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  Citation statistics : Table of Contents
   2012| January-March  | Volume 18 | Issue 1  
    Online since July 10, 2012

 
 
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ORIGINAL ARTICLES
Prevalence of cholesteatoma in chronic suppurative otitis media with central perforation
Manas Ranjan Rout, Diganta Mohanty, Y Vijaylaxmi, B Kamalesh, M Chakradhar
January-March 2012, 18(1):7-10
DOI:10.4103/0971-7749.98280  
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.
  10 11,135 977
CASE REPORTS
Epidermoid cyst of the outer ear: A case report and review of literature
Alka M Dive, Shughangi Khandekar, Rohit Moharil, Shrutal Deshmukh
January-March 2012, 18(1):34-37
DOI:10.4103/0971-7749.98297  
The purpose of this article is to present a rare case of epidermoid cyst of the outer ear in a 38-year-old male patient. During clinical examination, a soft, cystic, globular, and non-tender swelling with restricted motility and well-defined margins was seen in the retroauricular region. Skin over the swelling was normal and not attached to it. The chosen treatment was total surgical removal. The histopathological findings confirmed the diagnosis of epidermoid cyst, characterized by presence of cyst cavity lined by stratified squamous epithelium with orthokeratin production. The lumen was filled with keratin. The connective tissue capsule consisted of fibrocellular stroma with numerous endothelial lined blood capillaries, which were engorged with red blood cells. The proposed treatment was considered successful, as there was no recurrence.
  4 15,271 599
EDITORIAL
National deafness program and behavioral enforcement audiometry
Mahendra K Taneja
January-March 2012, 18(1):1-2
DOI:10.4103/0971-7749.98274  
  4 5,439 584
ORIGINAL ARTICLES
Audiological, psychological and cognitive characteristics of tinnitus sufferers
Noorain Alam, Ashish Katarkar, Pankaj Shah, Rajeev Jalvi, Anil Jain, Maulik Shah
January-March 2012, 18(1):20-23
DOI:10.4103/0971-7749.98288  
Objective: Tinnitus is widespread amongst clients attending hearing clinics and has been associated with a range of physical and emotional disorders. This study was undertaken with the assumption that tinnitus has a negative impact on psychological well-being as well as on mental concentration of the person. Materials and Methods: Three groups were selected, comprising 10 participants each. Two groups consisted of subjects with tinnitus complaints. The first group had no hearing loss (Tinnitus group (TIG)), the second group had mild hearing loss (PTA >25, <40 dBHL) (Tinnitus group with hearing impairment (TWHIG)), and the third group had no tinnitus or hearing loss (Normal control group (NCG)). After an audiological assessment, the following questionnaires were administered: 1) nature of tinnitus questionnaire, 2) tinnitus reaction questionnaire, 3) the symptom checklist (SCL-90-R), and 4) cognitive failure questionnaire (CFQ). Out of these, four were administered to all tinnitus groups while only the last two were administered on NCG. The results of these tests were compared using a t- test. Results: Participants with tinnitus reported significantly more psychological distress symptoms and everyday cognitive failures than the control group. Conclusion: Our assumption about the potential negative impact of tinnitus on psychological well-being as well as on mental concentration is supported by our study results. Implication: The present study indicates that there is a greater need for providing counseling as well as psychological intervention to reduce stress and assistance in coping with the cognitive failures for persons with tinnitus.
  4 3,673 423
Demarking and identifying points-reliable criteria for determination of sex from external ear
Prashant E Natekar, Fatima M De Souza
January-March 2012, 18(1):24-27
DOI:10.4103/0971-7749.98292  
Introduction: The anatomy of the external ear is clinically and surgically important as it is related to the vital structures in the neck. The morphometric measurements of the external ear were undertaken to determine the sex of an individual. These findings also suggest that this study will have a role in plastic and reconstructive surgery; identification of dysmorphic features in various chromosomal disorders. Aim: The present study will enlighten us to determine the sex from the external ear and provide an insight in determining the variations in sex from the external ear with 100% accuracy. It may also serve as a guideline before surgical intervention in otoplasty so as to resculpt or reshape the ear. Materials and Methods: The subjects were 100 healthy male and 100 healthy female medical students of age group 18-25 years of Goa Medical College, Bambolim, Goa, having no history of any diseases or other genetic disorder or heredity diseases. The anatomical landmarks used for this research study were the right and left a) ear length b) ear length above tragus c) ear length below tragus d) tragus length e) ear breadth f) concha length g) concha breadth h) lobule height i) lobule width of the external ear. Results: The measurement procedure proved to be easy and it did not show any discomfort to the participants. Ear length below tragus, lobule height and lobule width were larger in females than males. This method was made applicable to all the parameters except for ear length below tragus, lobule height and lobule widths since these parameters were greater in females than males. Conclusion: In this study, we could determine the sex from the external ear in a large percentage. The parameters were of little value when subjected to demarking point analyses. However, for a larger population the mean values for the above parameters from different regions will have significantly different values and hence, DPs are to be worked out separately for the different regions. These DPs are much simpler to apply than multivariate discriminant functional techniques for identification of sex with certainty.
