Ear Pathology Research Articles

Tinnitus, Use and Evaluation of Sound Therapy, Current Evidence and Area of Future Tinnitus Research.

Tinnitus is one of the otologic symptoms seen in persons with ear pathologies. It is defined as an acoustic sensation in the ear without a corresponding external acoustic stimulus. Tinnitus is said to be generated from the higher auditory centres because of reduced feedback from the peripheral or neural component but can be an outcome of irritation at different levels of the auditory system. Several treatment modalities have been tried in the management of tinnitus, either as a single treatment or as part of combination therapy. They range from lifestyle or dietary modification, medications, surgery, to Tinnitus Retraining Therapy (TRT), use of sound generating devices, hearing aids and cochlear implants. Current literature has shown that the prevalence of tinnitus is highly variable and reflects the difference in symptom criteria and patient selection for the various treatment modalities. This variability is also visible in the outcomes of cases where the various treatment modalities have been used. In the presence of an augmented hearing, the brain can focus on the meaningful sound generated externally while suppressing or even aborting the tinnitus. Future tinnitus research needs to apply the highest level of randomization and blinding, in line with the high subjectivity of tinnitus and the possibility of a response with control. The natural sequence of tinnitus is characterized by the conditioning or habituation and possible gradual attenuation of symptom, this implies that there is a limit to which the benefits observed was due to our intervention rather than a natural process of this symptom.

Etiology and Pathophysiology of Tinnitus - A Systematic Review.

Prevalence of tinnitus range from 7.1% to 14.6% (National Center for Health Statistics, 2016), but the mechanisms responsible for the development of this abnormal sensory state remain poorly understood. To determine the evidence for different etiologies and pathophysiology of tinnitus identified by clinical diagnostic tests in the adult population. Systematic literature review. Review of data base using PRISMA guidelines: Google Scholar, Medline, Springer Link, Pubmed. In addition, manual reference search of identified papers. Randomized controlled trials, case control study, prospective cohort studies, and retrospective reviews of consecutive patients in which clear data were reported with respect to etiology and pathophysiology of tinnitus. Sixty seven articles met the inclusion criteria. The papers searched recent studies from 2004 to 2018 for different etiologies such as noise exposure, age, ototoxic drugs, hearing loss among patients with tinnitus. Multiple pathophysiology were identified, including inner ear pathology, auditory nerve synchronisation, central nervous system anomalies and limbic and autonomous nervous system problems. The group of papers evaluated tinnitus patients with specific diagnostic tests such as pure tone audiometry, Immitance audiometry, otoacoustic emission, Auditory brainstem response and diagnostic imaging of fMRI, MRI and PET study. The results indicate a high level of heterogeneity between the studies for all the assessed areas. These results support the need for greater stratification of the tinnitus population and the importance of a standardized Puretone audiometry with extended high frequency, OAE, ABR and diagnostic imaging (fMRI, MRI & PET) method to make comparisons between studies possible. Diagnostic imaging is an important useful method for identification of intracranial pathology that can present with tinnitus as a primary symptom. Establishment of a direct causal link between tinnitus and these etiologies and pathophysiology remains elusive.

Хирургическое лечение пациентов с дефектами средней черепной ямки, осложненными менингоэнцефалитической грыжей, при различной ушной патологии

Surgical treatment of patients with defects of the middle cranial fossa complicated by meningoencephalic herniation, with various ear pathologies, is an important problematic issue at the intersection of two disciplines – otorhinolaryngology and neurosurgery. The issues of etiology and pathogenesis of bone formation in defects of the middle cranial fossa and the methods of surgical treatment of patients with bone defects of the middle cranial fossa complicated by meningoencephalic herniation of the temporal bone. The analysis of the causes of recurrence of the disease with the use of certain techniques was carried out, and based on this, an improved technique for multilayer plastics of a bone defect of the middle cranial fossa through a combined approach (behind the ear (BTE) transmastoid + infratemporal minicraniotomy) using autotissues, biocomposite materials, and adhesive components was developed and described. Evaluated performance criteria for all treated patients were: absence of recurrence of hernia formation of shells and substances of the brain in the middle ear cavity and the absence of otorrhea. All the operated patients with defects of the middle cranial fossa and meningoencephalocele of the temporal bone were followed up from 1 to 5 years. Preliminary analysis of the results of treatment of patients using the improved method showed its high efficiency, which is confirmed by the absence of disease recurrence. On this basis, the main conclusions are formulated and a brief algorithm of surgical tactics for the closure of bone defects of the middle cranial fossa of various sizes is presented.

