Abstract Semicircular canal dehiscence remains one of the rare and least touched chronic vestibular diseases worldwide. Even though microbial, congenital, and genetically determined, as well as mixed characteristics are known to be involved in the pathogenesis of superior semicircular canal dehiscence syndrome (SSCDS), many facets of the pathogenesis of semicircular canal dehiscence syndrome still need to be simplified. Management plan related to pathogenesis has not yet been established. The primary objective of this review is to present and evaluate the etiopathogenesis behind SSCDS. This study is a systematic narrative review. A PubMed search (1970–2022) was performed for studies on epidemiology and pathogenesis of SSCDS. All included articles were categorized according to level of evidence. Five hundred and sixty papers were identified, of which 25 were found to be relevant for this review. SSCDS is a multifactorial disease. There is still no consensus as to what the specific etiology is behind the syndrome. No convincing evidence is available for most associated factors and pathogenesis. Important objectives in research of SSCDS should be achieving consensus about the definition of SSCDS and gaining more in-depth knowledge of the pathogenesis of SSCDS, especially the role of congenital and acquired causes. There is still a need for further well-designed studies on the various etiopathogenesis and management of SSCDS.
The virus's widespread transmission can be linked to par-ticles in the air and droplets, making the use of personal protective equipment (PPE) crucial to preventing viral transmission. 1 Face masks are used to prevent pathogen transmission via droplets and/or aerosols. 2 As a result, N95 respirators and surgical facemasks are widely utilized in medical set-tings across the world. 3 Even traditional respiratory PPE, particularly full-face or partial-face masks, has been shown to diminish voice clarity and, as a result, communication efficiency. 4 Using a face mask reduces the distinctness of both messages: materials intended to reduce pathogen and other airborne particle transmission influence mouth mobility and sound delivery
AbstractBenign paroxysmal positional vertigo (BPPV) is a commonly recognized vestibular disorder which is characterized by brief periods of vertigo and a characteristic nystagmus. The nystagmus is often difficult to appreciate with naked eyes and hence video oculography is a helpful tool. Dizziness Handicap Inventory is an objective way to assess the impact of vertigo on quality of life. Objective Our study here aims at diagnosing undiagnosed, difficult and missed cases of BPPV using video-oculography and managing it with repositioning manoeuvre. This study also aims at measuring Dizziness Handicap Inventory Scores pre and post repositioning manoeuvre. We also observed the association between Vitamin D levels and the occurrence of BPPV. Methods and Materials One hundred and twenty-six patients were enrolled in the age group of 18-70 years. After recognizing patients with BPPV, vertigo evaluation was performed. Those patients with suggestive history and suspicion of multiple canal involvement were taken for video-oculography. Results Forty-four patients were in age group of 50-60 years, having female predominance. 35.71% cases which were missed on clinical examination were correctly diagnosed using video-oculography. The mean pre-intervention DHI was 41.29 ± 15.90 which lowered down to 14.84 ± 11.52 in post-intervention period. The highest DHI scores were seen in multi-canal BPPV involving lateral and posterior semi-circular canals. Conclusion With the help of vide-oculography we could diagnose more cases of anterior and multi canal BPPV which are often missed. Maximum number of participants had insufficient levels of Vitamin-D and in our opinion correcting it would reduce the occurrence and recurrence rate..
Background Universal newborn hearing screening is not yet fully implemented in India at a national level due to many challenges like cost, limited specialist staff, loss to follow-up, and importance of hearing in speech language development. Most often the parents identify and initiate intervention for the child's hearing loss after the critical period of development is over. There is a need to explore the age at which children are detected and identified with hearing loss, fitted with appropriate intervention, and the barriers faced during this process. Method Data was collected from parents of 60 children with hearing loss aged between 2 and 6 years. A questionnaire comprising of 27 items was developed and administered on parents through face-to-face and telephonic interviews. The data was descriptively analyzed to study the parents’ responses. Results The median age at suspicion was 12 months, median age at identification was 18 months, and age at initiation of intervention was 24 months in children with hearing loss between the age range of 2 to 6 years. Financial constraint was reported to be the most common barrier among the others faced by the parents. Conclusion This study highlights the current status of the age at identification and intervention of hearing loss in children in Maharashtra. These findings can help to create awareness regarding the need for early identification and appropriate management in children with hearing loss for development of adequate verbal communication skills.
