Segmental Facial Nerve Decompression in Patients of Chronic Suppurative Otitis Media with Diabetes Mellitus

Introduction: Facial nerve decompression is opening the bony canal and nerve sheath to release pressure and reduce compression on nerve fibers. The goal of decompression is to improve blood circulation and minimize damage to distal nerve fibers. Methodology: We present study of 20 patients who came to ENT OPD, From June, 2017 –March, 2020 presented to us with non-traumatic facial palsy grade III and above; in whom we did facial nerve decompression via trans-mastoid approach. Conclusion: Segmental decompression of facial nerve with masoidectomy provides better results than mastoidectomy alone because it enables expansion of nerve, reduces post-operative oedema and less need for steroid administration in diabetic patients with better clinical outcome.

Characteristics of Presbycusis in A Super-Aged Society

Objectives: To estimate presbycusis' characteristics and investigate whether any changes have occurred in the pathophysiology of presbycusis over the decades. Methods: This was a retrospective cross-sectional observational study. A total of 186 patients aged ≥ 65 years were selected for the elderly group; they included patients with mild-to-moderate sensorineural hearing loss of unknown cause. For the middle age group, 56 patients aged 30–50 years who had positive results for the recruitment phenomenon were selected as controls. The participants’ age, sex, pure-tone hearing levels of air conduction (125–8000 Hz), maximum speech discrimination score (SDSmax), and the presence or absence of the recruitment phenomenon were investigated based on medical records. Results: Sixty-one patients in the elderly group were aged ≥ 80 years. Hearing levels were significantly better in male patients in the low-frequency range and significantly better in female patients in the high-frequency range (p < 0.01). In the elderly group, the proportion of patients with poor speech discrimination was 52.4–70.2%. The SDSmax was significantly higher in female patients than in male patients (p < 0.01). The proportion of patients with the recruitment phenomenon was 93.5%. The audiometric hearing pattern was dominated by a gradual-down slope, high-frequency-impaired, and flat patterns. There were significantly more female patients with a flat pattern and significantly more male patients with a gradual-downslope pattern and U-shaped pattern (p < 0.01). Age, sex, mean pure-tone hearing level, and audiometric hearing pattern significantly affected the SDSmax (all, p < 0.05), as evaluated with multiple regression analysis. Conclusion: More than half of the elderly patients with mild or moderate hearing loss were estimated to have retrocochlear damage. The age of hospital visitors for presbycusis was found to have increased over time. However, the distribution of pathophysiologies was not different from that in previous studies performed with relatively younger patients. This suggests a shift of patients presenting with presbycusis toward an older age range.

Utilization of an Application in Dizziness Treatment: Pilot Study

Vestibular Rehabilitation (VR), a method of therapy for dizziness, aims at reestablishing body balance and also at facilitating central compensation by means of adaptation and substitution mechanisms. With technological advance, the feasibility of a device which aided in VR process took place, both for stimulating and monitoring patients. In that sense, an application called Dizziness APP was developed in order to simplify and automatize dizziness therapy process performed by the phonoaudiology professional. The aim of the present study was to report a Dizziness APP experience of usage as therapeutic strategic towards dizziness, besides comparing dizziness impact on quality of life before and after using that application. It is a descriptive, exploratory study with a qualitative approach. A subject, age 29, female gender, took participation in the present study being solely subjected to Vestibular-Ocular-Reflex (VOR) Exercises by means of vertical, horizontal and oblique optokinetic stimulation during a period of six months. The scores obtained on Dizziness Handicap Inventory (DHI), monthly, expressed by the utilization of an automatized and simplified digital process available on the Dizziness APP application, were used. Initial DHI score achieved 46 points and, upon treatment conclusion, 0 point. Using Dizziness APP as a therapeutic resource enabled the following up, monitoring and remission of dizziness symptom demonstrating the beneficial effects by means of optokinetic exercise during the Dizziness APP process of validation.

Comparative Characteristics of Bone-Plastic Materials for Mastoidoplasty

The paper presents the results of the comparative characteristics of the use of various bone-plastic materials for mastoidoplasty. The study included 30 patients who underwent an open-type sanitizing operation with mastoidoplasty with osteoplastic materials. When comparing drugs, the following criteria were used: 1) convenience of modeling the material; 2) the course of the wound process; 3) osseointegration - the process of formation of "new bone tissue (CT of the temporal bones 6 and 12 months). As a result, it was confirmed that the samples of the main groups of bone replacements studied by us. preparations (biositalls, composite materials and β- tricalcium phosphates) can be successfully used in mastoidoplasty after open types of sanitizing operations on the middle ear.