Study of role of autologous versus homologous cartilage ossicular reconstruction

Background: Chronic otitis media with ossicular discontinuity is most commonly faced otological condition which causes conductive hearing loss. It presents mostly with ear discharge and decreased hearing. The use of cartilage graft material in ossiculoplasty markedly improve the result in hearing. In this study we have used autologous (tragal/conchal) cartilage or homologous (septal) cartilage for ossiculoplasty and temporalis fascia graft for tympanoplasty.Aims: Aim of the study was to compare and analyze the outcome of ossiculoplasty using autologous conchal/tragal cartilage and homologous septal cartilage in terms of hearing results and graft uptake rates. Materials and method: The study was conducted in E.N.T. Department at S.C.L. Hospital, NHLMMC Ahmedabad. 50 patients were randomly selected and divided in 2 groups. 25 patients underwent homologous and 25 patients underwent autologous cartilage reconstruction. All patients underwent detailed ENT examination followed by audiological and radiological assessment of temporal bone, and those patients with evidence of ossicular erosion were subjected to ossiculoplasty with autologous cartilage and homologous cartilage randomly. Results: Majority of the patients have central perforation and retraction pockets in middle ear pathology in both groups. Overall graft taken up rate was 96% in autologous while 92% in homologous ossiculoplasty. Our study shows hearing improvement up to 20-25 dB in 80% and 88% in autologous and homologous ossiculoplasty. Conclusion: Both autologous and homologous cartilage have excellent outcomes and gives equivalent results irrespective of age or sex of the patient or middle ear pathology. In both the groups hearing improvement is similar. Subjective hearing is also improved. No post-op complications like wound infection, facial palsy, dead ear have occurred in either case.

Analysis of temporal bone thickness outside of the petrous temporal bone between superior semicircular canal dehiscence and normal patients

BackgroundSSCD is a rare inner ear disorder. This study aims to compare the thickness of the temporal bone beyond the petrous portion between healthy subjects and those with SSCD to determine whether the etiopathology of SSCD is localized to the petrous temporal bone or generalized to other parts of the temporal bone. MethodsA retrospective chart review of electronic medical records from September 2011 to February 2018 was conducted at a single-institution study at the University of California, Los Angeles. Participants were divided into two groups: Group 1 had a confirmed diagnosis of SSCD, while Group 2 had no known ear or temporal bone pathology. Participants’ high-resolution coronal and axial temporal bone computed tomography scans were analyzed. Regions within the temporal bone were measured and compared between the two groups. ResultsA total of 262 scans were included. Group 1 consisted of 103 scans, while Group 2 consisted of 159 scans. There was no statistically significant difference in the thickness of temporal bones between patients diagnosed with SSCD and patients without otologic disease. ConclusionThe results suggest that the etiology of SSCD is limited to the petrous portion of the temporal bone. SSCD may be unrelated to a larger process of global temporal bone degeneration. Additional clinical screening for regions outside the petrous temporal bone is not warranted unless SSCD patients present with symptoms characteristic of other temporal bone pathologies.

Middle Ear and Mastoid Diseases: Literature Review and New Classification Proposal.

There are many classifications for cholesteatomatous otitis media but none correspond exactly to the formulation of a surgical protocol for the middle ear and mastoid nor are any specific for the extension of the otitis media, making it difficult to interpret the published results. All the available classifications are limited to the cholesteatoma and, moreover, the variety of the reported studies in literature does not allow a standardization to define middle ear pathology and surgical procedures. The aim of this paper is to propose a novel staging system for middle ear diseases paying attention to the involvement of tympanic Cavity (C), Attic (A), and Mastoid (M): the CAM classification.In particular, CAM classification is composed of three symbols (0 / + / ρ) and two letters (t and m, tiny and ivory mastoid cases) related to the alphabetic initial of the macroscopic region, being able to allow a clear and specific description of the local situation. Moreover, the possibility to describe the temporal bone and the potential use of sub-groups to specifically define the involvement of the tympanic cavity and the attic could allow the creation of a common otologic language among all the different centres.

Usefulness of the Video Head Impulse Test for the Evaluation of Vestibular Function in Patients With Otitis Media With Antineutrophil Cytoplasmic Antibody-Associated Vasculitis.

