Introduction: The facial nerve is one of the most significant and vulnerable structures in the temporal bone. Its dysfunction affects both voluntary and voluntary motion leading to noticeable disfigurement and emotional distress to those suffering from it. Iatrogenic facial paralysis is known to be a feared complication of ear surgery, and its incidence is reported to be 0.6–3.6% in all otologic surgical procedures, which increases to 4–10% in revision cases. Objective: The aim of this study is to study the anatomical aspects of tympanomastoid segment of the facial nerve. Materials and Methods: Thirty wet human cadaveric temporal bones were dissected in the temporal bone dissection laboratory in the Department of ENT, Government Medical College, Jammu. The length of the tympanomastoid segment of the facial nerve, its relationship with important bony landmarks, and the presence of any anomaly or variation in its course were studied. Observations and Results: The mean length of the tympanic segment of the facial nerve was 10.44±1.428 mm while that of the mastoid segment was 13.33±2.202 mm. The angle formed between the tympanic and mastoid segments of the facial nerve varied between 95°and 120°with the mean angle being 104.66°±7.760°.

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Introduction: The cochlea and vestibule are anatomically and functionally related to each other and any dysfunction in each or both of them may result in vestibular functional derangement and subsequent deficit in the function of balance. This is especially true in children where the two systems are still evolving. Vestibular dysfunction has been reported in approximately 20-70 % of children with hearing loss of different causes. This study was aimed to detect and evaluate the prevalence of vestibular dysfunction in children with SNHL. Methods and Materials: Vestibular function assessment was done with monothermal warm air caloric test on 50 children less than 12 years of age with bilateral severe to profound SNHL. Recordings were made using a head band camera on SYNAPSYS Ulmer VNG software. “Monothermal Caloric Asymmetry” (MCA) was depicted in the recording software as unilateral weakness. MCA of >15 % was taken as evidence of canal paresis. Results: The mean age of the children was 5.48 years. Of the 48 children who successfully completed the test, 09 children had vestibular dysfunction indicative of canal paresis. Prevalence was 18.75 % with 95% CI (7.3, 30.2). Correlation between compensated vestibular function results with age and severity of SNHL was not significant. Conclusions: Children with SNHL should be evaluated for occult compensated vestibular dysfunction. It may also be relevant in the context of any further vestibular pathology the child may develop and should be kept in mind when surgical procedures like cochlear implantation are being contemplated.

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Introduction: Tympanometry is a standard clinical test to measure the middle ear function objectively. Ethnicity and gender may affect tympanometric results, and specific normative data are required for diagnosing middle ear disorders accurately. Aim: This study aimed to determine the effects of ethnicity (Malay vs. Chinese) and gender on tympanometric results among Asian adults. Materials and Methods: A total of 72 young adults aged 20–25 years participated in this comparative study. They comprised two ethnic groups: Malay (n = 31 [14 males and 17 females]) and Chinese (n = 41 [20 males and 21 females]) participants. All participants fulfilled the inclusion criteria (no history of ear and hearing difficulties and normal findings in routine audiological assessments) and underwent a standard 226 Hz tympanometric testing. Tympanometric parameters including static admittance (SA), ear canal volume (ECV), tympanometric peak pressure (TPP), and tympanometric width (TW) were recorded from each participant. Results: No significant differences in all tympanometric parameters were found between Chinese and Malay participants (P > 0.05). However, statistically higher SA and ECV values were noted in males than in females (P < 0.05). No gender effect was observed in TPP and TW (P > 0.05). Conclusions: For a more accurate middle ear evaluation in Malay and Chinese young adults, gender-specific tympanometric normative data derived from this study are recommended.

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Tinnitus is the ringing in the ears heard by the patients in the absence of external sounds. The potential causes for the tinnitus could be the vascular, temporal bone dysfunction, inflammation in the ear, idiopathic, muscular spasms of the middle ear and palatal muscles, functional impairment of the eustachian tube, functional disorders of the jaw, and cervical spine. The author reported a 30-year-old female case who presented with the complaint of buzzing and hissing in the right ear accompanied by the stiffness in the head and neck. Patient had no past medical and surgical history of any ear problem. On otoscopic examination of the tympanic membrane by otolaryngologist no abnormality was detected. In the present case, the diagnosis was made as somatic tinnitus accompanied by reduced cranial sacral motion. The craniosacral osteopathic manipulation was performed which remains the only choice in such cases. In follow-up of 1 month, patient was doing well and is asymptomatic.

