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   2012| April-June  | Volume 18 | Issue 2  
    Online since September 6, 2012

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Role of vitamin D in prevention of deafness
Mahendra K Taneja, Vivek Taneja
April-June 2012, 18(2):55-57
  19,040 924 13
Spontaneous CSF otorrhea, hidden and serious condition necessitate recognition of its presentation and the modalities of treatment
Bandar Al Qahtani
April-June 2012, 18(2):58-61
Spontaneous cerebro spinal fluid (CSF) otorrhea or temporal CSF leakage represents a difficult and serious condition to deal with, in term of its diagnosis, especially with intact drum, management and its sequalae if not treated or diagnosed. the clinical presentation, the types of leaks and which are the best approaches to repair it are reviewed.
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Intradiploic epidermoid tumor of temporal bone X-ray, CT, MR Imaging
Shibani Mehra, Garga Umesh Chandra, Suresh Kumar
April-June 2012, 18(2):98-102
Intradiploic epidermoid tumors are extremely uncommon. About 200 cases have been reported in literature. These lesions are caused by inclusion of ectodermal cells in the bone tissue during neural tube closure. These tumors either remain asymptomatic or are incidentally detected or they may present as a palpable lump. They can erode the bone and involve the brain parenchyma due to their proximity to the brain. Radiological imaging is very helpful in accurate diagnosis of these lesions and in differentiating intradural from intradiploic varieties of epidermoids.
  11,609 571 1
Bilateral facial (VII) and vestibulocochlear (VIII) nerves palsy: What is the cause?
Vanita Sarin, Baldev Singh, Vanika Anand, Jaskaran Singh
April-June 2012, 18(2):95-97
Bilateral facial (VII th) and vestibulocochlear (VIII th) nerves involvement is a rare presentation and often indicates a severe underlying medical condition. The differential diagnosis of its causes are extensive and so it presents as a diagnostic challenge. Both, physicians and ENT surgeons should be aware of these various diagnostic possibilities to avoid life long complications. We present here a case of 37-year-old female with sequential bilateral facial nerve and vestibulocochlear nerve involvement, which was successfully managed.
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Analysis of sensorineural hearing loss in chronic suppurative otitis media with and without cholesteatoma
Rohit Sharma, Vinit K Sharma
April-June 2012, 18(2):65-68
Background: Chronic suppurative otitis media (CSOM) still remains a major cause of conductive hearing loss in our country. On contrary a few patients also display an added sensorineural component. Materials and Methods: Hundred patients with unilateral CSOM undergoing ear surgery at our department were included in the study. The affected ears formed the 'CSOM group' and the normal ears formed the 'Control group'. Detailed otologic history, clinical, surgical, and audiometric findings were recorded and analyzed. Results: It was inferred that though CSOM is associated with sensorineural (SN) loss in small majority of patients only. No co-relation was established between the duration of discharge and SN loss. Conclusions: Though, greater SN loss was seen in patients of CSOM with cholesteatoma but it was not statistically significant. It can be further studied that whether an early surgery in CSOM can prevent SN loss or not.
  5,043 702 1
Spectrum of facial paralysis in chronic suppurative otitis media
Shyam S Kumar, Alok Thakar
April-June 2012, 18(2):92-94
Surgical management of facial paralysis associated with Chronic suppurative otitis media (CSOM) may vary depending on the duration and extent of paralysis and also the pathology affecting the nerve. Four illustrative cases are described. The literature is reviewed with regard to the management of the facial nerve in different situations.
  5,278 431 -
Electrocochleography in individuals with Meniere's disease
Prawin Kumar, Pallavi Peepal
April-June 2012, 18(2):72-75
Background: Electrocochleography (ECochG) is a useful tool helping in the diagnosis of Meniere's disease (MD). Extra-tympanic ECochG is a non-invasive technique to record the amplitude of summating potential (SP) alone or the amplitude ratio of SP and action potential (AP). Objectives: The present study was aimed to measure the SP and AP amplitudes alone and the ratio (SP/AP) in individuals with normal hearing and in those with MD. Materials and Methods: A total of 63 ears from 34 individuals with normal hearing and those with MD were selected for the study. Individuals with MD had hearing impairment in the range of mild to moderate sensorineural hearing loss. Extra-tympanic non-invasive ECochG recording was done for all the participants. Results: The results of the study revealed that in individuals with normal hearing, 75.75% of the individual ear had SP responses noticeable, whereas in individuals with MD, only 46.66% had SP waveforms present. Further, the mean latency and amplitude of SP were found to be 0.93 msec and 0.29 μV, respectively, in Meniere's ear, whereas in normal ears, they were 0.64 msec and 0.11 μV, respectively. In addition to that, a significant difference in SP/AP amplitude ratio between individuals with normal hearing and those with MD was also reported. Conclusion: Therefore, from the present study one can conclude that the SP values increase both in terms of latency and amplitude in pathological condition. Also, it can be concluded that SP/AP amplitude ratio can help in differentiating individuals with MD from individuals with normal hearing.
