Auditory neuropathy spectrum disorder (ANSD) is a condition in which the patient has poor speech perception abilities, which is characterized audiometrically with presence of oto acoustic emission and the absence of auditory brain stem response. Several authors have categorized ANSD into various types based on the anatomical and physiological origin or based up the audiometric findings. This systematic review study focuses on illuminating the benefit of cochlear implants or auditory brain stem implants for children diagnosed with ANSD.

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Aims: This study aims to study and compare the outcome of tympanic membrane grafting medial or lateral to handle of malleus in terms of graft uptake and closure of air bone gap. Materials and Methods: This prospective randomized study included 60 patients who presented in the ENT Outpatient Department of ABVIMS and Dr. Ram Manohar Lohia hospital with Inactive chronic Otitis media (COM) (tubo tympanic disease). Patients were randomly allocated to two groups of 30 patients each. Group A contained patients with graft placed medial to handle of malleus and Group B contained patients with graft placed lateral to handle of malleus. Patients were followed up at the 4^th, 6^th, and 12^th week postoperatively for graft uptake and hearing gain were assessed. Results: There was significant mean hearing gain postoperatively compared to preoperative in pure tone audiometry, however, there is no significant difference in short-term outcomes of both the grafting techniques for graft uptake and audio metric results. Conclusion: Both medial and lateral placement of grafting material to malleus handle into type I underlay tympanoplasty are good methods for graft uptake and audiological outcome for inactive COM (Tubo tympanic disease).

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Cerebral venous sinus occlusion is an exceptional presentation in the emergency department. Otitis and mastoiditis are rarely associated with cerebral venous sinus occlusion. It is considered as a redoubtable complication with potentially severe outcomes. Symptoms that may indicate this thrombosis are variable and include progressive headache, intracranial hypertension, seizures, focal neurological deficits, and ophthalmologic symptoms. In this article, we report a case of a young female patient presenting with otitis and mastoiditis complicated with intracranial thrombosis. She was successfully treated with antibiotics, anticoagulants, and analgesics. Furthermore, we provide a brief review on cerebral venous sinus thrombosis with a focus on its risk factors and its management. Finally, we emphasize the need for better awareness about this potential intracranial complication.

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Aims: The aim is to determine the quality of life (QOL) of mothers of Down syndrome (DS) children with hearing loss and without hearing loss. Another objective is to study the correlation of QOL of mothers of DS children with their characteristic of the social socioeconomic. Settings and Design: An experimental group of all mothers that have children with DS who were selected from The National University of Malaysia Medical Center (UKMMC). Materials and Methods: Observational study using the World Health Organization QOL Scale (WHOQOL-BREF) and UKMMC stress question. Statistical Analysis Used: This investigation is a descriptive-analytic study response to surveys by 151 mothers of DS children during 1 year period. Results: Eighty-three mothers (55.6%) are housewives. The mother's age ranged from 28 to 61 years, with a mean of 43 years. The QOL was described as “satisfactory” by 60% of the mothers. The following WOHQOL-BREF scores were found: Social (72.54); physical (71.27); environmental (69.21); and psychological (63.25). Of the 151 DS children, 87 (57.6%) children have a hearing impairment. The QOL was similar between mothers with DS children with and without hearing impairment. Conclusions: About two-thirds of mothers with DS children have a satisfactory level of QOL. The psychological domain has the lowest score in the QOL assessment, which suggested that mothers of DS require psychological support. The study also demonstrated no significant different QOL and stress level and hearing impairment was not a predictor of stress.

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Introduction: Ear is one of the most important parts of the face along with the nose and eyes, as normal pinna is projected outward, it is highly vulnerable to injury by road traffic accident (RTA) and other causes. Aim of Study: The aim of the study was to evaluate various etiology, management, and treatment outcomes of pinna injury. Materials and Methods: Fifty cases of pinna injuries were treated medically and surgically over a period of 1 year at Sir T Hospital, Government Medical College, Bhavnagar, India. Results: It was observed that RTA (46%) was the most common cause of pinna injury. Conclusion: RTA is the most common cause of injury to pinna, followed by assault, thermal injury, human bite, and animal bite. To lessen the risk of perichondritis, aseptic precautions are most important thing.

