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   2021| January-March  | Volume 27 | Issue 1  
    Online since October 26, 2021

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The limitations of pure-tone audiometry (as the gold standard test of hearing) that are worthy of consideration
Mohd Normani Zakaria
January-March 2021, 27(1):1-2
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Validity of modified whisper test as hearing screening method in presbycusis patients
Rizki Najoan, Nyilo Purnami
January-March 2021, 27(1):11-13
Background: Presbycusis is a hearing loss due to the degeneration process which is found at the age of more than 65 years old, with decreased hearing sensitivity in both ears, asymmetrical bilateral sensorineural detection type. Objective: To identify the validity of modified whisper test by detecting the hearing level in presbycusis patients. Methods: The design of this study was comparative, cross-sectional, prospective study. Subjects were elderly undergoing hearing monitoring at URJ Geriatric and URJ Audiology Dr. Soetomo Hospital, in August–September 2018 and examined using whisper test and audiometry. The statistical analysis used 2 × 2 tables, sensitivity, specificity, positive predictive value, and negative predictive value. Results: The lowest sensitivity at frequencies > 41–55 dB was at 100%, the lowest specificity at 100%, lowest sensitivity at frequencies >56–70 dB was at 23.07% with specificity at 100%. The positive predictive value (NRP) at frequencies >25–40 dB was 88.46% while the negative predictive value (NPV) was of 100%. Conclusion: The modified whisper test can be used as early detection of hearing impairment.
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Inner ear malformations in cochlear implant recipients
Luan Viet Tran, Vu Anh Duong, Saim Lokman
January-March 2021, 27(1):3-6
Objective: The aim of this study is to determine the prevalence of the inner ear malformations (IEMs) in cochlear implant recipients according to Sennaroglu's classification, and to document the intraoperative difficulties and complications in those cases. Methods: This was a descriptive cross-sectional study performed at our hospital between January 2016 and October 2019. IEMs on temporal bone computed tomography scans were identified in all patients who received cochlear implants during the study. Intraoperative difficulties and complications relating to these malformations were described. Results: Twelve patients with IEMs were identified from a total of 212 cochlear implant recipients, representing a prevalence of 5.7%. Among them, one patient with incomplete partition (IP) Type I (8.3%), seven patients with IP Type II (58.3%), one patient with IP Type III (8.3%), one patient with cochlear hypoplasia (CH) Type I (8.3%), and two patients with CH Type III (16.7%) were identified. Associated enlarged vestibular aqueduct was found in four cases with IP Type II (33.3%). Round windows were not identified intraoperatively in 3 cases with CH (25%). Three cases (25%) had cerebrospinal fluid gusher (one patient in each of the following anomalies: IP-I, IP-II, and IP-III). The mean categories of auditory performance score was 6, which was collected within 23.3 months after the surgery. Conclusion: This study documents the prevalence of IEMs in cochlear implant recipients (classified by Sennaroglu in 2017). The identification of such anomalies will significantly aid surgeons in making decisions regarding cochlear implant candidacy and surgical strategy when cochlear implantation is contemplated to obtain optimal outcomes.
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Anatomical variations of round window in different age groups and surgical difficulties associated with them during cochlear implantation
Rabindra Bhakta Pradhananga, Bigyan Raj Gyawali, Pabina Rayamajhi, Bebek Bhattarai
January-March 2021, 27(1):7-10
Introduction: Round window (RW) insertion of the electrodes during cochlear implantation is the most favorable route considered by many surgeons. The objective of this study was to review the anatomy of the RW based on visibility and accessibility of RW niche (RWN) and RW membrane (RWM) and to assess their implications in surgical difficulties during cochlear implantation in different age groups. Materials and Methods: This was a retrospective observational study conducted at the Department of ear, nose, and throat-Head and Neck Surgery, Institute of Medicine, Kathmandu, Nepal. We analyzed the record data of all the cochlear implants from January 2015 to December 2019 for the visibility of RWM, RWN, and associated surgical difficulties in different age groups. RWM visibility was classified as; Grade I (>50% of RWM is visible), Grade II (25%–50% of RWM is visible), Grade III (<25% of RWM is visible), and Grade IV (RWM is not visible). Similarly, RWN visibility was classified as; Type A (difficult to visualize), Type B (partially visible), and Type C (fully visible). Our final sample size was 81. Results: The most common variant of RWN and RWM was Type C (37 cases) and Grade IV (37 cases), respectively, in the age group of <15 years. In cases >15 years, Type B (eight cases) was the most common variant of RWN and Type II (six cases) was the most common variant of RWM. There was a statistically significant association between the visibility of the RWN and RWM and the visibility of RWN and different levels of surgical difficulty (P < 0.05). Conclusions: Type C RWN and Type IV RWM were the most common variants found, mostly seen in the pediatric population. With poorer visibility of RWN, RWM visibility decreases, increasing the difficulty level of the surgery.
