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   2014| October-December  | Volume 20 | Issue 4  
    Online since December 13, 2014

 
 
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EDITORIAL
Noise-induced hearing loss
Mahendra K Taneja
October-December 2014, 20(4):151-154
DOI:10.4103/0971-7749.146928  
  15,135 8,809 1
ORIGINAL ARTICLES
Bacterial isolate and antibacterial resistance pattern of ear infection among patients attending at Hawassa university referral Hospital, Hawassa, Ethiopia
Mesfin Worku, Muluken Bekele
October-December 2014, 20(4):155-159
DOI:10.4103/0971-7749.146929  
Background: Ear infection is highly prevalent worldwide. In the older child, long-standing Chronic Supparative Ottitis Media can result in a severe conductive hearing loss with significant drawbacks in learning, communication, and social adjustment. It is associated with hearing impairment, death, and severe disability due to central nervous system involvement in developing countries. Objective: To determine the bacteriological profile and antibacterial resistance of ear infection from patients seen at Ear Nose and Throat clinic of Hawassa University Referral Hospital. Materials and Methods: A cross-sectional study was conducted at clinic of Hawassa University Referal Hospital. Result: A total 117 study subjects included in this study from June 2013 to October 2013. Among these, 57 (48.7%) were male and 53 (45.3%) were children. Bacteria identified from positive ear swabs were: Staphylococcus aureus 24 (20.5%), Pseudomonas aeroginosa 17 (14.5%), Klebsiella species 10 (8.5%), Proteus species 7 (6.0%), Entrobacter species 4 (3.4%), Escherchia coli 3 (2.6%), Citrobacter species 2 (1.7%), and Providentia species 2 (1.7%). The overall sensitivity and resistance profile of antibacterial agent, Amikacin (90.0%) and Gentamycin (89.1) showed high level of antibacterial effect on all identified bacterial species. On other hand, all isolates were highly resistance to ampicilin (87.5%), oxacillin (84.0%), ceftriaxone (82.8%), cephalotin (81.4%), and penicillin G (73.8%). Conclusion: Most of the isolates were resistant to commonly prescribed drug in the area. However, Amikacin and Gentamycin were highly active against the isolated organism, whereas Ciprofloxacilin was moderately active. Therefore, culture and susceptibility test is vital for appropriate management of ear infection in study area.
  3,512 2,410 8
Overlay versus underlay myringoplasty: A comparative study
Parmod Kalsotra, Rohan Gupta, Nitika Gupta, Sunil Kotwal, Anil Suri, Sonika Kanotra
October-December 2014, 20(4):183-188
DOI:10.4103/0971-7749.146935  
Aims and Objectives: The objective of this study is to compare the outcome of overlay versus underlay myringoplasty procedure in the management of chronic inactive mucosal otitis media in terms of graft uptake, hearing improvement and complications. Materials and Methods: This study was conducted in the Department of Otorhinolaryngology and Head and Neck Surgery, S.M.G.S Hospital, Government Medical College, Jammu from June 1, 2012 to September 31, 2013 and clinical records of 77 patients who underwent myringoplasty by either overlay or underlay technique in this period were analyzed. A total of 72 patients with dry central tympanic membrane perforations of various sizes were included in this study. These patients were divided into two groups. In Group A, 37 patients were included in which tympanic membrane was repaired by using overlay technique of myringoplasty, whereas Group B comprised of 35 patients who underwent underlay myringoplasty. The results of two techniques were compared in terms of graft success rate that is, full uptake or failure to take up, medialization or lateralization of graft within 6 months of operation and improvement in hearing at the end of 6 months of follow-up. Results: In terms of graft uptake and postoperative AB gap improvement, Group B (underlay group) was slightly better with 91.43% uptake rate and mean postoperative AB gap of 11.11 dB than Group A (overlay group), which had 89.18% uptake rate and 11.72 dB as mean postoperative AB gap, though the difference was not statistically significant. There was only 1 case of graft medialization in Group B, while 3 cases had lateralization of graft in Group A. Conclusion: Both techniques of myringoplasty achieve satisfactory results, with the underlay technique being slightly better than the overlay technique. Therefore, underlay technique being technically simple should be preferred, but the ultimate decision about the technique to be employed depends on the surgeons preference and the site of perforation.