  4 3,125 332
A study of gender, head circumference and BMI as a variable affecting BAEP results of late teenagers
Jayesh D Solanki, Naisargi Joshi, Hemant B Mehta, Chinmay J Shah
January-March 2012, 18(1):3-6
DOI:10.4103/0971-7749.98276  
Background : Influence of sex on brainstem auditory evoked potential (BAEP) is not well understood with few studies in India that targets young Teenagers. Aim : Our study aimed to look into gender, head circumference, and body mass index (BMI) as a factor affecting BAEPs of healthy late teenagers. Materials and Methods : BAEP responses were elicited in age-matched teenager college students using standard protocol. Results of absolute latencies and interpeak latencies (IPLs) were compared among Male and female groups and compared for significance as such and after normalizing head size and BMI and tested for significant difference, if any. Results: Latencies and IPLs of BAEP were lower in males when compared with females, but significance was found only for the later parameter. IPLs showing significant gender difference were for I-III and III-V but not I-V. When test groups with comparable head size and BMI were compared, the difference decreased with neither of the parameter being statistically significant. Conclusion: Utility of BAEP can be optimized by establishing normative data for every setup based on BMI and head circumference along with age and gender before using it as a clinical tool.
  4 4,736 409
Arcuate eminence: Is it due to semicircular canal?
Manvikar Purushottam Rao, V Balasubramanyam
January-March 2012, 18(1):15-19
DOI:10.4103/0971-7749.98286  
Background: Arcuate eminence (AE) is an arc-like elevation seen on the anterior surface of petrous part of temporal bone in the middle cranial fossa (MCF). It has been believed and conventionally taught that AE is a protrusion caused because of the superior semicircular canal (SSC) present in the petrous bone. AE is an useful anatomical landmark in the MCF during surgical approaches to acoustic neuroma through suprapetrosal approach. However, the relevance of relation to AE and SSC has been questioned in recent times. Presence of AE of various shapes and dimensions supports this view. Aim: To study and to establish the relation between shape of AE and inferior surface of cerebral hemispheres. Classify various types and subtypes in case of variation in shape based on its appearance. AE could be a negative impression of either gyrus or a sulcus. Material and Methods: The study was conducted in two parts. In the first part, the shape of AE and the impression on cerebral surface were correlated while removing brain from cranial cavity in 8 cadavers (16 wet temporal bones). In second part of the study, 100 dry temporal bones were examined. Relevant photographs were taken. A total of 116 temporal bones were studied. AE was classified as linear, globular, generalized swelling, and flat based on the appearance. Results and Conclusion: 10 AE of 16 wet temporal bones were linear type and did correspond with a sulcus, whilein 1 cadaver no relation was seen. In dry bones, maximum linear variety was seen. There was no relation to shape of AE and cerebral surface in two cadavers. Diversity in shapes, (linear type 47%) and correlation with sulci on cerebral surface contests the earlier understanding that AE is due to SSC. Thickness of bone over SSC was not measured in this study. Having seen so many shapes of AE in this study, authors are of the opinion that there is a need to revisit this bony landmark in MCF and rethink if it can be used as a guide in middle canial fossa surgeries. This study, however, did not look into the bony thickness overlying SSC, which could have added the knowledge of depth of SSC from bony surface of petrous apex.
  1 6,555 290
CASE REPORTS
Invasive aspergillosis of the temporal bone
Renuka A Bradoo, Kshitij D Shah, H Gayathri, Mustafa A Kapadia
January-March 2012, 18(1):30-33
DOI:10.4103/0971-7749.98295  
Invasive aspergillosis of temporal bone, an extremely rare yet potentially life-threatening disease entity, occurs mostly in immuno-compromised individuals. We report a case of a 65-year-old diabetic male who presented with bilateral ear discharge, bilateral subepithelial ear masses, and progressive left facial palsy of recent onset. The biopsy specimen taken from either side after surgical debridement revealed only nonspecific inflammatory granulation tissue, but the culture of the tissue was positive for Aspergillus flavus. Invasive aspergillosis was confirmed by demonstration of the fungi in the tissues with Gomori-Methanamine Silver staining. The patient was hence put on long-term Itraconazole therapy and is presently doing well. The possibility of invasive fungal otitis always needs to be considered as a differential diagnosis in immuno-compromised patients presenting with atypical otomastoiditis so as to diagnose this rare condition at an early stage to reduce the delay in the treatment and prevent its possible complications such as skull base osteomyelitis and progressive cranial nerve palsies.
