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   Table of Contents - Current issue
October-December 2020
Volume 26 | Issue 4
Page Nos. 199-292

Online since Friday, April 23, 2021

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Oral submucous fibrosis and risk of eustachian tube dysfunction: A meta-analysis Highly accessed article p. 199
Surekha R Rathod, Vivek Harkare, Noopur P Gonde, Suresh Ughade
Introduction: Oral submucous fibrosis (OSF) is a chronic disease, affecting the oral cavity and sometimes the pharynx. It is always associated with juxtaepithelial inflammatory reaction followed by fibroelastic changes of the lamina propria, with epithelial atrophy leading to the oral mucosa and causing trismus and inability to eat. It may also involve the pharyngeal orifice of the eustachian tube (ET). Objective: The aim of this systematic review and meta-analysis was to synthesize the available evidence to determine the effect of OSF on ET function. Materials and Methods: Title and the protocol for the systematic review and meta-analysis were registered in Prospero. Individual with OSF, observational case–control study, human trials, and the article published in English language were included in the study. There were no limits on the number of patients were taken in cases or control groups. Results: The overall pooled odd ratio (OR) of hearing impairment for with OSF compared without OSF was 10.65 with 95% confidence interval (CI) =3.17–35.74. A positive association between OSF and prevalence of ET dysfunction was observed between the study characteristic. A strong and significant association between hearing impairment and OSF was observed (OR = 10.56, 95% CI = 3.17–35.75, P = 0.001). Conclusion: Results of our meta-analysis demonstrates increased risk of hearing impairment in patients with OSMF.
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Tissue engineering of a tympanic membrane graft using decellularized nasal septal mucosa seeded with tragus chondrocytes: a morphological In vitro study p. 205
Ozmen Ozturk, Ozge Sezin Somuncu, Sunel Bade Ozen, Doruk Somuncu, Ziya Bozkurt
Objective: Tympanic membrane (TM) perforations require surgical repair with graft constituents. Tissue engineering which used cells, scaffold materials, and bioactive molecules facilitates an opportunity in otology for the synthesis of an ideal TM graft having proper mechanical possessions and high acoustic properties. The purpose of this study was to analyze the efficacy and feasibility of decellularized nasal septal mucosa (DNSM) seeded with tragus chondrocytes for in vitro regeneration of a TM graft material. Methods: A NSM scaffold constructed with decellularization was seeded with flow cytometry-characterized tragus chondrocytes. Cells were grown on NSM scaffold to produce an “artificial TM graft” (ATMG). Sections of untreated NSM (UNSM), DNSM, and ATMG were compared by histological examinations and immunohistochemistry analysis (i.e., total oxidant status [TOS] assay, cytokeratin K15 expression, Bcl-2, and tumour necrosis factor-alpha TNF-α). Results: Histological analysis of DNSM seeded with chondrocytes indicated a healthy tissue formation suggesting that a cytocompatible ATMG was produced artificially. When compared with UNSM and DNSM, low TOS level, high cytokeratin K15 expression, high Bcl-2, and acceptable TNF-α levels in ATMG samples indicated the presence of healthy chondrocytes and their proper integration to the scaffold with low risk of apoptosis. Conclusion: This study is a prospective investigation for ATMG engineering based on the patient's own tragal chondrocytes seeded over DNSM scaffold, the employed biological niche. The aim of supplementing an ATMG to the armamentarium of graft alternatives will lead to a significant potential for surgical convenience in otology.
