Otology

Frequency-modulated Bhramari Pranayam in tinnitus and deafness Mahendra Kumar Taneja Indian Journal of Otology 2018 24(4):209-213

Bacteriology and antibiotic sensitivity of chronic suppurative otitis media in a government hospital Ashok Sharma, Madhurima Banerjee, Meenakshi Mehra, Pulkit Khandelwal, Vivek Taneja Indian Journal of Otology 2018 24(4):214-218 Background: Chronic Suppurative Otitis Media (CSOM) is a disease well known for its persistence and recurrence, inspite of giving treatment. The microbiology cultures show the growth of a lot of organisms, frequently multiple and these differ based on patient population, climate, and whether or not antibiotics have been recently used. Objectives: To identify the commonest causative organism of CSOM in a government hospital of northern India and identify the sensitivity to antibiotics so as to achieve early dry ear for surgical intervention. Methodology: This study was done, from March 2018 to September 2018 on 100 patients with complaints of ear discharge. Pus samples were collected from the discharging ears, subjected to culture and sensitivity and the organisms isolated were identified by morphological, cultural and biochemical characteristics. Results: Most common organism causing CSOM in our study Staphylococcus aureus, followed by Pseudomonas aeruginosa. Most patients with Staphylococcus infection were sensitive to Vancomycin followed by Linezolid and Gentamycin whereas patients with Pseudomonas aeruginosa were sensitive to Amikacin and Ciprofloxacin. Conclusion: Early and effective intervention using appropriate topical as well as systemic antibiotics can decrease the chronicity of CSOM and prevent long term complications.

Auditory & verbal outcomes following cochlear implant in patients with demyelinating diseases of brain Ankur Barot, Rajesh Vishwakarma, Nisarg Mehta, Kalpesh Patel, Dipesh Darji, Chandrakant Vishwakarma Indian Journal of Otology 2018 24(4):219-222 Objective: The objective of the study was to evaluate early auditory and verbal outcomes following cochlear implant (CI) in patients with radiological findings suggestive of demyelinating lesions in the brain. Methods: The study was conducted in the Department of ENT, Civil Hospital, Ahmedabad, Gujarat. We studied and evaluated early auditory and verbal outcome following CI in 30 patients who had demyelinating lesions in the brain on magnetic resonance imaging, of 1- to 5-year age group. Hearing and speech ability was recorded on categories of auditory performance (CAP) scale and speech intelligibility rating scale and was compared to patients with normal cerebral myelination. Results: Patients in case group showed comparable scores on CAP scale and speech intelligibility scale compared to the patients who did not have demyelinating disease in the same time frame. Conclusion: Patients with demyelinating lesions showed similar auditory and verbal responses compared to normal implant patients who show that demyelinating diseases do not pose limitations in the early outcome of auditory response in such patients.

Prevalence of chronic suppurative otitis media in schoolgoing children Sandip M Parmar, Abhey Sood, Hamjol Singh Chakkal Indian Journal of Otology 2018 24(4):223-226 Introduction: Chronic suppurative otitis media (CSOM) is a major health problem throughout the world in underdeveloped and developing countries including India. The high prevalence of CSOM in school children in India has led us to undertake this study in schoolgoing children of rural and urban areas of Muzaffarnagar, Uttar Pradesh and to find out the various predisposing factors for the development of CSOM. Objectives: The objective is to find out the prevalence of CSOM in schoolgoing children of the rural and urban population about age, sex, and socioeconomic status. Materials and Methods: Students were randomly selected from primary schools in rural and urban areas of Muzaffarnagar, Uttar Pradesh. Cases selected was categorized in relation to age, sex, socioeconomic status, and prevalence of the safe and unsafe type of CSOM. Observations: In the present study, a cross-sectional survey was conducted in 2158 school children between the age group of 5 and 15 years. A total of 1161 children belonged to urban school whereas 997 children were from three adjacent rural government schools. A total of 78 children were found to be suffering from either unilateral or bilateral CSOM. Conclusion: The prevalence of CSOM in urban school children was 2.32%, while for rural children, it was 5.11%. 42.10% of cases of CSOM belonged to upper-lower socioeconomic group followed by lower middle group (31.57%). The tubotympanic disease was present in 87.18% of CSOM cases while 12.82% had atticoantral disease. Active CSOM was found amongst 37.18% while 62.82% had inactive disease. 42.10% had smoking father, 36.84% had indoor cooking with kerosene oil exposure, and 34.21% used unhygienic ear cleaning methods. 31.58% had a history of recurrent URI, 28.95% had chronic tonsillitis, and 21.05% of children had domain name system as associated findings with CSOM.

