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Background: Currently preoperative magnetic resonance imaging (MRI) brain and High-Resolution Computed Tomography (HRCT) scanning of temporal bones form part of routine Cochlear implantation (CI) assessment. Pre- operative imaging demonstrates anatomic details or anomalies if any, that prove essential in pre-surgical evaluation of patients. These form a road map for the surgeon to anticipate any difficulty during surgery, to aid in decision making to implant the most appropriate ear, plan surgical technique, or select electrode arrays. Methods: A descriptive observational pilot study was conducted at tertiary care hospital involving 51 paediatric patients worked-up for CI. Patients after detailed clinical evaluation and MRI Brain, a tentative surgical plan was formulated by a candidacy CI screening committee. Patients selected for surgery underwent HRCT temporal bones and surgical plan was modified after analysing the same. Percentage of cases in which surgical plan changed (in terms of laterality of surgery) after correlating with HRCT findings were determined and data analysed. Results: A total of 51 patients worked up for CI were included in the study. In 37.3% cases, there were unfavourable MRI findings. HRCT scan was used to aid the surgical road map in these patients, which based on MRI findings would have had suboptimal outcome. Conclusion: With this understanding, we recommend that, MRI with precise interpretation would be sufficient to furnish all necessary information in preoperative assessment of CI patients, and a HRCT temporal bones maybe indicated only in difficult cases or those with unfavourable MRI findings, may aid predict surgical events.
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Aim and Objectives: This study is designed to compare the Intra Operative Neural Response Telemetry (NRT) results with Post-Operative NRT results of the cochlear implanted children, to assess the importance of Intra Operative NRT thresholds in device activation and/or switch on of the audio processor and to evaluate the importance of Intra and post operative AutoNRT results in predicting behavioural thresholds during mapping of prelingual Cochlear Implanted children. Materials and methods: A total of thirty (30) children (16 boys, 14 girls) with congenital Bilateral (B/L) severe to profound Sensorineural hearing loss (SNHL) were included in this study. Children between the age range of 12 to 60 months were participated in this study. All the participants were implanted with Nucleus 24 cochlear implant system. In each patient, the intra operative NRT-thresholds were measured for all 22 active electrodes. Then Intra Operative NRT thresholds were correlated with Post-Operative NRT thresholds at the time of switch on and the behavioural map after six months of switch on of the device (Audio Processor). Results: There is a significant enhancement observed in thresholds of postoperative NRT responses which were raised or absent during intraoperative session. There is a gain in NRT thresholds marked after 6 months of postoperative follow up in comparison with first measurement at the time of Switch On of the device but the change not that significant. During postoperative mapping, there was a significant positive correlation noticed between neural response telemetry level measurements and behavioural threshold level. Conclusion: Absent or elevated NRT responses during intraoperative testing for some electrodes especially basal electrodes does not mean that electrode is out of order or outside the cochlea, because an improvement in NRT thresholds usually occurs postoperatively. In case of children with congenital B/L severe to profound SNHL, the NRT values have a very useful role in predicting the behavioural thresholds. Combination of NRT values with behavioural thresholds and observations of Auditory Verbal Therapist can help in providing best suitable Map to the recipient. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-022-03284-x.
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This study was done to study the effect of Tinnitus Retraining Therapy (TRT) in Bilateral Normal Hearing Individual with subjective tinnitus and to evaluate the success of simplified TRT with relation to duration of tinnitus, the patient's age and state of mind. As on date there is no definite cure available for tinnitus, so current TRT focuses on reducing the impact of tinnitus on the patient's quality of life. This study included total fifty (50) participants with bilateral normal hearing sensitivity, who had reported to the department of ENT with a complaint of tinnitus in one or both ears. All the participants are active serving military personnel and their dependents of Indian Armed Forces. All the participants had undergone basic audiological test batteries to assess the hearing acuity followed by TRT and its components (TRT counselling and sound therapy) in randomized manner. Audiological test batteries include pure tone audiometry to make sure that the participants have normal hearing acuity in both the ears and then tinnitus matching i.e. pitch and loudness match and measurement of Uncomfortable Level (UCL) followed by sound therapy and counselling. There was significant improvement reported in impact of tinnitus after completion of six (06) months of TRT schedule. Amongst the participants, 40% reported with complete relief from tinnitus, 30% reported with remarkable benefit but they can still perceive the tinnitus, 20% reported with no benefit with TRT and rest of the 10% were not able to tell whether they have got any benefit or not. Normal hearing individual with tinnitus can be benefitted with TRT accompanied with counselling and the improvement in impact of tinnitus severity that ensued over six months of TRT appear to be vigorous with significant clinical outcomes.
