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   2015| October-December  | Volume 21 | Issue 4  
    Online since October 16, 2015

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Audiometric notching at 4 kHz: Good screening test for assessment of early onset of occupational hearing loss
Gaurav Agarwal, Prakash S Nagpure, Kamana Sindhu Pal, Amit Kumar Kaushal, Manish Kumar
October-December 2015, 21(4):270-273
Context: In noise induced hearing loss (NIHL), cochlear hair cells are damaged by exposure to loud sound. The basilar membrane is tonotopically organized with the lowest frequencies preferentially transduced at the apex and the highest frequencies at the base. On the basilar membrane, the outer hair cells area corresponding to the 4 kHz and the adjacent areas of 3 and 6 kHz are most susceptible to damage. Aims: To screen the factory workers for early onset of NIHL. Subjects and Methods: Study was done over a period of 2 years that is, from September 01, 2011 to August 31, 2013 on 341 steel factory workers. Workers having a minimum of 5 years of noise exposure were included whereas workers having age >45 years or with conductive hearing loss that is, air-bone gap >10 dB were excluded from the study. Results: It was found that factory workers showed normal hearing, when calculated as average of 500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz but they have started developing the early changes of NIHL in the form of notching at 4000 Hz frequency described as threshold shifts. It was seen that 198 right ears out of the total 341 studied showed threshold shifts >25 dB in 4 kHz frequency, even then 70 (35.35%) right ears showed hearing in normal range. In case of left ears 198 out of the total 341 studied showed threshold shifts >25 dB in 4 kHz frequency, even then 97 (48.99%) left ears showed hearing in normal range.
  23,802 593 1
Tympanometric patterns in patients undergoing cartilage tympanoplasty of 0.6 mm thickness
Bandar Al Qahtani, Mohammed Al Tuwaijri, Fahad Al Tamimi, Abdullah Al Majed, Mohammed Wasi, Ameer Al Jabber
October-December 2015, 21(4):233-237
Background: Tympanoplasty has been reported as early as in 1640 by Marcus Banzer, since then many different techniques have been developed for this procedure. The aim of this study is to analyze the tympanometric findings in those patients who underwent cartilage tympanoplasties of 0.6 mm thickness and in order to check different tympanometric patterns obtained in these patients. Materials and Methods: A prospective study was conducted on 60 patients diagnosed clinically with chronic suppurative otitis media in outpatient clinic between 2010 and 2013, in which a cartilage tympanoplasty of 0.6 mm thickness was planned. These patients were evaluated clinically and by pure tone audiograms and tympanograms for cartilage uptake and any late complications. Results: A total of 26 patients were included in our study. The male to female ratio was 3:1 and mean age was 36.1 years. The mean external canal volume of these patients was 0.928, and all of them had a closed air-bone gap. Ten patients had Type As tympanogram which represented 41.6%, 8 of these patients were females. The mean external canal volume of the patients with Type As tympanogram was 1.61. Only one patient had Type A tympanogram with external canal volume of 1.9 and a closed air-bone gap, he was a case of left cartilage tympanoplasty. Type B tympanogram was also found in only one patient who had left cartilage tympanoplasty, with external canal volume of 1.3 and a closed air-bone gap. No patients had Type C or Type Ac. Conclusion: Use of cartilage of 0.6 mm thickness in tympanoplasty for tympanic membrane perforation repair results in excellent outcomes and most common pattern of tympanogram is non-A, B, C postoperatively.
  9,998 2,519 1
Ossiculoplasty: A historical perspective
Narmaya Thapa
October-December 2015, 21(4):231-232
  3,235 9,038 3
Palatal myoclonus: A long follow-up experience
Viresh Arora, Mike Smith
October-December 2015, 21(4):294-297
Palatal myoclonus is an extremely rare neurotological disorder presenting to an otolaryngologist. It presents as objective tinnitus which is due to rhythmic, involuntary movements of the soft palate causing distress to the patients. Different medical and surgical remedies have been attempted with variable success. Botulinum toxin has been reportedly used in few cases and has reproduced good results lasting for a few months with minimum morbidity. We report a case suffering from palatal myoclonus for about 15 years and injection of botulinum toxin into his tensor veli palatini muscle resolved his objectionable unilateral tinnitus. Optimum results obtained initially, waned off over the years, for which the dose had to be gradually increased to achieve the desired clinical results.
