Evaluating the Incidence of Audiological Derangement in Cases of Thyroid Hormone Imbalance.

Thyroid hormone disorders are both congenital as well as acquired. According to a projection from several studies on thyroid diseases, it has been estimated that about 42 million people in India suffer from various kind of thyroid diseases (1) Thyroid hormone is closely associated with the development of the cognitive functions, thus deficiency of this hormone is said to have effect an overall impact on proper functioning of the body. The normal functioning of the thyroid gland and adequate levels in the blood are Needed for the formation and functioning of the middle ear, inner ear and the central auditory pathway. Thus, congenital hypothyroidism (CH) can be a potential risk factor for hearing impairment (2) if the hormones decrease or are absent during the development of the peripheral and central auditory system structures. This study was undertaken with the objective of studying the pattern of hearing loss in patients who have a deranged thyroid profile. The study was conducted among 50 patients who were known cases of thyroid disorder in the Otorhinolaryngology Department of our institute. The study was hospital based observational clinical study. The patients were subjected to thyroid profile test After this, those who satisfied the inclusion and exclusion criteria and were included, after detailed history and examination, patients were subjected to PTA, hearing loss was classified according to WHO guidelines. The age group of the patients was from 30-55 yrs. with the mean age being 42. On the basis of the t3, t4 and tsh levels, in the current study out of 50 patients,40 were hypothyroid (80%),with male to female ratio of 6:4. On pure tone audiometry, 15 patients had decreased hearing. The other 25 had normal hearing. The incidence of hearing loss in hypothyoroid patients in our study is 37.5%. On analaysis the PTA reports of these patients,9 patients (22.5%) had conductive hearing loss of mild variety, the mean value of hearing loss being 26.2 decibels. 2 (5%) patients had mixed variety of hearing loss, with sensorineural hearing loss at higher frequencies. All the remaining patients had sensorineural type of hearing loss, i.e., 10%. Of the 10 patients, that have hyperthyroidism 8 were female and 2 were male. 3 patients (30%) had hearing loss, all these 3 patients reported hearing losses at high frequencies and had moderate type of sensorineural hearing loss. Conclusion- From our current study, we could see that hearing loss is present in both extremes of thyroid hormone imbalance The dominant variety of hearing loss in thyroid disorder is sensorineural type, because thyroid hormone imbalance affects the inner ear function.

Wet Versus Dry Temporalis Fascia Graft in Type 1 Tympanoplasty: A Randomized Study on Controversy.

Aim-To evaluate and compare the success rate of dry and wet temporalis fascia graft in tympanoplasty type I using an underlay technique and determine the effect of fibroblasts, if any on the success rate. Materials and methods-. STUDY DESIGN: A 3 year prospective, randomized, comparative study between 2019 and 2021. SETTING: Mahatma Gandhi University of Medical Sciences and Technology, Jaipur. SUBJECTS: 100 adult patients of either sex were taken in this study, ranging between 15 and 60 years who fulfilled inclusion and exclusion criteria. These patients were randomly divided into 2 groups of 50 each, one in dry graft and another in wet graft group. METHODS: A comparative analysis was done on the graft placement time, fibroblast count and hearing improvement postoperatively between the two groups. Results- The dry graft and wet graft groups had overall surgical success rates of 86 and 94 per cent, respectively; this finding was not statistically significant. A statistically significant high fibroblast count was observed in wet grafts, but it did not correlate with surgical success. Conclusion- A dry or wet temporalis fascia graft has no influence on the outcome of tympanoplasty type I.

Relation Between Posterior Canal Benign Paroxysmal Positional Vertigo and Vitamin D Deficiency.

