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   Table of Contents - Current issue
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October-December 2022
Volume 28 | Issue 4
Page Nos. 265-327

Online since Thursday, December 29, 2022

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EDITORIAL  

Hearing aid interventions and its effect on hearing handicap inventory for elderly score among elders with bilateral hearing impairment: A meta-analysis on randomized-controlled trials p. 265
Navjot Kaur, C Vasantha Kalyani, Shiv Kumar Mudgal, B Athira, Rakhi Gaur, Saurabh Varshney
DOI:10.4103/indianjotol.indianjotol_58_22  
Background: Several elderly populations face impairment in hearing, difficulty in following discussions in the presence of multiple talkers, understanding the speech of unfamiliar people, understanding fast speech, and understanding speech in noisy environments. Many hearing rehabilitation programs came into the picture for the help of the elderly population. The aim of the meta-analysis was to assess the effect of hearing aid interventions on hearing handicap inventory for elderly (HHIE) scores among elders with bilateral hearing impairment in randomized controlled trials (RCTs). Materials and Methods: Two independent reviewers searched for full-text RCTs from worldwide online databases named PubMed and Google Scholar. Studies from January 2000 to January 2022 in the English language conducted among humans were considered. The search strategy contains PICO format in which P-elders with bilateral hearing impairment, I-hearing aid intervention, C-placebo, O-HHIE scores as outcome measures. Results: A total of 28 trials were identified from online databases using PICO format further on evaluation 8 trials with a total of 445 participants were included for the final meta-analysis of the study. The pooled results after sensitivity analysis revealed that 7 trials had a significant reduction in mean difference (MD) of HHIE score among elders with bilateral hearing impairment (MD-2.21 (95% confidence interval [CI] = −4.24 to −0.19), P = 0.03 with heterogeneity (I2 = 48%, P = 0.07) in the fixed-effect model. The Stratified analysis was also done between subgroups as HHIE-social/situational and HHIE-emotional scores shows no significant difference among subgroups for the reduction in a MD of scores −5.34 (95% CI −7.05, −3.64), P = 0.03 without any heterogeneity (I2 = 0%, P = 0.97) with use of fixed-effect model. Conclusion: The findings of the meta-analysis revealed that any type of hearing aids interventional program is found to be effective in reducing HHIE scores. It indicates that these interventions result in a reduction in social and emotional consequences due to hearing loss among elders with bilateral hearing impairment. Adherence to the hearing rehabilitation programs is highly recommended by the researchers to improve social and emotional aspects of life among elders.
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ORIGINAL ARTICLES Top

Malleus relocation in ossicular reconstruction by using autologous incus: New technique in ossiculoplasty, al-nahdha hospital experience p. 272
Zaina Khalfan Al Dhahli, Jagdish Zoivont Naik, Yousuf Al Saidi
DOI:10.4103/indianjotol.indianjotol_100_21  
Context: Malleus relocation is a technique in ossiculoplasty invented by Robert Vincent to make malleus at the same line of stapes. This study will use this technique with modification by using autologous incus instead of prosthesis for reconstruction. Aims: The objective of this study was to report the method of malleus relocation with auto-incus in ossiculoplasty in cases with chronic suppurative otitis media. Settings and Design: A retrospective study was done at Al-Nahdha Hospital tertiary referral center. Subjects and Methods: This is a study of 12 patients (out of 150 patients who underwent ossiculoplasty surgery done in the department) from 2012 to 2019 for chronic otitis media. This means that all patients had malleus relocation technique with use incus for reconstruction except one patient where malleus relocation done with use of prosthesis instead of incus which was absent. Audiometric assessment included pre- and postoperative audiometric evaluation using conventional audiometry. Air-bone gap, bone-conduction thresholds, and air-conduction thresholds were measured. Statistical Analysis Used: Data were collected and analyzed in SPSS version 21. Confidence interval, mean, and median are used to calculate the pre- and postoperative ABG. Results: Eleven patients underwent malleus relocation with incus interposition. The mean postoperative air-bone gap is 11, and 66.6% of cases had ABG less than or equal to 20 dB. The mean AC postoperative is 21, and 66.7% of cases show improvement of more than 20 dB. Conclusions: Malleus relocation with auto-incus ossiculoplasty showed in this study is safe and gives a good hearing outcome.
