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Introduction Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) virus mainly affecting the respiratory and circulatory system. In many, neuro-otological changes have been noted – tinnitus being one of the leading clinical manifestations which has skipped the limelight due to the other deadly complications of the disease. The study aims to assess the relation between COVID-19 infection and tinnitus, its relation with vaccination against COVID-19 and to assess the change in intensity of tinnitus at the end of 10 weeks after medical treatment in the patients with and without a positive COVID-19 RTPCR (Reverse Transcription-Polymerase Chain Reaction) report. Materials and Methods An institution based prospective comparative study was done in a tertiary hospital in Kolkata, West Bengal between July 2021 to December 2021. All patients aged between 18 and 65 years, with recent onset of subjective tinnitus since March 2020 (COVID-19 1st wave), were included in this study. Intensity of tinnitus was assessed at the end of 10 weeks after medical treatment with the help of Tinnitus Handicap Inventory (THI). Results Among the 84 patients with tinnitus - 20 had a history of (H/O) COVID-19 infection, 64 didn’t. Among the 20 patients who developed tinnitus post-COVID-19 infection, 2(10%) had been vaccinated while 39 out of the 64(60.9%) patients without a had been vaccinated against COVID-19 disease. At the end of 10 weeks post-treatment, 6 out of 20(30%) patients with a H/O COVID-19 showed an improvement in THI score– of them, 2 were vaccinated while 33 out of 64(51.56%) patients without a H/O COVID-19 showed improvement in THI score – of them 28 were vaccinated against COVID-19. Conclusion Our study concludes that the chances of developing tinnitus is more in those who have not been vaccinated against COVID-19 and post-medication improvement of tinnitus in COVID-19 infected patients was mu

Introduction Audio-Vestibular (AV) presentation as a consequence of COVID-19 is a less ventured zone. The aim of the study was systematically review the literature (both studies and case reports) published up to August 2021, in order to provide evidence on audio-vestibular symptoms in SARS-CoV-2, COVID-19 patients. Systematic review and meta-analysis was performed for assessment of prevalence of AV symptoms among COVID-19 patients. Materials and Methods A search of existing literature using key words and MeSH (Medical Subject Headings) terms was done. The methods were developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. 36 qualitative studies were narratively synthesized. Meta-analysis was performed on 18 quantitative studies Results Hearing loss was most commonly reported AV manifestation among case series / case reports. In the quantitative studies, the pooled estimate of Hearing loss, Dizziness and Tinnitus was 4.558%, 4.226% and 5.513% respectively. Other reported AV symptoms included ear ache, aural fullness and facial paresis. Conclusion Prevalence of AV symptoms in COVID-19 differs from that of the published literature. This prevalence of hearing loss is less than that reported amongst the world population. Structured community-based studies with homogeneous working definitions have to be conducted to assess the true prevalence.

Introduction Sclerosing inflammatory pseudotumor of the temporal bone is a rare fibro-inflammatory, benign albeit locally aggressive pathological entity. Case Report We report a case of Sclerosing inflammatory pseudotumor of the temporal bone, simulating a cholesteatoma. A 61-year-old female presented with right otalgia, hearing loss, facial pain and imbalance. Ear microscopy revealed a pulsatile mass in the external auditory canal. HRCT temporal bone and MRI reported soft tissue mass in the right middle ear and mastoid air cells, causing attenuation of the ossicles with erosion through the tegmen and mastoid cortex. The patient underwent canal wall down tympanomastoidectomy. The histopathology with immunohistochemistry was consistent with IgG4 related sclerosing inflammatory pseudotumor. Discussion This case report explores the similarities as well as the clinical differences between cholesteatoma and IgG4 sclerosing inflammatory pseudotumor of temporal bone, along with the diagnostic and treatment challenges. It is often mistaken for neoplasm or cholesteatoma, hence should be considered as a differential diagnosis.

Introduction The diagnosis of chronic otitis media (COM) implies a permanent abnormality of the pars tensa or flaccida. The definitive treatment of it is surgery. Restoration of hearing is by necessity a secondary consideration. Materials and Methods A prospective study was done from December 2017 to August 2019 in Department of ENT in a tertiary health care centre of eastern India. Total 50 patients were included in this study. Results Most of the patients (62%) are females and are within 30 years of age. Commonest ossicular defects are defects with incus. 82% patients gained hearing improvement >15 dB. Conclusion Our study shows that hearing improvement is greatest for type I tympanoplasty followed by cortical mastoidectomy, ossiculoplasty. Hearing improvement is inversely proportional to the incidence of post operative infection and complications.

Introduction The surgical treatment of Chronic Otitis Media by modified radical mastoidectomy usually results in an open cavity, with chronic discharge, hearing loss of 30 to 40 dB, frequent visits to OPD for debris removal and none the less dizziness on cold air exposure. One way to deal with these issues effectively is to obliterate the mastoid cavity. In our study we used vascularised periosteo-temporofascial swing flap with medicated bone dust to obliterate the mastoid cavity. Material and Methods In this prospective study, 50 patients who suffered from chronic otitis media, active squamous (cholesteatoma) disease, and underwent modified radical mastoidectomy with tympanoplasty procedure were and split between two equally sized groups. Group 1 had patients with open mastoid cavity and Group 2 had obliteration of mastoid cavity using vascularised periosteo-temporofascial swing flap with medicated bone dust. Patients were followed at 3rd week, 6th week, 3rd month and 6th month. Results Patients with cavity obliteration had better and statistically significant outcomes in term of discharge status of cavity and epithelization at 3 weeks. Patients with obliteration also had positive and statistically significant results in hearing levels and hearing gain at 6 months follow up. Conclusion Mastoid cavity obliteration with vascularised periosteo-temporofascial swing flap with medicated bone dust is a good and effective method for better post-operative outcomes and curtailing dependency on doctors for cavity care.

Introduction Tympanoplasty is the treatment of choice for patients suffering with Chronic Otitis Media (COM). Outcome of tympanoplasty depends on various factors like size and location of tympanic membrane perforation, ear ossicles, degree of otorrhea, cholesteatoma, smoking history, granulation tissue etc. Prediction of outcome of tympanoplasty procedure prior to surgery with respect to graft uptake and hearing improvement can serve as a crucial factor in decision making in resource limited nations. Hence, a study was conducted to evaluate the role of Middle Ear Risk Indices (MERI) in predicting the outcome among patients undergoing tympanoplasty procedure. Materials and Methods A prospective study at a tertiary care centre was conducted for a duration of 2 years among 60 patients with COM who underwent tympanoplasty. Results The mean age of patients was 25.32 ± 8.43 years with a male to female ratio of 3:2. Majority (78.46%) of the patients had Mild MERI score; 18.46% patients had moderate MERI score and 3.08% patients had severe MERI risk score. The difference in mean Air –Bone (AB) gap in the mild and moderate MERI groups’ pre and post operatively was found to be statistically highly significant (p<0.001). Conclusion Lower MERI scores prior to surgery showed significantly better outcomes with respect to graft uptake, degree of AB gap closure and hearing improvement.

