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   2020| January-March  | Volume 26 | Issue 1  
    Online since February 19, 2020

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Landmarks for facial nerve identification in parotid surgery: A clinico-anatomical study
Sonika Kanotra, Abhishek Malhotra, Sunanda Raina, Sunil Kotwal
January-March 2020, 26(1):15-19
Background: Preserving the integrity of the facial nerve during parotid surgery depends on its exposure, and this requires a detailed knowledge of its anatomy by the operating surgeon. For easy identification of the facial nerve, a number of landmarks have been described. Objective: The purpose of this study was to review the distances of the facial nerve trunk (FNT) from four commonly used landmarks, namely the tragal pointer, tympanomastoid suture, posterior belly of the digastric muscle (PBDM), and junction of the bony and cartilaginous external auditory canal. It was a clinico-anatomic study which included 15 patients who underwent parotidectomy for various indications and 15 cadavers from the laboratory of human anatomy. Results: PBDM is the most reliable and consistent landmark. Conclusion: Considering the variation in distances of these landmarks from the FNT as reported by various authors, the closest landmark is not necessarily the best or the most identifiable and more than one landmark may need to be used for the safe identification of the FNT.
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Granular myringitis as a differential diagnosis for chronic ear discharge
Wan Nur Anis Wan Draman, Nurul Syeha Abdul Rasid, Mohd Khairi Md Daud
January-March 2020, 26(1):47-50
Granular myringitis is a localized chronic inflammation on the lateral surface of the tympanic membrane. It is characterized by the presence of granulation tissue over the involved area in the absence of middle ear disease. It is a poorly understood disease and has received relatively little attention in the literature and easily mistaken for chronic otitis media due to similarity in clinical symptoms and findings. We reported a case of granular myringitis in a 25-year-old female that represents diagnostic and therapeutic challenges of the disease.
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A study on the prevalence of diagonal earlobe crease in patients with cardiovascular disease and diabetes mellitus
Ehrlson De Sousa, Vinson Louis Gonzaga Fernandes, Harish Chander Goel, Kanhai Naik, Nina Margarida de Gouveia Pinto
January-March 2020, 26(1):9-14
Background: The diagonal ear lobe crease also known as Frank's sign is a diagonal crease in the ear lobe that extends from the tragus across the lobule to the posterior edge of the auricle. There have long been postulates of the association of Frank's sign with cardiovascular disease, diabetes mellitus and there have been studies that have said that Frank's sign is a mark of cardiovascular disease but have not linked it to the severity of the disease. Methods: In our study we aim to assess the prevalence of Frank's sign in individuals with coronary artery disease and evaluate its correlation with its severity while also seeing if the correlation exists with diabetes mellitus, laterality of the sign and hair in the external auditory canal in our setting of a tertiary care hospital amongst a sample of 152 patients with proven ischemic heart disease. Clinical data included age, gender, presence of Diabetes mellitus, severity of IHD as per angiography, grade of Frank's Sign, presence of hair in the canal and laterality of Franks sign. Results: Franks sign was more often seen around the age group of 51 to 70 years and though it was seen more often in the male population this was not a statistically significant correlation. 98 patients with IHD (64.47%) had Franks sign. Of these, 50 (51%) had Diabetes Mellitus. The presence of bilateral Frank's sign was more often associated with IHD and this was seen to be statistically significant. So also, presence of hair in the canal was shown to be having a positive Frank's sign more often than not. While severity of IHD varied almost directly with grade of Frank's sign it was not a statistically significant correlation. Conclusion: Therefore, we may presume that the presence of the DELC correlates to some extent correlate with ischemic cardiovascular disease it does more so when bilateral. Though many patients also have diabetes mellitus, the co-existence was not found to have statistical significance and larger studies will be required to prove its usefulness in this regard.