The results of tympanoplasty for chronic suppurative medial otitis: Our experience for 10 years Chol-Ung Sin, Tae-Myong Kim, Hea-Sun Cheo Indian Journal of Otology 2018 24(4):227-230 Object: The aim is to analyze the results of the tympanoplasty (TP) for the chronic suppurative medial otitis and some factors which influence to the results of the TP. Materials and Methods: A total of 133 patients (148 ears) with chronic suppurative medial otitis (CSMO) undergone TP at our hospital for 10 years, were reviewed and the rates of the tympanic membrane perforation closure and the improvement of hearing loss by type of CSMO and operation, were retrospectively evaluated. Results: The success rates of the perforation and hearing loss were 29 ears (85.2%) and 22 ears (75.9%) in myringoplasty, 77 ears (82.8%) and 54 ears (70.1%) in TP, and 17 ears (80.9%) and 11 ears (64.7%) in TP with mastoidectomy. Conclusion: The rates of the tympanic membrane perforation closure and improvement of the hearing loss were 123 ears (83.1%) and 87 ears (70.7%). Some factors influence on the success of TP for CSMO, such as choosing the operation, eradication of focus, processing fascia, and management the effusion, should be considered.

Efficacy of vestibular rehabilitation on quality of life of patients with unilateral vestibular dysfunction Reem Elbeltagy, Marwa Abd El-Hafeez Indian Journal of Otology 2018 24(4):231-236 Objective: The aim of this study is to determine the efficacy of vestibular rehabilitation (VR) exercise of patients with uncompensated unilateral peripheral vestibular dysfunction. Materials and Methods: An intervention study was conducted on 20 patients their age ranging from 20 to 60 years. The main complaint of the participants was chronic dizziness (dizziness for >3 months). Dizzy patients were recruited from the Ear, Nose, and Throat department. The study was conducted in the audiovestibular unit. All participants in the study were subjected to basic audiological evaluation and vestibular evaluation (videonystagmography). The Dizziness handicap inventory questionnaire (DHI) was carried out twice (pre and post) rehabilitation program. The VR therapy was performed according to the protocol established by Cawthorne and Cooksey and Norre exercises. Results: All the DHI scores reduced significantly after VR. There were no differences among genders; adults and elderly patients. Conclusion: The result of this study proved the importance and the efficacy of VR. It considered a useful therapeutic approach for improvement in the quality of life of individuals with unilateral peripheral vestibular weakness. The improvement was not influenced by sex, age, or duration of disease. It considered a low-cost, short, and safe treatment technique which can be widely used in outpatients without the need for sophisticated tools.

Effect of N-acetylcysteine on cochlear function in patients with chronic kidney disease undergoing hemodialysis Hamidreza Abtahi, Mojgan Mortazavi, Mohammad Shafieyan Sararoodi, Mehrdad Rogha, Mahsa Sepehrnejad, Mohammad Hossein Nilforoush Indian Journal of Otology 2018 24(4):237-241 Objective: This study aimed to investigate the effect of N-acetylcysteine (NAC) on cochlear function in patients with chronic kidney disease (CKD). Methodology: The statistical population of this controlled clinical trial included all CKD patients. In total, 64 samples, selected from patients visiting the Dialysis Center of Al-Zahra Hospital from February 2017 to May 2017, were equally randomized into the intervention and control groups. At the baseline, the pure-tone audiometry (PTA) and Distortion Product Oto Acoustic Emissions (DP-OAE) tests were conducted. Then, NAC was administered in the intervention group for 8 weeks. Aforementioned hearing tests were repeated at the end of the interventions and results were compared. Finally, data analysis was carried out in SPSS. Results: Based on the mean scores of hearing threshold, there was no significant between-group difference in the speech discrimination score (SDS) speech reception threshold (SRT) of the left and right sides following NAC administration (P > 0.05). Comparison of the mean OAE following NAC administration showed a significant between-group difference, based on the mean signal/noise ratios (S/N 1000, 2000, and 4000) of the both right and left ears (P < 0.05). To compare the mean DP-OAE changes before and after the intervention between the two groups, the difference between pre- and post-intervention DP-OAE variables was first computed. Then, these changes were compared. A significant between-group difference was observed in S/N ratios of 1000, 2000, and 4000 Hz of the both right and left sides before and after the intervention (P < 0.05). In contrast, changes in other variables did not imply a significant between-group difference (P > 0.05). Conclusion: This study showed the effectiveness of NAC in improving cochlear function in 1, 2, and 4 KHz; whereas, it did not significantly affect the hearing threshold.

