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   2016| July-September  | Volume 22 | Issue 3  
    Online since August 8, 2016

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Bhramari (Shanmukhi Mudra) Pranayama in presbyacusis and dementia
MK Taneja
July-September 2016, 22(3):145-147
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Self-assessment of noise-induced hearing impairment in traffic police and bus drivers: Questionnaire-based study
Himanshu Kumar Sanju, Prawin Kumar
July-September 2016, 22(3):162-167
Background and Objectives: Noise-induced hearing loss is a major preventable occupational hazard. The ill effect of noise exposure is well evidenced by researchers. This study was done to study the self-assessment of hearing quality, annoyance evaluation, noise-related attitude and knowledge in traffic police, and bus drivers on Indian population in a growing city. Subjects and Methods: The study was done on 60 nonsmokers, male traffic police, and 80 long route bus drivers in the age range of 30–50 years. There were 15 questions related to self-assessment administered on these individuals. Results: The results revealed that in spite of regular noise exposure, around 60% individuals rated excellent hearing. Further, surprisingly all individuals rated no knowledge of any ear protection devices available. Nearly, 30–50% individuals related to poor quality of sleep due to noise exposure in both groups. The result also revealed strong association between the responses of most of the questions asked from bus drivers and traffic police. Conclusion: The negative consequences of noise exposure are well reflected as an outcome of this questionnaire-based study which shows these individuals are having signs of hearing-related problems. Hence, there is a need to educate these professionals about hazardous effect of noise exposure.
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Bezold's abscess: A case report and review of cases over 14 years
Hussain Al-Baharna, Hassan Al-Mubaireek, Viresh Arora
July-September 2016, 22(3):148-151
Bezold's abscess is one of the rare complications of otitis media. It was named after Friedrich Bezold in 1881, who described the pus escaping through the medial side of the mastoid process into the incisura digastrica (digastric grove) and forming an abscess. This article reports a case report of a 73-year-old male who presented with right otitis media complicated with Bezold's abscess. The diagnosis is confirmed radiologically by magnetic resonance imaging. The patient was managed by intravenous antibiotic, drainage of abscess, and cortical mastoidectomy. Then, we conducted a literature review for all the cases reported between 2000 and 2014. We found around 17 cases in the literature, and additional eight reported cases but we have excluded them because some are not in English language and the others are not registered in PubMed. We think that because of the evolution in imaging technology, these cases are easier to be diagnosed nowadays. Bezold's abscesses case reports were seen more in adults (10 of 18, 55.6%) than in pediatric of 18 years old and below (8 of 18, 44.4%). It is found more in males (11 of 18, 61%) than in females (7 of 18, 39%). In this review, the time latency between the presentation of the patient and the diagnosis of Bezold's abscess is ranging between 2 days and 2 weeks. The pattern of mastoid pneumatization is the main factor behind developing Bezold's abscess. Since this review confirms that the most common organisms are Gram-positive organisms, it is wise to choose the antibiotic directed against Gram-positive organisms. Finally, we conclude that the surgical treatment can be tailored according to the pneumatization of the mastoid bone and the extension of neck abscess.
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Current bacteriological profile of chronic suppurative otitis media in a tertiary facility of Northern Nigeria
Mohammed Jamiu Kazeem, Ruqayyah Aiyeleso
July-September 2016, 22(3):157-161
Aims: The aim of the study was to re-evaluate the current bacteriological profile of chronic suppurative otitis media (CSOM) and the sensitivity pattern to most of the currently available antibiotics in our environment. Settings and Design: This is a hospital-based, correctional study among CSOM patients. Materials and Methods: A total of 380 aural swabs were obtained from patients clinically diagnosed of CSOM. These swabs were cultured for microbial flora. Drugs susceptibility testing was conducted using Kirby–Bauer disc diffusion methods. Statistical Analysis Used: The result was expressed in percentages to investigate the common cause of CSOM, age distribution, and the sensitivity pattern using standard statistical method. Results: The most common bacteriologic organism isolated was Pseudomonas aeruginosa (31.55) while the least common was Streptococcus pneumoniae (0.5%). Antimicrobial profile of the organisms revealed maximum sensitivity (83–100%) to levofloxacin. Conclusions: The bacteriological agent of CSOM has not changed significantly. However, there is a gradual decline in their sensitivity pattern. Slightly different from what is known; levofloxacin stood out as the most sensitive agent in this study.
