An International Journal of Otorhinolaryngology Clinics

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2021 | January-April | Volume 13 | Issue 1

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Editors’ Speak

Bachi T Hathiram, Vicky S Khattar

Editors' Speak

[Year:2021] [Month:January-April] [Volume:13] [Number:1] [Pages:1] [Pages No:00 - 00]

   DOI: 10.5005/aijoc-13-1-iv  |  Open Access |  How to cite  | 


Original Article

Mohamed Mostafa, Mohamed Elkahwagi, Ahmed M AbdEl-fattah, Waleed Moneir, Yousef Shabana, Mohamed Ghonim

Role of Ionomeric Bone Cement in Primary Stapedotomy for Otosclerosis

[Year:2021] [Month:January-April] [Volume:13] [Number:1] [Pages:6] [Pages No:1 - 6]

Keywords: Bone cement, Crimping, Long process of incus, Necrosis, Otosclerosis, Revision stapedotomy

   DOI: 10.5005/jp-journals-10003-1362  |  Open Access |  How to cite  | 


Objective: Crimping of the prosthesis in the primary stapedotomy is a controversial step that can have a great impact on the long-term success of the procedure. The study aims to clarify the role of bone cement in primary stapedotomy with an assessment of the postoperative hearing state. Methods: A prospective randomized clinical study including patients with otosclerosis was conducted. The study population was divided into two equal groups. Group A had primary stapedotomy with crimping of the prosthesis while group B had the procedure with bone cement bridging between the prosthesis and a long process of the incus replacing the crimping step. Data of included patients were collected and included gender, age, family history, and audiological parameters. The outcome measurement was the improved hearing status postoperatively as shown by the 1-month postoperative audiogram. The long-term outcome was the stability of the prosthesis that was measured by the 6-month postoperative audiogram. Results: Sixty patients were included in the study. A statistically significant improvement of the hearing state was present in both groups in all frequencies (p <0.05). The difference in postoperative air-bone gap at 2000 Hz between both groups was statistically significant (p <0.05) with better closure in group B. The follow-up period was 1 year postoperatively in all patients. Conclusion: The use of hydroxyapatite bone cement in primary stapedotomy may have a role in providing stability for the procedure decreasing the incidence of recurrent conductive hearing loss in otosclerosis patients. This can provide a substitute for the problems of malcrimping of the prosthesis.


Original Article

Ravneet R Verma, Ravinder Verma

Transcanal Microscopic vs Endoscopic Type I Tympanoplasty in Dry Central Perforation: A Comparative Retrospective Study

[Year:2021] [Month:January-April] [Volume:13] [Number:1] [Pages:4] [Pages No:7 - 10]

Keywords: Endoscopic approach, Microscope, Myringoplasty, Tympanoplasty

   DOI: 10.5005/jp-journals-10003-1364  |  Open Access |  How to cite  | 


Introduction: Type I tympanoplasty or myringoplasty is the repair of the perforated eardrum. Comparisons of microscopic and endoscopic techniques present in the literature use different routes of access and cannot be compared head-on. Objective: To compare endoscopic and microscopic myringoplasty results when both are performed via the transcanal route. Methods: We present a retrospective study done at a single center to compare endoscopic and microscopic type I tympanoplasties both done via the transcanal route. A total of 70 patients, 30 operated with endoscope and 40 with microscope, were included in the analysis. Patients of either sex, between 18 and 60 years of age, with a dry perforation and air-bone gap (ABG) of ≤30 dB, were included. Results: Perforations were completely closed in 93% of the endoscopic group and 92.5% of the microscopic group. The ABG closure was 12.89 dB in endoscopic and 11.97 dB in the microscopic groups. There was no association of the site or size of perforation with failure of surgery. The time taken for surgery was also equivalent. The endoscope had the advantage of avoiding a canaloplasty and looking into the hidden areas of the middle ear. Conclusion: For transcanal, minimally invasive type I tympanoplasty, both techniques provide equivalent results. We recommend the use of an endoscope as the primary or an accessory tool for better visualization.



Supriya M Bhat

Cavity Problems Following Canal Wall Down Mastoidectomy in Chronic Suppurative Otitis Media: Are We Treating Adequately or Making Them Regular Outpatients?

[Year:2021] [Month:January-April] [Volume:13] [Number:1] [Pages:7] [Pages No:11 - 17]

Keywords: Canal wall down mastoidectomy, Cavity problems, Chronic suppurative otitis media, Granulations, Persistent discharge

   DOI: 10.5005/jp-journals-10003-1361  |  Open Access |  How to cite  | 


Aim: To identify and address the postoperative cavity problems following canal wall down mastoidectomy (CWDM) early in chronic suppurative otitis media (CSOM) to minimize the persistent otological problems was the aim of the study. Materials and methods: This was a prospective, observational study to describe the postoperative cavity problems following CWDM in CSOM patients. Results: Of 50 patients, men (54%) outnumbered women. The patients were aged between 6.5 years and 50 years with a mean ± standard deviation of 21.19 ± 10.58 years. Unilateral involvement was frequent (82%). Otorrhea (100%), hearing loss (86%), and perforation of tympanic membrane (84%) were the major findings. The mean duration of otorrhea and hearing loss were 7.57 years (5 days–30 months) and 1.33 years (2 days–7 years), respectively. Bilateral sclerosis (70%) was a remarkable radiological finding. Complications were categorized as extracranial (16%) and intracranial (20%). Intracranial complications included meningitis (03), subdural empyema (02), cerebellar abscess (02), temporal lobe abscess (02), and cerebritis (01). Mastoid abscess (07) and facial nerve palsy (01) were the extracranial complications. Intraoperative complications included cholesteatoma and destruction of incus; The common location of cholesteatoma was the epitympanum (62%) followed by a mastoid bowl (26%). Destruction of the incus either part or as a whole was noted in all. Superficial infection of the cavity, transient discharge, and granulations were the common postoperative complications. Facial nerve involvement after surgery was seen in three. Ninety-eight percent of the postoperative cavities were epithelialized by 6 months. Recurrent discharges from cavity, granulations, and debris were the persistent complications. Conclusion: We reemphasize the need for meticulous surgery (adequately lowered facial ridge, circumferential saucerization, and wide meatoplasty), as multiple factors are responsible for postsurgical cavity problems.



