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   2019| July-September  | Volume 25 | Issue 3  
    Online since October 18, 2019

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Long-term hearing results in endoscopic sandwich myringoplasty: An innovative Dhulikhel hospital technique
Bikash Lal Shrestha, Ashish Dhakal, K C Abha Kiran, Krishna Sundar Shrestha, Aakash Pradhan
July-September 2019, 25(3):135-140
Background: The endoscope has diagnostic and therapeutic role in different otological surgeries. It has excellent view of images where there are difficult nooks and corners. The use of sandwich cartilage perichondrium in the repair of tympanic membrane peroration has its own benefit in graft uptake and hearing results whether long term or short term. The main purpose of the present study was to evaluate the long-term hearing results in patients who underwent endoscopic sandwich myringoplasty with Dhulikhel Hospital (D-HOS) technique. Materials and Methodology: This was a prospective, cohort study performed among 45 patients who underwent endoscopic sandwich myringoplasty with D-HOS technique using tragal cartilage and perichondrium. The hearing was assessed by comparing pre- with post-operative air-bone gap (ABG) and ABG closure in speech frequencies (0.5 kHz, 1 kHz, 2 kHz, and 4 kHz). Results: Among forty-five patients, 42 (93.3%) had graft uptake in 12 months of follow-up. The postoperative ABG (17.0 ± 8.5 dB) was lesser than preoperative ABG (27.3 ± 12.5 dB) with statistically significant results. Conclusion: Endoscopic sandwich myringoplasty with D-HOS technique is a safe procedure with high-graft uptake rate and good long-term hearing results.
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Ear, nose, and throat manifestations of alkaptonuria patients from Jordan
Hani Mosleh Al-Shagahin, Nesrin Mwafi, Mahmoud Khasawneh, Khalid Al Zubi, Mohammad Alsbou
July-September 2019, 25(3):109-113
Objective: Alkaptonuria (AKU) is a rare inborn error of metabolism that is characterized as a multisystem disease with specific ear, nose, and throat (ENT) manifestations. The present study reports ENT findings in pediatric and adult AKU patients from Jordan. Materials and Methods: A full ENT examination and audiological assessment were conducted among the patients attending the AKU Research Office in our University. Results: The results showed that 88% of both pediatrics and adult patients had ENT signs or symptoms; while, the pediatric age group had only one sign that is the discoloration of the cerumen. The adult group had more than one sign, including the discoloration of cerumen and pinna, hearing loss, and discoloration of the gum and teeth. Conclusion: Discoloration of the cerumen is a common sign in pediatric patients; therefore, it is considered as an important early clinical sign for the diagnosis of AKU. Annual follow-up of pediatric patients with audiological assessment is needed to clarify the association between AKU and hearing loss. Otolaryngologist should be aware of these signs for early diagnosis and provide patients early treatment with nitisinone.
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Assessment of hearing in individuals with allergic rhinitis
Vikas Mysore Dwarakanath, Tejaswini Shambhu, Vinutha Jyothi Jayanna
July-September 2019, 25(3):117-120
Background: Allergic rhinitis is an allergic inflammation of nasal airways. It occurs when allergen, such as pollen, dust, or animal dander is inhaled by an individual with a sensitized immune system. Researchers have found that AR causes conductive hearing loss in adults. Although symptoms related to the inner ear structures were not studied till Singh et al., (2011) who reported a positive correlation between AR and sensorineural hearing loss. Aims and Objectives: The present study aimed to develop an audiologic profile in individuals with allergic rhinitis. Material and Methods: Fifteen individuals with allergic rhinitis and 15 individuals without any history of allergic rhinitis were subjected for pure-tone audiometry, distortion product otoacoustic emission, auditory brainstem response, tympanometry, auditory reflex thresholds, and Eustachian tube function tests. All these tests were repeated after 1 month on the same individuals. Results: Results indicated poorer pure-tone thresholds with reduced DP amplitude compared to normals. This can be attributed to the changes in outer hair cell function due to allergens (Singh et al., 2011). None of the individuals exhibited any middle ear or Eustachian tube dysfunction. As the pure-tone thresholds or distortion product otoacoustic emission amplitude did not improve overmedication, the effects on inner ear function might not be seasonal. Conclusion: It can be concluded from the present study that individuals with AR are more prone to sensorineural hearing loss.
