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   2015| April-June  | Volume 21 | Issue 2  
    Online since April 20, 2015

 
 
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ORIGINAL ARTICLES
Is sensorineural hearing loss related with thyroid metabolism disorders
Canan Filiz Karakus, Emine Elif Altuntaş, Fatih Kılıçlı, Kasım Durmuş, Zekiye Hasbek
April-June 2015, 21(2):138-143
DOI:10.4103/0971-7749.155310  
Objectives: In this study, we measured hearing thresholds in patients diagnosed with hyperthyroidism or hypothyroidism with high-frequency audiometry and otoacoustic emission before and after treatment to determine whether hearing losses were cochlear or retrocochlear and whether they would improve with medical therapy. Materials and Methods: This study was conducted on patients diagnosed with hyperthyroidism and hypothyroidism at Cumhuriyet University, Faculty of Medicine, Department of Endocrinology and Metabolism and accepting to participate in the study. We measured the hearing thresholds of the study population during the pretreatment period and in posttreatment euthyroid period. Result: The audiometric findings of patients with hyperthyroidism were better than those of the control group especially at high frequencies. Sensorineural hearing loss was detected in the euthyroid period. We compared the audiometric findings of the patients with hypothyroidism and the controls. We found sensorineural hearing loss in patients with hypothyroidism, especially at low frequencies. Conclusions: The results of this study showed that both hyperthyroidism and hypothyroidism may have an effect on hearing pathway disorders. Medical therapy may lead to hearing loss in patients with hyperthyroidism, and the underlying factors should be investigated in detailed future studies. It was shown in our study that the hearing loss induced by hypothyroidism may improve with medical therapy. Therefore, in all patients with thyroid dysfunction, hearing levels should be monitored closely with audiometric tests.
  15,014 604 5
Hearing benefits in various types of tympanoplasties: A prospective study
Ganesh Kumar Balasubramaniam, Ramanathan Thirunavukkarasu, Ramesh Babu Kalyanasundaram, Hemalatha Palaniappan, Paramaguru Rajesh Shanmugam
April-June 2015, 21(2):129-133
DOI:10.4103/0971-7749.155301  
Aims: The aim was to study about the hearing benefits achieved by various types of tympanoplasties done for both safe and unsafe type of chronic suppurative otitis media (CSOM). Subjects and Methods: A total of 60 patients with both tubotympanic and atticoantral type of CSOM were taken up and evaluated with otomicroscopy and otoendoscopy, pure tone audiometry and radiological images. Surgeries were planned according to the involvement of the mastoid cavity and extent of the disease, ossicular chain involvement in view of disease clearance and hearing improvement. Statistical Analysis Used: Prospective study design with probability values. Results: Of 60 patients who underwent tympanoplasties 49 patients (81%) showed significant improvement in hearing with successful graft uptake. Conclusions: Mastoidectomy along with tympanoplasty proves beneficial in both disease clearance and hearing improvement. The generally available autologous ossicular grafts like incus or head of the malleus for ossiculoplasty improves the success rate by >80% as shown by us. Aeration of middle ear and infection control postoperatively is essential for functional success after any kind of tympanoplasty as achieved by us.
  5,580 404 1
A study of brainstem evoked response audiometry in high-risk infants and children under 10 years of age
Ramanathan Thirunavukarasu, Ganesh Kumar Balasubramaniam, Ramesh Babu Kalyanasundaram, Gitanjali Narendran, Sajee Sridhar
April-June 2015, 21(2):134-137
DOI:10.4103/0971-7749.155306  
Aims: To evaluate the hearing threshold and find the incidence of hearing loss in infants and children belonging to high-risk category and analyze the common risk factors. Subjects and Methods: Totally, 125 infants and children belonging to high-risk category were subjected to brainstem evoked response audiometry. Clicks were given at the rate of 11.1 clicks/s. Totally, 2000 responses were averaged. The intensity at which wave V just disappears was established as hearing the threshold. Degree of impairment and risk factors were analyzed. Results: Totally, 44 (35.2%) were found to have sensorineural hearing loss. Totally, 30 children with hearing loss (68%) belonged to age group 1-5 years. Consanguineous marriage was the most commonly associated risk factor. Majority (34) had profound hearing loss. Conclusion: Newborn screening is mandatory to identify hearing loss in the prelinguistic period to reduce the burden of handicap in the community. The need of the hour is health education and genetic counseling to decrease the hereditary hearing loss, as hearing impairment due to perinatal factors has reduced due to recent medical advancements.