Yasser M Mandour, Mohammed Shendy, Safaa A Ramadan, Ayman A Mohammady, Samer Badae

Vitamin D Level in Children with Secretory Otitis Media

[Year:2021] [Month:January-April] [Volume:13] [Number:1] [Pages:5] [Pages No:18 - 22]

Keywords: Adenoid hypertrophy, Otitis media, Vitamin D

   DOI: 10.5005/jp-journals-10003-1366  |  Open Access |  How to cite  | 


Background: Vitamin D contains anti-inflammatory properties and plays a function in immune system regulation. Multiple investigations have proven the involvement of vitamin D deficiency in respiratory and middle ear infections. Aim: The goal of this study was to see how vitamin D levels in the blood affected the development of secretory otitis media (SOM) and adenoid hypertrophy. Patients and methods: This prospective case-control study included a total of 150 subjects who were divided into two groups; the case group included 100 confirmed cases of SOM and adenoid hypertrophy, and the control group included 50 healthy children. All cases and controls were subjected to complete history taking, thorough ENT examination, and tympanometry. In addition, serum vitamin D was ordered for all subjects. Results: The average age of the study participants was 7.65 years, which was significantly older than the control group (average age, 6.1; p = 0.002). However, there was no significant gender difference between the two groups (p = 1). The commonest season of presentation in the case group was winter (70%), while the remaining cases presented in summer. The season of the presentation was the difference between the two groups, and it was statistically significant (p = 0.017). Vitamin D levels in the cases were considerably lower (11.82 vs 23.72 ng/mL in the control group; p = 0.001). Using a cutoff value of 18.85, vitamin D had sensitivity and specificity of 100 and 90%, respectively, with a diagnostic accuracy of 96.7%. All cases showed hypertrophied adenoids on X-ray and type B tympanometry on tympanogram, while all controls showed normal-sized adenoids in addition to type A tympanogram. Conclusion: Our findings indicate that low vitamin D levels are associated with exudative SOM and enlarged adenoids. Therefore, in children with these symptoms, measuring serum 25 (OH) D levels should be investigated.



Hamizah Ismail, Nik AN Othman, Mohd N Zakaria, Mohd FN Rashid, Noor AA Wahab, Mahamad A Awang

Hearing within the Normal Limit may not Indicate that the Middle Ear is Healthy

[Year:2021] [Month:January-April] [Volume:13] [Number:1] [Pages:3] [Pages No:23 - 25]

Keywords: Air-bone gap, Bone conduction, Conductive hearing loss, Otitis media, Pure tone audiometry

   DOI: 10.5005/jp-journals-10003-1363  |  Open Access |  How to cite  | 


In clinical settings, air conduction (AC) thresholds of pure tone audiometry (PTA) represent the severity of hearing loss. If the AC thresholds are within the normal limit (≤20 dB HL), bone conduction (BC) thresholds are not typically determined. In this case report, the importance of having BC thresholds is highlighted (even though AC thresholds are normal) to achieve an accurate diagnosis.



Sindhu Parthasarathy, Hemanth N Shetty

Noise through Bone Conduction—Differential Diagnosis for the Type of Hearing Loss

[Year:2021] [Month:January-April] [Volume:13] [Number:1] [Pages:3] [Pages No:26 - 28]

Keywords: Bone conduction speech recognition threshold, Mixed hearing loss, Sensorineural acuity level

   DOI: 10.5005/jp-journals-10003-1365  |  Open Access |  How to cite  | 


Aim: The study aims to assess the threshold shift in sensorineural acuity level (SAL) test and bone conduction speech recognition threshold (BC SRT) in mixed and sensorineural hearing loss. Background: The diagnosis of moderate mixed hearing loss and sensorineural hearing loss is unclear when the air-bone gap (ABG) is at 15 to 20 dB. The study was designed to arrive at the accurate diagnosis of moderate mixed hearing loss and sensorineural hearing loss. Case description: The study includes five participants diagnosed with bilateral normal hearing (n = 1), bilateral conductive hearing loss (n = 1), bilateral sensorineural hearing loss (n = 1), and those with bilateral moderate loss with an ABG of 15 to 20 dB (n = 2). Conventional pure tone audiometry, speech audiometry, immittance, reflexes, and distortion product otoacoustic emission were administered. Conclusion: The BCSRT was almost the same in confirmed normal hearing and conductive hearing loss participants because their BC sensitivity was within the normal limit. BCSRT was high in individuals with sensorineural hearing loss and mixed hearing loss. In addition, the amount of threshold shift in SAL was taken into consideration for the diagnosis. Clinical significance: The amount of threshold shift in the SAL test with accompanying BCSRT concludes that the presence and absence of infection in the middle ear thereby lead to an accurate diagnosis.


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