Mean AC Research Articles

Evaluation of Liver Parenchyma in Dogs with Hyperlipidemia Using Ultrasound Attenuation Imaging (ATI)

(1) Background: Ultrasound attenuation imaging (ATI) is an innovative technique that allows for the evaluation of the degree of lipid infiltration of the liver parenchyma in a simple and non-invasive way. The objective of this study was to verify the applicability of the ATI method in the evaluation of hyperlipidemia. (2) Methods: This study included 53 dogs between January 2021 and December 2022, of which 21 were healthy (A) and 32 had hyperlipidemia (B). The dogs of Group B were divided into mild hyperlipidemic (B1; n = 15) and moderate/severe hyperlipidemic (B2; n = 17). Each dog underwent biochemical examination, B-mode ultrasound and ATI investigation at the liver level via a right intercostal approach. (3) Results: The mean AC value was significantly higher in Group B (0.95 ± 0.23 dB/cm/MHz) compared to Group A (0.81 ± 0.10 dB/cm/MHz). No statistically significant differences were highlighted regarding the ATI values between the subjects with mild and moderate/severe hyperlipidemia. (4) Conclusion: ATI could be a promising method for the non-invasive evaluation of hepatic steatosis in veterinary medicine.

The impact of waiting time on hearing outcome and patients’ satisfaction after cholesteatoma surgery

Background Cholesteatoma is a formation of epithelium mass in the middle ear. Surgery aims to prevent complications while maintain or improve hearing. Aims/Objectives To determine if waiting time until cholesteatoma surgery affects hearing outcome and patients’ satisfaction. Material and Methods A retrospective cohort study performed at the only Ear Nose Throat clinic in one county in Sweden. Sixty concomitant surgeries, both first time and revisions, were included. Results Of the 60 surgeries, 33 (55%) were performed within a 3-month period. The mean waiting time was 1.4 months. In the remaining 27 cases, the mean waiting time was 8.6 months. Both groups had preoperatively similar air conduction pure tone average (AC PTA4), 47.3 dB and 47.0 dB respectively. The mean AC PTA4 gain was greater in the group with waiting time ≤3 months (8.6 dB) compared to the >3 months group (1.2 dB, p = 0.040). The patients’ satisfaction was lower in the latter group, but the difference was not statistically significant. Conclusions This study indicates that longer waiting time to cholesteatoma surgery has a negative impact on postoperative hearing results but not on patients’ satisfaction. Significance The outcome of this study suggests that waiting time to surgery can be a factor determining postoperative hearing results.

Association between hemoglobin variants and laboratory outcomes in patients infected with P. falciparum from South West Uganda.

We assess the relationship between various hemoglobin variants and some hematological parameters packed cell volume, white blood cells (PCV, WBC) and parasitemia level of patients with malaria in the southwestern, Uganda. Patient were enrolled by rapid diagnostic tests (RDTs), confirmed by microscopy, and laboratory outcomes were determined. Patients positive for malaria RDTs were 155, microscopic-confirmed P. falciparum parasites were 95(61.29%) having hemoglobin variants HbAA andHbAS; 75(78.95%) and13(13.68%), respectively. The laboratory outcomes showed mean, PCV(32.19±4.83), WBC(5831.66±2888.29) and P. falciparum parasitaemia density (32,605.45±14031), while the hemoglobin variants mean values AA(39,008.85±31,261.56), AC(15908±10173.48), AS(16,561.46±15,380.93), SC(30,524±0.000) and SS(1652±0.000) were significantly different from the total population (34,321.5±21,924.26) parasite-density. Patients with hemoglobin variants HbAA had asignificantly higher parasite-carrying capacity and PCV levels.

Deep learning-based Automated Localisation of Anterior Commissure and Posterior Commissure Landmarks in 3D space from three-plane 2D MRI localiser slices of the brain

The operator first performs the three-plane MRI localiser slices acquisition protocol during brain MRI scan acquisition. Based on various anatomical landmarks such as anterior commissure AC), posterior commissure (PC), and mid-sagittal plane (MSP), the operator plans MRI position and orientation before a full brain MRI scan which is essential for good quality MRI. Automatic localisation of these landmarks is vital to automatise the process and minimise operator error. Prior approaches focused on automated AC and PC detection on 2D mid-sagittal MRI slices. However, improper head positioning leads to improper 2D mid-sagittal MRI slice; therefore, it may impact the localisation error, and the localisation is not in 3D space with respect to brain volume. In the present work, the AC and PC landmarks' locations were predicted in 3D space from three-plane 2D MRI localiser slices using a convolutional neural network-based approach. Six publically available brain MRI datasets were used. The mean AC and PC localisation error obtained was less than 2mm in a within-dataset evaluation and less than 3mm in a cross-dataset evaluation.

Using phosphate amendments to reduce bioaccessible Pb in contaminated soils: A meta-analysis.

