Pub Date : 2023-01-01DOI: 10.4103/indianjotol.indianjotol_180_22
R. Komathi, Karthik Ravi, M. Sivaranjani, M. Sharanya
Context: Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo accounting for around 24% of all peripheral vestibular abnormalities and the posterior semicircular canal being the most affected. The most common cause of BPPV is idiopathic, others being inner ear disorders, trauma, infection, and increasing age. Objective: This study evaluated the efficacy of Epley's maneuver alone and Epley's maneuver with Brandt–Daroff exercises in the management of posterior semicircular canal BPPV, thereby comparing the recurrence rate after treatment in both groups. Materials and Methods: The study was a randomized prospective clinical trial with parallel and superiority trial design where 94 consecutive patients with posterior semicircular canal BPPV and fulfilling the inclusion criteria were enrolled into two Groups A = 47 and B = 47. All subjects underwent detailed history, examination, and assessment with UCLA dizziness questionnaire and videonystagmography. Group A patients received Epley's maneuver while group B received Epley's maneuver with Brandt–Daroff exercises as the treatment, with follow-up done on the 1st and 2nd weeks and after 1 month. Results: The age group of the majority of the patients in the study ranged between 51 and 60 years. The percentage of females in the study was 54.3% and males 45.7%. Results showed significant improvement in vertigo and nystagmus in both groups, with Group B having lesser recurrence during the follow-up visits. Conclusion: Both Epley's maneuver and Brandt–Daroff exercises are ideal means of treatment, but a combined approach of the two maneuvers yields better outcome in terms of symptomatic resolution and less recurrence.
{"title":"Comparing therapeutic maneuvers in posterior canal benign paroxysmal positional vertigo","authors":"R. Komathi, Karthik Ravi, M. Sivaranjani, M. Sharanya","doi":"10.4103/indianjotol.indianjotol_180_22","DOIUrl":"https://doi.org/10.4103/indianjotol.indianjotol_180_22","url":null,"abstract":"Context: Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo accounting for around 24% of all peripheral vestibular abnormalities and the posterior semicircular canal being the most affected. The most common cause of BPPV is idiopathic, others being inner ear disorders, trauma, infection, and increasing age. Objective: This study evaluated the efficacy of Epley's maneuver alone and Epley's maneuver with Brandt–Daroff exercises in the management of posterior semicircular canal BPPV, thereby comparing the recurrence rate after treatment in both groups. Materials and Methods: The study was a randomized prospective clinical trial with parallel and superiority trial design where 94 consecutive patients with posterior semicircular canal BPPV and fulfilling the inclusion criteria were enrolled into two Groups A = 47 and B = 47. All subjects underwent detailed history, examination, and assessment with UCLA dizziness questionnaire and videonystagmography. Group A patients received Epley's maneuver while group B received Epley's maneuver with Brandt–Daroff exercises as the treatment, with follow-up done on the 1st and 2nd weeks and after 1 month. Results: The age group of the majority of the patients in the study ranged between 51 and 60 years. The percentage of females in the study was 54.3% and males 45.7%. Results showed significant improvement in vertigo and nystagmus in both groups, with Group B having lesser recurrence during the follow-up visits. Conclusion: Both Epley's maneuver and Brandt–Daroff exercises are ideal means of treatment, but a combined approach of the two maneuvers yields better outcome in terms of symptomatic resolution and less recurrence.","PeriodicalId":44304,"journal":{"name":"Indian Journal of Otology","volume":"29 1","pages":"61 - 65"},"PeriodicalIF":0.1,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46436048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.4103/indianjotol.indianjotol_105_22
M. Zulkaflay, J. Maktar, A. Abdullah
Breach in the leptomeninges of the temporal bone may lead to leakage of cerebrospinal fluid (CSF) from the subarachnoid space and present as CSF otorrhea. Traumatic CSF otorrhea is one of the most troublesome conditions associated with head trauma. Persistent CSF fistula, meningitis, or even death may complicate it. We present a 38-year-old male who sustained left CSF otorrhea secondary to head trauma following an accidental fall. High-resolution computed tomography revealed a complex comminuted fracture at the left temporal bone extending from the mastoid part of the temporal bone until the petrous apex. He was managed conservatively and had a resolution of the leakage after 5 days of injury. We report this case to uphold the role of acetazolamide as part of the conservative management in traumatic CSF otorrhea.
