Attic retraction pockets: Classification system.

INTRODUCTION: Although attic retractions have previously been classified into Grades 0 through IV, it is often not possible to assign attic retraction pockets into a single specific category. The present study describes an improved classification system based on otoscopic and endoscopic visualization of the retraction pocket fundus, the ossicular status in the attic, degree of scutal erosion, and the presence or absence of cholesteatoma. MATERIALS AND METHODS: One hundred and fifty-four patients (200 ears) with different grades of attic retraction pockets who were seen by a tertiary referral otology center between August 2015 and July 2018 were selected for this study. OBSERVATIONS: The new classification system (Grades I, IIa, IIb, IIIa, IIIb, IIIc, IVa, IVb, IVc, and V) was applied to these retraction pockets. Pure tone audiometry was obtained. RESULTS: All attic retraction pockets could be classified precisely using the new classification system. Forty-four of 200 (22%) of ears showed Grade I Attic retraction, 18 ears showed Grade IIa (9%), 14 showed Grade IIb (7%), 28 showed Grade IIIa (14%), 12 showed IIIb (6%), 20 showed Grade IIIc (10%), 16 showed grade IVa (8%), 12 showed grade IVb (6%), 28 showed grade IVc (14%), and eight showed grade V (4%) attic retraction pockets. Grades I, IIa, IIb, IIIa, and IVa had no significant hearing loss. Average hearing loss was 42 dB and 52 dB in Grades IIIb and IIIc, 44 dB and 58 dB in Grades IVb and IVc, and 61 dB in Grade V. LEVEL OF EVIDENCE: 5 Laryngoscope, 130: 2034-2039, 2020.

Sudden sensorineural hearing loss: an otologic emergency.

The study purpose was to determine the efficacy of steroids, volume expanders and antivirals in the management of idiopathic sudden sensory neural hearing loss and to establish importance of early medical intervention. In this prospective study, thirty-four patients presenting with idiopathic sudden hearing loss of 30 db or more were enrolled in study group between 2005 and 2009. Patient variables as they related to recovery were studied and include patient age, time to onset of therapy, status of contralateral ear, presence of diabetes, severity of hearing loss, pattern of hearing loss in audiogram and presence of associated symptoms, (tinnitus, vertigo). Treatment protocol with intravenous hydrocortisone, intravenous dextran and oral anti-viral agent was followed. Pre-treatment and post-treatment pure tone average was analyzed. With combination therapy the overall improvement in pure tone threshold was seen in 27 patients (79.4%). A statistically significant association was found between the time at which medical intervention was started and hearing improvement. Early intervention in patients presenting before 3 days has given 77.8% complete type 1 recovery Idiopathic sudden sensory neural hearing loss is a medical emergency. It should not be misdiagnosed. Early detection and management with volume expanders, steroids and antivirals will improve the chances of complete recovery.

Past, present and future of otology.

Otology deals with hearing and balance and is an important aspect of the special senses of the human system. We are proud to be Otologists since we can restore the hearing of millions of people who have hard of hearing. In the past for several centuries, till the 1960s and 70s, Otology's development was like a flat curve. We have heard of several cases of brain abscess and neurological complications as a sequelae to CSOM. These events are declining.

Bone conduction improvement after surgery for conductive hearing loss.

The objective is to evaluate change in post-operative bone conduction in patients who underwent surgery for conductive/mixed hearing loss due to various reasons. The study design is of retrospective case review and tertiary referral center setting. Five-hundred patients with unilateral conductive/mixed hearing loss were divided into five equal groups (each representing different causes for pre-operative hearing loss), who underwent appropriate surgical correction and had a follow-up audiogram available. The intervention comprises surgery (like myringoplasty and ossiculoplasty with closed or open cavity mastoidectomy for chronic otitis media, stapes mobilization for tympanosclerosis and stapedotomy for otosclerosis) for conductive/mixed hearing loss. Significant improvement or worsening in bone conduction was defined as 15 dB or more improvement or worsening of bone conduction threshold at least in two frequencies between 500 and 4000 Hz. All the other groups also showed a consistent pre-operative bone conduction reduction with an equally consistent improvement in post-operative bone conduction improvement to a varying degree with otosclerosis group having maximum percentage of patients with post-operative bone conduction improvement (60%). The measurement of bone conduction is not necessarily a true reflection of the function of the inner ear. Middle ear makes a contribution to bone conduction and correction of a middle ear conductive lesion causes an apparent improvement in inner ear function. The apparent inner ear hearing loss caused in this way may be reversible to some extent.

