An International Journal of Otorhinolaryngology Clinics

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2022 | January-April | Volume 14 | Issue 1

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Editors’ Speak

Bachi T Hathiram, Vicky S Khattar


[Year:2022] [Month:January-April] [Volume:14] [Number:1] [Pages:1] [Pages No:00 - 00]

   DOI: 10.5005/aijoc-14-1-iv  |  Open Access |  How to cite  | 



Sergul Ulus, Eyup Baz, Bulent Evren Erkul, Ibrahim Engin Cekin

Principles in Malignant Otitis Externa

[Year:2022] [Month:January-April] [Volume:14] [Number:1] [Pages:6] [Pages No:1 - 6]

Keywords: Malignant otitis externa, Mastoidectomy, Necrotizing otitis externa

   DOI: 10.5005/jp-journals-10003-1415  |  Open Access |  How to cite  | 


Objective: Malignant otitis externa (MOE) is a serious and recalcitrant disease with its morbidity and mortality. This infection and inflammation can spread easily and attack cranial nerves (CNs) and the skull base, even though it starts with simple otitis externa. Methods: This retrospective observational study agglomerates 10 MOE cases, including their diagnosis, follow-up, and treatment. Results: Otalgia that especially increases at night was the most common symptom. Diabetes was present in all patients. Seven cases had associated facial palsy. Half of the patients underwent mastoidectomy. Six patients were cured of MOE. Conclusion: Management of diabetes is the first step of the treatment. In our study, we could not demonstrate the contribution of mastoidectomy to the outcome. Resolution of cranial neuropathy is associated with good prognostic signs.



Swati Suneha, Mukesh Kumar, Kranti Bhavana

Clinical and Sociodemographic Profiles of Patients with Chronic Otitis Media Seeking Health Care at a Tertiary Care Center of Bihar: A Prescription-based Analysis

[Year:2022] [Month:January-April] [Volume:14] [Number:1] [Pages:5] [Pages No:7 - 11]

Keywords: Chronic otitis media (COM), Prescription pattern, Prevalence study

   DOI: 10.5005/jp-journals-10003-1419  |  Open Access |  How to cite  | 


Objective: To determine the clinical and sociodemographic characteristics of patients with chronic otitis media (COM) at the Department of Otorhinolaryngology, AIIMS, Patna. To deduce the pattern of treatment provided to these patients at this center. Materials and methods: A cross-sectional observational study was conducted on patients with COM visiting the outpatient department of Otorhinolaryngology, AIIMS, Patna, Bihar, for a period of 6 months (i.e., September 2019 to February 2020). Outpatient prescriptions were collected, and data were recorded and analyzed. Results were interpreted pictorially and through analysis tables. Chi-square test was applied to test the relationship between routes of different antibiotics administration used in the prescriptions. Results: COM was highly prevalent in males (54.29%), 16- to 40-year age-group (64.76%), and poor to middle-class strata (90.48%). Most cases were unilateral (63.33%) and of COM mucosal subtype (64.76%). Infection (64.28%) and residual/reperforation (24.29%) were major etiological factors. Concomitant sinonasal allergy was present in 69.05% of the patients. The most common symptoms were ear discharge (77.62%) and hearing loss (75.71%). All patients were prescribed antimicrobial-steroid ear drops. Additional drugs prescribed were systemic antibiotics (64%), antihistamines (79.52%), nasal decongestants (70.95%), non-steroidal anti-inflammatory drugs (NSAIDs) (49.05%), and systemic steroids (20.48%). Beta-lactam antibiotics (52%) and cephalosporins (22%) were the most frequently prescribed. The frequency of use of topical along with oral antibiotics was highly significant (p <0.0001) compared to topical with intravenous antibiotics or topical drugs alone. Conclusion: The study revealed middle-aged males of poor or middle-class socioeconomy forming the majority of patients seeking health care for COM. These patients mostly presented with ear discharge after underlying ear infection that led to a significant hearing loss too. Therefore, topical therapy along with oral antibiotics was the most frequently prescribed on an outpatient basis for prevention and cure.



