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   2017| July-September  | Volume 23 | Issue 3  
    Online since August 31, 2017

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Radiological changes in anatomy of temporal bone in cases of unsafe chronic suppurative otitis media: A retrospective study
Vinit Kumar Sharma, Neeraj Prajapati, Rohit Sharma, Zafar Iqbal, Shubham Dadoo
July-September 2017, 23(3):176-179
Introduction: The ability of high-resolution computed tomography (HRCT) to depict the status of structure of the temporal bone represents a major advance in delineating pathology before surgical exploration of ear in cases of unsafe chronic suppurative otitis media (CSOM) or cholesteatoma. Aims and Objectives: The aim of this study was to evaluate the role of HRCT temporal bone in cases of unsafe CSOM and to assess the erosion of various structures in middle ear cleft. Study Design: This was a retrospective analysis. Materials and Methods: Fifty HRCT scans of temporal bone of the patients who were diagnosed as case of unsafe CSOM were selected and analyzed retrospectively. Criterion for inclusion was CSOM with cholesteatoma or granulations or polyp or posterior canal wall sagging or foul smelling discharge. In HRCT scans, 1 mm thickness sections were studied in both axial and coronal planes. Criterion for exclusion was history of previous ear surgery, history suggestive of head injury or skull base trauma in the past or known cases of temporal bone neoplastic pathology. Results: Maximum number of patients belonged to the age group of 21–30 years. Ossicular erosion was the most common (90%) finding followed by scutum erosion (84%). Erosion of sigmoid sinus plate was seen in only one case (2%). Cochlear promontory fistula was seen in none of the computed tomography scans. In ossicular chain, incus was the most common ossicle to be necrosed (92%) followed by malleus (66%). Conclusion: HRCT temporal bone delineates the location and extent of the disease and provides information on anatomical variations and complications.
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Preauricular sinus: A comparative study between different surgical approaches
Ahmed Shaker ElAassar, Mohammad Abd-El Hady, Sherif M Askar, Hazem Said Amer, Mohammad Waheed El-Anwar
July-September 2017, 23(3):193-196
Background: The preauricular sinus is a congenital abnormality of the external ear that is usually asymptomatic. However, if recurrent infection, persistent discharge or abscess formation occurs, complete surgical excision of the sinus is required. Objective: The objective of the study is to compare the long-term results of the preauricular sinus excision by simple sinectomy, microscopic-assisted sinectomy, and supra-auricular approach. Patients and Methods: Patients who had symptomatic preauricular sinus scheduled for surgical excision were randomly categorized into three groups: Group A (sinectomy) for whom preauricular sinus was excised by simple sinectomy using methylene blue; Group B (microscopic-assisted sinectomy) treated by simple sinectomy using the microscopic to follow, dissect out and excise the sinus tract(s); and Group C (supra-auricular approach) treated by the supra-auricular approach. Results: Excisions of 68 preauricular sinuses were carried out in 58 patients. The mean follow-up period was 19.7 months with a range of 9–30 months. The overall recurrence rate was 13.4% (9 cases). The timing of recurrence ranged from 3 to 6 months (3–12 months). The simple sinectomy technique had the highest recurrence rate (28%). The recurrence rate of the microscopic-assisted technique was 15% while the supra-auricular approach had the lowest recurrence rate (3.4%). Conclusion: The supra-auricular approach offers the most favorable outcome for the management of the preauricular sinus.
  5,434 338 1
Comparison of myringostapediopexy and malleostapediopexy tympanoplasty with sculptured incus in case of hearing reconstruction in tubotympanic chronic otitis media: A case series
Virendra Pratap Singh, Neha Sharma, Chetan Bansal
July-September 2017, 23(3):189-192
Introduction: Chronic suppurative otitis media (CSOM) is a burden on Indian population due to hearing loss due to deformation of the ossicular chain which needs reconstruction (ossiculoplasty). This study is an attempt to analyze the use of autogenous incus in ossiculoplasty for the same. Aim: The aim of this study is comparison of malleostapediopexy and myringostapediopexy in seventy cases of tubotympanic CSOM. Materials and Methods: Seventy patients with CSOM were operated and tympanoplasty was done. Ossiculoplasty was done using incus interposition as malleostapediopexy and myringostapediopexy and results analyzed. Results: In the present study, the pre- and post-operative air-bone gap values for myringostapediopexy cases were 38.00 ± 6.84 and 27.28 ± 5.12, respectively, and for type malleostapediopexy were 37.95 ± 7.51 and 18.08 ± 4.34, respectively. Statistical Test Used: Unpaired t-test. Conclusion: A better outcome was seen in malleostapediopexy than myringostapediopexy.