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Association between hearing loss and dementia in elderly p. 275
Devika Sinha, Rajeshwary Aroor, Vadisha Srinivas Bhat, Marina Saldanha, Srinath DP Kamath, Shashank Kotian
DOI:10.4103/indianjotol.indianjotol_68_21  
Background: Long standing hearing-loss often leads to the setting in of dementia as hearing-loss. In this study, elderly population were screened for hearing-loss and dementia using Hindi-Mental State Examination. Aims: To know the association between the dementia and Hearing loss Method 206 participants in the age group of 60-80 years (110 were females and 96 were males) were subjected to audiological evaluation and dementia screening using HMSE dementia scoring scale and it was compared with hearing level. Results: Out of 206 subjects, 110 were females and 96 were males. Right ear hearing-loss was seen in 147 cases and left ear in 130 cases. 48 individuals had no hearing-loss, 39 participants had unilateral hearing-loss and 119 participants had bilateral hearing-loss. Most common type of hearing-loss observed was mild hearing-loss 124 participants had no dementia, 82 had dementia. 60 had mild cognitive impairment and 22 had severe cognitive impairment. 49 out of 82 participants with dementia had bilateral hearing-loss. As the hearing handicap percentage increases from 1-100, dementia score decreases. But it was not statistically significant. More number of men were affected with hearing-loss but more number of female participants had dementia. Conclusion: Hearing-loss is more common in men in elderly population but dementia is more commonly seen in females.
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Type 1 tympanoplasty with and without mastoidectomy in children p. 279
Gustavo Antunes De Almeida, Filipe Correia, João Pimentel, Pedro Escada
DOI:10.4103/indianjotol.indianjotol_162_21  
Objective: Assessment of the surgical benefit in children of a canal wall up mastoidectomy with Tos Type 1 tympanoplasty over Tos Type 1 tympanoplasty alone in patients with chronic suppurative otitis media (CSupOM) with tympanic membrane (TM) perforation. Study Design: Retrospective study. Setting: Tertiary care hospital. Methods: A retrospective chart review of CSupOM patients younger than 18-years old and admitted for elective tympanoplasty between 2010 and 2013 was conducted. Primary cases of patients submitted to Type 1 tympanoplasty (according to Tos classification 1993) were selected and were divided into two groups: tympanoplasty with canal wall up mastoidectomy and tympanoplasty without mastoidectomy. Surgical success was defined as the presence of an intact TM with no disease recurrence after 2 years of follow-up. Results: From a total of 125 ears (88 pediatric patients), 59 were selected according to the inclusion criteria. The mean age of the patients was 12.5 years, with 5.1% being 7 years old or younger, 67.8% between the ages of 8 and 14 years old, and 27.1% from 15 to 18 years old. 67.8% of the patients were boys and 32.2% girls. The overall surgical success rate was 89.8%, with 88.9% in the tympanoplasty group and 90.2% in the tympanoplasty with mastoidectomy group. Audiometric improvement was observed in both groups with a mean gap closure of 14 dB ± 8.4 dB in the tympanoplasty without mastoidectomy group and 12.5 dB ± 9.5 dB in the tympanoplasty with mastoidectomy group. Conclusion: Type 1 tympanoplasty is an effective treatment of CSupOM in children. In these cases, performing mastoidectomy at the time of primary Type 1 tympanoplasty is not associated with improved outcomes.