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Context: Benign paroxysmal positional vertigo (BPPV) is a disorder characterized by attacks of vertigo and nystagmus and aggravated with changes in head posture. BPPV can be treated effectively by relocating otoconia from the semicircular canal duct into the vestibule using different repositioning maneuvers. Our study is to determine the role of maneuvers in BPPV and to study the efficacy of the maneuvers in BPPV. Aims: The aim of this study is (1) to determine the role of Semont's and Epley's maneuver in BPPV and (2) to study the efficacy of these maneuvers with or without betahistine therapy. Settings and Design: A prospective study was done on sixty BPPV patients from Department of ENT, A. J. Institute of Medical Sciences, Mangalore. Subjects and Methods: Inclusion criteria were positive Dix-Hallpike maneuver and normal pure tone audiometry. Exclusion criteria were cervical spondylosis, multiple canal disease, and inner ear disease. Patients were selected based on above criteria, were examined for posterior semicircular canal BPPV, and further divided into four groups by random selection. Different treatment modalities are used. Statistical Analysis Used: Wilcoxon signed ranks test was used for statistical analysis. Results: The evaluation of outcome was done at the end of 4^th week and after 3 months of the initial therapy with Dix-Hallpike and the quality of life was evaluated using visual analog scale for Vertigo and Dizziness Handicap Inventory. The results were compared using the above scales before and after the treatment. Conclusions: Vertigo is a common symptom which has significant morbidity physically and economically. These maneuvers are safe, short, inexpensive, and effective in treating posterior semicircular BPPV and can be practiced regularly.

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Context: There is a need for a quick reliable home test for detecting hearing loss (HL), especially in the present era of telemedicine. Hum test is one such which can be performed easily without instruments but not much documented in the literature. Aims: The aim is to find out the diagnostic accuracy of hum test in detecting unilateral HL. Settings and Design: Tertiary healthcare center, prospective, cross-sectional diagnostic test accuracy study. Subjects and Methods: The study included 85 controls and 85 patients with unilateral conductive or sensorineural HL (SNHL). The patients were divided into four groups-controls, simulated unilateral conductive HL (CHL) subjects, unilateral CHL, and SNHL patients. They underwent 4 tests-Weber test, Low pitch hum test, High pitch hum test, and pure-tone audiometry (PTA), the latter being the gold standard. Statistical Analysis Used: To test the statistical significance of the agreement between the hum test and the Weber test with PTA, McNemar's Chi-square test was used. Diagnostic measures such as sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were computed. Results: The sensitivity (85%) and accuracy (95.2%) of Hum test were better in comparison to Weber test (70% and 88.8% respectively) in unilateral sensorineural patients. However, in the case of CHL the Weber test was more sensitive in comparison with hum test (95.6% and 83.35% respectively). Overall, the diagnostic accuracy of hum test was 92.5% when compared to the Weber test (93.5%). Conclusions: Hum test can be used as a reliable screening tool for suspected sudden HL cases.

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Purpose: The aim is to study the carrier rate of connexin 26 (Cx26) W24X gene mutation among the general population of Kerala, India. Subjects and Methods: This study included 248 normal-hearing individuals from the general population of Kerala, India. Polymerase chain reaction-restriction fragment length polymorphism was performed to detect the presence of Cx26 W24X mutation. Results: Of the 248 individuals, 7 cases were heterozygous and 241 cases were homozygous normal. The results showed a carrier frequency of 2.82% for the Cx26 W24X mutation in the Kerala population. Conclusion: Among the selected Kerala population sample, the Cx26 gene mutation showed a high carrier rate. Early detection of nonsyndromic hearing impairment has been proven to be very helpful in speech therapy and language development. Given the high carrier rate of Cx26 W24X mutation in the Kerala population, we propose the genetic screening of the suspected newborns for W24X mutation in the Cx26 gene.

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Ramsay Hunt syndrome (RHS) Type II is characterized by facial paralysis, herpetic eruptions on the auricle/mouth, and otic pain due to reactivation of the latent varicella-zoster virus in the geniculate ganglion. A typical case of RHS with multicranial nerve involvement is a rare disorder and more severe than without such involvement. In this case study, we report a case of a 54-year-old man with multicranial nerve involvement. The combined treatment with medicines (corticosteroids and antiviral drugs) and rehabilitation therapy has been partially successful but did not completely resolve facial palsy and hearing loss.