Introduction Postoperative hearing outcome after tympanomastoid surgery may sometimes be disappointing. This study aims to identify the factors influencing hearing outcome in squamous type of chronic otitis media (COM). Materials and Methods Prospective descriptive study on consecutive patients undergoing tympano-mastoidectomy for squamous COM. Results Analysis of 40 ears revealed that 10% had discharge less than one year with majority (75%) having more than three years. Pars flaccida and postero-superior pars tensa retraction pockets were most common findings with frank cholesteatoma only in 10%. Though mean preoperative pure tone average was significantly better (p=0.004) in those with ear discharge less than one year, 50% required type IV tympanoplasty, irrespective of duration of discharge. Type IV tympanoplasty revealed significant worsening of hearing (p=0.05), unlike type I-III where intact stapes suprastructure showed a significant postoperative improvement (p = 0.036). Successful graft uptake with discharge free ear was noted in 97.5% by 12 weeks. Conclusion Majority of our patients availed otolaryngologist opinion after more than three years of onset of discharge. Significant ossicular erosion occurs early in the disease. Preoperative better audiogram is not a predictor of ossicular status. Lack of significant symptoms and subtle clinical finding in the tympanic membrane, overlooked by the patient as well as the primary health care provider are confounding factors for early referral and surgical intervention by otolaryngologist. There appears to be a considerable delay for the common person in reaching the services of otolaryngologist; a relevant issue which need to be addressed at a national level to reduce the burden of the disease.

Introduction Diabetes mellitus cases are increasing worldwide. It affects almost all systems of the body including audio-vestibular system. Diabetic otopathy (DO) is the presence of symptoms and signs of vestibular and auditory disorders in patients with diabetes mellitus after the exclusion of other causes. In this review we aimed to study the mechanism of development of hearing loss in diabetes, the relationship between duration and severity of diabetes, and association of other complications with hearing loss. Materials and Methods We searched the MEDLINE & PubMed database using terms ‘diabetic otopathy’ and ‘diabetes & hearing loss’ for the articles published since 1970. Twenty articles were selected and reviewed. Results The mechanism of development of DO is not yet clearly known. But it is suggested to be multifactorial. This review of literature suggested that hearing impairment is two times more prevalent in subjects with diabetes as compared to those without diabetes. The relationship between diabetic otopathy and diabetic kidney disease is most commonly noticed. Conclusion The higher prevalence of hearing impairment in diabetic patients compared with nondiabetic patients was consistent. It is necessary to establish a screening and monitoring strategy for patients with diabetes mellitus to prevent the development of hearing loss and its consequences on life quality.

Introduction Oral Submucous Fibrosis (OSMF) in severe cases involves palatal and paratubal muscles of Eustachian tube leading to Eustachian tube dysfunction and hearing disabilities. This study aims to evaluate to evaluate hearing status and Eustachian tube function in patients of Oral Submucous Fibrosis and to correlate them with various groups of the disease. Materials and Methods A Cross Sectional study was carried out in a Tertiary Care Hospital on diagnosed patients of OSMF. Patients with hearing loss due to other middle ear pathologies or previous ear surgeries were excluded. Patients were classified into various Groups depending on the severityof the disease. They were subjected to Pure Tone Audiometry and Impedance Audiometry. Results obtained were statistically analysed. Results A total of 121 patients (242 ears) were included in the study. On Pure Tone Audiometry, minimal hearing loss was found in 20(8.26%) ears while mild and moderate hearing loss was seen in 26(10.74%) and 28(11.58%) ears respectively. On tympanometry, Type B and Type C tympanograms(abnormal) were seen in 36(14.88) and 26(10.74%) ears, respectively. On Eustachian Tube Function Test, out of 242 ears, 67 ears (27.68%) showed Eustachian tube dysfunction. On using Pearson’s chi square test, significant association was found between degree of hearing loss, type of tympanograms and eustachian tube function with various groups of OSMF (p value < 0.05). Conclusion OSMF may affect hearing efficiency and Eustachian tube function as the disease progresses.

Introduction Two types of surgical procedures are performed for the treatment of Chronic otitis media (COM) mucosal disease, namely myringoplasty and tympanoplasty. In the present study, an objective, comparative evaluation between the outcomes of tympanoplasty, performed in the ‘wet ear’ and the ‘dry (non- discharging) ear’ has been undertaken. Materials and Methods A prospective study was conducted in a peripheral referral institute over a period of 37 months wherein a total of 105 patients with tympanic membrane perforation were selected, amongst which 56 patients had moist ear and 49 patients had dry ear. All of the patients underwent tympanoplasty by underlay technique. Final results were analyzed 12 months post operatively. Results In the wet ear group amongst 56 patients, 51 patients had successful graft uptake (91.07%). In dry ear group, among 49 patients, successful graft uptake was seen in 44 cases (89.79%). In the wet ear group 50 out of 56 patients had hearing improvement (89.28%). In dry ear group 44 out of 49 patients had hearing improvement (89.79%). Statistically significant results were obtained postoperatively in each group; however, inter group analyses showed no statistical significance. Conclusion Success rate of tympanoplasty does not depend upon the wet or dry state of middle ear at the time of surgery.

Introduction Outcome assessments have emerged as an effective method for determining whether or not hearing aids are working to achieve positive results in rehabilitating the hearing impaired. Present study aims to assess the satisfaction level of clientele using hearing aids. Material and Methods One hundred and fourteen (114) hearing handicapped patients, fitted with government-provided hearing aids at various clinics spread over Gangetic plains were included in this prospective observational study for outcome analysis. Follow up was done at 2 weeks and 45 days when they were further motivated to continue using the aid, comfortable fitting of mould was ensured along with minor trouble shooting. Four and half months later, their satisfaction level was assessed by analysing their response to Clientele Satisfaction Questionnaire. Results Fifty percent of the patients were motivated by their family members to try the aid whereas 50% were self motivated. Better communication with family members and immediate social circle was the common motive. Majority (85%) reported high level of satisfaction in terms of hearing benefit. Patients with severe degree of hearing loss were more satisfied and used the aid for longer duration in a day. Handling the aid was not as much of a problem as tolerating the noise produced by aid itself. Cost of battery was a concern for 80% of our clientele. Conclusion Proper fitting of hearing aid improved the quality of life of majority of our hearing handicapped clientele by overcoming their psychosocial problems.

Introduction This study aimed to document the effect of Auditory Verbal Therapy (AVT) with proper assessment and management in early intervention of a child with bimodal hearing. Bimodal Hearing is the use of a cochlear implant in one ear and a hearing aid in the opposite ear. Auditory Verbal Therapy is a highly specialist early intervention programme which equips parents with the skills to maximise their deaf child’s speech and language development. Case Report A male child aged 5 years 1 month had bilateral severe to profound hearing loss and speech-language problem. He was using cochlear implant in the right ear and BTE hearing aid in left ear (Bimodal hearing). Speech and language assessment revealed delayed semantic, syntax and pragmatic skills. Assessment of language development test showed poor receptive and expressive language score. The functional auditory performance indicator score indicated poor auditory function. Auditory verbal therapy hierarchy plan was used for treatment. Post 15 sessions after applying AVT the child’s listening and linguistic skills showed a great improvement. Discussion The scales used to measure the efficacy of AVT are found to be useful for the assessment and goal setting for intervention. Thus, appropriate quantification of various aspects of communication skills may describe its potential impact in this case under ADIP scheme.