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Comparative study of epley's and semont's maneuver in treatment of benign paroxysmal positional vertigo in a tertiary care hospital Highly accessed article p. 211
Souvagini Acharya, Sabyasachi Biswal, Sarita Dash, Aishwarya Aparajita
Introduction: Benign paroxysmal positional vertigo (BPPV) is the most common cause of true vertigo resulting from displacement of otoconia into the semicircular canals. Both Epley's and Semont's maneuver have been used since decades with rewarding results. Aim: This study aims to compare the efficacy between the two methods in inducing remission of symptoms and preventing relapse. Materials and Methods: This study has been done in department of ear, nose, throat, and head and neck surgery of a rural tertiary care hospital in India with 10 month duration from April 2019 to February 2020. Sixty-six diagnosed cases of BPPV were included in the study and two groups were created. First group (A) included those 33 patients treated with Epley's and other group (B) included the rest 33 patients those had been treated by Semont's maneuver and the results compared. We excluded the patients having central or other peripheral causes of vertigo and those suffering from cervical spondilopathy. Data collected as entered into Microsoft office excel 2013 and were analyzed using SPSS 20.0 [IBM, New York, USA]. Chi-square test applied and statistical significance was set at P ≤ 0.05. Results: Both the treatments showed relief of symptom within 1st week of treatment. Thirty patients of Group A out of 33 (90.9%) o and 22 patients of group B out of 33 (67%) got relieved from symptoms. Patients followed up for 6 months post treatment for recurrence and it was found that 3 patients in group A and 6 patients in group B showed relapse of symptoms requiring further treatment. Conclusion: Both methods efficient in treating BPPV with Epley's maneuver relatively more effective than Semont's in terms of remission (statistically significant with P = 0.016 and both maneuvers gave similar results in terms of relapse.
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Reliability of preoperative gel foam patch test in predicting postoperative hearing outcome p. 215
Deepak Dalmia, Shruti Shailesh Kamble, Harish N Katakdhond, Narsinha Davange, Parth Patni, Karthika Bhagavan
Aim: This study aims to know the correlation between the preoperative gel foam patch test with the postoperative hearing outcome. Objectives: The objective is to correlate and compare the air-bone gap (ABG) and mean hearing thresholds obtained at frequencies 500 Hz, 1 KHz, 2 KHz, and 4 KHz through audiological evaluation preoperatively, immediately after gelfoam application and 2 months postoperatively (Type I tympanoplasty). Materials and Methods: A total of 124 cases with a mean age of 37 years with a history of chronic otitis media (COM, mucosal type) having medium to large size of central perforation of the tympanic membrane with pure conductive hearing loss participated in this study. Cases were subjected to routine investigations along with a battery of otological investigations. Further, pure-tone audiometric evaluation was performed before gelfoam patch application, immediately after gelfoam patch application and postoperatively after 2 months and the outcomes were compared. Results: Across all four frequencies, ABG was improved and showed a highly significant difference between preoperative mean findings in comparison to patch and postoperative findings. In this study, a strong positive correlation and reliability between patch test hearing thresholds and postoperative hearing thresholds are observed. Comparing preoperative hearing thresholds and postoperative hearing thresholds with student t-test thresholds improved by approx 17 dB hearing loss (17.50645). Conclusion: Hence, this study shows preoperative gel foam patch test in cases of pure conductive hearing loss is reliable in predicting the postoperative hearing outcome. Furthermore helps in convincing and counseling the patients.
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Assessing the efficiency of intranasal steroid treatment in cases with Eustachian dysfunction via the Turkish version of Eustachian tube Dysfunction Questionnaire-7 p. 221
Adem Bora, Kasim Durmus, Berat Baturay Demirkiran, Yasin Aslan, Emine Elif Altuntas
Aim: The aim of this study was to evaluate the efficiency of the treatment in the cases, who were diagnosed with Eustachian tube dysfunction (ETD) via history, physical examination, and tympanometry and for whom intranasal steroid treatment was planned to be used before surgical treatment options, by using Eustachian Tube Dysfunction Questionnaire (ETDQ)-7. Materials and Methods: Fifty-five cases, who applied to the otorhinolaryngology outpatient clinic due to the complaints suggesting Eustachian dysfunction such as aural fullness and pressure sensation and for whom the diagnosis of Eustachian dysfunction was considered due to the results of the examination, history, and physical examination, were included in the study. The 3rd and 6th weeks of intranasal steroid treatment ETDQ-7 scores were recorded. Results: ETDQ-7 mean scores of the cases were 2.72 ± 0.97 at the time of initial diagnosis (minimum–maximum: 1–4.71), 2.31 ± 0.85 in the 3rd week of the treatment (minimum–maximum: 1–5), and 2.12 ± 0.78 (minimum–maximum: 1–4, 14) in the 6th week. A statistically significant difference was observed when statistically assessing the ETDQ-7 scores determined at the time of diagnosis and in the 3rd and 6th weeks of the treatment (P < 0.001). When ETDQ-7 scores were assessed based on gender in assessment time, there was a statistically significant difference in the assessment conducted in the 3rd week (P < 0.05; P = 0.039). Conclusion: It is believed that the current study is the first study that evaluates the efficiency of intranasal corticosteroid treatment, which is frequently used by the doctors in daily practice in pharmacotherapy in the cases with ETD from young adult and adult age groups, on the symptoms via ETDQ-7. In addition, the results of the present study indicated that intranasal steroid treatment in early periods caused a significant recovery in the symptoms, however this recovery also reached a plateau after the treatment.