Surgical Treatment of Malignant Otitis Externa MOE A New Hope Although Challenging

Objective: Malignant external otitis is an aggressive inflammatory condition of the external auditory canal. Most often affects elderly patients with diabetes mellitus. This is a serious disease which spreads in the skull base associated with cranial nerve complications and high morbidity-mortality rate. Malignant otitis externa requires urgent diagnosis and treatment. The primary and most effective treatment is to control the diabetes and to fight infection with the proper antibiotic in adequate dose and duration. If medical treatment fails aggressive surgical management is the only option to save life. We present a short experience in the management of this disease. The aim of this study was to present our experience with the surgical management of malignant otitis externa. Methods: All patients' records with malignant otitis externa during the last 5 years (2007-2012) were retrieved and reviewed. Diabetes mellitus profile, erythrocyte sedimentation rate, ear swab for culture and sensitivity, computed tomography, were investigated for all patients. Results: During the last 5 years (2014-2019), 5 patients with the diagnosis of malignant otitis externa were admitted to our hospital for investigation and treatment. All between 60 and 70 years of age, with severe persistent otalgia, purulent otorrhea, granulation tissue in the external auditory canal, and diffuse external otitis, and there were 2 patients with facial nerve palsy. Patients were confirmed to have diabetes. Ear swabs for culture and sensitivity usually revealed Pseudomonas aeruginosa. One patient by systemic antibiotic and two patients were treated by Local debridement and systemic antibiotics were sufficient to control the disease. Two patients were treated by aggressive surgical debridement (skull base debridement) with 360degree Facial nerve decompression. Patients were recovered from dreadful necrotizing infection but with facial paralysis. Conclusion: Malignant otitis externa is still a serious disease associated with cranial nerve complications and high morbiditymortality rate. The primary and most effective treatment is to control the diabetes and to fight infection with the proper antibiotic in adequate dose and duration, debridement of necrotic tissue, and sometimes aggressive surgical management. Monitoring of therapy response is done through normalization of erythrocyte sedimentation rate, control of diabetes mellitus.

The Importance of Duration in the Prognosis of Facial Nerve Palsy and Its Treatment-A Case Report

Background: Facial nerve palsy is considered to be one of the most common consequence of untreated chronic suppurative otitis media. The incidence has significantly reduced over the decade due to better imaging technology and use of early antibiotics and better surgical procedures but if left untreated, it has a significant impact over the patient’s day to day life and markedly affects patient’s social life and causes serious psychological damage. An appropriate and prompt management ensures healing of the palsy without sequelae. Case Report: We report a case of bilateral chronic suppurative otitis media with unilateral right grade 4 facial nerve palsy which happened within a duration of 1 month for which patient underwent right modified radical mastoidectomy following which she had steady improvement. Conclusion: This case highlights that in patients with middle-ear cleft cholesteatoma the surgical approaches vary according to duration of palsy and post-operative improvement in facial nerve function can be anticipated in cases of acute palsy. Surgical interventions have been proved to have a good effect in restoration of facial nerve palsy in cases of shorter duration as compared to those of sudden onset and longer duration.

Thorwaldt’s Cyst: Management by Combined Endoscopic Approach and Literature Review

Thornwaldt cysts occur in the midline bursa of the nasopharynx above the upper border of the superior constrictor muscle. They represent a communication between notochord remnants and the pharyngeal endoderm. It is usually asymptomatic unless an infection or obstruction occurs, then, a Thornwaldt's cyst might develop. It is relatively uncommon, with a prevalence rate of 0.2% to 4%. Due to its nonspecific symptoms, physician often misdiagnose thornwaldt cyst. It is usually diagnosed as an incidental finding on MRI. Surgical excision is the definitive treatment. This paper describes a case of thornwaldt cyst in a 39 years old gentleman presented with neck stiffness. It also includes a literature review that aids in the clinical suspicion, prevalence, diagnosis, and treatment of thornwald cyst.

Human Dirofilariasis: A Case of Infraorbital Infection

Background: Human dirofilariasis is not perceived as a serious public health concern in India despite more number of sporadic cases being reported of late. Only a few dozen cases were reported in the first decade of the new millenium, but the number is gradually increasing during the last decade. With a high population of pet dogs & cats and vast number of stray dogs, the State of Kerala could be a potential infective area. Case Report: It is against this background that an interesting case of infraorbital incidence of dirofilaria repens is being reported that was mimicking as periorbital cellulitis. The cyst was surgically excised and sent for histopathological examination. The presence of Dirofilaria repens was confirmed. Conclusion: There has been an increase in the incidence of dirofilariasis in countries that were considered as non-endemic such as India of late. The probable contributing factors are discussed in detail. Coordinated parasite surveillance and preventive vector control measures with active participation from LSGs and local population are suggested.

Pseudoparalysis of Marginal Mandibular Nerve Branch by Big Submandibular Gland Sailolith: A Case Report

Sailolithiasis is the second most common etiology of salivary gland after sialadenitis. Present case of 29 years old male patient with giant submandibular sailolith with stony hard feel below the left angle of the mandible. X ray and CECT neck used for confirmation. Because of big stone incidental finding of pressure paresis of marginal mandibular nerve was noticed. Even patient unaware of that. En-block Submandibular salivary gland excision was done by trans-cervical approach with complete recovery of the nerve within 3-4 post-operative weeks.

Use of Biodegradable Implant in Rhinoplasty and Nasal Septum Surgery

The nasal septum has a significant influence on the form and function of the nose, as it is a key element of the nasal framework. Its shape, size, position, and integrity help determine not only the patency of the nasal fossae but also the appearance of the nasal pyramid. Achieving satisfactory functional and aesthetic results presents a real challenge for the surgeon in a wide range of nasal septal deformities. During the last decade, the absorbable biodegradable plate DePuySynthes Rapidsorb fixation system has been used to repair pediatric facial fractures. It provides stability during the initial period of healing until the bony fracture segments have reunited. There are many differently sized and shaped plates with varying thickness available. We believe this is a useful technique to improve the rate of septoplasty success, and with further experience, the indications and role in septal surgery can be better defined.