Introduction An important accompaniment of Non-syndromic sensorineural hearing loss is family history and consanguinity. One of the widely studied single nucleotide polymorphism is the gap junction protein beta-2 (GJB2) gene which encodes the protein connexin26. This study aims to detect the frequency of W24X mutation in a population with non-syndromic sensorineural hearing loss concerning the degree of consanguinity. Materials and Methods The study includes 76 subjects with Non-syndromic sensorineural hearing loss. These subjects had congenital sensorineural hearing loss and other causes for the same had been ruled out. The SNP rs 104894396 was identified by the PCR-RFLP method. Results The frequency of the wild allele was 0.84% and the mutant allele was 0.15%. The frequency of wild allele and mutant allele did not differ much between patients with and without consanguinity. The association between consanguineous marriage and allele frequency was not significant. Gene polymorphism was not present in 77 percent of our NSHL subjects, though 79 percent of our study population were a result of consanguineous marriage. Conclusion Though the role of consanguineous marriages in congenital sensorineural hearing loss is well established, the association between allele frequency and consanguineous marriage was not seen. We assume that other genes responsible for deafness may be involved in the population.

Introduction Diabetes has become a global epidemic. Hearing loss has been long associated with diabetes. Brainstem Evoked Response Audiometry (BERA) is an objective, non-invasive, electro diagnostic test that not only evaluates the functional integrity of the subcortical auditory pathway but also provides topo-diagnosis of hearing loss. This study aims to identify the role BERA in detecting hearing loss early in diabetic patients.Materials and Methods In this study a total of 210 patients were taken and subjected to blood glucose levels followed by PTA were divided into two groups. Group I (n=105) consisted of diabetic patients with sensorineural hearing loss (SNHL) and Group II (n=105) had age and sex matched non-diabetics with SNHL. All the patients were evaluated with BERA.Results All the patients were subjected to Brain Stem Evoked Response Audiometry (BERA). Absolute latency of Wave I, III, V, I-III, III-V and I-V were assessed for both the ears. In both ear Absolute latency were significantly higher in diabetics as compared to non-diabetic patientsConclusion The findings of present study showed that the severity of hearing loss was significantly higher in diabetic patients as compared to non-diabetic controls. Level of glycemic control showed a possible link with severity of hearing loss.

Introduction Mastoid dressings are conventionally used in patients who undergo Tympanoplasty using post auricular approach. The rationale behind using a mastoid dressing is that the said dressing prevents haematoma formation and acts as a protective covering during the post-operative period. This study aims to understand the significance of mastoid dressing in patients undergoing Cortical Mastoidectomy and Tympanoplasty and its role in preventing post-operative wound complications and patient comfort. Materials and Methods A total of 77 patients were enrolled in the study over a one year period and were randomised into dressing and no dressing groups with the aim of deciphering any advantage of the mastoid dressing over a smaller dressing. Results Our data revealed no added advantage of conventional mastoid dressing over a small gauze piece dressing in terms of haematoma/seroma formation, contusion and wound dehiscence. However, there was significantly reduced patient discomfort and sleeping difficulties post-operatively in the no dressing group. Conclusion We conclude that smaller dressing is more favourable than the bulkier conventional mastoid dressings.

Introduction The present study was devised to estimate the prevalence of neonatal hearing loss and document the importance of using DPOAE as a screening tool for identifying hearing loss in newborns. Materials and Methods This hospital based descriptive study was conducted from August 2018 to August 2019. A total of 928 newborn babies were included in the study. These newborn babies were subjected to hearing screening by distortion product otoacoustic emissions (DPOAE) at 24-72 hrs after birth. For pass cases, no further testing was done. For refer cases, repeat testing with DPOAE was done within 15-30 days. Newborns with refer result on repeat DPOAE testing were subjected to Brainstem evoked response audiometry (BERA) within 3 months to confirm hearing loss. Results Nine hundred and twenty eight newborn babies were screened by DPOAE. 851 newborns passed the first DPOAE hearing screening and 77 newborns gave refer result. 21 newborns were lost to follow-up. 56 newborns underwent repeat DPOAE testing and 5 newborns were referred for BERA. Amongst the 5 newborns who underwent BERA testing, one newborn was diagnosed with bilateral profound hearing loss. Hence, the prevalence of hearing loss of 1.08 per thousand newborn babies was estimated in this study. Conclusion Hearing screening of newborns using DPOAE followed by BERA in refer cases to confirm hearing loss is useful for early detection followed by timely intervention and rehabilitation.

Introduction Though itchy ears cause significant discomfort, patients generally do not consult a doctor till it becomes chronic. Moreover, itching as a symptom hardly receives any attention in non-dermatological clinics and is generally not considered as a condition worth evaluating. Thus, this study was performed to examine the predisposing factors of itchy ears and the outcomes of corresponding treatment. Materials and Methods This was a prospective observational study carried out over a period of 12 months (July 2019 to June 2020). The study included 200 patients belonging to the age group ranging from toddler to elderly (≤70 years) and presenting at the ENT OPD of a Tertiary Care Teaching Institute with the complaints of itching in one or both the ears. Following the diagnosis, appropriate treatment was started. The patients were then followed-up after 10 days, to note if symptom of itchiness in the ear(s) had relieved. Results Out of 200 patients, 89 presented with itchy ears due to various etiology, of which most common were otomycosis (N=30), allergic rhinitis (N=15), and keratosis obturans (N=10). However, majority of the patients (N=111) had impacted wax as the predisposing factor (trauma (N=27), abnormal anatomy (N=65), or hereditary (N=19)), resulting in itchy ears. On the 10th day, complaint of itchy ears was relieved in majority of the patients. However, amongst 30 patients, 3 patients with fungal infection of the external auditory canal still complained of itchy ears and thus, were referred to dermatologist. Conclusion Impacted wax was the most frequently observed predisposing factor and was commonly observed across all the age groups. Majority of the patients responded well to the treatment and were relieved of itchy ears.

Introduction Myringoplasty has often been viewed as a “basic” ENT procedure. This paper will discuss the factors that can make a myringoplasty more challenging and suggest some techniques to overcome these. Affecting FactorsPatient factorsThe age of the patient, their habitus and co-existing co-morbidities are usually the factors affecting the choice and outcome of the procedure. The earAnatomical variations, the nature of the pathology itself and the condition of the remnant tympanic membrane and the middle ear are important factors for consideration. Other factorsEquipment availability, expertise of the surgical team and anaesthetic support can also influence the surgical procedure. Surgical ProcedureThe actual procedure can be done in a variety of ways including but not limited to different approaches, different techniques and using different equipment like microscopes, endoscopes, LASER, etc.Results and ComplicationsThe primary author reported a success rate of about 95% in her series. Complications of myringoplasty include myringitis, residual perforations, otitis externa and epithelial pearl formation.