{"title":"Temporal bone fracture and cerebrospinal fluid otorrhea: The role of acetazolamide","authors":"M. Zulkaflay, J. Maktar, A. Abdullah","doi":"10.4103/indianjotol.indianjotol_105_22","DOIUrl":"https://doi.org/10.4103/indianjotol.indianjotol_105_22","url":null,"abstract":"Breach in the leptomeninges of the temporal bone may lead to leakage of cerebrospinal fluid (CSF) from the subarachnoid space and present as CSF otorrhea. Traumatic CSF otorrhea is one of the most troublesome conditions associated with head trauma. Persistent CSF fistula, meningitis, or even death may complicate it. We present a 38-year-old male who sustained left CSF otorrhea secondary to head trauma following an accidental fall. High-resolution computed tomography revealed a complex comminuted fracture at the left temporal bone extending from the mastoid part of the temporal bone until the petrous apex. He was managed conservatively and had a resolution of the leakage after 5 days of injury. We report this case to uphold the role of acetazolamide as part of the conservative management in traumatic CSF otorrhea.","PeriodicalId":44304,"journal":{"name":"Indian Journal of Otology","volume":"29 1","pages":"71 - 73"},"PeriodicalIF":0.1,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48584817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Diabetes Mellitus Type II (DMT II) is a metabolic disorder characterized by chronic hyperglycemia resulting from relative or absolute insulin deficiency. It can cause various complications, including hearing loss (HL). NLR and PLR can determine the severity of DMT II but are not yet known for HL. Methods: This research was quantitative, analytically observational, and cross-sectional, using medical record data from July-November 2022. The variables were age, NLR, PLR, FBG, the duration and severity of DMT II, the air and bone conduction thresholds at speech frequencies (500, 1000, 2000, and 4000 Hz). Results: 43 respondents (86 ears) met the inclusion and exclusion criteria. The mean age was 61.63 + 8.64 years, with more women (60.5%, 26/43) than men (39.5%, 17/43). The mean duration of DM was 10.45 + 8.77 years. The average severity level was 2.63 + 1.77, which means that respondents in this study had more than two complications on average. DM in the elderly > 60 years old has a risk of HL 9.839 times compared to those < 60. DM with a high NLR can increase the risk of HL by increasing the incidence of HL, bilateral sides, type and degree of HL, and air and bone conduction threshold. DM with NLR > 2.76 is more at risk of experiencing HL as much as 6.83 times compared to DM with NLR < 2.76. Factors that predict HL in DM are age, NLR, and FBG, which are 33.1%, while other factors determine 66.7%. The age, FBG, and NLR variables can predict hearing loss in DM with moderate accuracy (AUC 76.7%). Conclusion: Hearing loss needs to be added to the screening program for complications of diabetes mellitus. A hearing screening program is needed for DM aged > 60 years, FGB > 126 mg/dl and NLR > 2,76. NLR could be used to predict hearing loss incidents in DMT II.