  11,848 349 3
Correlation of high-resolution computed tomography temporal bone findings with intra-operative findings in patients with cholesteatoma
Sonika Kanotra, Rohan Gupta, Nitika Gupta, Rashmi Sharma, Saurabh Gupta, Sunil Kotwal
October-December 2015, 21(4):280-285
Aim: To evaluate the role of high-resolution computed tomography (HRCT) temporal bone in patients with active squamosal chronic otitis media (COM). Materials and Methods: Totally, 47 patients with active squamosal COM underwent preoperative HRCT temporal bone followed by surgery. Their intra-operative findings were considered as the gold standard and were compared and correlated with the radiological findings, to calculate the sensitivity, specificity, positive and negative predictive value of HRCT temporal bone. Results: According to the present study, HRCT was highly sensitive for detecting mastoid pneumatization, soft tissue extension, ossicular erosion, tegmen and sigmoid sinus erosion, and less sensitive for fallopian canal erosion and lateral sinus fistula. It was specific for all these parameters. Conclusion: The present study concludes that HRCT can be recommended not only in cases suspected with potential complications but also in all cases of COM to know the extent of disease, varied pneumatization, and the presence of anatomical variations, which should alert the clinician and guide in surgical approach and treatment plan.
  4,378 539 4
Otogenic brain abscess: A rising trend of cerebellar abscess an institutional study
Rupam Borgohain, Ramen Talukdar, Kunal Ranjan
October-December 2015, 21(4):286-289
Chronic inflammation of the middle ear is the most frequent cause of otogenic complications. Meningitis is the most frequent intracranial complications, followed by otogenic brain abscess in neglected otitis media. Although temporal lobe abscesses are more common than cerebellar abscesses, the converse was found to be true in our series of 17 cases. 16 cases of cerebellar abscess and 1 case of temporal lobe abscess were reported as a complication of chronic otitis media (COM). In our group of patients, otogenic brain abscesses were more frequent in male patients of age group 5–20 years with mean age of 14 years. Diagnostic procedure included history, clinical, otorhinolaryngological examination, audiological, microbiological, neurological, ophthalmological, and radiological examinations. The treatment included primary neurosurgical approach (abscess drainage) followed by radical otosurgical treatment.
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Latency-intensity function of speech evoked auditory brainstem responses in individuals with moderate sensory neural hearing loss
G Archana, MM Kishan, Vimal Kumar, B Rajashekhar, Hari P Prakash
October-December 2015, 21(4):254-259
Introduction: Compared to click evoked auditory brainstem response (ABR), speech evoked ABR holds an additional advantage by providing information on neural encoding of speech sounds. There is limited data available on speech ABR, both in normal and pathological ears. Aim: The present study focused on finding the latency-intensity function of speech evoked ABR in moderate sensorineural hearing loss (SNHL). Materials and Methods: Speech ABR was done using the standardized protocol on 13 ears with moderate SNHL were chosen from 20 participants. Results: Speech ABR recording on these ears produced V Peak till 60 dBnHL which was at the level of 10 dBSL. Results showed that the absolute latency of V Peak at the threshold level, that is, at 60 dBnHL was found to be 8.11 ms; 6.68 ms at 70 dBnHL; 5.96 ms at 80 dBnHL; and 5.41 ms at 90 dBnHL. Conclusion: It can be concluded that using speech as a stimulus in evoked responses, it can result in better estimation of loudness growth pattern in individuals with cochlear pathology. A phenomenon like recruitment can be explored in detail as it gives different results in comparison to click or tone evoked responses.
  3,309 244 -
Myringosclerosis in children with chronic renal failure on regular hemodialysis
Mohammad Waheed El-Anwar, Ahmed Shaker El-Aassar, Hany El-Sayed
October-December 2015, 21(4):238-242
Objective: To find out a possible association between children with chronic renal failure (CRF) on regular hemodialysis and myringosclerosis (MS). Materials and Methods: This study included 41 patients with CRF on regular hemodialysis 3 times weekly who were compared with 41 normal children without history of ear problems matched for age and sex serving as a control. Children were assessed by history, otoscopic examination, and laboratory assessment, at the time of ear examination. Results: The incidence of affected (MS) ears in CRF children was 9/82 (10.976%). While in healthy control was 4.878% (4/82 ears) with nonstatistically significant difference (P = 0.148). Regular hemodialysis for >3 years showed significantly more MS with no significant relation to the serum levels of calcium, phosphorus, parathyroid hormone, or other recorded laboratory findings. Conclusion: Regular hemodialysis for CRF more than 3 years is associated with significantly more MS incidence when dialysis duration exceeds 3 years with no significant relation laboratory findings.