Introduction Otitis media with effusion (OME) is a multifactorial disease and the treatment options for it are limited and controversial. The aim of the present study was to compare the efficacy of intratympanic steroid injection and conventional medical treatment in resistant cases of OME with hearing loss. Materials and Methods A comparative study was conducted among 20 patients of OME with hearing loss, resistant to conventional medical treatment between December 2019 to November 2020. ‘Intratympanic dexamethasone injection’ (ITDI) was given every week for 3 consecutive weeks to one group and the other group continued to receive medical treatment. Hearing was assessed by performing pure tone audiogram before every ITDI and also at 12 weeks follow up after completion of treatment. Results Hearing improvement was found to be better in the group which received ITDI (Mean AC-PTA hearing gain = 22.88 dB) than the group where conventional medical treatment was continued (Mean AC-PTA hearing gain = 6.83 dB). Conclusion Intratympanic dexamethasone injection has significantly better outcome in term of improvement of hearing loss in resistant cases of OME than conventional medical management, and is an effective and safe therapy.

Introduction It is an established practice to use non-EPI DWI MRI scans to detect the presence of cholesteatoma post operatively. In the present era of Covid-19 where routine surgery to remove cholesteatoma has been suspended resulting in potentially unprecedented demands on the service, a review of serial MRI scans performed over a 7 year period was undertaken to determine the rate of growth of cholesteatoma. Materials and Methods A retrospective longitudinal study identified 24 middle ear cholesteatomas in 17 patients with serial non-EPI DWI MRI scans (having excluded those having surgical intervention between scans) for a median period of 33 months (range of 6-91 months). Cholesteatomas were measured by the first author and by the consultant radiologist. Results Of 24 cholesteatomas, 1 resolved completely, 5 reduced, 6 stayed the same size, 4 grew slowly and 8 grew significantly. Conclusion Non-EPI DWI MRI scans to determine cholesteatoma growth in asymptomatic ears is useful in triaging patients in the Covid-19 era.

Introduction The study was aimed to find out whether any correlation exists between Middle Ear Risk Index (MERI) and the diagnostic ability of otoendoscopes to help in the decision making to preserve the posterior canal wall in management of cases of chronic otitis media(COM) squamous type. Materials and Methods Patients of chronic otitis media squamous active type were subjected to tympanomastoid surgery under the microscope and adjunctive use of otoendoscope. After proper disease clearance under microscope, otoendoscopes were taken as an adjunct to find out whether any residual disease was being left behind and to confirm whether the posterior canal wall could be preserved. Dubious cases in which the canal wall could be saved due to conclusive evidence of disease removal through the endoscope were taken as the ones being influenced by otoendoscopic decision-making. Results Patients having moderate MERI score were likely to have their canal walls spared by endoscopic evaluation. Discussion The percentage of residual disease detected with otoendoscopes were concurrent with other studies reporting similar figures. Conclusion The otoendoscope is decidedly more helpful in conclusive decision making in preserving the posterior canal wall in a case of chronic otitis media.

Introduction Otosclerosis presents as conductive or mixed hearing loss depending upon the stage of the disease. Isolated sensorineural hearing loss though known to occur has been rarely reported. Pure cochlear otosclerosis presenting as sensorineural hearing loss should be considered as a differential diagnosis in young patients presenting with progressive hearing loss. The aim of this article is to note the prevalence of cochlear otosclerosis in young patients presenting with progressive sensorineural hearing loss.  Materials and Methods Retrospective chart analysis of 19 patients who presented with progressive SNHL with unknown etiology was done. Results Otosclerosis involving the pericochlear region was diagnosed in 27 ears which was identified by high resolution CT scan of temporal bone. In four ears, in addition, there was demineralization just anterior to oval window without clinical evidence of stapes fixation. Conclusion In young patients with progressive SNHL, high resolution CT scan of temporal bone should be done to identify progressive cochlear otosclerosis. Medical management should be initiated in these patients to halt the progression of disease.

Introduction Mastoid operations have been in practice for over four centuries for suppurative conditions of the ear. Intact canal wall mastoidectomy has the advantage of better functional results while canal wall down mastoidectomy offers excellent exposure for disease eradication and post operative monitoring but is associated with significant cavity problems. In order to overcome the problems associated with canal wall down procedure while retaining its advantages the concept of mastoid cavity obliteration was introduced. This study analysed the outcomes of mastoid cavity obliteration and to assess the outcomes of mastoid cavity obliteration with autologous adipose tissue. Materials and Methods A prospective, experimental, randomized study was conducted over a period of 18 months among patients presenting with active squamous variety of Chronic Otitis Media. The patients were randomly allocated to two groups, A and B. Both groups underwent canal wall down Mastoidectomy followed by obliteration with autologous adipose tissue in Group B . Results In group A, the mean duration required for complete epithelialization was 10.8 weeks. In group B, the average time taken for complete epithelialization was 5.6 weeks. All cases had their graft intact at the end of 12 weeks. Debris was present in group A for a mean duration of 9.47 weeks. In group B, debris was found for a mean duration of 3.33 weeks. Patients from group A complained of discharge from their ears for a mean duration of 7.47 weeks. In group B the same symptom persisted over 3.33 weeks. Conclusion Cavity problems encountered is considerably less in the group obliterated with adipose tissue.

Introduction             Chronic otitis media (COM) is a most common and prevalent disease of the middle ear. COM has been defined as a longstanding inflammatory condition of middle ear and mastoid, associated with perforation of the tympanic membrane. Tympanoplasties are common surgeries performed for chronic otitis media in inactive mucosal type. Any otological surgery may involve a menace/ hazard of hearing loss post operatively.             In this study, an attempt was made to correlate, size of tympanic membrane perforation, pure tone audiometry and intra-operative findings in tympanoplasties, results were analysed and conclusion drawn. Materials and Methods Forty patients attending ENT OPD with chronic otitis media (COM), inactive mucosal type, with conductive hearing loss undergoing tympanoplasties who were willing to participate in the study were selected.  Ear was examined pre-operatively to assess the size of perforation and then, pure tone audiometry (PTA) was done to assess the type of hearing loss and its severity. During tympanoplasty, middle ear was inspected for ossicular status and any other pathology was noted. Later, the size of tympanic membrane perforation, pure tone audiometry and intra operative findings were correlated with each other and analysed. Result  In small and medium sized perforation, PTA and intraoperative findings correlated with each other. Whereas, in large and subtotal perforation, there was no correlation. Conclusion             In small and medium sized perforation, middle ear inspection may not be necessary. Whereas, in large and subtotal perforation it is necessary.&nbsp

Introduction Chronic otitis media (COM) is a commonly encountered condition in India because of socio-economic factors. Empirical antimicrobial therapy is crucial till definitive surgical management can be done. Periodic updating of prevalence and antibiogram of the etiological microorganisms of COM is thus important.This hospital based study aimed to detect the ongoing trend of microbes associated with chronic otitis media in eastern India and determination of antibiotic sensitivity patterns of bacteria. Materials and Methods A prospective study was conducted wherein ear swabs were taken from discharging ears of selected patients and sent for culture and antibiotic sensitivity tests. Results One hundred and forty two (142) samples were collected from 104 patients. 124 samples revealed monomicrobial involvement while 5 samples did not reveal any pathological organism. Pseudomonas aeruginosa and Staphylococcus aureus were the most common isolates comprising 31.33 % and 30.67 % respectively. Most organisms were susceptible to fluoroquinolones and aminoglycosides along with imipenem, meropenem followed by penicillin group of antibiotics. Conclusion The huge burden of chronic otitis media patients in India makes it essential to have an evidence-based protocol for initiation of empirical treatment. Hence, an idea about the microbes commonly responsible for disease and their antibiotic sensitivity patterns is helpful in clinical practice.

