Post-traumatic temporal bone pneumatocele presenting after aggressive Valsalva

We report a case of a temporal bone pneumatocele with full-thickness erosion of the cranium associated with aggressive nose blowing. This condition presented 9 years after traumatic fracture of the temporal bone. There are 17 reported cases of mastoid sinus hyperpneumatisation in the literature. Eleven of the 17 are associated with Valsalva manoeuvres or elevated middle ear pressure. However, no other cases of full-thickness erosion at the site of a former fracture have been reported. We propose that the fracture, in combination with elevated mastoid sinus pressure from aggressive nose blowing, led to escape and trapping of pressurised air in the epidural and subcutaneous spaces, which resulted in bone erosion.

Association between Adenoid-Nasopharyngeal Ratio and Tympanogram Width in Adenoid Hypertrophy Patients

Introduction Adenoid hypertrophy is a change in adenoid size that can lead to obstruction the Eustachian tube and become a risk factor for otitis media effusion (OME) in children. Standard objective examination of adenoid hypertrophy uses adenoid-nasopharyngeal ratio (A-N ratio) based on correct lateral skull radiography. Adenoid hypertrophy is one of the factors causing OME in children. There is still much debate about the association between A-N ratio and tympanogram width (Tw). Determining the association of A-N ratio and Tw in adenoid hypertrophy patients. Methods Participants performed a true lateral radiographic examination using Fujioka method to determine A-N ratio, and Tw to determine middle-ear pressure. The distance between examination of A-N ratio and tympanogram examination was at maximum of ~1 week. The association between A-N ratio and Tw in patients with adenoid hypertrophy used the Pearson correlation test. This research employed significance level p < 0.05. Results Most participants were aged between 6 and 10 years (38.10%), male patients (57.14%), and the symptom most participants complained of was snoring during sleep (38.10%). Most participants had A-N ratio of 0.53 to 0.70 (61.90%) with an average of 0.60 ± 0.05. The average value of Tw measurement was 102.83 ± 50.03 daPa (r = 0.605; p < 0.001). Conclusion There is a significant association between A-N ratio base on true lateral radiographic examination and Tw in adenoid hypertrophy patients.

A STUDY ON OSSICULOPLASTY

The diagnosis of chronic otitis media (COM) implies a permanent abnormality of the pars tensa or acida, most likely a result of earlier acute otitis media, negative middle ear pressure or otitis media with 1 2 effusion . Ossiculoplasty is a micro surgical operative procedure, performed to repair or reconstruct the ossicular chain . Present study was done to nd out the epidemiology and hearing result after ossiculoplasty. Materials and methods Study design –Retrospective study Study setting – Tertiary care hospitals in south India. Study period - Over a period of 3 years (from July 2017 to June 2020) Sample size – 55 Methodology - All the patient with COM and ossicular chain damage were considered for study. Data was collected from the medical record department and analyzed. Results - Study was to be done to nd out the natural behavior of the disease, COM with ossicular damage and how it can be managed effectively. In our study of 55 cases of ossiculoplasty, followings are nding1. 52.72% are male and 47.27% are female. And the male to female ratio is 1.11:1. 2. Mean age of the patient is 27.63. 3. Most common ossicle involved was incus. 4. Mean improvement in ABG is 15.49 and in 87.2% of patients ABG closure was with in 20dB.

P021 Does Obstructive Sleep Apnea (OSA) lead to impairment within the cochlea?

Introduction The cessation of breathing with OSA is linked to the continuous decrease in oxygen saturation throughout the night which could impact the inner ear as it is sensitive to hypoxic changes. Inner ear hair cells response from the cochlea is measured through Transient Otoacoustic Emission (TEOAEs). This study aimed to evaluate TEOAEs in suspected OSA patients and its correlation with oxygen saturation. Methods TEOAEs were measured before sleep and in the morning in suspected OSA patients and healthy participants. The following frequencies were measured: 1000Hz, 1500Hz, 2000Hz, 3000Hz and 4000Hz. Polysomnography with oxygen saturation was completed overnight. Preliminary analysis was completed on 11 no OSA, 22 mild OSA, 13 moderate OSA and 27 severe OSA patients. Results One-way ANOVA with Tukey post-hoc analysis revealed a difference between severe vs mild with average TEOAE only (p = 0.04). A moderate correlation was found between average TEOAE and minimum O2 saturation, rs (72) = 0.444, p&lt; 0.0001) through Spearman’s rank-order correlation. As middle ear function can impact TEOAE results, regression analysis revealed an association between a decrease in TEOAE and lowered minimum O2 saturation (F (1,63) = 8.951, p = 0.004, partial n2 = 0.124) when middle ear pressure was controlled. Discussion Oxygen desaturation with OSA is associated with a decrease in inner ear hair cells response, which was independent from middle ear function. Despite this association, a difference in TEOAE was only found between severe vs mild, which could be due to the current sample size of the preliminary data.

Pathogenesis of Retraction Pocket of the Tympanic Membrane—A Narrative Review

Several theories describe the development of the retraction pocket of the tympanic membrane (RP). Many authors suggest that the negative middle ear pressure is the main reason responsible for developing this condition. A narrative review has been undertaken, and conclusions are drawn reflecting a current knowledge with our new observations in the histological and immunohistochemical study. Recent studies show the important role of inflammation in the development and progression of RP. A review of the available literature shows that the inflammation plays a key role in pathogenesis of the RP and its progression to the cholesteatoma. We support this statement with our new results from histological and immunohistochemical analysis of the RPs.

Effects of Enlarged Adenoids on Middle Ear Pressure and Hearing

Background: Adenoids are common childhood upper respiratory tract problem which frequently obstruct the nasopharyngeal opening with tubal occlusion causes reduction in middle ear pressure with conductive hearing loss. Objective: To observe middle ear pressure and level of hearing in children with enlarged adenoids. Methods: This cross sectional observational study conducted among 72 children of enlarged adenoids admitted or attended in Dhaka Medical College Hospital and Bangabandhu Sheikh Mujib Medical University Dhaka. Results: 72 children of enlarged adenoids of age ranges between 5-12 years with male female ratio was 1.25:1. Mouth breathing (65.27%), hearing impairment (59.72%), nasal obstruction (55.55%) and snoring (56.94%) were the presenting symptoms of the patients. Majority of the patients of this study came from middle class (52.77%). Most of the patients with enlarged adenoids were grossly enlarged (51.38%). 43.05% grossly enlarged adenoids had significant hearing loss . In this series 65 ears (45.13%) had type A Tympanogram. 58 ears (40.27%) has Type B Tympanogram and 21 ears (14.58%) has Type C Tympanogram. Conclusion: This study revealed significant association between enlarged adenoids and conductive hearing loss of variable degree and negative middle ear pressure. Bangladesh J Otorhinolaryngol; April 2021; 27(1): 73-80