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Comparative study of speech and language development in children with normal hearing and cochlear implant in Iran
Hamed Ahmadi, Hamed Mahmoudian Sani, Gholamreza Farnoosh, Mohammad Reza Mahmoudian Sani
July-September 2017, 23(3):135-140
Today, cochlear implant provides an appropriate opportunity for the development of speech and language in children. In some studies, the age of children at the time of surgery has been stated as the most important factor in the development of speech and language of children after cochlear implant, while in other studies factors, including participation in rehabilitation programs, parental educational level, and lack of other disability have been regarded as key factors in the development of speech and language in these children. This review aims to assess the conducted studies in Iran to identify factors contributing to improving the auditory perception, language, and other skills in children with cochlear implants in comparison to children with normal hearing. The purpose of this study is to review the results of studies conducted on speech and language abilities in children with cochlear implant compared to the normal group in Iran. Directory of Open Access Journals, Google Scholar, PubMed (NLM), LISTA (EBSCO), and Web of Science have been searched. cochlear implants in deaf children before language learning results in the acquisition of speech and language skills in children. Timely detection of hearing impairment, early implantation, duration of hearing, and parental involvement in the rehabilitation process are important factors that affect the development of speech and language. The child's age at the time of implantation, continued participation in rehabilitation programs and the lack of associated problems directly impact the development of auditory perception, speech and language of children with cochlear implant while family education level indirectly impacts this developmental process.
  4,263 515 2
Significance of round window niche drilling for cochlear implant surgery
Deepak Dalmia, Sanjaya Kumar Behera
July-September 2017, 23(3):141-145
Aim: The aim of this study is to determine the extent of round window niche (RWN) drilling for optimal visualization of the round window membrane (RWM) during cochlear implant surgery. Materials and Methods: This is a prospective study of 38 candidates between 1 and 8 years for cochlear implant surgery from March 2014 to March 2016. We classified the visibility of RWM and its cover by RWN on the surgical view through the posterior tympanotomy during surgery into four types (1) Type 1 - fully visible, (2) Type 2-2/3rd (75%–99%) of RWM visible, (3) Type 3 - ½–2/3rd (50%–74%) of RWM visible, and (4) Type IV - ¼th–½ (25%–49%) of RWM visible. Extent of drilling of RWN into (1) drilling of anterosuperior and superior lip, (2) drilling of anterosuperior, superior, and posterosuperior lip, (3) drilling of the anterior lip with anterosuperior, superior, and posterosuperior lip, and (4) drilling of the posterior lip with Type III drilling. Results: Type-4 RWN is the most common and Type-1 least common. The extent of drilling most commonly performed was Type IV drilling of anterosuperior, superior, and posterosuperior and anterior and posterior lip of RWN. Conclusion: Sufficient drilling of the bony overhang is essential for complete exposure of RWM for insertion of electrodes without any hindrance.