Introduction                                                                           In the management of COM in paediatric age group, eradication of the septic foci in the tonsil and the adenoids while addressing the dysfunction of Eustachian tube play a key role This study aims to assess the success rate of type I tympanoplasty with cartilage graft in mucosal type of chronic otits media in paediatric age group and finally, whether concomitant adeno-tonsillectomy plays any role in outcome of surgery or curing the disease process.                                    Materials and Methods                                                          A prospective clinical study was done over a period of one and half years amongst 59 patients, aged between 5 and 12 years, presenting with chronic otitis media with dry central perforation of ear-drum and pure conductive hearing loss. Patients were divided into two groups. Group 1 (n1= 22) underwent type I cartilage tympanoplasty with adenoidectomy/ tonsillectomy/ both in the same sitting and Group 2 (n2= 37) underwent type I cartilage tympanoplasty without any adeno-tonsillectomy.     &nbsp

Introduction  Tuberculosis can involve any organ or site. Otorhinolaryngologist may encounter tuberculosis affecting lymph nodes, ear, larynx, deep neck spaces, salivary glands etc. which can mimic other chronic granulomatous conditions or malignancy. To ensure early diagnosis, it is important to recognize its cardinal signs and symptoms and to be aware of potential pitfalls in diagnosis. This study was done to learn the clinical presentation of tuberculosis in ear, nose, throat and head and neck region, and to assess the effectiveness of various investigations and treatment done for the same. Materials and Methods  A retrospective study done in our institution involving 120 patients suffering from tuberculosis in ear, nose, throat and head and neck region who attended pulmonary medicine or ENT OPD or ward between January 2008 to December 2017 that is, 10 years. Study period for data collection and analysis was 1 month. Results Total 120 patients-69 males and 51 females. Most common site was cervical lymph nodes(77.5% patients), followed by larynx(8.3%),middle ear(7.5%),deep neck spaces(2.5%) and salivary glands and nose(1.7% each). Histopathology was highly sensitive(99. 1%).All except one patient responded to first-line antitubercular drugs, the other patient was given treatment for MDR-TB to which he responded. Conclusion Tuberculosis can involve any site in the head and neck region, most common being cervical lymph nodes mainly presenting as neck swelling. Variable nature of manifestations of tuberculosis makes it essential to have high degree of suspicion for early diagnosis.

Background: Hearing impairment is known to hamper the quality of life among patients, especially among diabetics due to the association of neuropathy with diabetes. However, the prevalence and degree of the SNHL depends upon different factors, such as age, gender, disease duration of DM, family history and glycemic status of the patients. Therefore, this study aimed to assess the association of SNHL with DM duration and familial DM and gender preponderance among SNHL–DM patients. Methods: Total 140 patients with DM were assessed for hearing impairment using Rinne, Weber and Absolute Bone Conduction Tests along with pure tone audiometry. Patients’ glycaemic status was determined by estimating fasting blood glucose (FBG) and post prandial blood glucose (PPBG) levels. Independent t-test, chi-square, ANOVA and Pearson’s correlation tests along with linear regression model were used to find association and correlation using R software. Results: Out of 140 patients, 60 were suffering from SNHL and majority were suffering from bilateral minimal hearing loss. SNHL was significantly associated with family history, age, duration of DM, FBG and PPBG levels were(Pvalues:1.79E08, 4.41E-06 and 0.02), however, significant correlated with duration of DM, FBS and PPBG level (r value:0.14–0.41).Furthermore, significant SNHL at 500 and 8000Hz was observed in the present study (Pvalue:0.002). Conclusion: A conclusive proof was drawn that family history of DM serve as a valuable variable in assessing the SNHL among DM patients.

Introduction The influence of Socioeconomic (SE) status on delayed reporting and consequent complications in cases of Chronic Otitis Media-squamous (COMS) has been investigated. Materials and Methods This prospective observational study included 34 patients with complicated COMS who presented to Otolaryngology Department at a tertiary care teaching hospital between December 2012 and December 2016. The patients were classified into 5 classes namely upper, upper middle, lower middle, upper lower, and lower based on a standardised real-time Kuppuswamy’s SE status scale (KS) taking an average of consumer price indices for Industrial workers over 4 years (Jan ‘12 to Dec ‘16) as 267 and calculating their incomes. Level of education and occupation of the head of the family were the other components of KS which was calculated for each presenting patient. Results Of the 34 patients, 15 were males (44%) and 19 females (56%) with their ages ranging from 18 months to 61 years (Mean-24.1 years, SD-17.3). 15 of the 34 patients (44.1%) were in the Upper-lower SE class as per KS Scale, 13 were in lower-middle class (38.23%), 5 were in Upper-middle class ( 14.70%) and 1 patient belonged to Upper class (2.9%).  Though the literacy levels are integral to KS Scale a differential analysis showed 23 of the 34 patients/guardians had education level poorer or equal to Intermediate high school (67.64%). The time gap between onset of symptoms of COMS and presentation with complications of COMS ranged from 9 months to 8 years with a mean time gap of 3.48 years (SD-2.01). There were 24 Extra-cranial complications and 21 Intra-cranial complications with 10 patients having more than one complications. There was a strong inverse correlation between Time gap and composite KS (-0.51). A differential analysis showed that Time gap most strongly correlated with Education level of the head of the family (-0.615), followed by total family income (-0.403) and occupation of the head of the family (-0

Introduction With increasing life expectancy globally, hearing loss has become a major issue of concern. In addition to the negative implications on the people with hearing loss, it is also found to have a significant negative impact on the communication partners especially the spouse. Understanding the impact of hearing loss on their partners can aid us in addressing these issues during rehabilitation. Materials and Methods A cross sectional study was conducted among 60 people who presented with hearing loss and were living with their spouse. The hearing loss was assessed using pure tone audiometry. The third party disability among the spouses was assessed by using HII-SOP questionnaire. The disability scores were calculated and correlated with the severity of hearing loss using chi square test. Results The hearing loss was associated with some degree of third party disability (58.3%). The degree and duration of hearing loss did not correlate with the degree of third party disability. Female significant others had more difficulty than the male significant others. However, increasing age of the spouse, longer duration of married life and presence of chronic illness in the spouse were associated with more third party disability.  Conclusion Hearing loss causes third party disability among spouses. In addition to treating hearing loss, the health care professionals should involve the spouses in treatment and rehabilitation. This highlights the need for family centred policies in treatment of hearing loss.