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Role of in house tissue glue in tympanoplasty p. 227
Chetan Bansal, VP Singh, Arvind Varma, Prerna Anthwal, Tanvi Kanwar
Introduction: Tympanoplasty is one of the commonly performed surgical treatments for chronic otitis media (COM). Graft used in tympanoplasty is temporalis fascia which is placed at the perforation site but usually without any securing agent like sutures, etc., This can lead to various problems such as medialization or lateralization of the graft (graft displacement) or anterior blunting, which affects the hearing outcome of tympanoplasty. Aim: The aim of this study is to study the role of in house autologous tissue glue in tympanoplasty as a graft-securing agent. Materials and Methods: One hundred cases of COM were divided into two groups of fifty cases each. In Group I, tympanoplasty was done without using tissue glue, whereas in Group II, tympanoplasty was done using in house autologous tissue glue as the graft securing agent, and the results were analyzed. Results: Graft uptake rate in Group I was 84% and in Group II was 92%. Five cases of anterior blunting and three cases of graft medialization were recorded in Group I, whereas there was only one case of anterior blunting in Group II with no graft displacement. Conclusion: Autologous in house tissue glue can be used as a graft-securing agent in tympanoplasty.
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Investigating the effect of Hypericum Perforatum L. on hearing in rats: An experimental study p. 232
Emine Elif Altuntas, Adem Bora, Kasım Durmuş, Hayati Kale, Ahmet Kutluhan
Objectives: Hypericum perforatum L. (HP) is among the oldest used and most comprehensively studied medicinal herbs. Anti-inflammatory activities of different Hypericum extracts on external auditory canal and also in the prevention of tympanic membrane perforation and myringosclerosis were investigated experimentally in the animal model. This study was to investigate whether or not intratympanic injection of H. perforatum L. in the middle ear of the rats causes ototoxicity, via auditory brainstem response (ABR). Materials and Methods: Rats were assigned to three groups as Group C, S, and D. Excessive external auditory canal edema developed in the rats in Group D as of the 5th day and Group D was excluded from the study by considering that ABR records could be affected. Results: A statistically significant difference was observed mean latency values of the wave V and III at the baseline and on the 7th day in Group S (P < 0.05). A significant shortening was calculated in the interpeak mean latency values of the waves III–V at the baseline and on the 7th day in Group S (P < 0.05). A statistically significant difference was observed between the baseline III–V wave interpeak mean latency values in the between-group evaluation on the 7th day (P < 0.05). A statistically significant difference was detected in the mean values of the wave V/Va amplitude ratios at the baseline and on the 7th day in Group S (P < 0.05).In the between-group evaluation, a statistically significant difference was found in the mean values of the wave V/Va amplitude ratios on the 7th day (P < 0.05). Conclusion: The results of the study conducted in accordance with the hypothesis point out that the intratympanic injection of H. perforatum L. may have an ototoxic effect.
