We describe the clinical and radiological finding in a 57-year-old male with dilated petrosquamosal sinus, mastoid emissary vein, and external jugular vein on the right side; presented with pulsatile tinntus for three years and associated with vertigo and mild hearing loss in the right ear with normal clinical examination. Audiological assessment revealed mild sensorineural hearing loss in the right ear and normal tympanogram. Computed tomography scan with contrast show dilated petrosquamosal sinus, mastoid emissary vein, and external jugular vein on the right side showing the relationship between this abnormality and pulsatile tinntus, vertigo, and sensorineural hearing loss as one of differentials and its surgical importance in ear surgery as the first case to be reported with this combination of anomalies.

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Objective: To evaluate the middle ear function in patients of cleft palate treated under "Smile Train Project". Materials and Methods: Sixty patients (120 ears; 32 male and 28 female) of cleft palate with or without cleft lip were evaluated in pediatrics and ENT OPD in preoperative period. A general medical check up was performed in pediatrics OPD to evaluate the associated craniofacial anomalies. Middle ear function was evaluated in ENT OPD. Otoscopy was done in all patients. Cases under five years of age were evaluated for middle ear function by tympanometry and cases with more than five years of age were evaluated by tympanometry for middle ear function and pure tone audiometry to establish the type of hearing loss. The results are presented as number of ears. Results: A total of 50% of the patients in the study group were in zero- to two-year age group. Otoscopy findings in 120 ears showed that 66.66% of the patients had dull tympanic membrane suggesting a diagnosis of otitis media with effusion. Tympanometry was done in 110 ears, of which, 72.72% of ears had type B tympanogram suggesting otitis media with effusion. Pure tone audiometry in more than five years age group showed that 81.25% ears had conductive hearing loss. Conclusion: This study suggests the need of preoperative ENT check up and audiological assessment in patients of cleft palate undergoing palatal surgery under "Smile Train Project". The association of otitis media with effusion in patients with cleft palate appears strong and a high degree of suspicion for the disease should be kept in them. The anatomical defect and possible causative pathophysiology also supports the inference. Otitis media with effusion causing hearing loss in these patients causes speech delay and unfavorable outcome despite aggressive speech therapy in postoperative period. A co-ordinate team approach of concerned specialists involved in managing these patients would definitely improve their outcome.

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Objective : The effect of smoking on the outcome of tympanoplasty is to be confirmed. We sought to determine the effect of smoking habit on the results of tympanoplasty over 158 patients for a period of 2years. Setting : Tertiary care hospital. Materials and Methods : The study was carried out among 158 post operative tympanoplasty, smokers were 28 and non-smoker were 130. Results : Patients without smoking habit have 93% graft uptake with 94% improved hearing after tympanoplasty. Those were with smoking habit, have 68% graft uptake with 79% improved hearing. The average hearing improvement was 20 dB among nonsmokers and 16 dB among smokers. Conclusion : This study support the poor outcome of tympanoplasty among smokers in comparison to non-smokers.

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Introduction : Mobile phone usage is widespread and concerns have been raised on the safety of its long-term usage. The electromagnetic fields emitted from mobile can penetrate skull and deposit energy 4-6 cm into the brain resulting in heating of the tissue. In this study, we explore a possible relationship between prolonged mobile phone usage and sensorineural deafness. Materials and Methods: The study was conducted in a medical college situated in rural India. A total of 100 persons between the age group of 20-45years using mobile phone for at least 5 years are selected and screened for sensorineural deafness. Use of cellular phones was assessed by a questionnaire. Mean number of daily calls and minutes were asked for to calculate the cumulative use in hours for all years. The most frequently used ear during cellular phone calls was noted, or whether both ears were used equally. Otoscopic examinations were performed by an otolaryngologist before testing in order to rule out any external or middle ear pathology that could affect audiometric measurements. The hearing levels of subjects were tested using pure tone audiometry. Results : One hundred subjects who are habitual mobile phone users were screened by pure tone audiometry. It is found that the prevalence of sensorineural deafness was 3% and there is a linear relationship between the duration of mobile phone use and the degree of the severity of deafness. Conclusion : The prevalence of sensorineural deafness in our study in habitual mobile users is 3%. It is not clearly known whether mobile phone use is the direct cause of deafness in these subjects but the absence of other causes might point towards its etiological role.

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Cerebellar abscess is a serious complication of ear disease. In the present report, a case of cerebellar abscess and thrombosis of the sigmoid sinus, secondary to chronic otitis media is described. A 25-year-old male presented with clinical features suggestive of chronic suppurative otitis media. The patient hospitalized for operation. In postoperative third day the patient began to complain about headache. The patient suddenly began to lose his balance while walking and had difficulty in talking. MRI revealed that there was a cerebellar abscess and operated him for the cerebellar abscess. After 6 weeks antibiotherapy the patient discharged from the hospital as cured. As seen in the literature review; most of the patients having thrombosis of the sigmoid sinus and cerebellar abscess together have showed the symptoms of cerebellar abscess. However, the symptoms of thrombosis of the sigmoid sinus were more prominent than cerebellar abscess in our case unlike many others in the literature.

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Destruction of condyle of mandible is an extremely rare complication of malignant otitis externa. Here we describe such a rare instance in a patient with malignant otitis externa. It is very important to diagnose this category of patients and treat them accordingly. The available data indicate the need for external drainage. We report a case with malignant otitis externa with temporomandibular involvement treated successfully with radical mastoidectomy and drainage of the joint through the external auditory canal and an external incision was avoided.

