Objective: Our aim is to study the microbiological profile and their antimicrobial sensitivity pattern in patients of otitis media with ear discharge in tertiary care teaching centre in Agra region and its application in the empirical treatment of chronic suppurative otitis media (CSOM). Place and Duration : The study was conducted from March 2012 to July 2012 on 125 patients attending the ENT OPD and Microbiology Department having ear inflammation history for more than 3 months. Materials and Methods: Samples were taken from 125 patients (both male and female) in all age groups suffering from CSOM and having ear discharge. Their gram staining, direct microscopy with KOH, culture sensitivity, and biochemical tests were carried out to identify the organisms and to know their sensitivity pattern. Results: It showed the predominance by Staphylococcus species (37.6%), followed by Pseudomonas aeruginosa (32.8%), Klebsiella pneumoniae (4%), and Escherichia coli (3.2%). The susceptibility of Staphylococcus species was high (80-85%) with moxifloxacin, levofloxacin, and doxycycline among the commonly used antibiotics. Sensitivity of Staphylococcus species was low (<50%) with beta-lactam drugs. Pseudomonas aeruginosa was 100% sensitive with colistin, polymyxin B, and carbapenems. It is highly sensitive (80%-90%) to aminoglycosides and piperacillin/tazobactam. Its sensitivity was about 60-70% with the commonly used antibiotics, viz. cephalosporins and fluoroquinolones . Conclusion : The study of microbial pattern and their antibiotic sensitivity determines the prevalent bacterial organisms causing CSOM in local area and to start empirical treatment of otitis media and its complications for successful outcome, thus to prevent the emergence of resistant strains.

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Aim: To assess radiological findings in Chronic otitis media (COM), its involvement in middle ear and adjacent structure and to compare with similar published data. The ability of the radiological investigations to detect the various pathological and anatomical variations were evaluated and compared with intraoperative findings. COM is a long standing inflammation of the middle ear cleft without reference to etiology or pathogenesis. Due to the strategic location of the tympanomastoid compartment, separated from the middle and posterior cranial fossa by the thinnest of bony partitions, otitis media has the potential for intracranial extension. Hence, it becomes very important to know the location and extent of the disease before proceeding to surgical treatment. Radiological examination of the temporal bone helps us to achieve this objective. The present work has been undertaken to study the role of radiological imaging of the temporal bone as a diagnostic modality in COM and its use in determining the lines of management as in the type of surgical intervention required. Materials and Methods: This is a prospective study in which total of 50 cases with COM were studied. Results: HRCT is reliable for all the parameters like scutum erosion, ossicular erosion, mastoid pneumatisation, low lying dura, anterior lying sigmoid, Korner's septum, cholesteatoma extension in the middle ear and mastoid, and presence of complications such as mastoiditis and mastoid abscess, mastoid cortex dehiscence, sigmoid sinus plate erosion, facial canal dehiscence, tegmen mastoideum erosion and labyrinthine fistula and intracranial complications with a P < 0.05 but not reliable for tegmen tympani erosion and posterior fossa dural plate erosion. Conclusion: HRCT is highly reliable and findings are in par with intraoperative findings in this study.

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Aims: To analyze and compare the outcomes of ossiculoplasty in terms of hearing results and graft take-up rates, using autograft incus and titanium middle ear prosthesis in patients with ossicular chain erosion. Study Design: Randomized clinical trial. Materials and Methods: Patients between 10 and 60 years of age with a history of chronic ear discharge with moderate conductive deafness (>40 dB HL) were included in the study. The patients underwent detailed ENT examination followed by audiological and radiological assessment of temporal bone and those patients with evidence of ossicular erosion were subjected to ossiculoplasty with autologous incus (group I) or titanium prosthesis (group II) randomly. The patients were followed up after 3 months to analyze the functional and anatomical results. Results: A total of 24 patients with ossicular chain defect were included in the study, of whom 12 patients underwent ossiculoplasty with autograft incus and 12 with titanium prosthesis. Postoperative hearing evaluation by pure tone audiogram was done after 3 months, which showed successful hearing improvement in 58% of cases with autologous incus as compared to 33% cases with titanium prosthesis. Complications and extrusion rate were also higher in patients with titanium prosthesis. Conclusion: Hearing results after ossiculoplasty with autologous incus were significantly better compared with those after titanium prosthesis. Also, complications and extrusion rate were higher in patients with titanium prosthesis. This indicates that ossiculoplasty with autoincus offers better hearing results with minimal complications and extrusion rates as compared to titanium prosthesis.