The aim of this study is to establish a relationship between vitamin D levels and benign paroxysmal positional vertigo (BPPV) and its recurrence; and to evaluate the remedial effect of vitamin D on BPPV. In a pilot study, 40 patients with clinically diagnosed posterior canal BPPV were evaluated, treated and were followed up for a period of 6 months at ENT Department of Mahatma Gandhi Medical College, Jaipur. All the patients with clinical diagnosis of posterior canal BPPV were tested for 25(OH)D levels at their 1st visit. Patients were divided in two groups after appropriate matching. Group A was given vitamin D supplementation along with canal repositioning manoeuvre (CRM) and group B were only treated by canal repositioning manoeuvre. Patients underwent neuro-otological assessment during follow up visits and recurrent attacks were recorded. This study was conducted on 40 patients with BPPV (26 females and 14 males). The average age was 50 years. Average serum of 25(OH)D at the first visit was (12.2 ng/ml) for group A, and (12.4 ng/ml) for group B, all patients had low serum level of 25(OH)D (below 20 ng/ml). Recurrent BPPV episodes, were significantly lower in group A than that of group B. We second the hypothesis that the patients with BPPV who have insufficient levels of Vitamin D may benefit from vitamin D supplementation and we suggest further epidemiological and pharmacological studies to detect the effect of vitamin D deficiency on development and recurrence of vertigo.

Is Posterior Nasal Nerve Neurectomy Really a Ray of Hope for the Patients of Allergic Rhinitis.

Allergic rhinitis significantly affects the quality of life, it contributes to missed or unproductive time at school or work, disturbed sleep pattern and day time somnolence. Rhinitis is defined clinically as having two or more symptoms of anterior or posterior rhinorrhoea, sneezing, nasal blockage and/or itching of the nose during two or more consecutive days for more than 1 h on most days (International rhinitis management working group, 1994). Allergic rhinitis is diagnosed when these symptoms are caused by allergen exposure leading to an IgE mediated reaction. Nerve irritation causes sneezing and itching, the loss of mucosal integrity causes causes rhinorrhoea and the vascular engrogment leads to nasal blockage. Medical modalities are symptomatically effective in mild cases, with temporary relief and addressable adverse effects. Prolonged treatment with allergy immunotherapy causes a sustainable financial burden while remaining inaccessible at smaller towns. Posterior nasal nerve neurectomy is short, easy and effective alternative. The basic procedure is to selectively cut nerve bundles at the level of the sphenopalatine foramen (SPF) with a trans nasal approach. By denervating the nasal mucosa one renders it unresponsive to any sorts of allergen or allergic reaction. The aim of the study was to evaluate the outcome of posterior nasal nerve neurectomy in cases of severe allergic rhinitis by assessing its impact on the total nasal symptom score. The study is a hospital based prospective study, conducted on 15 patients who presented to the ENT department of Mahatma Gandhi Hospital from march 2021 to October 2021 (6 months) suffering from allergic rhinitis and did not show any satisfactory improvement even after 1 year of medical treatment. Adult patients in the age group of 20-45 yrs. diagnosed with allergic rhinitis were enrolled into the study after obtaining a due written consent. These included patients having 2 or more symptoms of allergic rhinitis and refractoriness to medical therapy for > 1 year along with significantly affected quality of life and elevated IgE level. Patients with drug induced & hormonal causes of rhinitis, chronic rhinosinusitis and any anatomical feature which precipitates to rhinitis such as deviated nasal septum, hypertrophied turbinates, blocked osteomeatal unit, polypoidal nasal mucosa and sinonasal polyposis were excluded from the study. During our study period from march 2021-September 2021, 15 patients were enrolled in the study. All the patients were followed up at 2nd and 6th month postoperatively. Amongst these patients, there were 11 females (73.34%) and 4 were male (26.67%)The mean age of patients was 35.2 years. Subjective nasal symptoms of all 15 patients improved over the period of 6 months. The mean TNSS improved from 12.067 preoperatively to 8.66 at the end of 2nd month, i.e., 23.1% improvement. By the end of the 6th postoperative month there was a consistent reduction in the tnss, which further reduced to a mean of 3.4 (70.2% reduction) indicating a further improvement in symptoms with time. With the advancement & popularity of endoscopic sinus surgery in the past decade, endoscopic resection of the posterior nasal nerve is emerging as a safe and less invasive technique with long standing results. Medical treatment usually provides mild and symptomatic relief with long duration of treatment period. Thus, PNN is safer, economical & easier alternative to current trend of treatment of allergic rhinitis, proving to be highly efficient in cases of intractable allergic rhinitis.