  4,260 480 2
Pseudomonas aeruginosa and its sensitivity spectrum in chronic suppurative otitis media: A study from Garhwal hills of Uttarakhand State, India
Deepak Juyal, Munesh Sharma, Vikrant Negi, Rajat Prakash, Neelam Sharma
July-September 2017, 23(3):180-184
Introduction: Chronic suppurative otitis media (CSOM) is a chronic inflammation of the middle ear and mastoid cavity, with recurrent ear discharge through a perforated tympanic membrane. It is a major health problem in developing countries causing serious local damage and life-threatening complications. The advent of sophisticated systemic antibiotics and their irrational use has led to the emergence of multidrug-resistant (MDR) bacterial strains and disease complication in return. Pseudomonas aeruginosa, one of the most common organisms to cause CSOM, is a notorious pathogen and is known for its MDR attribute. Objective: The aim of this study was to know the prevalence of P. aeruginosa among the patients suffering from CSOM, to analyze their antimicrobial susceptibility pattern, and to find out MDR P. aeruginosa strains. Materials and Methods: A total of 571 patients clinically diagnosed of CSOM were enrolled in the study (559 patients with unilateral and 12 with bilateral discharge), and 583 samples were obtained from them. Sample processing and identification was done by standard bacteriological methods. One hundred eighty-seven strains were identified as P. aeruginosa and were subjected to antimicrobial susceptibility testing for 10 different antibiotics categorized into five classes. Results: Of total 583 samples collected, growth was seen in 576 (98.8%) samples. P. aeruginosa strains were isolated from 187 (32.1%) samples. Piperacillin-tazobactam (75.4%), amikacin (74.3%), imipenem (70.6%), and cefepime (69.0%) were found to be the most effective antibiotics. Twenty-nine (15.5%) strains were resistant to all the five classes of antibiotics tested. The rate of resistance to fluoroquinolones (48.7%) was highest, followed by antipseudomonal penicillin (41.7%), and was lowest for carbapenems (29.4%). Conclusion: Knowing the etiological agents of CSOM and their antibiogram is of paramount importance for an efficient treatment and prevention of both disease complications and antimicrobial resistance.
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Comparative assessment of grommets with topical intranasal steroid in cases of otitis media with effusion
Sushil Suresh Chavan, Prakash S Nagpure
July-September 2017, 23(3):146-150
Aim: This study of 56 patients is to assess the effectiveness of grommet insertion compared with non-surgical treatment steroids (topical intranasal) in otitis media effusion (OME) cases and study complications related to the grommet and topical intranasal steroid. Material: A total subjects of various age groups attending out patient department of ENT, Kasturba Hospital, MGIMS Sevagram, Hospital, Wardha from june 2013 to august 2015 who meet the inclusion criteria and give their written consent in local language will be included in the study. Method: Comparison of medical and surgical management were done. Medical management include topical intranasal steroids by Mometasone fuorate. The recommended dose for treatment of the nasal symptoms is 1 spray (50 microgram of mometasone furoate in each spray). Recommended duration of spray is 2 to 4 weeks and the stated achievement of effect of spray is approximately 1 to 2 weeks. Surgical management include myringotomy with grommet insertion. Generally, myringotomy is performed in conjunction with the insertion of a polyethylene tube called as grommet. Infants and small children are best managed by performing this procedure under a general anesthetic. In older children and adults, local anesthetic can be used as a single block in posterior canal wall so as it block Arnold“s nerve. Results: From this present study cases of children 10 (47.62%) patients shows improvement and 17 (48.57%) adult patient shows improvement having minimal difference. Similarly failure of treatment in children is 1 (4.76%) complications in 2 (9.52%) and in adult patients 0 (0%) complication in 2 (5.71%) it was not showing significant differences. p value was not significant and showing that the differences in value was not having any level of significance in same group. It is concluded that topical nasal steroids are not so effective as surgical drainage of exudative material (myringotomy). Conclusion: Use of steroid causes nasal irritation and temporary relief only and in some patient causes only retention of fluid. Sometimes grommet retained in tympanic membrane and not extruded out needed manual removel. Beside that Overall results are in the favour of myringotomy with grommet insertion as a better modality.
  3,899 411 -
Impact of smoking and tobacco addiction on sensorineural hearing loss among normal healthy participants: A cross-sectional cohort study
Balaji Sekher, Vikas Sinha, Sushil G Jha
July-September 2017, 23(3):151-154
Background: Cigarette smoking and tobacco addiction is one of the major health issues worldwide. Tobacco addiction is generally related to health issues such as chronic obstructive pulmonary disease and heart disease hypertension. It is also said that tobacco addiction causes sensorineural hearing loss (SNHL). Aim and Objective: The aim of this study was to show direct correlation between tobacco addiction and SNHL. Materials and Methods: In our study, sixty participants who are addicted to tobacco products at least minimum of 20 years were taken as subjects and matched with age-specific controls who do not have any tobacco addiction. They were asked to undergo basic history taking session, otoscopy, and pure tone audiometry, and results were analyzed. Results: SNHL is more common in tobacco users than the age-specific control group. Conclusion: TObacco addiction (both smoking and tobacco chewing) is associated with increased risk of developing SNHL.
