficacy of vestibular rehabilitation (VR) exercise of patients with uncompensated unilateral peripheral vestibular dysfunction. Materials and Methods: An intervention study was conducted on 20 patients their age ranging from 20 to 60 years. The main complaint of the participants was chronic dizziness (dizziness for >3 months). Dizzy patients were recruited from the Ear, Nose, and Throat department. The study was conducted in the audiovestibular unit. All participants in the study were subjected to basic audiological evaluation and vestibular evaluation (videonystagmography). The Dizziness handicap inventory questionnaire (DHI) was carried out twice (pre and post) rehabilitation program. The VR therapy was performed according to the protocol established by Cawthorne and Cooksey and Norre exercises. Results: All the DHI scores reduced significantly after VR. There were no differences among genders; adults and elderly patients. Conclusion: The result of this study proved the importance and the efficacy of VR. It considered a useful therapeutic approach for improvement in the quality of life of individuals with unilateral peripheral vestibular weakness. The improvement was not influenced by sex, age, or duration of disease. It considered a low-cost, short, and safe treatment technique which can be widely used in outpatients without the need for sophisticated tools.
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Effect of N-acetylcysteine on cochlear function in patients with chronic kidney disease undergoing hemodialysis p. 237
Hamidreza Abtahi, Mojgan Mortazavi, Mohammad Shafieyan Sararoodi, Mehrdad Rogha, Mahsa Sepehrnejad, Mohammad Hossein Nilforoush
Objective: This study aimed to investigate the effect of N-acetylcysteine (NAC) on cochlear function in patients with chronic kidney disease (CKD). Methodology: The statistical population of this controlled clinical trial included all CKD patients. In total, 64 samples, selected from patients visiting the Dialysis Center of Al-Zahra Hospital from February 2017 to May 2017, were equally randomized into the intervention and control groups. At the baseline, the pure-tone audiometry (PTA) and Distortion Product Oto Acoustic Emissions (DP-OAE) tests were conducted. Then, NAC was administered in the intervention group for 8 weeks. Aforementioned hearing tests were repeated at the end of the interventions and results were compared. Finally, data analysis was carried out in SPSS. Results: Based on the mean scores of hearing threshold, there was no significant between-group difference in the speech discrimination score (SDS) speech reception threshold (SRT) of the left and right sides following NAC administration (P > 0.05). Comparison of the mean OAE following NAC administration showed a significant between-group difference, based on the mean signal/noise ratios (S/N 1000, 2000, and 4000) of the both right and left ears (P < 0.05). To compare the mean DP-OAE changes before and after the intervention between the two groups, the difference between pre- and post-intervention DP-OAE variables was first computed. Then, these changes were compared. A significant between-group difference was observed in S/N ratios of 1000, 2000, and 4000 Hz of the both right and left sides before and after the intervention (P < 0.05). In contrast, changes in other variables did not imply a significant between-group difference (P > 0.05). Conclusion: This study showed the effectiveness of NAC in improving cochlear function in 1, 2, and 4 KHz; whereas, it did not significantly affect the hearing threshold.
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Comparison of group therapy versus individual therapy for hyperfunctional voice disorders among teachers p. 242
Md Noorain Alam, Sanjay K Munjal, Naresh K Panda
Introduction: In general, voice therapy is given on one-to-one basis where each individual is provided therapy by the clinician individually. On the other hand, in group therapy, the treatment is provided to a group of individuals with a similar disorder. Need of the Study: There was a need to conduct this study as there are very few studies on finding the efficacy of group therapy for hyperfunctional voice disorder among teachers especially in India. Aim: The primary aim of the study was to find out the efficacy of group voice therapy in hyperfunctional voice disorders among teachers. The secondary aim was to compare the outcome of group therapy and individual therapy in hyperfunctional voice disorder among teachers. Methodology: Totally 16 individuals in the age range between 25 and 45 years who were teachers by profession with hyperfunctional voice disorder were enrolled in the study. Two age and gender-matched groups were constituted. Group A consisted of eight (6 males and 2 females) individuals with a mean age of 35.6 years. Group B was comprised of eight (6 males and 2 females) with a mean age of 34 years. Group A was enrolled into group therapy while Group B was enrolled into individual voice therapy. The participants underwent a clinical voice evaluation including auditory-perceptual and quality of life assessment using Grade, Roughness, Breathiness, Asthenia, Strain scale, Dr. Speech software and Voice Handicap Inventory. Voice therapy protocol included 12 sessions once a week. It consisted of 15 min. of indirect and the rest 45 min. of Lessac-Madsen Resonant voice Therapy. Posttherapy measures were taken for both the groups. Results and Discussion: Results showed significant improvement post voice therapy in acoustic analysis measures, i.e. jitter and shimmer in both the groups. In perceptual measures, there was a significant improvement in Grade, Roughness, and Strain measures in both the groups while in quality of life measures there was significant improvement post-therapy in both the groups. When compared between groups A and B there was no significant difference in all the measures in both pre- and post-therapy assessments. Our study has recruited the control group and found there was no significant difference between the individual versus group voice therapy. Conclusion: Group voice therapy is as effective in the treatment of hyperfunctional voice disorders as individual therapy. There is a need to get data on a larger population to generalize the findings.
