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Masking is a concept that is used in audiology to yield the accurate threshold of the test ear. The ear's selection to be masked is based on the Weber test, which can be misleading in certain conditions. There is a need to explain the concept, which can help audiologists give an accurate diagnosis. Reverse masking is one such technique where the nonlateralized ear is masked to get the lateralized ear's precise threshold. This presentation attempts to explain this concept in clinical audiological practice and avoid the limitations of conventional masking procedures.

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Aim: To assess the Eustachian tube function (ETF) in chronic otitis media (COM)-mucosal disease and the role of tympanoplasty in ETF. Materials and Methods: A longitudinal study from January 2019 to June 2020 which comprised of 110 patients diagnosed with COM– mucosal disease was carried out in a tertiary care referral hospital. They were divided into mucosal active (n = 34) and mucosal inactive (n = 76) groups. Preoperative ETF was assessed with immittance audiometry by Toynbee's method. All patients underwent tympanoplasty with or without cortical mastoidectomy depending on the disease status. Postoperatively between 8 and 12 weeks after successful graft uptake, ETF was tested by William's test. Results: Out of 110 patients, 29 had Eustachian tube dysfunction preoperatively and 27 had normal ETF posttympanoplasty ± cortical mastoidectomy. Mc Nemer test was applied and P value was found to be < 0.01 denoting a highly significant difference between the pre and postoperative ETF. Conclusion: Tympanoplasty with or without cortical mastoidectomy has a therapeutic effect on ET dysfunction in COM-mucosal disease.

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Introduction: Unaddressed hearing loss poses great loss with an annual risk of 750 billion United States dollars. In India, the incidence of adult-onset deafness is found to be around 7.6%. Unilateral Sensorineural Hearing Loss (USNHL) has been found to affect 7.9%–13.3% of the Indian population. Since, most of the literature available is on bilateral Sensorineural Hearing Loss (SNHL), and limited work is done on USNHL. Hence, this study tends to list and analyze the clinical characteristics of patients with USNHL and is the largest Indian series related to clinical profile of USNHL. Materials and Methods: A prospective observational study was conducted in the Department of Otorhinolaryngology to study the clinico-epidemiological profile of 130 adult patients having USNHL. Patients were worked up using clinical, audiological, laboratory, and radiological tests, to reach a particular diagnosis. Results: The most common age group seen was 36–45 years (36.9%) with male preponderance. The majority of patients had an education of less than high school. About 27.7% of the patients had associated tinnitus and vertigo both. Most of the patients (30%) presented with 1–5-years duration of illness and noise as the most common associated risk factor. Forty-three percent of patients had profound hearing loss. Magnetic resonance imaging (MRI) was done in 37% of patients and was found to be diagnostic in 6.1% of cases. The most common etiology found was idiopathic progressive SNHL (43.1%). Conclusion: USNHL was more commonly seen in nonelderly males. Majority had profound hearing loss and presented very late. This study also mentions the possible socioeconomic correlate of the patients with their clinical profile. MRI is useful in detecting rare etiologies such as dolichoectasia, multiple sclerosis, schwannoma, and vestibulocochlear anomalies. A very diverse etiology of USNHL was seen.

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Context: Aided Cortical Auditory Evoked Potentials (CAEPs) can be one of the objective methods to assess benefit from hearing devices in difficult-to-test population. There is a dearth of studies using CAEPs to evaluate the benefit obtained with bimodal stimulation. Aim: The aim of the present investigation was to investigate if CAEPs can be used as an objective measure to assess benefit from bimodal stimulation. Participants and Methods: CAEPs using /t/ stimmulus was recorded from 6 children in 3 conditions (using only hearing aid, with only cochlear implant [CI] and using bimodal condition). Behavioral tests carried out included aided sound field thresholds and Early Speech Perception Test (ESP) in auditory mode. Results: CI assisted thresholds for all the six children were within speech spectrum whereas hearing aid assisted thresholds were within speech spectrum for three children and outside speech spectrum for three. The results of ESP complimented the aided thresholds. Amplitude of CAEPs appeared to show an association with behavioural measures. The amplitude of CAEPs were lesser when the benefit from hearing device was lesser. Conclusion: The results of the present study indicate that CAEPs can be used to evaluate benefit/advantage from bimodal stimulation in difficult-to-test population. This case report series provides empirical evidence for use of CAEPs in clinics. Studies on larger population are needed to confirm the results of the present study.