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Introduction: Otosclerosis is a primary metabolic localized disease characterized by conductive deafness. The mainstay of treatment of this condition remains surgical. Several techniques and approaches are commonly used with largely excellent results. A newly developed piston made of Nitinol has the property of crimping by heat activation rather than manually. This study, carried out at a tertiary care centre of the armed forces, proposed to evaluate the efficacy and complications of the Nitinol Smart piston in comparison to the conventional pistons currently being used. Methods and Materials: 50 patients of otosclerosis were evaluated with Pure tone audiometry and randomized into test and control groups of 25 each. The control group underwent stapedotomy by the conventional Teflon piston and in the test group Nitinol smart pistons were used. Pure tone Audiometry for hearing thresholds and AB gap was performed at 06 weeks after surgery and repeated at 06 months, 01 year and 02 years after surgery. Results: Results show an almost identical outcome in terms of improvement of hearing thresholds with the two kinds of prosthesis used with the 'Smart' piston showing marginally better results. There was no significant difference in the postoperative ABG (P < .23) or ABG closure (P < .09). Conclusion: The nitinol piston prosthesis represents the latest advancement in stapes prosthesis design in that incorporates heat-sensitive crimping to preclude the technically difficult step of manual crimping. It is at least as effective as a standard prosthesis in closing the ABG in patients with otosclerosis.

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Background: Acoustic change complex (ACC) is an auditory-evoked cortical potential elicited for a change in the physical properties of the sound. It can be elicited for a change in frequency, amplitude, or periodicity in the ongoing speech and nonspeech stimuli. Earlier investigations have established a significant effect of stimulus-related factors on the cortical auditory-evoked potentials. However, investigations to understand the effects of stimulus factors on the ACC are rare. Purpose: This study aimed to investigate the effect of inter-stimulus interval (ISI) between the stimuli on the ACC elicited for speech and tone-complex stimuli. Research Design: This is a cross-sectional study. Method: A total of 12 young adults aged between 18 and 22 years with normal hearing in both ears participated in the study. The ACC was elicited using a consonant-vowel syllable/sa/and frequency-changing tone-complex. Tone-complex had an onset frequency of 1000 Hz and changed its frequency to 2000 Hz at 120 ms after the onset. Both stimuli had a total duration of 350 ms and changed their characteristics at 120 ms after the onset. The stimulus was presented monaurally with ISIs of 500, 1000, 1500, and 2000 ms, and the ACC was recorded from Cz to Fz. Results: The present study showed a significant effect of ISI on peak latencies and peak-to-peak amplitudes. Shorter ISI was found to elicit peaks with smaller amplitude and slightly longer latency, whereas longer ISI elicited peaks with larger amplitude and shorter latency. Further, the amplitude of response for tone-complex was larger than response for syllable/sa/. Conclusions: ISI is one of the stimulus-related factors which significantly affects the ACC. Longer ISIs (≥1500 ms) should be used to elicit the ACC.

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Objective: The objective of this study was to investigate the effect of postauricular incision (sulcus incision) during myringoplasty using conchal perichondrial graft with or without conchal cartilage on the ear protrusion. Patients and Methods: A prospective study was conducted on 243 patients who underwent myringoplasty using small postauricular sulcus incision. The distances from postauricular area to the lateral aspects of helical rim and ear lobule at three different levels and the maximum ear protrusion were measured pre- and post-operatively. Results: There were no statistically significant differences between the measures of the auricle position preoperatively and 2 weeks, 1 month, and 3 months postoperatively. Conclusion: There was no effect of the short postauricular sulcus incisions for myringoplasty on the ear position. It does not affect or annoy the glasses wearers with highly satisfactory cosmetic results without reported persistent complications.

