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  Citation statistics : Table of Contents
   2011| April-June  | Volume 17 | Issue 2  
    Online since December 20, 2011

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Ossiculoplasty with autologous incus versus titanium prosthesis: A comparison of anatomical and functional results
Amith I Naragund, RS Mudhol, AS Harugop, PH Patil
April-June 2011, 17(2):75-79
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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Cervico-ocular reflex in cervical vertigo
MK Taneja
April-June 2011, 17(2):51-53
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Pterion: An anatomical variation and surgical landmark
Prashant E Natekar, Fatima M DeSouza, Suhit P Natekar
April-June 2011, 17(2):83-85
Introduction : The frontal and the parietal bones superiorly and the greater wing of the sphenoid and the squamous temporal inferiorly of one side meet at an H-shaped sutural junction termed the pterion. This is an important anatomical and anthropological landmark as it overlies both the anterior branch of middle meningeal artery and the lateral fissure of the cerebral hemisphere. The knowledge of sutural joints between frontal, parietal, sphenoid and temporal bones at pterion is clinically, radiologically and surgically important during surgical interventions involving burr hole surgeries. Materials and Methods : Study performed on 150 dry temporal bones. The pterion, and its sutural articulations with frontal, parietal, sphenoid and temporal bones and also anatomical variations, if any, were studied. Results : Four types of pterion, i.e. sphenoparietal, frontotemporal, stellate and epipteric, were observed. Conclusions : The knowledge of the variations of pterion and its surgical anatomy, in Indian population are important for surgeons operating in the fieldThe present study will also contribute additional information of skull bone fractures in infancy and early childhood, which may be associated with large intersutural bones giving false appearance of fracture radiologically and also during surgical interventions involving burr hole surgeries, as their extensions may lead to continuation of fracture lines.
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Temporal bone dissection skill: A necessity for life otologic surgeries?
Samuel A Adoga, Nuhu D Maan, Benjamin T Ugwu, Babatanko M Umar, George O Nwaorgu
April-June 2011, 17(2):71-74
Background: The anatomy of the temporal bone is complex and not easily learned. Hours of study in the temporal bone laboratory are required for a good grasp by the intending otologic surgeon in order to avoid predictable complications. Aim and Objective: This study aims at highlighting the steps involved toward acquiring the necessary skills and understanding this complex anatomy before embarking on life otological surgeries (temporal bones surgeries and cochlear implant) in our center. Materials and Methods: This was a prospective study of cadaver temporal bone dissection conducted over a period of 3 months. A total of 10 dry, formalin-fixed cadavers were used for the dissection. A team of doctors headed by a consultant otolaryngologist carried out the dissections on the cadavers. The landmark of importance for the dissections was the McEwen's triangle. From this starting point, various otologic surgeries were performed hands-on on the cadavers using the appropriate burs and their sizes. Anatomic features encountered during the dissection were noted and recorded. Results: The 10 cadavers (100%) were all adult males. The youngest and oldest cadavers were aged 25 and 45 years, respectively, with an overall mean age of 38.9 years. The interval between death and embalmment varied from 5 to 79 days. The suprameatal crest, dural plate, aditus and antrum were all present in the 20 temporal bones dissected. Cribrifossae and wide marrow mastoid cavity were noted in 17 (85%) temporal bones each, highly pneumatized mastoid, herald air cells and incus were seen in 14 (70%) each, tympanic remnant was seen in 13 (65%) and stapes in 6 (30%). Conclusion: Temporal bone dissection provides an avenue in understanding the anatomic features and the variations that may pose a challenge in cochlear implant and other otologic surgeries and it enhances the dexterity of the otologic surgeon.
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Tympanometric study of eustachian tube function in oral submucous fibrosis
Maulik Shah, Ashish Katarkar, Pankaj Shah, Noorain Alam, Datt Modh
April-June 2011, 17(2):80-82
Background: Oral submucous fibrosis (OSMF) is a premalignant condition. Incidence of OSMF in India is 0.5%, mainly found in southern states and also in Saurashtra region. The pathological changes can involve mucosa, submucosa and the underlying muscles. The changes of tubal and paratubal muscles can affect the eustachian tube function. So, this study was carried out with an aim to determine the effect of OSMF on the eustachian tube function. Materials and Methods: 54 ears of 27 patients with OSMF and 50 ears of 25 normal persons were screened by eustachian tube function test (ETFT) after thorough history taking and clinical examination. Results: Out of the 54 ears in the OSMF group, type A curve was obtained in 42 (77.8%) ears, type B curve in none and type C curve was found in 12 (22.2%) ears, as compared to the normal group in which type A curve was obtained in 46 (92%) ears, type B curve in 2 (4%) ears, type C curve was found in 2 (4%) ears. On testing compliance of the middle ear, no change was observed at -200 daPa in 15 (27.8%) ears in the OSMF group and 5 (10%) ears in the normal group. Conclusion: The data observed were statistically analyzed by chi-square test, which suggested significant association between OSMF and eustachian tube function. Therefore, it can be concluded that eustachian tube function may be affected in OSMF and vice versa. So, while treating OSMF, hearing disability due to eustachian dysfunction has to be kept in mind and vice versa because treatment of hearing disability without taking care of OSMF will not be successful.
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Preauricular sinus: When to operate?