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Objective: The objective was to assess the efficacy of platelet-rich fibrin in increasing graft uptake and improved hearing outcome following Type I tympanoplasty by postauricular underlay technique. Materials and Methods: Adult patients without any comorbidities in the age group 20–40 years with chronic otitis media-mucosal (inactive) enrolled for type I tympanoplasty were included in this randomized control study. Sixty eligible patients were randomly grouped by lottery method into test (application of platelet-rich fibrin, n = 30) and control groups (without application of platelet-rich fibrin, n = 30). Postoperative closure of the perforation was compared on 1^st month and 3^rd month follow-up. Postoperative graft uptake was compared in both the study groups. Pre- and postoperative comparison of pure tone average (PTA) and air-bone gap (ABG) closure were measured in all patients. Results: The graft uptake rate in the test group was 100%, and for the control group was 86% on 3^rd month follow-up. PTA and ABG closure in patients did not show any comparable improvement in either group. The results were not statistically significant for graft uptake (P = 0.112), PTA (P = 0.221) and ABG (P = 0.931). Conclusion: The use of platelet-rich fibrin did not have significant improvement in postoperative outcome both in terms of tympanic membrane closure and hearing improvement statistically. However, we did notice better graft closure in patients where we used platelet-rich fibrin.

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Introduction: Residual vestibular dysfunction is a common sequela of benign paroxysmal positional vertigo (BPPV), causing morbidity even after the resolution of vertigo with otolith repositioning maneuvers. The subjective visual vertical (SVV) measurement is used to detect the vertical spatial disorientation which may be associated with utricular dysfunction. We used the bucket test to measure possible residual utricular dysfunction in patients with BPPV after successful treatment of BPPV with canalolith repositioning maneuvers. Objective: (1) To document the presence of utricular dysfunction after canalolith repositioning maneuvers for posterior semicircular canal BPPV using bucket test for SVV. (2) To compare the difference in residual utricular dysfunction represented by SVV after Epley's and Semont's maneuvers. Study Design: Prospective, clinical, single center, cross sectional study. Methods: Sixteen consecutive patients attending ENT OPD at a tertiary care hospital for canalolith repositioning maneuvers for posterior semi circular canal BPPV underwent bucket test for SVV on the first follow up after a single physician directed maneuver for the correction of BPPV. Results: Sixteen bucket test results were analyzed after repositioning manoeuvres – twelve of which were Epley's maneuver and four were Semont's maneuver. Fourteen had a deviation of SVV more than 2° s. There was a significantly lower mean deviation of SVV following Semont's maneuver versus Epley's maneuver. Conclusion: There is a residual vertical spatial disorientation following repositioning maneuvers which contributes to dizziness after treatment. Our new finding was a lower mean deviation in SVV after Semont's compared to Epley's maneuver. Larger studies are required to confirm our findings with better statistical weight.

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Objective: We investigated the effect of spectrally modified speech on speech perception of native speakers of Marathi. Methods: A total of eight word-lists with each list consisting of 25 words in Marathi were used as speech stimuli. The speech stimuli in List 1, List 2, List 3, List 4, List 5, List 6, and List 7 were spectrally modified by filtering them at 500 Hz, 1000 Hz, 1500 Hz, 2000 Hz, 2500 Hz, 3000 Hz, and 3500 Hz cutoff frequencies, respectively. The speech stimuli in List 8 were unfiltered. The speech identification score (SIS) testing was performed as a measure of speech perception using eight word-lists on a total of 125 normal hearing native speakers of Marathi in the age range between 18 and 25 years. Results: The results revealed that there was a statistically significant effect of spectral modification on speech perception. An increase in cutoff frequency of speech stimuli was analogous to increase in speech perception performance. The normal range of SIS (90%–100%) was achieved for speech stimuli filtered at 2500 Hz cutoff frequency. Conclusion: Although speech is a broadband signal, the findings of this study suggest that the spectral information till 2500 Hz is sufficient for optimum perception of speech of Marathi.

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Chronic suppurative otitis media (CSOM) with cholesteatoma can present with intratemporal complications such as postauricular subperiosteal abscess with or without fistula. In some postauricular cutaneous mastoid fistula cases, direct closure of the wound is not possible due to skin tension, leading to skin necrosis and postoperative recurrent cutaneous fistula. Here, we describe a surgical technique using a combination of a bilobed flap and a fibro-muscular-periosteal flap for fistula closure on a 31-year-old and a 35-year-old female with postauricular cutaneous mastoid fistula due to CSOM. All patients were successfully managed with no fistula recurrence.