Comparison of group therapy versus individual therapy for hyperfunctional voice disorders among teachers Md Noorain Alam, Sanjay K Munjal, Naresh K Panda Indian Journal of Otology 2018 24(4):242-245 Introduction: In general, voice therapy is given on one-to-one basis where each individual is provided therapy by the clinician individually. On the other hand, in group therapy, the treatment is provided to a group of individuals with a similar disorder. Need of the Study: There was a need to conduct this study as there are very few studies on finding the efficacy of group therapy for hyperfunctional voice disorder among teachers especially in India. Aim: The primary aim of the study was to find out the efficacy of group voice therapy in hyperfunctional voice disorders among teachers. The secondary aim was to compare the outcome of group therapy and individual therapy in hyperfunctional voice disorder among teachers. Methodology: Totally 16 individuals in the age range between 25 and 45 years who were teachers by profession with hyperfunctional voice disorder were enrolled in the study. Two age and gender-matched groups were constituted. Group A consisted of eight (6 males and 2 females) individuals with a mean age of 35.6 years. Group B was comprised of eight (6 males and 2 females) with a mean age of 34 years. Group A was enrolled into group therapy while Group B was enrolled into individual voice therapy. The participants underwent a clinical voice evaluation including auditory-perceptual and quality of life assessment using Grade, Roughness, Breathiness, Asthenia, Strain scale, Dr. Speech software and Voice Handicap Inventory. Voice therapy protocol included 12 sessions once a week. It consisted of 15 min. of indirect and the rest 45 min. of Lessac-Madsen Resonant voice Therapy. Posttherapy measures were taken for both the groups. Results and Discussion: Results showed significant improvement post voice therapy in acoustic analysis measures, i.e. jitter and shimmer in both the groups. In perceptual measures, there was a significant improvement in Grade, Roughness, and Strain measures in both the groups while in quality of life measures there was significant improvement post-therapy in both the groups. When compared between groups A and B there was no significant difference in all the measures in both pre- and post-therapy assessments. Our study has recruited the control group and found there was no significant difference between the individual versus group voice therapy. Conclusion: Group voice therapy is as effective in the treatment of hyperfunctional voice disorders as individual therapy. There is a need to get data on a larger population to generalize the findings.

Brainstem-evoked response audiometry in pediatric age group Dipen Thakkar, Dilavar Barot Indian Journal of Otology 2018 24(4):246-251 Introduction: Hearing loss in early life hampers development of children, early detection of hearing loss in paediatric age group gives opportunity to treat it and good speech and overall development of children. In this study BERA was done on high risk children and various risk factor compared. Comparison between BERA and OAE was done as a screening test. Aims: To evaluate the hearing threshold and find the incidence of deafness in high risk paediatric age group category and analyse the common risk factors and to compare BERA with OAE.Materials and Method: 60 infants and high risk children were subjected to BERA after detailed ENT examination. In 0 to 5 year age group dPOAE was done on same sitting. Results analysed. Statistical Analysis Used: Relative risk ratio was done for each risk factor. Sensitivity and specificity of OAE in comparison to BERA as a gold standard was done. Results: In this study 42% of high risk children showed hearing loss. Most common risk factor among children with hearing loss was consanguineous marriage (24%) followed by neonatal jaundice (16%), low birth weight (12%) and others. Comparison of OAE and BERA with BERA as gold standard test shows sensitivity of OAE is 96.15%, specificity is 72.73%. Conclusion: All high risk children should be screened with BERA early so that children with hearing loss identified and taken care for that. In centre where no experts available OAE can be used for screening of high risk children as OAE has a good sensitivity.

New transcutaneous bone conduction hearing implant system: Surgical and audiological outcomes Himanshu Swami, Viswanathan Anand, Sweekritha N Bhat Indian Journal of Otology 2018 24(4):252-256 Aim: A new generation of bone-anchored hearing aid, Baha® 4 Attract System has been introduced as a single-stage procedure with the magnet and abutment implanted on the skull with complete skin cover. Aim is to discuss the surgical and audiological outcome of this new device. Materials and Methods: This was a prospective study. There were 34 patients who fulfilled criteria for bone conduction hearing aid. Out of these patients, 27 were unwilling for the surgical procedure. Prior to the surgery, a trial with a soft band was carried out and seven patients were satisfied with the trial. The outcomes were measured in the form of free-field pure-tone audiometry (PTA) after 3 months of surgery and quality of life gain using Speech, Spatial and Quality of hearing scale (SSQ-12B) questionnaire. Results: Outcomes in terms of gain in free-field PTA were good in all the seven patients. An average gain of 37.85 dB was observed. There was an improvement in quality of life as assessed by SSQ 12B questionnaire. An average score of 40.25 was achieved. Conclusion: Transcutaneous bone conduction aids are fast emerging as a viable alternate to traditional devices. These devices provide almost similar functional gain in hearing along with better cosmetic results, less complications, and minimal wound care.