Endolymphatic duct papillary tumour: captured undercover of complicated chronic otitis media.

Endolymphatic sac tumor is a rare invasive benign neoplasm occurring sporadically or in Von Hippel-Lindau disease. This case mimics clinically to a complicated chronic otitis media with left ear discharge and facial weakness with sudden onset headache, vomiting, vertigo.

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.

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.

Use of autogenic and allogenic malleus in tympanic membrane to footplate assembly - long-term results.

The objective of this study was to assess the functional performance and long-term stability of autogenic and allogenic malleus used for ossiculoplasty as tympanic membrane to footplate assembly. A retrospective study of 119 patients who underwent such ossiculoplasty in closed cavity mastoidectomy from 1989-2004 was carried out. There was no extrusion in any of our cases. Serviceable hearing (<20 dB air bone gap closure) was achieved in 24 out of 37 (65%) over long-term follow up of more than 1 year (mean and median for follow up being 37.4 and 30 months respectively). Thus malleus ossicle graft give acceptable long-term hearing results in one of the most difficult ossiculoplasty situations (absence of stapes suprastructure and malleus) with virtually no extrusion problems.

Evaluation of auditory brainstem responses for hearing screening of high-risk infants.

Auditory brainstem responses (ABR) were recorded in 30 normal and 60 high-risk neonates with gestational age between 30 and 45 weeks. The normative data of normal group as regard to age, sex and various parameters of ABR were compared with high-risk group. ABR parameters especially wave V and interwave V-I intervals were significantly prolonged in high-risk infants. An infant was considered to "pass" the ABR test if an identifiable and replicable wave V response was present at 30 dB HL in both ears. All the normal neonates had click thresholds consistent with normal hearing. 12 of the highrisk neonates showed mild to moderate hearing impairment (absent replicable wave V at 30-60 dB HL) and 2 of them showed severe to profound hearing impairment (absent replicable wave V at 70 dB HL). 9 of the "failed" group were reevaluated within 3 months and several times thereafter if the abnormal responses persisted. 2 (3.3%) infants showed persistent hearing loss, which was confirmed later by behavioral audiometry.

Is surgical vestibular ablation necessary in disabling peripheral vertigo?

The use of intratympanic gentamicin is an easily performed office procedure for the conservative treatment of the Meniere's disease patient who has failed medical therapy. The procedure provides excellent control for the symptom of vertigo and is one of the most successful methods in the treatment of vertigo due to inner ear disorders. Surgical ablation is no longer necessary for adequate control of vestibular symptoms and that chemical ablation/alteration may replace the need for surgical vestibular ablation in cases of disabling Meniere's disease and other inner ear causes for peripheral vertigo.

Modified intact canal wall mastoidectomy - long term results in hearing and healing.

INTRODUCTION: The classic intact canal wall (ICW) mastoidectomy with tympanoplasty (combined approach tympanoplasty) [1, 2] has anatomic constraints for clearance of disease from the anterior attic and sinus tympani leading to high recidivism. Farrior [3, 4] described the modification of this technique and senior author (AM) has been using it with further modifications since 1973. MATERIALS AND METHODS: We report our long-term experience in hearing and healing in 126 cases with special reference to the age (pediatric versus adults), ossicle status (presence or absence of stapes suprastructure) and type of cholesteatoma (Attic versus posterior-superior versus secondary acquired cholesteatoma). RESULTS: All the patients had unsafe CSOM and underwent Modified ICW mastoidectomy with primary ossiculoplasty except five where the procedure was staged. CONCLUSION: Modified ICW technique is a one-stage procedure with the lowest recidivism rate when compared to various other ICW techniques. There is no significant difference in relation to age of the patient or type of cholesteatoma if the operative cases are selected judicially.

Surgical management of glomus tympanicum tumor.

Glomus tympanicum tumor (also known as paraganglioma or chemodectoma) is the most benign tumor of temporal bone. Treatment may be palliative or curative. Palliative therapy includes watchful observation or radiotherapy and curative treatment is surgical. During 1995 to 2005, 18 cases of glomus tympanicum were managed at Basavanagudi ENT Care Centre Bangalore. We review retrospectively the diagnosis and surgical management of these cases. Advances in the imaging and refinements in traditional surgery have made correct diagnosis and complete excision of these tumors possible in most of the cases.

Rehabilitation of the tympanomastoid cavity in Canal Wall Down procedures.

During 1980 to 2004, 1602 Canal Wall Down (CWD) procedures was performed of which 978 had primary surgery and 624 were revision cases. We have highlighted various methods for total clearance of disease process from the tympanomastoid area, making of a smooth cavity, augmentation of middle ear space for better functional results, inlay temporalis fascia grafting, ossiculoplasty with live tissue grafts, natural obliteration of the cavity and meatoplasty.Healing of cavity and tympanic membrane (TM) graft was achieved in 1548 (94.2%) of cases. Revision surgery was performed in 32 cases for recurrence or residual cholesteatoma, mostly in the attic and middle ear. Persisting discharge was present in 12 cases. Serviceable hearing (airbone (A-B) gap closure up to 20 dB) was achieved in 1017 (63.5%) cases. Hearing was worse than pre-operative level in 154 (9.6%) cases. There was no improvement in hearing in 397 (24.8%) cases. Serviceable hearing was obtained after second stage ossiculoplasty in 34 (2%) cases.

Transfacial nasal approach to paranasal sinuses, nasopharynx and anterior skull base.

There are different surgical approaches to remove lesion involving the large central lesions of nasal cavity, sinus and nasopharynx with anterior skull base and retromaxillary extension depending on the site extent and the type of tumor. In this paper, we are describing a method that is rhinological and is a direct approach for removal of such lesions in 6 patients.

Reparative granuloma following stapes surgery.

Reparative granuloma of the oval window is an uncommon complication of stapes surgery, which usually develops within one to six weeks after operation and causes a sudden hearing loss and disturbance of balance. We report 2 cases of post-stapedectomy reparative granuloma that developed during the tenure of senior surgeon (AM).

Value of ultrasonography in laryngeal and laryngopharyngeal cancers.

High-resolution sonography has improved in the past few years and has become a very valuable tool in the diagnosis of diseases of the head and neck. Ultrasonography (US) is commonly the first imaging modality after clinical examination. It is inexpensive, noninvasive and is easily tolerated by patients. It provides valuable diagnostic information with a high degree of diagnostic accuracy. This article provides the most up-to-date information about the indications, findings and limitations of high-resolution sonography in the evaluation of laryngeal and laryngopharyngeal cancers.

Can alzheimer's disease and dementias with Lewy bodies be distinguished clinically?

To determine if Alzheimer's disease (AD), its Lewy body (LB) variant (LBV), and diffuse LB disease (DLBD) are distinguishable at initial clinical evaluation, data from autopsy-confirmed AD, LBV, and DLBD were examined. No significant differences were found in age at onset, age at death, total duration of illness, duration of illness before initial visit, duration of illness from initial visit to death, or severity of illness at initial evaluation. Hallucinations and delusions were significantly more frequent for LBV and DLBD, respectively, than for AD, and falls were more frequent for DLBD than for AD. Extrapyramidal symptoms (EPS) were less frequent in neuroleptic-free AD subjects than in LB subjects; the percentage of AD patients with EPS after neuroleptic exposure was less than that among LB patients. Seizures were significantly more common for DLBD than for AD or LBV. LB dementias differed from AD at initial evaluation, with more frequent hallucinations and delusions, EPSs, and seizures, and longitudinally in neuroleptic sensitivity, but the data did not distinguish LBV from DLBD.