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   2017| January-March  | Volume 23 | Issue 1  
    Online since February 6, 2017

 
 
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ORIGINAL ARTICLES
Disability certificate for individuals with hearing impairment – Time to rethink
Hemanth Narayan Shetty, Jijo Pottackal Mathai, Ajith Kumar Uppunda
January-March 2017, 23(1):7-12
DOI:10.4103/0971-7749.199509  
Background: A retrospective research design was used to investigate the effect of degree of hearing loss on speech identification scores (SISs) and aided improvement in individuals with sensorineural hearing loss (SNHL) and auditory neuropathy spectrum disorder (ANSD). The present criteria (PWD Act, 2001) to issue disability certificate is suitable for individuals with SNHL, as there is a good agreement between their degree of hearing loss and speech understanding. In contrast, individuals with ANSD show severe speech understanding problems irrespective of their degree of hearing loss. Despite their problem, there are denied in giving disability certificate. The study also analyzed number of clients who have received the certificate of hearing disability, in both groups. Subjects and Methods: Clinical records of 165 clients who visited the Department of Audiology, All India Institute of Speech and Hearing, Mysore, India between October 2011 and October 2013 were reviewed. Results: Revealed that unlike SNHL, those with ANSD had no relation between the degree of hearing loss and SIS. In addition, aided improvement in ANSD was very limited and was not related to degree of hearing loss. All the individuals with SNHL, who had hearing loss above moderately severe degree received disability certificate. However, only 2 of the 36 clients with ANSD received disability certificate, although their hearing thresholds were above moderately severe degree. Conclusion: Pure-tone thresholds are not a deciding factor of speech understanding in ANSD. Thus, issue of disability certificate for ANSD should be based on SIS rather than pure-tone thresholds.
  44,976 924 2
Silver cauterization: An office procedure for repair of small tympanic membrane perforation
Mohammad Waheed El-Anwar, Mohammad El-Sayed Abd Elbary, Ibrahim Mohammad Saber
January-March 2017, 23(1):17-20
DOI:10.4103/0971-7749.199502  
Introduction: Patients with small tympanic membrane (TM) perforations often suffer from repeated infections rather than hearing loss. Repair of TM perforations is required regardless of its size, as without closure, morbidity may include hearing loss, chronic otorrhea, and cholesteatoma formation. Objective: To assess the effectiveness of the topical silver cauterization to refresh and close small TM perforation as an office-based procedure. Materials and Methods: Thirteen patients with small TM perforations were enrolled in the study. The margin of the perforation was cauterized using silver nitrate 10% that was repeated up to six times. The procedure was considered successful if there was no residual perforation within the follow-up period. Postoperative audiometry was performed before cauterization then at 3 months after. Results: Successful perforation repair was achieved in ten ears (76.9%). Mean hearing gain was 11.5 ± 8 for all cases and 15 ± 5.27 for succeeded cases. None of the patients developed infection, hearing impairment, tinnitus, vertigo, bleeding, taste disturbance, or hyperkeratosis. Conclusion: Office-based silver cautery is a safe, effective, and minimally invasive procedure. It is suitable for repairing small TM perforations with comparable success rate to conventional myringoplasty.
  8,457 393 -
The effect of mobile phone usage on hearing in adult population
Punnoose Philip, Satheesh Kumar Bhandary, Rajeswary Aroor, Vadish Bhat, Deepika Pratap
January-March 2017, 23(1):1-6
DOI:10.4103/0971-7749.199510  
Background and Objective: The widespread use of mobile phones in recent years, especially among young people, has given rise to concerns about the potential influences of its electromagnetic fields (EMFs) on human health. The present study is conducted to investigate the adverse effects of mobile phone usage on auditory functions and to study the pattern of hearing threshold in mobile phone users. Materials and Methods: The study group consisted of 150 healthy volunteers between the age group of 21 and 45 years. They were divided into three groups; Group A consists of fifty participants who were using mobile phones for more than 1 h per day, Group B consists of fifty participants who were using mobile phones for <1 h per day, (both groups for a minimum period of 4 years), and Group C consists of fifty participants who did not use mobile phones or very occasional users (<1 h per week), being taken as control group. All participants underwent tympanometry and distortion product otoacoustic emission (DPOAE) tests and the results were compared among groups. Results: It is found that the prevalence of sensorineural hearing loss was seen in 10% participants of Group A and only 2% participants of Group B, but none among Group C had hearing loss, but this was statistically insignificant. The changes in DPOAEs were studied among groups and found significant difference between Group A (>1 h/day) and Group C (control group). Conclusion: The present study revealed that prolonged and frequent exposure to EMFs from mobile phone use can cause damage to the outer hair cells, especially in the basal turn of the cochlea, which can be detected by otoacoustic emission test and can subsequently lead to high frequency hearing loss.