To investigate usefulness of the video Head Impulse Test (vHIT) as a method for evaluating semicircular canal function in patients with otitis media with antineutrophil cytoplasmic antibody-associated vasculitis (OMAAV). Retrospective case review. Tertiary referral center. Fourteen patients with OMAAV underwent vestibular examination. The gain in vestibulo-ocular reflex (VOR) and the presence of catch-up saccade were examined for each semicircular canal. Seven (50.0%) of the 14 patients felt subjective symptoms of disequilibrium. Dysfunction in at least one semicircular canal was detected in all ears of the OMAAV patients evaluated by vHIT. Dysfunction in posterior semicircular canal was detected more frequently than that in the anterior or horizontal canal. There were no significant correlations between the gain in VOR and hearing loss. vHIT is thought to be the most suitable method for evaluating semicircular canal function in patients with OMAAV as vHIT is not influenced by middle ear pathology and was able to evaluate vertical canal function including the posterior canal.

VESTIBULAR SYMPTOMS AFTER COCHLEAR IMPLANTATION: CLINICAL OVERVIEW AFTER A 2-YEAR FOLLOW-UP

Background Vestibular symptoms and balance disorders are still common complaints reported by the patients after cochlear implantation (CI). Much research has been devoted to assess dizzy patients after cochlear implantation using both self-prepared questionnaires as well as validated life-quality scales. From this work, various approaches to classifying symptoms according to their onset and duration have been recommended. Material and methods We studied 101 patients after round window approach (RWA) cochlear implantation giving them a self-prepared questionnaire asking them to list their major vestibular complaints formulated according to the consensus document of the Barany Society Committee for the classification of vestibular disorders. Those with persistent symptoms (both postoperatively and existing preoperatively) also filled in a DHI questionnaire. Additionally, cVEMP, oVEMP, caloric, and vHIT tests were performed before and after the CI procedure. Results The 101 patients were divided into four groups: with early symptoms (n = 25), with late symptoms (n = 2), with preoperative symptoms (n = 13), and with no symptoms (n = 61). Among the patients with early symptoms, 15 reported spontaneous vertigo attack, 6 only unsteadiness and/or lateropulsion, and 4 had other symptoms such as orthostatic vertigo, positional vertigo, visual tilt, and head-motion vertigo. Conclusions Close to 40% of the CI recipients suffered from vestibular complaints, either in the postoperative period or from already existing preoperative symptoms. The vast majority of postoperative complaints were transient and only rare cases (with preexisting inner ear pathologies and/or comorbidities) evolved into persistent dysfunction.

A study of factors affecting the success rate of type-1 tympanoplasty

<p class="abstract"><strong>Background: </strong>Chronic otitis media (COM) (tubo-tympanic) is a common ear pathology for which tympanoplasty is done. Factors that affect the success rate of tympanoplasty can be patient related (age, gender, socio-economic status), disease related (duration and severity of symptoms) or technique related (equipment and surgical approaches). This study was undertaken to know the factors affecting success rate of type-1 tympanoplasty at our institute.</p><p class="abstract"><strong>Methods:</strong> This was a prospective observational study conducted at ENT Department of Gujarat Adani Institute of Medical Sciences, Bhuj, from October 2017 to July 2019. All patients between 20 and 60 years of age with inactive mucosal COM operated for type-1 tympanoplasty were included in the study. Pre-operative, intra-operative and post-operative details were recorded as per the pre validated proforma and evaluated using Chi-square and paired t-test.</p><p class="abstract"><strong>Results: </strong>100 patients were included in our study. Females were more commonly affected (61%) than males (39%). In 78% of patients one ear was affected (left 40%, right 38%). Ear discharge was the most common symptom (99%). Maximum patients (55%) had a moderate perforation. The perforation was central in all cases. Microscopic surgery was done in 79% of patients. Post aural approach (Wilde’s incision) was the most common approach used (70%). The most common graft material used was temporalis fascia (96%). In 61% of patients graft was kept by underlay technique.</p><p class="abstract"><strong>Conclusions: </strong>In our study, the success rate of tympanoplasty was significantly more when duration of discharge was less, microscope was used for surgery and post aural approach was used. Success rate was less when there was history of any previous nasal pathology. Other factors, like age, gender, socio-economic class, occupation, side of involvement of ear, size and site of perforation and grafting techniques, did not affect the success rate of tympanoplasty.</p>