  4,972 385 -
A clinical study of age related hearing loss among diabetes patients
Sheetal Krishnappa, Khaja Naseeruddin
October-December 2014, 20(4):160-165
DOI:10.4103/0971-7749.146930  
Background: Age related hearing loss is one of the most common chronic health conditions affecting the elderly people. With aging, risk of presbycusis and diabetes increases. Our study aims at evaluating auditory dysfunction in patients with diabetes mellitus aged above 50 years as compared to non-diabetic patient. We also tried to find the relation between duration of diabetes and severity of hearing loss and whether HbA1c and blood sugars levels affected the type and severity of hearing loss. Materials and Methods: A cross-sectional study on 106 patients with type 2 diabetes mellitus and 90 non-diabetic patients with age and sex matched (controls) was carried out during November 2011 to October 2013. All patients were evaluated for hearing loss by subjecting to pure tone audiometry and blood investigations like glycated hemoglobin, fasting and postprandial blood sugars and serum creatinine levels. Results: A prevalence of 73% hearing loss was seen in diabetics. The degree of hearing loss increased with age. There was bilateral progressive sensory neural hearing loss with right sloping curve in both diabetics as well as controls but with significantly (P < 0.001) higher loss in diabetics (at 4 KHz and 8 KHz). A significant relationship between duration of the diabetes, HbA1c and severity of hearing loss was observed. Conclusion: Diabetes mellitus was associated with higher hearing loss compared to presbycusis and hearing threshold was seen to affect all frequencies, but significantly the higher frequencies in diabetics. As duration of diabetes increased, the severity also increased. Poorer the HbA1c, more severe was the hearing loss.
  2,891 1,210 3
Fat graft myringoplasty in small central perforations
Chandni Sharma, Jagat Singh, Vikas Kakkar, S. P. S. Yadav, Priya Malik, Surender Bishnoi
October-December 2014, 20(4):211-215
DOI:10.4103/0971-7749.146942  
Background: Perforations of the tympanic membrane (TM) are treated with various surgical techniques and materials. Although autologous temporalis fascia is the most common material used for the closure of TM perforations, however for a dry, small central perforation the fat graft myringoplasty (FM) is a good alternative as it is a simple and cost-effective technique. Objectives: The aim of this study was to determine the efficacy of FM for repair of small central perforations. Suggestions for optimizing the outcome of FM are presented. Material and Methods: Twenty patients (10 males and 10 females) who had uncomplicated dry small central perforation, which was confined to one quadrant of the pars tensa underwent FM. The outcome was evaluated after 1-week, 1-month, and 3 months. Results: After 3 months of follow-up, a closure rate of 80% was achieved. Mean preoperative air-bone (AB) gap was 22.90 ± 6.54 dB and mean postoperative AB gap was 21.80 ± 6.28 dB. Mean improvement in AB gap postoperatively was 1.1 ± 2.63 dB. Conclusion: Fat graft myringoplasty, with its ease of technique and good graft uptake rate justifies its use in the closure of small dry central TM perforations.
  3,366 311 1
Diagonal earlobe crease and coronary artery disease in Iranian population: A marker for evaluating coronary risk
Mahdi Montazeri, Maryam Montazeri, Negin Rashidi, Mohammad Montazeri, Mahmood Montazeri
October-December 2014, 20(4):208-210
DOI:10.4103/0971-7749.146941  
Background: The diagonal earlobe crease (DELC) has been proposed to be a marker of coronary artery disease (CAD), but this association remains controversial. The aim of the present study was to evaluate the frequency of DELC in patients with CAD. Materials and Methods: One hundred patients with angiographically documented CAD from Tehran Heart Center were evaluated for the presence or absence of ELC. The ELC was said to be present if a patient had a deep diagonal crease extending obliquely from the outer ear canal toward the border of the earlobe without discontinuity covering at least two-thirds of the earlobe length. Results: The prevalence of ELC was 62% (95% confidence interval 59.7-64.6). The frequency of smoking and hyperlipidemia was significantly higher in patients with DELC (P = 0.024 and P = 0.001, respectively). However, frequency of hypertension and diabetes were not significantly different between the two groups. Conclusion: The frequency of DELC in patients with CAD was high in our study. The data suggest that the ELC sign may be a useful marker for the presence of CAD in patients.
