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   2016| January-March  | Volume 22 | Issue 1  
    Online since February 16, 2016

 
 
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EDITORIAL
Nitric oxide Bhramari Pranayam and deafness
MK Taneja
January-March 2016, 22(1):1-3
DOI:10.4103/0971-7749.176507  
  25,092 454 3
ORIGINAL ARTICLES
Correlation between video-otoscopic images and tympanograms of patients with acute middle ear infection
Ching-Shiung Ting, Kuo-Wei Huang, Yuan-Chung Tzeng
January-March 2016, 22(1):10-13
DOI:10.4103/0971-7749.176508  
Objective: The tympanic membrane undergoes several changes in appearance in acute middle ear infection, which may be caused by a pressure change in the middle ear cavity. The tympanic membrane can be visualized through video-otoscopy, and the middle ear pressure can be detected through tympanometry. The objectives of this study were to assess the correlation between video-otoscopic images and tympanograms and to determine which of these tools can be used in diagnosing acute middle ear infection most efficiently and at an earlier stage. Materials and Methods: The study period was from April 2005 to August 2014, 900 patients, 1247 cases (693 males, 554 females), and 1951 infected ears were examined. Patients were encouraged to follow-up at our outpatient clinic where matched video-otoscopic images and tympanograms were obtained independently at each visit. A total of 4827 matched results were collected and their correlations were statistically analyzed using Pearson's Chi-square and logistic regression tests. Results:P< 0.05, determined using Pearson's Chi-square test, indicated a statistically significant correlation between video-otoscopic images and tympanograms. Furthermore, in 7.2% of the cases, video-otoscopy could be used to diagnose acute middle ear infection 1–2 visits earlier than tympanometry could, which was also confirmed by logistic regression tests. Conclusions: Handheld otoscopes coupled with video-otoscopes are more efficient than tympanometers in diagnosing any patient with a suspected acute middle ear infection. Video-otoscopy provides an opportunity for immediately observing the condition of the tympanic membrane, which is helpful for clinicians and patients.
  5,623 400 1
Sudden sensorineural hearing loss in adults: Our experience with multidrug high dose steroid regimen at tertiary care hospital
Vivek Gupta, Abhineet Jain, Praveer K Banerjee, Sonam Rathi
January-March 2016, 22(1):35-39
DOI:10.4103/0971-7749.176510  
Introduction: Sudden sensorineural hearing loss is a confusing and controversial issue in our practice since no standard definition, evaluation method and treatment protocol exists. It is an otological emergency with narrow golden period of treatment. Objective: To establish the early diagnosis, treatment and study the outcome of treatment. Design and Method: In a prospective study, including patients >18 year age who had presented with sudden sensorineural hearing loss in ENT opd; after ENT examination, PTA, impedance audiometry and necessary imaging, were treated with i.v. methylprednisolone and inj.methylcobalamine i.m. along with tablet Pentoxyfylline and tablet prednisolone. PTA was repeated on 4th day, 3 week, and 6 weeks after diagnosis. Results: Total 37 patients were diagnosed and treated. Majority of patients had sudden SNHL of <72 hrs. duration with severe hearing loss and tinnitus as commonest associated symptom. Idiopathic cause was commonest followed by acoustic trauma and head trauma. 35.14% patients had complete recovery while 40.54% and 24.32% patients had partial and no recovery respectively. Conclusion: PTA is single most important investigation. Prompt treatment in <72 hrs. carry good prognosis. Associated vertigo, flat audiogram, DM, HTN are of poor prognosis.