  4,912 581 1
Interlay Type I tympanoplasty in large central perforations: Analysis of 500 cases
Satish Jain, Nitika Gupta, Rohan Gupta, Abhinav Roy
January-March 2017, 23(1):32-35
DOI:10.4103/0971-7749.199503  
Aims and Objectives: To study the outcomes of interlay tympanoplasty (Type I) in patients with large central perforations (inactive mucosal chronic otitis media [COM]) in terms of graft uptake and hearing improvement. Materials and Methods: The present study is an analysis of database of 500 patients of inactive mucosal COM with large central perforation, who had undergone Type I interlay tympanoplasty at Jain ENT Hospital, Jaipur, during the past 5 years. Results: The graft uptake rate in the present study was found to be 96.6%, and 95.4% of the patients reported an improvement in terms of hearing with the mean air-bone gap improving from 26.08 to 10.12 dB. Conclusion: Tympanoplasty done by interlay technique has excellent results both in terms of graft uptake and hearing improvement, with minimal complications.
  4,622 404 3
Meniere's disease: A mystery! Our way to diagnose
Haris Manzoor Qadri, Arun Dehadaray, Maitri Kaushik, Danish Zamir Andrabi
January-March 2017, 23(1):13-16
DOI:10.4103/0971-7749.199512  
Introduction: Meniere's disease (MD) has long posed a diagnostic challenge. Characterized by recurrent vertigo, tinnitus, and fluctuant sensorineural hearing loss (SNHL), its presentation may limit initially to merely one or two of the above symptoms. Inability to obtain a fresh inner ear tissue leaves us to rely on hypothetical choices. Materials and Methods: Two adjuvants, glycerol test, and intratympanic gentamycin, were analyzed in our study, for their efficacy in diagnosing MD. Patients with symptoms of vertigo, tinnitus, and SNHL were evaluated. Those with presbycusis, conductive hearing loss (on pure tone audiogram [PTA]), benign paroxysmal positional vertigo (diagnosed by Dix Hallpike), retrocochlear pathology (short increment sensitivity index score below 70%), and central cause (magnetic resonance imaging angiography and neurology opinion) were excluded. Rest were subjected to glycerol test and subsequently intratympanic gentamicin. After a 6 month follow up, evaluation was performed for tinnitus and vertigo through a visual analog scale. Repeat PTA was done to look for any hearing deterioration due to gentamicin. Results: It was found that not only did glycerol positive patients get completely relieved of vertigo but also those who tested negative got completely or partially relieved of it. This shows a higher efficacy of intratympanic gentamycin as well as its significant association with glycerol test. Conclusion: This study lead us to form a strong diagnostic criterion which has already proven to be therapeutic in the management of MD.
  4,376 411 -
Influence of channel and ChannelFree™ processing technology on the vocal parameters in hearing-impaired individuals
Gopika Kizhakke Kodiyath, Kishan Madikeri Mohan, Rajashekhar Bellur
January-March 2017, 23(1):21-26
DOI:10.4103/0971-7749.199506  
Introduction: Hearing loss is common in all age ranged population. Hearing loss leads to poor speech perception in quiet and more in noisy situation. Intact system over comes problem by masking release ability and its mechanism however impaired system fails to do. Hearing aid being common rehabilitation option, strategies and technology tries to support better speech perception in noise. Hence comparative studies of technology and strategies for the betterment of impaired population are needed. Objective of the Study: Enhancing speech perception is being the mainstay of hearing aid manufactures, Comparison of ChannelFreeTM, novel technology which claiming superior speech perception with channel hearing aids, specifically for competing signals is the objective. Materials and Methods: Thirty-three clients fitted with multi-channel and ChannelFreeTM with noise reductions (NR) On, Off condition. Comodulated and Uncomodulated masking release was the outcome measure in free field condition through audiometer. Results: Overall, ChannelFreeTM performed superior over channel hearing aids. Effect of channels, NR, and modulation type of background noise played key role. Perceptually, ChannelFreeTM was significantly preferred, especially in the first time users. Conclusion: ChannelFreeTM hearing aid strategies and NR are able to process incoming signal faster in order to retain the spectral contrast and also facilitate temporal cues from the amplified speech in noise. Acclimatization period has a vital role. Updating and implementing the validated novel technologies for the hearing impaired individual is recommended.