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Background: Ear infection is highly prevalent worldwide. In the older child, long-standing Chronic Supparative Ottitis Media can result in a severe conductive hearing loss with significant drawbacks in learning, communication, and social adjustment. It is associated with hearing impairment, death, and severe disability due to central nervous system involvement in developing countries. Objective: To determine the bacteriological profile and antibacterial resistance of ear infection from patients seen at Ear Nose and Throat clinic of Hawassa University Referral Hospital. Materials and Methods: A cross-sectional study was conducted at clinic of Hawassa University Referal Hospital. Result: A total 117 study subjects included in this study from June 2013 to October 2013. Among these, 57 (48.7%) were male and 53 (45.3%) were children. Bacteria identified from positive ear swabs were: Staphylococcus aureus 24 (20.5%), Pseudomonas aeroginosa 17 (14.5%), Klebsiella species 10 (8.5%), Proteus species 7 (6.0%), Entrobacter species 4 (3.4%), Escherchia coli 3 (2.6%), Citrobacter species 2 (1.7%), and Providentia species 2 (1.7%). The overall sensitivity and resistance profile of antibacterial agent, Amikacin (90.0%) and Gentamycin (89.1) showed high level of antibacterial effect on all identified bacterial species. On other hand, all isolates were highly resistance to ampicilin (87.5%), oxacillin (84.0%), ceftriaxone (82.8%), cephalotin (81.4%), and penicillin G (73.8%). Conclusion: Most of the isolates were resistant to commonly prescribed drug in the area. However, Amikacin and Gentamycin were highly active against the isolated organism, whereas Ciprofloxacilin was moderately active. Therefore, culture and susceptibility test is vital for appropriate management of ear infection in study area.

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Aims and Objectives: To assess the eustachian tube function (ETF) and to evaluate the treatment outcome of chronic suppurative otitis media (CSOMtubotympanic type) in relation to eustachian tube dysfunction. Materials and Methods: Prospective study for a period of 2 years; the study comprises of 100 patients diagnosed to have CSOM (tubotympanic type). ETF was assessed by Toynbee's test. Patients with normal ETF were taken up for myringoplasty. Patients with totally impaired ETF irrespective of middle ear mucosal status (dry or wet) were taken up for cortical mastoidectomy with tympanoplasty. Patients with partially impaired ETF, with dry middle ear mucosa were taken up for myringoplasty and those with wet middle ear were taken up for cortical mastoidectomy with tympanoplasty. Results and Analysis: The ETF in these patients was analyzed and graft uptake was assessed clinically in reference to ETF status. The results are tabulated and analyzed using Chi-square test using number cruncher statistical system (NCSS) software. In our study, preoperative ETF had a highly significant P value = 0.0005. Conclusion: Methodology of treatment adapted for CSOM patients based on ETF proves that the eustachian tube plays a major role in the uptake of graft.

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Introduction: Mobile phones use electromagnetic radiation in the microwave range, which can be harmful to hearing. Earlier studies have showed an increase in hearing threshold with more than 30 minutes usage of mobile phones per day. Objective: To evaluate the relationship between the duration of usage of mobile phones per day and the change in auditory threshold. Materials and Methods: After obtaining institutional ethical committee clearance, 50 subjects, aged between 15 and 40 years, from institutional campus using mobile phones for more than 5 years were selected for this study. 25 subjects who used mobile phones for <30 min/day formed the control group, while 25 subjects who used their mobile phones for >30 min/day formed the test group. Pure-tone audiometry was done on all the subjects. Results: There was a significant increase in the hearing thresholds at all frequencies in air conduction and bone conduction in right ear in test group compared with the control group. Similarly, there was a significant increase in the hearing thresholds at all frequencies in air conduction and bone conduction in left ear also except for bone conduction at frequency 4 and 6 kHz. Conclusions: There is a significant increase in the hearing threshold in mobile phone users associated with duration of usage.