  3,353 243 -
CASE REPORTS
Bilateral facial nerve palsy in a newly diagnosed diabetic patient with associated herpes labialis
Manish Gupta, Monica Gupta
October-December 2014, 20(4):216-218
DOI:10.4103/0971-7749.146943  
Bilateral facial nerve palsy is a very rare condition, usually following neurologic, neoplastic, traumatic, infective or metabolic causes. We present here a case of 29-year-old male, diagnosed on admission as diabetic with herpes labialis and bilateral facial paralysis. As the differentials are extensive, diagnostic workup and subsequent treatment should be done keeping various etiological factors in mind.
  2,807 196 -
Eustachian dysfunction in chronic otitis media with bilateral concha bullosa: Is it chance finding?
Shraddha Jain, Minal Gupta, Prasad T Deshmukh
October-December 2014, 20(4):219-221
DOI:10.4103/0971-7749.146944  
Concha bullosa is reported to have a role in paranasal sinus infections. Role of asymptomatic concha bullosa in causation of Eustachian dysfunction and chronic otitis media is not well established with only few reports. Here, we report a case of a 42-year-old female patient who presented with bilateral hearing loss with no nasal complaints. On otoscopy, her tympanic membranes showed bilateral retractions with reduced mobility on the right side. Nasal endoscopy revealed incidental finding of bilateral concha bullosa confirmed on computed tomography scan of paranasal sinuses. Bilateral conchoplasty was done. In immediate postoperative period, patient had subjective as well as objective improvement in hearing status and Eustachian function. Consequently, we inferred that bilateral concha bullosa has etiological role in Eustachian dysfunction due to increased nasal resistance. Hence, conchoplasty provides immediate improvement in a dilatory function of Eustachian tube with hearing improvement.
  2,539 177 -
ORIGINAL ARTICLES
Technique and results of cartilage shield tympanoplasty
Sohil I Vadiya
October-December 2014, 20(4):196-198
DOI:10.4103/0971-7749.146938  
Aim: Use of cartilage for repair of tympanic membrane is recommended by many otologists. The current study aims at evaluating results of cartilage shield tympanoplasty in terms of graft take up and hearing outcomes. Material and Methods: In the current study, cartilage shield tympanoplasty(CST) is used in ears with high risk perforations of the tympanic membrane. A total of 40 ears were selected where type I CST was done in 30 ears and type III CST was done in 10 ears. Results: An average of 37.08 dB air bone gap(ABG) was present in pre operative time and an average of 19.15 dB of ABG was observed at 6 months after the surgery with hearing gain of 17.28 dB on average was observed. Graft take up rate of 97.5% was observed. The technique is modified to make it easier and to minimize chances of lateralization of graft. Conclusion: The hearing results of this technique are comparable to other methods of tympanic membrane repair.
  2,339 259 1
Evaluation of outcomes of tympanoplasties with and without cortical mastoidectomy
Madayambath Sagesh
October-December 2014, 20(4):178-182
DOI:10.4103/0971-7749.146934  
Context: Even today well-trained and experienced otologists remain divided as to the importance of combining mastoidectomy with tympanoplasty in the treatment of chronic non-cholesteatomatous otitis media. We performed a comparison of patients with postinfectious simple tympanic membrane perforations treated with tympanoplasty or with tympanoplasty combined with intact canal wall mastoidectomy, in terms of outcome. Aims: The aim of the study was to evaluate the outcomes of tympanoplasties with and without cortical mastoidectomy in terms of graft uptake rate and hearing improvement. Settings and Design: A combination of retrospective and prospective cohort study. Materials and Methods: A total of 65 patients undergoing tympanoplasty with or without cortical mastoidectomy were included in the study and were followed up for a period of one year for the graft uptake and hearing improvement. Statistical analysis used: Fisher's exact test and chi square test. Results: In our study, there was no significant difference in the graft uptake rate or the hearing improvement in both these groups. Conclusions: As per this study, it can be concluded that the addition of cortical mastoidectomy to type I tympanoplasty did not improve the graft uptake rate or the hearing improvement in cases of chronic suppurative otitis media tubotympanic disease.