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Brainstem-evoked response audiometry in pediatric age group p. 246
Dipen Thakkar, Dilavar Barot
Introduction: Hearing loss in early life hampers development of children, early detection of hearing loss in paediatric age group gives opportunity to treat it and good speech and overall development of children. In this study BERA was done on high risk children and various risk factor compared. Comparison between BERA and OAE was done as a screening test. Aims: To evaluate the hearing threshold and find the incidence of deafness in high risk paediatric age group category and analyse the common risk factors and to compare BERA with OAE.Materials and Method: 60 infants and high risk children were subjected to BERA after detailed ENT examination. In 0 to 5 year age group dPOAE was done on same sitting. Results analysed. Statistical Analysis Used: Relative risk ratio was done for each risk factor. Sensitivity and specificity of OAE in comparison to BERA as a gold standard was done. Results: In this study 42% of high risk children showed hearing loss. Most common risk factor among children with hearing loss was consanguineous marriage (24%) followed by neonatal jaundice (16%), low birth weight (12%) and others. Comparison of OAE and BERA with BERA as gold standard test shows sensitivity of OAE is 96.15%, specificity is 72.73%. Conclusion: All high risk children should be screened with BERA early so that children with hearing loss identified and taken care for that. In centre where no experts available OAE can be used for screening of high risk children as OAE has a good sensitivity.
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New transcutaneous bone conduction hearing implant system: Surgical and audiological outcomes p. 252
Himanshu Swami, Viswanathan Anand, Sweekritha N Bhat
Aim: A new generation of bone-anchored hearing aid, Baha® 4 Attract System has been introduced as a single-stage procedure with the magnet and abutment implanted on the skull with complete skin cover. Aim is to discuss the surgical and audiological outcome of this new device. Materials and Methods: This was a prospective study. There were 34 patients who fulfilled criteria for bone conduction hearing aid. Out of these patients, 27 were unwilling for the surgical procedure. Prior to the surgery, a trial with a soft band was carried out and seven patients were satisfied with the trial. The outcomes were measured in the form of free-field pure-tone audiometry (PTA) after 3 months of surgery and quality of life gain using Speech, Spatial and Quality of hearing scale (SSQ-12B) questionnaire. Results: Outcomes in terms of gain in free-field PTA were good in all the seven patients. An average gain of 37.85 dB was observed. There was an improvement in quality of life as assessed by SSQ 12B questionnaire. An average score of 40.25 was achieved. Conclusion: Transcutaneous bone conduction aids are fast emerging as a viable alternate to traditional devices. These devices provide almost similar functional gain in hearing along with better cosmetic results, less complications, and minimal wound care.
