Otology

Middle ear mucosal compartm Mahendra Kumar Taneja Indian Journal of Otology 2020 26(3):115-121 Mucosal folds of middle ear are not a significant barrier in spread of infection cholesteatoma spread towards the least resistance and usually follow the folds. The mucosa of the middle ear is continuous with that of the pharynx via Eustachian tube. It covers the ossicles, muscles, nerves and forms the inner layer of tympanic membrane. Mucosal fold are of two types Composite Fold – these are of ligament with lining mucosa. Duplicate Fold – Fusion of two expanding sacs in absence of any interposing structure. Epitympanic Diaphragm it is an oblique dividing septum between the posterior superior attic and anteroinferior mesotympanium. It comprises of anterior malleolar ligament, lateral malleolar ligament, posterior malleolar ligament, lateral incudal fold, tensor tympani fold and posterior incudal ligament fold. Tympanic Isthimus is 2.5 mm elongated narrow space in epitympanic diaphragm present naturally and provides ventilation. Key message is tensor tympani fold and anterior Pouch of VonTroltsch is responsible for ventilation of anterior compartment. It is extremely important to understand and restore the functional anatomy, proper gas exchange and mucosal clearance from the middle ear compartment. The obstruction site is at tympanic isthimus. It is crucial to visualise and clearance of disease to restore ventilation. In surgical procedures of ear just removal of tensor tympani fold along with resection of Cog provides good results by providing ventilation of attic, mastoid air cells and a successful tympanoplasty.

Speech recognition in noise in patients with type II diabetes Somayeh Falahzadeh, Sima Tajik, Faezeh Azadi, Farnoosh Farjadi Indian Journal of Otology 2020 26(3):122-126 Context: The chronic diabetes is associated with damage to the sensory and cognitive regions brain. The central auditory system is susceptible to the damage caused by high glucose level. Aims: Since the healthy auditory system plays an important role in communication, this study examined speech recognition in noise performance of these people so as to better identify the harmful impacts of diabetes on the auditory processing. Settings and Design: This cross-sectional comparative study compares the speech recognition in noise performance of 30 diabetic patients and 30 normal individuals aged 30–55 years with quick speech in noise (Q-SIN) test. Subjects and Methods: All people had normal hearing and the speech recognition performance in silent, the Persian version of the Q-SIN test was used. Statistical Analysis Used: Results of signal-to-noise ratio loss (SNR loss) and recognition of words at different SNR levels were analyzed with Chi-square test and independent t-test in two groups. Results: There was a significant difference between diabetic patients and normal individuals in mean of SNR loss (P < 0.05). The comparison of word recognition scores in each SNR showed no significant difference in 25, 20 SNRs between the two groups (P > 0.05), but the performance of diabetic patients was weaker in 15, 10, 5, 0 SNR (P < 0.05). Conclusions: In the absence of hearing loss, the diabetic patients have a significant speech perception disorder, especially at lower levels of SNRs, compared to normal people of the same age. Impaired speech comprehension in the presence of a competitive message can result from the damage to central auditory processing as a result of diabetes.

Auditory brainstem response to level-specific CE-CHIRP® threshold estimation in normal-hearing adults Ahmad Aidil Arafat Dzulkarnain, Suhaila Ahmad Shuckri, Noraidah Ismail Indian Journal of Otology 2020 26(3):127-131 Background: The aim of the present study was to compare the hearing thresholds between pure tone audiometry (PTA) and auditory brainstem response (ABR) from level-specific (LS) CE-Chirp® and click stimuli in normal adult subjects. Materials and Methods: Twenty-four adults with normal audiometric thresholds participated in the study. The ABR was recorded from the study participants at 80 dBnHL until their respective auditory thresholds using both the LS CE-Chirp® and click stimuli. Study Design and Statistical Analysis: A quasi-experimental study design was used. Audiometric thresholds (low frequencies [LFs], mid frequencies [MFs], and high frequencies [HFs]) and the ABR thresholds from both stimuli were compared using the Friedman test with Wilcoxon signed-rank test as the post hoc analysis. Results: No statistically significant difference was identified between the PTA and the ABR to LS CE-Chirp® thresholds at LFs and only small differences (<6 dB) median thresholds differences were identified at the MFs and HF. The amplitudes of wave III and V were larger for ABR to LS CE-Chirp® as compared to the ABR from the click stimulus. Conclusion: This study concluded that the ABR to LS CE-Chirp® has closer thresholds than the audiogram as compared to the ABR from click in normal-hearing adult subjects. At the suprathreshold (80 dBnHL), the ABR amplitudes of wave III, and V were larger in LS CE-Chirp® than the click stimulus.

