Hearing loss and ossicular status in cholesteatoma

Background: Chronic otitis media with cholesteatoma is associated with hearing loss. Cholesteatoma causes bone erosion leading to ossicular chain defects. These ossicular lesions are only detected intraoperatively. If the ossicular status could be detected preoperatively by audiometric parameters, it would aid in better information to the patient, surgeon and preparation for the surgery. The aim of this study is to describe the intraoperative ossicular status, preoperative hearing status and to correlate them in patients with cholesteatoma.Methods: This is a retrospective case series study conducted in a tertiary care centre. Data was collected from inpatient files of 47 patients who underwent surgery for cholesteatoma from January 2016 to December 2017. Air and bone conduction thresholds, air- bone gaps from pure tone audiometry (PTA) reports were collected. The status of the ossicles was collected from the operative notes. Results: PTA revealed hearing loss in all the patients, predominantly conductive loss (83%). Ossicular defects were noted in 87% with incus most frequently involved (78.7%). Ossicular lesions were significantly associated with worse air conduction, bone conduction thresholds and air bone gap.Conclusions: Cholesteatoma is frequently associated with ossicular defects. PTA shows worse parameters in ossicular defects. But, it doesn’t reflect the status of ossicle involved or the number of ossicles involved.

Download Full-text

HEARING LOSS IN BLAST TRAUMA VICTIMS. A MULTICENTRE RETROSPECTIVE STUDY

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71isuppl-1.6203 ◽

2021 ◽

Vol 71 (Suppl-1) ◽

pp. S130-35

Author(s):

Kamran Ashfaq Ahmed Butt ◽

Naeem Riaz Bhalli ◽

Wasif Siddique ◽

Attique Ahmed ◽

Maryam Khan ◽

...

Keyword(s):

Hearing Loss ◽

Tertiary Care ◽

Case Series ◽

Symptom Assessment ◽

Tympanic Membrane Perforation ◽

Care Hospital ◽

Tertiary Care Centre ◽

Ear Injury ◽

Blast Trauma ◽

The Impact

Objective: To describe the resultant Otologic morbidity and report on the early outcomes following blasts occurring in twin cities of Quetta and Peshawar. Study Design: Case series. Place and Duration of Study: ENT department Tertiary Care Centre Quetta and Tertiary Care Hospital Peshawar. Study period was, from Jan 2013 to Dec 2013. Methodology: All bomb blast patients brought to the hospitals were included in study. Participants completed Symptom Assessment Forms followed by detailed ENT examination and Pure Tone Audiograms on arrival and after 6 weeks. Results: A total of 504 patients were included initially of which 80% of the patients were male. About 57.8% of the patients complained of ear injury, 21.6% of the total patients had tympanic membrane perforation on initial presentation. Chances of spontaneous closure of perforation were 20.9% in our study. Chances of hearing improvement were 17.9% in our study at the end of the study period. Conclusion: Blast related otologic injuries constituted a major source of morbidity The most common type of hearing loss following a blast trauma was mild to moderate conductive type. Chances of recovery of hearing following blast do exist (17.9%). Suspected patients should be regularly assessed and followed up. Much work needs to be done to study the impact of blast trauma on hearing in our country.

Download Full-text

Acute flaccid myelitis—Clustering of polio-like illness in the tertiary care centre in Southern India

Journal of Tropical Pediatrics ◽

10.1093/tropej/fmy052 ◽

2018 ◽

Vol 65 (4) ◽

pp. 309-314 ◽

Cited By ~ 5

Author(s):

Syed N Sarmast ◽

Vykuntaraju K Gowda ◽

Maaz Ahmed ◽

Basvaraja GV ◽

Jitender Saini ◽

...

