Endolymphatic sac tumor (ELST) is a rare cystadenomatous neoplasm with a benign histopathological appearance and a locally destructive behavior. ELST can produce clinical manifestations even when it's microscopic in size. The imaging hallmark of ELST is the presence of retrolabyrinthine mass associated with osseous erosion. Treatment of ELST involves local resection of the tumor or radical mastoidectomy, or in combination with radiotherapy.

Introduction: Based on the hypothesis that neurovascular events involving in the pathophysiology of migraine can cause hearing loss by influencing blood flow of inner ear, it was aimed to determine whether migraine with or without aura in our clinics patients are at risk for hearing loss by assessing hearing levels via a high-frequency audiometry, acoustic reflex and transient otoacoustic emission responses; to discriminate whether hearing loss is cochlear or retrocochlear originated, if present; and to evaluate whether or not migraine treatment affect hearing level in patients received treatment for migraine in this study. Materials and Methods: The study included patients who were diagnosed as migraine between December 2011 and December 2012 at Neurology Department of Cumhuriyet University, Medicine School according to ICD-II classification and accepted to receive medical therapy. In all patients, hearing levels were measured at baseline and after treatment by using high-frequency audiometry, transient otoacoustic emission and acoustic reflex tests. Results: In the present study, hearing thresholds measured in the right ear was normal in migraine patients with or without aura at baseline, while mild hearing loss was detected in right ear at the frequency of 500 Hz after treatment when hearing thresholds at different frequencies were compared. This difference was significant (P < 0, 05). When hearing thresholds in right ear at baseline and after treatment was compared, mild hearing loss was detected at the frequency of 250 Hz in migraine patients with aura. This difference was significant (P < 0, 05). In migraine patients with aura, hearing was normal in all patients at baseline, while in both ears mild hearing loss was detected in 2 patients (8.7%) after treatment. This difference was not significant (P > 0, 05). Conclusion: Differently from literature, hearing loss in our patients developed at lower frequencies and after treatment. The results we obtained from our study also presented that there might be a relationship between migraine disease and sensorineural hearing loss.

Objective: With expanding cochlear implant (CI) candidacy criteria young children, children with additional co-morbidities and abnormal cochlea are being implanted. In many of these cases, the child's behavioral or cognitive limitations may make doing the task of behavioral mapping difficult or impossible in pediatric CI recipients (CIR). Therefore, the present study was aimed to determine whether behavioral thresholds (T) could be predicted from objective measurements of electrical auditory brainstem responses (EABR). Methodology: Seventy-five pediatric CIR using nucleus 24 R (ST) implant and operated and visiting the CI center of a tertiary care hospital in New Delhi, India were prospectively enrolled in the study. The correlation between postoperative thresholds-EABR (t-EABR) with behaviorally obtained T and C levels was studied for CIR in the age range of 5-9 years. Statistical Analysis: The significance of the correlation was calculated using Karl Pearson's correlation. Results: Mean age of CIR was 9 ± 1.6 years, with male: female: 38:37. Of the 75 recipients, one had Mondini deformity, and two subjects had auditory neuropathy spectrum disorder as per their medical records. The group correlation coefficient was found to be r = 0.989 at P < 0.0001 for the "T" level and r = 0.885 at P < 0.0001 for "C" level versus t-EABR. Conclusion: t-EABR was found to be more correlated with T levels than with C levels, and it was always between T and C levels.

Objective: To assess the role of dynamic slow motion video endoscopy (DSVE) for diagnosing eustachian tube (ET) dysfunction in the cases of middle ear disorders and to classify eustachian dysfunction into mechanical and functional for the purpose of systematic management of middle ear disorders. Materials and Methods: A prospective, case-control study was carried out on total 84 patients (168 ears) of whom 64 patients with ear complaints (total 95 ears) having middle ear disease was taken as cases. Remaining 20 patients without any ear and nasal complaints (40 ears) and the normal ears among the case group (33 ears) were taken as controls (total 73 ears). DSVE was performed in cases and controls to compare the incidence of eustachian dysfunction in the two groups. Tubal movements were classified into four grades depending on: (1) Appearance of tubal mucosa, (2) movements of medial and lateral cartilaginous lamina, (3) lateral excursion and dilatory waves of the lateral pharyngeal wall, (4) whether tubal lumen opened well or not and (5) presence of patulous tubes (concavity in the superior third of tube). Results: On correlating the DSVE findings of ET in both case and control group, 4 times higher incidence of abnormal ET dysfunction was obtained in cases of middle ear disorders as compared to controls (P = 0.001, odds ratio of 4.0852). We found that 29 tubes had mechanical type of dysfunction (Grades 2A and 3A), whereas 30 tubes had functional type of dysfunction (Grades 2B and 3B and patulous). Conclusion: There is a positive etiological correlation between eustachian dysfunction and chronic otitis media by DSVE. It provides valuable information regarding the structural and functional status of the pharyngeal end of the ET and in classifying the type of eustachian dysfunction into mechanical or functional, which has management implications.