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Comparative study of tympanoplasty and its outcome in various age groups using the middle ear risk index scale
Sushil Kumar Aggarwal, Reskey Dev
January-March 2020, 26(1):4-8
Introduction: Otitis media is an important and a highly prevalent disease of the middle ear and poses serious health problem world-wide especially in developing countries where large percentage of the population lacks specialized medical care. With a large number of patients frequently undergoing tympanoplasty for chronic suppurative otitis media (CSOM), it is important to assess the severity of the disease and predict the outcome of the surgical management. Aims and Objectives: To study the efficiency of MERI in predicting the outcome of tympanoplasty in all age-groups. Materials and Methods: A prospective study was carried out in the department of Ear Nose and Throat (ENT), Banaras Hindu University (BHU), Varanasi, where all cases of chronic suppurative otitis media in the age-group of 8–40 years were included from September, 2017 to December, 2018. Total 74 patients with unilateral or bilateral perforation of tympanic membrane were included and these were followed-up for 4 months after surgery. Results: Maximum cases fell under MERI 1-3 (mild disease) and these patients had the best prognosis after tympanoplasty. Patients with unilateral perforation had better success rate as compared to patients with bilateral perforation. Conclusion: Our study showed that myringoplasty is a good treatment modality in the paediatric population and MERI scoring can be useful in predicting the outcome of tympanoplasty in all age-groups.
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Physician attachment to stapedectomy: A comparison of survey responses
Johanna Wickemeyer, Virginie Achim, Miriam Redleaf
January-March 2020, 26(1):1-3
Objective: To demonstrate that surgeons who perform stapedectomies derive intrinsic enjoyment from the procedure. Subjects: An experimental group of 174 otologists/neurotologists who possibly perform stapedectomy, one control group of 145 head/neck oncologists who possibly perform parotidectomy, and a second control group of 365 pediatric otolaryngologists who possibly perform tonsillectomy. Intervention: Observational study using four-question anonymous surveys distributed by electronic mail. Outcome Measures: Responses to surveys by participants during a four-week period. Results: During the four-week survey periods, 84/174 neurotologists (48%) responded, while 33/145 oncologists (23%), and 87/365 pediatric otolaryngologists (24%) responded. Seventy-six of the 80 neurotologists who still performed stapedectomies (95%) enjoyed performing it, slightly more than the 30 of the 33 oncologists who still performed parotidectomies (91%), and appreciably more than the 67/87 pediatric otolaryngologists who still performed tonsillectomies (77%). Twenty-three neurotologists (30%) would sacrifice vacation time to perform additional stapedectomies, slightly more than 8 oncologists (27%) for additional parotidectomies, and more than the 7 pediatric otolaryngologists (10%) for additional tonsillectomies. Ten (13%) of the neurotologists, three (9%) of the oncologists, and one (2%) of the pediatric otolaryngologists would sacrifice five or more vacation days to perform more of the procedures. Conclusions: Our survey suggests that stapedectomy is intrinsically enjoyable.
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The presence of unusual bone conduction thresholds in pure tone audiometry
Wan Najibah Wan Mohamad, Maziah Romli, Mahamad Almyzan Awang, Aw Cheu Lih, Rosninda Abdullah, Mohd Normani Zakaria
January-March 2020, 26(1):54-57
In pure tone audiometry (PTA), the widely used transducer for bone conduction (BC) testing is Radioear B71. Nevertheless, the BC thresholds obtained with this bone vibrator can be questionable and invalid due to its technical limitations. In this study, we report a case where “abnormally good” BC thresholds were noted at low frequencies, possibly due to the occurrence of harmonic distortions by this transducer. In clinical settings, due to the technical limitations of the BC vibrator, it is imperative for hearing health-care professionals to properly interpret the BC results in PTA. Ultimately, having newly designed transducers (with low harmonic distortions) in clinical settings is advantageous to obtain a more accurate hearing diagnosis.