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Chronic suppurative otitis media and microbial flora: Adult versus pediatric population
Ashish Chandra Agarwal, Anitya Srivastava, Manodeep Sen
January-March 2021, 27(1):22-25
Context: Chronic suppurative otitis media (CSOM) is an inflammatory condition of the middle ear which manifests as recurrent episodes of ear discharge. Due to the inappropriate use of antibiotics, the microbiological profile and the drug sensitivity pattern is changing, leading to either inadequate treatment or recurrence. Hence, there is a need to study the microbial profile and its sensitivity pattern in order to initiate the appropriate treatment. Aim: The study has been done to evaluate the microbiological profile of ear discharge in patients of CSOM and also to assess any difference in the microbiology in the adult and pediatric population. Setting and Design: A cross-sectional record-based study was conducted in a tertiary care hospital in North India on patients diagnosed to have tubotympanic type of CSOM. Materials and Methods: The study duration was 12 months. Sterile swabs were collected from the study individuals. The organisms were isolated using the standard microbiological methods and antimicrobial susceptibility test was performed using diffusion method. Statistical Analysis: Descriptive statistics were used. Appropriate parametric and nonparametric tests were applied to assess the association between various variables. Results: Amongst children, the most common isolate was Staphylococcus aureus and this was followed by Proteus mirabilis and Pseudomonas aeruginosa. Among adults, the most common organism was P. aeruginosa and this was followed by S. aureus. Conclusion: Age, environmental, and geographical conditions of an individual affect the microbiological profile. Antibiotic therapy administered in accordance to the sensitivity pattern achieves best result.
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Risk of hepatic toxicity and drug response in patients with chronic suppurative otitis media
S M Tariq Rafi, Shafaque Mehboob, Mejabeen , Naila Tariq, Hurithmina Khan, Moona Mehboob
January-March 2021, 27(1):26-29
Objective: The aim of the current study was to evaluate the risk of hepatic and renal toxicity in patients with chronic suppurative otitis media (CSOM) and the effects of antibiotics (ciprofloxacin and co-amoxicillin) on it. Methods: This is a case–control study conducted on patients and healthy volunteers divided into four groups; G1 (negative control), G2 (positive control), G3 (patients treated with ciprofloxacin), and G4 (patients treated with co-amoxicillin). The study was conducted in Jinnah Postgraduate Medical College in Karachi, Pakistan, from May 2018 to October 2018. Results: There was a significant (P < 0.05) increase in total bilirubin, direct bilirubin, alkaline phosphatase, Serum glutamic pyruvic transaminase (SGPT), and Gamma-glutamyl transferase (GGT) in patients of G2 (positive control) as compared to G1 (negative control). However, the treatment with antibiotics may recover the normal liver enzyme levels except direct bilirubin and SGPT. An insignificant increase in blood glucose levels and urea was found in G2, G3, and G4 with insignificant increased creatinine levels. Conclusion: Hepatic toxicity may be induced in patients with CSOM, particularly if not properly treated. Therefore, precautions with proper follow-up of liver function test should be taken in CSOM.
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Conducting Fukuda stepping test in a noisy clinic and the effects of sound
Carren Sui Lin Teh, Erica Anak Gima, Hani Binti Mamat, Meng Hon Lye, Sobani Bin Din, Narayanan Prepageran
January-March 2021, 27(1):47-50
Context: The Fukuda stepping test (FST) is used to assess the labyrinthine function via the vestibulospinal reflex. The test is meant to be conducted in a quiet room, but in a busy clinic setting, it is often performed in the clinic itself, and individuals are exposed to environmental sounds. Aims: The aim of this study was to assess the effects of environmental sounds and the effects of fixed directional sound on the outcome of FST. Settings and Design: This is an observational study. Subjects and Methods: Thirty healthy participants performed the FST in the otorhinolaryngology clinic, in a sound-treated room, and then in a sound-treated room with the presence of a fixed directional sound where the angle of rotation, angle of displacement, and distance of displacement were compared. Statistical Analysis Used: Independent t-test and Chi-squared test were used for statistical analysis. Results: There was no statistical difference in the angle of rotation and angle of displacement in all three settings. Although the mean distance of displacement was above 50 cm in all three settings, there was a significant reduction between clinic versus sound-treated room (P = 0.016) and clinic versus room with sound-treated directional sound (P = 0.002). Fixed directional sound had no significant influence on the direction of rotation in all the participants. Conclusions: Performing FST in the standard clinic will not affect the results. Concurrently, we suggest omitting measurement of the distance of displacement in FST as it is not reproducible in our normal sample and is highly susceptible to auditory cues but to focus on the angle of rotation.