Context: The styloid process is a cylindrical bony outgrowth located in front of the stylomastoid foramen and it extends from the temporal bone outward. Elongation of the styloid process may be responsible for the irritation of a number of structures coursing through the parapharyngeal space. The styloid process presents with varied morphology. Aims: This is a study carried out to analyze the prevalence of various morphological patterns of the styloid process in South Indian population. Subjects and Methods: A total of 1200 digital panoramic radiographs were analyzed for the morphological assessment of the styloid process. The types and the pattern of calcification were determined based on the classification proposed by Langlais et al. Statistical Analysis Used: Cross tabulation using SPSS version 16. Results: Among the types of the styloid process, elongated type was the most common type present on both the sides. Among the patterns of calcification, completely calcified was the most common type observed, followed by calcified outline pattern. Conclusions: It is important for the clinicians to be aware of the variations seen in the morphological pattern of the styloid process as panoramic radiograph is a routine screening radiograph. Our study contributes to the literature, adding important information about the diversity of the styloid process in the South Indian population.

Aim of the Study: The aim of our study was to compare the impact of hearing loss in the life of adults who had congenital hearing loss with that of adults with acquired adult onset hearing loss (auditory neuropathy). Methodology: The quality of life scale questionnaire was administered on two groups. One group consisted of 10 adults with prelingual bilateral severe to profound hearing loss identified before the age of 3 years and who were using hearing aids and had received regular intervention for speech and language development by a qualified speech language pathologist. Second group consisted of 10 adults with auditory neuropathy. Results and Discussion: Wilcoxon rank sum test was used to compare the domains across the groups and the gender distributions between two groups were analyzed using Fisher's exact test. The results revealed that differences between the adults with early-onset hearing loss and late onset hearing loss was statistically significant for most of the domains. The results indicated the fact that accepting a hearing loss during adulthood leads to more psychological trauma than adjusting and living with the hearing loss from the early years of life. Loss of hearing is quite traumatic to adults. Psychological trauma that they undergo is as important as their physiological problem and psychological referral to a clinical psychologist may be beneficial to many of them.

Introduction: Tracheal intubation is the placement of a flexible plastic tube into the trachea to maintain an open airway or to serve as a conduit through which certain drugs are administered. Arytenoid dislocation is one of the rare reported complications of tracheal intubation. Decreased volume and breathiness are the most common voice symptoms. Need for the Study: There is lack of prospective and systemic study of the incidence of arytenoid dislocation and efficacy of voice therapy in such cases. Aim of the Study: Present study was carried out to find out the efficacy of voice therapy as independent management option in persons with arytenoid dislocation as a consequence of tracheal intubation. Materials and Methods: The study was based on a case study of a 37 year old male patient who reported to C U Shah Medical College and Hospital, Surendranagar with complaint of breathy and soft voice quality post laparotomy as a consequence of intubation. ENT examination revealed both vocal cord bowing with ? subclinical sublaxtition of arytenoid. Pre and post voice therapy assessment was done using GRBAS scale (for perceptual analysis), Praat software (for acoustical analysis) and VHI scale (for measuring the effect of voice disorder on the quality of life). Voice therapy was given for two months and pre and post findings were compared. Results: Significant improvement was observed on all the measures. Conclusion: Although arytenoid cartilage dislocation following the use of intubation is a rare event, it is important to be aware of its occurrence and to conduct diagnostic tests as early as possible in case of persistent hoarseness. Voice therapy may be used as an adjunct to phonosurgery or independently an effective intervention.