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Effect of suture material on lobuleplasty: Experience at a tertiary care center
Ashish Katarkar, Maulik Shah, Anil Jain, Pankaj shah, Datt Modh, Madhavi Patel
April-June 2012, 18(2):69-71
Introduction: The role of sutures in cosmetic cutaneous surgery is to close a wound and promote healthy wound healing with good cosmetic results. The ears are not only one of the most visible parts of the body, but also very fashionable and make a major statement by how they look and what jewellery a person wear. Lobuleplasty is the repair of torn ear lobule. Aim and Objective: To compare long-term results of Plain catgut 5-0 and Vicryl 5-0 suture materials in lobuleplasty of 88 patients from July 2009 to June 2011. Materials and Methods: A retrospective study of 88 patients who underwent lobuleplasty in Department of ENT, from July 2009 to June 2011, using Plain catgut 5-0 in 66 ears and Vicryl 5-0 suture material in 66 ears under local anesthesia as a day care procedure was performed. Observation and Results: All patients in the catgut group and Vicryl group were followed up on the seventh day and after 3 months for evaluation. No patient had wound infection and dehiscence in either group. Twenty-two ears (33%) were having a complaint of itching in the catgut group, whereas 11 ears (16.5%) in the Vicryl group, which is statistically significant by the χ2 -test. The average score for the scar mark at 3-month follow-up for the catgut group was 5 and for the Vicryl group was 8. Conclusion : The modern cosmetic surgeons have significantly increased a number of suture materials to choose from. When making this decision, it is important to consider the risk of infection, cost, cosmetic result, and wound location. From our study, we conclude that the Vicryl group was having less tissue reaction than the catgut group and appearance of the scar mark was better than the catgut group. Therefore, the Vicryl group can be preferred as a suture material for lobuleplasty.
  5,032 334 -
Effects of the preoperative anxiety and depression on the postoperative pain in ear, nose and throat surgery
Önder Kavakci, Emine Elif Altuntas, Suphi Müderris, Nesim Kugu
April-June 2012, 18(2):82-87
Background: Anxiety and depressive disorders can be widespread among patients who are being treated in surgical clinics and they can affect operation outcomes. Objective: The aim of this study was to investigate the relationship between the level of their anxiety and depression in the preoperative period and the pain level in the postoperative period, analgesic requirement, development of complications and the duration of hospital stay in patients followed up in an ENT clinic. Materials and Methods : One hundred and three (n=103) subjects [male = 56 (%54), female = 47 (%45.6)] filled out the Hospital Anxiety and Depression Scale, sociodemographic data evaluation form before the surgery. Postsurgical pain levels of the subjects were evaluated by the Visual Pain Scale. The analgesic requirements of the subjects were assessed and their duration of hospital stay was noted. Results: While the presence of preoperative anxiety was a predictor of postoperative pain, such a relationship was not found between depression and postoperative pain. On the Visual Pain Scale, it was observed that the anxiety levels were moderately correlated with the Visual Pain Scale assessments on the first day of postoperative period (r = 0.30, P < 0.00). Frequency of analgesic use and Visual Pain Scale assessments on the second day of postoperative period were negatively correlated (r = -0.43, P< 0.000). Conclusion: For elective conditions requiring short-term hospitalization in ENT surgery, presence of preoperative anxiety seems to be a significant predictor of postoperative pain.
  4,619 587 2
The value of TORCH screening in children with bilateral profound sensorineural hearing loss
Rabee M Al Sabellha, Abdulrhman Hager
April-June 2012, 18(2):62-64
We aimed to ascertain the effectiveness of TORCH (toxoplasma, rubella, cytomegalovirus, herpes simplex) investigation in children with profound sensorineural hearing loss (SNHL). Review of TORCH laboratory results in 2011 from 168 patients who had cochlear implants between 2006 and 2010 at King Abdul-Aziz University hospital Riyadh was conducted. Of the 168 patients, 102 had TORCH laboratory results. Nine were positive for cytomegalovirus (CMV) IgM antibody (8.8%), two were positive for herpes simplex virus (HSV) IgM antibody (1.96%), and one was positive for rubella IgG (0.9%). No patient showed positive results for toxoplasma or syphilis. The mean age at which the request was made was 5.89 years. All 102 patients who had TORCH laboratory results were above the age of 2 years, and all the patients had bilateral profound SNHL. The nine patients who were positive for CMV were above 1 year old, and it was thus difficult to differentiate between congenital and acquired CMV infection; however, acquired CMV is unlikely to cause a neurodevelopmental disability.
  4,095 434 -
Mycobacterium fortuitum otitis media: Diagnostic and therapeutic dilemma
Navneeta Gangwar, Ramaswamy Balakrishnan, Dipak Ranjan Nayak
April-June 2012, 18(2):106-109
Tubercular otitis media is well reported in the scientific literature, but infections with atypical mycobacteria are poorly represented. Atypical mycobacteria are slowly emerging as a cause of various head and neck infections over the past few decades. Mycobacterium fortuitum is a rapidly growing, Group IV organism of Runyon's classification. Review of literature reveals only five otology cases affected by this organism. We report a case who responded very well with surgery and conventional antitubercular treatment.