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Aims and Objective: The aim of the study was to evaluate hearing threshold and the severity of hearing loss at different frequencies (250Hz, 500Hz, 1000Hz, 2000Hz, 3000Hz, 4000Hz, 6000Hz, and 8000Hz) in patients of chronic renal failure (CRF), and to analyze the role of duration of disease on hearing threshold in patients of CRF. Materials and Methods: Fifty two patients of CRF were evaluated in Nephrology unit and ENT OPD. Cases with middle ear involvement were not included in the study. Pure tone audiometry was done in all cases to establish hearing threshold at different frequencies. Cases with hearing loss were classified according to the severity of hearing loss. In patients with sensorineural hearing loss, mean hearing threshold was calculated. Cases were classified in two groups on the basis of duration of disease (less than two years and more than two years) and the mean hearing thresholds were calculated. The significant differences between the mean hearing thresholds of these two groups were assessed using student's t test for unequal samples. Results : A total of 52 patients (28 males and 24 females) were included in the study. Majority of the patients were in 21 to 40 year age group (mean age 36.84 years). Of the 104 ears, 76 ears (73.07%) had sensorineural hearing loss and 28 ears (26.93%) had normal hearing. Majority of the ears with hearing loss had mild (44.73%) or moderate (42.11%) sensorineural hearing loss. Mean hearing threshold was higher at low frequencies and high frequencies with a relative sparing of mid frequencies. Comparison of the mean hearing threshold in patients of Group I (duration of disease less than two years - 42 ears) and Group II (duration of disease more than two years - 34 ears) showed a statistically significant difference (P<0.05) in mean hearing threshold at 250 Hz. Conclusion: Hearing loss is present in majority of the patients of CRF. Most of the cases have mild to moderate sensorineural hearing loss. Hearing threshold worsens at low frequency (250 Hz) as the duration of disease increases.

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Introduction : Identification of the facial nerve is very essential as injury to facial nerve is a dreadful complication of ear surgery and its outcome can be most devastating to the patient as well as the surgeon. Surgical intervention in acoustic neurinomas, cholesteotomas, preservation of cochlear nerve and inner ear is an ardous task and requires dedication to prevent an unfortunate disaster. Any damage to vestibule, labyrinth or cochlear can cause leakage of endolymph leading to deafness if tumors of the cochlear nerve are dissected in an a traumatic way. The location of the internal acoustic meatus and identifi cation and location of its anatomical landmarks minimizes the chance of injury to the facial nerve and provides an insight for the surgeons to rationalize the surgical approach in ear surgery. Materials and Methods : The study is carried out on 100 temporal bones (dried and cadaveric) by examining the foramen of internal acoustic meatus of the right and the left sides of both the sexes. Each foramen was carefully examined and its relation to the important anatomical landmarks was measured in millimeters on both the sides. Results : The average distance from IAM to superior petrosal sinus was 4.5 mm, IAM to sigmoid sinus was 24.08 mm, IAM to aqueduct of vestibule was 10.47 mm and IAM to jugular foramen was 8.6 mm. Conclusions: The present study evaluates the distance in millimeters between the IAM to superior petrosal sinus, sigmoid sinus, aqueduct of vestibule and jugular foramen. thorough knowledge of the distance between the IAM to important anatomical landmarks is basic and very important to the surgeons and radiologists before and during surgical intervention.

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A 40-year-old male presented with a fluctuant swelling in front of the right ear. His past history is significant for having undergone surgery for the swelling four times in the past 6 years with recurrence each time. We excised the swelling by using a preauricular incision with reverse question mark type extension into the temporal area. The advantages are complete unhindered exposure, excellent cosmesis, and prevention of damage to the temporal branch of facial nerve.

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Introduction: We report our experience with simultaneous bilateral mastoidectomies on 18 patients who underwent bilateral simultaneous mastoidectomies. Materials and Methods: Chart review of patients who underwent tympanomastoidectomies since 2002 revealed 18 patients who underwent bilateral simultaneous mastoidectomies. Results: Of the 18 patients, none had any complications from the surgeries that would have been avoided by staging the procedures. Of the 36 operated ears, 34 of them had the same or better hearing postoperatively. Discussion: This article re-emphasizes the safety of performing bilateral simultaneous tympanomastoidectomies. Although this procedure carries a theoretical risk of unilateral sensorineural hearing loss, compared with the unilateral procedure, the risk of bilateral sensorineural hearing loss is only 0.006- 0.2%, as derived mathematically from historical data. Conclusion: In carefully selected cases of parental request and noncompliance, simultaneous bilateral mastoidecomies are a safe and effective alternative to the traditional two-stage procedure.

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Aim: The aim of this study is to see the different functional gradings of Eustachian tube ventilatory function as assessed by Bortnick-Miller (B-M) apparatus in chronically diseased middle ears (dry cases) planned to undergo tympanoplasty and to correlate the results with the past experiences. Materials and Methods: This study consisted of 29 cases of chronic suppurative otitis media, inactive stage having central perforation. Tubal function was evaluated by B-M apparatus based on ability of tube assimilating the applied positive and negative pressure. Tubal opening pressure was noted after applying positive pressure while residual intratympanic pressure after 10 swallows was recorded after applying negative pressure. Results: This study revealed that results of tubal manometry in diseased ears cover a wide spectrum of normal function to partial/non-function. 51.72% of cases were able to equalize applied negative pressure, 41.39% partially equalizing, while 6.89% of cases were completely unable to equalize applied negative pressure. Conclusion: Our results of aspiration method with the help of BM apparatus explicitly suggest that tubal function in chronically diseased ears deviates from that of normal ears. It perpetually reflects that varied results of middle ear reconstructive surgeries could be anticipated in accordance with different tubal function gradings.

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