Screening of Newborn Hearing at a Tertiary Care Hospital in South India.

Hearing loss can have a devastating impact on the cognitive development and psychological well-being of children and their families. Newborn hearing screening should be given special attention especially in a country like ours where the burden of this disability is heavy. Screening all newborns irrespective of risk factors helps in better detection, and hence further management can be initiated at appropriate time. To implement newborn hearing screening at Vanivilas hospital and to estimate the incidence of hearing loss among the high risk groups. To create awareness about the need for detecting childhood deafness among parents and general population. To develop a centre of excellence for evaluation, intervention and rehabilitation for hearing impaired in a tertiary care hospital. Prospective study. All neonates born in Vanivilas Hospital attached to Bangalore Medical College and Research Institute underwent hearing screening using four stage protocols with otoacoustic emission (OAE) tests and final confirmation with Brainstem evoked response audiometry (BERA) tests. May 2015-May 2017. Number of newborns screened were 26,487, and 19 (0.717/1000) newborns were detected to have hearing impairment. The incidence of hearing loss among high risk group was 0.188/1000, and among the non risk group was 0.528/1000. Newborn hearing screening must be made mandatory and multi-staged protocol based screening for hearing loss should be implemented. This will make newborn screening programme more efficient and also will help in initiating treatment at an early stage so that further damage can be prevented.

Rhinosporidiosis: an unusual presentation.

Rhinosporidiosis is a chronic granulomatous disease that primarily affects the mucous membranes of the nose and nasopharynx. It is caused by Rhinosporidium seeberi. Clinically it presents as a reddish, bleeding, polypoid mass with a characteristic strawberry-like appearance on its surface, which is caused by the presence of mature sporangia. In the case described here, a 35-year-old man presented with a 6-month history of a slowly growing polypoid mass in his left nasal cavity. The surface of the mass was smooth, pale, and covered with nasal mucosa. It was attached to the nasal septum. Fine-needle aspiration cytology was suggestive of a parasitic cyst. The mass was excised with the use of local anesthesia. Histopathologic examination of the resected specimen revealed rhinosporidiosis. Prior to this diagnosis, the patient had not exhibited most of the typical clinical features that are suggestive of rhinosporidiosis. In the case of a nasal mass, a diagnosis of rhinosporidiosis is important to establish prior to any surgery because bleeding during and after surgery is usually profuse and can be life-threatening. The site of the excised mass should be cauterized to prevent recurrence.

Peripheral osteoma of the hard palate.

Peripheral osteomas of the hard palate are relatively rare. Two cases of osteoma of the hard palate are reported, along with a review of the literature.

Interhemispheric subdural abscess: a rare complication of atticoantral ear disease.

A 14-year-old girl who had been experiencing ear discharge for the previous 3 years was referred to a tertiary care center for management of a 3-day history of severe headache and vomiting. Otolaryngologic examination revealed the presence of an atticoantral type of ear disease on the left side. Computed tomography detected an interhemispheric subdural abscess that had originated on the left side. The patient was initially treated with antibiotics, and she later underwent a mastoidectomy to clear the ear disease. She recovered without complications. Subdural empyema is the rarest complication of otitis media, and it is very rarely seen in an interhemispheric setting.

Otomycosis in immunocompetent and immunocompromised patients: comparative study and literature review.

A comparative clinical study was carried out that included 50 cases of otomycosis in immunocompetent patients and 50 cases of otomycosis in immunocompromised patients. Clinical presentation, predisposing factors, mycologic profile, and treatment outcomes were compared. Aspergillus spp were the most commonly isolated fungi in the immunocompetent group, and Candida albicans in the immunocompromised group. Bilateral involvement was more common in the immunocompromised group. All the patients were treated with topical clotrimazole ear drops. Four patients in the immunocompromised group did not respond to treatment with clotrimazole but were treated successfully with fluconazole ear drops. Three patients had a small tympanic membrane perforation due to otomycosis.

Cholesteatoma of the nose and maxillary and ethmoid sinuses: a rare complication of palatal surgery.