  3,923 370 1
Basal cell carcinoma of the Auricular concha
Mohammad Waheed El-Anwar, Mohamed Salah
July-September 2017, 23(3):200-202
Basal cell carcinoma (BCC) is the most common skin cancer. Eighty percent of BCC affect the facial skin. The important challenge is removing all tumor cells to avoid recurrence because recurrent tumor is more difficult to cure. The current study describes the first surgically removed BCC of the concha and describes its management. A 65-year-old woman presented with left painless fixed conchal swelling proved by punch biopsy to be BCC. This mass was totally removed with 0.5 safety margin with excision of all the conchal cartilage and lower part of ascending ramus of the helix. Postauricular raw area was left to be healed with frequent dressing. Histopathological examination confirmed the diagnosis of BCC and proved free surgical margin. The patient was cosmetically satisfied and symptom free up to date without complication or recurrence. A case of BCC of the conchae was reported and could be safely and completely removed. This directs surgeon attention to BCC as a cause of conchal swelling as an early diagnosis when it is still small allows easy, safe removal without the need for reconstruction.
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Reimplantation of an amputated pinna: A case report and review of literature
Brajpal Singh Tyagi, Sushant Tyagi
July-September 2017, 23(3):208-210
Management of the partial or total amputations of the external ear has always stayed a difficult problem for otolaryngologists and plastic surgeons. For successful reimplantations of these amputations, multidisciplinary approach consisting of aggressive medical therapy with broad-spectrum intravenous antibiotics, anticoagulation, and reperfusion in conjunction with efficient surgical approach is needed. The surgeon's main objective is to obtain the best cosmetic result without damaging the auricular area to allow for subsequent future ear reconstruction in case any failure occurs after replantation. To enhance the survival of a reattached ear segment, Mladick et al. have advocated the use of the retroauricular pocket. This technique involves deepithelialization of the amputated part of the avulsed cartilage, followed by reattachment to the amputation stump and then burial into a retroauricular skin pocket. This increases the surface area of the avulsed segment in contact with surrounding nutrients, maximizing the probability of graft uptake and survival. We have used this technique successfully in our case and found acceptable results with it.
  2,918 174 -
Evaluation of effects of diabetes mellitus type 2 and hyperlipidemia on hearing
Sandip M Parmar, Pushkar Khare, Meenu Chaudhary
July-September 2017, 23(3):155-161
Background: Age related hearing loss or Presbyacusis may be defined as mid to late onset, bilateral, progressive sensorineural hearing loss, where underlying causes have been excluded. In recent decades there has been a rapid progression in population aging, and with advancing age, chronic diseases and functional impairments become more common. Varying ranges of the prevalence of sensorineural deafness in subjects with diabetes and hyperlipidemia has been reported. The present study was undertaken to determine whether or not diabetes mellitus type 2 and hyperlipidemia induced auditory dysfunction. Materials and Methods: A cross sectional observational study was undertaken which comprised of a total of 200 subjects who were divided in 4 groups, which comprised of 50 control subjects in one group and 150 case subjects in the other 3 groups with presence of diabetes mellitus type 2, hyperlipidemia and those having both diabetes mellitus type 2 and hyperlipidemia. All subjects were evaluated by conducting pure tone audiometry and blood investigations like lipid profile and fasting and postprandial blood sugars. Results: It was observed that hearing loss was more prevalent (62%) and highly significant (P 0.001) as compared to controls in patients with both diabetes mellitus type 2 and hyperlipidemia together. The hearing loss was significantly more for higher frequencies in air and bone conduction thresholds. Conclusion: The prevalence of sensorineural hearing loss was increased in subjects having both diabetes mellitus type 2 and hyperlipidemia and these subjects are at a higher risk of developing sensorineural hearing loss. The hearing loss was progressive, bilateral and affected mainly higher frequencies.