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To study the effect of site and size of tympanic membrane perforation on graft uptake rates and hearing improvement in type I tympanoplasty using sliced conchal cartilage reinforced with temporalis muscle fascia and temporalis muscle fascia alone
Satinder Pal Singh, Ravinder Singh Nagi, Jagdeepak Singh
July-September 2019, 25(3):121-126
Aim: To study the effect of site and size of tympanic membrane perforation on graft uptake rates and hearing improvement in Type I tympanoplasty using sliced conchal cartilage reinforced with temporalis muscle fascia and temporalis muscle fascia alone. Materials and Methods: In this retrospective study, a total of forty patients presenting with dry central perforation with intact and mobile ossicular chain and conductive type of hearing loss, visiting the ENT outpatient department of Government Medical College, Amritsar, were included. They were randomly divided into two groups of twenty patients each, with Group I patients undergoing Type I tympanoplasty with temporalis muscle fascia and Group II patients with sliced conchal cartilage as graft reinforced with temporalis fascia. A pure-tone audiometry (PTA) was done within 1 week prior to the surgery and at 3 months postoperatively to evaluate the hearing status. Results: Overall graft uptake rate in Group I was 85%, whereas that in Group II was 95% (P < 0.01). In Group I, graft uptake rate for small perforations was 100%, for medium 85.71%, subtotal 80%, and big central 66.66%. However, Group II graft uptake rates were 100% in all sizes except in medium-sized perforations (83.33%). The air–bone gap gain in Groups I and II was 14.91 (standard deviation [SD] ±9.741) and 14.48 (SD ± 9.366), respectively (P > 0.05). The hearing improvement was statistically insignificant between anterior and posterior perforations. Conclusion: From this study, we observed that size of the perforation is a major factor that influences graft uptake and hearing improvement results in Type I tympanoplasty using reinforced sliced conchal cartilage. Site of perforation failed to be a statistically significant influencing factor in this study.
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Outcome of hearing in stapedectomy versus stapedotomy in nonendemic areas
Ahmad Alroqi, Mohammad Alshahrani
July-September 2019, 25(3):114-116
Background and Objectives: Stapedectomy and stapedotomy are the standard techniques for surgical treatment of stapes fixation. Both techniques differ in the size of the created opening in the stapes footplate and the type of prosthesis used. The aim of the study is to evaluate the outcomes of hearing following the two surgical techniques. Methods: One hundred and forty-nine medical records of patients who underwent stapedectomy or stapedotomy between the years 1988 and 2011 were reviewed. The subjects were classified into two groups including stapedectomy and stapedotomy. The clinical and immediate pre- and postoperative air-conduction (AC) threshold, bone conduction, and air-bone gap (ABG) were compared between the two groups. Results: The average age of patients included (n = 149) was 34.4 years at the time of surgery. The pure-tone average calculated for AC for clinical and immediate preoperative and postoperative was 57.6, 58.9, and 35.3 dB, respectively. The ABG calculated for clinical, immediate preoperative, and postoperative was 37, 36.9, and 14.5 dB, respectively. The majority of the patients (80.5%) underwent surgery for otosclerosis. Stapedectomies were done for 60.4% versus 39.6% stapedotomies. Preoperatively, the majority of patients fall within the class of moderate to moderate-severe hearing loss. Closure of ABG to 10 dB or more was achieved in 50.4% of the cases. Postoperative ABG was statistically different (P = 0.002) between the stapedectomy (16.79 dB) versus stapedotomy (10.85 dB) group. Conclusions: Stapedotomy cases were better than stapedectomy ones in closing the ABG. The frequency (250 Hz) AC threshold was better in the stapedotomy group compared to the stapedectomy one in a postoperative audiogram. No statistical difference was observed between the two groups in the other frequencies.
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Translation and validation of hearing handicap inventory in adults in Hindi language
Rachit Sood, Amit Kumar, Amit Kumar Tyagi, Saurabh Varshney, Manu Malhotra, Madhu Priya
July-September 2019, 25(3):151-154
Context: At present, various questionnaires are being used to assess the effect of hearing loss on quality of life. Majority of questionnaires assessing hearing handicap in adults are in English language, whereas Indian population is predominantly Hindi speaking. Hence, the study is aimed at developing a questionnaire in Hindi language, assessing the impact of unilateral sensorineural hearing loss (USNHL) on quality of life. Aim: The aim of the study is to translate Hearing Handicap Inventory for Adults (HHIA) into Hindi language and to validate it for evaluating the impact of USNHL on quality of life. Settings and Design: This is a cross-sectional study of 15 patients at ENT outpatient department of a tertiary care center. Materials and Methods: A previously validated questionnaire – HHIA – was translated into Hindi. Fifteen patients of USNHL were evaluated using this translated questionnaire – HHIA-Hindi (HHIA-H). The responses were analyzed, and Cronbach's alpha was calculated to measure the internal consistency of the questionnaire. Results: The Cronbach's alpha score for HHIA-H was found to be 0.895 (0.829 for emotional subscale and 0.848 for social subscale), which is significant, and hence it shows good internal consistency. Conclusion: HHIA-H showed good internal consistency, and it can be recommended to be used for assessing the impact of USNHL on the quality of life.
