Anand Job

Hearing impairment and otitis media in a rural primary school in South India

In order to determine the prevalence of hearing impairment and otitis media in rural primary school children, a pilot study of 284 children aged 6-10 years was performed. These children were screened by otoscopy, pure tone audiometry and tympanometry. The overall prevalence of otological abnormalities (excluding wax) was 21.5%. Hearing impairment was detected in 34 children (11.9%). Conductive hearing impairment was predominant (10.9%). Otitis media was diagnosed in 17.6% of children. While 91.2% of children with hearing impairment had associated middle ear disease, only 53.4% of those with middle ear disease were detected as have hearing impairment. The importance of including tympanometry as part of the screening protocol is highlighted.

Medical therapy of rhinosporidiosis with dapsone

Clinical, histopathological and ultrastructural studies in three cases of rhinosporidiosis show complete remission of infection within one year of therapy with dapsone. Light and electron microscope studies confirmed arrest of the maturation of the spores and accentuated granulomatous response with fibrosis following dapsone therapy.

Cost-Effective Initial Screening for Vestibular Schwannoma: Auditory Brainstem Response or Magnetic Resonance Imaging?

OBJECTIVE Our goal was to determine the cost-effectiveness of including auditory brainstem response (ABR) testing in a screening protocol for the diagnosis of vestibular schwannoma (VS) in patients with asymmetric auditory symptoms at the Christian Medical College and Hospital, Vellore, India, where, commonly, patients with VS have tumors greater than 2 cm at the time of diagnosis. METHODS Ninety patients with asymmetric audiovestibular symptoms were investigated prospectively with both ABR and gadolinum-enhanced magnetic resonance imaging (GdMRI). RESULTS Of these 90 patients, 6 were diagnosed with VS on GdMRI. On ABR testing, 4 patients with VS had retrocochlear pathology and 2 with profound sensorineural hearing loss had no responses. ABR was found to have a sensitivity of 100% and specificity of 61.9%. A protocol involving screening of all patients with asymmetric audiovestibular symptoms using ABR and only subjecting those patients with no responses or retrocochlear pathology to GdMRI would effect a savings of

Light and electron microscopic findings in rhinosporidiosis after dapsone therapy

1200 for every patient detected to have a VS. CONCLUSIONS In our hospital setting, including ABR as the preliminary screen for patients with asymmetric audiovestibular symptoms is a cost-effective strategy.

Medical management of pseudocyst of the auricle

Morphological findings in serial nasal mucosal biopsies from three cases of rhinosporidiosis on dapsone therapy were compared with biopsies from 33 patients taken before dapsone or surgical treatment was initiated. All biopsies were examined by light microscopy and five by electron microscopy. Counts of histologically intact and degenerated organisms showed a decreasing proportion of intact forms with treatment.

Chronic adenoid hypertrophy in children — is steroid nasal spray beneficial?

Four male patients with pseudocyst of the auricle were successfully treated with oral corticosteroids. This condition is an asymptomatic, non-inflammatory, cystic swelling, usually located in the scaphoid or triangular fossa of the anti-helix which if untreated, leads to deformity of the pinna. All successful methods of treatment described in the literature so far have been invasive. All four patients in the above series responded to oral steroid therapy alone.

Laryngeal stridor in myasthenia gravis

ObjectivTo the efficacy of naial btvlomethosone spry in the treatmrnl of chronic adenoid hypertrophy in children.Method.-1 randomized double-blind placebo-controlled study Setting: Tertiary academic referral center Patients: Aged 3-12 years diagnosed to have chronic nasal obstruction due to hypertrophied adenoids.InterventionIntranasal beclomethasone at the dose of 200 microgramslday to one group and placebo to the other group in matched dispensers for 8 weeks. Outcome measures: Reduction of symptoms due to hypertrophied adenoids and the size of enlarged adenoids. Variables were noted at the beginning and end of the study for symptoms score severity. X-ray and flexible nasal endoscopie findings.ResultsAnalysis was done to find any significant improvement between the two groups. The Chisquare test was used to investigate the relationship between discrete variables. 26 children completed the study with 13 each in the drug and placebo group. There were 17 male and 9 female patients from 3 to 12 years of age. There was no significant difference in nasal obstruction, snoring or nasal discharge between the two groups. Comparison of x-rays and endoscopy also showed no significant difference between the 2 groups significant (P value =1.000 and P=0.0666 respectively).ConclusionThis study indicates that intranasal beclomelhasone therapy is not useful in treatment of ehronic adenoid hypertrophy in the general pediatrie population.

