Evaluation of Contralateral Ear in Unilateral Chronic Otitis Media: Necessary or Not?

Eustachian tube appears to be central to the pathogenesis of all forms of otitis media. The reported frequency of bilateral disease ranges from 27 to 55%. The affected ear may well be the end point of the pathology in the contra lateral ear (CLE). Cross sectional observational study. One hundred patients who had unilateral chronic otitis media (COM) were enrolled in the study. Diseased ear was divided into either mucosal or squamosal type. Otoendoscopy, pure tone audiometry, impedance audiometry and X-ray mastoid (Schuller's view) findings of CLE were noted. Considering all the changes including tympanic membrane, X-ray mastoid, hearing assessment and tympanometry, we found that 70% of patients had alterations in the CLE. Our study was consistent with many previous studies that there was an increased risk of COM in the CLE of unilateral COM.

Association Between Benign Positional Vertigo and Migraine in Indian Population.

Benign positional vertigo (BPV) occurs when freely floating otoconia which are normally attached to the utricular macula, enter the posterior semicircular canal and move under the influence of gravity. It is the most common cause of peripheral vertigo. Migraine is a common headache disorder which is characterized by hemicranial, throbbing pain and may be preceded by aura. The relation between vertigo and migraine is intriguing and in day to day practice, often not clear. 100 diagnosed patients of BPV, aged more than 20 years, were evaluated for presence of headache specifically migraine based on International Headache Classification 3rd Edition, beta version. We also compared the success of epley's manoeuvre in patients having BPV & headache as compared to patients with complaints of vertigo alone. Overall seventy-four patients had successful epley's manoeuver and the rest did not show improvement even after four trials. Thirty-four patients reported headache and migraine was diagnosed in only ten patients. 67.6% of patients with headache had successful epley's maneuver however fifty-one of the 66 patients without headache had successful epley's manoeuver. Prevalence of migraine was only 10% in patients with BPV in our population and we observed that presence of headache does not suggest success or failure of epley's manoeuvre.

Long Term Outcomes of Intratympanic Dexamethasone in Intractable Unilateral Meniere's Disease.

To evaluate the long term effect of Intratympanic dexamethasone in intractable Meniere's disease. 30 patients with refractory Meniere's disease which did not respond to the standard medical management, were treated with Intratympanic dexamethasone injections. Post treatment hearing outcome and dizziness scores were compared with the pretreatment values respectively. The mean dizziness handicap inventory (DHI) score was reduced from 91.58 (range 80-100) to be 31.00 (p = 0.00) at 3 months of treatment. With the successive follow-up periods, the mean DHI scores were reduced to 51.50, 46.6, and 50.90 at the end of, 6, 12, and 24 months (p = 0.04, 0.35, and 0.49 respectively). Again at the end of 24 months, 23.80% of patients were free of vertigo (p = 0.01). No patient had improvement in the hearing (> 10 dB) in any of the follow-up periods and 6.6% demonstrated deterioration in hearing. There were no major intraoperative or postoperative complications detected. Intratympanic injection of steroid is a safe and effective method for treating intractable Meniere's disease. Although short term improvement in the vertigo is well documented, still in 23% of the patients were found to be free of vertigo at even the end of 24 months. There was no significant improvement in hearing noticed, either in short term or in long term.