Home Ahead of print Instructions Contacts
About us Current issue Submit article Advertise  
Editorial board Archives Subscribe Reader Login  
Export selected to
Reference Manager
Medlars Format
RefWorks Format
BibTex Format
  Access statistics : Table of Contents
   2014| April-June  | Volume 20 | Issue 2  
    Online since May 3, 2014

  Archives   Previous Issue   Next Issue   Most popular articles   Most cited articles
Hide all abstracts  Show selected abstracts  Export selected to
  Viewed PDF Cited
Radiological study of the temporal bone in chronic otitis media: Prospective study of 50 cases
Thripthi Rai
April-June 2014, 20(2):48-55
Aim: To assess radiological findings in Chronic otitis media (COM), its involvement in middle ear and adjacent structure and to compare with similar published data. The ability of the radiological investigations to detect the various pathological and anatomical variations were evaluated and compared with intraoperative findings. COM is a long standing inflammation of the middle ear cleft without reference to etiology or pathogenesis. Due to the strategic location of the tympanomastoid compartment, separated from the middle and posterior cranial fossa by the thinnest of bony partitions, otitis media has the potential for intracranial extension. Hence, it becomes very important to know the location and extent of the disease before proceeding to surgical treatment. Radiological examination of the temporal bone helps us to achieve this objective. The present work has been undertaken to study the role of radiological imaging of the temporal bone as a diagnostic modality in COM and its use in determining the lines of management as in the type of surgical intervention required. Materials and Methods: This is a prospective study in which total of 50 cases with COM were studied. Results: HRCT is reliable for all the parameters like scutum erosion, ossicular erosion, mastoid pneumatisation, low lying dura, anterior lying sigmoid, Korner's septum, cholesteatoma extension in the middle ear and mastoid, and presence of complications such as mastoiditis and mastoid abscess, mastoid cortex dehiscence, sigmoid sinus plate erosion, facial canal dehiscence, tegmen mastoideum erosion and labyrinthine fistula and intracranial complications with a P < 0.05 but not reliable for tegmen tympani erosion and posterior fossa dural plate erosion. Conclusion: HRCT is highly reliable and findings are in par with intraoperative findings in this study.
  20,603 2,016 17
Management of cholesteatoma complications: Our experience in 145 cases
Aziz Mustafa, Shklzen Kui, Arsim Behramaj
April-June 2014, 20(2):45-47
Objectives: To assess the incidence, clinical features, diagnosis and treatm ent of complications of cholesteatomatous chronic otitis media (CCOM) seen in the ENT/Head and Neck Surgery Clinic, University Clinical Center of Kosova, Prishtina. Materials and Methods: This is a retrospective study of the medical records of patients with complications of CCOM who had undergone surgical treatment at the ENT Clinic of the University Clinical Center of Kosovo for the period time of 1994 to 2011. Results: From a total of 2765 patients suffering from COM, 502 (18.08%) had cholesteatoma. From this group, in 145 patients had complications. The mean age was 30 years. Eighty-two (56.55%) cases had extracranial complications (ECC) and 49 patients (33.79%) intracranial complications (ICC). For the ECC cases, we found that subperiostal mastoid abscess occurred in 25%, facial nerve palsy was seen in 13% and labyrinthine fistula in 9.6 %. For the ICC cases, meningitis (12%) and perisinusal abscess (11%) were the most common complications. The most frequent radiological diagnostic procedures were mastoid X-rays, which were performed in 70% of the patients, and computed tomography in 20%. Patients with ECC were treated in the ENT Clinic, whereas patients with ICC, after otologgic surgical procedures, were transferred to the Neurosurgery Clinic. In this series, 5 patients (3.4%) died as a result of complications. Conclusions: The incidence of cholesteatoma and its complications in our country still poses a challenge that requires higher dedication. Application of sophisticated diagnostic methods, CT and MRI is going to assist in choosing the adequate surgical approach, especially in cases with intracranial complications
  5,831 497 4
Dexmedetomidine and propofol for monitored anesthesia care in the middle ear surgery
Reetu Verma, Rajni Gupta, VK Bhatia, Jaishri Bogra, SP Agarwal
April-June 2014, 20(2):70-74
Context: Local anaesthesia with sedation is a well established approach used for tympanoplasty. Dexmedetomidine is a new drug which acts on α2-adrenergic receptors in the dorsal horn of the spinal cord to produce analgesic effects. Aims: Efficacy and safety of intravenous dexmedetomidine in comparison to propofol. Setting and Design: Randomized controlled trial. Materials and Methods: Eighty patients were randomly allocated to receive either dexmedetomidine or propofol as intravenous bolus followed by the same in infusion supplemented with local anaesthesia for tympanoplasty. Statistical Analyses Used: Statistical Package for Social Sciences version 15.0. Results: Dexmedetomidine and propofol provides adequate sedation but the use of propofol is associated with more requirements of rescue analgesia and poor patient and surgeon satisfaction. Conclusion: These results suggest that dexmedetomidine provides adequate sedation with analgesia and good surgical and patient comfort without any adverse effects for patients undergoing tympanoplasty under local anaesthesia
  5,312 732 4
Asymptomatic mucormycosis of middle ear: An incidental finding during tympanoplasty
K Biniyam, Vadisha Bhat, Satheesh Kumar B Bhandary, Rajeshwary Aroor
April-June 2014, 20(2):83-85
Mucormycosis is a fungal infection, commonly affecting the paranasal sinuses. An aggressive invasive form of infection is common in people with uncontrolled diabetes and in immunocompromised people. Mucormycosis affecting temporal bone is a rare entity, most of the reported cases are of invasive disease in diabetic people. We report a case of mucormycosis of middle ear cavity which was found incidentally in a healthy nondiabetic woman while performing revision tympanoplasty for chronic suppurative otitis media.