Anuj Kumar Goel, Subhash Chand Sylonia, Ajay Garg, Kamal Rattan
April-June 2011, 17(2):63-65
Purpose: Experiences with preauricular sinus (PAS) excision in pediatric age group. Materials and Methods: A retrospective analysis of 110 patients who underwent PAS excision was done. A total of 112 excisions (63 left, 49 right) were performed by standard surgical technique. All the patients were operated upon in an infection-free period under general anesthesia. Results: A total of 32 excisions had bad surgical results in the form of bad scar or recurrence, out of which 28 had history of symptomatic sinus infection preoperatively. Conclusions: Surgical excision of PAS should be done in quiescent phase; once infected, it becomes very difficult to eradicate the infection and also the chances of bad surgical results (bad scar or recurrence) increase manifold.
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Etiopathology of acquired cholesteatoma
Prabodh Karnik, Inita Matta, Sunita Chhapola
April-June 2011, 17(2):54-57
The etiopathology of acquired cholesteatoma has undergone numerous changes over the past 150 years. However, certain facts stand out with clarity. The presence of cytokeratins in acquired cholesteatoma, which are akin to those found in the tympanic membrane and external auditory canal, shows that these are probably the site of origin of acquired cholesteatoma. The cholesteatoma sac also shows its greatest growth at its tympanic membrane attachment into the middle ear. Implantations of squamous epithelium due to trauma or surgery could be another originating factor. The basic pathology is the formation of papillary cones from the tympanic membrane or external auditory canal, which progress from microcholesteatoma to frank cholesteatoma with keratin collections. There is an altered matrix metalloproteinase pathway. Tumor necrosis factor activation with altered wound healing process contributes to the collateral destruction of bone. Trisomy and aneuploidy of chromosome 8 predispose to cholesteatoma formation in affected individuals. In this article, we present the etiopathology of acquired cholesteatoma as it stands today.
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Otomastoiditis by Mycobacterium fortuitum: A rare case
Archana Wankhade, Dnyaneshwari Ghadage, Rupali Mali, Arvind Bhore
April-June 2011, 17(2):86-88
We report a case of a 26-year-old female patient diagnosed with chronic otomastoiditis caused due to Mycobacterium fortuitum. Definitive identification of pathogen was done on the basis of growth characteristics and biochemical reaction. M. fortuitum was isolated from the lesion. M. fortuitum is a rarely reported cause of otitis media and mastoiditis. The isolate showed resistance to antitubercular drugs and sensitivity to amikacin, ciprofloxacin and imipenem.
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Etiopathogenesis of lower motor neuron facial palsy: Our experience
M Venugopal, Sheeja Rajan, R Suma, Subin Thomas
April-June 2011, 17(2):58-62
Introduction : Facial nerve is the seventh cranial nerve having important functions, and hence its paralysis can lead to a great deal of mechanical impairment and emotional embarrassment. Etiopathogenisis of lower motor neuron facial palsy is still a diagnostic challenge and the literature has shown varying results pertaining to the same. This study was designed to sketch out the prevalence of disease causation and the profile of peripheral facial palsy patients presenting to the ENT department at Government Medical College, Kozhikode. Materials and Methods : A prospective study involving 60 patients with facial nerve palsy, presented during the period November 2006 to October 2008, was undertaken. Detailed analysis of etiopathogenesis, age and sex distribution, severity of palsy, anatomical levels and follow up for 1 year was done. Results : Trauma, both iatrogenic and non-iatrogenic, was the most widespread etiology in our study, followed by Bell's palsy which is described as the commonest cause in world literature. Majority of the patients belonged to the age group of 31-40 years and there was slight male preponderance Non-iatrogenic facial palsy following road traffic accident was common in young males, while females dominated in infectious palsies. Majority of cases reported with grade III palsy, followed by grade IV. High-resolution computed tomography of temporal bone is exceedingly sensitive in delineating facial canal. Conclusions : Data analysis shows similarity with the existing literature except a novel trend towards amplified incidence of trauma surpassing Bell's palsy. The need for comprehensive history taking, meticulous clinical examination, judicious investigations and appropriate intervention is substantiated by the study.
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Fatal unresectable malignant neoplasms of temporomastoid region - A case series
Somnath Saha, Sudipta Pal, Saibal Misra
April-June 2011, 17(2):66-70
Objective: To highlight the importance of early detection of the fatal and highly invasive malignant neoplasm of the temporomastoid region and to identify the criteria that signify their unresectability. We present six cases of unresectable neoplasm of the temporomastoid region, of which three cases are embryonal rhabdomyosarcoma, two cases are squamous cell carcinoma and one is a case of adenoid cystic carcinoma. Study Design: Retrospective case series. Materials and Methods: Clinical, radiographic and pathologic slides of patients with extensive temporomastoid neoplasm were studied. Results: Of the six cases, five patients died and only one patient is alive and is living with the disease. Conclusion: The neoplasms of temporomastoid region are predisposed to intracranial spread due to their close proximity to the base of skull as well as their aggressive behavior, factors which rapidly turn the tumor unresectable. Hence, it is very important for the treating surgeons to correctly diagnose these cases at an early stage and identify the unresectable neoplasm so as to avoid unnecessary surgery on these patients which only adds to their morbidity and jeopardizes the quality of life.
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