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Aural polyps are secondary to multiple ear pathologies, most commonly inflammatory or cholesteatoma related. Here, we present a rare case of recurrent aural polyps caused by guidewire migration into the middle ear with serious systemic complications and our attempts at removal.

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Glomus tumors are non chromaffin paraganglionomas, a vascular tumor arising in the middle ear, presents with tinnitus and aural block with radiological supportive findings. Diagnosis is made easy by the radiological investigations. Even in this modern era, the role played by clinical examination is vital and as we present in this case report, played an important role in management of the disease.

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With widespread use of antibiotics, the occurrence of brain abscess and lateral sinus thrombosis together is rare these days, especially with enterococcus as the causative organism. We here present a case of pediatric case of brain abscess and lateral sinus thrombosis which developed an additional complication of postoperative cerebrospinal fluid leakage. The case was successfully treated by excision of the abscess, canal wall down mastoidectomy with partial obliteration of cavity, and Type III tympanoplasty with umbrella graft.

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Objectives: The objective of the study was to evaluate the effect of mastoid pneumatization on myringoplasty success. Patients and Methods: Forty-two adult patients with dry central tympanic membrane perforation scheduled for myringoplasty were included in the study. Computed tomography (CT) scans of the temporal bone coronal and axial cuts were done 1–2 days before surgery. The patients were evaluated on the basis of postoperative graft taking. Results: Success rate was 85.7% while failure rate was 14.3%. The mean longitudinal diameter of the mastoid was found to be 2.35 cm in succeeded cases and 1.43 cm in failed cases with near significant difference (P = 0.0636). The mean transverse diameter was 1.44 cm in succeeded cases and 0.83 cm in failed cases with a significant difference (P = 0.0476). The mean depth of the mastoid was 0.4 in both succeeded and failed cases. The mean total mastoid volume was 2.832 ml in succeeded cases and 1.13 ml in failed cases with nonsignificant difference (P = 0.1218). The mean mastoid surface area was 516.9 cm² in succeeded cases and 448.5 cm² in failed cases with a significant difference (P = 0.0087). Conclusions: Success rate of myringoplasty is higher in patients with chronic suppurative otitis media (CSOM) having large mastoid system than those having small one. Preoperative CT scans in patients with CSOM undergoing myringoplasty are advisable.

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Background: Diabetes mellitus (DM) is a syndrome of chronic hyperglycemia due to relative insulin deficiency or resistance. The risk of complications of diabetes has been observed to increase as a function of the duration of hyperglycemia. Objective: The objective of this study is to determine the effect of duration of DM on hearing thresholds among type 2 diabetics. Methodology: This was a cross-sectional descriptive study conducted between October 2015 and May 2016 in Usmanu Danfodiyo University Teaching Hospital Sokoto among type 2 diabetic patients attending the Endocrine Clinic of the hospital. Patients had their blood sugar and hearing thresholds measured. Results: A total of 170 type 2 diabetics were recruited into the study, out of which 98 (57.6%) were females and 72 (42.4%) were males. The mean age was 46.49±10.02 years. One hundred and twenty-two (71.8%) had elevated hearing thresholds. The mean duration of diabetes among participants was 7.81±5.34 years, with durations ranging from <1 year to 30 years. The mean pure tone average increased with increase in duration of diabetes (P < 0.001). Simple linear regression showed that increase in duration of diabetes was positively related with hearing threshold (P < 0.0001). For every year increase in duration of type 2 DM, a 1.036 dB HL increase in pure tone average is to be expected. Conclusion: This study demonstrated a relationship between duration of diabetes and hearing threshold. It has shown that as the duration of hyperglycemia increased, the hearing threshold among participants also increased.

