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   2015| July-September  | Volume 21 | Issue 3  
    Online since July 17, 2015

 
 
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EDITORIAL
Ototoxicity, drugs, chemicals, mobile phones and deafness
MK Taneja, Himanshu Varshney, Vivek Taneja, Jitendra Varshney
July-September 2015, 21(3):161-164
DOI:10.4103/0971-7749.161014  
  16,491 599 3
CASE REPORTS
Van Gogh syndrome: A rare case of bilateral ear mutilation
MK Goutham, Rajeshwari Aroor, Vadish Bhat, Marina Saldanha
July-September 2015, 21(3):222-224
DOI:10.4103/0971-7749.159701  
Self-injury is the intentional and direct injury to self that include bite, burn, ulceration, and head banging. Repetitive self-mutilation is termed the van Gogh syndrome after Vincent van Gogh a renowned Dutch painter of late 19 th century, who during a bout of psychosis deliberately mutilated his ear. Self-mutilation of ears is a rare condition seen usually in patients with mental illness. An unusual case is presented of a psychotic young man who experienced command auditory hallucinations which directed him to amputate his own ears.
  5,916 271 1
Pre- and post-auricular sinus
Rajiv Ranganath Sanji, Chandrakiran Channegowda, Sanjay B Patil, Bhavitha Anand
July-September 2015, 21(3):225-228
DOI:10.4103/0971-7749.159702  
A 16-year-old female patient presented with left preauricular sinus since birth with retro auricular swelling and discharge since 2 years. Examination revealed two puncta: one anterior to the tragal line and one posterior to it. She had a history of previous surgery at another institution. Our case had two puncta both anterior and posterior to the tragal line and the tract which was extending from anterior to the external auditory canal extending superior to it till the postauricular groove: features which are common to preauricular and postauricular sinuses. We present our use of the bi-directional approach to complete excision and discuss the anatomical basis of this approach.
  5,844 291 1
ORIGINAL ARTICLES
Role of electronystagmography in balance disorders: A clinical study
M Panduranga Kamath, S Vijendra Shenoy, Suja Sreedharan, Kiran Bhojwani, Sujith Sam Mammen, Nazeem Abdul Majeed
July-September 2015, 21(3):201-208
DOI:10.4103/0971-7749.159706  
Aim and Objectives: To evaluate the role of electronystagmography (ENG) in the diagnosis of balance disorders, to localize the level of lesion in cases of vertigo, and to classify the etiology into peripheral and central causes. Materials and Methods: This study included 120 patients who presented with primary complaints of vertigo or dizziness. The inclusion criteria were all patients with complaints of vertigo with satisfactory vision. All patients underwent a thorough examination and appropriate investigations. Patients were subjected to ENG under optimal conditions and the results were obtained in the form of a butterfly chart after analysis of the ENG data. Results and Observations: Of the 120 patients subjected to ENG, we found that half the patients who presented with complaints of dizziness turned up as normal. 39 patients (33%) were diagnosed with peripheral vestibular lesion whereas 17% showed a central lesion of the vestibular system. The presence of a vestibular lesion was confirmed by performing a Dix-Hallpike maneuver. This returned a positive result in 33% of the cases. Canal paresis and directional preponderance, which were taken as the parameters of our study were analyzed in detail and significant correlation between the two was found. For higher values of directional preponderance, the canal weakness assumed greater significance. Conclusion: ENG has proven to be a useful first-line investigation in the diagnosis of vertigo. It can also act as a useful screening tool to differentiate between classical vertigo and other causes of the disequilibrium. It has special significance in localizing the side of the lesion which is especially useful in the further management of disorders like benign paroxysmal positional vertigo.
  4,969 387 -
Comparison of canal wall incisions for tympanoplasty for large central perforations
Sohil I Vadiya, Saumya K Shah, Mamta Chaudhary
July-September 2015, 21(3):186-189
DOI:10.4103/0971-7749.159709  
Aim and Objective: To compare surgical outcomes with different canal wall incisions used in common practice for tympanoplasty for large perforations. Materials and Methods: Totally 88 patients included in the study and three groups formed. Group A consisted of 35 patients and the vascular strip incision with anterior tucking (VSAT) technique used in these patients. Group B consisted of 31 patients and the tympanometal flap with anterior tucking (TMFAT) technique used in these patients. Group C had 22 patients and the near full cuff (NFC) technique used in them. Results: Success rate of 97.15% observed for Group A, 93.55% observed for Group B and 86.36% observed for Group C patients. Most of the patients in Group A had healing time <4 weeks, whereas most patients in Group C had more than 5 weeks of healing time. Granulations were not seen in Group A, whereas 3 among Group B and 4 among Group C patients developed granulations. Canal wall sagging was seen in 1 among Group A, 2 among Group B and 4 among Group C patients. The average hearing gain in terms of improvement in air-bone gap for Groups A, B and C have been 19.62, 19.25 and 17.35 db, respectively. Conclusion: The VSAT is the method of choice in terms of better success rates and minimum canal skin related complications in postoperative period. The VSAT also provides good exposure during surgery. Hearing gain in Group A is significantly better than Group C (P = 0.023).