  2,176 281 -
Brainstem evoked response audiometry in stone cutting workers at a construction site
Roohi Aboobackr, Balaji W Ghugare, Mukesh R Dinkar
October-December 2014, 20(4):203-207
DOI:10.4103/0971-7749.146940  
Context: Noise-induced hearing loss (NIHL) is the most prevalent and preventable occupational disease in developing countries. Manufacturing industry workers and other sector industries with special profession where exposure to noise is inevitable are the victims of NIHL. Pure tone audiometry has widely been used to establish the prevalence of NIHL. Brainstem evoked response audiometry (BERA) offers an objective assessment of the auditory pathway from receptor to cortex. Aims: With paucity of data among stone cutting workers, the present study evaluated this cohort using BERA to assess involvement of the auditory pathway. Settings and Design: A cross-sectional study. Materials and Methods : A total of 31 cases and 30 controls underwent BERA after its selection following inclusion and exclusion criteria. Statistical Methods : Data obtained was compared using unpaired student's t-test between means of cases and controls. Results: Absolute peak BERA waveform I, III and III latencies on left side and wave I latencies on the right side showed significant prolongation (P < 0.05). Inter-peak latencies I-III, I-V, and III-V differences were non-significant. Mode BERA threshold values were 60 dB and 40 dB for cases and controls respectively. Conclusion: Study concluded with the observations that, workers engaged in stone cutting are at the risk of developing NIHL (mild to moderate) that may affect the peripheral component of the auditory pathway.
  1,984 187 -
Effects of acute thyroxine depletion on hearing in differentiated thyroid carcinoma patients
Zekiye Hasbek, Canan Filiz Karakus, Emine Elif Altuntas, Fatih KiliÁli
October-December 2014, 20(4):191-195
DOI:10.4103/0971-7749.146937  
Introduction: Radioiodine ablation refers to the destruction of functioning remnants of normal thyroid tissue or metastatic foci remaining after thyroidectomy. Effective thyroid ablation requires adequate stimulation of thyroid-stimulating hormone. Our aim in this study was to evaluate the hearing changes of patients before ablation therapy in the iatrogenic hypothyroid period, which has been constituted with the purpose of treatment success and following the ablation therapy in the euthyroid period 1 month after the thyroid hormone (TH) replacement therapy was initiated. Materials and Methods: Patients who were diagnosed with thyroid cancer, treated with total/near-total thyroidectomy and referred for 131 I therapy or low-dose 131 I whole body scan were included in our study. Hearing tests as high-frequency audiometry, autoacoustic emission and tympanometry were made during hypothyroid and euthyroid periods on all the patients included in the study. Results: In the present study were enrolled 75 patients with a mean age of 46.6 ± 12 years (range: 19-69 years). In hypothyroid period, while there was not any hearing-loss in 124 of 150 (82.7%) ears of 75 patients; mild hearing-loss in 18 (12%) ears, moderate hearing-loss in 7 (4.7%) ears and severe hearing-loss in 1 (0.07%) ear were detected. In euthyroid period, while there was not any hearing-loss in 132 of 150 (88%) ears; there were mild hearing-loss in 11 (7.3%), moderate hearing-loss in 6 (4%), and severe hearing-loss in 1 (0.07%) ear. However, there could not be found any significant difference between hearing levels of patients before and after treatment (P = 0.317). Conclusion: Although THs play an important role in the physiology of hearing, the hypothyroidism made in 4 weeks period causes serious damages on hearing functions of patients. However, with regard to temporary hearing losses that hearing levels could improved with treatment, we believe that hearing should also be questioned in the follow-up of patients with differentiated thyroid cancer.