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Managing eustachian tube dysfunction with balloon catheterization: A local experience report p. 282
ST Tan, Noor Dina Hashim, Asma Abdullah
DOI:10.4103/indianjotol.indianjotol_30_22  
Objective: Eustachian tube dysfunction (ETD) is not commonly acknowledged until it leads to sequelae within the middle ear. Thus, treatments are focusing on treating active middle ear diseases repetitively rather than identifying possible fundamental causes. This study aims to report a preliminary local experience in treating ETD using balloon dilatation. Methods: This prospective, randomized controlled study was conducted in a tertiary academic center. Sixteen patients who were identified with symptoms of ETD were recruited. Six who had failed initial medical therapy underwent balloon dilatation of Eustachian tube (BDET); meanwhile, ten subjects were recruited into the medical treatment group. The primary efficacy endpoint was the comparison of reduction from baseline in overall 7-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7) score. Added endpoints were normalization of tympanogram and improvement of tympanic membrane appearance at 2 weeks, 6 weeks, and 3 months after intervention. Results: The median in reduction of overall ETDQ-7 score for the interventional group was 2.93 (2.14, 3.14) versus 0.43 (0, 0.86) for the control group. Reduction in overall ETDQ-7 score showed a significant improvement at 6 weeks which was persistent at 3 months post balloon dilatation (P < 0.05). Similarly, the BDET group demonstrated changes in tympanogram at 6 weeks and 3 months post balloon dilatation (P < 0.05). Tympanic membrane appearances were similar at the end of the study in both the groups. Conclusion: BDET is a promising precise treatment for patients who present with symptoms of ETD. The improvement of symptoms it provides may increase the readiness for it to be introduced as a standard practice in local settings and beyond.
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A comparative study between topical versus combined (systemic plus topical) therapy in ciprofloxacin-sensitive chronic suppurative otitis media (tubotympanic) p. 288
Sandip M Parmar, Sapna Chauhan, Shweta Mittal, Meenu Chaudhary
DOI:10.4103/indianjotol.indianjotol_21_22  
Introduction: Chronic suppurative otitis media (CSOM) is defined as a chronic inflammation of the middle ear and mastoid cavity, which presents with recurrent ear discharge or otorrhea through a tympanic perforation. Aim: The study aimed to compare the effectiveness of topical versus combined (systemic and topical) therapy in ciprofloxacin-sensitive CSOM (tubotympanic). Materials and Methods: A hospital-based prospective study of 100 patients aged >18 years with clinically diagnosed CSOM (tubotympanic type) was conducted. After aural toilet, patients were randomly assigned to one of the two treatment groups: Group A (topical ciprofloxacin ear drops) Group B (topical plus oral ciprofloxacin). These patients were received 1 week of treatment and followed up on day 3 and day 7. Statistical comparisons were performed using Chi-square test. Results: In this study, maximum numbers of patients were found in the age group of 20–29 years. Patients in Group A (topical ciprofloxacin ear drops) showed less side effects in comparison to Group B (topical plus oral ciprofloxacin). Forty-one (82%) patients showed improvement in Group A, whereas 43 (86%) patients in Group B. Conclusion: Topical ciprofloxacin drops were as effective as combined (oral plus topical ciprofloxacin) and that the addition of oral drug did not have any beneficial effect adding only to the side effects and to the cost of treatment.
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Window deroofing with dental roll suturing for pseudocyst pinna, simple solution for notorious disease p. 292
Yogeesha S Beesanahalli, K Ramya, KM Ajith, Nagaraj Maradi, R Latha Bai
DOI:10.4103/indianjotol.indianjotol_66_22  
Background: Pseudocyst of the pinna is a benign cystic lesion on the lateral surface of the pinna with no definitive etiology or treatment. Various methods are currently used to manage this disease. Most of the treatment options are prone to disease recurrence and are associated with cosmetic sequelae. We report 16 cases of unilateral pseudocyst that were treated with window deroofing and pressure dressing with dental roll suturing. Aim: This study aimed to study the effectiveness of window deroofing with dental roll suturing in the treatment of pseudocyst of the auricle with respect to recurrence and postprocedural sequelae. Materials and Methods: A prospective study at a tertiary care center for 2 years, which included 16 patients with a diagnosis of pseudocyst pinna. All the patients were treated by excising a small triangular piece of skin along with perichondrium, followed by dental roll suturing for pressure dressing; and were followed up after 1 week and 1 month of surgery. Results: All 16 cases were completely relieved of the disease at the end of 1 month. None of our patients had a recurrence and only 2 cases (12.5%) showed thickening of the pinna skin. Conclusions: The surgical treatment by window deroofing with dental roll suturing technique gave a reliable result in all cases of pseudocyst pinna with no evidence of recurrence and acceptable cosmetic results.