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Introduction: Chronic suppurative otitis media (CSOM) is a long-standing infection of middle ear cleft having a permanent perforation in the tympanic membrane with or without discharge. This is usually classified into two main groups: tubotympanic and atticoantral disease. The atticoantral type is called unsafe type because of the associated complications due to granulations and cholesteatoma which may be life-threatening. Tubotympanic type with central perforation is usually not associated with major complications such as cholesteatoma formation. Materials and Methods: This study has been conducted in the Department of ENT, Alluri Sita Rama Raju Academy of Medical Science, Eluru, A.P., India. Study group includes 210 patients having CSOM with central perforations in the tympanic membranes who underwent different types of procedures in our department. Preoperatively, all the patients were evaluated with otoscopy, microscopy, pure-tone audiometry, and some patients with computed tomography scan. All the patients had been evaluated peroperatively for confirmation of preoperative findings under microscope. Results: Surprisingly, seven patients with central perforations were having cholesteatoma, confirmed by biopsy. Conclusion: This study suggests that no perforation in CSOM is safe. Any patient coming for medical advice having CSOM with any type of perforation should be evaluated properly to exclude the underlying pathology like cholesteatoma which may be dangerous later on if not identified.

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Background : Chronic suppurative otitis media (CSOM) is a disease of multiple etiology and its importance lies in its chronicity and dreaded complications. Both Gram positive and negative organisms are responsible for infection of the middle ear. Due to advent of newer and sophisticated antibiotics, the microbiological flora is changing constantly. This requires a reappraisal of the flora in CSOM and their in vitro antibiotic sensitivity pattern in cases of CSOM, which do not respond to local antibiotics. The frequent presence of CSOM in general practice and its poor response to the routine treatment are the factors responsible for undertaking this study. Materials and Methods : One hundred and twenty six patients with CSOM were prospectively studied. They had chronic ear discharge and had not received antibiotics for the previous five days. Swabs were taken and cultured for bacteria. The standard method of isolation and identification was followed. Antimicrobial susceptibility of the bacterial isolates was performed by Kirby-Bauer's disc diffusion method. Results: Analysis of bacterial flora of the present study showed predominance of Gram negative bacilli (69.84%). The highest incidence (45.24%) was that of Pseudomonas aeruginosa followed by Staphylococcus aureus (22.22%). Amikacin was found to be the most effective drug. Conclusion: This study suggests that the common etiological agents for CSOM were Pseudomonas aeruginosa followed by Staphylococcus aureus. Amikacin was found to be the drug of choice.

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Aim: Chronic suppurative otitis media (CSOM) is a common cause of hearing impairment, especially in rural population. This study was carried out to know about the bacterial flora and antibiotic sensitivity for better management of the disease and to reduce morbidity due to CSOM. Materials and Methods: This study was undertaken in a tertiary care center of western UP with an aim to study the bacterial flora and their sensitivity to a series of antibiotics in cases of CSOM (unsafe) with active purulent discharge. There was no history of topical or systemic antibiotic therapy in these patients in the last 3 months. Aural swabs were taken and cultured for aerobic bacteria. For cases showing growth on culture media, sensitivity for a series of antibiotics was studied to have an understanding of the antibiotics showing sensitivity and resistance. Results: A total of 62 (mean age 17.38 years) diagnosed cases of CSOM unsafe were included in the study. The study group included 38 males (61.29%) and 24 (38.71%) females. Fifty-four patients (87.09%) had unilateral diseases, while 8 patients (12.90%) had bilateral diseases. 94.28% of the ears showed growth on culture media. Majority of these ears showed monomicrobial growth (90.90%). Conclusion: The most common bacteria isolated in descending order were Pseudomonas, Klebsiella, Staphylococcus, Proteus, and Escherichia coli. Majority of the patients showed sensitivity to cefoperazone and salbactum (90.69%), ofloxacin (79.06%), and ciprofloxacin (79.06%). 95.35% of the patients showed resistance to amoxicillin.