  - 3,621 291
Epidermal cyst of the bony external auditory canal in an adult
Ihshan Ali, Rauf Ahmad, Irfan Iqbal, Imtiaz Darwesh
January-March 2012, 18(1):28-29
DOI:10.4103/0971-7749.98294  
To present a rare case of epidermal cyst of the bony external auditory canal (EAC) in an adult. Epidermal cyst of the bony EAC, although very rare, should be kept in the list of differential diagnosis of a skin-lined mass of the EAC. Epidermal cyst is very rare in the EAC. Only two cases of epidermoid cyst arising from the bony EAC are reported previously in English, but both were in pediatric age group. Epidermal cyst in EAC in adult patients may be confused with masses that are commonly seen, and these include osteomas, exostosis, ear polyps, carcinomas, etc. Epidermal cyst should be included in the differential diagnosis of a patient with an ear mass.
  - 4,937 284
Absent posterior semicircular canal: HRCT feature of Waardenburg syndrome
Sandeep M Mahajan, Manish Pithwa, Apeksha Chavan, Deepti Pimple
January-March 2012, 18(1):38-40
DOI:10.4103/0971-7749.98300  
Absence of posterior semicircular canal is a rare condition, having been reported with only a few syndromes such as Waardenburg syndrome (WS), Alagellie, CHARGE, and Goldenhaar syndromes. We report a 12- year old male with bilateral absent posterior semicircular canals. These phenotypic characteristics of the patient favored the diagnosis of WS. WS is a rare autosomal dominant condition characterized by sensorineural hearing loss, in conjunction with pigmentary abnormalities and defects of the neural crest-derived tissues. The case is presented for its rarity and for its high resolution computed tomography (HRCT) temporal bone findings so as to reach a precise diagnosis.
  - 5,597 319
Primary tuberculosis of the temporal bone: A rare case report
Rakesh Singh Meena, Deepali Meena, PC Verma
January-March 2012, 18(1):41-43
DOI:10.4103/0971-7749.98303  
We report a rare case of a 5-year-old child with tuberculous chronic suppurative otitis media with postaural fistula. The review of available literature reports on the primary tuberculosis of the temporal bone has shown that the primary tuberculosis of the temporal bone is an extremely rare occurrence, but there is a need for swift recognition of this elusive diagnosis and prompt management. The case report highlights how diligent one must be in order to get the diagnosis.
  - 6,272 371
LETTER TO EDITOR
Diagnosis of alkaptonuria
Viroj Wiwanitkit
January-March 2012, 18(1):44-44
DOI:10.4103/0971-7749.98306  
  - 1,417 201
ORIGINAL ARTICLES
A locoregional study over clinical pattern of external auditory canal foreign body and management
Ravindra S Bisht, Amit K Singh, Anshuman Darbari, Vikas Sikarwar, Vikram Singh Sayana, Sonam Rathi
January-March 2012, 18(1):11-14
DOI:10.4103/0971-7749.98283  
Aims : The purpose of this study was to evaluate the clinical pattern of external auditory canal (EAC) foreign body (FB) and management in the Garhwal hill region and to set guidelines for the management of EAC FB for the general practitioners in rural or remote settings. Materials and Methods : This study was undertaken in the outdoors and emergency of Otorhinolaryngology Department, VCSG Government Medical Science and Research Institute, Srinagar, Uttarakhand. Statistical analysis used : The data were analyzed using graph pad and SPSS version 15. Results : The age of patients ranged from 1 to 75 years. Out of 118 cases, most common FBs were insects (32), followed by beads (21), beans (16), and others. Maximum numbers of FBs were seen in age group 1-15 years and the most common FB in this age group was beads. Methods of successful removal included Alligator forceps (59), Jobson's probe (31), and syringing (28). Conclusions : Successful removal of EAC foreign depends on several factors. Patient's co-operation level is vital. FB removal techniques were more successful for irregularly shaped objects with soft and graspable parts in comparison to hard and rounded objects which were difficult to grasp with forceps. Syringing technique is the safest and easy.
  - 2,491 280
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