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Acute otitis media is one of the common conditions that we see in practice every day. It could be a simple condition but also may bring more sinister outcome if not properly treated. Cerebral venous sinus thrombosis is one of the rare but dangerous intracranial complications in acute otitis media. Here, we presented a case in a young adolescent who had acute otitis media complicated with subperiosteal abscess, concomitant sigmoid sinus, and internal jugular vein (IJV) thrombosis. To date, many case reports regarding otogenic sigmoid sinus thrombosis have been published, but a case report discussing concomitant sigmoid sinus and IJV thrombosis is very rare.

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Context: Persistent ear discharge in chronic otitis media leads to various complications, hearing loss, and is a hindrance in the successful surgical management of the patients. Recent and updated culture and sensitivity data are an imperative tool in achieving this goal. Empirical antibiotics lead to the development of resistant organisms. Aims: This study aimed to identify the most common organisms in chronic otitis media and to study the current sensitivity and resistance patterns to the antibiotics. Settings and Design: This was a retrospective descriptive study. Subjects and Methods: Retrospective data were collected for patients visiting the outpatient department of the department of otorhinolaryngology from May 2019 to September 2020, who underwent culture and sensitivity for ear discharge. Results: Pseudomonas aeruginosa was the most common organism isolated (54.6%) and showed the highest sensitivity toward piperacillin/tazobactam and polymyxin-B (96.4%). Staphylococcus aureus was the second most common organism which showed the highest sensitivity toward linezolid and teicoplanin (100%). Both Pseudomonas and S. aureus showed the lowest sensitivity toward ciprofloxacin. The incidence of multidrug resistance organisms was 46%. All Methicillin-resistant S. aureus (MRSA) were resistant to ciprofloxacin. Conclusion: The study data indicate a shift in the antibiotic sensitivity patterns of the organisms. Due to the high resistance pattern, ciprofloxacin should be avoided in empirical treatment regimens. Culture and sensitivity should be made mandatory for all ear discharges and we should have antibiotic protocols based on recent culture and sensitivity data.

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Lymphangioma is a rare benign tumor in the head-and-neck region. These lesions are usually congenital malformation of the lymphatic system. Development of lymphangioma in the postauricular area of the head-and-neck region is extremely rare. Although lymphangioma can be found throughout the body, it has a greater frequency in the cervicofacial area. Histological examination of the excisional biopsy confirms the diagnosis of lymphangioma. Surgery is still considered as the treatment of choice. There are few other treatment options like sclerosing agents such as bleomycin, sodium morrhuate, doxycycline, tetracycline, and OK-432. Here, we are presenting a case of giant lymphangioma in the postauricular area and treated with complete surgical excision.

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Goldenhar syndrome is a rare genetic disorder that includes various signs and symptoms, including facial, auricular, ocular, vertebral, renal, lung, cardiovascular, and limb deformities. Such individuals have severe-to-profound sensorineural hearing loss as a common feature. However, implanting them with either cochlear implants or brainstem implants is challenging, and the article discusses literatures that have carried out these procedures based on a systematic review of case reports. Databases such as PubMed, J-Gate, and Google Scholar were used to extract the articles related to auditory implantation and Goldenhar syndrome.

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Introduction: High jugular bulb (HJB) is usually discovered incidentally; however, it may interfere with inner ear structures such as vestibular aqueduct (VA), facial nerve, and the posterior semicircular canal (PSCC). Objective: The aim is to investigate the incidence of HJB in benign paroxysmal positional vertigo patients with PSCC involvement (PSCC-BPPV). Materials and Methods: The study group included 53 consecutive, PSCC-BPPV patients, diagnosed in our clinic. Following the diagnosis, their high resolution computed temporal bone tomography were performed. The control group consisted of 90 patients, who attended to our clinic for various complaints, and to whom high resolution computed tomography of the temporal bone was conducted. Results: The incidence of HJB in the study group was 41.5% (n = 22). The incidence of ipsilateral HJB in this group was 28.3% (n = 15). The incidence of HJB in the control group was 11.1% (n = 10) (P < 0.001). The closest distance between HJB and PSCC canal in the control and study groups was 1.61 ± 0.74 mm and 1.17 ± 0.37 mm, respectively (P = 0.098). Conclusion: The HJB is significantly more frequent in PSCC-BPPV patients. Furthermore, the rate of incidence of HJB in the ipsilateral ears of these patients is significantly higher. Venous hypertension or the turbulence may cause strong pulsations, which influence the detachment of the otoconia into the PSCC.

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