This study attempted to document success of surgery postoperatively, be it type I tympanoplasty or type III tympanoplasty with or without modified radical mastoidectomy. Materials and Methods This retrospective study involved 90 patients of Chronic Otitis Media who underwent surgery in the Department of Otorhinolaryngology in a tertiary care centre in the state of Uttar Pradesh.   Results                                At 3 week postoperatively, 83 patients (92.22%) had successful uptake of graft. Overall successful graft uptake was reduced to 87.78% (79 patients) after 3 months. Postoperatively, after 3 months, 90% of the patients (n=81) reported improvement in hearing. Preoperatively, 89.71 % patients of mucosal disease and 63.64% of squamosal disease had 21-40 dB hearing loss. Postoperatively, 88.24% patients with mucosal disease and 63.64% of squamosal disease had no conductive hearing loss. There was statistically significant gain in air conduction postoperatively. Average improvement in AB gap was also notably significant postoperatively in both subgroups. Conclusion Both type I and type III tympanoplasty give excellent response in term of graft uptake and postoperative hearing. Abbreviations: COM-Chronic Otitis Media, AC-Air Conduction, AB-Air Bone, TP-Tympanoplasty, MRM-Modified Radical Mastoidectomy

Introduction Although temporalis fascia is the commonly used graft material for tympanoplasty, cartilage has become the material of choice in cases with eustachian tube dysfunction, bilateral disease, total or anterior perforation of tympanic membrane, tympanosclerosis etc. Cartilage slices < 0.5 mm thick are similar to the tympanic membrane in their acoustic properties. The present study is aimed to describe stitch-less type 1 tympanoplasty with sliced tragal cartilage-perichondrium and evaluate anatomical, audiological and cosmetic outcomes. Materials and Methods A prospective study was conducted from March 2014 to August 2016, in ENT department of a Government Medical College and Hospital, West Bengal, India. Primary tympanoplasty cases irrespective of age, size and site of perforation, laterality and eustachian tube function were included in the study. History of previous tympanoplasty or mastoid surgery and cases requiring ossicular reconstruction or mastoidectomy were excluded from the study. Sliced tragal cartilage-perichondrium graft of 0.2 mm thickness was placed in underlay fashion through trans-canal or end-aural route. Results Among 95 cases 38 were male, 57 were female with age range between 7 to 68 years. Average operative time was 30 minutes. Graft take was successful in 97.89% of cases. Average Air Bone Gap 12 months after operation was 13.03dB. Conclusion Sliced cartilage-perichondrium graft gives good balance between sufficient stability and adequate acoustic sensitivity. Moreover, no stitch technique reduces operative time and increases cosmesis.

Introduction It is a common practice to infiltrate 2% lignocaine with 1:2,00,000 adrenaline for Type 1 Tympanoplasty, even when the surgery is done under general anaesthesia. The purpose of this study is to evaluate the necessity of infiltration of lidocaine with adrenaline (2% lidocaine with 1:2,00,000 adrenaline) in Type 1 Tympanoplasty surgeries performed under general anaesthesia in terms of per-operative bleeding and post-operative pain relief.   Materials and Methods A double blinded, prospective randomized comparative study was conducted in a tertiary care centre. A total of 50 patients planned for Type 1 Tympanoplasty under general anaesthesia, for chronic otitis media, inactive, mucosal disease were selected and divided into two groups randomly. Group A (25 patients) received local infiltration of 2% Lidocaine with 1:2,00,000 adrenaline and Group B (25 patients) patients received infiltration of sterile water. The per -operative bleeding and post-operative pain relief were assessedat 2nd, 4th and 6th post-operative hour in both the groups and the results were analysed.   Results P value for per operative bleeding was <0.77 (non-significant). And the P value for post-operative pain relief at 2nd hour was <0.002 (significant). But the P value for 4th (<0.133) and 6th (<0.358) post-operative hours were not significant.   Conclusion Infiltration of 2% lidocaine with 1:2,00,000 adrenaline, doesn’t have any significant impact in per-operative bleeding and post-operative pain relief at 4th and 6th hour. But there is a significant pain relief, for 2 hours after surgery, when 2% lidocaine with 1:2,00,000 adrenaline is used for infiltration.

Introduction Pseudocyst of pinna is a cystic swelling with collection of serous fluid between the auricular cartilage and perichondrium. Successful treatment of pseudocyst of pinna is challenging because of its high propensity for recurrence and cosmetic deformity. None of the treatment modalities described in literature gives fully satisfactory result. So a novel treatment modality is required which gives good cosmetic outcome with zero recurrence. Materials and Methods                                                        A prospective study was done in the Department of ENT and Head and Neck Surgery of a Government Medical College, West Bengal from April 2014 to March 2017. The effusion was aspirated aseptically with sterilized 10 ml syringe with 18G IV needle. An equal amount of Inj. Dexamethasone and Inj. Gentamicin 80 mg in 1:1 ratio mixed in a new 10 ml syringe was injected into the swelling through the same prick point. Result Most of the patients in this study were males between 31-40 years of age and labourer by profession. Maximum number of patients had swelling involving concha. Only one case of one month old infant had bilateral involvement. All patients were cured without any recurrence or disfigurement. Conclusion The results of present study points to the fact that aspiration and instillation of equal amount of Inj. Dexamethasone and Inj. Gentamicin works very good in treatment of pseudocyst of pinna. This therapy is minimally invasive, less painful, cost-effective and less cumbersome for the surgeon. It gives faster recovery, good cosmetic outcome and recurrence is prevented.

Introduction In a series of day care office procedures, techniques like fat plug myringoplasty and Trichloroacetic acid (TCA) cauterization are becoming increasingly popular for managing small central perforations now-a-days[Office1] . These are minor, cost effective procedures and have success rates that match success rates of conventional tympanoplasty[Office2] . The aim of this prospective randomized controlled trial, was to compare the effectiveness of fat plug myringoplasty and chemical cauterization in the management of small centrally located perforations of the pars tensa. Materials and Methods The study was carried out over a period of 2 years on 62 patients selected from ENT OPD in our tertiary health care setup of central India. All the selected patients were grouped into two using a random allocation software EPi Info7.1.1.14. Group A included those who underwent fat plug myringoplasty while group B were those who underwent TCA cauterization. Results At 6 months follow up there was closure of perforation in 29 out of 30(96.6%) patients of group A and 29 out of 32(91%) patients of group B. In both groups success was defined by closure of perforation. Comparison of results was done using Fisher Exact Test. The difference between the success rates of the two procedures was statistically insignificant with p value of 0.6624, indicating that both the office procedures are equally effective and can be used according to the needs of the patients. Conclusion These office procedures can revolutionize the protocol of tympanoplasty which has an obvious higher morbidity and more days of absenteeism as compared to these minor procedures.

Introduction     This comparative study aims to analyze findings and their significance in the contralateral ears of patients with unilateral Chronic Otitis Media (COM) and compare it with a control group of healthy subjects. Materials and Methods      One hundred patients of unilateral COM and 100 healthy individuals were included in this study from Jan 2015 to July 2016. The findings were noted in the contralateral ears of patients with unilateral COM and 100 control subjects. The changes found in the contralateral ears were assessed statistically for significance. Results In 100 cases of unilateral COM, 58 patients had some abnormality in the contralateral ear. Myringosclerosis patches being the most common finding were seen in 29 patients followed by TM retractions seen in 28 patients. Prevalence of abnormal findings was found to be significantly higher in the squamous group as compared to the mucosal group.  In 100 ears in the control group, only 11 % had positive findings. TM retractions were seen in 5 subjects (3 Attic and 2 Pars tensa retractions).  Conclusion             It can be statistically concluded that the disease of COM in one ear affects the contralateral ear slowly and silently. Hence both ears are affected as pairs and a slow pathological process continues behind an intact TM and kept hidden from the view unless it is actively sought for. Contralateral ears should also be actively followed up, in cases of unilateral COM in order to pick up disease harboring silently.