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Aim: All cholesteatoma cases are managed surgically under microscopic visualization since decades. But, the recurrence of the disease was found due to inadequate removal of cholesteatoma tissue from the hidden areas such as anterior attic region, tubotympanic recess, sinus tympani, and facial recess. Objectives: An angled otoendo scopes with panoramic view increases the accessibility and thereby thorough clearance of cholesteatoma which leads to better outcome. Materials and Methods: This prospective observational study evaluates the long-term results of transcanal endoscopic management of Stage-2 attic cholesteatoma. It was conducted at the Department of Otorhinolaryngology, from January 2018 to January 2020. Eighteen patients with acquired limited attic cholesteatoma had undergone endoscopic transcanal tympanotomy and atticotomy for the complete removal of cholesteatoma sac. Reconstruction of attic with a composite tragal cartilage was performed in all cases. Results: Office-based endoscopic inspection of ear in all cases was done up to 6 months in terms of graft uptake and recurrence. Postoperative hearing evaluation at 3 months and 6 months was also performed. All cases in our series had good graft uptake with improved hearing. There was no recurrence and one case had postoperative granulation which was managed with culture and sensitivity directed antibiotics and regular aural toileting. Conclusion: Thus, an endoscopic transcanal surgical management of attic cholesteatoma is a less invasive procedure with long-term results that compare well to those of postauricular microscopic approach.

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Background: Rubella is caused by the rubella virus that transmits through droplets or direct contact that can cause congenital defects such as hearing loss. Immunoglobulin M (IgM) rubella can be detected in infants under 1 year of age with suspected congenital rubella syndrome (CRS). Objectives: This study was to analyze the correlation between hearing loss with IgM rubella in infants. Methods: This was an observational analytic study with a retrospective in infants <1 year of age with suspected CRS. Medical records and CRS surveillance data of subjects who came to the Otorhinolaryngology Outpatient Clinic, Dr. Soetomo Hospital, Surabaya, from January 1, 2015, to December 31, 2017, were collected. The data were grouped based on age, gender, place of residence, clinical symptoms, hearing examination (otoacoustic emission and automated auditory brainstem response), IgM and IgG examination, and CRS classification. Results: Total patients were 171 patients with the highest number of patients was the 0-3 years age group as many as 136 patients (79.5%) and girls patient more than boys as many as 88 patients (51.5%). The most clinical symptom of CRS was 24-hr postpartum jaundice were 111 patients (74.4%). The serological Rubella IgG were positive results with a total patient were 140 (81.9%) and Rubella IgM results were negative with 141 (82.5%). The most CRS case criteria were non-CRS with 78 patients (45.6%). There was correlation of hearing loss with IgM rubella in infants <1-year with suspected CRS and statistical results p= 0.03. Conclusion: IgM rubella correlates to clinical symptoms of hearing loss in infants <1 year of age with suspected CRS.

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Background: Sickle cell disease is characterized by vaso-occlusion which leads to impaired blood supply to several organs. The cochlear in particular has been known to be highly sensitive to anoxia which is, in turn, a proven cause of sensorineural hearing loss (SNHL). Early detection of hearing loss is paramount in these patients, as the cochlear ischemic damage is repetitive and progressive. Once the damage is sufficiently enough to cause noticeable hearing loss, the loss is mostly substantial and irreversible. Otoacoustic emission is useful in detecting early cochlear damage. Materials and Methods: Children with sickle cell anemia (SCA) (HbSS) aged between 1 and 12 years diagnosed by hemoglobin electrophoresis and equal number of controls matched (HbAA) matched for age and sex were recruited for the study. All participants underwent a detailed ear, nose, and throat examination and tympanometry. Those with normal middle ear function were further subjected to transient-evoked otoacoustic emissions (TEOAEs) testing. Results: There were 60 patients with SCA (cases) and 60 controls. The age of the participants ranged between 1–12 years with a mean of 6.5 ± 3.74 among the cases and 7.02 ± 3.54 among the controls. The male–female ratio was 0.9:1. Among participants with normal middle ear function, TEOAE was abnormal in 43 (48.8%) ears of the cases and 70 (73.7%) ears of the controls. There was a statistically significant difference in abnormal TEOAEs outcome between cases and the control group (P = 0.002). Conclusion: Children with SCA had a high rate of abnormal cochlear function. Therefore, there is a need for periodic monitoring of cochlear function in these patients so as to detect and treat SNHL early.