Abstract Introduction Chronic otitis media (COM) is a common problem affecting 65 to 330 million population worldwide with 50% patients suffering from hearing impairment. In active COM, the usual clinical practice is to wait for the ear to become dry and to consider tympanoplasty with/without cortical mastoidectomy. If cortical mastoidectomy can be avoided without compromising the outcomes, it is desirable. Various prognostic factors have been studied; however, the effect of altitude on the outcome of tympanoplasty has not been commonly studied. High-altitude areas can have poor connectivity and can result in middle ear pressure changes when the patients commute from low-altitude areas. Aim The aim of this article was to assess the surgical outcome in patients undergoing tympanoplasty for active COM mucosal type in comparison to inactive COM mucosal type in a hilly area located at an altitude of 4,757 ft (1,450 m). Objective This article compared the success rate and audiometric improvement in patients undergoing tympanoplasty for active COM mucosal type and inactive COM mucosal type. Materials and Methods This prospective cohort study included 24 patients with 12 patients each in active and inactive groups. At 3 months follow-up, there was significant improvement in all the air conduction threshold frequencies and air bone gap in both the groups. Conclusion The success rate for our tympanoplasties for active and inactive COM performed in a hilly area was 92% and it was comparable to those reported from other centers. Altitude may not negatively affect the outcome of tympanoplasty and that the active ear COM can have similar success rate as inactive COM tympanoplasty.
AbstractIntroduction Benign paroxysmal positional vertigo (BPPV) is characterized by brief but violent attacks of paroxysmal vertigo provoked by certain positions of the head. This study aimed to compare the outcomes of Epley and Semont maneuvers for the relief of vertigo in posterior semicircular canal BPPV.Materials and Methods This was a prospective comparative study conducted in a tertiary referral hospital over 1 year. Among 70 cases of BPPV, 35 were treated with Epley and 35 with Semont maneuver. Follow-up was done at 1 week, 1 month, and 3 months to assess symptomatic improvement using visual analogue scale.Results Out of 70 patients of BPPV, 62 patients responded very well to the maneuvers and got relief from vertigo. Thirty-two patients (91.4%) in the Epley group and 30 (85.7%) patients in the Semont group had a significant improvement post-therapy and the balance was the same in both groups. At 1 month, there was no significant statistical difference in mean visual analogue score (VAS) score between both groups.Conclusion Majority of cases showed symptomatic improvement with both maneuvers. However, patients treated with Epley maneuver showed earlier relief from vertigo than those treated with the Semont maneuver.
Abstract Introduction The prevalence of tinnitus is increasing in younger adult rapidly. It is increasing mainly because of increased daily noise levels due to the unrestrained usage of recreational devices like mobile phones, MP3s, iPods, and other personal stereos. The aim of this study is to describe awareness and experience of tinnitus among younger adult with respect to the existence, cause, effects, and management. Methods A descriptive cross-sectional study was conducted in 205 young adult Nepalese population between the age ranges between 20 and 40 years through online survey mode. Statistical analyses were carried out using SPSS 25.0 software. Data were analyzed using the descriptive statistics. Results Result showed more than half of the participants (59.2%) were aware about the existence of tinnitus; however, only 16.1% of participants were aware about the effect of tinnitus. The incidence of tinnitus was found to be high (11.71%) in Nepalese population. Conclusion Even though most of the participants were found to be aware about existence of tinnitus, most of them were not aware about the effect of tinnitus and its cause. This result has implications for audiologist who are involved in hearing health care program across the various age groups. As per this study, since most of the participants pointed to the Internet as their source of awareness, that could be further tapped on to provide awareness in these age groups.
