An International Journal of Otorhinolaryngology Clinics

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2017 | September-December | Volume 9 | Issue 3

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Editors’ Speak

Bachi T Hathiram, Vicky S Khattar

Readers’ Special

[Year:2017] [Month:September-December] [Volume:9] [Number:3] [Pages:1] [Pages No:0 - 0]

   DOI: 10.5005/aijoc-9-3-iv  |  Open Access |  How to cite  | 


Original Article

Andrii G Sirko, Volodymyr V Berezniuk, Dmytro M Romanukha

Spontaneous Cerebrospinal Fluid Leak of Posterior Surface of Temporal Bone: Review and Case Report

[Year:2017] [Month:September-December] [Volume:9] [Number:3] [Pages:9] [Pages No:81 - 89]

Keywords: Arachnoid granulations, Posterior cranial fossa, Spontaneous cerebrospinal fluid leaks, Temporal bone

   DOI: 10.5005/jp-journals-10003-1272  |  Open Access |  How to cite  | 


Aim. To analyze the rarity of the clinical case report on spontaneous liquorrhea (SL) posterior cranial fossa (PCF) together with a review of the literature. To determine the features of PCF SL in contrast to anterior and middle cranial fossa (MCF) SL. To identify the optimal diagnostic and treatment tactics in patients with PCF SL. Materials and methods: We present clinical observations of a PCF SL patient and a detailed review of reports on SL with a defect on the posterior border of the petrous temporal bone (PTB). Results: Based on the literature review, 22 cases with a sufficient description were analyzed. PCF SL occurs more commonly in women than in men; middle-aged and elderly patients prevail. The average body mass index (BMI) was 33.3 ± 7, corresponding to a degree I obesity. The number of postoperative complications was quite large; each included recurrent liquorrhea. Conclusion: The data from our experience and a literature review for PCF SL patients are comparable with those of similar studies of SL in the anterior and MCF. Middle-aged and elderly women with excessive BMI are the most vulnerable. In most patients, the defect is located in the lateral regions of the posterior border of the PTB, namely anteriorly, medially from the sigmoid sinus, and below the upper petrosal sinus. A fairly high percentage of postoperative complications is due to insufficient preoperative diagnosis or intraoperative examination of the posterior PTB in patients with combined MCF and PCF defects, causing revision surgery. Clinical significance. If rhinorrhea, otorrhoea, and/or signs of intracranial space integrity loss (pneumocerephaly or latent liquorrhea with recurrent meningitis) are revealed, careful examination of bone structures of the anterior, middle, and also, be sure PCF is required, especially at the intersection with paranasal sinuses (frontal, ethmoidal, sphenoid) and mastoid air cells and PTB.


Original Article

Rahul T Thakur, SL Sonawale, Samir Joshi

A Comparative Study of Myringoplasty Using Temporalis Fascia as a Graft Material by Underlay and Overlay Techniques

[Year:2017] [Month:September-December] [Volume:9] [Number:3] [Pages:3] [Pages No:90 - 92]

Keywords: Myringoplasty, Overlay, Temporalis fascia, Underlay

   DOI: 10.5005/jp-journals-10003-1273  |  Open Access |  How to cite  | 


Introduction: Comparative study of myringoplasty (CSOM) with perforation is one of the common otological condition for which patients seek advice from otorhinolaryngologist. Materials and methods: The study was carried out on patients diagnosed as CSOM in ENT department. Fifty patients were operated for myringoplasty with underlay (25) or overlay (25) technique with temporalis fascia as a graft material. The audiological evaluation was done after 3 months. Results and observation: Total 82% cases showed improvement in hearing. The mean preoperative hearing loss was 35.90 (+8.433 SD), and postoperative was 25.40 (+5.962SD) on paired t-test the differentiating factor was 8.832 and p ≤ 0.001 which is statistically highly significant. Mean improvement in hearing using temporalis fascia and underlay technique was 9.8 dB (+ 7.702 SD) and overlay technique was 11.2db (+ 9.160 SD. Conclusion: On applying paired t-test, the differentiating factor was 0.585 and p = 0.561 which is statistically nonsignificant. Thus underlay and overlay technique of myringoplasty are equally effective.



