Aims: It is accepted that Rinne's test is negative in the same ear having a conductive hearing loss (CHL). It is also accepted that false negative Rinne's occurs in the ear with severe sensorineural hearing loss (SNHL). However, we wanted to demonstrate the presence of false negative RInne in unilateral CHL. Materials and Methods: Observational study with 13 patients with unilateral, moderate to severe CHL and ten patients with severe to profound SNHL of 40db-115 db in the frequency range of 250/500/1000 Hz. Results: The patients with CHL demonstrated a false negative Rinne on the better hearing ear at a minimum threshold of 50 dB while patients with SNHL demonstrated false negative Rinne on the worse hearing ear with a minimum threshold of 70 dB. Conclusions: Based on our observation, false negative RInne can occur in patients with conductive hearing loss and this phenomenon needs to have a different name.

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Great strides have been accomplished recently in providing better medical services for handicapped children. As the dentist begins to understand the complexity of each particular form of handicap and its characteristics, he is able to plan more efficiently for satisfactory treatment. Because many dentists do not understand deafness and the unique problems that deaf children exhibit, inadequate dental care for deaf children still ensues. Handicapped persons are at a greater risk for dental disease, for the most part, because of greater neglect or poor oral hygiene and access to routine dental care. Deaf patients in particular often fail to obtain needed care because of communication difficulties experienced in the treatment situation.

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Aims and Objectives: To assess the eustachian tube function (ETF) and to evaluate the treatment outcome of chronic suppurative otitis media (CSOMtubotympanic type) in relation to eustachian tube dysfunction. Materials and Methods: Prospective study for a period of 2 years; the study comprises of 100 patients diagnosed to have CSOM (tubotympanic type). ETF was assessed by Toynbee's test. Patients with normal ETF were taken up for myringoplasty. Patients with totally impaired ETF irrespective of middle ear mucosal status (dry or wet) were taken up for cortical mastoidectomy with tympanoplasty. Patients with partially impaired ETF, with dry middle ear mucosa were taken up for myringoplasty and those with wet middle ear were taken up for cortical mastoidectomy with tympanoplasty. Results and Analysis: The ETF in these patients was analyzed and graft uptake was assessed clinically in reference to ETF status. The results are tabulated and analyzed using Chi-square test using number cruncher statistical system (NCSS) software. In our study, preoperative ETF had a highly significant P value = 0.0005. Conclusion: Methodology of treatment adapted for CSOM patients based on ETF proves that the eustachian tube plays a major role in the uptake of graft.

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Aim: Chronic suppurative otitis media (CSOM) is a common cause of hearing impairment, especially in rural population. This study was carried out to know about the bacterial flora and antibiotic sensitivity for better management of the disease and to reduce morbidity due to CSOM. Materials and Methods: This study was undertaken in a tertiary care center of western UP with an aim to study the bacterial flora and their sensitivity to a series of antibiotics in cases of CSOM (unsafe) with active purulent discharge. There was no history of topical or systemic antibiotic therapy in these patients in the last 3 months. Aural swabs were taken and cultured for aerobic bacteria. For cases showing growth on culture media, sensitivity for a series of antibiotics was studied to have an understanding of the antibiotics showing sensitivity and resistance. Results: A total of 62 (mean age 17.38 years) diagnosed cases of CSOM unsafe were included in the study. The study group included 38 males (61.29%) and 24 (38.71%) females. Fifty-four patients (87.09%) had unilateral diseases, while 8 patients (12.90%) had bilateral diseases. 94.28% of the ears showed growth on culture media. Majority of these ears showed monomicrobial growth (90.90%). Conclusion: The most common bacteria isolated in descending order were Pseudomonas, Klebsiella, Staphylococcus, Proteus, and Escherichia coli. Majority of the patients showed sensitivity to cefoperazone and salbactum (90.69%), ofloxacin (79.06%), and ciprofloxacin (79.06%). 95.35% of the patients showed resistance to amoxicillin.

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Modern day high-performance machines, weapons, aircrafts and locomotives are more powerful, more efficient, and unfortunately, frequently produce high noise levels resulting in Noise-induced Hearing Loss (NIHL). Mechanical hearing protection is essential and effective; however, inherent limitations allow a significant percentage of permanent hearing loss to occur despite protection. Hence, a pharmacological preventative or rescue agent for NIHL forms an important element of a comprehensive approach to maintaining inner ear functional integrity in individuals exposed to noise. The ideal pharmacologic agent would specifically address known mechanisms of acoustic injury, be orally administered, be exceptionally safe, be effective and affordable. Though currently such a pharmacological agent is not available, but the ongoing research is promising. In this article, we discuss various pharmacological agents for prevention and management of NIHL.