  4,676 353 1
Proportion of hearing loss in chronic renal failure: Our experience
EK Reddy, DR Surya Prakash, Manda G. K. D. Rama Krishna
January-March 2016, 22(1):4-9
DOI:10.4103/0971-7749.176503  
Introduction: This study is taken up to study the magnitude of sensorineural hearing loss (SNHL) in chronic kidney disease (CKD) patients. Two hundred patients (400 ears) who had CKD 5 and all patients underwent hemodialysis were taken into study. Methods: All patients had clinical ENT examination and audiological evaluation with pure tone audiometry and impedance audiometry. All patients had SNHL. Results: In summary, high frequencies are affected in 52%, middle frequencies in 9%, and low frequencies in 2.5% of individuals. About 2.5% of patients had hearing loss in all frequencies. Hearing loss is observed only at 8000 Hz in 10% of individuals. Among all patients, 21 patients (42 ears) underwent a renal transplant, and post-transplant duration was about 1 year, 11 patients (57%) having hearing loss. Thus, hearing loss was found in 122 (61%) members bilaterally. Unilateral hearing loss is present in 5 (2.5%) patients. Conclusion: Hearing loss is present in 63.5% individuals (249 out of 400 ears). Thus, SNHL is present in 63.5% in patients with chronic renal failure and severity correlated with duration of disease. No correlation between other covariables.
  4,253 567 -
CASE REPORTS
Sudden sensorineural hearing loss posthypothyroidism: A case study
Priya Karimuddanahally Premkumar, Varsha Vijayan, Rajith Begur Nataraj, Chandni Jain
January-March 2016, 22(1):56-58
DOI:10.4103/0971-7749.176511  
Sudden sensorineural hearing loss is defined as a loss of at least 30 dB in three contiguous frequencies over a period of three days or less. In the present study a client with sudden hearing loss post hypothyroidism is discussed. A 56 year old client reported of awakening from sleep due to ear fullness along with severe tinnitus and experienced reduced hearing sensitivity in the right ear. The client had a history of hypothyroidism and was under medication for the same. The successive audiological investigations revealed that there was no improvement from prescribed medications, even with early identification and intervention. For better treatment outcomes correct identification of the cause as well as application of cause based treatment procedure is essential. Endocrine disorder is said to be one of the causes for sudden sensorineural hearing loss and one among this disorder is hypothyroidism. The present study aimed to throw a light on this aspect by giving a detailed case report of the client who suffered sudden sensorineural hearing loss which is suspected to be a long term effect of hypothyroidism.
  4,359 277 -
Congenital aberrant internal carotid artery in the middle ear: 10 years follow-up
Ahmad Marai Aldhafeeri, Munahi M Alqahtani, Ali Khalaf Alhaidey
January-March 2016, 22(1):48-51
DOI:10.4103/0971-7749.176500  
An aberrant internal carotid artery (ICA) in the middle ear is a rare vascular anomaly causing objective tinnitus. The aberrant ICA (AICA) can mimic glomus tympanicum, dehiscent of jugular bulb, hemangioma, or cholesterol granuloma. The patient can exhibit nonspecific symptoms such as tinnitus, decrease hearing, and/or ear fullness. It is frequently diagnosed during surgery or biopsy, which may lead to massive bleeding. In this report, we present a 13-year-old girl referred from a primary health clinic with right retrotympanic mass in a routine examination. In her case, there is a history of tinnitus which increases with playing. The examination showed retrotympanic pulsatile red mass. The pure tone average discovered a mild conductive hearing loss on the same side. In addition, the images show a picture of an AICA. In this report, we also review the literature on this vascular anomaly, which may lead to serious complication if manipulated during surgery or other outpatient instrumentation.