Wideband absorbance pattern in adults with otosclerosis and ossicular chain discontinuity

ObjectivesEvidence from previous literature had shown that the use of a single frequency probe tone is not sensitive enough to detect middle ear pathologies, especially related to the ossicles, which hinders accurate diagnosis. The goal of the present study was to compare the outcome of wideband absorbance (WBA) tympanometry and to determine the difference in WBA pattern in adults with otosclerosis and ossicular chain discontinuity. Materials and methodsEstimated adult cases of otosclerosis (10 ears) and ossicular chain discontinuity (06 ears) along with healthy individuals (10 ears) in the age range of 24 to 48 years (mean age: 38.6 years) were considered for the study. WBA was measured at peak and ambient pressure along with resonance frequency and compared with the data obtained from the healthy individuals to determine the WBA pattern. ResultsData analysis revealed a distinct WBA pattern showing high absorbance at 750 Hz for ossicular chain discontinuity compared to healthy individuals, whereas the otosclerosis group showed reduced absorbance (p < 0.05) at low frequencies (250 Hz to 1500 Hz). WBA measured at the peak and ambient pressure did not elicit any significant difference across the frequencies. Also, the average WBA tympanogram measured between 375 Hz and 2000 Hz showed a significant difference in ambient pressure only in the otosclerosis group. In comparison to healthy individuals (901 Hz), ossicular chain discontinuity showed a significant reduction in resonance frequency (674 Hz), whereas in cases with otosclerosis had higher resonance frequency (1445 Hz). Conclusions and significanceThe present study showed different WBA patterns between the groups and the absorbance values were significantly different at the low frequencies. This suggests that WBA has the potential to differentiate ossicles related pathologies from normal and also between the ear with otosclerosis and ossicular chain discontinuity.

Quantitative Measurements in Otological Surgery: Use of an Endoscopic Integrated Multipoint Laser System.

Assess the clinical utility of an Endoscopic Integrated Multipoint Laser System (EMLS) to otology. This is an emerging technology from automotive engineering that may offer the ability to accurately measure anatomy and pathology using an endoscope while undertaking ear surgery. Simulated otology patients were used incorporating the Phacon Temporal Bone synthetic models and Kyoto Kagaku Ear Examination Simulator models to allow assessment of the EMLS technology in evaluating external ear and middle ear pathology, e.g., perforation or prosthesis sizing. Eight otolaryngology resident and fellows at a tertiary university teaching hospital were given training in EMLS and reviewed simulated anatomy and pathology within the models including tympanic membrane perforation, ossicular discontinuity, and a cochleostomy. Variance in measurement was assessed in relation to those made manually by an independent surgeon using surgical calipers (0.1 mm). The 8 participants produced 47 mean measurements. The mean difference from independently made manual measurement was 0.294 mm (standard error of the mean 0.033). Maximum variance was 0.98 mm and minimum 0.01 mm. Use of an integrated endoscopic laser measurement tool allows reliable, easy-to-obtain measurements to be obtained within a simulated otological surgical environment. Translation of the technology to a thinner delivery system through a rigid endoscope offers further promise for routine use in a clinical setting.

Inner Ear Complications in Children and Adolescents with Sickle Cell Disease

Hearing impairment is a reported complication of sickle cell disease, yet inner ear pathology is not fully understood. The study purpose was to examine the patterns of inner ear involvement in patients with sickle cell disease by magnetic resonance imaging (MRI) and to assess its association with auditory functions. A cross-sectional study included 22 children with sickle cell disease examined for inner ear pathology by audiogram, MRI inner ear and transcranial Doppler (TCD) with revision of their hospital records for transfusion, chelation and hydroxyurea (HU) therapy. Abnormal MRI in the form of intrinsic T1 hyperintensity within the lumen of inner ear structures and cochlear neuropathy was found in five (22.7%) patients; left middle cerebral artery (MCA) flow velocity was higher in patients with abnormal MRI (83.4 ± 5.3 cm/sec) compared to normal MRI (68.2 ± 11.1 cm/sec) (p = 0.015), however, none of the patients had TCD of >170 cm/sec. There was no significant difference between patients with normal and abnormal MRI as regards hearing level and speech audiometry. Sensorineural hearing loss (SNHL) was present in two (9.1%) and conductive hearing loss (CHL) in two (9.1%) patients. There was a significant negative correlation between right ear mean hearing level and right MCA flow velocity and significant negative correlation between left ear mean hearing level and basilar artery (BA) flow velocity. We concluded that inner ear pathology is not uncommon in asymptomatic patients with sickle cell anemia, yet it did not correlate with hearing impairment and may occur with normal TCD results.