Mukund D Rahalkar, Anand M Rahalkar, Vardhan S Joshi, Kailash Sant, Kourabhi Zade

Computed Tomography Cisternography for the Management of Cerebrospinal Fluid Fistulae

[Year:2017] [Month:September-December] [Volume:9] [Number:3] [Pages:3] [Pages No:93 - 95]

Keywords: Adenosine deaminase lymphocytes, Ear discharge Microorganism, Sterile cotton swabs

   DOI: 10.5005/jp-journals-10003-1274  |  Open Access |  How to cite  | 


Background: Chronic otitis media (COM) of mucosal type is a chronic condition of middle ear characterised by permanent perforation of tympanic membrane and hearing impairment, which is commonly seen in developing countries due to various factors such as low socioeconomic status, virulence of the organism, poor personal hygiene, increased antibiotic resistance, recurrent episodes of upper respiratory tract infections and inadequate health facilities. So, early and effective measures to be undertaken to prevent possible complications. Aim: To determine whether there is any difference in bacterial isolates in clinically diagnosed chronic otitis media compared with adenosine deaminase enzyme (ADA) level proved chronic otitis media. Materials and methods: Total 80 patients were included in the study selected on a random basis and divided into two groups. Group A consisted of 40 patients diagnosed clinically as chronic otitis media and group B consisted of 40 patients diagnosed as ADA level proved chronic otitis media. The discharge was collected from the middle ear with a sterile cotton swab and sent to the microbiology department immediately for further processing of the sample and to identify the microorganisms. A blood sample is collected from 40 patients of group B to estimate the adenosine deaminase level. Results: We have deciphered that Pseudomonas aeruginosa was the most common bacteria isolated in both the groups. In this study, none of the samples shows mixed growth or anaerobic organisms. Conclusion: From this study, we concluded that the increased level of serum adenosine deaminase can be used as one of the indicative tools in chronic otitis media and its raise indicates the chronicity of the disease. ADA level will be an essential diagnostic tool in identifying the bacterial isolates.



Nalakath K Bashir, Suma Radhakrishnan, Konath A Kumar

Efficacy of Tragal Cartilage Perichondrial Composite Autograft in the Management of Posterosuperior Retraction Pockets

[Year:2017] [Month:September-December] [Volume:9] [Number:3] [Pages:6] [Pages No:96 - 101]

Keywords: Ear cartilage, Retraction pockets, Tragal cartilage perichondrial composite autograft

   DOI: 10.5005/jp-journals-10003-1275  |  Open Access |  How to cite  | 


Chronic middle ear infection is highly prevalent in our country. Retraction pockets elude early detection due to lack of overt symptomatology. The exact etiology of development of retraction pockets is still unknown. But it is certain that faulty middle ear aeration is the primary cause for this clinical entity. This paper is aimed to study the effectiveness of tragal cartilage perichondrial composite autograft in the management of posterosuperior retraction pockets of pars tensa of the tympanic membrane and also to study the predisposing factors responsible for the development of retraction pockets. Eighty-nine ears of 56 patients with retraction of pars tensa were studied. There were 30 males and 26 females; age varies from 6 to 45 with an average of 20 years. Most of the patients in this study had mild or moderate hearing loss. Very few had a severe conductive hearing loss or sensory neural hearing loss. The severity of hearing loss does not bear any relation to the stage of the retraction of the tympanic membrane. Very severe retraction may be associated with mild hearing loss and vice versa. Similarly, the presence or absence of ossicular necrosis does not make any difference in the degree of hearing loss. Out of this 56 patients, 29 underwent surgical management. Twenty-two out of this 29 patients had ossicular necrosis. Twenty-five patients had no recurrence of retraction after the surgery. Even though four patients developed retraction that was only around the cartilage graft and there were no pocket formations, and the retraction was not directly in contact with the ossicles. There was no graft failure as such; that means graft take up was 100 percent. So the study suggested early surgical intervention with cartilage perichondrial composite grafting is a successful technique for management of posterosuperior retraction pockets of pars tensa to safeguard hearing and to prevent possible cholesteatoma formation later.