{"title":"The Effect of Neutrophil-to-lymphocyte Ratio and Platelet-to-lymphocyte Ratio on the Severity of Diabetes Mellitus Type II and Air and Bone Conduction Hearing Threshold at Speech Frequency","authors":"Khuznita Dasa Novita, Dian Hasanah, Thareq Bharasaba","doi":"10.4103/indianjotol.indianjotol_22_23","DOIUrl":"https://doi.org/10.4103/indianjotol.indianjotol_22_23","url":null,"abstract":"Background: Diabetes Mellitus Type II (DMT II) is a metabolic disorder characterized by chronic hyperglycemia resulting from relative or absolute insulin deficiency. It can cause various complications, including hearing loss (HL). NLR and PLR can determine the severity of DMT II but are not yet known for HL. Methods: This research was quantitative, analytically observational, and cross-sectional, using medical record data from July-November 2022. The variables were age, NLR, PLR, FBG, the duration and severity of DMT II, the air and bone conduction thresholds at speech frequencies (500, 1000, 2000, and 4000 Hz). Results: 43 respondents (86 ears) met the inclusion and exclusion criteria. The mean age was 61.63 + 8.64 years, with more women (60.5%, 26/43) than men (39.5%, 17/43). The mean duration of DM was 10.45 + 8.77 years. The average severity level was 2.63 + 1.77, which means that respondents in this study had more than two complications on average. DM in the elderly > 60 years old has a risk of HL 9.839 times compared to those < 60. DM with a high NLR can increase the risk of HL by increasing the incidence of HL, bilateral sides, type and degree of HL, and air and bone conduction threshold. DM with NLR > 2.76 is more at risk of experiencing HL as much as 6.83 times compared to DM with NLR < 2.76. Factors that predict HL in DM are age, NLR, and FBG, which are 33.1%, while other factors determine 66.7%. The age, FBG, and NLR variables can predict hearing loss in DM with moderate accuracy (AUC 76.7%). Conclusion: Hearing loss needs to be added to the screening program for complications of diabetes mellitus. A hearing screening program is needed for DM aged > 60 years, FGB > 126 mg/dl and NLR > 2,76. NLR could be used to predict hearing loss incidents in DMT II.","PeriodicalId":44304,"journal":{"name":"Indian Journal of Otology","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136257761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.4103/indianjotol.indianjotol_23_23
J. S Tejaswini, Manwinder Walia, Sandeep Bansal, Samanvaya Soni
Background: Sudden sensorineural hearing loss (SSNHL) is a common otologic emergency, with hearing loss of 30 dB or greater at three contiguous frequencies, and an abrupt onset within 3 days or fewer, with no recognizable cause. Aims and Objectives: In this study, the efficacy of intratympanic (IT) injections of dexamethasone are compared with oral prednisolone and the behaviour of the different audiometric curves in response to both the steroid therapies in studied. Materials and Methods: Patients presenting with SSNHL to the Department of ENT, Head and Neck Surgery at Government Multi Speciality Hospital, Chandigarh, were subjected to routine tests. Informed written consent was taken from each patient, and cases meeting the selection criteria were included in the study. Pure-tone audiometry was done before starting treatment. Patients were randomly assigned into two groups based on their enrollment number. Those in Group 1 were treated with three doses of 0.3–0.6 mL IT injections of dexamethasone (4 mg/mL) on alternate days and those in Group 2 received OP 1 mg/kg/day with tapering doses. Pure-tone audiogram (PTA) will be repeated after 2 weeks, 4 weeks, and 8 weeks from the first dose. Results: In the IT dexamethasone group, the pretreatment PTA was 61.05 dB while the posttreatment PTA was 37.45 dB. The hearing gain was 23.6 dB. In the oral steroid group, pretreatment PTA was 66.79 while posttreatment PTA was 47.36 dB. The hearing gain was 19.43 dB. The hearing gain in both the groups was statistically significant; however, there was no statistical difference between the two in terms of superiority of efficacy ( P > 0.05). Conclusion: The treatment of SSNHL still remains a challenge among the otologists. The present study establishes that the efficacy of IT steroids was as good as the oral steroid therapy for the management of SSNHL as both the modalities showed significant hearing improvement. Hence, IT steroid can be used as a first-line therapy in patients with. Our study also uncovered the fact that patients who come with shorter duration of onset recover quickly compared to those patients who delay their treatment. Hence, IT steroid can be used as a primary modality of treatment instead of a salvage therapy in the selected group of patients.