Aim: To evaluate the commonest presentation and intraoperative findings and significant post operative challenges in patients who underwent modified radical mastoidectomy in Melmaruvathur adhiparasakthi Institute of medical sciences and research. Design: Retrospective study. Materials and Methods: Fifty six patients who underwent modified radical mastoidectomy for unsafe ear disease were included in this study. The study period was from 2009 to 2012.The commonest presentation was evaluated with the history taken from the patient's records. The intraoperative evaluation of primary pathology and its anatomic extension and ossicular status were identified. Common problems we faced postoperatively were documented. Results: Of the 56 patients,thirty eight(68%) were male and eighteen(32%) were female. The age ranged from nine years -fifty years of age. The commonest presentation in this study was foul smelling scanty discharge (75%) and the primary pathology was isolated cholesteatoma (54%). The involvement of mesotympanum, attic, aditus & antrum with primary disease was more than the isolated involvement of attic,aditus and antrum. Stapes erosion was more common than incus erosion in our study. We faced a very rare postoperative complication of delayed facial palsy in one patient who had no facial nerve dehiscence. Conclusion: Good attention given to patients with infrequent, minimal ear discharge helps to identify unsafe ear. In unsafe ear, otologists should be well prepared to face the stapes erosion during surgery. Even though rare, otologists should be aware of delayed facial palsy and be cautious about the past history of herpes simplex and varizella infection and consider antiviral prophylaxis before surgery.

Introduction: Tinnitus is "a sound in one ear or both ears, such as buzzing, ringing, or whistling, occurring without an external stimulus." Magnetic resonance imaging (MRI) is a well-established, cost-effective investigation for the patients with tinnitus. Aim: The purpose of the study was to define the frequency of incidental findings on MRI scans, of patients with a history of tinnitus but with normal clinical examination, audiometry and otoacoustic emissions. Materials and Methods: A total of 62 patients were enrolled for the present study with a history of gradually increasing tinnitus and normal clinical ENT examination. All these patients underwent MRI scan to find out any lesion that would cause tinnitus. Results and Conclusion: In the present study, evaluation of MRI scans of 62 patients with gradually increasing tinnitus was done, with ipsilateral vestibular schwannoma and neurofibromatosis II being diagnosed in 1 patient (1.61%) each. Incidental findings were demonstrated in 26 cases (41.93%); with 8 cases (12.90%) of white matter lesions, 5 cases (8.66%) of vascular anomalies, 3 cases (4.83%) of arachnoid cyst, 2 cases (3.22%) of empty sella, 4 cases (6.45%) of sinus involvement, 2 cases (3.22%) of cerebral atrophy and 2 cases (3.22%) of vascular infarcts, though none of these findings were serious and neither warranted an urgent surgical intervention but a few cases required assessment by other specialties and were referred accordingly.

Background: Reconstruction of microtia is a challenging issue in otology. Autogenous costochondral reconstruction is the most widely accepted approach. However, it is time-consuming and has some limitations. Irradiated homograft costal cartilage has been proposed as a suitable alternative. In the present study, we represent our experience with this approach. Patients and Methods: A total of 19 ears were treated with irradiated homograft costal cartilage prepared from 18 to 40 years old cadaver under a standardized processing method. The reconstruction was achieved a two-stage procedure with at least 3 months interval. Results: The study population included 9 (56.25%) males and 7 (43.75%) females with the mean age of 13.7 ± 5.1 years. Microtia was bilateral in 3, right-sided in 8 and left-sided in 5 subjects. Averagely, subjects were followed for 36.0 ± 9.9 months during which none of the cases showed cartilage resorption. Short-term and long-term complications were negligible. Totally, 90% of subjects were satisfied with the procedure. Conclusion: Irradiated homograft costal cartilage resulted in relatively high satisfaction and low complication rates for auricular reconstruction. Esthetic appearances of the reconstructed auricle were acceptable. The advantages of this approach are the elimination of additional incisions for graft harvesting and donor-site morbidity.

Background: Eustachian tube function (ETF) has been the center of focus as a prognostic factor because of its presumed primary role in the pathogenesis of otitis media and clearance of the middle ear cavity. There is a general agreement that adequate ETF is necessary for middle ear surgery. In this study, the incidence of ET dysfunction and its patency has been evaluated in inactive mucosal variety of chronic otitis media, in relation to the types of central perforation. Materials and Methods: A cross-sectional study was done with 54 patients presenting with inactive mucosal type of chronic otitis media. All the recruited patients were first examined clinically and under microscope and then their audiological (impedance audiometry) and radiological assessment of mastoid was done. Alongside otoendoscopy, nasal endoscopy, dye test were done. In all these cases, other routine investigations were also performed. Results: Impedance audiometry offers an easy means of assessing ETF. The automatic Toynbee test can be a practical, objective and suitable method to assess ventilatory function of ET. The saccharin test is a simple, cost-effective and is valuable diagnostic tool to assess the mucociliary function of the ET. Mucociliary and ventilatory function may vary in the same patient. Saccharin test and methylene blue tests are comparable. Patients having poor saccharin test, methylene blue test, and ventilatory test are more prone to develop central perforation posterior to the handle of the malleus. The most frequent abnormal finding at nasal endoscopy was edema about the tubal orifice. Conclusion: A clinically useful test for ETF is still lacking. Impedance audiometry offers an easy means of assessing ETF. Ventilatory function of ET which is the single most important contributory factor in the pathogenesis of chronic otitis media should be evaluated with the objective method before tympanoplasty.