Keyword(s):

Spinal Cord ◽

Grey Matter ◽

Electrophysiological Study ◽

Tertiary Care ◽

Case Series ◽

Tertiary Care Centre ◽

Limb Weakness ◽

Laboratory Findings ◽

Acute Flaccid Myelitis ◽

Case Series Study

Abstract Introduction Acute flaccid myelitis (AFM) is characterized by limb weakness with spinal cord grey matter lesion on imaging or electrodiagnostic evidence of spinal cord motor neuron injury. This Poliomyelitis-like illness is rare in children, and its natural course is not yet well defined. Purpose of the study The purpose of the study was to report the clinical presentation, laboratory findings, management and outcome of children with AFM. Materials and methods This is a prospective case series study. Results Nine children met the case definition given by CDC. All cases presented with prodromal symptoms followed by acute onset asymmetrical limb weakness. Maximum weakness is reached within 4 days from the day of onset. Cerebrospinal fluid analysis shows that pleocytosis with viral markers for arboviruses and enteroviruses was negative. Electrophysiological study revealed decreased muscle action potential in all. MRI of the spinal cord showed predominantly grey matter involvement. Conclusion AFM should be one of the differential diagnoses in any child presenting with acute flaccid paralysis.

Download Full-text

An overview of endoscopic stapedotomy in a tertiary care centre

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20202207 ◽

2020 ◽

Vol 6 (6) ◽

pp. 1102

Author(s):

Atish B. Gujrathi ◽

Siddharth A. Shroff ◽

Nishikant Gadpayale ◽

Naman Agarwal

Keyword(s):

Hearing Loss ◽

Intraoperative Complications ◽

Adult Population ◽

Tertiary Care ◽

Case Series ◽

Anatomical Variations ◽

Common Symptom ◽

Tertiary Care Centre ◽

Female Ratio ◽

Endoscopic Stapedotomy

Background: Stapedotomy is now one of the most popular and common surgeries done worldwide. Otosclerosis remains the most common single cause of conducting hearing loss in adult population. Females are more frequently affected than males with an approximate 2:1 ratio.Methods: This study consists of 30 patients who underwent stapedotomy for otosclerosis. This study was conducted at Dr Shankarrao Chavan Government Medical College, Nanded, during the period of 2 years (2017-2019). Patients were evaluated and operated. The various anatomical variations, diagnostic dilemmas, intraoperative complications, its management and follow-up were done systematically. Results: Age of patients included in this study ranged from 15 to 50 years. Youngest patient was a 17-year-old male. Age of presentation was most commonly seen in third decade of life. Male to female ratio was 1:2. The most common symptom was hard of hearing followed by tinnitus. In this study, 76.67% of the patient’s had bilateral disease. 66.66% of patients had hearing loss between 41-55 dB with mean pre-operative pure tone average was 51.16 dB. About 80% of patients had successful air bone closure between 0-10 dB after the surgery.Conclusions: Endoscopic stapedotomy seems a feasible and relatively safe surgical technique in limited case series. Cosmetically this procedure was more compliant by the patients however endoscopic stapedotomy requires a significant learning curve and an extreme expertise.

Download Full-text

Tympanoplasty Type-I using tragal perichondrium graft: Our experience

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.35.4.421 ◽

2019 ◽

Vol 35 (4) ◽

Cited By ~ 2

Author(s):

Fazali Wahid ◽

Sajid Rashid Nagra

Keyword(s):