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The credibility of a smartphone-based application for use as a hearing screening tool in underserved areas p. 296
Satish Kumar Chokalingam, Prakash Mathiyalagen, Kumaran Ramesh Colbert, Bhanu Vazhumuni, Sathiyaseelan Murugesan, Niveda Nagarajan
DOI:10.4103/indianjotol.indianjotol_60_22  
Context: Hearing loss has been rightly regarded as “invisible disability.” Globally, it is the third largest cause for years lived with disability. It is imperative to detect it early to initiate remedial measures. We intended to find a cheaper, quick, and reliable alternative to the traditional audiological services. Aims: The aim of this study was to assess the hearing levels using a self-administered smartphone hearing application and compare these results with pure-tone audiograms performed by an audiologist. Settings and Design: This diagnostic study was conducted at a tertiary care hospital in the State of Puducherry, between 2019 and 2021. Subjects and Methods: One hundred and nineteen participants were recruited; hearing screening was done using the smartphone application “Hearing Test” followed by pure-tone audiometry. Statistical Analysis Used: The results were analyzed for validity and reliability using SPSS software. Results: The mean age was 34.23 ± 9.39 years, and 57.1% had ear complaints at presentation. At the level of statistical significance of P = 0.05, no difference was found between the tests. An absolute difference of <6.712 for each frequency was observed with the average difference being 5.18 dB (95% confidence interval 5.65–4.73) with standard deviation of 3.56. The smartphone application demonstrated a sensitivity of 76.26% and a specificity of 98.99%. Conclusions: We did not find any significant difference between the application and pure-tone thresholds in any frequency. Thus, the Hearing Test application is a valid screening tool to assess hearing loss early.
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Efficacy of human epidermal growth factor in the regeneration of tympanic membrane perforation: A randomized clinical study p. 301
Anjana A Mohite, Bhagyashree Shrestha, Rajashri S Mane, Balasaheb C Patil, Vasundhara P Varute, Arpita P Yasatwar
DOI:10.4103/indianjotol.indianjotol_163_22  
Introduction: Majority of tympanic membrane perforations require myringoplasty for closure. Recently, epidermal growth factor (EGF) has been shown to promote the healing of tympanic membrane perforations. Aim: The aim of this study was to find out a simple nonsurgical outpatient procedure to close one-quadrant tympanic membrane perforations that could reduce the hospital stay, medical cost, and morbidity in these patients. Materials and Methods: An interventional prospective randomized clinical study was done on 120 patients at our tertiary hospital. The allocation ratio was 3:1. Pure-tone audiometry, otomicroscopy, and otoenodoscopic recording were performed in all eligible patients who consented to take part in the study. Ninety cases received EGF gel application, whereas 30 controls received antibiotic ofloxacin application. Trichloroacetic acid chemical cautery and fibrin glue application were done in patients of both groups. Results: The closure rate was 97.7% in the EGF group and 70% in the ofloxacin group. The time taken for closure of perforations was 10 to 14 days in the EGF group and 3–4 weeks in the ofloxacin group. Hearing gain was observed in healed perforations of both groups. Conclusion: EGF application enhances the healing effect of one-quadrant nonhealing tympanic membrane perforations. It showed encouraging results and reliable safety in the regeneration of tympanic membrane. Clinical Significance: Apart from its use in single quadrant perforation, EGF may be considered for treating residual perforations after failed tympanoplasty.