Inmaculada Moreno, Antonio Belinchon

Safety of Intratympanic Dexamethasone to Treat Inner Ear Diseases

[Year:2022] [Month:January-April] [Volume:14] [Number:1] [Pages:5] [Pages No:12 - 16]

Keywords: Corticoids, Dexamethasone, Intratympanic treatment, Safety, Hypoacusis

   DOI: 10.5005/jp-journals-10003-1425  |  Open Access |  How to cite  | 


Introduction: Corticoids are often used in medicine, mainly for their anti-inflammatory properties. Although their action in the inner ear is not well known, they are employed to treat diseases like sudden hypoacusis or Ménière's disease with good results. Nowadays, the intratympanic (IT) delivery is frequently used as a treatment strategy to reduce the systemic secondary effects of corticoids. Administering IT dexamethasone (DXM) is considered a safe treatment and does not alter the hearing function. Objective: Demonstrate the safety of IT dexamethasone treatment at high doses over long periods. Materials and method: This study forms part of a clinical trial. The sample comprises a group of patients with neoplastic disease, managed by using cisplatin. The treatment protocol consists in applying a daily IT dexamethasone dose of 8 mg/24 hour for the time that chemotherapy treatment lasts. The auditory threshold was evaluated by tone audiometry. A basal examination was performed and, before each cisplatin cycle, both treated ears and control contralateral ears were explored. Results: Twenty-three patients were recruited with a mean age of 60 years. The mean IT dexamethasone treatment time, with a daily administered dose of 8 mg/mL, was 8.3 weeks, within a 2- to 18-week range and a median of 8 weeks. At the end of IT dexamethasone treatment, the difference between the mean auditory threshold between the treated and the control ears did not exceed 10 dB, which was considered to be clinically significant. Discussion: The safety of IT treatment with corticoids has been demonstrated in experimental studies with animals, in which hearing did not become worse. In the works performed with patients diagnosed with sudden hypoacusis or Ménière's disease and treated with IT dexamethasone, the incidence of hypoacusis related to treatment was very low, although the typical characteristics of these pathologies may have influenced the results (fluctuating hypoacusis or spontaneous improvement). The data obtained in our study about previously healthy ears showed no significant hearing alterations in the ears treated with IT dexamethasone, even after maintaining treatment for longer periods and at higher doses than those of previously published works. Conclusion: Using high doses of IT dexamethasone treatment for long periods does not lead to significant clinical hearing alterations in humans.


Original Article

Debayan Dey, C Shilpa, S Sandeep, Manjunath S Shetty

Early Detection of Dwindling Cochlear Sensitivity in Patients with Chronic Kidney Disease

[Year:2022] [Month:January-April] [Volume:14] [Number:1] [Pages:5] [Pages No:17 - 21]

Keywords: Chronic kidney disease, Distortion product otoacoustic emissions, Hearing loss, Pure-tone audiometry, Sensorineural hearing loss

   DOI: 10.5005/jp-journals-10003-1423  |  Open Access |  How to cite  | 


Introduction: Chronic kidney disease (CKD) is a recognized global public health issue. The burden of CKD is even greater in developing countries like India as compared to developed countries. CKD affects multiple organ systems, including the auditory system. The cochlea and kidney also share certain anatomical resemblance at an electron microscopic level and similar antigens. Materials and methods: A cross-sectional observational study with sixty CKD patients and 20 age-matched controls to establish a relationship between stage 3, stage 4, and stage 5 of CKD and degree of hearing loss. These patients underwent a complete clinical evaluation, including blood investigation and audiometry, and categorized into stages 3, 4, and 5 of CKD based on estimated glomerular filtration rate values and compared to the control group. Results: The most common etiology identified was hypertensive CKD affecting 42 cases. Tinnitus was the most common symptom. The pure-tone audiometry (PTA) findings of both ears showed increased hearing thresholds in CKD patients as opposed to the control group. As the disease progressed from stage 3 to stage 5, the hearing loss also increased across all frequency. A significant correlation between duration of disease and mean PTA of patients was noted in our study. As the disease progressed from stage 3 to stage 5, distortion-product otoacoustic emissions (DPOAE) sound noise ratio values in both ears decreased, indicating cochlear hypofunctionality across all frequencies. Conclusion: We suggest a routine DPOAE evaluation at least once in 6 months for patients who are newly diagnosed or are receiving treatment for CKD to pick up outer hair cell abnormality early.


Original Article

Yojana Sharma, Girish Mishra, Deepanjali A Mahida

Effect on Hearing due to Amplified Music Exposure

[Year:2022] [Month:January-April] [Volume:14] [Number:1] [Pages:4] [Pages No:22 - 25]

Keywords: Hearing loss, Music-listening habit, Personal listening device, Pure-tone audiometry