A 10-year-old boy presented with a complaint of a left-sided nasal obstruction with an associated foul-smelling discharge. Physical examination and anterior rhinoscopy revealed that a whitish, friable mass had completely filled the left nasal cavity. On computed tomography, a soft-tissue mass was seen filling the cavity and extending to the paranasal sinuses with bone erosion. A biopsy of the mass suggested that it represented a cholesteatoma. The lesion was removed via nasal endoscopy, and histopathology confirmed the diagnosis of a cholesteatoma. No recurrence was noted during 6 months of follow-up. Cholesteatoma of the paranasal sinuses is a rare entity, as only a few dozen cases have been reported in the literature.

Fungal infections of the ear in immunocompromised host: a review.

Otomycosis is a fungal infection of the external ear; middle ear and open mastoid cavity.1 Meyer first described the fungal infection of the external ear canal in 1884. External ear canal has an ideal warm humid environment for the proliferation of fungus.2 Although this disease is rarely life threatening, it can presents a challenging and frustrating situation for the otologist and patients due to long term treatment and high rate of recurrence.3 Otomycosis is seen more frequently in immunocompromised patients as compared to immunocompetent persons. Recurrence rate is high in immunocompromised patients and they need longer duration treatment and complications are more frequent in immunocompromised patients.In the recent years; opportunistic fungal infections are gaining greater importance in human medicine as a result of possibly huge number of immunocompromised patients.4 In immunocompromised patients, it is important that the treatment of otomycosis be vigorous, to minimize complications such as hearing loss, tympanic membrane perforations and invasive temporal bone infection.5 Fungal cultures are essential to confirm the diagnosis.Hematological investigations play a very important role in confirming the diagnosis and immunity status of the patients. In diabetic patients with otomycosis, along with antifungal therapy, blood sugar levels should be controlled with medical therapy to prevent complications.

Lateral sinus thrombosis in children: a review.

A retrospective study was undertaken to review the clinical presentation, evaluation, management, and outcome of otogenic lateral sinus thrombosis (LST) in children. All pediatric patients with LST seen in our department between 1999 and 2007 were included; there were 9 cases involving 6 boys and 3 girls whose ages ranged from 8 to 12 years. They had all been treated with antibiotics elsewhere prior to admission, and the duration of symptoms before admission ranged from 5 to 18 days. The most common presenting symptoms were ear discharge, headache, otalgia, and fever. Radiologic evaluation included computed tomography and magnetic resonance imaging. All patients underwent radical mastoidectomy with incision of the lateral sinus and removal of its content. There were no deaths. Pseudomonas and Proteus spp were the most commonly identified organisms. Otogenic LST still poses a serious threat that warrants immediate attention and care. It is often associated with other intracranial complications, such as cerebellar abscess. Computed tomography and magnetic resonance imaging play an important role in the management of this disease. Early and aggressive surgical intervention of this otogenic complication can potentially minimize mortality.

Characteristics of osteoma of the temporal bone in young adolescents.

The author conducted a retrospective review of the clinical presentation, management, and complications of temporal bone osteoma in young adolescents. The study population was made up of 9 patients-5 girls and 4 boys, aged 12 to 15 years at presentation (mean: 13.7)-who had been seen for radiologically and histopathologically proven temporal bone osteoma at the author's institution over a 9-year period. Of this group, 5 patients had extracanalicular osteoma (3 in the mastoid portion of the temporal bone, 1 in the squamous portion, and 1 in the mastoid antrum) and 4 patients had osteoma of the external auditory canal. Six of the 9 patients underwent surgical treatment; of the remainder, 1 refused surgery and 2 were managed conservatively with ongoing observation. All patients were followed for a minimum of 1 year, and no recurrences and no complications were observed during that time.

Otitic hydrocephalus: a report of 2 cases.

Otitic hydrocephalus is a rare intracranial complication of otitis media. It is characterized by elevated cerebrospinal fluid (CSF) pressure with normal CSF biochemistry and without any focal neurologic abnormality other than those related to the increased intracranial pressure. The pathophysiology of this rare condition is unknown. The incidence of intracranial complications was reduced dramatically with the introduction of newer antibiotics, but complicated cases still occur. Serious consequences can ensue if complications are not identified and treated properly. The author reviews the literature on otitic hydrocephalus and describes 2 new cases.

Inferior turbinate osteoma: case report.