Abstract Introduction Tinnitus is a sound heard in the ears or head that originates from both external and internal sources. Tinnitus epidemiological data are critical for proper assessment and management of tinnitus sufferers. The study’s goal was to determine the prevalence of tinnitus and its characteristics among middle-aged Indian individuals, as there has been no previous research in this area in India. Methods A descriptive cross-sectional study was performed in 273 Indian adult populations ranging in age from 18 to 60 years old, utilizing a random sampling approach and an online survey mode. The SPSS 25.0 software was used to conduct the statistical analysis. The descriptive statistics were used to assess the data, and the chi-square test was used to see whether there was any correlation between the variables. Results Studies related to tinnitus prevalence show larger variability across countries, which may be due to inconsistent research methods used. Our survey found the prevalence of tinnitus to be 6.7% among the Indian adult population, and most of the participants 76 (76%) reported that their tinnitus is of intermittent nature. In our study, we found that 15% of participants have problem with sleep and none of the participants reported perception of tinnitus in their dreams. Conclusion Tinnitus is the most prevalent otological condition, which may have a great impact on the quality of life of sufferers as well as their family members. As the prevalence of tinnitus is high among adult population, it is very much essential to develop proper assessment and management protocols to help the patient with tinnitus.
Abstract Objective The aim of the study was to evaluate the effects of narrow band level-specific Claus Elberling-Chirp (NB LS CE-Chirp) and LS CE-Chirp stimuli on the amplitudes, latencies, and interpeak latencies in comparison with tone burst (TB) and click. Methods A total of 40 ears (10 males, 10 females; age range: 20–26) individuals who had no complaints related to hearing participated in the study. Differences between click and LS CE-Chirp, frequency-specific (500—1,000—2,000—4,000) TB, and NB LS CE-Chirp were investigated at stimuli intensity of 70 decibel normal hearing loss (dBnHL). Results Absolute latencies were obtained longer in LS CE-Chirp than click stimulus, except wave V. At all frequencies, absolute latencies of I-III-V waves obtained with TB were significantly longer than those obtained with NB LS CE-Chirp. Amplitudes were higher in NB LS CE-Chirp compared to click and TB at all frequencies except 500 Hz. Conclusion The use of NB LS CE-Chirp is advantageous in patient assessment, but the benefit decreases at low frequencies. The differences in latency values of the stimuli should be taken into account in order to make a reliable interpretation of the results.
Abstract Objective The aim of this study was to determine the prevalence and types of inner ear and/or cochlear nerve anomalies in children who are candidates for cochlear implantation. Methods This was a descriptive cross-sectional study with a retrospective review of medical and imaging records performed in a tertiary care children's hospital. All cochlear implants candidates under 15 years old with imaging assessment between January 2019 and December 2021 were concerned. The studied parameters were reason for consultation, risks factors, inner ear malformations (IEMs) classified and stratified by sensorineural hearing loss (SNHL) degree, gender, and age at diagnosis. Results In total, 81 children (162 ears) were included in the study. Abnormalities of the inner ear were found in nine children representing a prevalence of 11.1%. These children were aged between 2 and 14 years. The average age at diagnosis of SNHL was 3.5 years. Seven children had bilateral anomalies and two unilateral anomalies, that is, 16 ears presenting 40 malformations. These included 1 complete labyrinthine aplasia (2.5%), 12 cochlear malformations (30%), 1 common cavity (2.5%), 17 vestibular/squamous cell carcinoma (SCC) malformations (42.5%), and 5 internal auditory canal malformations (12.5%). Three ear out of 16 with abnormalities demonstrated a deficient cochlear nerve. There was an association between IEMs and profound deafness, and age at diagnosis of SNHL less than 2 years. Conclusion This study shows that 11.1% of children with profound deafness have IEMs. SCC malformations and cochlear hypoplasia were the most common. A precise description of these malformations during the imaging assessment is particularly useful for cochlear implantation to better plan this surgery.