Primary Meningioma of the Middle Ear - A Rare Presentation

Abstract Introduction/Objective Meningiomas are the benign intracranial neoplasm, most commonly occurring in the third and sixth decade of life. The most common intracranial locations for meningiomas are parasagittal sinuses and large dural sinuses. Very rarely extracranial meningiomas can also be observed. We present a case of fibrous meningioma presenting as middle ear mass, in which a 13 years old female was presented with drainage from the left ear. Biopsy showed fibromyxomatous tissue. CT scan of the head showed soft tissue filling the middle ear and extending into the mastoid. Methods The mass was resected and sent to pathology, where H&amp;E staining and immunohistochemistry was done for diagnosis. Results The H&amp;E stained section showed a spindle-shaped neoplasm with areas of sheet-like growth interspersed with areas showing tumor cell growth in short fascicles, and some areas of decreased cellularity. Tumor cells have moderate cytoplasm, fine nuclear chromatin and inconspicuous nucleoli. The tumor cells were positive for EMA, PR(nuclear staining) and pan-TRK and negative for D-240, SOX-10, S-100 and desmin. These histological features alone with immunohistochemistry profile were consistent with meningioma WHO grade 1. Conclusion Primary middle ear meningioma although a rare diagnosis, but should be considered while dealing with middle ear pathologies. Histomorphology and immunohistochemistry play an important role in making diagnosis.

Low-fidelity otoscopy simulation and anatomy training: A randomized controlled trial

ObjectivesTo evaluate whether the use of low-fidelity otoscopy simulation improved medical students’ theoretical knowledge of middle ear anatomy and pathologies compared to traditional teaching methods. MethodsThis was a randomized controlled trial. Simulation workshops were conducted in April 2019 in the Lyon Sud University medical faculty, France. Students were randomly assigned to the simulation group (n=105) or to the control group (n=95). The students in the control group answered a questionnaire evaluating theoretical knowledge (25 true-false questions) before the simulation tutorial, while the students in the simulation group answered the same questions after the tutorial. Both groups also filled out a satisfaction questionnaire for feedback. Results196 of the 200 students who participated in the study completed the knowledge assessment questionnaire. Scores were 32.0% higher in the simulation group than in the control group (mean scores, 12.0/20 vs. 9.1/20; P<0.0001). 184 of the 191 students who completed the satisfaction questionnaire (96.3%) were satisfied or very satisfied with the workshop, and all but one (99.5%) recommended keeping it in the curriculum. In the free comments fields, students highlighted the educational value of learning without the stress of patient discomfort. ConclusionOtoscopy simulation is an effective training method, improving theoretical knowledge compared with conventional theoretical training.

Tinitus (Acúfeno) en la población adulta nicaragüense

El tinnitus (acúfeno) es descrito por el paciente como “zumbido” o “silbido” “pitido” dentro del oído, los cuales se producen sin que exista fuente sonora externa que lo origine, su prevalencia real es difícil de precisar sobre todo en nuestro medio ya que la mayoría de la población que acude al hospital acude por otras causas otológicas y audiológicas. El objetivo de esta investigación consistió en describir el perfil epidemiológico y clínico del tinnitus en la población nicaragüense de 25 a 65 años de edad atendidos en la consulta externa por el servicio de otorrinolaringología en el Hospital Antonio Lenín Fonseca durante el periodo comprendido entre el 1 de enero y el 31 de diciembre de 2018. Para ello se realizó un estudio observacional, descriptivo, de corte transversal. Se revisaron 312 expedientes clínicos de pacientes diagnosticados con patologías del oído de los cuales 15 tenían diagnóstico de tinnitus asociada o no a otras patologías otológicas; Se empleó una técnica de muestreo probabilística sistemática. La información fue recolectada haciendo uso de una ficha de recolección de datos, la cual fue validada mediante una prueba piloto, para ello se revisaron 35 expedientes clínicos. El procesamiento estadístico de las variables: edad, sexo, tratamiento farmacológico y pruebas diagnósticas, se llevó a cabo haciendo uso del programa informático IBM-SPSS® versión 25.0 para Windows 7 de 32 bits, utilizando un análisis descriptivo, expresado en frecuencia y porcentajes. Se obtuvieron los siguientes resultados, el 4.8% de los pacientes con patologías del oído presentó tinnitus; el sexo femenino se vio afectado en el 3.2%, la edad mayormente afectada fue la comprendida entre 51 – 59 años, los pacientes con diagnóstico único de tinnitus no recibieron ningún fármaco, fueron diagnosticados mediante otoscopía y audiometría. El tinnitus persistente representó el 4.8 % de los hallazgos clínicos presentes en la segunda reevaluación del paciente diagnosticados con patologías del oído y un 3.8 % estaba relacionado con hipoacusia persistente. Concluimos que el tinnitus prevaleció en el 4.8% del grupo poblacional estudiado y supuso el 0.4% de los diagnósticos en la población que acude a consulta por afectación otológica.