  3,605 505 1
A comparative study of outcome of ossiculoplasty using cartilage graft, bone and different alloplasts in chronic otitis media
Sougata Mahanty, Amit Bikram Maiti, Sourav Naskar, Sudip Kumar Das, Satadal Mandal, Minakshmi Karmakar
April-June 2015, 21(2):144-148
DOI:10.4103/0971-7749.155314  
Objective: The objective was to determine which material, among autologous cartilage, autologous incus and partial ossicular replacement prosthesis (PORP), gives better postoperative hearing result in ossiculoplasty. Study Design: Nonrandomized prospective cohort (longitudinal study). Settings: Tertiary referral center. Materials and Methods: Patients were selected from outpatients department with the clinical diagnosis of chronic suppurative otitis media with cholesteatoma or granulation tissue. Patients underwent necessary preoperative investigations including pure tone audiometry (PTA). Total 67 patients were selected for this study, among them 12 patients did not fit the selection criteria and 5 patients lost during follow-up. Hence, total 50 patients were taken in the study group. Intervention: Ossiculoplasty with cartilage, incus and PORP after modified radical mastoidectomy. Main Outcome Measure: Hearing results were measured by PTA-air bone gap (PTA-ABG) after 6 months of operation. Results: Selecting the criteria <20 dB ABG as success when stapes superstructure is present, cartilage has 60% success rate, incus has 73.68%, and PORP has 56.25% success. Extrusion rate of different prosthesis shows, PORP has 25%, cartilage has 20% extrusion. Incus has the lowest (5.26%) extrusion rate. Conclusion: Among the ossiculoplasty materials, autologous incus gives best postoperative hearing gain and lowest extrusion rate.
  3,483 458 1
REVIEW ARTICLE
Mismatch negativity
Himanshu Kumar Sanju, Akhil Mohanan, Prawin Kumar
April-June 2015, 21(2):81-87
DOI:10.4103/0971-7749.155290  
Mismatch negativity (MMN) is a recent event-related potential to assess preattentive attention of the individuals. MMN has been gaining impetus as a measure to assess preattentive auditory discrimination. In the literature, the studies done on MMN have used different recording protocols. Various database such as Medline, PubMed, Google, and Google Scholar were searched for the reference related to the MMN. The different recording and analysis procedures from the literature have been summarized in the present article.
  2,869 347 1
ORIGINAL ARTICLES
Survey on hearing aid use and satisfaction in patients with presbyacusis
Nalini Bhat, Shalaka S Shewale, Pushkar D Kasat, Harshada S Tawade
April-June 2015, 21(2):124-128
DOI:10.4103/0971-7749.155299  
Context: Hearing aids (HAs) are the principal means of auditory rehabilitation for patients with sensorineural hearing loss. Yet, there are a lot of resistances to use HAs due to the expense, cosmetic concerns and lack of sufficient perceived benefit. A scientific analysis of outcomes in HAs users and the factors involved will lead to a better understanding among the care givers and will ultimately positively influence the outcomes in the HA users. This is the basis of the following study. Aims: (1) To assess the subjective level of satisfaction in patients of presbycusis using mono-aural HAs. (2) To study various attributes in HA users. Settings and Design: Study design - Prospective. Study period - February 2011 to September 2012. Subjects and Methods: The study was done in five basic steps: (1) Selection of subjects based on inclusion criteria. (2) Awareness and counseling regarding HAs. (3) Preintervention assessment. (4) HA fitting, adjustment and rehabilitation. (5) Postintervention assessment. Statistical Analysis Used: Mean, percentage, two-tailed P value using Fischer exact. Results: There was a high level of satisfaction in terms of hearing benefit (74%) among users at the end of 4 months. Almost half the subjects reported no problems with their HAs. Subjects with mild hearing impairment were less satisfied with their HAs than the others. Most people under used their HAs even when they were satisfied. Subjects with severe hearing loss used their HAs for longer duration daily. Conclusions: Mono-aural HAs significantly and satisfactorily rehabilitate patients with presbycusis. Mono-aural fitting is a cost effective option, especially in developing countries like ours.