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Effect of time since diagnosis of type 2 diabetes mellitus and glycemic control on distortion-product otoacoustic emissions p. 240
Deeksha Shetty, Panduranga M Kamath, Vijendra S Shenoy, Thripthi Rai, Jayashree S Bhat
Objectives: The objective of this study is to analyze the effect of glycemic control and factors like time since the diagnosis of type 2 diabetes mellitus on hearing. Materials and Methods: Hearing of 75 type 2 diabetes mellitus patients aged 40–55 years categorized into three groups of 25 patients based on their glycemic control (HbA1c %) and also based on time since the diagnosis was assessed using pure-tone audiometry (PTA) and distortion-product otoacoustic emissions (DPOAE). Results: Of 68% of the study population showing hearing loss, 40 patients (76.92%) had sensorineural hearing loss (SNHL) and 11 patients showed mixed hearing loss. The highest incidence of SNHL was seen in patients with poor glycemic control (45%) (P = 0.01) and in those with longer duration of diabetes >10 years (50%). Maximum patients showed moderate-to-moderately severe degree of hearing loss, affecting higher frequencies (P < 0.05). Bilateral SNHL was observed in 24% of patients. The absence of DPOAE was seen statistically significantly more in patients with uncontrolled glycemic control (P = 0.008) and those with the duration of diabetes of 5–10 years, affecting mid-to-high frequencies (2 and 8 kHz) (P < 0.01). Our study showed nine patients with normal PTA thresholds with absent DPOAE's. Age showed a statistically significant correlation in DPOAE outcomes with respect to glycemic control only (P = 0.038). Patients on treatment with both insulin and oral hypoglycemic agents showed the highest incidence of hearing loss but with no significant correlation. Conclusion: Patients with poor and uncontrolled glycemic control are likely to have more hearing loss. Subclinical hearing loss due to cochlear dysfunction seen commonly in patients with diabetes can be detected earliest with the aid of otoacoustic emissions in conjunction with PTA.
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Is cervical vestibular evoked myogenic potentials an effective tool for the evaluation of saccular function in patients suffering from peripheral vertigo? An analytical study p. 247
Shailendra Tripathi, Renu Rajguru, Arvind Kumar Gupta, Basavaraj Patil
Introduction: Vertigo, a multisensory symptom, is one of the most common presentations to otolaryngology clinic and may occur in a multitude of ENT-related diseases, thus making a correct diagnosis challenging. In the last few decades, there has been a paradigm shift in the diagnostics of vertigo due to the availability of better objective modalities that allow assessment of different components of the complex vestibular labyrinth with relative ease. With the advent of vestibular evoked myogenic potentials (VEMP) since the last few decades, it is possible to test otolith organs in isolation and objectively. Aim: The aim of this study is to study the effectiveness of cervical VEMP (cVEMP) in the evaluation of saccular function in patients suffering from peripheral vertigo. Study Design: Analytical cross-sectional study. Setting: Tertiary care hospital. Materials and Methods: The study was conducted over a period of 2 years, from December 2016 to October 2018 at the ENT department of a tertiary care hospital. A sample size of 40 patients of peripheral vertigo and 40 age-matched healthy controls was selected. Air conduction cVEMP was performed in cases of posterior canal benign paroxysmal positional vertigo (pBPPV), vestibular neuritis (VN), superior semicircular canal dehiscence syndrome (SCD), and Meniere's disease (MD) and their values were compared with contralateral healthy ears and controls. Results: cVEMP parameters in VN, SCD, and MD were found to be abnormal, and the difference from normal was statistically significant. However, in the case of pBPPV patients, they did not show any difference from the normal. Conclusion: cVEMP is found to be a useful screening tool for conditions such as VN, SCD, and MD.
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A study to determine the incidence of otitic barotrauma during hyperbaric oxygen therapy p. 254
Nirbhesh Saxena, Dilip Raghavan
Context: Barotrauma is caused by the difference in pressure between the air-containing spaces of the ear and the outside environment. Aim: The aim of the study was to determine the incidence of otitic barotrauma during hyperbaric oxygen therapy (HBOT). Setting and Design: A prospective study was conducted in a tertiary care hospital setting. Materials and Methods: All patients planned for HBOT were clinically assessed for Eustachian tube function by pneumatic otoscopy. Patients undergoing HBOT were subjected to otoscopy, and the tympanic membrane of these patients was evaluated before and immediately following the session of HBOT. These changes were correlated with other variables of the patient such as age, underlying illness, comorbidities, and general condition. Analysis: Data collected were analyzed using appropriate statistical means to determine the level of correlation. Results: Of the 100 conscious patients, 19 (19%) had otitic barotrauma. Of those, 31.6% had Grade I otitic barotrauma, 47.4% had Grade II otitic barotrauma, and 21.0% had Grade III otitic barotrauma. Risk factors for otitic barotrauma were pressure equalization problems. We found no influence of age, sex, or comorbidities on the occurrence of barotrauma. Conclusions: Difficulties in pressure equalization were the only risk factors for middle ear barotrauma. Age, sex, or other comorbidities did not affect the incidence of otitic barotrauma.