Effects of familial Mediterranean fever on the middle ear

ObjectiveTo evaluate middle and inner ear function and hearing status of children with familial Mediterranean fever (FMF). MethodsWe assigned 56 patients with FMF to the study group and 52 healthy volunteers to the control group. The mean age of patients in the study and control groups were 10.10 ± 3.70 and 9.77 ± 3.74 years, respectively. Physical examination and hearing evaluation were performed in both groups. The audiological test battery included 226-Hz tympanometry, pure tone audiometric evaluation, acoustic stapedial reflex measurements, distortion product otoacoustic emission recording, and wide-band tympanometry assessment. ResultsThe groups were similar in age and sex ratio (p > 0.05 for both comparisons). Pure tone audiogram and distortion product otoacoustic emission results were also similar for both groups (p > 0.05). The ipsilateral acoustic stapedial reflex were present in both of the groups and all participants had Type A tympanogram. The contralateral acoustic stapedial reflex thresholds were significantly higher in the familial Mediterranean fever group (p < 0.05 for all comparisons). The ambient and peak pressure absorbance values of wide-band tympanometry were significantly lower at 2000 Hz and significantly higher at 4000 Hz in the familial Mediterranean fever group (p < 0.05 for both comparisons). The severity and duration of disease adversely affected the absorbance values of wide-band tympanometry at 2000 and 4000 Hz (p < 0.05). ConclusionTo our knowledge, this is the first study to demonstrate the adverse subclinical effects of familial Mediterranean fever on the middle ear. We recommend that children diagnosed with FMF should be closely monitored for future clinical middle ear pathologies.

Use of sound therapy in management of tullio phenomenon associated with unilateral endolymphatic hydrops

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; The tullio phenomenon consists of the production of vestibular signs or symptoms by an acoustic stimulus. TP was found to be present in many inner ear pathologies such as superior semicircular canal dehiscence, perilymphatic fistula and endolymphatic hydrops. No previous study probed the value of tinnitus maskers in the alleviation of Tullio phenomenon associated with endolymphatic hydrops.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods&lt;/strong&gt;: Twenty one patients who had a confirmed unilateral endolymphatic hydrops associated with Tullio phenomenon were selected for the study. Their age ranged from 20 to 52 years old. Tinnitus masker±amplification was used according to the audiological findings of each patient. The device was used in the affected ear for a minimum of 6 months.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; Ten patients reported marked improvement on a graded scale with a mean of 8.6±1.2 as regards the occurrence of tullio phenomenon. Six patients achieved an average amelioration (mean 5.9±0.12) while five patients reported failure of the device (mean 3.4±0.6).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Sound therapy using tinnitus masker±amplification is a good tool for alleviation of tullio phenomenon associated with unilateral endolymphatic hydrops.&lt;/p&gt;

A randomised trial to assess the educational benefit of a smartphone otoscope in undergraduate medical training.

Competent otoscopy is a key otolaryngology skill for a broad range of medical careers, yet undergraduate's confidence to perform otoscopy is reported as low. Smartphoneotoscopes have been suggested to improve undergraduates learning of normal eardrum anatomy because unlike the traditional otoscope, the learner and educator share the same image. This study aimed to evaluate whether a smartphoneotoscope could enhance medical undergraduates recognition of common ear pathology. 52 medical students were randomised into a standard group that used a traditional otoscope and an intervention group that used a smartphoneotoscope. Both groups received a short didactic presentation on the recognition of common ear pathologies and were asked to diagnose four simulated pathologies. Both groups received feedback and guidance on how to better visualise the tympanic membrane. Force response items and 5-point Likert scales loaded on an electronic platform recorded their diagnosis and their perceptions towards the otoscope. The smartphone-group (n = 20) had higher overall rates of correct diagnosis compared to control (n = 22) (84% vs. 39%, p = < 0.001). Only the grommet station did not show a significant improvement between the two groups (100% vs. 91%, p = 0.49). 90% (n = 20) of participants felt the smartphone otoscope was preferential for their learning. The same number expressed that they want to use it in future learning. The remainder were indifferent. The smartphoneotoscope enabled learners to better observe and recognise middle ear pathology. This popular learning tool has the potential to accelerate the learning curve of otoscopy and therefore improve the proficiency of future doctors at recognising middle ear diseases.