  2,679 353 -
Otoacoustic emissions in noise-induced cochlear damage in artillery soldiers
Aman Pankaj, Abhijeet Bhatia
April-June 2015, 21(2):98-102
DOI:10.4103/0971-7749.155293  
Aim: Study the utility of distortion product otoacoustic emissions (DPOAEs) in the detection of preclinical noise-induced hearing loss (HL) in artillery soldiers. Materials and Methods: This cross-sectional study included all male subjects aged 18-35 years from the Indian Army and general civilians. Subjects underwent pure tone audiometry and DPOAE test. DPOAE parameters of subjects with normal hearing, nonexposed (control group 1 [CG1]) and noise exposed, HL (control group 2 [CG2]) were compared with noise exposed normal hearing (study group [SG]). Results: Mean DPOAE amplitude and sound to noise ratio of SG at all frequencies were significantly more than CG2 and less than CG1. SG had lower proportion of ears with absent DPOAEs than CG2, but higher than CG1 at all frequencies. Conclusions: Hearing loss is common among artillery soldiers. Artillery soldiers with normal hearing are more likely to develop HL due to impaired DPOAEs as compared to civilians with no history of noise exposure. Adequate safeguards are necessary to prevent handicap.
  2,517 372 -
Role of high-resolution computed tomography scan in the evaluation of cholesteatoma: A correlation of high-resolution computed tomography with intra-operative findings
Sandeep Sreedhar, Kailesh Pujary, Ashish Chandra Agarwal, R Balakrishnan
April-June 2015, 21(2):103-106
DOI:10.4103/0971-7749.155294  
Context: Correlation of the extent of disease on a high-resolution computed tomography (HRCT) temporal bone with intraoperative findings. Aim: This study was done to find the correlation between the preoperative HRCT scan and intra-operative findings in patients diagnosed with chronic suppurative otitis media (CSOM) attico-antral type of disease. Settings and Design: The study was done at a tertiary care hospital, and a cross-sectional study design was employed. Subjects and Methods: The findings of HRCT scan of 25 patients clinically diagnosed to have CSOM attico-antral type of disease were compared with the intraoperative findings. The commonly affected structural parameters were compared. Statistical Analysis Used: Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 11.5 (SPSS: An IBM company). For the current study, kappa, frequency and percentage were considered. Results: HRCT scan was found to have a high sensitivity for identification of the disease at most of the sites within the temporal bone except for the sinus tympani and the stapes region. Conclusion: A HRCT scan acts a good preoperative imaging modality for the otologist to predict disease during the surgery and to explain the possible outcomes to the patient.
  2,403 390 2
Efficacy of voice therapy in teachers: Using perceptual assessment protocol
Rupali Mathur, Chandrakant Vishwakarma, Vikas Sinha, Rajesh Vishwakarma, Ambuj Pandey, Prabhakant Thakur
April-June 2015, 21(2):149-153
DOI:10.4103/0971-7749.155334  
Introduction: Teachers are professional voice users, and thus, they have more chances of having voice disorders. Risk factors due to occupation have been comprehensively examined; however, very little research has been done on the need of therapy and efficacy of voice therapy in teachers. Objectives: To assess the efficacy of voice therapy in teachers using qualitative assessment protocol and to recognize factors those are more sensitive to voice therapy. Methods: This study included two groups within the age range of 25-50 years. Group 1 included 10 participants having dysphonia who attended therapy and group 2 included five participants having dysphonia who could not attend therapy due to some reasons. Participants in both groups were teachers. Further, a perceptual assessment protocol was administered twice with the interval of 3 months. Results and Discussion: Voice therapy improved voice quality in group 1 who attended therapy compared to group 2. There was a significant difference seen in perceptual measures in group 1 pre- and post-therapy. Conclusion: Voice therapy lead to improvement in voice quality which is indicating that teachers should be sensitize for vocal hygiene and voice therapy, and further research is needed in this area.
  2,249 330 2
Clinicomicrobiological evaluation and antibiotic susceptibility in cases of chronic suppurative otitis media
Vijay Kumar Poorey, Pooja Thakur
April-June 2015, 21(2):107-110
DOI:10.4103/0971-7749.155295  
Aims: The present study was aimed to identify the bacterial isolates causing chronic suppurative otitis media (CSOM) and to study their antimicrobial susceptibility pattern. Subjects and Methods : Totally, 120 patients of CSOM complaining of ear discharge were included in the study. Aural swabs were taken and sent immediately to the microbiology laboratory and processed. Bacterial isolates were identified using standard methods, and antibiotic susceptibility testing was done. Results: In the present study, from 120 cases of tubo-tympanic type of CSOM, majority that is, 82 (63.56%) were Gram-negative; Pseudomonas sp. 48 (37.21%) were the most common bacteria isolated followed by Staphylococcus aureus 32 (24.81%). Among Pseudomonas aeruginosa, the most common isolated bacteria, meropenem has the highest susceptibility rate (97.91%); among S. aureus, vancomycin has the highest susceptibility rate (100%). Conclusions: Pseudomonas sp. and S. aureus were found to be the common cause of CSOM in the present study. These organisms are found to be less susceptible to the routinely used drugs such as quinolones and aminoglycosides and also the resistance pattern of the micro-organisms usually keeps changing. Hence, judicial use of antibiotics is recommended.