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Steroid injection and negative pressure application in successful treatment of auricular seroma
D Anand Karthikeyan, Karunagaran Alalasundaram
July-September 2016, 22(3):168-170
Background: There are various treatment modalities for auricular seroma. The location of seroma and pathogenesis ushered new concepts in management like steroid injection and negative pressure application. Aim: To apply a novel approach- steroid injection and negative pressure application in treating auricular seroma. Methodology: Thirty four auricular seroma patients were treated by the authors in a two year period by aspirating the seroma, steroid irrigation and negative pressure application. Results: 94.11% showed improvement with single instance and had neither recurrences nor complications. Conclusion: This novel approach was based on the pathogenesis of seroma and to arrest it in early stages, steroid was used. Negative pressure was applied owing to the demerits of positive pressure application. This cost effective, conservative treatment was successful in treating seroma without any complications.
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Comparative study of microscopic-assisted and endoscopic-assisted myringoplasty
Raghvendra Singh Gaur, Praveen Tejavath, Swati Chandel
July-September 2016, 22(3):177-182
This study was conducted to determine the advantages and disadvantages of the endoscope as compared to microscope in myringoplasty surgery and to compare the results of both groups. The cases for this study were taken from the inpatient cases of the Department of Otorhinolaryngology, in tertiary care hospital for prospective study during the period of January 2012–August 2013. Thirty cases were taken for the study under each group. All patients in both groups were followed up for a minimum of 6 months. Final assessment of tympanic membrane and hearing was done at 6 months postoperation. Subjective and objective assessment of scar was done at 6 months postoperation. In our study, the success rate of endoscope-assisted myringoplasty was comparable to that of microscope-assisted myringoplasty. Regarding cosmosis endoscope produced superior results. The wide angle, telescopic, magnified view of the endoscope overcomes most of the disadvantages of the microscope. Loss of depth perception and one-handed technique are some of the disadvantages of the endoscope that can be easily overcome with practice.
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Malnutrition among children having otitis media: A hospital-based cross-sectional study in Lucknow district
Shikhar Saxena, Anuja Bhargava, Shitanshu Srivastava, Mrinal Ranjan Srivastava
July-September 2016, 22(3):188-192
Introduction: Otitis media (OM) is one of the most frequent diseases affecting humans and is prevalent in both developed and developing countries. It is the leading cause of hearing loss and is associated with significant morbidity. Children are at a greater risk and suffer most frequently from Otitis media. Studies show that 80% of children would have experienced at least one episode of Otitis media by their third birthday and 40% would have six or more recurrences by the age of 7 years. Materials and Methods: Study was carried out from Department of Otorhinolaryngology & Pediatrics at Era's Lucknow Medical College and Hospital, Lucknow during a time period of January 2014 to June 2015. A total 850 subjects were included in our study between 1 – 5 years with symptoms such as ear discharge, ear pain and itching in ear. Observations and Results: Out of 851 children under study 186 (21.9%) were diagnosed as Acute Otitis Media cases, 462 (54.3%) as Chronic Otitis Media cases and rest 203 (23.9%) children were diagnosed to be affected by Otitis Media With Effusion. Out of 851 cases 510 cases were found to be malnourished i.e. 59.9%. Conclusion: Otitis media has a strong positive association with malnutrition. (P< 0.001).
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Subjective visual vertical and horizontal: Normative values using a software-based test in the Indian population
Gaurav Ashish, Ann Mary Augustine, Amit Kumar Tyagi, Anjali Lepcha, Achamma Balraj
July-September 2016, 22(3):208-212
Aims and Objectives: To determine the normative values for static and dynamic subjective visual vertical and horizontal (SVV and SVH) in a group of Indian volunteers. Materials and Methods: This hospital-based, prospective, cross-sectional study was done on 82 normal adults. The SVV and SVH angles were measured under static and dynamic conditions using the software MUS_VS-V1.3.2.Rev B (Synapsis, France). Six readings each were taken for SVV and SVH in both static and dynamic situations. Results: The obtained mean value for static SVV, dynamic SVV, static SVH, and dynamic SVH were 1.52° ± 0.70°, 1.96° ± 0.65°, 1.64° ± 0.81°, and 1.99° ± 0.78°, respectively. Static SVV for females was 1.4° ± 0.68°; static SVV for males was 1.58° ± 0.71°; dynamic SVV for females was 1.82° ± 0.64°; dynamic SVV for males was 2.04° ± 0.65°; static SVH for females was 1.63° ± 0.76°; static SVH for males was 1.65° ± 0.84°; dynamic SVH for females was 1.80° ± 0.60°, and dynamic SVH for males was 2.1° ± 0.86°. There was no significant difference between the sexes and between the age groups 20–40 years and 41–60 years. Conclusions: This is the only study in the Indian population, and the normative data obtained in this study can serve as a reference for future studies and vestibular testing, especially in those suffering from chronic vertigo and suspected to have otolithic pathway abnormalities.