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Left mastoid abscess and right automastoidectomy: Two rare complications of cholesteatoma in a patient
Boon Chye Gan, Mohd Khairi Md Daud
July-September 2017, 23(3):205-207
In most cases of cholesteatoma, patients have a history of occasional scanty ear discharge, tinnitus, and gradual progression of hearing loss that may not bother their daily activities. Therefore, late presentation may occur when this group of patients attributes little importance to the otological symptoms. We report a patient with bilateral cholesteatoma who presented with mastoid abscess on the left ear and automastoidectomy on the right ear. Early detection and management of cholesteatoma is crucial in preventing its complication.
  2,641 132 -
Beck depression Inventory-II in hearing impaired elderly patients: A presbycusis study
Mohammad Hossein Nilforoush, Mahsa Sepehrnejad, Zahra Habibi
July-September 2017, 23(3):168-170
Background and Objective: Hearing impairment is one of the most common sensory deficits in human communities. Recent studies have shown that presbycusis happens earlier than before. Hearing loss due to the aging process, or presbycusis, can cause inability to interpret sounds in speech, decreased ability to communicate and withdrew from society. Therefore these factors may lead to psychological problems such as depression. Since there are few studies evaluating the side effects of presbycusis in Iran, we started the study of depression in presbycusis clients referred to the audiology clinics of Isfahan University of medical science, Isfahan, Iran. Materials and Methods: In this cross-sectional study, the relationship between demographic characteristics and depression was determined. In order to collect information and evaluate depression, Beck Depression Inventory-II (BDI-II) was utilized and conducted on 35 cases. Results: Results indicated that 8.6fcr% had minimal depression, 14.3% with mild, 20.0% moderate depression and 57.1% had severe depression. No significant correlation between age, gender and depression was achieved. Conclusion: Using depression questionnaire such as BDI-II during aural rehabilitation process could be valuable. More complications were found in acceptance of hearing aids in elderly people with depression. Psychological treatment can be suitable while audiological management was accomplished simultaneously for this group.
  2,509 223 -
Effects of nonlinear amplification on differential sensitivity measures in individuals with cochlear hearing impairment
N Devi, G Amritha, Kishore Tanniru
July-September 2017, 23(3):162-167
Objective: The current study focused on exploring the influence of multichannel amplification with wide dynamic range compression (WDRC) on frequency, intensity, and duration discrimination measures at two frequencies in different channels of amplification. Methods: Discrimination measures were performed on twenty ears with moderate flat sensorineural hearing loss using 2-down and 1-up adaptive procedure to achieve 70.7% response on the psychometric function. All stimuli were generated through AUX script and presented using Psycon version 2.18 experimental software and delivered through the speakers oriented at an angle of 0° azimuth. Discrimination measures were performed in both aided and unaided conditions for two pure tone frequencies of 750 and 1500 Hz with 500 ms duration (on/off ramp duration of 80 ms to avoid spectral splatter) presented at a level of 20 dBSL (with reference to the threshold separately in each condition). The responses were recorded through three interval alternative forced choice paradigm with visual feedback. An average of final four reversals out of eight was considered for discrimination threshold estimation. Results and Conclusions: Results revealed a statistically significant deterioration in intensity discrimination and a significant improvement in difference limen for frequency and duration with nonlinear amplification. The deteriorated intensity discrimination scores were explained in perspectives of WDRC acting in amplification device.
  2,256 219 -
Unrare but unfamiliar preauricular pilomatricoma mimicking parotid tumor
Anna Park, Jeong Hwan Choi
July-September 2017, 23(3):203-204
Pilomatricoma is a benign skin tumor arising from the outer root sheath cell of the hair follicle that usually present in the head and neck region. Pilomatricoma usually presents as an asymptomatic, solitary, firm or hard, freely mobile, dermal or subcutaneous nodule, and exhibits no fixation to neighboring tissues and has a cartilage-like hardness. The characteristic image findings are reported as well-defined subcutaneous masses with or without visible calcification. Despite these general clinical characteristics, the preoperative diagnosis-based solely on the clinical examination is often difficult because of various manifestations frequently presented by the tumor.