  2,060 317 -
Audiological profile in cases with cerebrovascular accidents
Matlapudi Venkata Subbarao, Prema Devi, Venkat Raman Prusty, Srihimaja Nandamudi
April-June 2015, 21(2):88-91
DOI:10.4103/0971-7749.155291  
Background: Over the past decades there has been increase demand of audiological complaints coinciding with neurological impairments due to cerebrovascular accidents (CVAs). Most of the cases represent inconsistent responses to acoustic stimuli or total lack of response to sound, documented as auditory agnosia. Aim: The present investigation aims at understanding of potential anatomical co-relates to the involvement of the cortical structure and the processing of auditory stimuli. Materials and Methods: A case series with convenient sampling method included eight cases (six male and two female) with age range 45-55 years with CVA, were taken for this study. Of them two cases were found with lesion in right middle cerebral artery, four cases with left middle cerebral artery and two cases with left posterior cerebral artery lesion confirmed from magnetic resonance imaging scan. Audiological test battery including otoscopy, tuning fork test, pure tone audiometry, speech audiometry, immittance audiometry, dichotic-diotic listening test, auditory brainstem responses, otoacoustic emissions and gap detection tests were carried out including routine ENT evaluation. Results and Conclusion: Result suggests; there is a significant difference in hearing threshold and speech perception in all the eight subjects. The findings and compromised vascular anatomy in all these cases were discussed in this article.
  2,025 292 -
Effects of background noise on transiently evoked otoacoustic emissions in newborn hearing screening
Chandrakant Vishwakarma, Rupali Mathur, Vikas Sinha, Rajesh Vishwakarma
April-June 2015, 21(2):111-113
DOI:10.4103/0971-7749.155296  
Introduction: Newborn hearing screening program is one of the services offered in Neonatal Intensive Care Units (NICU) by most of the neonatologist today. Aim of the Study: Present study aimed to investigate the ambient noise levels which allow successful transient evoked otoacoustic emission testing. Method: 25 normal hearing neonates (group 1) and 25 normal hearing adults (group 2) participated in the study. Both groups were tested at 30 dB sound pressure level (SPL), 40 dB SPL and 50 dB SPL noise levels. Results and Discussion: Tests results showed with increase in noise levels number of passing subjects decreased and also testing was done at times more than once. Conclusion: Tester should take care of noise levels while doing the test in NICU, which can give false negative responses.
  1,982 251 3
Relationship between behavioral measure of ANL and its physiological mechanism in the normal hearing participants
Vishal Kooknoor, Hemanth Narayan Shetty
April-June 2015, 21(2):92-97
DOI:10.4103/0971-7749.155292  
Context: In previous studies, the efferent mechanism was speculated on low and high acceptable noise level (ANL) groups. Thus, an attempt is made to measure the auditory afferent and efferent mechanisms indirectly through event related potentials on same individuals of different ANL groups. Aims: To study the relationship between behavioral measure ANL and its physiological mechanism. Settings and Design: One shot partly replicative and correlative research design was utilized. Subjects and Methods A total of 40 normal-hearing individuals were classified into low, high and average groups based on ANL. From each study participant the contra-lateral suppression of otoacoustic emission (CSOAE), auditory brainstem response in different fixed levels (50, 55, 60 and 65 dB HL) and also in 5 dB noise above each fixed level of intensity were measured. Kruskal-Wallis test and Pearson correlation statistical analysis were used. Results: The mean amplitude of CSOAE was larger in the lower ANL group than compared to other groups, but this difference was not significant. Further, it was found that the slope of V-A (quiet) in the low ANL group was significantly steeper than the high ANL group (P < 0.05). Similar result was found in slope of V-A (noise) . In addition, the Pearson correlation coefficient result revealed that there was no correlation between global ANL and CSOAE. However, a moderate negative correlation was found between global ANL and the slope of V-A (quiet) and; in slope of V-A (noise) . Conclusion: The slope of V-A in quiet and in noise conditions was found steeper in low ANL group indicating stronger auditory afferent and efferent auditory pathway at the central level.
