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   2013| January-March  | Volume 19 | Issue 1  
    Online since March 6, 2013

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Clinical anatomy of greater petrosal nerve and its surgical importance
Prashant E Natekar, Fatima M De Souza
January-March 2013, 19(1):20-22
Background: Surgical approach towards greater petrosal nerve has to be done with caution as many surgeons are unfamiliar with the anatomy of the facial nerve. The anatomical landmarks selected must be reliable and above all easy to identify for identification of the greater petrosal nerve so as to avoid injury to the structures in the middle cranial fossa. Observation and Results: The present study is carried out on 100 temporal bones by examining the following measurements of the right and the left sides a) length of the hiatus for grater petrosal superficial nerve b) distance from superior petrosal sinus c) distance from lateral margin of middle cranial fossa d) arcuate eminence and e) distance from exit to the foramen ovale. Discussion: The anatomical landmarks selected must be reliable and above all easy to identify. Bony structures are more suitable than soft tissue or cartilaginous landmarks because of their rigid and reliable location. These anatomical landmarks will definitely help the surgeon while performing vidian nerve neurectomy and also the anatomical relationship of the facial nerve in temporal bone. The middle fossa approach involves a temporal craniotomy in cases of perineural spread of adenoid cystic carcinomas hence these anatomical landmarks will serve as useful guide for the surgeons and radiologists.
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Microbiological profile and their antimicrobial sensitivity pattern in patients of otitis media with ear discharge
Arti Agrawal, Dharmendra Kumar, Ankur Goyal, Sapna Goyal, Namrata Singh, Gaurav Khandelwal
January-March 2013, 19(1):5-8
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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Malignant otitis externa with bilateral cranial nerve involvement: Report of a unique case
Somnath Saha, Kanishka Chowdhury, Sudipta Pal, Vedula Padmini Saha
January-March 2013, 19(1):33-35
Malignant otitis externa is an inflammatory condition caused by pseudomonas infection usually in the elderly diabetics, or an immunosuppressive condition that presents with diffuse otitis externa along with excruciating pain and granulations tissue in the external auditory meatus. Facial paralysis is common along with occasional involvement of other cranial nerves. Case report describing a patient of malignant otitis externa who presented to a tertiary referral hospital of eastern India. This patient had ipsilateral facial and tenth cranial nerve paralysis along with delayed-onset contralateral sixth and twelfth cranial nerve palsy. The patient was treated initially with intravenous anti-pseudomonal antibody followed by tympanic platectomy, facial nerve decompression and medialisation thyroplasty. The contralateral cranial nerve palsy was managed conservatively with partial recovery of function. Malignant otitis externa, though a common disease, may occasionally present with uncommon or unexplained presentations. The management of these cases should be prompt and aggressive and specifically address each of the debilitating complications.
  6,764 379 4
Middle ear risk index as a prognostic factor in pediatric ossicular reconstruction
Khalid Almazrou, Munahi Alqahtani, Mohamed Alshehabi
January-March 2013, 19(1):23-26
Objectives: To study the hearing results in children following ossicular reconstruction and to determine if the middle ear risk index (MERI) is a useful tool for predicting the outcome of surgery. Design: A retrospective case series. Setting: A tertiary academic center. Patients: Forty-four children underwent ossicular reconstruction using autologous or alloplastic prostheses from January 1995 to January 2005. Materials and Methods: Patients' audiograms were evaluated preoperatively and postoperatively for pure-tone average (PTA) and air-bone gap (ABG). Each ear was scored using the MERI and a total index was calculated. Results: 23 boys and 21 girls were included in the study. The mean preoperative ABG was 38 dB, and the mean postoperative ABG was 25.3 dB. The mean MERI was 3.40 for excellent results (0-10 dB postoperative ABG), 4.42 for good results (11-20 dB postoperative ABG), 4.45 for fair results (21-30 dB postoperative ABG), and 4.06 for poor results (ABG > 30 dB). The complications included perforation of tympanic membrane (13.6%), worsening of the conductive hearing loss (6.8%), retraction pockets (9.1%), recurrent or residual cholesteatoma (6.8%), high-frequency sensorineural hearing loss (4.45%), and prosthesis extrusion (2.3%). The mean follow-up period was 14 months. Conclusion: Children have poorer hearing outcome following ossicular reconstruction in comparison to the published adults' results. The MERI was not a reliable tool for predicting the hearing results of ossicular reconstruction in children.
  6,056 436 1
Pure tone audiometry and otoacoustic emissions for the assessment of hearing loss in diabetic patients
Ashish C Agarwal, Kailesh Pujary, Kanaka Ganapathy, R Balakrishnan, Dipak R Nayak, Faisal Hasan
January-March 2013, 19(1):13-17
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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Medicated gelfoam for the treatment of recalcitrant otomycosis
Surya Prakash Dorasala, Srinivas Dorasala
January-March 2013, 19(1):18-19
Introduction: Otomycosis is a very common condition accounting to almost 20% of all outpatient ENT consultations. Treatment of otomycosis is very simple. However, sometimes, it is very difficult to treat, especially in patients with chronic suppurative otitis media and immunocompromised states. We describe a technique, which we have been using regularly for the past two years in patients with recurrent and persistent otomycosis, which has been very effective in the management. Materials and Methods: Six patients presenting with recalcitrant otomycosis not responding to conventional management were treated with medicated gelfoam placed in the external auditory canal. Results: All patients showed complete resolution of otomycosis and tolerated the treatment. Conclusion: Use of antibiotic antifungal using gelfoam as a carrier is an effective and well tolerated method for treating recalcitrant otomycosis.