  5,719 312 4
A case of posttraumatic incudomalleolar disruption
Vivek Sasindran, Antony Joseph, Binu Babu, Pratibha George
April-June 2014, 20(2):89-91
Hearing loss following head trauma or head injury is a major medical problem. Trauma related conductive hearing loss can be due to injury to the ossicular chain, hemotympanum or laceration to the tympanic membrane. Sensorineural hearing loss is caused due to injury to the cochlea or organ of Corti. Head trauma associated with ossicular disruption should be suspected in patients with conductive hearing loss that persists after a healing process of 2 months. High-resolution computed tomography is the investigation of choice. Here, we present a case of traumatic isolated incudomalleolar disruption in a 46-year-old male following a road traffic accident. He presented with a persistent conductive hearing loss for 4 months following the incident.
  4,986 279 1
Audiological assessment modalities in children with multiple handicaps and parents' perception
Noorain Alam, Shamim Ansari, Deepanshu Gurnani, Vikas Sinha, Pawan K Sharma, Sachin Jindal
April-June 2014, 20(2):67-69
Aim of the Study: Children with multiple disabilities have combination of various disabilities. Accurate hearing evaluation is difficult in this population. Audiologists generally employ a test battery approach, which includes combining findings of parent impression with behavioral observation audiometry (BOA) as well as auditory brainstem response (ABR) findings. Present study was done to find if there exists correlation among various steps in test battery for the children with multiple handicaps as well as to find out which disability is most common among this population. Materials and Methods: Total 103 numbers of children with multiple handicaps were chosen at random who were referred to CU Shah Institute of Audiology and Speech Therapy for audiological assessment. The three steps involved in assessment that is parental impression, BOA, and ABR findings were taken into account. The relationship was obtained using data analysis. Results: It was found that among children with multiple handicaps referred for audiological assessment, mental retardation (MR) was the most common (32.03%). Also, it was found that there were more contradictory findings between parent impression and ABR (48%) when compared with parent impression with BOA (38%). In between BOA and ABR, contradictory findings were found in 41% of cases. Conclusion: There are wide contradictions among various steps involved in assessment of children with multiple handicaps. Implication: Audiologist should use a test battery approach to assess hearing ability of this population and audiologists should interpret findings carefully at each level.
  4,769 364 1
Postaural incision closure in single layer versus multiple layers: A comparison
Kuldeep Moras, Mahesh Bhat, Savita Lasrado, Celina Jayakumar, George Pinto
April-June 2014, 20(2):60-62
Background: By tradition, the postaural incision is closed in single or multiple layers. In this study single layer closure is compared with multiple layer closure. Materials and Methods: Two hundred patients with Chronic suppurative otitis media undergoing ear surgery by post aural approach at our department were included in the study. Results: It was observed that time taken for single layer closure was far less compared with time taken for multiple layer closure, which was of statistical significance. Conclusion: single layer closure is as effective as multiple layer closure of postaural incision, with the distinct advantages of reduced closure time and lesser cost of suture material.
  4,723 405 2
Distortion product otoacoustic emission fine-structure: An insight into the ear asymmetries
Bhamini Sharma
April-June 2014, 20(2):56-59
Context: Use of distortion product otoacoustic emission (DPOAE) as a measure of hearing sensitivity is common in clinical practice. However, use of a more informative DPOAE fine-structure has been limited due to non-reliability of DPOAE fine-structure. Aim: The current study was aimed at testing the interaural differences between the DPOAE fine-structure across three age groups. Settings and Design: Acoustically treated room with a calibrated dual channel audiometer (Orbiter 922) along with TDH-39 headphones and B-71 bone vibrator. GSI Tympstar was used for tympanometry and acoustic reflex measurements while 'ILO V6' OAE analyzer was used for recording of DPOAE and DPOAE fine-structure. Material and Methods : A total of 98 subjects with normal peripheral hearing sensitivity were tested for DPOAE fine-structure. The three age groups consisted of young (8-18 years; n = 50), middle aged (30-40 years; n = 30), and elderly (50-60 years; n = 18). DPOAE fine-structure was studied at 8 points per octave on a total of 25 frequencies from 1000 to 8000 Hz. Statistical Analysis Used: Repeated measure analysis of variance. Results: There was a significant difference (P < 0.05) in the amplitudes at frequencies between 2000 and 3000 Hz. This was evident irrespective of the age groups. There was also a decrease in DPOAE amplitude in elderly group. Conclusions: Interaural asymmetry can be attributed as a reason to these findings and it occurred mostly in the speech perception frequencies. Reduced amplitude of DPAOE in the elderly group can be attributed to presbycusis.