Abstract Background Distention of Reissner’s membrane in endolymphatic hydrops is a classical otopathologic finding in cases of Meniere’s disease. A recent double hit analysis raised the possibility that the variability in the distensile behavior in Reissner’s membrane may contribute to the vagaries of membrane pathology encountered in this disease. Such distensile variability is suspected to stem from the viscoelastoplastic behavior of the type IV collagen in Reissner’s basement membrane. Objective To analyze the known distensile characteristics of Reissner’s membrane for evidence of viscoelastoplastic behavior. Methods Extant data on human Reissner’s membrane were analyzed for distensile characteristics. These features were then compared to the known characteristics of viscoelastoplasticity as manifested by polymers in general as well as a variety of collagenous tissues. These tissues included a synthetic collagen membrane as well as selected mammalian tissues. Results The limited extant data on human Reissner’s membrane distensile behavior was found to manifest sigmoid load deformation at a lower strain rate of 0.47%/sec and a rigid rupture pattern at a 10-fold higher strain rate of 5.5%/sec. These characteristics were found to be similar to the general characteristics of polymer viscoelasticity, namely a sigmoid load deformation pattern at lower strain rate that stiffens and straightens as strain rate increases. Tensometric data from a synthetic collagen membrane and selected mammalian tissues were found to exhibit comparable load deformation patterns. These findings support the conclusion that human Reissner’s membrane behaves in a viscoelastoplastic manner. Conclusions Human Reissner’s membrane appears to exhibit viscoelastoplastic behavior comparable to that observed in other collagenous tissues. Such variable distensile behavior provides insight into why the degree of lesion distention before rupture in Meniere’s disease might vary depending on the dynamics of membrane loading and the resultant rate of membrane strain.
Abstract The otolith of vestibular system in the human body helps in maintaining the static balance. Travelling can cause defect in static balance that may lead to motion sickness. The evidence showing the relation between vestibular evoked myogenic potential (VEMP) that assesses otolith function and motion sickness is contrasting. The current systematic review is aimed to understand outcomes of published articles in reporting association between vestibular evoked myogenic in individuals with motion sickness. For this study, the database used is PubMed, Scopus, ProQuest, CINHAL, and Web of Science. The data is extracted from the final articles where VEMP is done on individuals with and without motion sickness. The total articles included are 125 out of which five articles used for the systematic review. In this study, motion sickness susceptibility questionnaire is used to assess individuals with and without motion sickness. The latency and amplitude of both cervical VEMP (cVEMP) and ocular (oVEMP) of individuals with and without motion sickness are normal. However, the review indicates a significant change in the interaural asymmetry ratio of both cVEMP and oVEMP results in individuals with motion sickness. This shows that there might be a variation in the functional asymmetry in the otoliths. From the review, it is clear that there might be otolith changes due to motion sickness that can have a smaller impact on the interaural asymmetry ratio in VEMP. These findings can be further applied for the diagnostic purpose in individuals with motion sickness.
Abstract Objective Hypertension is a condition in which the blood vessels have persistently raised pressure. The damage of the cochlea is due to the loss of sensitive hair cells in the inner ear or the damage to the eighth cranial nerve. When the cochlea is damaged, the functioning abilities such as coding, differentiation, and temporal processing abilities will be affected. Hence, there might be deficits in differential sensitivity in individuals with hypertension. The aim of this article was to study the effect of hypertension on differential sensitivity as there is limited literature in this area. Method Thirty participants were included in the study and classified into two groups: group I as individuals with hypertension and group II as individuals with normal blood pressure in the age range of 25 to 45 years. Psychophysical tests like frequency, intensity, and time discrimination tests were performed using the maximum likelihood procedure (MLP) toolbox, which implements a maximum likelihood procedure for threshold estimation in MATLAB. Results In all the three test conditions, the scores were significantly poorer in individuals with hypertension compared with individuals of the normal at all the frequencies such as 500 Hz, 1,000 Hz, 2,000 Hz, and 4,000 Hz. Conclusion This could be because of reduced frequency selectivity and poor temporal coding as well as due to difficulty responding to rapid change in the envelope of sound over time because of cochlear and neural damage in individuals with hypertension.