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Aim: To study the opinions of grandmothers of newborns on hearing loss, Newborn hearing screening (NHS) and intervention options. Materials and Methods: 100 grandmothers were interviewed in a tertiary care hospital, using a questionnaire adapted from Olusanya, Luxon and Wirz (2006). The responses were analyzed using frequency distribution. Results: 63% were aware that hearing loss could be congenital. Among the causes studied, more awareness was present for family history (67%), noise exposure (62%), and ear discharge (61%). Less than 50% of the participants were aware of other causes. Majority knew that bewitchment (72%) and ancestral sins (69%) were not a cause for hearing loss. Only 20% were aware that hearing loss could be identified at birth and 12% knew about availability of NHS. 75% thought that intervention is possible for hearing loss, and 33% believed that hearing-impaired children could attend regular school, if intervened. 86% of grandmothers preferred testing soon after birth. 87% preferred OAE compared to BERA (33%) as a screening tool. Hearing aids (92%) and surgery (89%) was widely accepted as intervention for hearing loss. Conclusion: Grandmothers had good awareness on congenital hearing loss. And limited awareness was present on causes of hearing loss, identification of hearing loss at birth, NHS and intervention. Thus, indicating an urgent need to create awareness in the above areas. A demonstration of positive attitude was shown in the results towards NHS and intervention for hearing loss, which will facilitate early identification and intervention.

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Introduction: Occupational noise induced hearing loss causes sensorineural hearing loss (SNHL) in industrial workers who are continuously exposed to high frequency noise due to degeneration in hair cells and associated nerve fibers. Materials and Methods: This study was conducted in 100 industrial male workers, including officials, machinery operators, and helpers. ENT and audiometry examination were done and noise level was measured. The age, noise level, duration of exposure, type of activity, and measurement of hearing loss were co-related. Results: The workers who worked in machinery area were affected more when compared to official and helpers. The age group 36-40 was affected more when compared to other age groups. Conclusions: Chronic exposure to noise is common hazard in industrial workers that affect bilateral cochlea and causes high frequency SNHL with 4 kHz notch. We observed 39% industrial workers who were exposed to noise level >87.3 dBA, for 8-12 h/day in textile and hard strip rolling mills in spite of noise free machine are recommended suffered from SNHL.

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Context: Evaluation of hearing loss with diabetic control. Aims: The aim of this study was to profile the audiologic findings of diabetic patients by assessing the degree of hearing loss and the presence/absence of otoacoustic emissions (OAEs); to correlate the factors, namely, age, gender, glycemic status, and duration of diabetes mellitus with hearing loss. Settings and Design: The study was done at a tertiary care hospital and a cross-sectional study design was employed. Materials and Methods: Forty known diabetic patients who satisfied the selection criteria and consented were included in the study. Three tests were carried out, namely, pure tone audiometry, immittance audiometry, and OAEs. Statistical Analysis Used: Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) version 11.5. For the current study, median, interquartile range (IQR), frequency, and percentage were considered. Results: Majority of the patients had bilateral sensorineural hearing loss ranging in severity from minimal to mild degree. Median pure tone average (PTA) values were less in patients with good glycemic status as compared to those with poor glycemic status. OAEs were absent in 30% of the subjects. Age had a contributing effect on raising the hearing threshold but gender and duration of diabetes did not show such an effect. Conclusion: Diabetic patients are at an increased risk of developing sensorineural hearing loss.