Laryngeal schwannomas-case reports with rare presentations.

Schwannomas also known as Neurilemmomas are benign encapsulated, slow growing perineural tumours of Neuro-ectodermal origin that arise from the sheet of schwann cells. Two cases are being presented due to their rarity and in both cases the diagnosis was arrived at after the excision of the tumour.

Comparative study of hearing improvement in type 1 tympanoplasty with and without canalplasty.

INTRODUCTION: Widening of the external auditory canal is canalplasty. It is an intergral part of tympanoplasty, especially in anterior perforations and gives wide surgical access for proper repair. MATERIALS AND METHODS: After elevating tympanomeatal flaps the canal is widened using conical cutting and diamond burrs following which entire tympanic annulus is visible and corresponds to an inverted truncated cone. RESULTS: Canalplasty gives 9 db gain in hearing compared to without canalplasty. CONCLUSION: Canalplasty gives better visualization, better graft placement and better post-operative care.

Comparative study of tympanoplasty in wet perforation v/s totally dry perforation in tubotympanic disease.

In our initial experience the failure rate in totally dry ear Tympanoplasty were more as compared to wet Tympanoplasty. Hence we suspected the avascularity of totally dry tympanic membrane is the cause for such failures. So we did histopathological study of both types of remnant tympanic membrane & compared the finding. According to the results we infer that graft take up rate is better in wet central perforation than totally dry perforation following tympanoplasty, so is the success rate. This also correlates with our clinical experience. We have further seen that such types of failures can he prevented, if(i) the central perforation is converted to subtotal perforation by removing the necrotic portion of the TM, (ii) stabilization of the underlay graft by antero-superior anchoring myringoplasty in which a window in the anterior canal skin is made at about 3 O'clock position in right ear & 9 O'clock position in left ear and the graft is tucked under it.

A safe and reliable technique in the management of preauricular sinus.

Preauricular sinus/pit is a common congenital malformation, which presents as a pit or depression at the anterior margin of the ascending margin of helix, adjacent to helicine crux, or adjacent to the tragus. It is inherited as an autosomal dominant incomplete pattern with variable power of expression. It is due to a defect in the auricular embyrogenesis, which results in the preauricular sinus or pit. It is closely related to the helical cartilage. Using local anaesthesia in adults an elliptical incision is made around the sinus, and extended to the postauricular area. Plane of temporalis fascia identified, skin anterior to the sinus is separated from the underlying soft tissue. The soft tissue between the plane of temporalis fascia and the skin anterior to the sinus is excised along with a piece of adjoining helical cartilage. With this method no recurrences were encountered.

Micro ear surgery-Its purpose and procedure for tubo tympanic pathology.

Hearing is one of the special senses god has bestowed upon human beings. One can really appreciate the value of hearing only when one ceases to hear. Unfortunately, in our country the hearing impaired individuals are ridiculed, where as the visually impaired are sympathized upon. Our country being a developing nation with poor socio-economic status and low environmental surroundings, chronic diseases of the ear account for nearly 5% of the population. One will not be surprised if the statistics reveal five crores chronic ear patients in our country. If this ailment is not corrected, the hardship faced by the patients will be tremendous. Hence, the purpose of ear surgery is to restore normal anatomical and physiological status of the ear, so that the patient leads a comfortable lifestyle. ENT surgeons by performing corrective surgery for chronic suppurative otitis media (CSOM) can change the lifestyles of their patients profoundly. The medical line of management will only lessen the severity of symptoms. With the present modern gadgets coupled with skill acquired by otologist. I will exhort every patient with CSOM to undergo corrective ear surgery as to ensure a healthy and normal life.

A safe and reliable technique in the management of pseudocyst.

Pseudocyst is a benign asymptomatic swelling, which develops in the lateral and anterior aspect of the pinna-scaphoid and triangular fossa. Usually occurs due to defect in the auricular embryogenesis. The paper describes a simple and safe technique carried out in 27 cases. The cartilage is exposed by making a linear incision in the posterior aspect of the pinna and a rectangular piece of cartilage if excised. The wound is then closed with drain in-situ. The patients were monitored for a period of 2 months, during which no recurrence or alteration in shape was noted. Hence, this procedure can replace other modes of treatment.