Side effects of vaccines in the form of tinnitus and hearing loss are not uncommon. Various reports talk about temporary tinnitus and other audio-vestibular effects after taking different types of vaccination shots such as hepatitis B, H1N1, measles, and rabies.[1]–[3]As the COVID-19 vaccination program continues to be rolled out at pace around the globe, with increasing numbers of people being encouraged to undertake vaccination shots, a similar challenge seems to be on the rising.
Abstract Introduction Chronic otitis media (COM) is an otological challenge in the developing countries as it is a persistent disease causing severe destruction of middle ear with irreversible sequalae. To assess Middle Ear Risk Index (MERI) score and study its prognostic effect in postoperative outcome following mastoidectomy with tympanoplasty. To evaluate MERI score with respect to graft uptake and A-B gap closure. Materials and Methods This prospective study comprised 25 patients suffering from COM who presented to the Department of ENT, HSK Hospital, Bagalkot, over a period of 1 year from November 2020 to November 2021. The patients underwent tympanoplasty with mastoidectomy. MERI 2001 was used in the current study, and risk factors were assessed based on pre- and intra-operative findings to obtain the MERI score. Patients were segregated into those with mild (1–3), moderate (4–7), and severe (8–15) MERI. They were evaluated at 1 month follow-up visit. Results and Conclusion The study reveals the degree to which MERI score can predict the extent of disease and indicate outcome of surgery. In the present study, patients with lower MERI score benefitted more favorably in terms of graft uptake and hearing improvement as compared with success rate of severe MERI score. MERI index is in fact a very reliable predictor of graft uptake and audiological alteration in patients undergoing tympanoplasty with mastoidectomy surgeries for COM.
Abstract Introduction Treatment of Eustachian tube dysfunction has remained an enigma for a long time. Balloon tuboplasty, even though effective, is not considered by many, as it is invasive, expensive, and cumbersome. Hence, we tried to find some simple and inexpensive solution for the same in chronic otitis media. In this background, we evaluated the use of the Eustachian barotubometer to treat obstructive Eustachian tube dysfunction in mucosal chronic otitis media. Materials and Methods The pilot study was undertaken in a tertiary referral hospital with 25 cases and 30 controls. Case group patients were administered Eustachian barotubometer therapy along with ciprofloxacin-dexamethasone ear drops and xylometazoline nasal drops until the recovery or up to 10 days. Control group patients received the same ear and nasal drops along with Valsalva maneuver for the same duration. Results The recovery of the Eustachian tube was categorized as complete, partial, or nil. It was found that the case group had 60 and 32% complete and partial recovery, respectively, while it was 33.33 and 13.33% in the control group. The recovery was faster with Eustachian barotubometer therapy than with the Valsalva maneuver. No complications were observed with the new procedure. Conclusion The Eustachian barotubometer is a simple, inexpensive device that can be used to treat Eustachian tube dysfunction in chronic otitis media. This device is particularly suitable for the peripheral health care centers of developing countries.
Abstract Introduction Presbycusis, or age-related hearing loss being a cumulative effect of aging on hearing, is a progressive and irreversible bilateral symmetrical sensorineural loss. In older individuals, one of the most important structures which undergo changes due to aging is the middle ear. There is a dearth of studies in Indian population regarding the tympanometric characteristics in older individuals. Thus, this study was taken up with an objective to report the different tympanometric characteristics in elderly individuals (aged above 50 years) who reported with ear- or hearing-related complaints to the Department of Audiology, All India Institute of Speech and Hearing, Mysore, Karnataka, India. Materials and Methods A register-based analysis was conducted where immittance tests were performed. Results There was no effect of age on static admittance, ear canal volume, and tympanometric peak pressure values. Also, there was no gender effect on tympanometric findings. Conclusion The result of the present study helps in understanding the different middle ear mechanisms in older adults.