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Characteristics of hearing loss in patients with chronic kidney disease undergoing hemodialysis
Sabrina Izzattisselim, Nyilo Purnami
January-March 2020, 26(1):43-46
Background: Hearing loss in chronic kidney disease (CKD) patients undergoing hemodialysis (HD) is sensorineural and bilateral and occurs at high or low frequencies. Hearing loss in HD is caused by osmotic disorders, changes in fluid and electrolytes in the cochlea's endolymph, and possible exposure to membrane dialyzer. Objective: The objective of this study is to explain the characteristics of hearing loss in patients with CKD undergoing HD. Methods: This was a descriptive research using the secondary data from 20 ears in 10 CKD patients undergoing HD at the Airlangga University Hospital in September–October 2018. Results: Sensorineural hearing loss in 13 of 20 ears (65%) and bilateral in 6 pairs of ears (85.7%). The highest degree of hearing loss was mild in 11 of 20 ears (55%). The average hearing threshold is 32.1 dB. The average hearing threshold for each frequency is dome shaped. The highest average hearing threshold at a frequency of 8000 Hz is 44 dB. The refer results of DPOAE in 17 of the 20 ears (85%) refer result in four patients without hearing loss. The most refer results of DPOAE are obtained at a frequency of 4000 Hz. Conclusion: The most characteristic hearing loss is sensorineural, bilateral, and mild hearing threshold. The average hearing threshold graph forms a dome-shaped image that illustrates the hearing loss that can occur at high and low frequencies.
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An electronystagmographic study in post head injury vertigo patients
Stanley John, Shruthi Dechamma
January-March 2020, 26(1):27-31
Vertigo is a well-known sequelae in post head injury patients. Etiopathology is multifactorial. Vertigo is recognized in all types of head injury-mild-to-severe and is a part of the post-concussion syndrome. However, it may also present later due to degenerative process involving the vestibular system. The observations made by the analysis of the tracings of electronystagmography and by noting the corresponding code we can identify the site and side of the vestibular lesion. The present study intends to understand post head injury vertigo using electronystagmography. Objectives of the Study: To evaluate post head injury vertigo using electronystagmography, to determine the side and site of origin of vertigo, and to localize the level of lesion – peripheral, central, or combined. Methodology: Fifty patients with post head injury vertigo presenting to ENT OPD of Dr. B. R. Ambedkar Medical College and Hospital were included in the study after taking their consent. Observations and Results: Fifty patients with post head injury vertigo were subjected to electronystagmography. Young adults between the age group of 20 and 30 years were found to be the most common group involved, constituted 34% of the patients. Equal gender predisposition was observed. 1111 ENG CODE was found to be the most common type seen in 18% of the cases, followed by 0000 in 16% of patients, and 0222 seen in 16% of the patients. Bilateral peripheral lesion was the most common type seen in 36% of patients followed by unilateral peripheral lesion in 20% of patients, central lesion in 22%, and normal in 20%. Conclusion: Electronystagmography is an effective tool in the assessment of post head injury vertigo. It is useful in identifying the cause of vertigo and to localize the lesion for timely management and early vestibular rehabilitation of the patient providing better clinical outcome.
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Study of brainstem evoked response audiometry in medical students having long time mobile usage
Ruchi Kothari, Aneesh Karwande, Pradeep Bokariya
January-March 2020, 26(1):20-26
Background: Mobile phones are undoubtedly one of the most revolutionizing inventions of the 21st century and are indispensable communication tools. Concomitantly, there has also been a potential increase in the health risks associated with prolonged mobile phone usage. Electromagnetic radiations emitted from telecommunication systems absorbed by the recipient's body may bring about changes in the brain electrical activity. Brainstem evoked response audiometry allows quantifying the activity of auditory pathway, and hence, the present study was undertaken to evaluate the auditory evoked potentials in the MBBS students who have been long-term mobile users. Materials and Methods: The study was conducted using Evoked Potential Recorder (RMS EMGEP MARK-II) in the Neurophysiology unit, Department of Physiology, Mahatma Gandhi Institute of Medical Sciences. This was an observational noninterventional study design incorporating a total of 50 MBBS students, from institutional campus using mobile phones for >1 year. 25 students who used mobile phones for <30 min/day formed the controls whereas, 25 students who used mobile phones for >30 min/day formed the test group. Results: The mean age among the test group was 17.5 ± 1.4 years and among controls was 16.2 ± 2.0 years. The average latency (both the right and left ear) of waves I–V and interpeak latencies (IPLs) I–III, III–V, and I–V waves were found to be prolonged (P > 0.001) in the test group when compared to controls. The mean latencies of the left ear were significantly (P < 0.05) prolonged as compared to the right ear in the test group. Conclusion: This study revealed that there is a significant prolongation in the absolute latencies and IPLs in mobile phone users associated with the duration of usage.