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Daily activities, interpersonal relationship, employment, and general well being; among such skills, communication skills are essential to a successful life for all individuals. Such skills affect education, adequate hearing acuity is of paramount importance and acts as a prerequisite in the overall personality development of an individual. Hearing impairment at any age has serious effects on the day to day life of an individual and he/she feels handicapped socially, emotionally, and scholastically. A child stuck with this malady is a back bencher in the class, excommunicative, and absent-minded. This study was conducted in order to find out various causes of hearing impairment in children and to study role of various audiological and radiological tests in finding the cause of impaired hearing in children. Aims and Objectives: To assess the possible etiological causes of hearing impairment in children. Study role of various audiological tests in finding the cause of impaired hearing in children. Study Design: Prospective study. Materials and Methods: This study was conducted in the Department of ENT and HNS of government medical college Srinagar. A total of 150 children of age range 0-14 years visited our ENT Department with complaints of impaired hearing, but only 70 children who met the inclusion criteria of impaired hearing and defective/delayed speech were selected for this study. Results of initial evaluation by means of comprehensive clinical history and followed by proper thorough systemic physical examination from head to toe was performed. These hearing impaired children were subjected to various subjective and objective tests; pure tone audiometry and behavioral observation audiometry were performed for subjective tests and impedance audiometry, Oto-acoustic emissions (OAE), and brainstem evoked response audiometry (BERA) were performed for objective tests. Results: Possible etiological cause on the basis of history were birth anoxia (2.85%), premature (5.71%), low birth weight (4.28%), hyperbilirubinemia (4.28%), and consanguinity (42.86%). Possible cause revealed after proper systemic examination includes 2.85% children with craniofacial abnormalities, 2.85% children with Down's syndrome, and 1.42% with Usher's syndrome. OAE revealed 70% bilateral REFER and 30% bilateral PASS. Impedance audiometric results were mostly Type A tympanogram. Pure tone audiometric results were mostly on profound hearing loss (86.69%). BERA findings were mostly on profound hearing loss (85.79%). Conclusion: In this study large vestibular aqueduct (LVAQ) is most common cause of abnormality detected in hearing impaired children.

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Fibrous dysplasia is a benign disease where all components of normal bone are present, but they fail to differentiate into mature structures. Management of temporal bone fibrous dysplasia is conservative. Surgery usually in the form of canaloplasty is performed in cases of complication like hearing loss, canal cholesteatoma, etc., In this report we would like to give emphasis on the role of mastoid exploration in the treatment of fibrous dysplasia of temporal bone especially in context of hearing results. 2 cases of temporal bone fibrous dysplasia underwent surgical treatment in a tertiary hospital. Hearing of the patient improved significantly in one case whereas there was no auditory benefit in the other case with inner ear involvement.

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Objective: To investigate the effect of human cerumen on the growth of Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa and Candida albicans. Study Design: Prospective study Setting: The study was conducted in the Department of Otolaryngology-Head and neck Surgery and Department of Microbiology, at a tertiary care teaching hospital in southern India. Materials and Methods: Cerumen samples were collected from 120 healthy cases by using sterile Jobson Horn Probe. Sterile samples were taken and further tested. The bacterial strains were cultured on nutrient agar and Candida was grown on SDA. Serial 10 fold dilutions of the test organisms were made using normal saline acting as control and using 3.5% cerumen suspension as test and were incubated at 37°C for 12 hours. Subcultures were performed from test as well as control tubes to assess the inhibitory activity of human cerumen. Results: Of 120 samples, only sterile samples were tested. At dilutions of 1 in 10 ³ there was complete inhibition of Escherichia coli and Pseudomonas aeruginosa in all samples, complete inhibition of Staphylococcus aureus in 83.3% samples and Candida albicans in 80% samples. The order of inhibition demonstrated by cerumen in the present study was Escherichia coli > Pseudomonas aeruginosa > Staphylococcus aureus > Candida albicans. Conclusion: Human cerumen has antibacterial and antifungal properties against the commonest bacterial and fungal pathogens. Other than the physical barrier, wax acts as protective coating over the external auditory canal. Hence, routine wax removal/ear cleaning is not mandatory unless impacted wax is leading to earache or conductive hearing loss.

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We report a glomus jugulare tumor in a 60 yrs old female; non diabetic, non hypertensive who presented with continuous pulsatile hissing tinnitus in right ear with progressive hearing impairment and fullness in the ear. Detailed history and examination with aid of investigations it turned out to be glomus jugulare, treated by surgical excision by post auricular hypotympanotomy approach.