  4,079 358 4
CASE REPORTS
Rhino-orbito-cerebral mucormycosis: Magnetic resonance imaging
Parveen A Lone, Nisar A Wani, Majid Jehangir
July-September 2015, 21(3):215-218
DOI:10.4103/0971-7749.159700  
Rhino-orbito-cerebral mucormycosis (ROCM) is a potentially fatal fungal infection that commonly affects diabetic and other immunocompromised patients. Necrotizing and angioinvasive features of this class of pathogenic fungi facilitate spread from sinuses into orbit and brain with devastating consequences like cavernous sinus thrombosis. We describe magnetic resonance, including diffusion weighted imaging findings in a case of micobiologically documented ROCM in a 50-year-old diabetic man. Restricted diffusion was demonstrated in the distribution of infiltrating lesion right from soft issue facial component through left orbit and in the cavernous sinus. Favorable outcome was achieved with surgical debridement and prolonged amphotericin therapy.
  3,972 362 -
Ototoxicity following Vinblastine chemotherapy in a patient of Hodgkin's Lymphoma
Raj Kumar Nirban, Akhil Kapoor, Satya Narayan, Sitaram Maharia, Mukesh Kumar Singhal, Harvindra Singh Kumar
July-September 2015, 21(3):229-230
DOI:10.4103/0971-7749.161071  
Sudden hearing loss is a well-known complication of certain chemotherapeutic agents. However, vinblastine has seldom been implicated causing ototoxicity. We report a case of sudden bilateral hearing loss in a 36-year-old male patient of Mixed cellularity Hodgkin's lymphoma following standard adriamycin, bleomycin, vinblastine, and dacarbazine chemotherapy.
  3,310 231 2
ORIGINAL ARTICLES
Demographic influences on complicated chronic suppurative otitis media
Sameer Raisuddin Qureshi, Uneeba Rehman Rehman
July-September 2015, 21(3):170-173
DOI:10.4103/0971-7749.161016  
Objective: Chronic suppurative otitis media (CSOM) can lead to dreadful and fatal complications. Objective of my study is an assessment of factors leading to the development of CSOM complications in different age groups and which age group is more prone to the development of complications. And to find out most frequent complication occurring in the target population. Introduction: CSOM is a long standing infection of a part or whole of the middle ear cleft characterized by ear discharge and a permanent perforation. It affects both sexes and all age groups. Pathways of spread of infection: Direct bone erosion, venous thrombophlebitis, preformed pathways. Classification of complications: Intracranial - Mastoiditis, facial paralysis, labrynthitis, petrositis. Extracranial - Meningitis, extradural abscess, subdural abscess, brain abscess, lateral sinus thrombophlebitis, otitic hydrocephalus. Development of complications depends upon; organism's virulence, poor resistance of the patient, systemic disease, resistance to antibiotics, poor socioeconomic status, lack of awareness about healthcare, lack of availability of trained specialist. Materials and Methods: A descriptive cross-sectional study was carried out from 2008 to 2013 in ENT Head and Neck Surgery Department, Jinnah Postgraduate Medical Centre, Karachi. Record of 65 patients was selected through nonprobability convenient sampling; sample was divided into two groups according to age Group A 10-18 years and Group B 18-45 years. Data were analyzed on SPSS software; Chi-square test was used and P < 0.05 was considered significant with confidence interval taken as 95%. Results: Population means age was found to be 18.28. Population sex dominant was male 63.1%. Mean duration of complaints is 1.69. There are strong associations between duration of complaints and family income (P = 0.05), and also between age of patient and diagnosed complication (P = 0.00). Conclusions: Most of the patients were of poor socioeconomic background with disease negligence, delayed treatment, poor access to health facilities and improper use of antibiotics. Mostly low age group patients develop complications.