{"title":"Efficacy of Oral versus Intratympanic Steroids in the Treatment of Idiopathic Sudden Sensorineural Hearing Loss: A 1-year Randomized Control Trial","authors":"J. S Tejaswini, Manwinder Walia, Sandeep Bansal, Samanvaya Soni","doi":"10.4103/indianjotol.indianjotol_23_23","DOIUrl":"https://doi.org/10.4103/indianjotol.indianjotol_23_23","url":null,"abstract":"Background: Sudden sensorineural hearing loss (SSNHL) is a common otologic emergency, with hearing loss of 30 dB or greater at three contiguous frequencies, and an abrupt onset within 3 days or fewer, with no recognizable cause. Aims and Objectives: In this study, the efficacy of intratympanic (IT) injections of dexamethasone are compared with oral prednisolone and the behaviour of the different audiometric curves in response to both the steroid therapies in studied. Materials and Methods: Patients presenting with SSNHL to the Department of ENT, Head and Neck Surgery at Government Multi Speciality Hospital, Chandigarh, were subjected to routine tests. Informed written consent was taken from each patient, and cases meeting the selection criteria were included in the study. Pure-tone audiometry was done before starting treatment. Patients were randomly assigned into two groups based on their enrollment number. Those in Group 1 were treated with three doses of 0.3–0.6 mL IT injections of dexamethasone (4 mg/mL) on alternate days and those in Group 2 received OP 1 mg/kg/day with tapering doses. Pure-tone audiogram (PTA) will be repeated after 2 weeks, 4 weeks, and 8 weeks from the first dose. Results: In the IT dexamethasone group, the pretreatment PTA was 61.05 dB while the posttreatment PTA was 37.45 dB. The hearing gain was 23.6 dB. In the oral steroid group, pretreatment PTA was 66.79 while posttreatment PTA was 47.36 dB. The hearing gain was 19.43 dB. The hearing gain in both the groups was statistically significant; however, there was no statistical difference between the two in terms of superiority of efficacy ( P > 0.05). Conclusion: The treatment of SSNHL still remains a challenge among the otologists. The present study establishes that the efficacy of IT steroids was as good as the oral steroid therapy for the management of SSNHL as both the modalities showed significant hearing improvement. Hence, IT steroid can be used as a first-line therapy in patients with. Our study also uncovered the fact that patients who come with shorter duration of onset recover quickly compared to those patients who delay their treatment. Hence, IT steroid can be used as a primary modality of treatment instead of a salvage therapy in the selected group of patients.","PeriodicalId":44304,"journal":{"name":"Indian Journal of Otology","volume":"2011 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136257762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.4103/indianjotol.indianjotol_145_22
P. Verma, Charu Singh, Shivesh Kumar, A. Rana
Background: Chronic suppurative otitis media (CSOM) is a disease of a low-socioeconomic group with high prevalence in India. Tympanoplasty is a common procedure done for CSOM. Hopkins endoscopes are now more popular for various ear surgeries due to better optics, portability, and cost-effectiveness. The objective was to compare the surgical outcome of minimally invasive endoscopic tympanoplasty and microscopic tympanoplasty. Materials and Methods: A prospective follow-up comparative study was performed on 60 patients who underwent tympanoplasty from January 2021 to December 2021. The subjects were divided equally and randomly into two groups (endoscopic group and microscopic group). Demographic data, perforation size of the tympanic membrane, pure-tone audiometry results preoperatively, and at the 8th week postoperatively, type of anesthesia used, average surgical time, postoperative morbidity, and graft uptake rate in both the groups were compared. Results: Graft uptake was 93% in the endoscopic group and 96% in the microscopic group. Postoperative morbidity was more in the microscopic group as compared to the endoscopic group. Average surgical time was less in the endoscopic group as compared to the microscopic group. Endoscopic tympanoplasty was done under local anesthesia and is economically more acceptable to the patient as compared to the microscopic group. The mean air–bone gap gain was 16.44 dB in the endoscopic group and 16.07 dB in the microscopic group. Conclusion: With minimally invasive endoscopic procedure, it is possible to get a similar graft uptake rate and hearing gain as compared with conventional microscopic procedure with the advantage of having less postoperative morbidity and lesser consumption of medical resources. Thereby making it a more cost-effective technique and can be easily performed in remote places.