Osteomas of the turbinates are extremely rare. In this report, a case of inferior turbinate osteoma in a 24-year-old woman is described. The patient presented with a 6-month history of unilateral nasal obstruction. Computed tomography showed a bony dense mass in the anterior part of the left inferior turbinate. The lesion was removed endoscopically, and the patient recovered uneventfully. To the best of the author's knowledge, this is only the fifth case of a turbinate osteoma to be reported in the world literature, and only the second case that involved the inferior turbinate.

Kimura disease: An unusual cause of head and neck masses. Report of 2 cases.

Kimura disease is an uncommon chronic, benign, inflammatory condition of unknown etiology. It occurs endemically in Asia and sporadically in the West. Because it often imitates neoplastic or inflammatory processes of the head and neck, otolaryngologists and head and neck surgeons should be aware of its clinical presentations. In this article, the author reports 2 cases of Kimura disease-1 that was characterized by an unusual bilateral presentation and 1 that was managed conservatively-and he briefly reviews the literature on this entity.

External auditory canal cholesteatoma: a rare complication of tympanoplasty.

The author describes a rare case of external auditory canal cholesteatoma. This particular case occurred in a 20-year-old woman who had undergone a tympanoplasty 1 year earlier. Previous tympanoplasty is one of several known predisposing factors for external auditory canal cholesteatoma. The mass was excised, and it was diagnosed on histopathology. The patient recovered uneventfully.

Syringomyelia with syringobulbia presenting as vocal fold paralysis.

A 36-year-old woman presented with a history of change in voice of 1 month's duration and difficulty swallowing and episodes of nasal regurgitation of 6 days' duration. Examination revealed paralysis of the right vocal fold and the right side of the soft palate. On further investigation, she was found to have syringomyelia with syringobulbia and a Chiari type I malformation. She underwent foramen magnum decompression surgery and was followed up for 1 year. Her dysphagia and nasal regurgitation resolved, but no functional improvement was seen in either her vocal fold or palate.

Nonseptic lateral sinus thrombosis: the role of the otolaryngologist.

Nonseptic lateral sinus thrombosis differs from septic lateral sinus thrombosis in that it is not associated with ear or sinus infection. Mastoid changes are frequently detected on computed tomography or magnetic resonance imaging in cases of nonseptic lateral sinus thrombosis. An otolaryngologic evaluation is usually required to exclude coexisting mastoiditis.

Prostatic carcinoma metastatic to the paranasal sinuses: a case report.

In the paranasal sinuses, metastatic carcinoma is far less common than primary carcinoma. Metastasis of prostate cancer to the paranasal sinuses is very rare. The author describes a case of prostatic adenocarcinoma that metastasized to the frontal and ethmoid sinuses in a 68-year-old man. The patient was treated with radiotherapy but was lost to follow-up after 3 months.

Extracanalicular osteoma of the temporal bone.

Extracanalicular osteomas of the temporal bone are rare, slow-growing, benign neoplasms. Although they may occur anywhere in the temporal bone, they are most common in the mastoid area. Often, symptoms are negligible and treatment is unnecessary. However, surgical removal is indicated when growth of the osteoma causes distressing symptoms or cosmetic issues. The patient described in this report had no symptoms but underwent surgical excision of a mastoid osteoma for cosmetic reasons. At 4-month follow-up, she remains asymptomatic and recurrence-free.

Cholesteatoma of the maxillary sinus.

Cholesteatoma of the maxillary sinus is a rare condition, but it should be considered in the differential diagnosis of any slowly expanding lesion of the maxillary sinus. Because the keratinizing squamous epithelium continues to desquamate and expand, thereby causing erosion of the surrounding structures, the cholesteatoma sac must be removed completely. We describe a case of cholesteatoma of the maxillary sinus in an 18-year-old woman.

Embryonal rhabdomyosarcoma of the temporal bone.

The most common soft-tissue sarcoma in infants and children is rhabdomyosarcoma. The head and neck is the most common site of involvement; temporal bone involvement has been seen in about 7% of reported cases. Multimodality therapy--surgery, multiagent chemotherapy, and radiotherapy-yields sufficiently good results. The author reports a case of embryonal rhabdomyosarcoma of the temporal bone with cranial nerve palsies and extension into the parapharyngeal space in a 4-year-old boy. Despite surgery and chemotherapy, the patient died of his disease within 3 months of presentation.