  4,509 432 -
An oblivious cholesteatoma
Arvind Kumar Kairo, Kapil Sikka, Rakesh Kumar, Krishan Kudawla
April-June 2014, 20(2):92-93
  4,158 302 2
Osteoblastoma of the temporal bone: A recurrent case report and a review of the literature
Chen Shu-Lin, Zhuang Hui-Wen, Fan Yun-Ping, Jiang Hong-Yan
April-June 2014, 20(2):79-82
Osteoblastoma (OB) is an uncommon mostly benign, vascular, osteoid-forming bone tumor, characterized by histological presence of rich in osteoblasts. The OBs of temporal bone are extremely rare. We reported a 27-year-old woman patient with recurrent temporal bone OB, who had three different diagnoses and underwent four operations. The purpose of the present case was to interpret the different clinical and radiological character of the tumor in different stages showed interestingly in one case. Meanwhile, to make a review on this disease further explored the general clinical, histological, and radiological features and treatment and prognosis of the tumor. It's proved that the clinical presentation and radiographic studies were in accordance with the character of different stage of the tumor. Total resection should be advocated whenever possible, due to good prognosis and relatively low recurrence, even in the recurrent cases.
  3,313 283 -
Audiological outcomes in cases with mucopolysaccharidoses (Morquio's disease)
Prawin Kumar, Priyanjali Harit, Rashika Sharma
April-June 2014, 20(2):75-78
Background: The mucopolysaccharidoses (MPS) is an autosomal recessive disorder, caused due to malfunctioning of certain lysosomal enzymes involved in degradation of glycosaminoglycans. This report presents audiological evaluation findings found in two siblings with Morquio syndrome (MPS type IV). Materials and Methods: The present study evaluated two individuals (case A: 18-year-old male and case B: 15-year-old female) with a routine audiological evaluation including pure tone audiometry, speech audiometry, and immittance evaluation. Results: Case 'A' and 'B' were assessed for three consecutive audiological evaluations over time in a span of 2 years. For case A, all three evaluations revealed same degree of hearing loss in both ears. However, for case B, results reveal that there was increase in degree of hearing loss in both ears. Further, immittance results in both case A and B revealed middle ear pathology in both ears in all the three evaluations. Hence, it can be concluded that there was no progression in severity of hearing loss in case A; however, same was observed in case 'B'. In addition to that, at present both case A and B are using moderate gain digital behind the ear hearing aid in both the ears which is enabling them to communicate better. Conclusion: To conclude on these case reports of the siblings, otologist and audiologist need to be aware of this relevant information and take immediate steps to provide services to patients. Regular follow-up of the clients is an important aspect as it is highlighted in present study.
  3,127 252 -
A short-term evaluation between the result of palisade cartilage tympanoplasty and temporalis fascia technique
Irfan Ul Shamas, Zafarullah Beigh, Shakil Ahmad, Aleena Shafi, Rafiq Ahmad Pampori
April-June 2014, 20(2):63-66
Introduction: The use of cartilage as a grafting material has been advocated in cases where there is a high risk of graft failure, such as subtotal perforations, adhesive processes, and residual defects after primary tympanoplasties. The purpose of this study was to compare the graft acceptance rates and auditory outcomes of cartilage tympanoplasty operations using a palisade technique with those of primary tympanoplasty using temporalis fascia in a homogenous group of patients. Study Design: Prospective study. Materials and Methods: The study population included 54 patients who were operated on in two groups (palisade technique and temporalis fascia technique) with each group containing 27 patients. Patients with pure subtotal perforations (perforation of >50% of the whole tympanic membrane [TM] area), an intact ossicular chain, at least 1 month dry period, and normal middle ear mucosa were included in the study. Grafts acceptance rates and pre and postoperative audiograms were compared. The follow-up time was 6 months. Results: Graft acceptance was achieved in all patients (100%) in the palisade cartilage tympanoplasty group and in 25 patients (92.5%) in the temporalis fascia group. This difference was not statistically significant (P = 0.15). Comparison of the increases in mean speech reception threshold, air-bone gap, and pure-tone average scores between both techniques showed no significant changes. Conclusion: Our experience with the palisade cartilage technique demonstrates that subtotal or total perforation at high risk for graft failure can be treated efficiently, and that a durable and resistant reconstruction of the TM with reasonable auditory function can be achieved.
  2,969 293 1
Jugular foramen chondrosarcoma
Vinay Vaidyanathan, Deepa Nair, SL Juvekar, Caren D'Souza
April-June 2014, 20(2):86-88
Chondrosarcomas are rare skull base lesions and presenting as a mass lesion in the jugular foramen is even rarer. The clinical picture and series of scans unfolded its diverse presentation on imaging making its diagnosis very interesting. Preoperative finding and final histopathological picture were diagnostic.
  2,855 214 -