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Knowledge and attitude of pediatric hearing impairment among general physicians and medical interns in coastal Karnataka, India
Krishna Yerraguntla, Rohit Ravi, Sadanand Gore
July-September 2016, 22(3):183-187
Objective: The objectives of the present study were to investigate and compare the knowledge and attitude among general physicians in primary health-care centers and medical interns. Materials and Methods: A questionnaire-based observational study design was implemented to assess and compare the knowledge and attitude of physicians and medical interns regarding pediatric hearing impairment in setups that have speech and hearing services and that do not offer these services. Results: The general physicians and medical interns showed a positive attitude toward different issues such as importance of hearing in development of speech and language, importance of hearing as a sense, need of hearing screening in newborns, consideration of suspicion of hearing loss by parents, and need of speech therapy. Conclusion: Even though the participants showed adequate knowledge and attitude toward pediatric hearing impairment, there are certain areas that need attention and awareness development. There is also a need to introduce speech and hearing settings at all hospitals as this will ensure a better awareness about the role of the professionals and enable more referrals.
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Hearing threshold of sawmillers in Kaduna, Nigeria
Tijjani Sa’idu Abubakar, Abimiku Solomon Labaran, Garba Mainasara Mohammed, Abdullahi Musa Kirfi, Onyekwere George Benjamin Nwaorgu
July-September 2016, 22(3):152-156
Background: Hearing loss due to occupational noise exposure is a malady with millions of employees having occupational hearing loss (OHL) worldwide though under-appreciated. The neglect of hearing loss, especially OHL has resulted in human and economic consequences worldwide. The WHO estimates a global burden of 1.06 million in Sub-Saharan Africa. Nigeria is experiencing rapid industrial growth, and large number of workers are exposed to industrial noise. Prevention of noise-induced hearing loss is relatively simple and inexpensive. Aims and Objectives: This study was carried out to determine the pattern and prevalence of hearing loss among sawmillers at old Fanteka market, Kaduna. Materials and Methods: This was a cross-sectional descriptive study of the hearing threshold of sawmillers at the old Fanteka market, Kaduna. Ethical clearance was obtained from both the Kaduna state Ministry of Health and the National Ear Care Centre, Kaduna. Questionnaires were duly completed and thereafter the participants had pure tone audiometry in a soundproof booth. Noise meter was used to measure the sound level at the workplace and machines. Pure tone average was calculated for both the left and right ear. Statistical analysis was done using Statistical Package for Social Sciences (SPSS version 16.0, Chicago, Illinois, USA). Results: One hundred and twenty sawmillers with age- and sex-matched controls were assessed. Subjects' age ranged between 20 and 62 years, mean age of 31.36 ± 11.33, whereas controls' age ranged between 20 and 70 years, mean age of 33.29 ± 7.40. All the subjects were males. Prevalence of sensorineural hearing loss (SNHL) was 26.7%. Conclusion: Noise level within the study site environment ranged from 85 to 105 dB. The prevalence of SNHL was 26.70%, moderate type 9–16.70% by pure tone average bilaterally.