  3,963 278 1
CASE REPORTS
Kyasanur forest disease
Pranathi Kavi, PG Bhargavi
January-March 2017, 23(1):56-58
DOI:10.4103/0971-7749.199504  
Kyasanur forest disease (KFD) a rare viral disease found to be related to the Russian-spring summer virus but differs only because of its hemorrhagic form. KFD is known to be prevalent in the Shimoga District of Karnataka, and it was first identified in the year 1957. Victims of this disease would be those who have been exposed to deceased monkeys in forests or otherwise, have been bitten by an infected tick. Some of the initial phase symptoms include persistent headaches, fever, and muscle weakness. However, the neurological symptoms begin to appear only in the second phase of the viral attack. At this stage, viral encephalopathy, meningoencephalitis, or even meningitis could manifest and lead to vast deficits. Previous literature reviews of this disease have shown no signs of language deficits. A case of a 5-year-old child, confirmed with the KFD, with diffuse encephalopathy as well as other organ functioning deficits, showed deficits in language skills.
  2,947 292 -
Congenital absence of stapedius muscle and tendon: Rare finding in two cases
Deepak Dalmia, Sanjaya Kumar Behera
January-March 2017, 23(1):43-45
DOI:10.4103/0971-7749.199511  
During surgery for otosclerosis, the surgeon cut the stapedius tendon before removing stapes suprastructure. The absence of the stapedius tendon is uncommon. In this case report, we present two cases of the absence of the unilateral stapedius tendon with muscle. During exploratory tympanotomy of the right ear in the first patient and left ear in the second patient with moderately severe mixed hearing loss, the absence of the stapedius tendon was found. The tympanic cavity was explored with the help of a Zeiss microscope by endomeatal route. The pyramidal process and stapedius muscle with its tendon were absent. Awareness of the variations or anomalies of the stapedius muscle and tendon is important for surgeons who operate upon the tympanic cavity, especially during surgery for ossicular fixation or ossicular discontinuity. As most of the time, these anomalies may be associated with the other middle ear anomalies.
  2,765 219 2
Organized hematoma of the maxillary sinus mimicking tumor
Jeong Hwan Choi
January-March 2017, 23(1):52-55
DOI:10.4103/0971-7749.199501  
Sinonasal organized hematomas are rare, nonneoplastic, benign lesions that usually arise in the maxillary sinus. They are composed of neovascularization in a hematoma and surrounding organizing fibrotic tissue. Factors that may predispose a patient to hematoma formation are vary, and the pathogenesis of the mass is still uncertain. They have the potential for progressive bony erosion and compression of adjacent structures. They are a diagnostic dilemma clinically and radiologically mimicking benign diseases such as inverted papilloma or even malignant neoplasms and causing clinicians undue worry regarding these diagnoses.
  2,734 185 1
First branchial cleft anomaly presenting as recurrent postauricular cyst
Prakriti Shukla, Uroos Fatima
January-March 2017, 23(1):59-61
DOI:10.4103/0971-7749.199505  
First branchial cleft anomalies are a special group of congenital malformations that represent <10% of all branchial cleft anomalies. They may present as cysts, swellings, or fistulas in the periauricular region or in the lateral aspect of the neck. Failure to identify these lesions can lead to delay in the diagnosis, often misdiagnosis, inadequate treatment, and subsequent recurrence. We report a case of 15-year-old girl who presented with recurrent postauricular cyst. Fine-needle aspiration biopsy was performed, and it was diagnosed as infected cystic lesion. On histopathological examination, the diagnosis was confirmed as first branchial cleft cyst.
  2,535 236 -
Not a chondroma, but a cartilaginous choristoma of the bony external auditory canal
Jeong Hwan Choi
January-March 2017, 23(1):49-51
DOI:10.4103/0971-7749.199500  
When the small white mass is found at the anterior wall of the bony external auditory canal (EAC) just in front of the short process of the malleus, the differential diagnosis of cartilaginous choristoma (CC) besides exostosis, osteoma, and keratoma should be included. CC of bony EAC is not as rare as it has been thought to be. Furthermore, it is very surprising that the term chondroma has been wrongly used to describe CC in many previous studies. In this report, I present my clinical experience with four patients with CC in the bony EAC and discuss the clinical importance of CC in differential diagnosis.