  2,316 1,170 3
Expression of 16.2kDa protein in elderly population: A quest for the detection of age related hearing impairment
Lucky Ramesh Thakkar, Shubhangi Kailas Pingle, Divya Vishambhar Kumbhakar, Aruna Anil Jawade, Rajani Ganpatrao Tumane, Pravin Naresh Soni, Ruchika Kishor Jain, Kaiser Jamil
October-December 2015, 21(4):248-253
Introduction: Age related hearing impairment (ARHI) is the most common sensory deficit in the elderly population and has become a severe social health problem. Several mechanisms have been described for hearing impairment in elderly people. Probable cause of hearing impairment may result from damage in the inner and outer hair cell, loss of stria vascularis, thickening of basilar membrane, or loss of sensory elements in the basal end of the cochlea. The aim of present study is to identify the protein biomarkers associated with ARHI using sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). Materials and Methods: Total 96 study subjects (48 experimental and 48 controls) were selected for this study. Serum samples were used for biochemical analysis and one-dimensional electrophoresis. Statistical analysis was done by GraphPad software. Results: Glucose, serum creatinine, and urea levels were in normal range and mean urea and creatinine levels are insignificantly associated with ARHI while mean glucose level is significantly associated with ARHI. Smoking/alcohol consumption did not show any significant association with ARHI. The molecular weight of the differentially expressed protein was 16.2 kDa as calculated by gel image analyzer software. The differentially expressed protein may be cochlin tomoprotein (CTP) of 16 kDa which is an isomer of cochlin protein. CTP contains all the known mutation sites associated with deafness. Conclusion: The expression of differentially expressed protein was consistently observed among experimental subjects as compared to control. This protein may help in the prediagnosis of ARHI due to added advantage of enhanced expression in subjects of ARHI. Results revealed males were more prone to ARHI than female.
  2,350 378 -
Basosquamous cell carcinoma of pinna
Vivek Sasindran, Cyril Joseph, Sathibhai Panicker, Mithra Sara John
October-December 2015, 21(4):290-293
Basosquamous cell carcinoma (BSC) is a rare cutaneous lesion with features of both basal cell carcinoma and squamous cell carcinoma. We report a case of a 75-year-old male presented in our outpatient department with an ulceroproliferative lesion left pinna extending into the external auditory canal at Stage II temporal bone malignancy. Wide excision pinna and lateral temporal bone resection with reconstruction with a pedicled fascial flap was carried out.
  2,447 211 -
To evaluate and compare the results of over-underlay graft technique with conventional underlay myringoplasty
Vineet Panchal, Joginder Singh Gulia, S P. S Yadav, Sharad Hernot, Bhushan Kathuria, Madhuri Kaintura
October-December 2015, 21(4):274-279
Objective: To evaluate the efficacy of over-underlay graft technique of myringoplasty and compare the results of over-underlay graft technique with conventional underlay myringoplasty. Methods: In this prospective study, 40 patients of either sex in the age group of 15–50 years with noncholesteatomatous chronic suppurative otitis media were recruited. The patients were initially managed medically to make the ear dry and after that they were operated upon. Twenty patients underwent conventional underlay myringoplasty and 20 patients underwent over-underlay myringoplasty. The follow-up period was 3 months. Results: Graft uptake and hearing improvement was comparable in both groups. Although the graft uptake was 5% lower in the group which underwent conventional underlay myringoplasty (90%) as compared to over-underlay myringoplasty (95%), however, the difference was not statistically significant (P = 0.5). However, there was statistically significant difference in gain in hearing threshold (gain in A-B gap) in the conventional underlay myringoplasty (14.5 dB ± 7.236) as compared to over-underlay myringoplasty (18.75 dB ± 5.349) (P = 0.04). Conclusion: The over-underlay technique, which is a hybrid of both overlay and underlay technique, allows the advantages of both methods. It improves the graft uptake rate and hearing in subtotal and large perforations.
  2,368 234 5
Auditory alterations following chemoradiotherapy: A comparative study between cisplatin and paclitaxel
Anirudh Kaul, Nitika Gupta, Rohan Gupta, IP Singh, Sunil Kotwal
October-December 2015, 21(4):243-247
Aim: To study the auditory effects of chemoradiotherapy with cisplatin and paclitaxel. Materials and Methods: Eighty patients with head and neck cancer undergoing chemoradiotherapy with cisplatin or paclitaxel were enrolled for the present study and monitored for any auditory alterations. Results: Forty-eight patients underwent chemotherapy with cisplatinum while 32 patients with paclitaxel. Hearing loss was observed along with tinnitus, vertigo, and nausea and vomiting. Conclusion: Taxanes-based chemoradiotherapy cause less auditory alterations than cisplatin-based chemoradiotherapy.