   DOI: 10.5005/jp-journals-10003-1424  |  Open Access |  How to cite  | 


Introduction: Recently with technology boom, the prevalence of mobile phones and listening to music with earphones/headphones has increased in young adults. This study will help us to understand music-listening habit in Indian population and correlate with hearing loss with their music-listening habit. Methods: This is an observational study including 100 participants who underwent self-filled questionnaire regarding their music-listening habits. Pure-tone audiometry was conducted on them. Their hearing loss was correlated with duration of usage, volume, and type of transducer using Fischer's test. Results: Out of 100 participants, 61% were males and 39% were females, all of 18–25 age-group. In the type of devices, earphones, headphones, and speaker were used by 82, 10, and 8%, respectively. Hearing loss was present in 41%. Bilateral mixed hearing loss was in 59.2%. Isolated right and left side sensorineural loss was 7 and 5, respectively. Out of 100 participants, 31 were considered exposed, out of which 71% developed mild hearing loss, which was statistically significant (p-value <0.001), and 65.8% had bilateral hearing loss. Isolated right-sided and isolated left-sided hearing loss was present in 19.5% and 14.6% of participants, respectively. Conclusion: Listening to music with personal listening device that causes hearing loss is a known fact. A significant number of participants had bilateral hearing loss. Sensorineural hearing loss (SNHL) is the commonest form of hearing loss due to amplified music exposure. Listening to amplified music for more than 2 hours, every day, and for more than 2 years was significantly associated with hearing loss.


Original Article

Afshan J Shaikh, Samir V Joshi, Rahul A Telang, Sanjaykumar L Sonawale, Rahul T Thakur

Have We Found an Ideal Grafting Material for Tympanoplasty? Cartilage Island Graft!

[Year:2022] [Month:January-April] [Volume:14] [Number:1] [Pages:5] [Pages No:26 - 30]

Keywords: Cartilage, Grafts, Island, Methods, Trends, Tympanoplasty

   DOI: 10.5005/jp-journals-10003-1417  |  Open Access |  How to cite  | 


The study was carried out to find out the ideal graft material by comparing the audiological outcome after tympanoplasty by using three different types of grafts: tragal cartilage, temporalis fascia, and cartilage island. The study included ninety patients, 30 in each group of tympanoplasty using temporalis fascia, tragal cartilage, and cartilage island by underlay technique. The patients were followed up for a period of 6 months, and hearing outcomes were compared by using pure-tone audiometry. The outcomes were analyzed in terms of residual perforation (graft uptake) and preoperative and postoperative hearing air–bone gap. Using statistical analysis, the cartilage island graft was found to be far superior to temporalis fascia and tragal cartilage grafts. The hearing outcome was improved in all groups but was statistically significant in the cartilage island group when compared to both the other groups (p <0.001). Hearing results of temporalis tympanoplasty and tragal cartilage tympanoplasty were similar and statistically insignificant (p = 1). Graft uptake of cartilage island was the best with no failures in our limited series. Graft uptake of temporalis fascia and tragal cartilage were also good, with slightly better results in the temporalis fascia group than in the tragal cartilage graft group (statistically insignificant p = 1). Overall, cartilage island graft is much superior to either the temporalis fascia or the whole cartilage graft as far as both graft uptake and hearing results are concerned. Although it is a more skillful job as far as the technique is concerned, the superior results make it worth following by every otology surgeon.



Divya Gupta, Pankhuri Mittal, Nita Khurana

Cutaneous Horn: A “Seemingly” Innocuous Marvel!!!

[Year:2022] [Month:January-April] [Volume:14] [Number:1] [Pages:2] [Pages No:31 - 32]

Keywords: Cutaneous horn, Ear horn, Skin lesions, Squamous cell carcinoma

   DOI: 10.5005/jp-journals-10003-1414  |  Open Access |  How to cite  | 


Cutaneous horns are uncommon keratotic lesions. We report a cutaneous horn in conchal portion of the ear which turned out to be carcinomatous on histology. This case report highlights the malignant potential of such lesions and hence, the necessity to assess them histologically for complete treatment.



Bharathi Murundi Basavaraj, Rakesh Bambore Suryanarayan Rao, Thanzeem Unisa, Sriram Madhan, Kavya Sivapuram

A Rare Case of Middle Ear Mucormycosis Presenting with Facial Nerve Palsy

[Year:2022] [Month:January-April] [Volume:14] [Number:1] [Pages:3] [Pages No:33 - 35]

Keywords: Amphotericin B, Facial palsy, Middle ear, Mucormycosis

   DOI: 10.5005/jp-journals-10003-1416  |  Open Access |  How to cite  | 


Introduction: Mucormycosis is an uncommon emerging fungal infection with high morbidity and mortality among diabetic and immunocompromised patients. The most common clinical manifestation is rhino-orbito-cerebral mucormycosis. Occurrence of middle ear mucormycosis with facial palsy is very rare. Case description: We report a case of a 59-year-old male patient who was presented with ear pain, ear discharge, and facial asymmetry. On clinical examination House-Brackman grade IV facial nerve palsy was noted and otoendoscopy showed external auditory canal edema, subtotal tympanic membrane perforation, necrotic malleus, lenticular process erosion with pale granulation tissue in anterior epitympanum. High resolution computed tomography (HRCT) temporal bone revealed soft tissue density in middle ear, mastoid, and external auditory canal with mild erosion of tegmen tympani and rarefaction of facial canal at first genu and tympanic segment with thickening and edema of first genu of facial nerve. Based on histopathological diagnosis of mucormycosis, patient was started on liposomal amphotericin B injection and clinical improvement was noted after a total dose of 3500 mg over 16 days. Conclusion: Early diagnosis and treatment with antifungals, glycemic control, and other supportive treatment with regular facial physiotherapy remain the mainstay of management in mucormycosis. Amid an increased number of COVID-19-associated rhino-orbito-cerebral mucormycosis, we report an unusual case of facial nerve palsy secondary to middle ear mucormycosis emphasizing the need for surgeons to have a broad mind to look for fungal infection in patients presenting with above-mentioned complaints and refractory to antibiotics.