  3,713 279 -
Primary tuberculosis of the nasopharynx: A rare case and literature review
Emine Elif Altuntas, Canan Filiz Karakus, Kasim Durmus, Ismail Önder Uysal, Suphi Müderris, Sahende Elagöz
April-June 2012, 18(2):88-91
The isolated pulmonary involvement as well as upper respiratory tract involvement is declining in consequence of anti-tuberculosis treatment and vaccine programs. However, the incidence of tuberculosis is increasing in less developed and in some developed cities. A 56-year-old woman presented with 5-6 years history of nasal obstruction, sleep with open mouth, and snoring. The mass of the nasopharynx biopsy was performed under local anesthesia. The biopsy material's histopathological examination showed features of tuberculosis and diagnosis confirmed as tuberculosis by the pathologists. Primary nasopharyngeal tuberculosis without the lung involvement is very rare; otorhinolaryngologists should keep in mind the possibility of tuberculosis in the differential diagnosis of nasopharyngeal mass as the incidence of tuberculosis in developed countries is steadily increasing.
  3,537 324 2
Chronic fungal rhinosinusitis due to Aspergillus versicolor
Dnyaneshwari P Ghadage, Rupali J Mali, Archana B Wankhade, Arvind V Bhore
April-June 2012, 18(2):103-105
Fungal rhinosinusitis is an increasingly recognized entity in both immunocompromised as well as immunocompetent patients. Aspergillus spp. is commonest of all causative fungi. A case of chronic fungal rhinosinusitis in a 35-year-old immunocompetent female is reported. Presenting symptoms were bilateral nasal block, discharge, and change of voice. Initially, it was diagnosed as nasal polyposis. Microscopy and culture established the diagnosis of chronic fungal rhinosinusitis due to Aspergillus versicolor.
  3,103 271 -
Evaluation of central neuropathy in patients of chronic renal failure with normal hearing
Ravinder Sharma, Prachi Gautam, Sanjay Gaur, Sanjay Kumar, Vivek Taneja
April-June 2012, 18(2):76-81
Aims and Objective: The aim of the study was to study the involvement of inner ear and eighth nerve in patients of chronic renal failure (CRF) with normal hearing. Further, the mean absolute and inter-peak latencies were correlated with the duration of disease, blood urea level, and the severity of the disease. Materials and Methods: A total of 46 patients of CRF with normal hearing (29 males and 17 females) were included in the study. Majority of the patients were in 21 to 40 year age group. Mean absolute latencies of wave I, III, and V, and inter-peak wave latencies I-III, III-V, and I-V were calculated and compared with the mean wave latencies in 15 normal hearing age- and sex-matched control subjects. Student's t test was applied to evaluate the significance of delay in wave latencies. The patients were divided on the basis of the duration of disease (less than 2 years and more than 2 years), blood urea level (less than 200 mg% and more than 200 mg%), and severity of disease (Patients with glomerular filtration rate [GFR] less than 60 mL/min/1.73 m 2 but more than 10 mL and patients with GFR less than 10 mL/min/1.73 m 2). The significant differences between the hearing thresholds of these two groups were assessed using student's t test for unequal samples. Results: There was a statistically significant delay in absolute latencies of wave I, III, and V and inter-peak latencies I-III, III-V, and I-V. Mean wave latencies with values outside mean ± 2 SD of control were considered as abnormal. Abnormal absolute wave latencies and inter-peak latencies were present in 63.05% and 67.39% of cases, respectively. There was a significant delay in mean absolute latency of wave V and mean inter-peak latency of wave I-III, III-V, and I-V in patients of CRF with duration of disease more than 2 years as compared with patients of CRF with duration of disease less than 2 years. There was a significant delay in mean absolute latency of wave III and V and mean inter-peak latency of wave I-III, III-V, and I-V in patients of CRF with blood urea level more than 200 mg% as compared to patients of CRF with blood urea level less than 200 mg%. There was a significant delay in mean absolute latency of wave III and V and mean inter-peak latency of wave I-III, III-V, and I-V in patients of CRF with GFR less than 10 as compared with patients of CRF with GFR less than 60 but more than 10. Conclusion: The study suggests the involvement of central neural axis and auditory end organ in patients of CRF with normal hearing. It further establishes the role of brainstem evoked response audiometry in earlier detection of central neural axis and auditory end organ. As the duration of disease increases, inferior colliculus and auditory pathway is more prone to damage by uremic neuropathy. An increase in blood urea and decrease in GFR (severity of disease) leads to uremic neuropathy causing damage to superior olivary nucleus and inferior colliculus. Increased blood urea also causes delay in inter-peak latencies, suggesting diffuse axonal neuropathy in patients of CRF.
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