  1,873 168 1
Pre-post therapy comparison of electrophysiological auditory findings in stutterers
Noorain Alam, Vikas Sinha, Deepanshu Gurnani, Sachin Jindal, Pawan Sharma, Ambuj Pandey
October-December 2014, 20(4):169-172
DOI:10.4103/0971-7749.146932  
Introduction: Stuttering is a speech disorder in which the flow of speech is disrupted by involuntary repetitions and prolongations of sounds, syllables, words or phrases, and involuntary silent pauses or blocks in which the stutterer is unable to produce sounds. Aim: The aim of the study was to verify whether there is alteration of auditory-evoked potentials (AEPs) as a result of speech therapy; and to find out which parameters of AEPs alters, which can be attributed to the effect of speech therapy. Materials and Methods: The research sample was composed by 14 adult males with moderate stuttering. This group was assessed twice through brainstem auditory evoked response (BAER), middle latency response (MLR) and late latency response (LLR); assessments were carried out with a 3-month interval time. Both pre and post therapy measurements were compared. Results: Comparison between pre and post speech-language therapy results indicate an alteration of at least one parameter of each category. The observed results showed that in auditory brain stem response (ABR) test there was predominance decrease in 8 subjects (64.28%) was observed in wave I latency, while in MLR, there was predominance of increase of Pa wave (57.14%) in 8 subjects. Conclusion: Altered electrophysiological findings were observed in persons with stuttering as a result of speech therapy. ABR and LLR measurements were mostly altered showing the change in neural response to auditory stimuli.
  1,604 270 -
Audiological assessment modalities in children with multiple handicaps and parents' perception
Noorain Alam, Shamim Ansari, Deepanshu Gurnani, Vikas Sinha, Pawan K Sharma, Sachin Jindal
October-December 2014, 20(4):166-168
DOI:10.4103/0971-7749.146931  
Aim: Children with multiple disabilities have combination of various disabilities. Accurate hearing evaluation is difficult in this population. Audiologists, generally employ a test battery approach, which includes combining findings of parent impression with behavior observation audiometry (BOA) as well as auditory brainstem evoked responses (ABR) findings. This study was carried out to find if there exists a correlation among various steps in the test battery for children with multiple handicaps as well as to find out, which disability is the most common among this population. Methodology: A total of 103 numbers of children with multiple handicaps were chosen at random who were referred to C U Shah Institute of Audiology and Speech Therapy for audiological assessment. The three steps involved in assessment that is parental impression, BOA and ABR findings were taken into account. The relationship was obtained using data analysis. Results: It was found that among children with multiple handicaps referred for audiological assessment, mental retardation was the most common (32.03%). Furthermore, it was found that there were more contradictory findings between parent impression and ABR (48%) when compared with parent impression with BOA (38%). In between BOA and ABR contradictory findings were found in 41% of cases. Conclusion: There are wide contradictions among various steps involved in assessment of children with multiple handicaps. Implication: Audiologist should use a test battery approach to assess hearing ability of this population and audiologists should interpret findings carefully at each level.
  1,530 302 -
Inca bones at asterion
Prashant E Natekar, Suhit E Natekar, Fatima M De Souza
October-December 2014, 20(4):189-190
DOI:10.4103/0971-7749.146936  
Background: Surgical approach towards asterion has to be done with caution as many surgeons are unfamiliar with the anatomical variations. The asterion corresponds to the site of the posterolateral (mastoid) fontanelle of the neonatal skull which closes at the end of the first year. Inca bones provide information as markers for various diseases, and can mislead in the diagnosis of fractures. Observation and Results: 150 dry skull bones from the Department of Anatomy at Goa Medical College, India and other neighboring medical colleges by examining the asterion, and its sutural articulations with parietal, temporal and occipital bones and also anatomical variations if any in adults. Discussion: The anatomical landmarks selected must be reliable and above all easy to identify. Bony structures are more suitable than soft tissue or cartilaginous landmarks because of their rigid and reliable location. Presence of these bones provides false impressions of fractures or the fractures may be interpreted for inca bones especially in the region of asterion either radiologically or clinically which may lead to complications during burr hole surgeries.