Siowping Loong, Sarmad Al-Azzawi

Facial Nerve Palsy due to Temporal Bone Metastases: A Rare Case Report

[Year:2022] [Month:January-April] [Volume:14] [Number:1] [Pages:2] [Pages No:36 - 37]

Keywords: Facial nerve palsy, Temporal bone metastases

   DOI: 10.5005/jp-journals-10003-1420  |  Open Access |  How to cite  | 


Temporal bone as a site of metastasis is uncommon and usually asymptomatic. However, on rare occasions, they may present with facial nerve paralysis. The primary origin of the metastases is commonly the breast and lung and hematogenous spread is frequently the route of spread. A 70-year-old woman with newly diagnosed lung adenocarcinoma presented to our clinic with complaints of left-sided facial weakness. Radiological investigations revealed lytic destructive lesions in the left squamous part of the temporal bone extending and eroding into adjacent mastoid cells. The patient was given low-dose prednisolone planned for chemotherapy. Here, we present a rare case of facial nerve paralysis secondary to temporal bone metastases from a primary lung adenocarcinoma.



Vasanthi Anand, Sandhya Balasubramanyan, Lakshmi Shantharam

Management of Exposed Cochlear Implants: A Report of Two Cases

[Year:2022] [Month:January-April] [Volume:14] [Number:1] [Pages:4] [Pages No:38 - 41]

Keywords: Cochlear implantation, Device exposure, Major complication, Temporalis fascial flap

   DOI: 10.5005/jp-journals-10003-1421  |  Open Access |  How to cite  | 


Aim: There are several major and minor complications experienced by cochlear implant surgeons. Skin flap complication leading to exposure of the device is a major complication and can lead to explantation. In this article, we discuss about two cases where the implants were exposed, and the devices were successfully covered by flap rotation surgery. Background: Two patients experienced major skin flap complication (MSFC) after a trauma and followed by local site hematoma. The receiver stimulator was exposed. The infection was controlled. The exposed receiver-stimulator was covered with temporalis facial flap and scalp rotation. Case description: Case 1: The child had undergone cochlear implantation 2 years prior to presentation. The child had a head injury while playing that resulted in hematoma. It later got infected resulting in wound dehiscence and exposure of the device. Case 2: This implantee developed a small abscess near receiver stimulator 2 months after the surgery. Flap necrosis led to the devise getting exposed. In both the cases, double layer of temporalis fascia and skin flap rotation surgery was done. Conclusion: MSFCs can lead to exposed device. The device can be salvaged by two layers of vascularized temporalis facia with skin flap. This way it is possible to save the device avoiding explantation. Clinical significance: Every cochlear implant surgeon must know how to handle complications. The temporalis fascial graft is a good workhorse for covering the exposed device.



Aldo Messina, Cosimo Galletti, Francesco Gazia, Francesco Ciodaro, Alessandro Corvaia, Davide Piraino, Bruno Galletti

A Phlebectasia of Internal Jugular Vein as a Manifestation of Chronic Cerebrospinal Venous Insufficiency in Meniere Syndrome Patients

[Year:2022] [Month:January-April] [Volume:14] [Number:1] [Pages:5] [Pages No:42 - 46]

Keywords: Chronic cerebrospinal venous insufficiency, Echography, Ectasia, Jugular vein, Meniere disease

   DOI: 10.5005/jp-journals-10003-1422  |  Open Access |  How to cite  | 


Cerebral and ear flow with possible anomalies should cause a chronic cerebrospinal venous insufficiency, analyzed by echo color Doppler ultrasound examination in patients with Meniere disease. The current classification of the International Society for Neurovascular Disease considers the venous anomalous outflow as an endovascular and/or compressive syndrome proposing a corresponding treatment. We present a case of a patient with Meniere disease with phlebectasia of the internal jugular vein, a condition not described in the current classification. Phlebectasia should be a possible mechanism of anomalous venous outflow, giving us the possibility to introduce a new treatment for these patients and reinforcing the concept that echo-Doppler of jugular and vertebral veins should be a routine examination in patients with Meniere disease.


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