Transcranial direct current stimulation (tDCS), a treatment option for tinnitus in profound hearing loss

A 45-year-old man presented with a history of sudden sensory neural hearing loss and severe tinnitus in his left ear. Audiological investigations revealed a profound hearing loss on his left ear and mild conductive hearing loss on his right. Tinnitus pitch and loudness were matched to a 4 kHz narrow-band noise at 50dBHL and subjective tinnitus questionnaires revealed that he had a catastrophic handicap (grade IV). Traditional audiological treatment approaches (tinnitus maskers, hearing aid and sound therapy) that stimulate the cochlea to induce cortical reorganisation were futile. Hence, a top-down approach (transcranial direct current stimulation (tDCS)) to directly modulate the cortical centres was attempted. tDCS was provided for a sum of 15 sessions across 2 phases. There was a substantial improvement in the tinnitus loudness, distress and depression scores which maintained for 3 months post-treatment. tDCS is a potential treatment for phantom perceptions (tinnitus) in cases of profound sensory neural hearing loss where there is no residual sensory ability. Tailor-made approaches seem to be more appropriate until a standard protocol for tDCS in tinnitus is established.

A REVIEW ON ROLE OF VACHA ARKA KARNAPOORANA IN BADHIRYA W.S.R TO SENSORY NEURAL HEARING LOSS

Ear is a very important sensory organ of hearing. Loss of hearing has a very negative impact on one’s social, pro- fessional and personal life. According to WHO (1st March 2020), there are over 5% of the world’s population are suffering from hearing loss. It is estimated that by the year 2050, 1 in every 10 people will have hearing loss. There are many modern interventions which have been used nowadays like hearing aids, etc. But it is not possible for everyone to afford such treatment. To provide effective and alternative treatment for the betterment of society with simple and less expensive local administrative treatment with the help of Ayurvedic modalities i.e. Karnapoorana (instillation of medicated volatile oil into external auditory canal) of Bilwa Taila (Bilwa oil), Katu Taila (Katu oil), Arka (volatile oil), etc. Arkas are prepared by the combination of Jala (water) and Agni (fire) and it assimilates in the body very quickly, hence it can be used in the management of Badhirya (dwindle hearing). Considering all this, the study is planned for the Evaluation of Vacha Arka Karnapoorana in Badhirya W.S.R. To Sensory Neural Hear- ing Loss. Keywords: Sensorineural hearing loss, Vacha Arka, Badhirya, Karnapoorana.

APPROACHING SENSORY NEURAL HEARING LOSS THROUGH AYURVEDA - A SINGLE CASE REPORT

Objectives: Sensory Neural Hearing Loss (SNHL) is caused by damage to the structures of the inner ear or the auditory nerve. It is the cause of more than 90 percent of hearing loss in adults. It can interfere with your ability to communicate if not properly managed. SNHL has no permanent cure, in modern medication it is managed by application of Hearing aid or surgical intervention like cochlear implant depending upon the condition. Thus, here we are aiming for the management of SNHL without surgical intervention and improving the condition through the application of Ayurveda. Methods: A 60- year old elderly male adult approached OPD of SJIIM Bengaluru, complaining of decreased hearing in both the ears along with tinnitus since 2months. He was taken in for treatment after assessment. Result: After 6 months of treatment there was relief from tinnitus and improvement in hearing. Conclusion: There will be halt in the progression of the disease as well as improvement in hearing by following the Ayurvedic protocol, which will in return also improve the quality of life.

Profil Klinis dan Laboratoris Infeksi Sitomegalovirus Kongenital di Rumah Sakit Umum Pusat Dr. Sardjito

Latar belakang. Sitomegalovirus (Cytomegalovirus/CMV) kongenital merupakan infeksi yang menimbulkan beban kesehatan yang berat bagi anak dan keluarga. Manifestasi infeksi CMV kongenital, antara lain, jaundice, trombositopenia, mikrosefali dan kalsifikasi intrakranial. Di Indonesia, data mengenai profil klinis dan laboratoris infeksi CMV kongenital belum banyak dilaporkan, terutama di RSUP Dr. Sardjito, Yogyakarta. Tujuan. Mengetahui profil klinis dan laboratoris infeksi CMV kongenital pada pasien anak di RSUP Dr. Sardjito.Metode. Penelitian observasional ini dilakukan dengan melihat rekam medis pasien usia kurang dari 2 tahun dengan infeksi CMV kongenital, yang dirawat inap di RSUP Dr. Sardjito dari Januari 2012 sampai Juli 2017. Hasil. Selama periode penelitian terdapat 36 pasien dengan infeksi CMV kongenital. Manifestasi klinis yang paling mendominasi adalah tetraparesis spastik (12,5%), mikrosefali (25,81%), hepatomegali (22,86%), sensory neural hearing loss (SNHL) (23,81%), atrofi cerebri (40,00%), dan kalsifikasi intrakranial (72,73%). Manifestasi laboratoris ditemukan IgG positif 100%, IgM positif 30,30%, antigenemia positif 100%, anemia 50,00%, neutropenia 40,00%, peningkatan SGPT 61,11%, dan bilirubinemia 75,00%. Kesimpulan. Manifestasi klinis berdasarkan pemeriksaan klinis yang paling banyak ditemui adalah mikrosefali dan manifestasi laboratoris yang paling banyak ditemui adalah IgG positif dan antigenemia positif.

