Gautam Bir Singh

Extended high frequency audiometry in users of personal listening devices

PURPOSE Noise exposure leads to high frequency hearing loss. Use of Personal Listening Devices may lead to decline in high frequency hearing sensitivity because of prolonged exposure to these devices at high volume. This study explores the changes in hearing thresholds by Extended High Frequency audiometry in users of personal listening devices. MATERIAL AND METHOD A descriptive, hospital based observational study was performed with total 100 subjects in age group of 15-30years. Subjects were divided in two groups consisting of 30 subjects (Group A) with no history of Personal Listening Devices use and (Group B) having 70 subjects with history of use of Personal Listening Devices. Conventional pure tone audiometry with extended high frequency audiometry was performed in all the subjects. RESULT Significant differences in hearing thresholds of Personal Listening Device users were seen at high frequencies (3kHz, 4kHz and 6kHz) and extended high frequencies (9kHz, 10kHz, 11kHz, 13kHz, 14kHz, 15kHz and 16kHz) with p value <0.05. Elevated hearing thresholds were observed in personal listening devices users which were directly proportional to volume and duration of usage. CONCLUSION In present study no significant changes were noted in hearing thresholds in PLD users before 5years of PLD use. However, hearing thresholds were significantly increased at 3kHz, 10kHz, 13kHz in PLD users having >5years usage at high volume. Thus, it can be reasonably concluded that extended high frequencies can be used for early detection of NIHL in PLD users.

Paediatric tympanoplasty: comparative study between patients aged 5–8 years and those aged over 14 years

OBJECTIVE To evaluate and analyse the success rate of tympanoplasty type I in paediatric patients aged 5 to 8 years compared to a control group (patients aged over 14 years). METHODS In this prospective study, 60 patients (of either sex) with chronic suppurative otitis media inactive mucosal disease were divided into 2 groups (30 in each): group A comprised paediatric patients aged 5-8 years and group B consisted of older individuals aged over 14 years. All patients underwent tympanoplasty type I with an underlay technique using a temporalis fascia graft. RESULTS Impressive surgical success rates of 87 and 90 per cent were recorded in groups A and B, respectively. Furthermore, audiological success rates of 69 and 78 per cent were achieved in groups A and B respectively. Statistical analysis of the data revealed that eustachian tube function had no impact on the outcome of tympanoplasty. CONCLUSION Tympanoplasty type I performed in children aged five to eight years gives comparable results to those of older individuals.

Management of otogenic lateral sinus thrombosis

OBJECTIVE To evaluate the changing clinical course and trends in management of otogenic lateral sinus thrombosis (OLST), in view of the rarity of the said lesion and antibiotic abuse. METHODS A retrospective case study was done in 6 patients referred to our tertiary care centre with OLST over a period of three years from May 2007 to May 2010: Department of Otorhinolaryngology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi - a tertiary care university teaching hospital under central government of India. Medical records of all the patients were scrutinized and data pertaining to patient profile, type of chronic suppurative otitis media (CSOM), clinical course with any other complication and management were tabulated. The said data was scientifically analyzed w.r.t. current medical literature on the subject. RESULTS Clinically, it was observed that all patients had protracted CSOM - attico antral type, with history of rampant misuse of antibiotics. The attack of OLST in each case was triggered off by an acute attack of suppurative otitis media. Moreover, in all the cases OLST was masquerading as an intra-cranial complication, with no specific clinical features thereby causing missed diagnosis initially. All these patients were diagnosed by CT scan, and underwent modified radical mastoidectomy (MRM) with needle aspiration of sinus under antibiotic cover. The said treatment protocol resulted in excellent prognosis with no morbidity or mortality whatsoever. Pathologically, cholesteatoma was detected in 5 of the six cases with one case having only granulations. CONCLUSIONS In this era of antibiotic abuse, the clinical presentation of OLST has altered substantially, and mimics other intra-cranial complication with vague signs and symptoms. There are conflicting views in contemporary medical literature regarding management of OLST. In our experience, MRM with needle aspiration under antibiotic cover is the treatment of choice for all cases of OLST associated with CSOM attico antral disease/cholesteatoma disease.

A rare case of congenital rhabdomyosarcoma with review of the literature.

We present a rare case of rhabdomyosarcoma of lip in a neonate with multiple lesions within the head and necksub site hitherto unreported in the medical literature. This case report also reviews the scant medical literature on neonatal rhabdomyosarcoma.

Tympanoplasty: does dry or wet temporalis fascia graft matter?

OBJECTIVES To evaluate the success rate of dry and wet temporalis fascia grafts in type I underlay tympanoplasty. METHODS A prospective, randomised study was conducted. One hundred adult patients (males and females) with chronic suppurative otitis media (mucosal type) were divided into 2 groups of 50 each: one group underwent dry graft tympanoplasty and the other underwent wet graft tympanoplasty. Fibroblast count was calculated in dry and wet grafts. RESULTS The dry graft and wet graft groups had overall surgical success rates of 82 and 90 per cent, respectively; this finding was not statistically significant. A statistically significant high fibroblast count was observed in wet grafts, but it did not correlate with surgical success. CONCLUSION A dry or wet temporalis fascia graft does not influence the outcome of tympanoplasty type I.

A Rare Case of Congenital Simple Cystic Ranula in a Neonate

Congenital ranula in a neonate is an uncommon occurrence. We present one such case of the said lesion where the clinical presentation and management were found to be interesting, hitherto unreported in the medical literature. This clinical record also reviews the scant medical literature on congenital ranula in neonates.

A Rare Case of Survival after Complete Traumatic Cricotracheal Separation

We report the survival of an extremely rare case of complete cricotracheal transection following incisional trauma with knife. The clinical record underlines the importance of prompt airway management and immediate neck exploration in such cases. To the authors knowledge, such a case has not been reported previously in the literature.

A Rare Case of Lateral Sinus Thrombosis with Carotid Space Abscess

This case report describes a case of carotid space abscess secondary to lateral sinus thrombosis associated with internal jugular vein thrombosis. With this case, we illustrate a rare entity that presented in an extremely rare manner. To the authors knowledge such a case has not been previously reported.

Role of circumferential subannular tympanoplasty in anterior and subtotal perforations.

OBJECTIVE This study aimed to evaluate the surgical success of a modified inlay tympanoplasty technique, known as circumferential subannular tympanoplasty, for anterior and subtotal perforations. METHODS This prospective study was performed in a tertiary care teaching hospital between October 2013 and April 2016. A total of 58 adult patients of both sexes with anterior or subtotal perforations underwent circumferential subannular tympanoplasty under local anaesthesia. In this technique, after tympanomeatal flap elevation, the temporalis fascia graft is placed directly onto the annulus instead of being tucked underneath the tympanic membrane remnant. Outcome data were graft uptake and hearing improvement. RESULTS This technique had a surgical success rate of 97 per cent and led to significant hearing improvement. CONCLUSION Circumferential subannular tympanoplasty has a definitive role in managing anterior and subtotal perforations.

A Rare Case of Angiofibroma Arising from Inferior Turbinate in a Female.

A rare case of extranasopharyngeal angiofibroma arising from the inferior turbinate in a young female of 28 years is presented. The case is discussed in light of scant contemporary literature on the cited subject. This clinical record highlights the distinct clinical nature of Extranasopharyngeal angiofibroma (ENA) and importance of Immunohistochemistry in diagnosis of such lesions. With this case we report a rare clinical entity which presented in an extremely rare manner.