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Aims: The aim of this study was to identify the microorganisms associated with the chronic discharging ears and their antimicrobial susceptibility pattern. To find the pattern in bacteriological flora and their susceptibility patterns in patients from the different parts of India. Settings and Design : Observational, retrospective study. Subjects and Methods : A total of 106 patients with unilateral or bilateral active chronic discharging ears attending the outpatient clinic or in-patients were included in the study. All patients' chart details were reviewed and history, clinical findings and microbiology reports were noted. Results : The microbiology of 106 samples (106 patients) was studied (in bilateral ear disease, information about the side from where the swab was taken, was not available). Among them, 72 (67.92%) grew a single isolate while 34 (32.07%) grew two or more organisms. Major micro-organism isolated was Pseudomonas aeruginosa 48 (30.96%), followed by Staphylococcus aureus 46 (29.676%), non-fermenting gram negative bacilli (NFGNB) 17 (10.96), Coliforms 22 (14.20%). Drug susceptibility pattern of P. aeruginosa showed that Piperacillin was active against the majority of the isolates 94%, followed by Ceftazidime 83.3%, Amikacin 81.2%, Netilmicin, Tobramycin 60% and Ciprofloxacin, Gentamicin, Aztreonam 62.5%. Most of the S. aureus isolates were susceptible to Oxacillin in 80% and Erythromycin in 43%. Conclusions : Commonest organisms isolated from chronically discharging ears were P. aeruginosa and S. aureus, with P. aeruginosa marginally more than S. aureus. When patients from north and south were segregated, majority of isolates were P. aeruginosa in south (P. aeruginosa 28, S. aureus 23), whereas S. aureus was more in north (23 S. aureus, 20 P. aeruginosa). Coliforms were isolated more in south (13 south, 9 in north), similarly, NFGNB were also more in south (11 south, 6 north). Majority of isolates of P. aeruginosa were susceptible to Piperacillin and S. aureus was susceptible to Oxacillin.

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Aim: The aim of the present study was to find out the measurement of real protection of ear muffs and as well ear plugs along with comparison of the efficacy of different hearing rotection devices (HPDs) in attenuation of stimulus levels for various stimuli by real ear attenuation at threshold method. Materials and Methods: Subject group consisted of ten males with the mean age of 20 years having normal hearing sensitivity (pure tone audiometry (PTA) less than 25 dB). Sound field measurement of thresholds was carried out for various stimuli, that is, warble tone, narrow band noise, and speech noise. Frequencies from 250 Hz to 12 KHz were tested in a sound treated room. For comparison, experimenter personally fitted the HPDs, that is, ear muff using experimenter fit method. Occluded threshold levels, that is, threshold of audibility for the test signals were measured in exactly same way as was done for open thresholds. The same procedure was followed for ear plugs also. Measurements were summarized at each frequency in terms of grand mean and a standard deviation of the protection values for both HPDs. Results: In all cases the mean attenuation was similar to optimum figures suggested in the literature, but the standard deviation was relatively high. Ear plugs produce more attenuation for low as well as high frequencies of warble tone and narrow band noise, but ear muff are better attenuators at mid frequencies for both warble tone and narrow band noise and also for speech noise stimulus. Conclusion: The attenuations provided by different types of HPDs vary across various nature and frequencies of that noise. This is to be kept in mind while suggesting for appropriate type of Hearing Protection Devices [HPDs] for optimal benefit.

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Objective: The correlation between tympanic membrane perforations and hearing loss was studied. Study Design: Cross sectional prospective study design. Setting: E. N. T OPD, at a tertiary referral center. Materials and Methods: 100 perforated ears in patients of CSOM safe were selected from May 2011 to September 2013. Instruments used for data collection/processing included questionnaires, oto-endoscopy and micro-otoscopy, Pure tone audiometer and image J software. Results: Sixty-three patients (27-males, 36-females), aged 10-56 years (mean age 23.2 years ± 11.8 years) with 100 perforated eardrums were studied. 37(58.7%) had bilateral TM perforations, 7(11.1%) right unilateral and 19(30.2%) left unilateral. The various sizes of perforation and their hearing loss were as follows: Group I (0-8 mm ² ), n=18, with mean hearing loss 29.41 ± 4.39. Group II (8.1-30 mm ² ), n=39, with mean hearing loss 34.69± 4.96. Group III (>30.1 mm ² ), n = 43, with mean hearing loss= 38.79± 3.44. Difference was significant, P value 0.000. The various sites of perforations were Central (69 ears. Mean hearing loss 35.64 dB ± 5.31), Posterior (16 ears, mean hearing loss 39.99 dB ± 2.79) and Anterior (15 ears, mean hearing loss 30.1 dB ± 2.98). Difference was significant, P value 0.000. Lower frequencies were affected more than higher frequencies. Inverted 'V' pattern of audiograms was observed at 2000 Hz. Conclusion: A linear relationship existed between size and degree of hearing loss. Posterior perforations had a higher hearing loss. Lower frequencies were affected more in general. Inverted 'V' pattern of audiograms was observed with turning point at 2000 Hz.