  3,872 257 2
ORIGINAL ARTICLES
Prevalence, awareness, and preventive practices of noise-induced hearing loss in a plywood industry
Mukesh Edward, Sai Manohar, Gangadhara Somayaji, Hebin H Kallikkadan
January-March 2016, 22(1):14-18
DOI:10.4103/0971-7749.176569  
Introduction: Noise exposure is the most common preventable cause of occupational noise-induced hearing loss (NIHL); however, once acquired, it is irreversible. The predominant damage occurs to the hair cells and their associated nerves leading to the hearing loss. Objective: To determine the prevalence and also to evaluate the awareness and practices regarding prevention of occupational NIHL in the selected industry, to emphasize the critical importance of educating industry workers regarding NIHL and its prevention. Methodology: All staff working in the selected plywood industry excluding the ones with chronic otitis media were included. Relevant history, demographics, and clinical data were collected using prestructured questionnaire based proforma. All of them underwent pure tone audiometry. Results: Of 111 workers who were exposed to noise, 51.85% had NIHL, the average ambient noise being 80.5 dB. The most common complaints in workers with NIHL was hearing loss (52.6%), difficulty in hearing in noisy surroundings (43.9%), and difficulty in telephonic conversations (38.6%). There was a significant number (47.4%) who were asymptomatic. The majority had mild (56.1%) and moderate (38.6%) hearing loss. Majority of them with NIHL belonged to the age group of 30–60 years. This study showed a positive correlation between duration of noise exposure and degree of hearing loss. No one has ever used any sort of ear protection devices nor aware of health effects associated with noise exposure and its prevention. Conclusion: Considering zero awareness, screening, education, and prevention methods are emphasized to reduce the impact of noise exposure at workplace.
  3,050 413 1
Adult auditory training is it part of aural rehabilitation? Focused group discussion
G Archana, Y Krishna, B Rajashekhar, PG Bhargavi
January-March 2016, 22(1):24-27
DOI:10.4103/0971-7749.176514  
Aim: To conduct focused group discussion on audiologist and hearing aid users to find out the necessity of auditory training in adults and geriatrics. Materials and Methods: A qualitative focused group discussion was conducted on 30 audiologist and 10 hearing aid users to gather the information on auditory rehabilitation in adults and geriatrics. Eight different questions were proposed for the discussion on aural rehabilitation in these population. Discussion was recorded and analyzed for the outcome of the study. Results: The participants of the group collectively agreed that just fitting of hearing aids on adults was insufficient and that they require further auditory training to facilitate their communication skills. There was a consensus of the group on the need to develop an auditory rehabilitation program that catered to the variations of culture, language, and dialects of the same in Indian population. Conclusion: Focused group discussion revealed that adults and geriatrics should undergo auditory training after fitting hearing aid.
  3,016 312 -
Reasons for nonacceptance of hearing aid in older adults
G Archana, Y Krishna, Ruth Shiny
January-March 2016, 22(1):19-23
DOI:10.4103/0971-7749.176513  
Introduction: Hearing aids (HAs) are the electro acoustic device, developed for individuals with hearing loss. Aim: The present study was focused on analyzing the possible reasons for nonacceptance of the HAs in older adults.Methodology: A cross-sectional study was conducted in which 100 participants were enrolled in the study. Self-reported questionnaire was adapted to regional language Kannada in the first phase of the study. Adapted questionnaire was administered in individual with hearing loss in the second phase. Descriptive statistics was used for compiling the result of the study. Results: The result revealed that attitude-related factor had the highest mean score followed by device-related factor, personal, and financial-related factors. Conclusion: In developing countries such as India, still the stigma toward hearing loss and HAs are dominating these individuals and rejects them in procuring the HA.