  2,848 349 1
Clinico-audio-radiological and operative evaluation of otitis media with effusion
Karan Sharma, Raghav Mehan, Archana Arora
July-September 2015, 21(3):174-178
DOI:10.4103/0971-7749.161017  
Aims: Otitis media with effusion (OME) is a common cause of hearing and speech impairment in children. The correlation of the clinical, audiological, radiological, and intraoperative findings was carried out so as to make a protocol for early diagnosis and management of OME. It will help prevent the more serious sequelae of OME such as tympanosclerosis, chronic adhesive otitis media, and even chronic suppurative otitis media. Methods: 300 clinically diagnosed patients of OME were studied prospectively. Thereafter, patients underwent impedance audiometry, pure tone audiometry, and X-ray soft tissue nasopharynx for adenoids. The patients were given adequate medical treatment for 3 to 6 months, and the patients who did not respond to the treatment were subjected to adenoidectomy with ear examination under magnification and myringotomy with or without grommet insertion. Results: The mean age at presentation was 5.96 years. Only 32% patients gave a history of hearing loss. About 90% patients had mouth breathing, followed by snoring (84%). About 79% ears had abnormal tympanic membrane appearance and mobility; 65.5% had an abnormality on impedance audiometry; and 69.75% had an air condition threshold level of >20 dB. About 78% patients had either Grade III or Grade IV Adenoid hypertrophy. Adenoidectomy was done in all 300 patients with myringotomy in 472 ears. Grommets were inserted in 365 ears. There was a significant reduction in mean air conduction threshold with an improvement of 8.0 dB and 7.5 dB in right and left ears, respectively at 2 months postoperatively. At 6 th month postoperative, the average improvement from baseline dropped to 6.0 dB in right ear and 5.5 dB in the left ear. Conclusion: OME is the most frequent causes of silent hearing impairment in young children which needs a close vigil. All suspected children (on clinical and otoscopic findings) must be subjected to impedance audiometry and X-ray soft tissue nasopharynx for adenoids. After the failure of medical treatment for 3-6 months, the child should be subjected to myringotomy with adenoidectomy in the same sitting. Whenever a child is planned for tonsil or adenoid surgery, he/she must undergo evaluation for OME beforehand so that the child's hearing risk can be simultaneously taken care of in the same sitting.
  2,822 364 1
Temporalis muscle fascia and cartilage palisade technique of type 1 tympanoplasty: A comparison
Kumar Subhanshu, Rohit Sharma, Vinit K Sharma
July-September 2015, 21(3):165-169
DOI:10.4103/0971-7749.161015  
Background: Chronic suppurative otitis media is one of the common causes of deafness in india and occupies a considerable amount of clinic and operating time of otolaryngologists. Materials and Methods: This was a prospective study containing 50 patients, which was further divided into two groups of 25 patient each. One group was cartilage palisade technique group and other was temporalis fascia technique group (TFT group). Detailed history and examination along with pure tone audiometry was performed. Pre- and postoperative hearing results and graft uptake were compared. All surgeries were performed through the post aural approach. Cartilage was harvested from cymba concha and fascia from temporalis muscle. Results: Hearing improved significantly when either of the technique was used. Though this was slightly better, but stastically insignificant in TFT. there was no significant difference in the graft uptake rates, but it was better in cases of Eustachian tube dysfunction when cartilage palisades were used. Conclusion: There was no statistically significant difference in results in terms of success and auditory function but cartilage palisade technique gave better results in specific conditions like Eustachian tube dysfunction.
  2,713 397 1
Nonspecific otalgia: Indication for cartilage tympanoplasty
Rauf Ahmad, Zafarullah Beigh
July-September 2015, 21(3):183-185
DOI:10.4103/0971-7749.159707  
Introduction: Myringoplasty and tympanoplasty are commonly performed otologic surgical procedures. The aim of this study was to analyze the influence of nonspecific otalgia on the successful autologous conchal cartilage and temporalis fascia graft take up in type-1 tympanoplasty. Materials and Methods: A total of 250 adult patients who met the inclusion criteria were enrolled for this study. Patients were placed in two groups (otalgia and nonotalgia group) depending upon the history of otalgia. Patients in both groups were operated (type-1 tympanoplasty) using randomly either temporalis fascia or conchal cartilage as the graft material. Follow-up of patients was done after 3 weeks, 6 weeks, and 3 months of surgery to check the status of graft take up. Result: Our study shows that patients in otalgia group in which autologous temporalis fascia was used as the graft material, the majority of patients had graft necrosis by 3 months after surgery (9.6% success only). Whereas patients of the same group in which autologous conchal cartilage was used as the graft material, successful graft take up was in 93.5% patients after 3 months of surgery. Our study shows that there was not much difference in using autologous temporalis fascia or autologous conchal cartilage on successful graft take up in nonotolgia group of patients, with success rate of 97.89% and 97.84%, respectively.