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Retrospective evaluation of the surgical result of tympanoplasty for inactive chronic otitis media and comparison of endoscopic versus microscopic tympanoplasty
Rajiv Ranganath Sanji, Chandrakiran Channegowda, Sanjay B Patil
July-September 2016, 22(3):171-176
Context: The evaluation of techniques of middle ear surgery is fraught with difficulty due to varieties of surgical technique and several confounding factors. Although endoscopic middle ear surgery has been described in English literature for decades, there are limited data comparing surgical result with microscopic tympanoplasty as highlighted by recent systematic reviews of literature. Aims: (1) To evaluate the surgical result of tympanoplasty only for patients with inactive chronic otitis media of mucosal type in our institution. (2) To compare the surgical result obtained by endoscopic tympanoplasty with postaural approach microscopic tympanoplasty. Settings and Design: This retrospective study carried out in M.S. Ramaiah Hospitals, Bengaluru, Karnataka, India. Materials and Methods: Retrospective study of the inpatient and outpatient records of patients with inactive chronic otitis media operated by a single surgeon from May 2010 to September 2015. Statistical Analysis Used: Chi-square test was used to compare the qualitative results and Student's t-test was used to compare quantitative results with a level of significance of P= 0.05. Results: A total of 44 ears in 42 patients were analyzed. There were 16 ears operated by transcanal endoscopic method, and 28 ears operated by postaural microscopic post method. The operative time was significantly less (difference of means 16.2 min) for endoscopic versus microscopic approach. Primary transcanal endoscopic superior flap tympanoplasty had statistically comparable surgical success with postaural microscopic anterior vascular strip tympanoplasty (92.9% vs. 88.5%).Discussion: In this retrospective study, by appropriate case selection, we have attempted to reduce the factors which may confound the result of tympanoplasty, such as the use of ancillary procedures such as cortical mastoidectomy. The transcanal endoscopic and postaural microscopic approach as practiced by us had similar outcomes. We found reduced operative time for transcanal endoscopic approach to tympanoplasty. Conclusions: Tympanoplasty alone for inactive chronic otitis media of mucosal type is an effective primary treatment option. Transcanal endoscopic approach is surgically as effective as postaural microscopic approach and may be associated with reduced operative time. Additional evaluation is required for revision cases and for comparing the audiometric result.
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Short-term audiometric profile in army recruits following rifle firing: An Indian perspective
Arpit Saxena, AV Ramesh, Poonam Raj Mehra, DK Singh
July-September 2016, 22(3):199-202
Aim: This study is aimed to assess the short-term audiometric profile in army recruits with green ears following rifle firing. Materials and Methods: A total of 100 fresh army recruits were selected by simple randomization. Recruits with a history of firearm exposure and ear surgery were excluded. Screened recruits underwent pure tone audiometry (PTA) by modified Hughson-Westlake method 1 day before firing. Recruits fired 100 rounds from 5.56 mm Indian Small Arm System rifle in a single session as per standard military protocol. After firing, recruits reported within 4 h for repeat evaluation. Ear complaints such as tinnitus and hearing loss were recorded and repeat PTA was performed. Recruits having standard threshold shift (STS) were not exposed to further firing and called for an evaluation of hearing after 2 weeks. Student's paired t-test and Chi-square test were used to analyze the results. Results: The mean age of subjects was 19.69 ± 0.61 years old. After rifle firing by the 100 recruits, 16 subjects (16.0%) had complaints of hearing loss and tinnitus. Only tinnitus was seen in further 11 subjects. Twelve subjects were found to have STS. In four subjects audiogram showed audiometric notch two being at 2 kHz, one at 4 kHz and one at 6 kHz. Double notch was observed in none of the audiograms. All subjects were asymptomatic at the end of 2 weeks after firing. P< 0.05 was considered significant. Conclusion: Short-term audiometric profile of army recruits shows there is a significant change in audiometric thresholds immediately after firing which recover back to normal within 2 weeks.
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Can use of a cold light source in endoscopic middle ear surgery cause sensorineural hearing loss?
Suat Terzi, Engin Dursun, Abdulkadir Özgür, Zerrin Özergin Coskun, Özlem Çelebi Erdivanli, Mehmet Birinci, Münir Demirci
July-September 2016, 22(3):213-216
Objectives: To investigate possible sensorineural hearing loss created by the use of a cold light source in patients undergoing endoscopic tympanoplasty surgery. Materials and Methods: The medical records of 203 patients, who underwent endoscopic Type 1 tympanoplasty surgery in our ear, nose, and throat clinic between 2012 and 2015, were checked retrospectively. Ninety-one patients were male and 112 were female, and their mean age was 34.4 ± 11.2 years. Results of audiometric measurements performed during the preoperative period and repeated 1 and 3 months postsurgery were compared to each other. Results: The mean duration of the operations was determined to be 52.4 ± 9.1 min. In addition, average preoperative bone-conduction was 11.4 ± 7.4 dB nHL. However, it was 9.57 ± 7.1 dB nHL and 9.51 ± 7.4 dB nHL, respectively, in the 1st and 3rd postoperative months. Levels of postoperative average bone-conduction at the 1st and 3rd month, as well as the thresholds of bone-conduction at 500, 1000, and 2000 Hz, were significantly lower than the preoperative results (P < 0.05). However, there was not a remarkable difference at 4000 Hz (P > 0.05). Conclusion: Based on our findings, the increased heat generated by the use of a cold light source during an endoscopic tympanoplasty surgery is unlikely to cause the development of sensorineural hearing loss.