Vestibular evaluation in patients with congenital profound hearing loss using ice cold water caloric test and rotational chair test Arun Dehadaray, Viraj Gaikwad, Maitri Kaushik, Prasun Mishra, Sai Belsare Indian Journal of Otology 2020 26(3):132-134 Introduction: With the introduction of newborn hearing screening, hearing problems are often detected at the neonatal stage and in early infancy, and holistic approach including not only auditory but also vestibular function is needed. This study hopes to establish some corelation between cochlear and vestibular system dysfunction in a patient born with congenital profound hearing loss (CPHL). Materials and Methods: In this observational and descriptive study conducted at a tertiary care hospital, we evaluated eighty patients with bilateral CPHL from 2016 to 2018. After taking a detailed history and thorough ear, nose, and throat examination, the patients underwent vestibular function evaluation by ice cold water caloric test (ICCT) and rotational chair test (RCT) in the outpatient department, and the duration of nystagmus was calculated based on which hypoactive or absent vestibular function was found out. Results: In the present study, out of eighty patients with CPHL, vestibular function of 62 (77.50%) was normal, 9 (11.25%) hypoactive, and 9 (11.25%) with absent vestibular function. Conclusion: In the outpatient department where sophisticated equipment and laboratory facilities are not available, ICCT can be used to determine the vestibular function and also RCT can be used. From the present study, it can be concluded that vestibular dysfunction is present in 22.50% of patients with CPHL with the use of ICCT and RCT. There is a strong possibility of genetic origin etiology for vestibular dysfunction. The present study also concludes that consanguinity may be major etiological factor for vestibular dysfunction.

Influence of cardiovascular risk factors on cochlear dysfunction Nemanja Radivojevic, Nenad Arsovic, Zoran Dudvarski, Vladimir Nesic, Ljiljana Cvorovic, Snezana Babac, Aleksandra Radivojevic Indian Journal of Otology 2020 26(3):135-140 Background: Cochlear dysfunction can arise not only from various factors such as ear diseases but also from systemic disorders of the body. The occurrence of otologic symptoms such as hearing loss, dizziness, and tinnitus can be due to cardiovascular disorders. Therefore, current understandings in the field of the diagnosis and therapy of cardiovascular diseases (CVDs) should include, among others, evidence of otologic disorders. Objective: The aim of this study is to determine the association between risk factors for CVD and cochlear dysfunction. Methods: The cross-sectional study included 128 participants with major CVD risk factors who underwent auditory function examination (pure tone audiometry). Results: There were 52 women (40.6%) and 76 men (59.4%) in total. The mean age of the participants was 58 years (a range of 28–83 years). The mean age among participants with hearing loss was 60 (±10.88), whereas the mean age among participants that had normal hearing thresholds was 54 (±12.18). Sensorineural hearing loss (SNHL) was measured in 59% of participants, of most frequent mild degree hearing loss. The prevalence of SNHL was higher in participants with arterial hypertension (P < 0.001, OR = 5.881, 95% CI 2.694–12.837) and the most common among them was moderate degree hearing impairment (38%). There is also a statistically significant association of SNHL with dyslipidemia and elevated body mass index (P < 0.001, [OR]: 4.118, 95% [CI]: 1.873–9.053 and P< 0.001, [OR]: 1.517, 95% [CI]: 1.237–1.859 ) with moderate and profound hearing loss. Conclusion: Based on the data obtained, it seems that the presence of major cardiovascular risk factors was a significant predictor for cochlear dysfunction.