  2,629 128 -
ORIGINAL ARTICLES
Sound localization performance in children with cochlear implants using bimodal stimulation
Poonam Raj, Sachin Saini, AK Mishra
January-March 2017, 23(1):27-31
DOI:10.4103/0971-7749.199508  
Introduction: There are clear benefits of having bilateral inputs to the auditory nervous system. Hearing-impaired children are, therefore, generally fitted with two hearing aids so that they can benefit from hearing binaurally. Children who use a cochlear implant in one ear and no amplification in the opposite ear are, however, deprived of these advantages. The current study was undertaken to determine the benefits of bimodal stimulation in pediatric population. Methods and Materials: This study comprised of 20 children between 6-11 years of age with profound bilateral sensorineural hearing loss with cochlear implant in one ear and fitted with digital hearing aid in non-implanted ear. Mean sound localization score was compared in children with cochlear implant only and those with both cochlear implant and hearing aid. Result: A statistically significant difference was found between mean sound localization in both test condition under quiet surrounding. Conclusion: Hence it is suggested that the use of bimodal fitting can be considered as an effective management option in order to obtain binaural hearing benefits in children who undergo unilateral cochlear implantation.
  2,350 285 -
CASE REPORTS
Prelingual auditory verbal agnosia, A rare condition
Violeta Necula, Cristina Mirela Stamate, Krishna Luchoo, Marcel Cosgarea
January-March 2017, 23(1):46-48
DOI:10.4103/0971-7749.199499  
Auditory agnosia, agnosia for speech is a rare condition, caused mostly by stroke, in adults, while in children it is often a sequel of herpes simplex encephalitis or is associated with epilepsy, in Landau–Kleffner syndrome. This article presents a rare case of verbal auditory agnosia as a result of meningoencephalitis, caused probably by herpes simplex virus. The patient's developed encephalitis at the age of 1 year and 4 months. After her recovery, the family noticed the absence of language development. She was initially diagnosed with profound hearing loss, and the hearing aids did not help her. The speech therapy developed her lip-reading skills with a hard-to-understand pronunciation. Later, audiometry showed a nearly normal peripheral auditory system and magnetic resonance imaging revealed the characteristic brain lesions in both the temporal lobes, explaining the patient's evolution. Assessment of children with delayed speech development must consider the central hearing disorders as a differential diagnosis.
  2,453 179 1
ORIGINAL ARTICLES
To study the results of àWengen titanium clip piston prosthesis in stapedotomy
Raman Wadhera, Madhuri Kaintura, Sharad Hernot, Sandeep Bhukar, S Dheeraj, Usha Sehrawat, Jitu Sam George
January-March 2017, 23(1):36-42
DOI:10.4103/0971-7749.199507  
Objective: To study the hearing results in patients implanted with àWengen titanium clip piston prosthesis after stapedotomy. Methods: In this prospective study, 15 patients of either sex in the age group of 18–50 years having conductive hearing loss with an air-bone gap (ABG) of 30 dB or more, with an intact tympanic membrane, and A or As type of curve in tympanometry were recruited. All patients underwent stapedotomy using àWengen titanium clip piston (Kurz, Germany) which was designed to avoid the scrupulous task of crimping a piston onto the long process of incus. The results were tabulated in accordance with the guidelines set by the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery (1994) at frequencies of 0.5, 1, 2 and 3 kHz. The follow-up period was 3 months. Results: The mean preoperative bone conduction (BC) was 16.00 ± 6.02 dB, at 6 weeks postoperative was 16.58 ± 12.40 dB, and at 3 months was 16.00 ± 10.80 dB. The mean preoperative ABG was 42 ± 7.26 dB, at 6 weeks postoperative was 20.5 ± 9.77 dB, and at 3 months was 17.25 ± 10.59 dB. There was improvement in postoperative BC, as well as ABG in 14 patients (except one). Conclusion: The use of the àWengen titanium clip stapes piston gives good results in cases of stapedotomy for otosclerosis. It is easy to insert onto the long process of incus and evades the complex step of crimping. The gain in hearing post surgery is comparable with the other types of pistons reported in literature.
  2,091 133 -
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