Outcome of bacterial culture from mastoid granulations : is it relevant in chronic ear disease?

Two patients with laryngeal stridor secondary to myasthenia gravis are reported. The cause of bilateral abductor weakness in myasthenia is discussed; anticipation of the stridor in myasthenic patients is highlighted.

Adult Onset Spontaneous CSF Otorrhea with Oval Window Fistula and Recurrent Meningitis: Mri Findings:

OBJECTIVE To detect the presence of bacteria in mastoid granulations and compare its prevalence in both types of chronic suppurative otitis media (CSOM). To find out if stage of disease activity, age, duration of disease, and aditus patency relate to obtaining positive cultures. STUDY DESIGN AND SETTING A prospective, parallel group study done at a tertiary care referral centre. Mastoid granulations from 79 patients with CSOM undergoing mastoidectomy were processed for anaerobic and aerobic bacteria. RESULTS Aerobes were isolated from 57.55 per cent of the tubotympanic and 74.4 per cent of atticoantral disease (p=0.18). Anaerobic cultures were positive in one case from each group. Monomicrobial growth was detected in 37.5 per cent of tubotympanic and 48.5 per cent of atticoantral disease. Polymicrobial growth occurred in 20 per cent and 25.6 per cent in the tubotympanic and atticoantral groups, respectively. The predominant aerobic isolate was coagulase negative Staphylococcus, followed by Pseudomonas aeruginosa, Staphylococcus aureus, non-fermenting Gram-negative bacteria, Enterobacter and Enterococcus, Proteus species, Citrobacter, non-pathogenic Neisseria, aerobic spore formers were grown only in atticoantral disease. A single isolate of Aspergillus was grown. Correlating the state of disease activity of the ears with positive mastoid granulation cultures, six out of the eight inactive ears were culture positive along with seven out of the nine active and 10 out of the 23 quiescent ears. Positive mastoid granulation cultures were obtained in 60 per cent of those with blocked aditus and 42.9 per cent with patent aditus. CONCLUSION AND SIGNIFICANCE In this study, we found that mastoid granulations are not sterile but harbour polymicrobial pathogens. Positive cultures were obtained irrespective of stage of disease activity, age, duration of disease and aditus patency. The pattern of organisms cultured from safe and unsafe CSOM and also from ears in active, quiescent and inactive stages, were similar. These findings suggest that these organisms may be responsible for mastoid granulations. We also noted that positive cultures had no statistical correlation with aditus patency and duration of disease. We suggest further studies to evaluate the significance of asymptomatic mastoid granulations harbouring organisms and whether opening the mastoid antrum and achieving aditus patency, irrespective of the stage of disease activity, will help improve the long-term surgical outcome and also prevent recurrence of ear discharge.

Malignant otitis externa in an infant with selective IgA deficiency: a case report.

Spontaneous cerebrospinal fluid (CSF) otorrhea as the result of a congenital dural fistula causing recurrent meningitis is a rare entity. Two distinct clinical presentations of this condition have been described, based on single case reports and a small series of patients published over the last century.1,2 The more common juvenile variety, reportedly seen in 72% of cases, is represented by an infant or young child with a history of recurrent episodes of meningitis, unilateral, or bilateral severe to profound sensorineural hearing loss and an inner ear anomaly, typically, Mondini’s dysplasia.3 In addition, a history of recurrent middle ear infections or frank CSF otorrhea after myringotomy for suspected middle ear effusion may be present.2 An oval window fistula and/or enlarged cochlear aqueduct are often associated findings.3 In contrast, adult onset CSF otorrhea, a considerably rarer clinical entity, is typically seen in an older patient, aged 40 years or more, with a congenital tegmen or posterior fossa defect through which dura and brain may herniate.1-3 Either middle ear effusion or CSF otorrhea (or otorhinorrhea) is the presenting feature. Occasionally, these patients may present with meningitis.4 Fewer than 5 cases of adult onset CSF otorrhea from a congenital labyrinthine anomaly presenting with recurrent meningitis have been reported in the literature to date.3,4 Because of the rarity of such a presentation, we report 1 more case of spontaneous CSF otorrhea through an oval window fistula involving an adult patient with recurrent meningitis. We also highlight the utility of magnetic resonance imaging (MRI) in demonstrating the communication between the subarachnoid space and the vestibule through a defect at the fundus of the internal auditory canal as well as an associated inner ear anomaly.