{"title":"Comparative study of minimally invasive endoscopic tympanoplasty with microscopic tympanoplasty","authors":"P. Verma, Charu Singh, Shivesh Kumar, A. Rana","doi":"10.4103/indianjotol.indianjotol_145_22","DOIUrl":"https://doi.org/10.4103/indianjotol.indianjotol_145_22","url":null,"abstract":"Background: Chronic suppurative otitis media (CSOM) is a disease of a low-socioeconomic group with high prevalence in India. Tympanoplasty is a common procedure done for CSOM. Hopkins endoscopes are now more popular for various ear surgeries due to better optics, portability, and cost-effectiveness. The objective was to compare the surgical outcome of minimally invasive endoscopic tympanoplasty and microscopic tympanoplasty. Materials and Methods: A prospective follow-up comparative study was performed on 60 patients who underwent tympanoplasty from January 2021 to December 2021. The subjects were divided equally and randomly into two groups (endoscopic group and microscopic group). Demographic data, perforation size of the tympanic membrane, pure-tone audiometry results preoperatively, and at the 8th week postoperatively, type of anesthesia used, average surgical time, postoperative morbidity, and graft uptake rate in both the groups were compared. Results: Graft uptake was 93% in the endoscopic group and 96% in the microscopic group. Postoperative morbidity was more in the microscopic group as compared to the endoscopic group. Average surgical time was less in the endoscopic group as compared to the microscopic group. Endoscopic tympanoplasty was done under local anesthesia and is economically more acceptable to the patient as compared to the microscopic group. The mean air–bone gap gain was 16.44 dB in the endoscopic group and 16.07 dB in the microscopic group. Conclusion: With minimally invasive endoscopic procedure, it is possible to get a similar graft uptake rate and hearing gain as compared with conventional microscopic procedure with the advantage of having less postoperative morbidity and lesser consumption of medical resources. Thereby making it a more cost-effective technique and can be easily performed in remote places.","PeriodicalId":44304,"journal":{"name":"Indian Journal of Otology","volume":"29 1","pages":"27 - 32"},"PeriodicalIF":0.1,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47531895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fibrous dysplasia (FD) is a benign and chronic abnormal proliferation of fibrous tissue and bone. It presents as a growth; however, most authors do not consider it to be true neoplasia. Despite its affinity to affect craniofacial bones, it usually remains asymptomatic and, sometimes, presents with deformity. Owing to its rarity, diagnostic difficulty, scarce literature, and staggered opinions on optimal management, it still interests otolaryngologists. FD involving temporal bone is even rarer. The most common initial findings are stenosis of the external auditory canal and conductive hearing loss. Most cases involve a single bone; however, about 20% of patients have polyostotic involvement often with extraosseous abnormalities. This disease produces widely variable radiographic images. Radio imaging is highly suggestive; however, the diagnosis is clinched only by histopathology with a surgical specimen. Here, we present a series of two cases of temporal bone FD with its management and outcomes.
{"title":"Fibrous Dysplasia of the Temporal Bone: A Case Series","authors":"Tanuj Madan, Sunil Goyal, Mandavi Dwivedi, Himanshu Swami","doi":"10.4103/indianjotol.indianjotol_47_23","DOIUrl":"https://doi.org/10.4103/indianjotol.indianjotol_47_23","url":null,"abstract":"Fibrous dysplasia (FD) is a benign and chronic abnormal proliferation of fibrous tissue and bone. It presents as a growth; however, most authors do not consider it to be true neoplasia. Despite its affinity to affect craniofacial bones, it usually remains asymptomatic and, sometimes, presents with deformity. Owing to its rarity, diagnostic difficulty, scarce literature, and staggered opinions on optimal management, it still interests otolaryngologists. FD involving temporal bone is even rarer. The most common initial findings are stenosis of the external auditory canal and conductive hearing loss. Most cases involve a single bone; however, about 20% of patients have polyostotic involvement often with extraosseous abnormalities. This disease produces widely variable radiographic images. Radio imaging is highly suggestive; however, the diagnosis is clinched only by histopathology with a surgical specimen. Here, we present a series of two cases of temporal bone FD with its management and outcomes.","PeriodicalId":44304,"journal":{"name":"Indian Journal of Otology","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136258071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.4103/indianjotol.indianjotol_195_22
D. Anand Karthikeyan, Poornima Kumar
Dizziness and imbalance are one of the most common complaints seen in elderly people. Age-related ischemic diseases have varying degrees of manifestations and imbalance problems. Cerebral small vessel white matter disease has recently been a topic of interest in view of its association with geriatric syndromes–development of cognitive decline, dementia, falls, etc., but the association between small vessel disease and dizziness has not established clearly yet. Magnetic resonance imaging (MRI) brain is the most commonly used imaging modality for neurological disorders. White matter hyperintensities (WMHs) on T2-weighted sequences on MRI are known as leukoaraiosis (LA) and are suggestive of small vessel white matter disease and represent a high risk of cerebral, cerebellar, and brainstem stroke. The purpose of the present study is to investigate the correlation between unexplained vertigo and radiological changes of LA (small vessel disease) and videonystagmography (VNG) findings of such patients. First patient, a 55-year-old male patient had complaints of short-lasting episodes of spinning sensation and imbalance for the past 2 years. MRI brain showed small vessel ischemic changes (leukoaraiosis) with right vascular loop type 3 (anterior inferior cerebellar artery) without compressive symptoms. VNG showed broken smooth pursuit in horizontal and vertical planes; a hypometric saccades tracing in both planes and microsaccadic oscillations in spontaneous gaze. Second patient, a 60-year-old male had recurrent episodes of vertigo for the past 15 years. His VNG showed micro-oscillations in the saccades and impaired smooth pursuit. MRI revealed bilateral symmetrical T2 FLAIR hyperintensities in white matter and lateral ventricles. Third patient, a 69-year-old female presented with giddiness, nausea, and vomiting for 5 days. Pure-tone audiogram showed mild sensorineural hearing loss. MRI brain showed diffuse cerebral atrophy with small vessel ischemic changes. VNG showed impaired smooth pursuit and microsaccadic oscillations when the gaze was fixed. All three patients were managed successfully by vestibular rehabilitation and antioxidants and Coenzyme Q10. Through this study, we would like to highlight the possibility of a relation between leukoaraiosis and unexplained dizziness among elderly patients.
{"title":"Leukoaraiosis and Dizziness: Are They Related? – A Case Series","authors":"D. Anand Karthikeyan, Poornima Kumar","doi":"10.4103/indianjotol.indianjotol_195_22","DOIUrl":"https://doi.org/10.4103/indianjotol.indianjotol_195_22","url":null,"abstract":"Dizziness and imbalance are one of the most common complaints seen in elderly people. Age-related ischemic diseases have varying degrees of manifestations and imbalance problems. Cerebral small vessel white matter disease has recently been a topic of interest in view of its association with geriatric syndromes–development of cognitive decline, dementia, falls, etc., but the association between small vessel disease and dizziness has not established clearly yet. Magnetic resonance imaging (MRI) brain is the most commonly used imaging modality for neurological disorders. White matter hyperintensities (WMHs) on T2-weighted sequences on MRI are known as leukoaraiosis (LA) and are suggestive of small vessel white matter disease and represent a high risk of cerebral, cerebellar, and brainstem stroke. The purpose of the present study is to investigate the correlation between unexplained vertigo and radiological changes of LA (small vessel disease) and videonystagmography (VNG) findings of such patients. First patient, a 55-year-old male patient had complaints of short-lasting episodes of spinning sensation and imbalance for the past 2 years. MRI brain showed small vessel ischemic changes (leukoaraiosis) with right vascular loop type 3 (anterior inferior cerebellar artery) without compressive symptoms. VNG showed broken smooth pursuit in horizontal and vertical planes; a hypometric saccades tracing in both planes and microsaccadic oscillations in spontaneous gaze. Second patient, a 60-year-old male had recurrent episodes of vertigo for the past 15 years. His VNG showed micro-oscillations in the saccades and impaired smooth pursuit. MRI revealed bilateral symmetrical T2 FLAIR hyperintensities in white matter and lateral ventricles. Third patient, a 69-year-old female presented with giddiness, nausea, and vomiting for 5 days. Pure-tone audiogram showed mild sensorineural hearing loss. MRI brain showed diffuse cerebral atrophy with small vessel ischemic changes. VNG showed impaired smooth pursuit and microsaccadic oscillations when the gaze was fixed. All three patients were managed successfully by vestibular rehabilitation and antioxidants and Coenzyme Q10. Through this study, we would like to highlight the possibility of a relation between leukoaraiosis and unexplained dizziness among elderly patients.","PeriodicalId":44304,"journal":{"name":"Indian Journal of Otology","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136258085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-01DOI: 10.4103/indianjotol.indianjotol_163_22
A. Mohite, Bhagyashree Shrestha, R. Mane, B. Patil, V. Varute, Arpita Yasatwar
Introduction: Majority of tympanic membrane perforations require myringoplasty for closure. Recently, epidermal growth factor (EGF) has been shown to promote the healing of tympanic membrane perforations. Aim: The aim of this study was to find out a simple nonsurgical outpatient procedure to close one-quadrant tympanic membrane perforations that could reduce the hospital stay, medical cost, and morbidity in these patients. Materials and Methods: An interventional prospective randomized clinical study was done on 120 patients at our tertiary hospital. The allocation ratio was 3:1. Pure-tone audiometry, otomicroscopy, and otoenodoscopic recording were performed in all eligible patients who consented to take part in the study. Ninety cases received EGF gel application, whereas 30 controls received antibiotic ofloxacin application. Trichloroacetic acid chemical cautery and fibrin glue application were done in patients of both groups. Results: The closure rate was 97.7% in the EGF group and 70% in the ofloxacin group. The time taken for closure of perforations was 10 to 14 days in the EGF group and 3–4 weeks in the ofloxacin group. Hearing gain was observed in healed perforations of both groups. Conclusion: EGF application enhances the healing effect of one-quadrant nonhealing tympanic membrane perforations. It showed encouraging results and reliable safety in the regeneration of tympanic membrane. Clinical Significance: Apart from its use in single quadrant perforation, EGF may be considered for treating residual perforations after failed tympanoplasty.