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Comparison of auditory and speech outcome score with parental satisfaction after cochlear implantation in children p. 258
Pabina Rayamajhi, Anil Kumar Adhikary, Susmita Shrestha, Nar Maya Thapa, Sunita Neupane
Introduction: The result of cochlear implantation is commonly assessed postoperatively by scores such as Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR) scores. Since parents are the main people involved in the day-to-day life of children, parental satisfaction also counts for the assessment of the child's progress after implantation. The objective of the study is to compare the auditory and speech outcome score with parental satisfaction after cochlear implantation in children. Methods: The auditory performance was assessed by the CAP score and the speech by the SIR score. The parents were asked for their satisfaction in their children's audiological and speech progress after surgery by questionnaire. The two results were compared to see the difference in the rating scales and the parents' satisfaction. Results: The CAP score reached a maximum of 7 in children implanted before 3 years of age and reached a maximum of 6 in children implanted after 3 years of age. The SIR score reached the highest of 5 in children before 3 years of age and a maximum of 3 in children implanted after 3 years of age. The parental score of satisfaction was also better in children implanted before 3 years of age and correlated with the CAP and SIR score results. Conclusion: The CAP and SIR scores were better in children implanted at an earlier age. The CAP and SIR scores were comparable with parental satisfaction after 1 year of auditory and speech habilitation.
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Neonatal hearing screening during breastfeeding p. 263
Divya Shantha Kumari Adinarayanan, Heramba Ganapathy Selvarajan, Binu Ninan
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Peculiar presentation of congenital cholesteatoma in a young girl with congenital canal atresia p. 265
Jeyasakthy Saniasiaya, Mohd Khairi Md Daud, Hazama Mohamad, Siti Nazira Abdullah
Congenital cholesteatoma is a rare entity, which traditionally is diagnosed as an incidental finding. The patient typically turns out to clinic complaining of reduced hearing and classical otoscopic finding of congenital cholesteatoma leads to the diagnosis. These may not be the case in a patient with underlying canal atresia which oftentimes may feign the actual pathology. Herein, we present a case of cholesteatoma in a teenage girl with congenital canal atresia who presented with recurrent postauricular abscess. The patient subsequently underwent modified radical mastoidectomy with meatoplasty. We would like to draw attention to the fact that early recognition and intervention are prudent as delaying appropriate management may succumb both patient and physicians to devastating outcomes and unnecessary burden.
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Basal cell carcinoma of pinna p. 268
Harish N Katakdhond, Parth Patni, Deepak Dalmia, Narsinha Davange, Rizul Goyal
Basal cell carcinoma (BCC) is the most common malignant tumor of facial skin due to its anatomical characteristics; complete removal of BCC of pinna is a challenging task. Our study describes surgical excision with adequate margin as one of the treatment modalities. A 62-year-old male presented with a painless swelling over the left pinna (cymba conchae). Biopsy proved to be BCC. The mass was surgically excised with 0.5-cm margin, and the defect was closed with a split-thickness skin graft. Histopathological examination confirmed the diagnosis of BCC. The patient's postoperative healed scar is cosmetically acceptable, and he has no recurrence.
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Chromoblastomycosis of the auricle: A rare cause of ear deformity p. 271
Spandana Prakash Hegde, Rizvin Koyaliparambil Rasheed, Sathya Prakash Anandam, Anuradha C K Rao, Manjunath Mala Shenoy
Chromoblastomycosis is a slowly progressing fungal infection of the skin and subcutaneous tissue caused by traumatic implantation of dematiaceous (brown) fungi. This condition frequently affects the lower extremities. We report the case of a 65-year-old farmer who presented with a pruritic undiagnosed erythematous scaly plaque over the left ear for 18 years. A preceding history of trauma, presence of sclerotic bodies on potassium hydroxide mount, macroscopic and microscopic culture characteristics helped in establishing the diagnosis of chromoblastomycosis due to Fonsecaea pedrosoi. We report this case for the rarity of the site of involvement of the disease and to highlight the importance of considering chromoblastomycosis as a differential diagnosis for a chronic deforming lesion of the auricle.