Prevalence of sensorineural hearing loss in patients with head and neck malignancy who underwent chemotherapy and or radiotherapy

<p class="abstract"><strong>Background:</strong> Our study aimed to focus on the importance of the rate at which the sensory neural hearing loss (SNHL) is caused by chemotherapy (CT) and or radiotherapy (RT). This study also tells about the importance of informing the patient and the caretakers prior to the start of treatment for carcinoma, so that they can be prepared for it if it happens. </p><p class="abstract"><strong>Methods:</strong> Total 75 patients who were diagnosed to have any form of head and neck malignancy formed the study group. Pure tone audiometry was recorded pre-treatment, one month after treatment and six months after treatment. All the data obtained were bio statistically analysed by running in SPSS software version 26. </p><p class="abstract"><strong>Results:</strong> There is a correlation between CT, RT and concurrent chemo radiotherapy (CRT) and SNHL. It is also found that most of the patients who have undergone CRT suffered SNHL in the long run. </p><p class="abstract"><strong>Conclusions:</strong> It is high time the patients are made aware of the side effects like SNHL before the start of the proposed treatment. This will allow them to be prepared and then face it. </p><p> </p>

A study on the association of cervical spondylosis severity, as indicated by cervical motions, with hearing impairment

Study aim: The present study investigates the possible relation between the limitation of cervical motion in a patient with cervical spondylosis and hearing impairment. Material and methods: Cross-sectional research was performed based on 60 participants suffering from cervical spondylosis (CS) selected from an orthopaedic and physiotherapy department. The data collection techniques included questionnaire, electronic tools, measurements with a mechanical device including measuring the cervical range of motion (ROM) by goniometer, and physical examination including pure tone audiometry (PTA) and tympanogram. Results: Right rotation was the most common limitation, which affected 43 patients, followed by left rotation limitation, which was recorded in 40 patients. The extension, left lateral flexion, flexion, and right lateral flexion limitation showed less effect. Conclusions: Left rotation limitation was found to be an independent predictor of hearing impairment especially in men. Age was also a risk factor for sensory neural hearing loss (SNHL). These findings are important in the facilitation of investigating SNHL in cervical spondylosis patients.

Does Drilling Induce Hearing Loss after Modified Radical Mastoidectomy? A Retrospective Study

Introduction Incidence of sensory neural hearing loss following mastoid surgery varies from 1.2 – 4.5%.There are various causes for postoperative sensorineural hearing loss during mastoid surgery. This study aims to identify whether there is any correlation between drilling and postoperative sensory neural hearing loss. MethodsA retrospective study was conducted in the Department of ENT from January 2018 to June 2019. A total number of 68 patients above five years of age who underwent modified radical mastoidectomy for chronic otitis media squamous were included. Revision surgery, preoperative sensorineural hearing loss, injury to the ossicular chain during surgery, patients with lack of follow up or doubtful reports in mentally challenged were excluded from the study. The average bone conduction threshold was calculated from 500, 1000, 2000, 4000 Hz and compared using the Wilcoxon signed-rank test. ResultsThere were 43 males and 25 females in the study with a median age of 23.5 years (16-55). The mean preoperative bone conduction threshold in the four frequencies of 500 Hz, 1kHz, 2kHz, 4kHz were -2.06dB, -2.06dB, 3.31dB, 4.63 dB respectively and the mean postoperative bone conduction thresholds were 1.03, 1.32, 5.29, 4.04 respectively. There was a decline of mean of 3.09 dB and 3.38dB only at the low-frequencies (500Hz and 1kHz) BC threshold respectively which were statistically significant, whereas at higher frequency there was no decline in average postoperative BC threshold. ConclusionThere is no definite role of drill in inducing hearing loss and if present other causes of hearing loss should be sought in postoperative sensorineural hearing loss.

Recurrent bilateral breast abscess due to Mycobacterium abscessus in an immune-competent woman

Mycobacterium abscessus is a rapidly growing, non-tubercular mycobacteria, often associated with skin and soft tissue infections. We report a case of 57-year-old immune-competent woman who suffered recurrent bilateral breast infection for 6 years. She did not benefit from repeated surgical interventions and multiple courses of antibiotics, and one course of empirical antitubercular therapy. Chronicity of the presentation and non-response to varied treatment interventions prompted further microbiological investigations. The patient was diagnosed with M. abscessus and treated with rifabutin, clarithromycin daily for 6 months and injection amikacin for 1 month. Amikacin was replaced with oral levofloxacin due to bilateral sensory-neural hearing loss for higher frequencies after 6 months. Suspicion and identification of NTM are important as the treatment involves long-term combination antibacterial therapy along with surgical debridement for extensive infection or when implants are involved.

Extended High Frequency Audiometry for Revealing Sudden Sensory Neural Hearing Loss in Acute Tinnitus Patients

Introduction The measurement of extended high-frequency (EHF) audiometry has become more popular recently, mainly in connection with ototoxicity and noise-induced hearing loss. New-onset tinnitus evaluation includes a standard hearing test that shows no pathology. Objective The aim of the present study was to evaluate the possibility that acute tinnitus is essentially connected to sudden sensory neural hearing loss (SSNHL), by utilizing EHF audiometry in cases in which standard audiometry for frequencies between 8 kHZ to 8000 Hz is within normal limits. Methods A retrospective study was conducted between January 2009 and May 2014 that included all patients presenting with acute tinnitus and normal standard audiometry. All patients underwent EHF audiometry and were treated accordingly. Results Thirty-two patients with acute tinnitus and asymmetric sensorineural hearing loss on EHF audiometry were identified. The average deltas between the ears were between 9.2 and 33 dB (worse in the affected ear). Conclusion Extended high-frequency audiometry up to 20,000 Hz should be performed in all patients with acute tinnitus and standard audiometry within normal limits.