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Chelation-induced ototoxicity in thalassemic patients: Role of distortion-product otoacoustic emissions and various management parameters
Vikram Bhardwaj, Rohit Verma, Hemant Chopra, Praveen Sobti
July-September 2016, 22(3):193-198
Context and Aims: A limited number of studies have been conducted for the assessment of hearing loss in thalassemic patients on regular chelation therapy and even fewer studies were conducted using otoacoustic emissions (OAEs). The present study was conducted to assess the prevalence of ototoxicity in multiple transfused thalassemic patients on regular iron chelation therapy (with desferrioxamine [DFO] and deferasirox), to compare the efficacy of OAEs (distortion-product OAEs [DPOAEs]) with that of pure tone audiometry (PTA) for hearing assessment and to correlate ototoxicity with age, mean hemoglobin (Hb), serum ferritin levels, dose and duration of chelation therapy, and therapeutic index Settings and Design: This was a prospective, observational study conducted in a tertiary care hospital. Subjects and Methods: Thirty thalassemic patients undergoing regular iron chelation therapy with DFO and deferasirox were included in this prospective study. Hearing assessment was done using otoscopy, tympanometry, PTA, and DPOAEs between January 1, 2010, and June 30, 2010. Follow-up studies were conducted after 12 months of chelation therapy using the same tests. Patients with and without ototoxicity were compared with respect to age, mean Hb, serum ferritin levels, dose and duration of chelation therapy, and therapeutic index. Statistical Analysis Used: Statistical analysis was carried out using the Student's t-test for normally distributed data and Pearson Chi-square test for categorical data. For nonparametric variables, Mann–Whitney and Wilcoxon tests were applied. Results: Using DPOAEs, 36% of patients were detected having a hearing deficit at the start of the study which increased to 46% at the end of study, whereas using PTA, the detection of hearing loss was 10% and 23%, respectively. DPOAE analysis showed a statistically significant decrease in the signal to noise ratio after 1 year of therapy at 4000 Hz, 5714 Hz, and 8000 Hz with maximum number of patients showing abnormality at 5714 Hz. The analysis revealed no significant difference between the affected and unaffected groups with respect to age, sex, height, weight, serum ferritin level, mean Hb, cumulative dose, mean daily dose and duration of chelation, or therapeutic index. Conclusions: Despite DFO doses usually felt to be low risk for ototoxicity (<40 mg/kg/day), we found a high rate of ototoxicity in our patients using DPOAEs (46%). No variables were identified that reliably predict ototoxicity. We impress on the need for regular audiological screening using DPOAEs for early detection of ototoxicity.
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Impact of climate on bacteriology of chronic suppurative otitis media without cholesteatoma
Surender Kumar, Leena Goel, Harish Chander Goel, Lohith Shivappa
July-September 2016, 22(3):203-207
Introduction: Climate change with global warming is concerning humanity of the various effect of this change in temperature and humidity, there is a distinct possibility of change in bacteriology of chronic suppurative otitis media with change in the climate parameters. Aims: The objective of this study is to evaluate effect of climate on bacteriology of Chronic Suppurative Otitis Media without cholesteatoma in various seasons. Methods: Assesement of type and incidence of different bacterias in four different seasons in one year was carried out in 202 patients and their sensitivity was assessed to commonly available antibiotics. Results: The study found that annually Staphylococcus aureus had highest incidence followed by Pseudomonas. On study of organisms according to seasons, Pseudomonas had a higher incidence than other organisms during monsoon season. Conclusion: Staphylococcus aureus is the most common isolate in other seasons while Pseudomonas aerugenosa is most common during the monsoon season. Therefore, it is recommended that during monsoon season (June - September), empirical treatment should be started with antibiotics sensitive to Pseudomonas while in other seasons treatment can be continued with antibiotics sensitive to Staphylococcus.
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Pediatric Ramsay Hunt syndrome: A rare clinical entity
Natashya Hilda Sima, Poonam K Saidha, V Sreenivas
July-September 2016, 22(3):217-219
Ramsay Hunt syndrome is a rare cause of facial nerve paralysis in children, caused due to reactivation of latent Varicella–Zoster virus within the geniculate ganglion. In addition to the facial nerve, Ramsay Hunt syndrome may also affect the vestibulocochlear nerve leading to inner ear dysfunction and in severe case may also involve other cranial nerves. We report a case of Ramsay Hunt syndrome in a 15-year-old child.
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