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The evidence of noninner ear involvement in the presence of depressed bone conduction threshold at 2 kHz frequency p. 274
Mohd Normani Zakaria
Pure-tone audiometry is a standard clinical test for hearing diagnosis. Air–bone gaps derived from the difference between air conduction (AC) and bone conduction (BC) thresholds are important indicators to distinguish between different types of hearing losses. Even though BC thresholds are typically unaffected in conductive hearing loss (CHL) cases, a notch or depression at 2 kHz frequency (i.e., Carhart notch) could occur, which could be mistakenly considered as the involvement of sensorineural hearing loss (SNHL). In this article, it was clearly demonstrated that the BC notch at 2 kHz (that could exceed the normal limit) was in fact related to CHL (not SNHL). That is, in this case, both AC and BC thresholds became “perfectly” normal after the treatment (and the notch at 2 kHz disappeared). Several useful points were highlighted from the present case report to guide clinicians, medical trainees, and respective students to avoid misdiagnosis in clinical practice.
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Facial palsy due to intraparotid schwannoma invading the stylomastoid foramen p. 277
Mehtab Alam, Sabeeh Beig, Kamlesh Chandra, Humra Shamim
Intraparotid facial nerve schwannomas are rare and facial palsy because of them is even rarer. They should be kept in the differential diagnosis of parotid swellings, though preoperatively they are difficult to diagnose. We herein report a case of 30-year-old female who presented with left-sided massive preauricular swelling with facial nerve palsy, on computed tomography, there was invasion and widening of the stylomastoid foramen. This mass was diagnosed as pleomorphic adenoma on fine-needle aspiration cytology and came out to be schwannoma on histopathological examination.
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Lemierre's syndrome: A rare complication of otitis media p. 280
B Y Praveen Kumar, Kiran Mali, KC Sunil, M K Veena Pani
Lemierre's syndrome, also known as septic internal jugular vein thrombophlebitis, is an extremely rare complication of chronic otitis media, which can be fatal if not managed on time. A 28-year-old female presented to us with left sided otorrhea lasting from 1 month, headache, fever with chills and rigors since 10 days. This was accompanied by torticollis and tenderness along the course of the left internal jugular vein. Otological examination revealed features of chronic suppurative otitis media squamosal type. Computerized tomography revealed features of an occluding thrombophlebitis of the left internal jugular vein up to the left brachiocephalic vein. We performed a canal wall down mastoidectomy for the left ear. The internal jugular vein was not ligated. Patient recovered well after the surgery.
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Lateral temporal bone resection for carcinoma external auditory canal with hearing preservation – Our approach p. 283
Deepak Dalmia, Narsinha Davange, Parth Patni, Harish N Katakdhond, Karthika Bhagavan
The case series is regarding effective management of carcinoma external auditory canal (EAC). Patients were assessed clinically and radiologically preoperatively, and an operative plan was decided. Patients were operated for carcinoma EAC, and lateral temporal bone resection along with ancillary procedures such as superficial parotidectomy and selective neck dissection were performed. With the help of frozen section, adjacent clinically suspicious tissue involvement was ruled out for malignancy. Hearing mechanism reconstruction was performed using autologous cartilage and instead of cul-de-sac closure of EAC, canal was kept open by doing wide conchomeatoplasty to aid in postoperative assessment and can avoid repeated imaging.
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Otological manifestations of Langerhans cell histiocytosis in a child - An enigma that persists! p. 289
Chow Xiao Hong, Asma Abdullah, Azila Alias, Suriyati Mohd Yusoff
Langerhans cell histiocytosis (LCH) is a rare nonmalignant entity commonly seen in the pediatric population which encompasses a variety of clinical presentations. Otological involvement in LCH is uncommon which can be manifested as symptoms similar to otomastoiditis or malignancy, thus diagnosis is often delayed. Herein, we report a 1-year 7-month-old boy presented with unresolving left otorrhea complicated with left postauricular swelling. Otoscopic examination revealed granulation tissue in the left external auditory canal. Initial diagnosis of left otomastoiditis was made until high-resolution contrast-enhanced computed tomography of the temporal bone showed soft-tissue masses occupying bilateral mastoids with bony destruction. Histopathological examination with immunohistochemical staining expressed CD1a cytoplasmic immunoreactivity. The diagnosis of LCH was made. This report serves to highlight such a rare clinical entity which often masquerades as other otological diseases and hence becomes a diagnostic challenge in the pediatric population.
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