Rohit Sharma

Analysis of sensorineural hearing loss in chronic suppurative otitis media with and without cholesteatoma

Background: Chronic suppurative otitis media (CSOM) still remains a major cause of conductive hearing loss in our country. On contrary a few patients also display an added sensorineural component. Materials and Methods: Hundred patients with unilateral CSOM undergoing ear surgery at our department were included in the study. The affected ears formed the CSOM group and the normal ears formed the Control group. Detailed otologic history, clinical, surgical, and audiometric findings were recorded and analyzed. Results: It was inferred that though CSOM is associated with sensorineural (SN) loss in small majority of patients only. No co-relation was established between the duration of discharge and SN loss. Conclusions: Though, greater SN loss was seen in patients of CSOM with cholesteatoma but it was not statistically significant. It can be further studied that whether an early surgery in CSOM can prevent SN loss or not.

Temporalis muscle fascia and cartilage palisade technique of type 1 tympanoplasty: A comparison

Background: Chronic suppurative otitis media is one of the common causes of deafness in india and occupies a considerable amount of clinic and operating time of otolaryngologists. Materials and Methods: This was a prospective study containing 50 patients, which was further divided into two groups of 25 patient each. One group was cartilage palisade technique group and other was temporalis fascia technique group (TFT group). Detailed history and examination along with pure tone audiometry was performed. Pre- and postoperative hearing results and graft uptake were compared. All surgeries were performed through the post aural approach. Cartilage was harvested from cymba concha and fascia from temporalis muscle. Results: Hearing improved significantly when either of the technique was used. Though this was slightly better, but stastically insignificant in TFT. there was no significant difference in the graft uptake rates, but it was better in cases of Eustachian tube dysfunction when cartilage palisades were used. Conclusion: There was no statistically significant difference in results in terms of success and auditory function but cartilage palisade technique gave better results in specific conditions like Eustachian tube dysfunction.

A clinical, radiological, and histopathological correlation of neck nodes in patients undergoing neck dissection

Objectives: Management of neck metastases in terms of diagnosis and treatment has always been a controversial issue in patients of head and neck malignancy. The main area of debate in case of diagnosis lies with the fact that whether we should rely on ultrasound, as a diagnostic modality for diagnosing micrometastases in the neck in head and neck malignancy patients? The second controversial issue is the management of N0 neck, whether to be radical or conservative? Materials and Methods: This study was conducted on 70 diagnosed patients of head and neck carcinoma who were planned for resection of the primary. An appropriate neck dissection was performed in all the patients, and their clinical, ultrasonography, and postoperative histopathological neck findings were correlated. Results: In our center, the most common site of the primary tumor was oral cavity with most involving buccal mucosa. As expected, T4 lesions were commonly associated with nodal metastasis (71%). The sensitivity of clinical examination and ultrasound was 80% and 93.3%, respectively, and specificity of clinical examination and ultrasound was 57% and 27.2%, respectively. Histopathologically positive but clinically nonpalpable metastases in the study group were more frequent in levels Ib, II, and III, respectively. Conclusion: We concluded that ultrasonography being a low cost and a highly sensitive investigation can act in tandem with clinical examination for diagnosing the neck for metastases preoperatively in head and neck malignancy patients. However, due to its low specificity, we cannot completely rely on it, hence doing a neck dissection in selective form, will definitely improve the clinical course of the disease in N0 necks.

Radiological changes in anatomy of temporal bone in cases of unsafe chronic suppurative otitis media: A retrospective study

Introduction: The ability of high-resolution computed tomography (HRCT) to depict the status of structure of the temporal bone represents a major advance in delineating pathology before surgical exploration of ear in cases of unsafe chronic suppurative otitis media (CSOM) or cholesteatoma. Aims and Objectives: The aim of this study was to evaluate the role of HRCT temporal bone in cases of unsafe CSOM and to assess the erosion of various structures in middle ear cleft. Study Design: This was a retrospective analysis. Materials and Methods: Fifty HRCT scans of temporal bone of the patients who were diagnosed as case of unsafe CSOM were selected and analyzed retrospectively. Criterion for inclusion was CSOM with cholesteatoma or granulations or polyp or posterior canal wall sagging or foul smelling discharge. In HRCT scans, 1 mm thickness sections were studied in both axial and coronal planes. Criterion for exclusion was history of previous ear surgery, history suggestive of head injury or skull base trauma in the past or known cases of temporal bone neoplastic pathology. Results: Maximum number of patients belonged to the age group of 21–30 years. Ossicular erosion was the most common (90%) finding followed by scutum erosion (84%). Erosion of sigmoid sinus plate was seen in only one case (2%). Cochlear promontory fistula was seen in none of the computed tomography scans. In ossicular chain, incus was the most common ossicle to be necrosed (92%) followed by malleus (66%). Conclusion: HRCT temporal bone delineates the location and extent of the disease and provides information on anatomical variations and complications.