  2,711 201 -
CASE REPORTS
Tympanic membrane gangrene
DR Surya Prakash, Altaf Hussain
July-September 2015, 21(3):219-221
DOI:10.4103/0971-7749.159711  
Necrosis of tympanic membrane (TM) can be due to infections, drugs, radiation, and foreign body. Strain of group A Streptococcus is associated with acute otitis media or in immunocompromised individuals resulting in TM necrosis. Gangrene of lower limb has been described, but the selective loss of TM due to emboli is an uncommon finding. A 62-year-old female presented with sudden behavioral changes and irrelevant talk. After 2 days, she noticed a discharge from left ear. There was perforation of left TM in posterior superior and inferior quadrant with areas of the black patch around the perforation suggesting a loss of blood supply. Patient was recently detected retrovirus positive with multiple lung shadows. Patient is not on any anti-retroviral medications or other medications. The discharge started 2 days after an episode of left middle cerebral artery infarct due to emboli with no previous history of ear symptoms. Culture of discharge showed no growth. This suggests that TM might have gone for gangrene due to emboli affecting deep auricular artery branch or posterior tympanic branch, which is a branch of the stylomastoid artery.
  2,594 210 -
ORIGINAL ARTICLES
Otologic surgeries in National Ear Care Centre, Kaduna, Nigeria: A 5 years review
Grema Umar Sambo, Aminu Bakari, Musa Thomas Samdi, Garba Mohammed Mainasara, Joseph Yohanna, Abdullahi Musa Kirfi
July-September 2015, 21(3):190-193
DOI:10.4103/0971-7749.159703  
Background: Otologic surgeries that endure are based on a detailed knowledge of anatomy, physiology, and pathology of the temporal bone. Ear surgeries are challenging to most otolaryngologists practicing in Nigeria. The aim was to present a 5 years review of indications, types, complications, success, and limitations of the ear surgeries at the study center. Materials and Methods: A 5 years retrospective review of all the otologic surgeries are done under general and local anesthesia from July, 2009 to July, 2014. Results: There were 1067 patients who had ear, nose, and throat surgeries within the period under review, out of which 68 were ear surgeries. Prevalence was 6.37%, there were 25 (37%) males and 43 (63%) females, male: female 1:1.7. Age ranged from 1 to 58 years, mean age 21 ± 6 years. Chronic suppurative otitis media was the most common diagnosis 39 (57.4%) and indication for tympanoplasty 31 (46.6%). Meatocanaloplasty was the least with 2 (2.9%), mastoidectomy 7 (10.3%), myringotomy and grommet insertion 11 (16.2%), excisional biopsy 7 (10.3%), foreign body removal 4 (5.90%), tympanomastoidectomy 3 (4.40%), and pinnaplasty 3 (4.40%). Forty-one (60.3%) achieved resolution of symptoms while 8 (11.8%) had persistence of symptoms. One (1.5%) had revision surgery. The success rate is about 60.3% within the period under review. Postoperative complications (facial nerve paralysis, persistence discharge from the mastoid cavity, worsened deafness, postauricular fistula) were seen in 14 (20.6%). While 4 (5.9%) were lost to follow-up. Conclusion: Ear surgeries are still underdeveloped when compared to nose and throat surgeries in our center. Complication (chronic suppurative otitis media) was the most common indication for ear surgery. Provision of adequate training facilities, especially in the field of otology and review of the training curriculum for otorhinolaryngology residency in Nigeria is indispensable.
  2,546 207 1
CASE REPORTS
Malignant round cell tumor of temporal bone masquerading as chronic suppurative otitis media
Madhuri Dadwal, Dev Raj Sharma, RS Minhas, Shallu , Payal
July-September 2015, 21(3):209-211
DOI:10.4103/0971-7749.161039  
Chronic suppurative otitis media is a commonly encountered disease entity in pediatric population in India.Malignant small round cell tumors (MSRCT),are common malignant tumour seen frequently in pediatric age group, that are characterised by small, round, relatively undifferentiated cells. It is difficult to make a differential diagnosis due to their undifferentiated or primitive character. Immunohistochemical staining and chromosomal study is useful to categorize these tumors. Differential diagnosis of small round cell tumors is particularly difficult due to their undifferentiated or primitive character.Since these are undifferentiated tumors, treatment protocols are not well established. While combined treatments (surgery, chemotherapy, radiotherapy) is currently being applied, the tumor still has a poor prognosis. Since both CSOM and MSCRT are common in pediatric age group and have similar clinical presentations, possibility of MSCRT must be kept in mind while dealing with cases of CSOM in pediatric population. We present to you a rare case of malignant small round cell tumour of temporal bone in three years old child who presented with unsafe CSOM right ear for which Modified Radical mastoidectomy was done. But patient presented again after one month with fifth, sixth and seventh cranial nerve involvement presented with facial palsy and gradenigo syndrome of right side and nasal bleed from same side.