Examination of ototoxicity induced by imatinib, being a tyrosine kinase inhibitor: An experimental study Emine Elif Altuntas, Kasim Durmus, Adem Bora, Nergiz Hacer Turgut, Hatice Terzi, Ahmet Kutluhan Indian Journal of Otology 2020 26(3):141-146 Objectives: Two rats were excluded from the study. Because otitis media developing one rat in Group C (7th dayof the experiment) and bleeding-related death one rat in Group I-50 (14th day of the experiment). While the side effects of imatinib are investigated in the literature, it is remarkable that the case reports suggesting an ototoxic side effect also take place among the publications. The aim of this study was to investigate whether or not imatinib has any ototoxic effect on rats via auditory brainstem response (ABR) responses. Materials and Methods: Rats were divided into three groups as Group C (0.25 mL/kg/day), Group I-30 (30 mg/kg/day), and Group I-50 (50 mg/kg/day). In the ABR record, hearing threshold, latency, amplitude, and interpeak latency values on test days were recorded and assessed. Results: In the assessment made in terms of mean V Wave latency within the group, a difference was determined at all stimulus intensities at 8 kHz in Group I-50 (P < 0.05). In the within-group assessment performed in terms of mean Wave III latency, there were differences in Groups I-30 and I-50 (P < 0.05). In the within-group assessment performed in terms of I–III interpeak latency mean values, there was a difference at 4 kHz and 70 dB in Group I-30 (P < 0.05). In the within-group assessment in terms of mean III–V interpeak latency values, the difference between the groups was significant on the 7th day at 6 kHz and 50 dB (P = 0.044) and on the 14th day at 8 kHz and 70 dB (P = 0.036). In the within-group assessment in terms of Wave I amplitude mean values, the change in the amplitude values at 4 kHz (P = 0.003) and 6 kHz (P = 0.018) in Group I-50 was significant. Conclusion: It was observed that imatinib application caused elongation in latency and interpeak latency values and changes in amplitude values. These differences were not enough to state that imatinib is having an ototoxic side effect.

Vestibular epilepsy: Clinical presentation, diagnosis, and management Ajay Philip, GR Haripriya, Manju Deena Mammen, Anjali Lepcha, Ann Mary Augustine Indian Journal of Otology 2020 26(3):147-150 Background: Vestibular epilepsy as a cause of vertigo is rare. This clinical entity occurs primarily due to epileptic activity in parts of the cortex that represents the vestibular system. It is often distinctive with sudden, brief episodes of vertigo followed by rapid recovery without sequelae. In vestibular epilepsy, vertigo is not simply an aura, but constitutes a part of the seizure, and maybe its only manifestation. Aim: The aim of this study was to describe the clinical profile of patients diagnosed with vestibular epilepsy who presented to the neurotology clinic in our hospital in the past 7 years from January 1, 2014, to May 1, 2020, and to present their clinical features, diagnosis, and management. Materials and Methods: This was a retrospective observational clinical study based on the medical records of all patients diagnosed with vestibular epilepsy who presented during the period January 1, 2014–May 1, 2020, to our neurotology clinics. Each patient's history and neurotological examination were documented. All investigations carried out such as audiovestibular tests, electroencephalogram, cardiac tests, and imaging were noted. Results: Ten patients were diagnosed with vestibular epilepsy in our clinic during this time period, with a prevalence of vestibular epilepsy being 0.001%. The main subjective aura in our patients was vestibular disturbance in the form of rotatory type of vertigo which lasted for a few seconds. These symptoms were followed by abnormal movements of limb and loss of consciousness (LOC) in six patients. The patients who experienced a LOC had cardiology workup. Electronystagmogram was abnormal in three patients, while magnetic resonance imaging showed an abnormality in three patients. All patients were started on anticonvulsant drugs and showed a good response to treatment. Conclusion: Vestibular epilepsy is a rare but treatable cause of transient dizziness. The diagnosis of vestibular epilepsy is often missed or delayed and should be considered when brief episodic spontaneous vertigo occurs with LOC and unresponsive to standard vestibular treatment. Treatment with anticonvulsants seems to give relief of symptoms.