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SLC26A4 pathogenic variants as a third cause of hearing loss: Role of three exons in DFNB4 deafness in Iran
Elham Davoudi-Dehaghani, Nejat Mahdieh, Atefeh Shirkavand, Hamideh Bagherian, Samira DabbaghBagheri, Sirous Zeinali
July-September 2019, 25(3):146-150
Context: Pathogenic variants in SLC26A4 gene are the third-most frequent cause of autosomal recessive hearing loss in different populations. Aims: This article reports results of homozygosity mapping and SLC26A4 variant analysis in Iran. Settings and Design: A case series study was performed on forty GJB2-negative Iranian deaf families. Subjects and Methods: Homozygosity mapping, using microsatellite markers flanking the SLC26A4 gene, was performed on GJB2-negative Iranian deaf families. The SLC26A4 variant analysis was done by Sanger sequencing. A literature review was performed to identify all reported SLC26A4 pathogenic variants in Iran. Results: In one of the families, the hearing loss showed co-segregation with the DFNB4 STR markers. A previously reported SLC26A4 pathogenic variant was identified in homozygous state in all the affected members of this family. The literature review showed that variant screening of only three SLC26A4 exons and their boundary regions can detect variants responsible for deafness in about half of all DFNB4 Iranian deaf cases. Conclusions: The results of this study emphasize the important role of SLC26A4 pathogenic variants in the development of deafness in Iran. More information on the frequency of pathogenic variants can help in choosing faster and cost-effective methods for genetic testing.
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A boy with clicking ears
Noor Elyana Ahmad Fawzi, Nur Aida Razuan, Iskandar Hailani, Hafeza Ahmad, Nik Adilah Nik Othman
July-September 2019, 25(3):173-175
Middle ear myoclonus is a rare condition which leads to objective tinnitus. We report a 12-year-old boy who presented with bilateral ear tinnitus posttrauma. Endoscopic ear examination reveals rhythmic movement of the tympanic membrane with continuous clicking sound from the bilateral ear; otherwise, other structures were normal. Left endoscopic stapedius and tensor tympani tenotomy were performed and had brought immediate temporary relief for this patient. We discuss the rarity of the disease and the management strategies for this rare condition.
  732 75 -
Hearing loss in a child with cystic dilated internal auditory canal
Muath Alsabih, Khalid Alosaimi, Roa Halawani, Farid Alzhrani
July-September 2019, 25(3):169-172
We report a detailed retrospective chart review of a case of a child with bilateral enlarged cystic-like internal auditory canals (IACs) displaying profound sensory neural hearing loss. He was subsequently treated with cochlear implantation (CI) in one ear, thereby causing his hearing to improve. As far as we are aware, this is the first such case in the world that has been reported of a patient with cystic-like IACs.
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Intranasal hyaluronic acid improves the audiological outcomes of children with otitis media with effusion
Davide Topazio, Francesco Maria Passali, Antonia Cama, Federica Martino, Roberta Di Mauro, Angelo Tirabasso, Theodoro Varakliotis, Stefano Di Girolamo
July-September 2019, 25(3):155-161
Background/Aim: We evaluated the efficacy and compliance of a therapeutic approach based on intranasally-administered hyaluronic acid (HA) in the treatment of chronic otitis media with effusion (OME) in pediatric patients. Materials and Methods: Forty-four pediatric patients were enrolled and randomized into two groups: the first one (Group A) received a treatment based on HA and Group B was treated with saline solution only. Both therapies were intranasally administered by compressed-air nebulizer and Rinowash, a nebulizer designed to treat the upper airway structures. Patients were evaluated by medical history, otoscopy, pure-tone audiometry, and impedentiometry at 0 (T0), 4 (T1), 12 (T2), and 16 (T3) weeks. Results: The analysis of tympanometric and audiometric data, such as the evaluation of otoscopic improvements, showed significant differences between the two groups. After just 1 month of therapy, (T1) tympanometric evaluation showed greater improvements in Group A. Data on the audiometric threshold improvements, measured at different stages of the treatment, showed a greater improvement of the mean/median value of the auditory thresholds in patients treated with HA than in patients of Group B. Conclusion: The absence of side effects and the results observed make this therapeutic approach a potential valid alternative in the difficult long-term management of OME.