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Detection of two pathogenesis previously unreported myosin xva pathogenic variants in two large Iranian pedigrees with autosomal recessive nonsyndromic hearing loss
Fatemeh Azadegan-Dehkordi, Korosh Ashrafi, Gholam Reza Mobini, Nasrin Yazdanpanahi, Maryam Shirzad, Effat Farrokhi, Morteza Hashemzadeh-Chaleshtori
January-March 2021, 27(1):14-21
Purpose: Hearing loss (HL) is a genetically heterogeneous common neurosensory disorder. Among different ethnic groups, pathogenic variants of Myosin XVa (MYO15A) at the DFNB3 locus are the common causes of autosomal recessive nonsyndromic hearing loss (ARNSHL). The aim of this study was to determine the prevalence and the type of MYO15A pathogenic variants in a subset of Iranian pedigrees with ARNSHL. Materials and Methods: Thirty-eight Iranian pedigrees with no Gap junction beta-2 pathogenic variants were included in the study. For all pedigrees, linkage analysis was performed using five short tandem repeat markers of DFNB3 locus. The DNA sequencing was then applied to identify MYO15A pathogenic variants in linked pedigrees. Results: Altogether, two out of 38 (5.3%) pedigrees were linked to locus 3. After sequencing, five previously unreported MYO15A pathogenic variants (c.1775-1776insA, c.1766-1767insC, c.7694delA, c.611G > C (G204A), and c.6442T > A (W2148R)) were revealed in homozygous and heterozygous state in the two pedigrees studied. Furthermore, the pathogenicity of pathogenic variants was confirmated by Insilco and cosegregation analysis in this study. Conclusions: Our findings support a relatively high prevalence and specificity of MYO15A pathogenic variant among Iranian ARNSHL patients. Molecular study of MYO15A may lead to elucidation of the population-specific pathogenic variant profile, which is of importance in molecular diagnostics of HL.
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Speech intelligibility enhancement in elderly with high-frequency hearing loss through visual speech perception
Himanshu Chaurasiya
January-March 2021, 27(1):30-35
Background: Pathological and physiological disabilities of human auditory receptors reduce speech intelligibility under hearing loss (HL) at high frequencies. Objectives: The objective of the study is to investigate the speech-intelligibility-enhancement (SIE) in elderly with high-frequency HL (HFHL) through visual-speech-perception (VSP). The hypothesis is that the VSP of spondee words (two-syllable words with equal stress on both syllables) is properly recognized and reproduced with HFHL. Also; to decide the statistical relevance of the precise significant difference in speech discrimination (SD) with VSP on the subjected ear. Methods: Observational and descriptive studies of SIE with VSP on 12 elderly listeners (24 clear ears; without wax impaction) with progressive and bilateral HFHL were examined. The entire experimental records were checked for distribution with normal (Gaussian) using the Shapiro–Wilk's and paired Student's t-test (parametric test) had the 5% (0.05) significance level (α). Results: We analyzed, improved, and better performance in SIE with HFHL through VSP. The statistical P (probability) measure was calculated nothing, i.e., 0 (P < 0.05). Therefore, investigators strongly and carefully discarded the null hypothesis consideration. There was some significant value of statistical variation also exists with VSP. Moreover, with the help of the confidence-interval analysis, the same conclusion was achieved. Conclusions: In this study, it is concluded that the elderly-individuals of this experiment, whose mother tongue and official language is Hindi and English, respectively, they demonstrate the SIE with HFHL through VSP. This investigation also helps to improve the hearing sensitivity to some extent with VSP.