  2,506 213 1
Case report of congenital cholesteatoma in the oval window and posterior mesotympanum surrounding a dehiscent fallopian canal in a young adult
Mahmood A Hamed, Seiichi Nakata, Yoichi Nishimura, Kenji Suzuki
July-September 2015, 21(3):212-214
DOI:10.4103/0971-7749.159705  
Congenital cholesteatoma is defined as cholesteatoma occurring behind an intact tympanic membrane (TM). In the middle ear, it has different stages according to its site and relation with surrounding structures. We report an unusual case which is congenital cholesteatoma in the oval window and posterior mesotympanum surrounding a dehiscent fallopian canal in a young adult without obvious lesion behind intact TM, discussing its management. We have focused light in an unusual case in our practice and concluded that early intervention in such cases is recommended to prevent complications and planning a staged surgery is the treatment of choice.
  2,486 213 -
ORIGINAL ARTICLES
Abnormalities of incus in chronic otitis media and methods of ossiculoplasty using remnants of incus or cartilage
Sohil I Vadiya
July-September 2015, 21(3):194-196
DOI:10.4103/0971-7749.159704  
Aim and Objective: To study various erosion patterns related to incus and observe results of various methods of ossiculoplasty using autologous incus or cartilage. Materials and Methods: A total 82 cases found suitable for the study having some abnormalities of incus with inclusion criteria being presence of intact and normal malleus and stapes and where canal wall preserved. Cases were divided into four groups with group A having minimum erosion of lenticular process and group D includes those cases where incus found absent. Results: Appropriate methods of ossiculoplasty performed using remnant of incus or tragal cartilage and hearing results compared. More than 75% of cases had a postoperative air-bone gap (ABG) <25 db in all groups with group C having 85% of cases with <25 db ABG at 1-year after surgery. No statistically significant difference observed in ABG at 3 months and 1-year. Conclusion: Abnormalities of incus are commonly observed during tympanomastoid surgeries and ossiculoplasty using remnant of incus or cartilage offers a good improvement in hearing.
  2,235 232 -
Tinnitus: A hospital-based retrospective study
Hanifa Akhtar Laskar, Neizekhotuo Brian Shunyu, Jayanta Medhi, Md Jamil, Collete Nongsiej, Eusebia Khyriem
July-September 2015, 21(3):197-200
DOI:10.4103/0971-7749.159710  
Aims and Objectives: To find out age, sex, laterality distribution of patients with tinnitus, to investigate the type and characteristics of associated hearing loss and to find different etiology causing tinnitus. Materials and Methods: Retrospective hospital-based study. Data collected for 154 patients who attended tinnitus clinic of Department of ENT of our institute during the year 2013. Patients with incomplete data were excluded from the study. Results: Among 154 patients included for study, 73 were male and 81 were female. The highest percentage of patients were in the middle age group of 41-50 years (27.9%) followed by 31-40 years (18.83%) and 51-60 years (16.2%) with decreasing number of patients in both younger and elderly age group. Conclusion: Tinnitus can affect any age group but its prevalence increases with age without any gender predilection. Left ear involvement is slightly more common among unilateral tinnitus. Sensorineural hearing loss is most common factor associated but in one-sixth of the cases no cause has been found for tinnitus.
  2,205 239 -
Universal hearing screening vs targetted hearing screening: Make a choice
Chandrakant Vishwakarma, Rupali Mathur, Rajesh Vishwakarma, Sachin Jindal, Pawan Sharma, Vikas Sinha
July-September 2015, 21(3):179-182
DOI:10.4103/0971-7749.161023  
Introduction: Universal newborn hearing screening (UNHS) is mandatory in all developed country and is setting the trend in developing country too. Due to a large population, lack of education, less professionals, and limited access to such facilities in India few places targeted hearing screening (THS) is coming up. However, the comparison between UNHS and THS is less investigated till date. Aim of the Study: This study aimed to investigate the comparison between two hearing screening program that is UNHS and THS in the Indian context. Methods: In UNHS all the infants were screened at Tertiary Centre and for THS only infant with high-risk factors were screened at Advanced Audiological Centre. Further, all referral, screening, and diagnostic data were included in data analysis of both hearing screening program. Result: UNHS was difficult due to some system failure and a lot of time was wasted doing the different procedure. However, THS was much easier and false-positive and negative were lesser. Conclusion: In a vast population country with lack of manpower for the fi eld, it is important to have an alternative approach to the system for better outcome of the program.
  2,137 255 1
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