  1,899 249 1
The frequency of congenital long QT syndrome based on new formula in children with sensori-neural hearing loss
Arezoo Khosravi, Susan Amirsalari, Mohammad Ajalloueyan, Ayeh Honaramooz, Roya Issa Tafreshi, Amin Saburi
April-June 2015, 21(2):114-118
DOI:10.4103/0971-7749.155297  
Introduction: Long QT syndrome (LQTS) is a repolarization cardiac disorder that can lead to syncope, cardiac arrest and sudden death in apparently healthy individuals. The congenital type can be accompanied with congenital sensory-neural deafness (Jervell-Lang-Nielsen syndrome). Although there are limited studies assessed the frequency of LQTS in these children in developed countries, regarding introducing the new formula, it is necessary to re-evaluate the frequency of this syndrome. Materials and Methods: This cross-sectional and descriptive study was done on 203 patients with congenital sensory-neural hearing loss (SNHL) that had cochlear implant surgery in Baqiyatallah cochlear implant center from 2008 to 2012. Corrected QT was calculated with this formula: QTC = QT + 1.75 (heart rate-60) Patients with QTC > 460 ms, were categorized in four groups: Long QT: QT > 460, Borderline: 440 < QTC ≤ 460, markedly long QT: QTC > 470 and very markedly: >500. Also, cardiac arrhythmias or arrest were evaluated in patients during cochlear implant surgery and in the postoperative recovery period. Result: Prevalence of LQTS in patients was 12.32% (25 patients). Prevalence of markedly long QT and very markedly long QT were 8.87% (18 patients) and 2.46% (5 patients) respectively. The prevalence of borderline group was 14.29% (29 patients). None of the patients during or after surgery were affected by cardiac arrhythmias or arrest. Conclusion: This study showed higher prevalence of LQTS in patients with SNHL than the normal population, and we suggest that all patients with congenital deafness should be screen for LQTS.
  1,849 205 3
CASE REPORTS
Diagnostic dilemma whether Malignant hidroacanthoma or seborrheic keratosis
P Venu Gopal Reddy, Kiran Kumar, Arvindh Kumar, MK Srinivasan, M Sakthivel, K Muthubabu
April-June 2015, 21(2):157-159
DOI:10.4103/0971-7749.155342  
Eccrine porocarcinoma is a rare cutaneous neoplasm that mainly affects elderly people and grows slowly over a long period but often experiences an accelerated growth phase. Malignant eccrine poroma is a rare skin adnexal tumor arising from the eccrine sweat glands. It arises from different sites in the body extremities, palm and trunk. Porocarcinoma is a rare condition, and we are presenting a case of porocarcinoma of pinna.
  1,842 180 -
ORIGINAL ARTICLES
Auditory alterations following radiotherapy in patients with head and neck malignancy: A prospective study
Anirudh Kaul, Rohan Gupta, Nitika Gupta, Sunil Kotwal
April-June 2015, 21(2):119-123
DOI:10.4103/0971-7749.155298  
Aims and Objectives: The objective is to study the auditory alterations following radiotherapy (RT) in patients with head and neck (H and N) malignancy. Materials and Methods: Patients reporting to ENT OPD and those admitted, with histologically proved H and N malignancy, undergoing RT, as the treatment modality, were included in the present study, after complete ENT and general physical examination, excluding patients with previous history of ear disease, diabetes and hypertension. Results: A total 120 patients were enrolled for the present study and were examined for otological complications following RT. It was found that the patients had hearing loss, tinnitus, ear fullness and serous otitis media. Hearing loss was mainly sensorineural and was mostly seen in carcinoma of the oral cavity, oropharynx, and nasopharynx. The patients with carcinoma of esophagus, thyroid, and occult primary did not show any significant change in hearing. Conclusion: As radiation field descends down from nasopharynx to esophagus, the effect on otological structures decreases.
  1,674 212 -
CASE REPORTS
Auricular pleomorphic adenoma: A rare presentation
Ripu Daman Arora, Sunder Singh Dogra, Bal Chander, Kuldeep Thakur
April-June 2015, 21(2):154-156
DOI:10.4103/0971-7749.155338  
Pleomorphic adenoma, the most common benign tumor of major salivary glands, may rarely present outside the salivary glands. However, it is extremely rare for these tumors to occur in auricle. We present a case of 40-year-old female with chief complaints of swelling in right pinna in tragal region for 3 years duration with a progressive course. Following inconclusive fine-needle aspiration cytology, excision of the mass was done under local anesthesia. Histopathology report was suggestive of pleomorphic adenoma.
  1,688 181 -
LETTER TO EDITOR
A comment on hearing evaluation in mobile phone users at a tertiary care hospital
Sunil Kumar Raina
April-June 2015, 21(2):160-160
DOI:10.4103/0971-7749.155343  
  1,153 189 -
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