  2,951 357 1
Pediatric rhabdomyosarcoma of the ear and temporal bone: An analysis of seven cases in Sokoto, Nigeria
Mohammed Abdullahi, SB Amutta, KR Iseh, D Aliyu, SS Yikawe, K Abdullahi
January-March 2016, 22(1):40-43
DOI:10.4103/0971-7749.176506  
Background: Rhabdomyosarcoma is a common childhood soft tissue sarcoma but rare in the ear and temporal bone region, often mimicking features of chronic suppurative otitis media. Objective: The objective of this analysis is to determine the clinical pattern, stage at presentation, traditional healer intervention, and outcome. Methodology: A retrospective study of patients under the age of 15 years with histological diagnosis of rhabdomyosarcoma of the ear and temporal bone, who presented at the Ear, Nose, and Throat Department of the Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria, from January 2000 to July 2015. Results: A total of seven patients were seen. Two (28.6%) were male and 5 (71.4%) were female. The age ranged between 3 and 9 years with mean age of 6.7 years. Clinical features mimic that of chronic suppurative otitis media. All were advanced embryonal rhabdomyosarcoma. Traditional healers performed incision in 3 (42.9%) patients with the aim of draining pus from the swelling. The incision was done with a knife and hot iron. Multimodality treatment was offered: mortality and discharge on parole to source for funds to undergo radiotherapy was recorded in 3 (42.9%) patients, but they never came back for follow-up. Conclusion: Advanced embryonal rhabdomyosarcoma of the ear and temporal bone were seen in all the patients with clinical presentation mimicking that of chronic suppurative otitis media. Outcome was not favorable because of the advanced tumor stage presentation, dangerous traditional healer intervention, and financial constraints. We recommend creation of patients' awareness and the improvement of the populace socioeconomic status.
  2,927 204 1
Smoking and its influence on success of tympanoplasty: A prospective study
Leena Jain, Sadat Qureshi, Ashish Maurya, Shalini Jadia, Manish Jain
January-March 2016, 22(1):28-30
DOI:10.4103/0971-7749.176565  
Objective: To compare the surgical outcome of tympanoplasty in smokers and nonsmokers. Design: Prospective cohort study. Setting: Tertiary Care Center in Central India. Patients: The study included 245 male patients who underwent type 1 tympanoplasty and were subsequently divided into 2 groups. Group A: Nonsmokers (115 patients). Group B: Smokers (130 patients). All the cases were operated by postaural route and underlay technique. Revision cases and patients with systemic disease were excluded from the study. Main Outcome Measures: The success rate and hearing gain at the last follow-up i.e., 6 months from the day of surgery. Results: The overall success rate of tympanoplasty in our study is 91.3% in nonsmokers and 73% in smokers. Most of the patients were in the age group 15–30 years. Smokers had significantly longer duration of complaints associated with chronic suppurative otitis media. Preoperatively, eustachian tube dysfunction was assessed by tympanometry and it showed a significant difference in both the operated and the nonoperated ears of smokers. Sclerosis in X-ray mastoid Schuller's view was seen more in smokers than in nonsmokers (P = 0.001). There was a significant difference in otomicroscopic findings of smokers and nonsmokers i.e. more patients with grade 3 and 4 pars tensa retractions in the contralateral ear (P = 0.0001). Mean gain in the postoperative air-bone gap was significantly more in nonsmokers as compared to smokers (P = 0.013). Conclusion: Smoking is a definitive risk factor in the success of tympanoplasty in terms of graft take up and hearing gain.
  2,595 232 1
CASE REPORTS
A rare complication due to button battery cell in ear
Sharad Hernot, Samar Pal Singh Yadav, Bhushan Kathuria, Madhuri Kaintura
January-March 2016, 22(1):52-55
DOI:10.4103/0971-7749.176509  
We report a case of a 7-year-old male child who presented to ENT emergency with 24 h history of excessive pain and blackish otorrhea from right ear after accidentally inserting button battery in the ear while playing. Otoscopic examination revealed a shiny and round foreign body with excessive blackening of the surrounding skin. Chest and abdominal examination and routine investigations were normal. X-ray bilateral mastoid (Schuller's view) was done which revealed a radiopaque double-contoured foreign body in the right ear. It was removed under general anesthesia and was confirmed as a button battery. A few days later, biopsy from granulation tissue and surrounding bone was taken which revealed acute suppurative osteomyelitis on histopathological examination.