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Evaluation of cochlear ototoxicity with otoacoustic emissions and pure-tone audiogram following treatment for multidrug-resistant tuberculosis in our tertiary care center p. 306
P Thamizharasan, S Muthuchitra, SP Indu, Sumee Venkatesh
DOI:10.4103/indianjotol.indianjotol_131_22  
Background and Objectives: Hearing is a vital function and can be impaired by drugs causing ototoxicity which is inevitable in situations such as multidrug-resistant tuberculosis (MDR-TB). A longitudinal study was conducted to evaluate cochleotoxicity by otoacoustic emissions (OAEs) and pure-tone audiogram (PTA) in patients following treatment for MDR-TB. Materials and Methods: Sixty-five patients were included in the study after excluding cases as per criteria. Baseline pure-tone audiometry and OAEs were done. If asymptomatic, the patient followed up with PTA and distortion product OAE after 3 months and 6 months of treatment with a selected regimen for MDR-TB. Results: Compared to the pretreatment prevalence of 67% hearing loss, 81% of patients had hearing loss at 3 months and 97% at 6 months. OAEs were abnormal in 32% before treatment, which increased to 86% at 3 months and 97% at 6 months' follow-up. Conclusion: OAEs were able to pick up early the cochlear damage before it became apparent in PTA and well ahead of becoming symptomatic in patient. OAEs should be included in the pre- and post-treatment assessment of hearing with a high-frequency PTA for follow-up in MDR-TB patients or any patient on treatment which may cause ototoxicity.
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Is endoscopic tympanoplasty an alternative to microscopic tympanoplasty for small central perforations? A study p. 310
Renu Rajguru, Tejpal Singh Bedi, Garima Rajguru
DOI:10.4103/indianjotol.indianjotol_93_22  
Introduction: Traditional approaches to tympanoplasty involve the use of a microscope. However, with the advent of endoscopes and HD cameras, endoscopic tympanoplasty has appeared as an alternative to microscopic tympanoplasty. Our study was aimed at assessing the success rates of endoscopic tympanoplasty in small dry central perforations of pars tensa. Materials and Methods: 49 patients were enrolled in this study for undergoing endoscopic tympanoplasty and the surgical outcome was analyzed in terms of graft uptake and postoperative air-bone gap closure for 6 months. Results: Among the study population, 45 participants (91.84%) had an intact neotympanum at the end of 6 months, two participants (4.08%) had residual perforation, and two (4.08%) had recurrent perforations due to upper respiratory tract infection. The mean preoperative air-bone gap (AB gap) was 23.63 dB ± 3.9 dB in the study population with a minimum of 16 dB and a maximum of 31 dB (95% confidence interval [CI] 22.43–24.83), whereas the mean postoperative AB gap was 13.84 dB ± 2.79 dB, minimum being 8 dB and maximum being 20 dB (95% CI 12.98–14.69). The difference between the preoperative and postoperative air-bone gap was statistically significant (P < 0.001). Conclusions: We conclude that the endoscopic myringoplasty is an attractive alternative to conventional microscopic myringoplasty in terms of surgical outcomes, graft uptake, and air-bone gap closure.
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Pre- and postoperative treatment of keloid pinna with triamcinolone injection: Our experience p. 314
D Anand Karthikeyan, Poornima Kumar
DOI:10.4103/indianjotol.indianjotol_90_22  
Introduction: Keloid is a pathological cutaneous dermal lesion resulting from aberrant wound-healing process. It mainly arises in the chest, upper back, earlobes, and shoulder region. Keloid pinna is common diagnosis in the ear, nose, and throat, for which various treatment options are available. We describe our experience with pre- and postoperative injections with triamcinolone. Materials and Methods: This is a retrospective observational study from December 2020 to April 2022. A total of 16 cases (14 females and two males) were included in the study. Triamcinolone acetonide (TAC) (40 mg/mL) was injected both preoperatively and postoperatively following surgical excision. Results: The triamcinolone injections resulted in drastic size reduction of the keloids and made the keloids softer in consistency. The main benefit of the triamcinolone injection was the soft-tissue margin reclamation making surgical excision easy. Discussion: The main advantage of preoperative intralesional TAC is size reduction, reduced vascularity and scar pliability, and better soft-tissue margin reclamation which helps in getting better operative margins for surgical excision leading to better cosmetic results. Conclusion: TAC injection perilesional in keloid pinna preoperatively improves the surgical outcomes and postoperative injection reduces the recurrence rates considerably.
