ABSTRACT
Background: Noise is excessive, unwanted sound stimulus in the atmosphere produced by extraneous sources resulting in permanent pathological changes in the inner ear, the cochlear nerve and its ganglia. It is one of the constituents of atmospheric pollution. Noise in the vicinity of workplaces is termed as occupational noise trauma which is imminent in workers in certain industries and unavoidable in them, but preventable to some extent. The present study is to measure such audiological threshold values to correlate the pathological changes in the workers with the help of audiometry. The aim of the study is to measure the noise levels in the industry and its effect on hearing capabilities of miners working there with audiological data and to formulate effective preventive measure for them. Methods: Miners from a Hard Rock cutting industry near Kadapa, A.P. are chosen and divided into 2 groups depending upon their work experience between 3 to 14 years. Audiometry is performed to record their Air Conduction thresholds in both ears at all the frequencies, before and after working hours. The data are analyzed and looked for statistical significance. Results: Miners with less than 7 years work experience had smaller temporary threshold shifts compared to miners above 7 years experience. The base level A.C threshold values were higher compared to miners with less than 7 years experience. The threshold shift was mostly observed in the frequency 6000KHZ, in both the ears. The average of mean thresholds of Air Conduction was found to be higher in the higher frequencies. Conclusion: Prolonged exposure to noise levels above 85dB for 8 hours in a day, 6 days per week for 3 to 14 years results in hearing loss due to permanent changes in the inner ear. Higher frequencies are more affected than the lower frequencies with higher base level thresholds. All the frequencies showed temporary threshold shifts ranging from 1.69 to 4.37dB when recorded immediately after the working periods. There was statistical significance observed for all frequencies in both ears for the threshold shifts with a P value less than 0.05.
ABSTRACT
Background: The incidence of Acute Mastoiditis in children has diminished, but it is not uncommon in clinical practice. Clinical presentation includes a history of otorrhea, pain in the ear, post aural swelling, a shift in pinna position and tenderness over the mastoid. The etiology includes acute and chronic suppurative otitis media, trauma and rarely hematogenous infection. Otoscopy is difficult in this age group due to edema of the EAM skin, pain and non-cooperation. Temporal bone CT scan is very useful in evaluating the pathology in the middle ear cleft such as cortical necrosis, Ossicular erosion and Cholesteatoma. Conservative medical management is useful in tiding over the crisis but surgical exploration of middle ear cleft, eradication of the disease and Tympanoplasty alone leads to cure prevents recurrence. The study aimed at analyzing retrospectively clinical and etio-pathological characteristics of pediatric acute mastoiditis and mastoid abscess in 62 children and to plan a strategy for the management in our Hospital. Methods: Retrospective evaluation of the medical records of 62 children aged below 14 years was scrutinized to record demographic data, history, investigations, etiological factors and treatment outcomes to establish a treatment protocol for future adaptation. Results: 62 patient records were taken up in the present study; patients mean age was 9± 2.4 years. In 18 children (29.03%) previous history of CSOM was reported. All children had clear evidence of post-auricular inflammation. Other clinical features like shift in pinna position, otorrhea, fever and otalgia were noted. Increase in WBC count in 69.35% of the cases, anemia with Hb less than 8 gms% was noted in 19 (30.64%) patients. Total cell count more than 11000 was observed in 69.35% of the patients. C T scan temporal bones in the present study showed 11 (17.74%) children showed signs of Cholesteatoma, clouding of mastoid air cells was noted in 17 (27.41%) and 7 (11.29%) children presented intracranial complications. Immediate medical treatment with 3rd generation parenteral Cephalosporins, NSAIDS was initiated. Abscess drainage was done in 18 (29.03%) children. Cortical Mastoidectomy and/or MRM with Tympanoplasty were performed in 39 (62.90%) of the children. Conclusion: Surgical exploration of the middle ear cleft after initial stabilization of the child with medical treatment gave statistical significant cure rate with low recurrence rate. CT scan was significant in accurately diagnosing the mastoid involvement correlated per operatively in 71.79% of CSOM and 100% of ASOM in children undergoing surgical exploration. Surgical approach is required in cases of complications or failure of medical treatment. Watchful clinical monitoring to rule out intracranial complications is always essential in all patients with Acute Mastoiditis.