Introduction: Chronic suppurative otitis media (CSOM) is an infection characterized by recurrent ear discharge through a persistent tympanic membrane perforation. In cases such as these, an ASLP is concerned with early prevention, assessment and provision of suitable client based rehabilitation options. Case Report: A 3.5yrs old male with bilateral aural stenosis post CSOM surgery reported to clinic with a complaint of reduced hearing sensitivity to soft sounds with delayed in speech and language. A test battery approach for Audiological and Speech and Language evaluation was conducted. Recommendations and referrals were suggested at the end. Discussion: Regardless of all the restrictions, this study highlights the challenges encountered by an ASLP in dealing with post operative aural stenotic case. This case study highlights the occurrence of stenosis post surgery of bilateral CSOM, which is rarely found.

Mucormycosis is a serious, relatively uncommon invasive fungal infection and one of the most aggressive and lethal invasive mycoses. In the region of head and neck, it usually invades nose, paranasal sinuses, orbit, intracranial structures. Mucormycosis of temporal bone with facial palsy is by far very rare and till now only one case has been reported in the literature. ^[1] Our experience with a diabetic patient who developed this disease and the treatment aspects in the form of surgical debridement and amphotericin B are discussed here.

Numerous theories have been proposed in the past for the etiology of cholesteatoma. Foreign body (FB) of middle ear has been rarely reported in the literature which if neglected for long duration of time can lead to cholesteatoma. An adolescent male presented with chronically discharging ear. Patient was taken up for exploration. During which multiple FB was seen in the middle ear overlying extensive cholesteatoma. Patient underwent canal wall down mastoidectomy with tympanoplasty. Foreign body of external auditory canal should be managed meticulously by skilled otologist. Patient with chronic ear discharge not responding to antibiotics should raise a suspicion of FB. Neglected middle ear FB can cause cholesteatoma. Early intervention in these cases will prevent complications .

Cholesteatoma presenting with a Bezold's fistula is extremely rare, and such presentation has been reported. It is infrequent these days in this era of antibiotics, due to early institution of treatment. Fistula results in untreated and inadequately managed Bezold's abscess. The treatment of Bezold's abscess is with prompt intravenous antibiotics, followed by drainage of cervical abscess, but management that of Bezold's fistula is primarily surgical in which a mastoidectomy is done to eradicate the disease with exposure of the mastoid tip with laying open the fistulous tract. One such unusual case of a Bezold's fistula with cholesteatoma is reported in a teenager with a long-standing history of ear discharge, but without any other complications. The patient had being managed conservatively with ear drops since childhood. High resolution computed tomography (CT) mastoids revealed extensive cholesteatoma is destroying the mastoid and perforating the tip with erosion of the tegmen tympani with extra cranial extension. Patient underwent modified radical mastoidectomy with reconstruction of the mastoid bowl with bone pate. Patient was successfully treated and was followed to 1-year with CT scan without recurrence.

We report an extremely rare case of CC isolated to the mastoid process, with no middle ear involvement. An 18-year-old male presented with an ear ache and minimal discharge for 4 months. On examination, external auditory canal was found narrowed with granulations and bony defect present in the posteroinferior part of the canal. Computed tomography showed soft tissue contents in the mastoid bone causing full thickness erosion of the same along with attenuation of the ear canal. At surgery, a large cholesteatoma sac was found within the mastoid process completely eroding it and extending to the posterior part of external auditory canal. The mastoid antrum and aditus were found normal. Tympanic membrane was intact. CC isolated to the mastoid was diagnosed. Diagnosis of CC isolated to the mastoid should be based on clinical examination and radiological evaluation.

Bilateral anotia or microtia is known to be associated with multiple congenital malformations. It may occur due to the teratogenic effect of maternal ingestion of thalidomide and retinoic acid or spontaneously. We report a case of an infant with congenital bilateral anotia and left facial motor weakness presenting with persistent failure to thrive due to recurrent respiratory tract infection.

Jervell and Lange-Nielsen syndrome is a syndrome affecting hearing organ and heart conduction system since birth. It is easy to overlook heart defect as cardiac conduction defect is often asymptomatic, but can lead to disastrous complications if left undiagnosed. Hence, we are presenting a case report to discuss briefly the diagnosis and management of this syndrome to prevent cardiac complications