  2,266 155 -
Comparison of manual and computer-assisted measurement of cochlear nerve obtained from magnetic resonance imaging
S Jeevakala, A Brintha Therese, Rajeswaran Rangasami
July-September 2017, 23(3):171-175
Objectives: Cochlear implantation of sensorineural hearing loss requires accurate measurement of cochlear nerve (CN). The precise measurement of very small structures can be improved by automated segmentation and measurement. The variability and reproducibility of the computer-assisted measurement were compared with manual measurements. Materials and Methods: The 3D-constructive interference in steady state magnetic resonance imaging (MRI) images of twenty patients who were referred for MRI in the assessment of giddiness/vertigo or fitness for cochlear implant during the period from June 2013 to June 2014 were analyzed. The CN sizes were measured manually by two independent radiologists. The automatic measurements were then performed on the same images, and its correlation and agreement were calculated between automated and manual measurements. Results: The intra-observer correlation coefficients were significantly larger for cross-sectional area (CSA) of CN using automated measurements when compared to manual measurement (intra-observer r: 0.94021 vs. 0.91437). Similarly, the inter-observer correlation for CSA of CN is also higher in automated measurements (inter measurement r: 0.94786 vs. 0.92013). Conclusions: Using computer-assisted CN dimension measurement, the intra- and inter-observer correlation can be improved when compared to manual measurements. The automated measurement can assist the radiologist in eliminating the need for tedious manual tracing and thus, the time and effort for manual segmentation are also significantly reduced.
  1,962 187 -
Simultaneous labyrinthectomy and cochlear implantation for a case of otosclerosis with intractable vertigo
Joyce Pascal Rozario, Anjali Lepcha, John Mathew
July-September 2017, 23(3):197-199
Stapedotomy, though a common surgical procedure for otosclerosis, if inadequately performed, can cause dreaded complications of vertigo and profound hearing loss. Labyrinthectomy with cochlear implantation can be considered in cases of intractable vertigo, as numerous reports have shown that the cochlea still remains responsive to electrical stimulation postlabyrinthectomy. This report presents a case of otosclerosis, with severe to profound deafness and intractable vertigo poststapedotomy surgery, which was treated with simultaneous labyrinthectomy and cochlear implantation. This patient had good control of vertigo postoperatively and the Dizziness Handicap Index score pre- and post-operative were 80 and 38, respectively, with significant improvement in speech perception.
  2,027 118 -
Multimodality approach in evaluation of common crus aplasia
Sai Kiran Pendem, Rajeswaran Rangasami, S Sanjeev Mohanty, Prabhu Radhan Radhakrishnan
July-September 2017, 23(3):211-215
Common crus aplsia is a rare congenital anomaly caused due to abnormal reabsorption of neuroectodermal tissue of membranous common crus. Three patients came to the Department of Otorhinolaryngology with the complaints of poor response to sound. Audiometry examination revealed bilateral sensorineural hearing loss. They were referred to radiology department for high resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) temporal bone as a part of preoperative cochlear implant work up. In the present study, we discuss the HRCT and MRI findings helpful in the diagnosis of this rare anomaly in three cases.
  1,974 154 -
Malnutrition among children having otitis media: A Hospital-based cross-sectional study in Lucknow District
Mahmood Dhahir Al-Mendalawi
July-September 2017, 23(3):216-216
  1,521 67 -
Speech language development after cochlear implants in prelingual children according to the age of implantation
Alexandre Caixeta Guimarães, Henrique Furlan Pauna, Silvia Badur Curi, Vagner Rodrigues Silva, Alexandre S. M Duarte, Arthur Menino Castilho
July-September 2017, 23(3):185-188
Objectives: The purpose of this article is to evaluate the results regarding speech development of implanted children according to the age of implantation. Materials and Methods: This is a retrospective study with all implanted children at a tertiary hospital from 2003 to 2010. Children were grouped according to the age of the activation of the cochlear implant (CI), gender, and etiology. The degree of oral communication and the speech development using the MacArthur-Bates scale were evaluated. Results: Fifty-six children were included, 23 of them were activated before 3 years of age and 33 between 3 and 6 years. The average time of CIs use was 66 months with no significant difference between groups. Oral communication and the MacArthur-Bates Communicative Development Inventories were significantly better in children activated before 3 years (P = 0.018). Conclusion: The oral communication and speech development of children implanted before 3 years of age were significantly better than children implanted after 3 years of age.
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