Abstract Introduction Cochlear implant (CI) magnets and surgical techniques (e.g., positioning) have made an impact on the relationship between CI and magnetic resonance imaging (MRI) by solving the problem of pain and artifact. Recent investigations displayed the possibility to evaluate the CI electrode position by MRI in vivo. However, further improved perceptual quality is needed to allow an improved evaluation of the electrode. Aims The aim of this study was to assess a cochlear model for the examination of CI electrode pattern and MRI sequences in vitro. Materials and Methods We investigated CI electrodes in a fluid-filled three-dimensional artificial scala tympani model combined with a fluid package in a 3T MRI scanner. Different high-resolution T2 sequences (0.6–0.2 mm voxel size) were used for the visual electrode pattern evaluation for finding an optimized sequence. Results Artificial models can be used to evaluate MRI characteristics of CI electrodes. In our scanner configuration, a 0.3 mm voxel and 0.9 mm slice thickness sequence showed the best compromise between resolution and scanning time. Conclusion and Significance MRI model-based testing can be performed in vitro to evaluate CI electrodes’ pattern and to optimize sequences. An MRI model is a tool for in vitro testing of MRI sequences and might help for future in vivo applications.
Abstract Aims The burden of chronic otitis media continues to be high, especially in developing countries. The demand for corrective procedure of surgical myringoplasty, which is considered the gold standard for tympanic membrane perforations, is also growing. Hence, there is a need to innovate simpler alternative office procedures that could save effort, time, waiting period, and expenditure. Materials and Methods This prospective study of 84 patients with mucosal chronic otitis media was undertaken in a tertiary referral hospital. All patients underwent eustachian tube function test, diagnostic nasal endoscopy, and pure tone audiometry. The size of the perforation was assessed endoscopically. All perforations were freshened first with silver nitrate solution. Silastic pieces were placed medial and lateral to the perforation with epidermal growth factor gel in between. Patients were followed up for 3 months. Results The perforations were classified into three groups (healed, partially healed, and nonhealed) based on the treatment response at the end of the first and third follow-up months. Completely healed and partially healed perforations were considered as “success” and were found to be 79% in this study. Significant association was found between healing status and type of anesthesia. However, the disease stage, size of perforation, and the duration of procedure did not affect the healing status. Conclusion Silastic enhanced myringoplasty with epidermal growth factor is a simple, effective, and economical procedure that can become an alternative to surgical myringoplasty for chronic otitis media.
Abstract Introduction Human auditory and vestibular systems change due to noise exposure. Professional musicians are often subjected to loud music and longer durations as part of their practice. Although the effects of music have been explored extensively on the auditory system, it is important to understand changes in the vestibular system also. The current study is aimed to compare cervical vestibular evoked myogenic potential (cVEMP) findings in nonmusicians and violinists to understand if there are any changes in the P1 and N1 latencies and absolute amplitudes in the violinists’ groups because of their exposure to violin music. Materials and Methods Twelve participants (6 nonmusicians and 6 violinists) of both genders were included in the study. Pure tone audiometry and distortion product otoacoustic emissions (DPOAEs) were performed on all the participants. cVEMP P1 and N1 latencies and absolute amplitudes were obtained, and overall mean differences were compared within and between groups. Results Pure tone average and DPOAE were within the normal range between and within the groups. Results indicate that P1 and N1 absolute amplitudes and latencies were slightly prolonged in the violinists’ group; however, the mean difference was not statistically significant. Comparison of mean absolute amplitudes and latencies between the ears in the violinists’ group showed longer latencies and greater absolute amplitudes in the left ear of violinists as compared with the right ear. In the study, the violinists’ group consisted of participants who had an average daily exposure of about one-and-a-half hours and had an experience of playing the instrument for more than 5 years. Conclusion cVEMP is useful in detecting early changes in the saccule that may occur due to noise exposure. It can be concluded that, even before a clinically detectable hearing loss or vestibular damage, changes in saccule are observed with the help of cVEMP and should be included in the audiovestibular test for early identification.