Efficacy of medical grade manuka honey in acute otitis externa: A pilot study Amit Kumar, Shweta Mittal, Amit Kumar Tyagi, Hano Romesh, Saurabh Varshney, Manu Malhotra Indian Journal of Otology 2020 26(3):151-154 Introduction: Manuka honey has been used in chronic diabetic ulcers and traumatic wounds. We have used Manuka honey in cases of otitis externa because of its antibacterial and anti-inflammatory properties. Objectives: The objective was to study the efficacy of topical applications of Manuka honey in the patients of acute otitis externa. Materials and Methods: Patients with acute otitis externa without any prior ear complaint or intervention were selected for the study after informed and written consent. All patients selected for the study were packed with Manuka honey-impregnated umbilical tape and pain scores; canal wall edema was recorded on days 0, 1, 3, and 7. Results: A total of 20 patients were included in our study. Twenty patients followed us on day 1, 15 patients on day 3, and seven patients followed us till day 7. The mean pain score for day 0 was 5.35, and the mean pain score decreased to 2.95 on day 1, and the difference was statistically significant. Conclusion: Manuka honey appears to be an effective therapeutic agent in the management of otitis externa.

Effect of middle ear surgery on taste in patients with chronic otitis media Vijin Ravindran, Deviprasad Shetty, K S Gangadhara Somayaji Indian Journal of Otology 2020 26(3):155-158 Objective: The objective was to identify the gustatory changes in patients with chronic otitis media due to chorda tympani nerve involvement and to identify the gustatory changes with minimal manipulation, stretching, and cutting of the nerve during surgery and its postoperative recovery. Methodology: A total of 100 patients were selected. Clinical assay, with tests based on “taste strips” with different concentrations of salt, sweet, bitter, and sour, was done preoperatively. The taste strips used were sodium chloride for salt, sucrose for sweet, quinine sulfate for bitter, and citric acid for sour. The same was tested postoperatively after 1 week, 1 month, and 6 months. Analysis: Of the total 100 patients, 22 patients had squamosal disease, and the remaining 78 patients had mucosal disease. Fourteen patients were found to have taste changes preoperatively, of whom nine recovered their taste 1 week following surgery. Remaining five patients recovered at 1 month following the surgery. It was also observed that, in all the 25 patients where the nerve was cut, postoperative changes were noted, which recovered completely at the end of 6 months, except in two patients. In patients where the nerve was stretched, patients showed more gustatory alterations when compared with patients where the nerve was minimally manipulated. Conclusion: We conclude from our study that cutting the nerve produced less gustatory alterations, when compared with patients where the nerve was stretched. We also concluded that chronic inflammation of the middle ear itself can cause gustatory alterations, and these changes recovered once the disease was cleared.

Assessment of vestibulotoxicity of neem leaf (Azadirachta indica) in a rat animal model Rosdan Salim, Mohd Khairi Md Daud, Maithrea Suresh Narayanan, Aziah Ab Rani Indian Journal of Otology 2020 26(3):159-162 Introduction: Otomycosis is a challenging and frustrating entity for both patients and otolaryngologists for it frequently requires long-term treatment and follow-up, yet the recurrence rate remains high. The management is directed toward intense aural toileting with administration of topical antifungals. There has been increased resistance to classical antifungal agents, typically involving the azoles and polyenes. This has led into the research of medicinal plants as an alternative treatment for treating fungal infections. Objective: This study aims to investigate the possible vestibulotoxic effects of neem leaf (Azadirachta indica), a commonly used home remedy on the inner ear in a rat animal model. Methodology: Twenty healthy, mature Wistar albino rats were divided into three groups: Groups A (eight animals), B (eight animals), and C (four animals). They underwent baseline vestibular parameter testing, following which an endoscopic-guided transtympanic instillation of aqueous and alcohol neem extract was performed into the right middle ear of the rats in Groups A and B, while normal saline was instilled into the right middle ear of rats in Group C. Vestibular parameter testing was repeated on the rats in both groups post instillation of transtympanic neem at 4-h, 24-h, 48-h, 72-h, 1-week, 2-week, and 3-week intervals. Results: There was no deterioration in all vestibular parameters recorded post instillation of neem extract within the middle ear. Conclusion: Neem extract is a safe alternative in the treatment of otomycosis in the presence of tympanic membrane perforation as it poses no vestibulotoxic side effects.

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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,

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