Alok Rathi, Kamran A Syed, Mayur Suryawanshi

Otological Hemangioma: A Case Report and Literature Review

[Year:2017] [Month:September-December] [Volume:9] [Number:3] [Pages:4] [Pages No:102 - 105]

Keywords: External ear, Hemangioma, Mastoid, Middle ear

   DOI: 10.5005/jp-journals-10003-1276  |  Open Access |  How to cite  | 


Aim: To report a rare case of hemangioma involving external and middle ear. Background: Vascular anomalies are common in head and neck but rarely reported in the ear. Hemangiomas are tumors growing with age. They can cause significant morbidity in the enclosed spaces of the ear. Case report: A 6-year-old boy presented with itching and pain in the right ear on evaluation had a polyp in the external auditory canal. He underwent excision biopsy of the lesion which was reported as hemangioma involving external and middle ear. Conclusion: Otological hemangioma is not much studied. We here report a case of hemangioma involving both external and middle ear, which is sixth such case in the literature. Clinical significance: Knowing the various presentations will help in early diagnosis and appropriate management of these lesions



Purnima Joshi, Rajiv Jain, Priyanko Chakraborty, Sidharth Pradhan, Rakhi Kumari

Mirror Image Pinna: A Rare Case Report

[Year:2017] [Month:September-December] [Volume:9] [Number:3] [Pages:3] [Pages No:106 - 108]

Keywords: Hillocks, Mirror image pinna, Polyotia, Tubercles

   DOI: 10.5005/jp-journals-10003-1277  |  Open Access |  How to cite  | 


Aim: To report a rare congenital anomaly of the external ear. Background: Pinna or the external ear is the branchial apparatus derivative which may be anomalous due to error in embryological development many such anomalies are reported as anotia, microtia, preauricular sinus or cysts, tags, bat ear, etc. double pinna or the mirror image pinna is one such anomaly as others it may or may not be associated with syndromes. Case description: A 9-year-old boy presented with left ear mirror image pinna and right ear preauricular tag had no other complaints. On systemic examination, no abnormality was detected. The patient was advised surgery which was deferred by the patient for time being. Conclusion: Mirror image pinna is a rare congenital malformation which may or may not be associated with any syndromes. Surgical correction is possible which is done usually at age of 5–6 years. Clinical significance: To know the rare congenital malformation, its probable embryological cause, associated features, and its correction.



Gaurav Ashish, Naina Picardo, Mary Kurien

Parry Romberg Syndrome: An Unusual Clinical Diagnosis

[Year:2017] [Month:September-December] [Volume:9] [Number:3] [Pages:3] [Pages No:109 - 111]

Keywords: Blaschko's lines, En coup de sabre, Hemifacial atrophy, Parry Romberg syndrome

   DOI: 10.5005/jp-journals-10003-1278  |  Open Access |  How to cite  | 


Parry Romberg syndrome is a very rare clinical entity, manifested by chronic progressive hemifacial atrophy. The exact pathophysiology is poorly understood; however many hypotheses have been put forward to explain the above condition. It is a self-limiting condition and usually settles down after a few years of active facial resorption. This can clinically overlap with linear scleroderma also known as “en coup de sabre,” which is seen as a diagonal pit in the frontoparietal area. When the active phase is over, various treatment modalities have been employed such as fat, silicone or bone implants and pedicled flaps but with limited success. We present a case of Parry Romberg syndrome with involvement of sagittal sutures of the skull, an association that has been rarely reported. This case is being reported with aim of better understanding of this clinical entity regarding diagnosis and management.


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