  3,216 506 1
Pseudoaneurysm of petrous internal carotid artery presenting as aural polyp
Mohan Johnson, Venugopal Madhavakurup, AV Sandeep
January-March 2013, 19(1):27-29
A 62-year-old male presented with a rare case of pseudoaneurysm of petrous internal carotid artery (ICA) caused by chronic otitis media manifesting as right aural polyp. There was massive bleeding following aural polypectomy and histopathology came as inflammatory polyp. HRCT temporal bone showed defect in petrous part of right ICA canal and features suggestive of cholesteatoma. CT angiogram showed a laterally directed aneurysm from the junction of horizontal and vertical segment of petrous ICA. Right ICA trapping done using coil embolization. Postcoiling angiogram showed nonopacification of aneurysm and good cross circulation from opposite side. After two months right modified radical mastoidectomy was done and intraoperative findings showed automastoidectomy with cholesteatoma filling mastoid and middle ear and erosion of ossicles. There was no postoperative complications and patient is now on regular follow-up and is asymptomatic. Psedoaneurysm of petrous ICA is rare and psedoaneurysm as a complication of chronic otitis media is extremely rare.
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MISME syndrome: A rare clinical entity
Sajad Majid Qazi, KS Mehta, Mirza Aneesa, Irfan Iqbal
January-March 2013, 19(1):36-38
We report a case of a 16 year-old male patient diagnosed as MISME syndrome (MISME: Multiple inherited schwannomas, meningiomas, and ependymomas) which is a rare clinical entity. The disease is autosomally hereditary, without gender predilection and having a clinical penetrance rate of nearly 90%.The gene defect is in chromosome 22 ( NF II gene) and is distinguished from NF I where the gene defect is in chromosome 17.
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Solitary lupus vulgaris of pinna: A rare presentation
Shweta Gogia, Alok Agarwal
January-March 2013, 19(1):30-32
Lupus vulgaris is a rare manifestation of infection by Mycobacterium tuberculosis. Isolated involvement of the pinna is a rare clinical presentation, which can be a diagnostic dilemma. We present a case of a 35-year-old male who presented with a chronic, non-healing ulceration of the helical margin of the pinna, without any other sites of involvement. The histopathological evaluation of the lesion, led to the diagnosis of tuberculosis. The patient was given antitubercular regimen for six months, to which he responded with complete resolution of symptoms.
  3,050 257 1
A study of effect of shift work, sex, and smoking on development of ONIHL in plastic weavers
Jayesh D Solanki, Hemant B Mehta, Chinmay J Shah, Pradyna A Gokhale
January-March 2013, 19(1):1-4
Background: Exposure to Occupational noise is the major avoidable cause of permanent hearing loss that is preventable by protective measures. Present study evaluated hearing profile and effects of shift, sex, and smoking on hearing loss in plastic weavers working in textile industry exposed to impact type of noise. Materials and Methods: A cross-sectional study of hearing threshold of various shift workers of plastic weaving industries (18 males, 32 females) at various frequencies was done and effect of various factors was tested at low and high frequencies and compared at 4 kHz, 6 kHz, and 8 kHz statistically. Results: Hearing thresholds were significantly higher at high frequencies than speech frequencies, in day shift workers than night shift workers and within day shift workers more with continuous type of shift work than interrupted type. Females showed better hearing than males and for non-smokers than smokers, but the difference observed in both instances proved statistically insignificant. Conclusion: It can be concluded that the use of alternate day and night shift, interrupted day shift may be used to prevent hearing loss and for further confirmation few more studies are warranted. Being female and non smoking also proved an advantage. Comparatively, mild to moderate degree of hearing loss further reinforces the scope of prevention by hearing protective devices and interrupted shift design of work.
  2,766 361 1
Effect of short-duration noise exposure on behavioral threshold and transient evoked otoacoustic emission
Prawin Kumar, Kaushlendra Kumar, Animesh Barman
January-March 2013, 19(1):9-12
Background: It is well known that the short- or long-duration exposure to loud noise can either cause temporary or permanent threshold shift. Pure tone audiometry is most widely used to predict the individual who is susceptible to such noise-induced hearing loss (NIHL). Transient evoked otoacoustic emission (TEOAE) is a noninvasive, objective technique and required less time to administer to find out such effect. However, one must know the sensitivity of TEOAEs to predict susceptibility of NIHL. Objectives: Thus, the present study was taken up to find out the susceptibility of TEOAE to identify the individual who is more susceptible by comparing behavioral temporary threshold shift (TTS). Materials and Methods: There were 28 ears in the age range of 18 to 30 years participated in the study. All participants were evaluated for pure tone thresholds and TEOAEs amplitude before and after exposure to the short-duration noise. Results: Results indicated that there were statistically significant differences observed for both behavioral thresholds shift and TEOAEs amplitude reduction after exposure to short-duration noise at 0.05 levels at different frequencies. Conclusion: Further, it was observed that though there was agreement between the two, TEOAE amplitude shift was not as much as pure tone TTS. Reason and the importance of the TEOAE to use as a tool to find out susceptibility are being discussed in the article.
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