Tertiary Care ◽

Case Series ◽

Pure Tone Audiometry ◽

Neck Surgery ◽

Tympanic Membrane Perforation ◽

P Value ◽

Type I ◽

Care Hospital ◽

Female Ratio ◽

Case Series Study

Objective: To determine the efficacy of tragal perichondrium graft used in tympanoplasty Type-I at a tertiary care hospital. Methods: This descriptive case-series study was performed at the department of E.N.T, Head and Neck Surgery, Medical Teaching Institution/Lady Reading Hospital (MTI/LRH), Peshawar, Pakistan from June 2017 to May 2018. After approved from IREB, a well informed consent was taken. Pure Tone Audiometry (PTA) was performed before surgery and post-operatively at three and six months interval. The mean ± SD Air-Bone Gap (ABG) was calculated in pre- and postoperative PTA. The data were analyzed using SPSS (version 20). Chi-square (X2) test of significance was used taking confidence interval at 95%. The p-value ≤0.05 was considered significant. Results: Total patients were 36; male 21 (58.3%), female 15(41.7%) with male: female ratio of 1.4:1. Mean ± SD age was 27.14 ± 7.49 years (Range 15 – 50Years). Tympanic membrane perforation was commonly found on right side 22 (61.1%), predominantly involving anterioinferior site 19 (52.8%) and medium sized perforation outnumbered 22 (61.1%). Mean pre-operative air-conduction of 49.72 dB was significantly reduced to 18.27 dB with pvalue of <0.05. Similarly the pre-operative mean air bone gap on PTA of 45.63 ± 8.35dB was also reduced to statistically significant level of 7.41 ± 3.51 dB on post-operative PTA with p-value of <.05. Graft was taken up well in 34 cases (94.4%). Conclusion: Tragal perichondrial graft is an effective grafting material used for tympanoplasty due to its possessing qualities. doi: https://doi.org/10.12669/pjms.35.4.421 How to cite this:Wahid FI, Nagra SR. Tympanoplasty type I using tragal perichondrium graft: Our experience. Pak J Med Sci. 2019;35(4):---------. doi: https://doi.org/10.12669/pjms.35.4.421 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Download Full-text

Maternal and perinatal outcome in rupture of unscarred uterus: a case series

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20212981 ◽

2021 ◽

Vol 10 (8) ◽

pp. 3204

Author(s):

Ancy M. Kurian ◽

Indrani Roy ◽

Neelotparna Saikia ◽

Kerlin Mihsill

Keyword(s):

Risk Factors ◽

Perinatal Outcome ◽

Tertiary Care ◽

Case Series ◽

Lateral Wall ◽

Home Delivery ◽

Active Management ◽

Fetal Mortality ◽

Tertiary Care Centre ◽

Case Series Study

Uterine rupture is one of the main contributory factors of maternal morbidity and fetal mortality. The aim of this study was to study the maternal and perinatal outcome in rupture of unscarred uterus and to identify the etiology, risk factors, diagnosis and management in a tertiary care centre. This case series study was often cases of rupture of unscarred uterus conducted at the department of obstetrics and gynecology, Nazareth hospital, Shillong, Meghalaya from July 2018 to February 2021. During the study period there were 7840 deliveries and ten patients presented with rupture of unscarred uterus, the incidence being 0.127 %. The patients were referred from different primary health centres and all patients presented with history of trial of home delivery. All patients were multigravida and the highest parity was a patient with para 11. The cases were between the gestational age of 39 to 41 weeks. Rupture was observed in the lower uterine segment in 5 patients, left lateral wall in 3 and right lateral wall in 2 patients. Five patients underwent hysterectomy, and 4 patients had repair of the rupture. There was one maternal death. Grand multipara and trial of home delivery were the most common identifiable risk factors along with obstructed labour. Identifying high risk women, prompt diagnosis, early referral from periphery and active management is the key factor to avoid adverse maternal and perinatal outcome.

Download Full-text

Aetiology of arthritis in hospitalised children: an observational study

Archives of Disease in Childhood ◽

10.1136/archdischild-2014-307490 ◽

2015 ◽

Vol 100 (8) ◽

pp. 742-747 ◽

Cited By ~ 15

Author(s):

Camille Aupiais ◽

Brice Ilharreborde ◽

Catherine Doit ◽

Audrey Blachier ◽

Marie Desmarest ◽

...

Keyword(s):