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Introduction: Otitis media (OM) is common in children. In developing countries, it is the most common cause of hearing impairment. Many factors predispose to OM, some of which are modifiable through lifestyle changes. This study aimed to determine the knowledge of caregivers on the risk factors (RFs) associated with OM and their willingness to modify their lifestyle to reduce the risk of OM. The impact of socioeconomic status (SES) on the knowledge and willingness in lifestyle alteration was also assessed. Materials and Methods: This is a prospective study using a modified Ear Infection Survey questionnaire. The SES of caregivers/mothers was determined, and they were interviewed to determine their knowledge of RFs for OM and their willingness to undergo lifestyle modifications. Results: One hundred caregivers (96 females) were interviewed, majority of whom (81%) were in the higher SES. There were significant differences between low and high SES in day care attendance, siblings and parents with history of OM. Apart from daycare attendance and household smokers, all other RFs were higher among the lower SES. Individuals from low SES background had poorer knowledge of the RFs for OM. A strong willingness to modify behavior to avert a surgical procedure for OM is seen in both groups. Conclusion: Caregivers in both SES groups were willing to undergo behavioral modifications in reducing the risk of OM; utilizing this knowledge in educational programs will help to reduce the prevalence of OM in children. This must be coupled with training and encouragement of health workers to disseminate information on RFs of OM.

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Waardenburg syndrome (WS) is a rare disease characterised by sensorineural deafness in association with oculocutaneous pigmentary anomalies and dystopia canthorum. In this article, we report a 6-year-old boy with WS2, one of four clinical types of WS, for its rarity and relative paucity of reports in the otological literature. We also review the relevant literature of this rare disorder.

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Objective: To assess the role of infective agents as cause of sensorineural hearing loss (SNHL) in children. Setting: Tertiary care center actively involved in management of hearing impairment through cochlear implant program and other rehabilitation program. Materials and Methods: Retrospective chart review of 213 patients who underwent cochlear implantation at our center from 2007 to 2011 was carried out. Out of these, 185 were children. We have done the data analysis with regard to etiology of hearing loss in these 185 children. An etiology for SNHL could be established in 100 out of these 185 cases. Out of these 100 cases, we have further segregated cases where an infectious etiology was implicated. Results: Out of 185 prelingual cochlear implantees, etiology could be determined in 100 cases. Etiology was of infective origin in 26 of these 100 cases. Infective agents implicated in congenital acquired hearing loss were Toxoplasma, Rubella, Cytomegalovirus, and Herpes (TORCH) infections ( n = 9) including Rubella ( n = 7) and Cytomegalovirus (CMV) ( n = 2). Meningitis ( n = 11) and other infections ( n = 6) were responsible for secondary acquired hearing loss. Conclusions: Results showed that among the identified causes, infective agents were responsible in one-fourth cases of profound SNHL. Building awareness about such existence and their major role in causing SNHL among the otolaryngologists, pediatricians, obstetricians, physicians, audiologists and public is considered essential so that such preventable and controllable maladies are reduced by combined efforts from all these stakeholders.

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Background: Because of the subjective nature of tinnitus, variation of causes, and diversity of patients, this subject is a complex topic to study and understand. The main aim of our study was to find the frequency of tinnitus and also analyze its etiological factors. Since this kind of study has not been performed previously in Nepal, we conducted this study to know the different etiological factors related to tinnitus. Materials and Methods: One hundred and fifty-two patients who came to outpatient at Department of Otorhinolaryngology from 1 August 2011 to 1 August 2012 with history of tinnitus were included after taking informed consent, except six patients who had a co-existing psychiatric problem. Detailed history, clinical examination, and all necessary investigations were done to reach diagnosis. Data were collected and analyzed using SPSS 16.0 software. Results: There were a total 13,598 outpatients who came to Department of Otorhinolaryngology from 1 August 2011 to 1 August 2012. Among them 158 had a history of tinnitus, but six patients were excluded from the study because of a co-existing psychiatric problem. So frequency was found to be 1.11%. Regarding age distribution, 60.6% of the patients were <40 years. Mean age was 41.22 (±17.33) years. Regarding sex distribution, females were affected more than males. Housewives and businessman accounted for 58.5%. In distribution of ethnic group, Newar ethnicity accounted for 49.3% whereas Tamang ethnicity accounted for only 3.3%. Likewise, the right ear was affected more than the left ear. In distribution of etiological factors, mainly conductive hearing loss and sensorineural hearing loss were responsible, whereas an unknown cause was also responsible in 22.4% of the cases. Conclusion: Tinnitus is a distressing symptom, which causes a decrease in the quality of life. So it is important to find the sociodemographic factors and also the main etiological factors related to tinnitus as these findings will help to find out remedial measures and improvement in quality of life.

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