Aims: The aim of this study was to identify the microorganisms associated with the chronic discharging ears and their antimicrobial susceptibility pattern. To find the pattern in bacteriological flora and their susceptibility patterns in patients from the different parts of India. Settings and Design : Observational, retrospective study. Subjects and Methods : A total of 106 patients with unilateral or bilateral active chronic discharging ears attending the outpatient clinic or in-patients were included in the study. All patients' chart details were reviewed and history, clinical findings and microbiology reports were noted. Results : The microbiology of 106 samples (106 patients) was studied (in bilateral ear disease, information about the side from where the swab was taken, was not available). Among them, 72 (67.92%) grew a single isolate while 34 (32.07%) grew two or more organisms. Major micro-organism isolated was Pseudomonas aeruginosa 48 (30.96%), followed by Staphylococcus aureus 46 (29.676%), non-fermenting gram negative bacilli (NFGNB) 17 (10.96), Coliforms 22 (14.20%). Drug susceptibility pattern of P. aeruginosa showed that Piperacillin was active against the majority of the isolates 94%, followed by Ceftazidime 83.3%, Amikacin 81.2%, Netilmicin, Tobramycin 60% and Ciprofloxacin, Gentamicin, Aztreonam 62.5%. Most of the S. aureus isolates were susceptible to Oxacillin in 80% and Erythromycin in 43%. Conclusions : Commonest organisms isolated from chronically discharging ears were P. aeruginosa and S. aureus, with P. aeruginosa marginally more than S. aureus. When patients from north and south were segregated, majority of isolates were P. aeruginosa in south (P. aeruginosa 28, S. aureus 23), whereas S. aureus was more in north (23 S. aureus, 20 P. aeruginosa). Coliforms were isolated more in south (13 south, 9 in north), similarly, NFGNB were also more in south (11 south, 6 north). Majority of isolates of P. aeruginosa were susceptible to Piperacillin and S. aureus was susceptible to Oxacillin.

Aim and Objective: To investigate saccular damage in patients with sudden sensorineural hearing loss (SSNHL) with or without vertigo and to evaluate the saccular damage according to the hearing loss and presence or absence of vertigo. Materials and Methods: All tests done in this study were performed in the audio vestibular unit of ENT department from September 2009 to November 2010. Statistical Analysis Used: The association between the severity of hearing loss and changes in the vestibular evoked myogenic potential (VEMP) recordings were assessed using descriptive statistics. The pattern of VEMP in different diseases and also the behavior of VEMP in presence or absence of vertigo were evaluated using SPSS 15. Results: Among 27 patients there were 11 cases of idiopathic SSNHL. Out of nine unaffected ears, 88% had normal and 12% had absent VEMP. Whereas out of 13 affected ears, only 53.9% had normal VEMP. Among all the 54 ears, 17 ears had normal hearing. In this group 76.47% had normal VEMP. The group with hearing loss > 90 dB had 61.53% absent VEMP. Conclusions: In patients with unilateral SSNHL, there was a tendency for the affected ear to have absent VEMP indicating the saccular involvement. The extent of saccular damage did not correspond to the amount of hearing loss or presence or absence of vertigo.

Background: Although bilateral same day myringoplasty scores over unilateral myringoplasty in terms of convenience and conservation of resources, it is rarely performed because of theoretical risk of postoperative sensorineural deafness. Objectives: This study was performed to evaluate single sitting bilateral myringoplasty. Materials and Methods: Twenty five patients (50 ears) opted for single sitting bilateral myringoplasty and underwent mini-endaural and permeatal routes with or without tympanomeatal flap. Other 25 patients (25 ears) opted for unilateral myringoplasty by post auricular route. Temporal fascia was used for graft by underlay technique in all patients. Results and Observations: Perforation closure was successful in 90% ears with single sitting bilateral myringoplasty and in 88% ears in the other group. Post operative assessment of hearing improvement started after 1.5 months in 90% ears of both the groups. None of the patients developed iatrogenic sensorineural hearing loss. Conclusion: Single sitting bilateral myringoplasty by any of conventional routes can be performed in most patients without much discomfort or apprehension of sensorineural hearing loss and results are comparable to that of other methods.

Background: Risk factors for hearing impairment can offer important information for both the family and health-care providers regarding etiology, other associated health problems, and risk of recurrence in sub-sequent pregnancy. Family history and consanguinity indicates the possible involvement of genetic factors. Objective: The aim of the study is to find the strength of association of family history and consanguinity with permanent hearing impairment in infants. Materials and Methods: A case-control study was designed on 420 infants with permanent hearing impairment and normal hearing from the year 2008 to 2012. The case control ratio was 1:1. Alternate sampling method was used in a hospital for selecting the control group. Parent interview was carried out to collect the information of family history of hearing impairment and consanguineous marriage. Results: Family history and consanguinity was seen in 18.6% and 39.5% of the hearing-impaired group. These factors were associated with hearing impairment with a high significance (odds ratio (OR) 6.5; 95% Confidence interval (CI) 2.8, 15.1; P = 0.000 and OR: 2.7; 95% CI 1.9-3.9; P = 0.000). The combination of risk-factors is seen in 10% of the hearing-impaired group, whereas only 0.5% had it in the control group. Conclusion: Family history and consanguinity seems to be an important risk factor of hearing impairment both in isolation and in combination.