Septic Arthritis ◽

Tertiary Care ◽

Case Series ◽

First Episode ◽

Tertiary Care Centre ◽

Female Ratio ◽

Fluid Analysis ◽

Case Series Study ◽

Male Female Ratio ◽

Series Study

Background and objectiveArthritis in children has many causes and includes septic and viral arthritis, reactive arthritis and juvenile idiopathic arthritis (JIA). We aimed to describe the different types of arthritis among children hospitalised for a first episode of arthritis.DesignRetrospective, descriptive case series study.SettingA French tertiary care centre.PatientsChildren under 16 years of age hospitalised for an arthritis episode between 1 January 2008 and 31 December 2009.Main outcome measuresDemographic and clinical features were compared with χ2 or Fisher's exact tests and non-parametric tests.Results173 children were hospitalised for a first episode of arthritis during the study period, with a male/female ratio of 1.14. The most frequent cause of hospitalisation was septic arthritis (43.4% of cases, 69.3% of which were due to Kingella kingae and 10.7% to Staphylococcus aureus). JIA was responsible for 8.1% of cases and arthritis without any definitive diagnosis for 40.4%. Median age at diagnosis was 2.7 years (IQR 0.3–14.6) and was lower in the septic arthritis group (1.5 years; 1.1–3.4) than in the JIA group (4.7 years; 2.5–10.9) (p<0.01). Septic arthritis involved a single joint in 97.3% of cases, while JIA involved four joints in 14.3% of cases and two to four joints in 28.6% of cases (p<0.01).ConclusionsSeptic arthritis was the most frequent cause of arthritis in hospitalised children. Despite the increasing application of microbiological molecular methods to synovial fluid analysis, further measures are required to improve the diagnosis of arthritis of unknown cause.

Download Full-text

Evaluation of hearing loss by pure tone audiometry in chronic suppurative otitis media patients

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20182948 ◽

2018 ◽

Vol 4 (5) ◽

pp. 1173

Author(s):

Prakash S. Handi ◽

Mallikarjun N. Patil ◽

K. R. Prasenkumar

Keyword(s):

Hearing Loss ◽

Pure Tone ◽

Bone Conduction ◽

Pure Tone Audiometry ◽

Ossicular Chain ◽

Poor Quality ◽

Suppurative Otitis Media ◽

Mixed Hearing Loss ◽

The Status ◽

Preoperative Status

Background: Hearing loss associated with the CSOM affects the patients’ communication with others and results in poor quality of life. Degree and type of hearing loss can be assessed by pure tone audiometry, which helps in predicting the status of tympanic membrane, ossicular chain, and inner ear and also helps in preoperative planning.Methods: Patients with CSOM aged 10 years and above were included in the study. All patients underwent pure tone audiometry. With the help of air and bone conduction threshold, the degree and type of hearing loss in each ear was determined. The data collected was evaluated and results are reported as rates and proportions (%). Results: Most of the ears (83%) had mild to moderate hearing loss. Average ABG observed was 31 dB. Maximum ABG observed was 55dB on right side and 50 dB on the left side. There was mixed hearing loss in 10.9% cases.Conclusions: This study reinforces the idea of using preoperative pure tone audiometry, which not only helps in planning surgery but also helps in documenting the preoperative status of patients’ sensorineural hearing loss, if present.

Download Full-text

Pathar dye (paraphenyldiamine) poisoning: our experience of this lethal emerging health problem in a tertiary care centre

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20174332 ◽

2017 ◽

Vol 3 (4) ◽

pp. 1056

Author(s):

Shivani Nautiyal ◽

Shashwat Tiwari ◽

Kumar Ashutosh

Keyword(s):

Health Problem ◽

Public Awareness ◽

Tertiary Care ◽

Case Series ◽

Medical Emergency ◽

Tertiary Care Centre ◽

Hair Dye ◽

Medical College ◽

Case Series Study ◽

Initial Symptoms

<div class="page" title="Page 1"><div class="section"><div class="layoutArea"><div class="column">Background: The aim of this case series study is to share our experiences regarding paraphenylenediamine (PPD) poisoning, its otolaryngological clinical presentation ,outcomes and need of tracheostomy in patients of hair dye poisoning at GSVM Medical College, Kanpur, U.P.Methods: This prospective study was carried out on 165 patients who presented in GSVM medical college Kanpur in period of December 2012 till December 2014. Data including demographic features (age, sex, marital status, socio-economic status), clinical features, laboratory findings, mode of intoxication (accidental or suicide) were collected and recorded. Results: A majority of the patients were young females (21-30 years) and belonged to a low socioeconomic class. The main cause was intentional suicidal ingestion. Cervicofacial edema, stridor, hoarseness of voice and pain in throat were initial symptoms. Tracheostomy was needed in 115 (69.69%) patients. Mortality of 21 (12.72%) patients was observeds.Conclusions: It is a major emerging health problem with high mortality. It is a medical emergency and early intervention is needed to save patient's life. It is imperative to raise public awareness of the potential toxicity of the dye as well as to educate physicians about the need for aggressive and early treatment. </div></div></div></div>