Introduction With increasing popularity of  Endoscopic middle ear surgeries, a better understanding of the features salient to endoscopic and microscopic tympanoplasty has gained importance. This study aims to compare the results of both.   Materials and Methods It is a retrospective study based on MRD data collected from January 2017 to July 2018 on 40 patients with dry central perforation. 20 patients underwent endoscopic tympanoplasty and other 20 underwent microscopic tympanoplasty. Results of the surgery were compared at the end of 3 months which was based on the outcomes of surgery by means of graft uptake, comparison of pre-op and post-op audiogram readings . Results Eighteen cases (90%) of endoscopic surgery had mild CHL while in microscopic surgery 7 cases (35%) had moderate CHL. Average pre–op  ABG was 29.05 dB in microscopic  and 22.8dB in endoscopic surgery.  Average post-op ABG 12.65dB and 18.4 for endoscopic and microscopic surgery. There was significant improvement in hearing gain in both the surgeries (p<0.001). Graft uptake was found to be have similar outcome. Conclusion Endoscopic tympanoplasty can be a good alternative of microscopic tympanoplasty but needs more training as compared to conventional method.

Introduction  Temporalis fascia is the commonly used graft material for tympanic membrane reconstruction. Tragal perichondrium share with the fascia the quality of being mesenchymal tissue. In our study we compared perichondrium and temporalis fascia in terms of graft uptake and hearing improvement. Materials and Methods All patients presenting with discharge from ear and decreased hearing were subjected to clinical examination and investigation. Patients satisfying inclusion criteria were included in study with total of 40 patients. Twenty underwent type1 tympanoplasty with temporalis fascia (TF) and another 20 patients with tragal perichondrium (TP). To evaluate success patients are evaluated at end of 6 months for graft uptake and 3 months for hearing results in audiological gain of 10 dB in two consecutive frequencies. Results Mean Pre-op AC Threshold in TF group was 30.75 dB±5.16 and Post-op AC Threshold was 14.15 dB±8.05. Mean Pre-op AC Threshold in TP group was 32.2 dB±4.81 and Post-op AC Threshold was 20.95 dB±7.14. Mean post-op AC Threshold, Mean Post-Op AB Gap and Mean Audiological Gain was statistically significant among 2 groups p=0.0075, p=0.0013, p=0.0294 respectively.  Temporalis fascia was better than Tragal Perichondrium. Graft uptake in 2 groups was not significant (p=0.6325). Conclusion From the present study we may conclude that temporalis fascia, tragal perichondrium free grafts provide viable autograft material for tympanoplasty. Both achieve good hearing restoration but the improvement in hearing or audiological gain is better in temporalis fascia graft than in tragal perichondrium graft.

Introduction Various studies have shown high incidence of subjective vestibular dysfunction in cases of chronic otitis media (COM). Evaluation of vestibular dysfunction in chronic otitis media patients is becoming an integral part of comprehensive management of COM. In our study, we have evaluated vestibular dysfunction in patients with COM, using computerized static posturography, an objective technique in contrast to other subjective tests of vestibular dysfunction. Materials and Methods In this prospective case control study done over a period of 1.5 years, 50 cases of COM and 50 healthy controls were included and they underwent Computerized Static Posturography. Parameters taken were Somaesthetic, visual and vestibular scores in both antero-posterior (AP) and medio-lateral (ML) axis; and in combined axis (Antero-posterior +Medio-lateral) and these scores were compared with those of healthy controls. Results Total 50 cases of COM (average disease period - 5.7 years), of both sexes, with age range of 15-60 years and mean age of 31.58 years were taken. On analyzing above mentioned parameters using SPSS software, we found no significant difference in vestibular function in cases of COM as compared with healthy individuals.  Discussion The outcome of computerized static posturography can be quantified with respect to changes in center-of-force sway amplitude, distance, or velocity, which, by virtue of not being burdened by subjective interpretation, its results can be, documented both graphically and numerically. Conclusion This study, further solidified with objective evidence, raises a question on COM without complications being directly responsible for vestibular dysfunction.

Introduction: This present study is an attempt to study the demographic characteristics of individuals presenting with hearing loss in a peripheral tertiary care hospital using the available database of pure tone audiometry results. Materials and methods: A retrospective, observational, descriptive study was conducted over a period of 5 years in the Department of ENT of a peripheral tertiary care hospital wherein all subjects having a pure tone audiometry were included in the study. The records of PTA done were analyzed followed by systematic analysis. Results: A total of 9790 individuals inclusive of 5566 males and 4224 females were studied. Maximum no of individuals belonged to the age group of 21-30 years. Nearly 63% of total subjects suffered from Bilateral hearing loss. Sensorineural hearing loss was most prevalent type of loss. Mild degree of loss was most prevalent. Adolescents and young adults comprised the bulk of the study population. Sensorineural hearing is the most common type. Bilateral hearing loss is more frequent. Mild degree of loss is most frequent. Conclusion: This study emphasized the ‘Composite parameter distribution’ in addition to the classical single parameter demographic profile of deafness in a remote tertiary care hospital. Adolescents and young adults comprised the bulk of the study population. Sensorineural hearing is the most common type. Bilateral hearing loss is more frequent. Mild degree of loss is most frequent.

Introduction: Various materials have been used in tympanoplasty to ensure the adherence of the graft with the remnant tympanic membrane. This study aims to compare the clinical outcomes of type I tympanoplasty done with and without fibrin glue. Materials and Methods:           This is a prospective comparative study conducted in a tertiary care centre between August 2014 and July 2016. A sample size of 70 patients was used. The patients were randomly divided into two groups – Group A and Group B. Patients in group A underwent tympanoplasty with fibrin glue and patients in group B underwent tympanoplasty without fibrin glue. The patients were followed up for 6 months and the postoperative hearing improvement and graft uptake rates were compared. Results: The pre-operative mean pure tone average for group A was 34.33±7.3dB; it improved to 22.14±6.5 at the end of 6 months. In group B, it improved from 34.25±8dB to 22.64±7.4dB at the end of 6 months. There was no statistical significance in hearing improvement between both the groups. Though there was no statistically significant difference in the graft uptake rates between group A (94.3%) and group B (91.4%), fibrin glue had better outcomes with larger perforations. Conclusion: The use of fibrin glue in tympanoplasty is safe and it has a particular advantage in the graft uptake in subtotal perforations.