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Aim and Objectives: The current study was undertaken to assess the effect of the coronavirus disease 2019 (COVID-19) pandemic on cochlear implant rehabilitation of children with congenital nonsyndromic bilateral severe-to-profound sensorineural hearing loss (SNHL). The objectives were to find out the psychological impact of COVID-19 on parents of children with cochlear implant habilitation, to assess the performance of children with cochlear implant habilitation through teletherapy, and to analyze the problems faced by the parents to obtain the professional hearing health-care services for their cochlear implanted children. Materials and Methods: An online questionnaire survey was conducted among the parents of children who had undergone cochlear implantation (CI) consequent to congenital severe-to-profound SNHL. Prior to the COVID-19 pandemic, these children were receiving regular auditory verbal therapy (AVT) including visits to the Centre for audiological services (mapping and troubleshooting of the speech processor). Results: The online questionnaire survey has undertaken. A total of 50 parents were participated in this study. All the parents are unanimously reported that the COVID-19 pandemic has adversely affected them in the form of accessing the professional health-care services for regular mapping and troubleshooting of the speech processor and also their children's rehabilitation. However, active involvement between the health-care professionals and the parents through video consultation and tele AVT has definitely helped the children to a great extent. Conclusion: The present study emphasizes the great challenge posed by the COVID-19 pandemic for continued rehabilitation of CI children. The innovative digital media technology helps in addressing such medical issues through telemedicine, teleaudiology, and teletherapy.

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Background: Chronic otitis media (COM) is a chronic infection of the middle ear cavity caused by an ongoing inflammatory response within the middle associated with unresolved and resistant bacterial infections. Aim: Assessing the middle ear status in mucosal type of COM with only conductive hearing loss with no complications and their outcomes following tragal cartilage ossiculoplasty with tympanoplasty. Materials and Method: A prospective study was conducted on 60 patients of mucosal type of COM with only conductive hearing loss, who underwent tragal cartilage ossiculoplasty with tympanoplasty. The outcomes are assessed by the gain in hearing loss postoperatively 3 months and 6 months, pure tone audiometry. Results: Age of the patients ranged from 18 to 65 years, with a mean of 34.17 (standard deviation [SD] +13.436) years and median age being 31.5 years. Twenty seven (45%) were females and 33 (55%) were males. The mean hearing loss preoperatively was 47.24 dB (SD = 8.351). This reduced to 24.54 dB (SD = 6.018) at 3 months and further to 22.47 dB (SD = 5.173) at 6 months postoperatively. The preoperative hearing loss was significantly higher among females as compared to males (43.68 vs. 51.93 dB, P < 0.001). Hearing loss at 3 and 6 months postoperation showed no significant difference with sex. At 3 month follow up, there was gain in hearing in all age groups. Conclusion: Autologous tragal cartilage ossiculoplasty proved to be an effective procedure for reconstructing incus which was the most commonly affected ossicle in our study.

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Objective: The aim of this study was to investigate the normal gain values specific to each semicircular canals by using the goggle-less model of video head impulse test (vHIT) between ages of 20–39 and 40–60, gender and age-related gain values changes. Materials and Methods: The present study was performed in 99 participants aged 20–39 years and 100 participants aged 40–60 years. Each semicircular canal gain values were interpreted by comparing for both the age group of 20–39 and 40–60 years and gender. Results: The mean right lateral, right posterior, left lateral, and left posterior canal gain of 20–39 age group was significantly higher than the 40–60 age group. Regardless of age, while the mean left lateral canal gain in females was significantly higher than males, the mean right anterior and right posterior canal gain was significantly higher in males. The mean right lateral and the left lateral canal gains were significantly higher in females in the 20–39 years' age group; however, the mean right anterior, right posterior, and left posterior canals gains were significantly higher in males than in females. The mean right lateral canal gain in males was significantly higher in the 40–60 age group than that of females. Conclusions: The vHIT as a standard test for vestibular assessment provides clinical benefits, in addition the comparing for different age groups for goggle-less vHIT model will provide more beneficial results in the evaluation of patients. In the literature, there are not many studies on the goggle-less vHIT device, so we believe our study will be a pioneer in this field.

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Cochlear-facial dehiscence (CFD) has been considered in differential diagnosis in case of intermitting hearing loss and/or rotational vertigo. Dehiscence into cochlea involving facial nerve is relatively rare. They are usually sequel of secondary events. A case of bilateral CFD clinically revealed in a sudden way after performing Heimlich maneuver in a middle-aged nurse. We hypothesized clinically onset resulting of a pressure-related mechanism added to congenital dehiscence. High-resolution computerized tomography is mandatory in patients with hearing loss without otherwise identifiable cause. Anyway, symptomatic CFD is less more than radiological prevalence. CFD may create a third window effect and could arise with a wide range of symptoms of whom intermitting hearing loss ad rotational vertigo.

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