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Effect of preemptive pregabalin for postoperative pain relief in myringoplasty p. 257
Ashish Dhakal, Bikash Lal Shrestha, Monika Pokharel, Pradeep Rajbhandari, Sameer Karmacharya
Context: Myringoplasty is a common surgical procedure done by ENT surgeons. Postoperative period requires use of analgesics which are being given on a regular basis. Aims: The aim of this study was to investigate the effect of preemptive pregabalin on postoperative pain reduction after endoscopic myringoplasty. Settings and Design: This was a prospective, experimental study conducted in the department of ENT and Head and Neck surgery in Dhulikhel Hospital, Kathmandu University Hospital, Kavre from September 2015 to December 2017. Subjects and Methods: Patient were randomly assigned to one of the two groups with 30 participants each by lottery method. Pregabalin group received capsule pregabalin 150 mg and placebo group were given Vitamin B capsule 1 h before surgery. Statistical Analysis Used: Normally distributed variables were analyzed with the Student's t-test and nonnormally distributed variables with the Mann–Whitney test. SPSS v. 21.0 for Windows (SPSS Inc., Chicago, USA) was used for the statistical data analysis. Results: Pain scores were significantly lower in pregabalin group as compared to placebo group at 6 h (U = 123, P < 0.01), 12 h (U = 107.5, P < 0.01), 24 h (U = 160.5, P < 0.01), and 48 h (U = 121.5, P < 0.01). Number of patients who required rescue analgesics and dosage was lower in pregabalin group than placebo group (P < 0.01). Conclusions: The preemptive administration of single dose of pregabalin 150 mg is an effective way to reduce postoperative pain and analgesic consumption in patients undergoing endoscopic myringoplasty.
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To study auditory functions in chronic kidney disease p. 261
Kapil Kumar Singh, Arvind Trivedi, Nikunj Jain, Mohd Irteza
Chronic kidney disease (CKD) is worldwide public health problem with a rapidly expanding disease burden. In CKD, auditory damage occurs both at the sensory organ and the neuronal level. The incidence of hearing loss has been found to be higher in patients suffering from CKD as compared to the general population in various studies conducted so far. Bazzi et al. reported hearing loss in 77% of the CKD patients tested by them.
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Neglected cause of referred otalgia: Eagle's syndrome p. 266
Jeong Hwan Choi
Eagle's syndrome should be kept in mind when the otologist is faced with vague, nonspecific secondary otalgia. The vagueness of symptoms and the infrequent clinical observations are often misleading the clinician to do unnecessary workup, incorrect diagnosis, and wrong treatment.
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Silent keratosis obturans causing exposure of the facial nerve p. 268
Senthilraj Retinasekharan, Mohd Khairi Md Daud
Keratosis obturans is a condition of the external ear canal and could be described as an intensification of keratin plugs within the canal. The disease may lead to erosion and widening of the external auditory canal. Undiagnosed wax keratosis may lie passively for a long period without revealing any symptoms. We report a case that was largely silent causing exposure of the vertical segment of the facial nerve.
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Nonmuscle myosin heavy chain IIA mutation and hearing loss in two cases of MYH9-related disease p. 270
Joana Raquel Correia Carvalho da Costa, Miguel Bebiano Coutinho, Teresa Soares, Cecília Almeida e Sousa
MYH9-related disease is a rare disorder associated with the risk of developing progressive sensorineural hearing loss, nephropathy, cataracts, and/or liver enzyme alterations during childhood or adult life. To date, many reports on MYH9 disorder exist but only a few have provided a detailed description of the onset, degree of deafness, and shape of audiogram in individuals with this disorder. Further, the correlation between genotype–phenotype and hearing impairment and these descriptions were not very detailed. We described two particular cases that stand out from those described in the literature: two cases with an early diagnosis and an early auditory evaluation with the possibility to analyze the initial stages of hearing impairment. In addition, we confirm and reinforce the idea recently described in the literature that patients with mutations in the head domain have a higher risk of early-onset deafness than patients with mutations in the tail domain.
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Sudden sensorineural hearing loss as the only symptom of multiple sclerosis p. 274
Hatice Celik, Coskun Ozdemir
We present a 33-year-old male patient with sudden sensorineural hearing loss, the main and only symptom of the second attack, who had been diagnosed with multiple sclerosis (MS) 8 years ago. The patient came to our clinic with a sudden onset of hearing loss and tinnitus in his right ear 1 week ago. Four consecutive frequency sensorineural hearing losses were observed in the audiogram of the patient. Brain diffusion magnetic resonance imaging (MRI) has been reported to result in an increase in the number of plaques and a new plaque in the area of the left temporal lobe subcortical white matter compared to the plaques of many demyelinated, compared with MRI about 1 year ago. As in our patient, brain diffusion MRI, time and location of MS lesions, and evidence of dissemination can provide evidence for MS-related hearing loss in these patients. The auditory brainstem responses may also provide important supporting information in this case.
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