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Objective: The purpose of this study is to evaluate the effects of myringosclerosis (MS) localized to the tympanic membrane (TM) on the mechano-acoustics of hearing using wideband tympanometry (WBT). Materials and Methods: In this prospective case-controlled study, 86 ears of 54 patients who were found to have MS localized to the TM were compared to 40 healthy eardrums in 20 patients. Thirty-seven ears which had a MS ratio to the whole TM of <25% were classified as Group 1, 33 ears with a ratio of 25–50% were classified as Group 2, and 16 ears with a ratio of >50% were classified as Group 3. Peak acoustic compliance, resonant frequency (RF), and frequency-specific absorbance results of WBT were compared among the MS groups and the control group. Results: When the amplitudes of peak acoustic compliance of the MS groups and control group were compared, the MS groups were found to have lower amplitudes, and the difference was statistically significant (P < 0.05). There was no difference in frequency-specific absorbance values (250, 500, 1000, 2000, 4000, 8000, and 375–2000 Hz averaged absorbance) among the groups (P > 0.05). The RF of Groups 1, 2, and 3 were 1062, 1154, and 1166 Hz, respectively, and the RF of the control group was 1077 Hz. There was no significant difference among the groups with regard to resonant frequencies. Conclusion: This study showed that although MS localized to the TM decreased the amplitude of peak acoustic compliance of the tympanogram, it did not affect the RF or the wideband acoustic absorbance.

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Diabetes mellitus (DM) is a multifunctional metabolic disorder affecting almost all the systems of the body. There is a strong relation between DM and hearing. The three main theories of pathogenesis of hearing impairment in patients with diabetes are microangiopathy, neuropathy, and combination of both. Even though studies have proved the occurrence of sensorineural hearing loss in DM, disagreement still exists among some about their relation. Material and Methods: This study was a prospective design. Aim: The present study aimed (1) to focus on and evaluate the interrelation between Type 2 DM and hearing loss; (2) to screen the degree of auditory acuity in patients with Type 2 DM using pure tone audiometry; and (3) to analyze the effect of age, glycemic status (fasting blood sugar and postprandial blood sugar), glycemic control (glycosylated hemoglobin), and duration of Type 2 diabetes on auditory acuity. Results: In the present study, it was found that the patients with Type 2 diabetes had a higher hearing threshold than the healthy controls. The patients with diabetes showed significant high-frequency, bilateral, mild-to-moderate SNHL. Conclusion: The glycemic status had significant correlation with hearing loss may be explained by diabetic microangiopathy of the inner ear, and the hearing was affected in both sexes equally.

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Background: Children with unilateral hearing loss (UHL) of severe profound degree find it challenging to locate a sound source and to comprehend speech in the presence of noise, like in classrooms. The objectives of the present study were to compare the available rehabilitative options for children with UHL and arrive at a probably appropriate option. Methods: Fifteen children with unilateral severe sensorineural or profound hearing loss participated in the study. The sound field thresholds, speech perception in the presence of noise and in quiet were assessed with the digitally programmable bone-anchored hearing implant (BAHI), the trimmer digital BAHI and the transcranial contralateral routing of signal (T-CROS). Results: BAHI and T-CROS both provide significant benefit for the children with UHL. However, the children performed better with the BAHIs than the T-CROS both in quiet and noise in most of the measures. It was also noted that the digitally programmable and the trimmer digital BAHI both gave similar performance. Conclusions: BAHI was a better option in both quiet and noise than the T-CROS as a rehabilitation option for children with UHL. The current study helps in prioritizing the rehabilitation options while considering trial and also helps in narrowing down at the appropriate rehabilitative option for the children with UHL.

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Background and Objective: The role of efferent system in auditory perception is very important. To assess this, a reliable measure of efferent functioning is necessary. The efferent suppression of otoacoustic emission lacks good test-retest reliability, and there is a need to look for the reliability of other measures of efferent auditory functioning. The current study evaluated the test-retest reliability of contralateral suppression of acoustically evoked middle ear muscle reflexes (MEMR). Method: Nineteen normal hearing adults in the age range of 18–24 years participated in the study. A Repeated measures design was used to establish the reliability of the contralateral suppression of MEMR. Measurements were spaced 1 h and 1 day apart. Results: The results showed acceptable test-retest reliability of contralateral suppression of acoustically evoked MEMR in terms of its Cronbach's alpha. However, inspection of the individual data did not support the impression to call it a reliable tool to assess efferent auditory functioning. The findings of the study are discussed in light of its clinical utility. Conclusion: Contralateral suppression of acoustically evoked MEMR has questionable reliability to be used as a clinical tool.

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