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CASE REPORTS Top

A camouflaged brain abscess with zygomatic Abscess – A bizzare presentation in chronic suppurative otitis media p. 317
Priti S Hajare, Yashita Singh, Keerthana Veenish, Salonee S Das
DOI:10.4103/indianjotol.indianjotol_65_21  
Intracranial complications of chronic suppurative otitis media (CSOM), even though rare, can have a simultaneous occurrence of multiple complications. An 8-year-old child, a case of CSOM (squamosal) with zygomatic abscess, was referred to us with HRCT temporal bone showing left otomastoiditis and 7 days of higher intravenous antibiotics. The patient was treated with modified radical mastoidectomy and incision and drainage of the abscess. On the 4th postoperative day, he developed focal neurological deficits which confirmed a brain abscess on magnetic resonance imaging on the same side. It was further managed by neurosurgeons. Here, we report this unusual presentation of multiple complications of CSOM.
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Middle ear actinomycosis p. 320
Zaina Khalfan Al Dhahli, Jagdish Zoivont Naik, Yousuf Al Saidi
DOI:10.4103/indianjotol.indianjotol_111_21  
Actinomycosis subacute to chronic infection caused by actinomyces. Actinomyces is filamentous, Gram-positive, anaerobic, nonacid-fast microaerophilic bacteria. Although it is considered as normal flora it is rarely colonize middle ear. The aim is to report the case of middle ear actinomycosis. We present 35-year-old female complain of recurrent left ear discharge. The whole tympanic membrane was bulging (due to granulation tissue behind it) with tiny hole that are discharging. Underwent tympano-mastoidectomy surgery with surgery finding of whitish material and granulation tissue in the middle ear. Histopathology of that material reported as the colony of actinomyces. Middle ear actinomycosis although is rare infection but should be done as one of differential diagnoses for recurrent otorrhea. Both surgical treatment and antibiotics are recommended as treatment for middle ear actinomycosis.
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Superior semicircular canal dehiscence presenting as long-standing vertigo p. 322
Noor Elyana Ahmad Fawzi, Azila Alias, Nik Adilah Nik Othman, Mohd Khairi Md Daud
DOI:10.4103/indianjotol.indianjotol_68_22  
Superior semicircular canal dehiscence (SSCD) is a complex syndrome and the symptoms can mimic other otologic diseases. We describe a case of a female who presented with imbalance for 10 years which has been psychologically disturbing. Cervical vestibular-evoked myogenic potentials and high-resolution computed tomography scan of the temporal bone confirmed the diagnosis of SSCD. The patient's symptoms improved after the closure of the defect. SSCD should be considered as a differential diagnosis in a case of long-standing vertigo.
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Case report on rare otologic sequelae of coronavirus disease-2019: Labyrinthine ossificans p. 325
Shikha Gianchand, Mustajib Ali, Himanshu Swami
DOI:10.4103/indianjotol.indianjotol_151_22  
Among multiple etiologies of hearing loss, viral infections often goes unnoticed due to flu like symptoms.Otologic dysfunctions have been reported with COVID – 19 infection as well. however, this case report is unique in terms of otologic dysfunction following the COVID illness. This case report is indicative of the intracochlear damage following COVID - 19 illness. So far, there is no reported case of LO following COVID -19 in the literature. This article brings out the first reported case of SNHL due to labyrithnine ossificans following covid-19 infection.
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