{"title":"Efficacy of human epidermal growth factor in the regeneration of tympanic membrane perforation: A randomized clinical study","authors":"A. Mohite, Bhagyashree Shrestha, R. Mane, B. Patil, V. Varute, Arpita Yasatwar","doi":"10.4103/indianjotol.indianjotol_163_22","DOIUrl":"https://doi.org/10.4103/indianjotol.indianjotol_163_22","url":null,"abstract":"Introduction: Majority of tympanic membrane perforations require myringoplasty for closure. Recently, epidermal growth factor (EGF) has been shown to promote the healing of tympanic membrane perforations. Aim: The aim of this study was to find out a simple nonsurgical outpatient procedure to close one-quadrant tympanic membrane perforations that could reduce the hospital stay, medical cost, and morbidity in these patients. Materials and Methods: An interventional prospective randomized clinical study was done on 120 patients at our tertiary hospital. The allocation ratio was 3:1. Pure-tone audiometry, otomicroscopy, and otoenodoscopic recording were performed in all eligible patients who consented to take part in the study. Ninety cases received EGF gel application, whereas 30 controls received antibiotic ofloxacin application. Trichloroacetic acid chemical cautery and fibrin glue application were done in patients of both groups. Results: The closure rate was 97.7% in the EGF group and 70% in the ofloxacin group. The time taken for closure of perforations was 10 to 14 days in the EGF group and 3–4 weeks in the ofloxacin group. Hearing gain was observed in healed perforations of both groups. Conclusion: EGF application enhances the healing effect of one-quadrant nonhealing tympanic membrane perforations. It showed encouraging results and reliable safety in the regeneration of tympanic membrane. Clinical Significance: Apart from its use in single quadrant perforation, EGF may be considered for treating residual perforations after failed tympanoplasty.","PeriodicalId":44304,"journal":{"name":"Indian Journal of Otology","volume":"28 1","pages":"301 - 305"},"PeriodicalIF":0.1,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70770504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-01DOI: 10.4103/indianjotol.indianjotol_66_22
Yogeesha Beesanahalli, K. Ramya, K. Ajith, Nagaraj Maradi, R. Bai
Background: Pseudocyst of the pinna is a benign cystic lesion on the lateral surface of the pinna with no definitive etiology or treatment. Various methods are currently used to manage this disease. Most of the treatment options are prone to disease recurrence and are associated with cosmetic sequelae. We report 16 cases of unilateral pseudocyst that were treated with window deroofing and pressure dressing with dental roll suturing. Aim: This study aimed to study the effectiveness of window deroofing with dental roll suturing in the treatment of pseudocyst of the auricle with respect to recurrence and postprocedural sequelae. Materials and Methods: A prospective study at a tertiary care center for 2 years, which included 16 patients with a diagnosis of pseudocyst pinna. All the patients were treated by excising a small triangular piece of skin along with perichondrium, followed by dental roll suturing for pressure dressing; and were followed up after 1 week and 1 month of surgery. Results: All 16 cases were completely relieved of the disease at the end of 1 month. None of our patients had a recurrence and only 2 cases (12.5%) showed thickening of the pinna skin. Conclusions: The surgical treatment by window deroofing with dental roll suturing technique gave a reliable result in all cases of pseudocyst pinna with no evidence of recurrence and acceptable cosmetic results.