Download Full-text

Peripartum hysterectomy: a five year review at a tertiary care centre

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20173490 ◽

2017 ◽

Vol 6 (8) ◽

pp. 3590

Author(s):

Deepak A. V. ◽

K. J. Jacob ◽

Sumi P. Maria

Keyword(s):

Tertiary Care ◽

Case Series ◽

Case Fatality ◽

Tertiary Care Centre ◽

Retrospective Case ◽

College Hospital ◽

Peripartum Hysterectomy ◽

Medical College ◽

Obstetric Haemorrhage ◽

Suboptimal Care

Background: Peripartum hysterectomy is a life-saving procedure resorted to when conservative measures fail to control obstetric haemorrhage. Several predisposing factors, suboptimal care and lack of infrastructure may lead to this emergency procedure. We wanted to find out factors associated with peripartum hysterectomy and the adverse maternal outcomes at our centre.Methods: A retrospective case series analysis of 40 cases of peripartum hysterectomy performed over a period of 5 years from January 2010 to December 2014 at Government Medical College Hospital, Thrissur, Kerala was done.Results: The incidence of peripartum hysterectomy was 0.29%. The most common indication for peripartum hysterectomy was hysterectomy was uterine atony (50%). Thirty-five women (88%) were between 20 and 35 years. Most of the subjects were unbooked. There were two maternal deaths (case fatality rate of 5%) following peripartum hysterectomy during this period. All the subjects required blood transfusion.Conclusions: Prompt performance hysterectomy before the patient’s clinical condition deteriorates is the key to success. The incidence of adherent placenta is increasing, so every effort should be taken to reduce the caesarean section rates globally.

Download Full-text

S153 – Radiological Balloon Dilatation of Neo-Pharyngeal Strictures

Otolaryngology ◽

10.1016/j.otohns.2008.05.327 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P127-P128

Author(s):

Robert L Harris ◽

Grundy Alan ◽

Tunde A Odutoye

Keyword(s):

Total Laryngectomy ◽

Balloon Dilatation ◽

Malignant Disease ◽

Outcome Measure ◽

Tertiary Care ◽

Case Series ◽

Stent Insertion ◽

Care Centre ◽

Tertiary Care Centre ◽

Main Outcome Measure

Objectives Radiological balloon dilatation of lower oesophageal strictures is common practice. Other than some early reports from our own centre, there is little published regarding radiological dilatation of pharyngeal and upper oesophageal strictures and less still on radiological balloon dilatation of post-total laryngectomy and pharyngolaryngectomy neo-pharyngeal strictures. Standard practise is bouginage under general anaesthaesia. The objective of this study is to assess the efficacy of radiological balloon dilatation for the treatment of dysphagia secondary to neopharyngeal strictures in patients who have undergone laryngectomy. Methods A tertiary care centre case series of 20 consecutive patients (17 males and 3 females aged 40 to 84) with pharyngeal stricture and dysphagia post-total laryngectomy or pharyngolaryngectomy who underwent balloon dilatation of the stricture under radiological guidance. Maintenance of swallowing was the main outcome measure. Results 5 patients gained relief of their dysphagia with 1 balloon dilatation only. 9 patients required more than 1 dilatation to maintain swallowing. 2 patients had balloon dilatation procedures and stent insertion for palliative relief of dysphagia from known recurrent malignant disease. 3 patients failed to maintain swallowing with repeat dilatations. No patients suffered any significant complications such as perforation. Conclusions Balloon dilatation is minimally invasive and less traumatic than rigid pharyngoscopy with bouginage dilatation. It is well tolerated. It may be repeated frequently and can successfully relieve strictures of the pharynx in patients who have undergone total laryngectomy or pharyngolaryngectomy.

Download Full-text