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Outcome dependency on the level of task: Gap detection threshold and temporal modulation transfer function
Farooq Hussam, Udit Saxena, Venkata Damarla
January-March 2020, 26(1):32-37
Introduction: It has been demonstrated that a listener's temporal-processing capability is predictive of his or her performance on speech recognition, especially in noisy and complex environments. Aims and Objectives: The objective of the study is to check the task-related dependency of gap detection threshold (GDT) and temporal modulation transfer function (TMTF) tests in adults and children. Methods and Materials: The study was conducted on 40 normal-hearing participants, in which 20 children and 20 adults. All the participants in the study were subjected to the basic audiological evaluation. Results: It was observed that there is a significant difference (P < 0.001) between children and adults for GDT and TMTF. In the present study, the relation between GDT and TMTF and their outcome dependency has been measured to show that these two measures correlate in terms of measuring temporal resolution. Conclusions: The results shows that the average value for TMTF (8–9 ms) is comparatively more than GDT (2–3 ms), which indicates that the task involved in GDT is simpler than TMTF.
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Prominent auditory and balance disturbances in a patient with trigeminal nerve schwannoma
Nurul Syarida Mohd Sakeri, Mohd Normani Zakaria, Rosdan Salim, Nik Adilah Nik Othman
January-March 2020, 26(1):51-53
Trigeminal nerve schwannoma, a rare type of schwannoma, can be challenging to be diagnosed. Its initial clinical presentations may be subtle in nature but could deteriorate rapidly once the mass is large enough to compress the surrounding nerves. In this article, we report a case of a 55-year-old Malay female who complained of only numbness (without other symptoms) during her visit in the year 2014. As such, the otological findings were unremarkable. In the year 2017, her condition was worsening to the extent that she was not able to walk or stand independently and her hearing had dropped to a profound level in the right side. Low gain on the anterior and lateral right semicircular canals was found in video head impulse test, suggesting the hypofunction of the right semicircular system. The magnetic resonance imaging was carried out, and the presence of mass at the trigeminal nerve was confirmed. It is important to highlight that the auditory and balance can be prominently affected in trigeminal nerve schwannoma. Audiological and vestibular assessments are important to complement the diagnosis and prognosis of the patient.
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Meningitis and hearing loss during an outbreak of meningococcal meningitis
Stephen Semen Yikawe, Caleb Manya, Joseph Hassan Solomon, Ango Ali Yaroko, Nasir Aliyu, Mfon Ime Inoh, Andrew Musa Adamu
January-March 2020, 26(1):38-42
Background: A large-scale outbreak of meningococcal meningitis, serotype C, occurred from December 2016 to June 2017 in some states in Nigeria. Meningitis is associated with significant morbidity and mortality. The most common sequel of this disease is hearing loss. The mechanism could be through spread of infection to the ear via the cochlear duct. Objective: The study objective was to assess the hearing threshold of patients diagnosed with meningitis during an outbreak of meningococcal meningitis in Sokoto. Materials and Methods: This was a cross-sectional descriptive study carried out on patients diagnosed with meningitis managed at the meningitis emergency response center in Sokoto. A standardized semi-structured questionnaire was used to obtain relevant information after which the patients were examined and their hearing thresholds were measured. Results: A total of 72 patients were recruited in the study. Twenty-eight (38.9%) patients had varying degrees of hearing loss. The mean duration of illness was 3.28 ± 2.75 days. The mean duration of illness among patients with hearing loss was 5.32 ± 3.28 days and that among those without hearing loss was 1.98 ± 1.13 years (t = 6.230,P< 0.001). Steroids were administered to forty (55.6%) patients by the managing physician. Out of these, only seven (17.5%) were observed to have hearing loss. Conclusion: Meningitis is a common cause of acquired hearing loss. We observed a prevalence of early hearing loss of 38.9% among our patients. Patients who stayed longer before presenting to the hospital had worse hearing compared with those that presented earlier. We observed that steroid use was beneficial and was associated with reduced prevalence of hearing loss.
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