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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.

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Objective: To evaluate the efficacy of over-underlay graft technique of myringoplasty and compare the results of over-underlay graft technique with conventional underlay myringoplasty. Methods: In this prospective study, 40 patients of either sex in the age group of 15–50 years with noncholesteatomatous chronic suppurative otitis media were recruited. The patients were initially managed medically to make the ear dry and after that they were operated upon. Twenty patients underwent conventional underlay myringoplasty and 20 patients underwent over-underlay myringoplasty. The follow-up period was 3 months. Results: Graft uptake and hearing improvement was comparable in both groups. Although the graft uptake was 5% lower in the group which underwent conventional underlay myringoplasty (90%) as compared to over-underlay myringoplasty (95%), however, the difference was not statistically significant (P = 0.5). However, there was statistically significant difference in gain in hearing threshold (gain in A-B gap) in the conventional underlay myringoplasty (14.5 dB ± 7.236) as compared to over-underlay myringoplasty (18.75 dB ± 5.349) (P = 0.04). Conclusion: The over-underlay technique, which is a hybrid of both overlay and underlay technique, allows the advantages of both methods. It improves the graft uptake rate and hearing in subtotal and large perforations.

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Background and Objectives: Intratympanic gentamicin therapy is an effective modality for control of vertigo in Meniere's disease (MD) and when given in low concentration (<30 mg/mL), once weekly minimizes its side effects like chronic vestibular insufficiency or hearing loss. We studied the efficacy of low dose interval intratympanic gentamicin therapy in control of intractable vertigo in MD and the postprocedure hearing loss. As gentamicin is vestibular end-organ selective and not specific for treatment of MD alone we studied its efficacy in non-Meniere's peripheral vertigo (NMPV) in patients with nonserviceable hearing in affected ear. Subjects and Methods: Our study included 13 patients with “Definite” MD and seven patients with NMPV. In MD group, one treatment series consisted of a maximum of 3 weekly intratympanic gentamicin injections of 0.3 mL (12 mg) of gentamicin. In NMPV group, the schedule was similar but dosage per injection was 0.5 mL (20 mg). Another similar series of injections were repeated for recurrences. Results: Significant reduction was noted in number of vertigo spells in both groups after treatment (P < 0.001). All the patients experienced either complete or substantial control (Class A or B) of their vertigo. The functional level scale had significantly improved posttreatment in both groups (P < 0.01). No significant worsening in hearing was noted in any of the patients in MD group. Interpretation and Conclusion: Low dose interval intratympanic gentamicin is a simple cost-effective office procedure for managing vertigo in patients with MD and in patients with NMPV and nonserviceable hearing.

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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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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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Alkaptonuria is a rare inborn error of metabolism due to the deficiency of the enzyme homogentisic acid oxidase. It presents clinically by blackish discoloration of the cartilages and collagen-containing structures of the body. There may be blackish or brown discoloration of the auricles, tympanic membrane and other areas of the head and neck. Although the initial clinical manifestation is of multiple-joint pathology, it may be diagnosed only due to characteristic black discoloration of the urine. Here we present a case of ochronosis due to alkaptonuria which had a long undiagnosed course. A 56-year-old male patient was referred to us for evaluation of nodules of the pinna. He was found to have characteristic clinical features of ochronosis. The final diagnosis was difficult and the clinical findings in the head and neck aided in supporting it. This case highlights the role of the ENT specialist in the diagnosis of this disease, the pitfalls and difficulties in diagnosis and the diagnostic dilemmas.

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