Drying the temporalis fascia graft is often an understated step in tympanomastoid surgery. Different surgeons use different methods to dry the graft. We report a novel method of drying temporalis fascia graft for tympanomastoid surgery using hot boiling water. The method is quick, easy, and safe.

Paraganglioma is a rare tumor of the cerebellopontine angle. We report a case of a 55-year-old female presented with otalgia and decreased hearing in the left ear, hoarseness of voice, difficulty in swallowing, nasal regurgitation, and tinnitus. The tumor was excised by left retromastoid and posterior fossa craniectomy approach. Intra-operative crush smear and histopathological examination revealed a paraganglioma. Post-surgery the patient was treated with fractionated radiotherapy.

The benign paroxysmal positional vertigo results in dizziness and imbalance leading to risk of fall thus, imposing functional limitations. The repositioning-liberatory maneuvers, habituation and balance exercises are widely used as the treatment strategies of the rehabilitation program. This case report discusses the success of such rehabilitation program on two subjects based on the updated clinical evidence.

A rare case of congenital cholesteatoma of petrous apex with facial nerve palsy and its successful management is reported. 49 year old female presented with progressive vertigo since 2 years. Patient developed tinnitus and hearing loss in the right ear since 7 months and right sided complete facial asymmetry since 6 months. She had normal right tympanic membrane and complete right lower motor neuron facial nerve palsy. She also had profound sensorineural hearing loss with positive Cerebellar signs. Magnetic resonance imaging and High resolution computed tomography with contrast temporal bone showed extensive bony destruction and petrous apex lesion. Facial nerve and vestibular cochlear nerve was compressed by abnormal soft-tissue present in the internal auditory meatus. Transmastoid translabyrinthine exploration was carried out for petrous apex lesion. Intra-operative extensive bony erosion was noted in the temporal bone. Erosion was extending upto Internal Acoustic Meatus compressing VII and VIII nerve bundle. Post-operatively patient was relieved of vertigo and tinnitus. Though hearing didn't improve, but there was an improvement in facial palsy. Congenital petrous apex cholesteatoma is very rare case. With no specific radiological signs congenital cholesteatoma is difficult to diagnose pre-operatively. It was a challenge to treat surgically such a rare case with extensive neurosurgical presentation without any neurological deficit. Patient showed improvement official nerve after the 1΍ year of surgery.

Lateral sinus thrombosis (LST) is a rare complication of Acute Otitis Media and associated mastoiditis. Although, in the era of antibiotics, the presentation may be variable and diagnosis is difficult. High index of suspicion is required to diagnose the atypical presentation. We report an atypical presentation of LST wherein a 12-year-old female presented with sudden onset severe occipital headache following ear syringing. Contrast enhanced computed tomography of temporal bone revealed LST without coalescent mastoiditis. Patient was managed conservatively with intravenous antibiotics and low-dose heparin. The management protocols in such cases are discussed and relevant literature reviewed.

Vestibular paroxysmia (VP) is attributed to neurovascular cross-compression due to vascular loops around the Vestibulocochlear nerve. The exact audio-vestibular profile of individuals with VP is uncertainly reported in literature. Thus, the study was aimed at reporting the results of audio-vestibular test battery in VP. A 37 year-old-female and a 30 year-old-male with tinnitus, giddiness, and positional vertigo underwent routine audiological testing, oto-acoustic emissions, auditory brainstem response, vestibular evoked myogenic potentials, and chochlear hydrops analysis masking procedure which produced normal results. The Dix-Hallpike maneuver revealed positional vertigo and nystagmus while symptoms such as oscillopsia and giddiness were reported during central vestibular tests. The magnetic resonance imaging (MRI) report revealed labyrinthine artery loops around the VII and VIII cranial nerves. We conclude that subtle symptoms like oscillopsia, giddiness, or vomiting sensation on central vestibular tests should be carefully noted to enhance the identification of VP using audio-vestibular tests battery and MRI should be done for all cases presenting with symptoms of non-fatigable positional vertigo.

Temporal bone hemangiomas are rare, difficult to diagnose and may cause devastating permanent sequelae. We report a case of 10-year-old female with middle ear and mastoid hemangioma who presented with facial palsy and conductive hearing loss. Due to presence of associated scalp swelling, hemangioma was suspected and confirmed by angiography. Treatment was performed by embolization leading to arrest of progression and partial reversal of hearing loss. On extensive review of literature, we conclude that this is the first case of temporal bone hemangioma to be diagnosed pre-operatively and to be treated with embolization techniques.

External auditory canal cholesteatoma (EACC) is an uncommon disease and its pathogenesis remains unclear. Clinically, patients usually present with symptoms like chronic dull pain and otorrhea, but many patients can be astonishingly silent or even asymptomatic. The intracranial complication with extensive mastoid cavity from primary EACC is extremely rare. Early diagnosis is imperative to facilitate best possible intervention and to relieve patient symptoms and to prevent further complications. We present the first report in the English literature of a case of primary EACC presenting as cerebellar abscess. We experienced a rare case of a 55-year-old female patient admitted in our hospital with cerebellar abscess complicated by a cholesteatoma in the external auditory canal. The patient was first managed conservatively with systemic antibiotics by neurosurgeon, and then the disease was removed successfully by canal wall down mastoidectomy and no recurrence had occurred in the first 4 months post-operatively.