  1,641 186 1
Evaluation of auditory brain-stem evoked response in middle: Aged type 2 diabetes mellitus with normal hearing subjects
Debadatta Mahallik, Preeti Sahu, Rajkishor Mishra
October-December 2014, 20(4):199-202
DOI:10.4103/0971-7749.146939  
Background: Diabetes mellitus (DM) is commonly metabolic disorders of carbohydrate in which blood glucose levels are abnormally high due to relative or absolute insulin deficiency. In addition, it is characterized by abnormal metabolism of fat, protein resulting from insulin deficit or insulin action, or both. There are two broad categories of DM are designated as type 1 and type 2. Type 2 diabetes is due to predominantly insulin resistance with relative insulin deficiency noninsulin-dependent DM. Type 2 diabetes is much more common than insulin-dependent DM. Objectives: The aim of this study was to assess, if there is any abnormality in neural conduction in auditory brain-stem pathway in type 2 DM patients having normal hearing sensitivity when compared to age-matched healthy populations. Materials and Methods: This study included middle - aged 25 subjects having normal hearing with diabetes type 2 mellitus. All were submitted to the full audiological history taking, otological examination, basic audiological evaluation and auditory brain-stem response audiometry which was recorded in both ears, followed by calculation of the absolute latencies of wave I, III and V, as well as interpeak latencies I-III, III-V, I-V. Results: Type 2 DM patients showed significant prolonged absolute latencies of I, III (P = 0.001) and interpeak latencies I-III, III-V and I-V in left ear (P = 0.001) and absolute latencies of I, V (P = 0.001), interpeak latencies III-V was statistically significant in right ear. Conclusions: The prolonged absolute latencies and interpeak latencies suggests abnormal neural firing synchronization or in the transmission in the auditory pathways in normal hearing type 2 diabetes mellitus patients.
  1,492 224 -
Cortical bone total ossicular replacement prosthesis
Manu Malhotra, Saurabh Varshney, Rashmi Malhotra
October-December 2014, 20(4):173-177
DOI:10.4103/0971-7749.146933  
Objectives: Evaluate an autologous cortical bone total ossicular replacement prosthesis (B TORP) made of cortical bone for cost effective and sustainable hearing results. Materials and Methods: A prospective study was undertaken in the patients who underwent tympanoplasty with new B-TORP from January 2011 to December 2011. All patients had an absent superstructure of the stapes and long process of the incus due to chronic otitis media. Totally 40 patients were evaluated. Hearing results were evaluated using four-frequency average pure tone air conduction and air-bone gap (ABG) measured at 0.5, 1, 2, and 3 kHz after a period of 12 months. Pre- and post-operative continuous variables were compared using a paired t-test and data from unequal groups were assessed for significant differences using unpaired t-test. Results: Successful rehabilitation of the ABG to 20 dB or less was achieved in 95% of patients. Overall mean improvement in ABG was 25.8 ± 5.6 dB, which was statistically significant (t = 26.8, P < 0.001). Mean postoperative ABG in the tympanoplasty only group was 12.9 ± 2.7 dB with an average improvement of 26.8 ± 4.9 dB (t = 22.0, P < 0.001) and in the intact canal wall group was 14.9 ± 5.1 dB with an average improvement of 24.5 ± 6.1 dB (t = 16.0, P < 0.001). There was no significant difference between ABG improvements of the two groups (t = 1.2, P > 0.5). Conclusion: The new autologous B-TORP provides sustainable hearing improvement and is bio-compatible, stable, and magnetic resonance imaging compatible.
  1,442 198 -
LETTER TO EDITOR
Wegener's granulomatosis: A diagnostic dilemma for otologists
Madan P Gupta, Kapil Sikka, Alok Thakar
October-December 2014, 20(4):222-222
DOI:10.4103/0971-7749.146945  
  1,006 139 -
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