  2,138 394 -
Neurophysiologic measures of auditory brainstem responses to Hindi speech stimulus in typically developing children
Mohammad Shamim Ansari, Rangasayee Raghunath
October-December 2015, 21(4):260-265
Context: Speech evoked auditory brain stem responses (spABR) are used to assess brain stem ability to encode speech. However, brain stem representations of speech sound are affected by acoustic differences of speech, language background and experiences. Hence, linguistically and culturally specific stimulus should be used. Therefore, there is need to investigate the brain stem encoding of Hindi speech sound. Objective: The purpose of the study was to investigate the spABR to Hindi stimulus in typically developing children. Methods and Material: Total 25 atypical children of the mean age of 6.3 years with SD 2.3 years in the age range of 8-12 years were recruited. A 40ms duration Hindi stop phoneme of CV combination,da,was synthesized to gain response of consonant (transient) and vowel (sustained) portion of speech stimulus from all subjects. Results: The spABR latencies and amplitudes of discrete peaks as well as the latency, amplitude, area & slope of V-A complex were measured. The stimulus to response timing and spectral magnitudes of periodic portion were also calculated. The mean, median, standard deviation, minimum, maximum and 95% confidence interval values were calculated. Conclusions: The obtained spABR values suggest faithful representation of acoustic characteristic of speech at brain stem level. These values are found to be similar with previous reports. Hence, spABR can serve as important tools in the diagnostic work up of auditory processing deficits in children to understand speech perception and production abilities.
  2,325 174 -
Actinomycetoma of temporal bone: A rare case report
Viresh Arora, Bhanu Handa
October-December 2015, 21(4):298-302
Mycetoma is a specific chronic granulomatous disease affecting subcutaneous tissues and the dermis. It is caused by either actinomycetes or fungi. It is endemic and distributed worldwide. The clinical presentation is variable and the diagnosis being made on the presence of pustular exudates and the culture. The treatment depends on the cause, antibacterial medication for the actinomycetoma, and antifungal for eumycetoma. The prognosis is grave if neglected, requiring even amputation of the organ. Although mycetoma mainly involves the extremities, its rare involving head and neck. We report an unusual case of actinomycetoma of the temporal bone which hasn't been reported before, who had presented with a short history of discharging ear and was successfully managed.
  2,296 191 -
Has mastoid pneumatization any bearing on tympanoplasty?
Chander Mohan, Shilpam Sharma, Abhinav Srivastava
October-December 2015, 21(4):266-269
Aims: The importance of the mastoid in determining the success or failure of tympanic membrane reconstruction has been a topic of debate since long. A decrease in the mastoid air cell volume has been shown to be related to atelectatic ear diseases, cholesteatoma, and chronic otitis media with effusion. The aim of this study was to see the surgical outcome in cases of type I tympanoplasty in well-pneumatized and sclerotic mastoids. Materials and Methods: Eighty patients undergoing type I tympanoplasty were randomly selected. X-ray of the mastoid (Schullers' view) was advised in all the patients. The patients were divided into two groups. Group I having fully pneumatized mastoid and group II having sclerotic mastoid. These cases were followed up for a period of 1-year for the graft uptake. Results: It was seen that the graft uptake rate was better in well-pneumatized mastoid as compared to sclerotic mastoid. The results were analyzed and were found to be statistically significant with Chi-square value 3.94 and P = 0.047. Conclusion: As per the study, it can be concluded that graft uptake rate in cases of tubo tympanic chronic suppurative otitis media was better in well-pneumatized mastoids as compared to sclerotic mastoid.
  2,143 230 1
Helical lipoma in adult female
Ahmed Hassan Sweed, Mohammad Waheed El-Anwar
October-December 2015, 21(4):303-305
To report the unusual site of commonly presented benign tumor (lipoma). We here present a case of a 17-year-old female patient who presented with painless swelling of the helix of the right auricle slowly growing since 1-year. histopathological examination of an excisional biopsy obtained from radiation therapy helical swelling confirms the diagnosis lipoma. Helical Lipoma is a very unusual location for a very common tumor.
  2,037 160 -
Sequential pictorial account of results of sealant gel-aided cable nerve grafting in a case of iatrogenic facial nerve palsy
Produl Hazarika, Seema Elina Punnoose, Joyse Zachariah, John Victor
October-December 2015, 21(4):306-308
The uniqueness of this surgical case report is in the use of a stitchless anastomosis of the harvested greater auricular nerve cable graft with the sealant gel to the stump ends of the facial nerve. A liberal use of the gel was done in the full length of the cable graft and a folded hammock support by the temporalis fascia was used to reinforce the stability of the nerve. The restoration of the grafted facial nerve has been documented in different stages in its course of the recovery. Our review of medical literature in PubMed and Medscape search engines failed to show such a sequential pictorial account of documented nerve grafting with the use of sealant gel in the Indian perspective.
  1,438 142 -