{"title":"Window deroofing with dental roll suturing for pseudocyst pinna, simple solution for notorious disease","authors":"Yogeesha Beesanahalli, K. Ramya, K. Ajith, Nagaraj Maradi, R. Bai","doi":"10.4103/indianjotol.indianjotol_66_22","DOIUrl":"https://doi.org/10.4103/indianjotol.indianjotol_66_22","url":null,"abstract":"Background: Pseudocyst of the pinna is a benign cystic lesion on the lateral surface of the pinna with no definitive etiology or treatment. Various methods are currently used to manage this disease. Most of the treatment options are prone to disease recurrence and are associated with cosmetic sequelae. We report 16 cases of unilateral pseudocyst that were treated with window deroofing and pressure dressing with dental roll suturing. Aim: This study aimed to study the effectiveness of window deroofing with dental roll suturing in the treatment of pseudocyst of the auricle with respect to recurrence and postprocedural sequelae. Materials and Methods: A prospective study at a tertiary care center for 2 years, which included 16 patients with a diagnosis of pseudocyst pinna. All the patients were treated by excising a small triangular piece of skin along with perichondrium, followed by dental roll suturing for pressure dressing; and were followed up after 1 week and 1 month of surgery. Results: All 16 cases were completely relieved of the disease at the end of 1 month. None of our patients had a recurrence and only 2 cases (12.5%) showed thickening of the pinna skin. Conclusions: The surgical treatment by window deroofing with dental roll suturing technique gave a reliable result in all cases of pseudocyst pinna with no evidence of recurrence and acceptable cosmetic results.","PeriodicalId":44304,"journal":{"name":"Indian Journal of Otology","volume":"28 1","pages":"292 - 295"},"PeriodicalIF":0.1,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47551440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-01DOI: 10.4103/indianjotol.indianjotol_111_21
Zaina Al Dhahli, J. Naik, Yousuf Al Saidi
Actinomycosis subacute to chronic infection caused by actinomyces. Actinomyces is filamentous, Gram-positive, anaerobic, nonacid-fast microaerophilic bacteria. Although it is considered as normal flora it is rarely colonize middle ear. The aim is to report the case of middle ear actinomycosis. We present 35-year-old female complain of recurrent left ear discharge. The whole tympanic membrane was bulging (due to granulation tissue behind it) with tiny hole that are discharging. Underwent tympano-mastoidectomy surgery with surgery finding of whitish material and granulation tissue in the middle ear. Histopathology of that material reported as the colony of actinomyces. Middle ear actinomycosis although is rare infection but should be done as one of differential diagnoses for recurrent otorrhea. Both surgical treatment and antibiotics are recommended as treatment for middle ear actinomycosis.
{"title":"Middle ear actinomycosis","authors":"Zaina Al Dhahli, J. Naik, Yousuf Al Saidi","doi":"10.4103/indianjotol.indianjotol_111_21","DOIUrl":"https://doi.org/10.4103/indianjotol.indianjotol_111_21","url":null,"abstract":"Actinomycosis subacute to chronic infection caused by actinomyces. Actinomyces is filamentous, Gram-positive, anaerobic, nonacid-fast microaerophilic bacteria. Although it is considered as normal flora it is rarely colonize middle ear. The aim is to report the case of middle ear actinomycosis. We present 35-year-old female complain of recurrent left ear discharge. The whole tympanic membrane was bulging (due to granulation tissue behind it) with tiny hole that are discharging. Underwent tympano-mastoidectomy surgery with surgery finding of whitish material and granulation tissue in the middle ear. Histopathology of that material reported as the colony of actinomyces. Middle ear actinomycosis although is rare infection but should be done as one of differential diagnoses for recurrent otorrhea. Both surgical treatment and antibiotics are recommended as treatment for middle ear actinomycosis.","PeriodicalId":44304,"journal":{"name":"Indian Journal of Otology","volume":"28 1","pages":"320 - 321"},"PeriodicalIF":0.1,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44963125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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