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This study was done to identify the effect that environmental noises have on consonant perception of individuals with normal hearing sensitivity. The objectives were to find out the effect of white noise and environmental noises on consonant identification and to find the effect of noises on consonant features. Adult with normal hearing in both ears whose mother tongue was Odia were included. Initially the participants underwent pure tone audiometry, speech audiometry, immittance audiometry to confirm their normal hearing, good speech identification scores and normal middle ear function. For consonant identification test, the presentation level was 40 dB sensation level with reference to speech recognition threshold for all subjects. Consonant identification test was carried out in white noise and real environmental noises (traffic noise, classroom noise, park noise, restaurant noise) at 0 dB signal to noise ratio (SNR) and at + 5 dB (SNR). The results showed that at + 5 dB SNR condition all subjects were able to get 80% and above consonant identification (CI) scores irrespective of type of noise used for stimulus while at 0 dB SNR, the mean scores ranged from 75.5% (restaurant noise) to 84% (traffic noise). At + 5 dB SNR only in restaurant noise the CI scores were low as compared to those in white noise. At 0 dB SNR, the scores were low for both the test conditions of park noise and that of restaurant noise. Different types of noisy environments can affect consonant perception which can affect speech intelligibility.
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This study was done to measure the outcomes of hearing aid (HA) and cochlear implantation (CI) in case of congenital non syndromic severe to profound sensorineural hearing loss (SNHL) by using aided audiometry (AA), categories of auditory perception (CAP) score and speech intelligibility rating (SIR) scale. The objectives were to find out the effective management options available for bilateral severe to profound SNHL, to study the impact of age of CI on language development and to study the outcome of HA and CI. Patients with congenital severe to profound SNHL were included in the study. Initially the case history of the participants was taken then they underwent audiological tests to confirm hearing loss. To assess the outcomes of HA and CI, they were initially fitted with high gain digital behind the ear HA, then underwent auditory verbal therapy for twelve months, after that AA, CAP and SIR test done to measure the outcomes of HA and similar hierarchy followed for CI. The results showed that with HA, the benefit is very limited whereas with CI the benefit is significant. The average SIR score of HA and CI are 1 and 3.16 and average CAP score are 0.83 and 7.8 respectively. The study shows that the CI is one of the most effective management options available for severe to profound SNHL and found that early intervention followed by early detection of hearing loss helps in achieving better speech and language skills.
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This study was done to evaluate the incidence of otitis media with effusion (OME) in cases of head and neck malignancies who undergo irradiation, excluding nasopharyngeal malignancies. This prospective observational study was done at a tertiary care hospital. Adult patients of head and neck malignancies treated with radiotherapy (RT) with or without concurrent chemotherapy as definitive or adjuvant therapy from September 2017 to August 2018 were included. Cases of nasopharyngeal malignancies and cases of malignancies of other sites extending to nasopharynx causing mechanical obstruction to ET were excluded. The otoscopy, tympanometry and pure tone audiometry findings of these patients were recorded pre RT, immediately after completion of RT and at 6 months post RT. The pre and post RT data were analysed to determine the incidence of OME. 39.3% of ears had retracted tympanic membrane (TM) and 7.1% had air-fluid levels in middle ear at first follow up (FFU). At second follow up (SFU), 13% of ears continued to have retracted TM while none had air-fluid levels. At FFU, 23.2% of ears had 'B' curve on tympanometry, indicative of OME while 19.6% of ears had 'C' curve, indicative of Eustachian tube (ET) dysfunction. At SFU, 1.8% had B curve while 14.3% had C curve, indicating improvement in ET function as compared to that at FFU. There is a considerable percentage of non-nasopharyngeal head and neck malignancy cases who develop OME post RT, however, in most of them it resolves spontaneously.