  2,478 226 -
Neurofibroma of external auditory canal: An unusual differential diagnosis of aural polyp
Panduranga M Kamath, Vijendra S Shenoy, D Deviprasad, Flora D Lobo, Oj Giri
January-March 2016, 22(1):62-65
DOI:10.4103/0971-7749.176504  
Neurofibromas are circumscribed but nonencapsulated neoplasms of the nervous system. They are relatively common in the nervous system, but only a few have been reported in ear. Here, we report a case of a 38-year-old female who presented with the complaints of right ear pain and right ear obstruction. Examination revealed a mass in external auditory canal, which was excised by postauricular approach. Surgery resulted in an excellent functional outcome.
  2,432 210 -
ORIGINAL ARTICLES
Butterfly cartilage graft versus fat graft myringoplasty
Sonika Kanotra, Anil Suri, Sunil Kotwal, J Paul
January-March 2016, 22(1):31-34
DOI:10.4103/0971-7749.176502  
Aim: The aim of the study was to compare the graft take up rates of two minimally invasive techniques of butterfly cartilage graft (BCG) and fat graft myringoplasty (FGM). Materials and Methods: Two groups of 30 patients each with small dry central perforations of the tympanic membrane (T.M.) were randomly subjected to either of the two techniques of myringoplasty. Statistical Analysis Used: The results were compared using the Chi-square test. A value of <0.05 was taken as statistically significant. Results: The graft take up rate was 93.3% with BCG and 83.3% with fat graft. Conclusions: The BCG scores over FGM in small perforations of the T.M.
  2,232 241 -
CASE REPORTS
Is cholesteatoma a precursor of verrucous carcinoma: A diagnostic dilemma
Rohit Singh, Divya Hari Nair, Aarushi Mishra, Anshul Singh
January-March 2016, 22(1):59-61
DOI:10.4103/0971-7749.176515  
Verrucous carcinoma is an unusually well-differentiated variant of squamous cell carcinoma, characterized by local invasion and cytologically benign appearance. We report a case of 52-year-old male who presented with postauricular growth and cholesteatoma in the right ear. High-resolution computed tomography temporal bone showed an enhancing soft tissue mass lesion extending into the mastoid, external auditory canal, and middle ear. Growth was histopathologically confirmed to be verrucous carcinoma extending from the cholesteatoma in mastoid cavity. Review of literature confirms the rarity of cases of cholesteatoma which could progress and present as verrucous carcinoma in the postauricular region.
  2,024 199 1
Intracochlear schwannoma
Manoj Manikoth Puthiyaparambil, Sandeep Puthiya Koiloorveetil
January-March 2016, 22(1):44-47
DOI:10.4103/0971-7749.176512  
Intracochlear schwannoma is rarely diagnosed. We report the case of a 27-year-old woman with intracochlear schwannoma who presented with 7 years history of hearing impairment. Audiological tests and imaging studies revealed a possibility of intracochlear schwannoma. Excision of the tumor was done by transcochlear approach. The histologic diagnosis was schwannoma. Her postoperative course was uneventful. We present this rare case and discuss the presentation, diagnosis, and management options in such cases.
  2,016 198 -
LETTER TO EDITOR
Experiences of wearing hearing aids for past 15 years
Vagish Kumar Laxman Shanbhag
January-March 2016, 22(1):70-71
DOI:10.4103/0971-7749.176505  
  2,010 148 -
CASE REPORTS
Migrated aural foreign body in parapharyngeal space
Surya Kanta Pradhan, Sanjeev Gupta
January-March 2016, 22(1):66-69
DOI:10.4103/0971-7749.176501  
Foreign bodies in ear are very frequently encountered by an otorhinolaryngologist. They should be diagnosed and removed immediately. Otherwise it may cause complications like tympanic membrane perforation, chondritis, ossicular necrosis, facial palsy, inner ear injury or it may migrate to adjacent structures. It may migrate to subcutaneous tissue or middle ear. Migration of aural foreign body to parapharyngeal space is very rare and never been reported in literature. We are reporting this type of very unusual migrated foreign body which was recovered from the parapharyngeal space by a small incision endoscopic assisted approach after 8 years if insertion.
  1,878 173 -
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