  651 79 -
Osteosarcoma misdiagnosed as cholesteatoma
Mehdi Nikkhah, Maryam Ghasemi, Rostam Poormoosa, Somayeh Sheidaei, Mozhdeh Akbari
July-September 2019, 25(3):166-168
Osteosarcoma is a malignant neoplasm and the most common primary tumor of the bone. Craniofacial bones involvement is relatively rare, but if it occurs, most bone affected is the mandible and the maxillae. Osteosarcomas of extragnathic craniofacial bones are rare lesions, constituting fewer than 2% of all osteosarcomas. We report a rare case of de novo osteogenic sarcoma of the middle ear and mastoid and discuss the features associated with diagnosis and treatment.
  651 75 -
Tympanogenic labyrinthine ossificans as rare sequelae of cholesteatoma
Nur Syazwani Mohd Salehuddin, Nik Mawaddah Nik Din, Mohd Sazafi Mohd Saad, Azliana Aziz, Zulkiflee Salahuddin
July-September 2019, 25(3):162-165
Labyrinthine ossificans (LO) is the formation of pathological new bone within the membranous labyrinth of the inner ear. Most commonly, it is caused by meningitis, via communication of labyrinth with subarachnoid via the cochlear aqueduct and internal auditory canal. We highlight a case of cholesteatoma with a rare complication of tympanogenic LO that results in unilateral profound mixed hearing loss with concomitant severe vertigo.
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Suction-assisted device: A substitute to postoperative packing of abscess cavity in patients with ear burns
Chandrashekhar Chalwade, Amit R Peswani, Dhirendra Patil, Amresh Baliarsing
July-September 2019, 25(3):127-134
Background: Ear burns abscesses managed by incision and drainage and daily packing cause significant pain. The management of ear burns abscess involves avoiding pressure on the ear and ensuring collapse of the dead space. To achieve this and a pain-free recovery, we used a technique – suction-assisted device (SAD). Methods: SAD technique was used in patients with an undamaged abscess cavity (cases). Patients who did not consent to use of SAD or with burst abscesses or exposed cartilages were managed by I and D (controls). The SAD was made from: (1) 10 ml syringe, (2) 5 ml plunger, and (3) 8 Fr infant feeding tube. In both groups, the VAS was documented daily. The mean VAS and the treatment-time were compared between cases and controls. Results: The mean VAS and treatment time were significantly lower with SAD (P < 0.001). Conclusion: SAD has some distinct advantages over the standard dressing and was accepted by patients.
  610 58 -
The radiologic evaluation of adenoid hypertrophy and the presence of sinusitis in pediatric patients with chronic otitis media
Bilge Türk, Arzu Yasemin Korkut, Pinar Soytaş, Kerem Sami Kaya, Ersin Vanli, Suat Turgut
July-September 2019, 25(3):141-145
Objective: The present study was conducted to evaluate whether adenoid hypertrophy and the presence of sinusitis were associated with pediatric chronic otitis media (COM) radiologically. Materials and Methods: The computed tomography scans of 71 pediatric patients (33 males and 28 females) ranging in age from 3 to 17 (mean 12 ± 3.9) years who had been admitted to our tertiary care hospital were retrospectively evaluated for adenoid size, nasopharyngeal (NP) airway opening, and the presence of sinusitis. Thirty-six pediatric patients who had been operated on COM were selected as Group 1, and 35 patients who had no middle ear disease were selected as Group 2. The radiological findings of the two groups were compared. Results: Adenoid size and NP airway opening measurements were not statistically different between the groups (P = 0.237 and P = 0.298), so as the NP narrowing by soft palate (P = 0.992). Furthermore, there was no statistically significant difference in the incidence of sinusitis between the groups (P = 0.464). Conclusion: Our results have shown that there was no significant difference of adenoid hypertrophy and the presence of sinusitis in pediatric COM patients and non-COM patients radiologically. For further information, prospective epidemiological trials with longer follow-up periods including pediatric patients are suggested.
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