Microbiological Profile and Drug Sensitivity Pattern in Persistently Discharging Ears: A Tertiary Level Hospital Based Retrospective Study

Introduction Antimicrobial resistance is an emerging issue resulting from the misuse of antibiotics in today’s world. As an effect of it, cases with persistent ear discharge not responding to the conventional oral antibiotics prescribed in ear pathologies are seen increasing in our day to-day practice. This study aims to review the microbiological growth and the pattern of their antibiotic sensitivity in this group of population.&#x0D; MethodsThis was a retrospective study which was conducted at the Department of ENT-HNS of Tribhuvan University Teaching Hospital. Record files of all cases who presented with persistently discharging ear for more than 2 weeks and not responding to oral antibiotics, between January 2017 to March 2020 were assessed. Cases of chronic otitis media (COM) squamous with persistent discharge were excluded as most of the times it is the disease process rather than type of organism which causes the persistence of ear discharge despite the use of antibiotics.&#x0D; ResultsCOM mucosal and cavity infection following modified radical mastoidectomy (MRM) were the commonest pathologies. Pseudomonas aeruginosa (PA) and Coagulase negative Staphylococcus (CoNS) were the commonest bacterial isolates. Pseudomonas aeruginosa showed a good sensitivity to antibiotics like Tazobactam and Piperacillin and resistance to conventionally used antibiotics like Ciprofloxacin and Levofloxacin. Similarly, CoNS had good sensitivity to antibiotics like Oxacillin and Levofloxacin and resistance to conventionally used antibiotics like Amoxicillin.&#x0D; ConclusionCOM mucosal and post MRM cavity infection are the commonest pathologies presenting with persistent ear discharge with PA and CoNS as the predominant isolates. Pseudomonas aeruginosa holds a good sensitivity to drugs like Tazobactam and Piperacillin; and CoNS to drugs like Oxacillin and Levofloxacin.

Microbiological Profile and Drug Sensitivity Pattern in Persistently Discharging Ears: A Tertiary Level Hospital Based Retrospective Study

Introduction: Antimicrobial resistance is an emerging issue resulting from the misuse of antibiotics in today’s world. As an effect of it, cases with persistent ear discharge not responding to the conventional oral antibiotics prescribed in ear pathologies are seen increasing in our day to-day practice. This study aims to review the microbiological growth and the pattern of their antibiotic sensitivity in this group of population. Methods: This was a retrospective study which was conducted at the Department of ENT-HNS of Tribhuvan University Teaching Hospital. Record files of all cases who presented with persistently discharging ear for more than 2 weeks and not responding to oral antibiotics, between January 2017 to March 2020 were assessed. Cases of chronic otitis media (COM) squamous with persistent discharge were excluded as most of the times it is the disease process rather than type of organism which causes the persistence of ear discharge despite the use of antibiotics. Results: COM mucosal and cavity infection following modified radical mastoidectomy (MRM) were the commonest pathologies. Pseudomonas aeruginosa (PA) and Coagulase negative Staphylococcus (CoNS) were the commonest bacterial isolates. Pseudomonas aeruginosa showed a good sensitivity to antibiotics like Tazobactam and Piperacillin and resistance to conventionally used antibiotics like Ciprofloxacin and Levofloxacin. Similarly, CoNS had good sensitivity to antibiotics like Oxacillin and Levofloxacin and resistance to conventionally used antibiotics like Amoxicillin. Conclusion: COM mucosal and post MRM cavity infection are the commonest pathologies presenting with persistent ear discharge with PA and CoNS as the predominant isolates. Pseudomonas aeruginosa holds a good sensitivity to drugs like Tazobactam and Piperacillin; and CoNS to drugs like Oxacillin and Levofloxacin.