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Effectiveness of intratympanic dexamethasone as salvage therapy in treating sudden sensorineural hearing loss
Bigyan Raj Gyawali, Rabindra Bhakta Pradhanaga, Pabina Rayamajhi
January-March 2021, 27(1):36-39
Introduction: The steroid is the drug of choice in patients with sudden sensorineural hearing loss (SSNHL). Thirty to fifty percent of cases, despite receiving steroids may have incomplete recovery. Furthermore, there are a significant number of patients in whom systemic steroids are contraindicated such as cases with uncontrolled diabetes, uncontrolled hypertension, and pregnancy. Intratympanic steroids can play a vital role as salvage therapy in these cases. The aim of this study was to evaluate the effectiveness of intratympanic Dexamethasone as salvage therapy in cases who fail to respond with systemic steroids, who present late (>1 week) after the onset of symptoms and cases, in whom systemic steroids are contraindicated. Materials and Methods: This was a retrospective study conducted in the Department of ENT-Head and Neck Studies, T.U. Teaching Hospital, Kathmandu, Nepal. Approval from the Institutional Review Committee was taken. A prospectively set record data of cases with SSNHL receiving intratympanic Dexamethasone as a salvage therapy from April 2018 to April 2020 were analyzed for improvement in hearing outcome. We used SPSS version 25 for the statistical analysis. Chi-square test and Fisher's exact test were used to draw statistical co-relation. Value of P < 0.05 was considered statistically significant. Results: A total of 34 cases met the inclusion criteria. M: F was 3:1 with the majority of cases in the third–fifth decades of life. A total of 11 cases showed partial improvement and one case had complete improvement. There was no statistically significant co-relation between hearing outcome and time interval (from the onset of symptoms to intratympanic injection), level of hearing loss, comorbidities, and prior use of systemic steroid therapy (P > 0.05). Conclusion: Intratympanic Dexamethasone has audiological benefits as a salvage therapy in cases with SSNHL failing to respond with systemic steroid therapy.
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Prospective study of use of Island of tragal cartilage in revision tympanoplasty
Bhavika Verma, Naresh Dawat, Yogesh G Dabholkar, Sachin J Patil
January-March 2021, 27(1):40-43
Background: Ideal graft material in revision tympanoplasty is a topic of much research. Cartilage being sturdy and stable even in negative pressure situations, is a viable option. Aims and Objectives: The aim of the present study was to evaluate graft uptake and hearing improvement using the technique of island of tragal cartilage as a graft material in revision tympanoplasty. Materials and Methods: This was a prospective study of total of 60 Type 1 revision tympanoplasty surgeries which were done using tragal cartilage island graft from December 2017 to December 2019 in our institute with a follow-up of 3 months. Results: Graft uptake in our study was found to be 93.33%. Four patients showed a re-perforation during follow-up. The mean preoperative air-bone gap (ABG) was 28.13 dB, while the postoperative mean ABG was 16.83 dB and the mean gain was 12.83 dB. Conclusion: It is thus worthwhile to consider island of tragal cartilage as a graft material in revision tympanoplasty.
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Antimicrobial susceptibility in patients with chronic suppurative otitis media in a North-Central secondary health facility in Nigeria
Solomon Joseph Hassan, Yikawe Stephen Semen, Dabit Othniel Josep, Ekuma Otu Gabriel, Osisi Kingsley, Solomon Ndudiri Calista
January-March 2021, 27(1):44-46
Introduction: Antibiotic resistance is a major challenge in managing patients with chronic inflammation of the middle ear cleft in our facility. This is also a concern in many sub-Saharan African and Asian countries. Many secondary and primary health facilities lack the services of trained ear nose and throat nurses, and it is rare to have an otorhinolarynogologist in these centers. To reduce the risks of antibiotics resistance and complications from middle ear cleft infection, there is a need to know the pattern of microbial susceptibility to facilitate the selection of antibiotics in treating patients with chronic otitis media in the region. Methodology: We carried out a prospective, hospital-based study in a secondary health facility in Makurdi, North-Central Nigeria, for 11 months from August 2018 to July 2019. One hundred and twelve patients of all age groups with chronically discharging ear (s) were consecutively recruited for the study. Ear swabs were carefully taken from the middle ear using sterile swab sticks and quickly taken for microscopy culture and sensitivity. The results were analyzed using IBM-SPSS version 20. Results: One hundred and twelve patients were recruited with ages ranging from <1 year to 56 years. Nearly 57.1% were female and 42.9% were male. Thirty-two (28.6%) of the swab taken yielded no growth. Pseudomonas spp. was the most frequent isolate (50%), and Staphylococcus, Klebsiella, and Streptococcus spp. isolated in 10.7%, 7.1%, and 3.6%, respectively. Pseudomonas, Streptococcus, and Klebsiella spp. had the highest susceptibility to ciprofloxacin (88%–98%); only 50% by Staphylococcus spp. Gentamicin was effective against all the isolates (70%–97%). All four isolates also showed moderate-to-high susceptibility to levofloxacin and pefloxacin; organisms showed least sensitivity to ofloxacin (30%–58%). Conclusion: Pseudomonas spp. is the most common isolate in chronic otitis media patients in this subregion, with excellent susceptibility to ciprofloxacin (98%). All isolates had a good level of susceptibility to the commonly used topical antibiotics, except for ofloxacin (30%–58%). More studies should be done at intervals to note any change in microbial isolates and susceptibility pattern, this will enhance success in treating chronic otitis media.
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