Introduction Endoscopes are not only complementing microscopic ear surgery but are also establishing their independent role in recent years. Materials and Methods This observational study was conducted from February 2018 to February 2019. Thirteen patients with clinical and audio-tympanometric features suggestive of stapedial otosclerosis underwent unilateral endoscopic stapedotomy from February to July 2018. They were followed up for a minimum of 6 months, till February 2019. Zero degree naso-endoscopes were exclusively used. Details of the surgical technique, its usefulness and subjective drawbacks are described. Results Two patients with sequel of otitis media with effusion evident at surgery were excluded. With a female predilection, the average age of the subjects was 31 years (range: 17-56 years). Curettage of the posterosuperior wall was needed in 7 patients; significant canalplasty was performed in 2 of them where the endoscope was difficult to negotiate. The chorda tympani required mobilization in only 3 patients, including those requiring significant canalplasty. Per-operative complications included injury to the chorda, tearing of tympanomeatal flap, and instability of the long process of incus in 1 patient each. One patient was lost to follow up. Average pre-operative bone conduction was 10±5dB with an air-bone gap at 35±5dB. At 6 months follow up, air-bone gap of <10dB was achieved in 5 patients, and that at10-20dB in 4. One patient developed moderate sensorineural component. Otherwise, there was no significant complication at 6 months following surgery. Conclusion Endoscopic stapedotomy is a safe and effective approach towards stapes surgery, with better surgical field of view and minimal tissue trauma

Introduction: Otosclerosis usually manifests as a progressive conductive or mixed hearing loss occurring clinically to varying degrees in 0.5% - 1% of the general population. Stapedectomy /stapedotomy is the current treatment of choice for conductive component of Otosclerosis. Materials and Methods: Sixty patients attending the department of ENT of a Medical College Hospital in Bangalore between October 2012 and October 2017 were included in the study.  Results: The incidence of otosclerosis is highest in the 3rd and 4th decade. Bilateral symptoms were present in 25% and 75% had unilateral symptoms, right side being more common in our study. Tinnitus and vertigo with deafness are seen in 60% and 25 % of the patients respectively.  Ninety percent of the patients presented with moderate to moderately severe hearing loss. Twenty four (40%) out of 60 audiograms studied showed Carhart's notch. Postoperativeclosure of a-b gap to within 10dB could be achieved in 65% cases. The p value calculated comparing pre and post op results is <0.0001 and significant. Vertigo was found to be most common post-operative complication (35%) followed by sensorineural hearing loss (6.6%). Other complications observed during the study include -  tympanic membrane tears, foot plate extrusion, lax long process of incus, perilymph leak. Conclusion: From the assessment of the postoperative hearing gain and postoperative complications, it can be concluded that small fenestra stapedotomy gives satisfactory post-operative outcome and may be appropriatein the Indian scenario.

Introduction This study was conducted to study the fungal profile in otomycosis patients in the tropical region of North Karnataka. A total of 108 samples of symptomatic otomycosis were investigated in this study. Materials and Methods Aural swabs were collected on 1st visit and these swabs were immediately inoculated over Sabouraud’s dextrose agar media and incubated at 37 degree Celsius for culture of fungi. Results Fungal pathogens were isolated in 89 samples, 18 samples were negative and 1 sample was reported as being contaminated. Fungi belonging to genus Aspergillus was isolated in 92.11% of cases of which Aspergillus niger was commonest isolated in 38(41.57%) followed br Aspergillus flavus 32(35.95%) and Aspergillus fumigatus 7(7.86%). Candida species were found in 2(2.24%) and Mucor in 1(1.12%). The most common symptom was Itching 91(84.25%). In this study ear discharge was the commonest finding (44.44%) followed by Black mycotic plug (28.70%). Conclusion Otomycosis is a condition encountered in hot, humid climate with symptoms like itching and ear discharge. Aspergillus and Candida are the fungal species responsible for majority of cases. Local antifungal treatment with measures like keeping the ear dry resolves most of the cases.

Introduction Auditory Verbal Therapy (AVT) is considered as most successful therapeutic approach for cochlear implant children. The impact of auditory verbal therapy has been studied vividly in Indian context. The number of cochlear implantees receiving AVT has been increased nationwide but there is no structured protocol that is used to assess the efficacy of AVT on children with cochlear implant. Hence, it is important to develop a structured protocol consisting of established tools to study the effectiveness of AVT. Materials and Methods          The study was conducted on 62 (male-38, female-24) bilaterally profound sensorineural hearing impaired children with cochlear implant done under ADIP (Assistance to Disabled Persons for Purchase/ Fitting of Aids and Appliances) scheme. Pre-therapy assessments were done before 2 weeks of cochlear implantation using Functional Auditory Performance Indicator (FAPI), Assessment of language development, Speech intelligibility rating scales, Brown’s (1973) stages of mean length of utterance (MLU) assessment, and Overall rating of parental satisfaction on a visual analog scale of 0 to 10. Auditory verbal therapy (AVT) was given for 6-8 months, twice per week under video-monitoring of the sessions. Post therapeutic scores were obtained by assessing with the same tools through observation and interaction with the children and interviewing the caregivers.  Results Independent Sample’s T-test in SPSS -16 software were used and significant differences between pre and post therapy scores were obtained (p<0.005). Conclusion These tools can be used further as a protocol for assessment of baseline skills before AVT, then develop an individualized management program and finally to assess the improvement after AVT.

Introduction: Large central and subtotal tympanic membrane (TM) perforations are difficult to repair because of less vascularity of anterior TM than posterior TM and the anterior bony overhang that blocks visualization. Some studies reported very encouraging results with the medio-lateral tympanoplasty in such cases. We have undertaken this study to find out efficacy of this technique in large central and subtotal perforations and to compare the results of medio-lateral with medial tympanoplasty. Materials and Methods: The present prospective study was conducted in the Department of Otorhinolaryngology of a medical college and hospital, West Bengal from January 2013 to December 2014. Patients were alternatively divided into two groups. Medial technique was used in Group I and medio-lateral technique was used in Group II.    Results: Each group comprised of 40 patients each. Maximum number of patients in each group was in the age group of 15-25 years. The overall graft uptake rate in this study was 95% in medio-lateral technique compared to 80% of underlay technique. Conclusion: The medio-lateral tympanoplasty is suitable for reconstruction of large central or subtotal TM perforation. It takes advantage of both medial and lateral grafting methods while avoiding their pitfalls.

Introduction Oral steroids currently represent the standard treatment for idiopathic sudden sensorineural hearing loss The aim of this study is to assess the effectiveness of intratympanic dexamethasone injection for treating ‘Idiopathic sudden sensori-neural hearing loss’ (ISSNHL) not improved with conventional oral steroid. Materials and Methods A prospective study was conducted on 30 patients refractory to oral steroid therapy between June 2017 to May 2018. ‘Intratympanic dexamethasone injection’ (ITDI) was given every week for 3 consecutive weeks. Hearing was assessed by performing pure tone audiogram before every ITDI and also 1 week after the completion of treatment. Results Hearing improvement was found in 19 out of the 30 cases (63.3%).   Conclusions Intratympanic dexamethasone significantly improves the prognosis of ISSNHL and is a safe, inexpensive and effective treatment.

Introduction Cornu cutaneum is a nodule of dense keratin, resembling the horn of animals, an uncommon clinical condition predominantly seen in elderly men, and even rare to be seen on the pinna.   Case Report A 70 year old man, presented with a horn like swelling on the left pinna for 2 years. The lesion was excised and histopathological examination did not show any underlying or associated conditions.  Discussion The cause of worry here is not the disfigurement, but the probability of underlying premalignant or malignant condition. Exposure to sunlight is considered as the etiology. Ours being a tropical country where exposure to sunlight could not be avoided, a high clinical vigil and early intervention is recommended to reduce the mortality and morbidity from the spectrum of diseases resembling this condition.