Measuring the reduction of in vitro bioaccessible (IVBA) Pb from the addition of phosphate amendments has been researched for more than 20 years. A range of effects have been observed from increases in IVBA Pb to almost 100% reduction. This study determined the mean change in IVBA Pb as a fraction of total Pb (AC) and relative to the IVBA Pb of the control soil (RC) with a random effects meta-analysis. Forty-four studies that investigated the ability of inorganic phosphate amendments to reduce IVBA Pb were identified through 5 databases. These studies were split into 3 groups: primary, secondary, and EPA Method 1340 based on selection criteria, with the primary group being utilized for subgroup analysis and meta-regression. The mean AC was approximately -12% and mean RC was approximately -25% for the primary and secondary groups. For the EPA Method 1340 group, the mean AC was -5% and mean RC was -8%. The results of subgroup analysis identified the phosphorous amendment applied and contamination source as having a significant effect on the AC and RC. Soluble amendments reduce bioaccessible Pb more than insoluble amendments and phosphoric acid is more effective than other phosphate amendments. Urban Pb contamination associated with legacy Pb-paint and tetraethyl Pb from gasoline showed lower reductions than other sources such as shooting ranges and smelting operations. Meta-regression identified high IVBA Pb in the control, low incubated soil pH, and high total Pb with the greater reductions in AC and RC. In order to facilitate comparisons across future remediation research, a set of minimum reported data should be included in published studies and researchers should use standardized in vitro bioaccessibility methods developed for P-treated soils. Additionally, a shared data repository should be created for soil remediation research to enhance available soil property information and better identify unique materials.

TO COMPARE ANTERIOR CHAMBER DEPTH MEASUREMENTS OBTAINED BY PENTACAM WITH THOSE OBTAINED BY IOL MASTER 700, CIRRUS AS-OCT IN NORMAL HEALTHY EYES.

Purpose: To assess the anterior chamber depth measurements obtained by Pentacam with IOL Master 700 and anterior segment optical coherence tomography. Two hundred and six eyes of healthy subjects were underwent anterior chamber depth meas Methods: urements by Scheimpugbased Pentacam (Oculus, Wetzlar, Germany), IOL Master 700 (Carl Zeiss Meditec, Dublin, CA) and anterior segment optical coherence tomography by same individual. The measurements resulted in mean AC depth of 2.89 ( 0.26)m Results: m with Pentacam, 2.92 ( 0.281)mm with AS OCT and 2.91 ( 0.27)mm with IOL Master 700. Distribution of data showed statistically signicant difference in ACD (P= 0.001) between Pentacam and AS OCT. Similarly, there was statistically signicant difference in ACD (P = 0.000) between Pentacam and IOL Master 700. Conclusions: In healthy individuals, ACD measured between Pentacam and AS OCT showed statistically signicant difference. Similarly, measurements with Pentacam and IOL Master 700 also showed signicant difference. Hence these devices cannot be used interchangeably.

Malleus Relocation in Ossicular Reconstruction by Using Autologous Incus

Context: Malleus relocation is a technique in ossiculoplasty invented by Robert Vincent to make malleus at the same line of stapes. This study will use this technique with modification by using autologous incus instead of prosthesis for reconstruction. Aims: The objective of this study was to report the method of malleus relocation with auto-incus in ossiculoplasty in cases with chronic suppurative otitis media. Settings and Design: A retrospective study was done at Al-Nahdha Hospital tertiary referral center. Subjects and Methods: This is a study of 12 patients (out of 150 patients who underwent ossiculoplasty surgery done in the department) from 2012 to 2019 for chronic otitis media. This means that all patients had malleus relocation technique with use incus for reconstruction except one patient where malleus relocation done with use of prosthesis instead of incus which was absent. Audiometric assessment included pre- and postoperative audiometric evaluation using conventional audiometry. Air-bone gap, bone-conduction thresholds, and air-conduction thresholds were measured. Statistical Analysis Used: Data were collected and analyzed in SPSS version 21. Confidence interval, mean, and median are used to calculate the pre- and postoperative ABG. Results: Eleven patients underwent malleus relocation with incus interposition. The mean postoperative air-bone gap is 11, and 66.6% of cases had ABG less than or equal to 20 dB. The mean AC postoperative is 21, and 66.7% of cases show improvement of more than 20 dB. Conclusions: Malleus relocation with auto-incus ossiculoplasty showed in this study is safe and gives a good hearing outcome.

Influence of Emerging Semiconductive Nanoparticles on AC Dielectric Strength of Synthetic Ester Midel-7131 Insulating Oil.

Exploring impressively effective dielectric nanofluids for transformers to improve dielectric strength and thermal stability is indispensable. It is crucial to determine the modification mechanism of dispersed nanomaterials in insulating oil for operative applications in power transformers. This paper aspires to authenticate the experimental evidence of the enhancing AC dielectric strength of synthetic ester Midel-7131 using two newly introduced semiconductive nanoparticles, CdS and Co3O4, and uncover the potential reasons for enhanced AC dielectric strength. The AC breakdown voltage (BDV) of synthetic ester and nanofluids was investigated and statistically evaluated. The mean AC breakdown voltage of SE/CdS and SE/Co3O4 was increased by 31.9% and 31.3%, respectively. The augmentation in AC breakdown strength is possibly due to the facilitated charge-scavenging ability owing to the large specific surface area and wide bandgap. Simultaneous thermogravimetric analysis, differential scanning calorimetry, and derivative thermogravimetry analyses (TGA–DSC–DTG) confirmed that the initial decomposition temperature was high and heat dissipation was low, indicating that the nanofluids were thermally stable in both air and nitrogen. Hence, emerging semiconductive CdS and Co3O4-based nanofluids of synthetic ester possess remarkable dielectric strength and thermal stability enhancement for their application in power transformers.

Arthroscopic reduction of congenital hip dislocations in infants

Open reduction of congenital hip dislocations currently remains the standard treatment for those hip joints which are irreducible by closed means. The open reduction of the dislocated hip joint represents arelatively invasive surgical method. Thus, the goal was to develop aminimally invasive and safe procedure with alower complication rate as an alternative to open reduction. This work presents the arthroscopically guided reduction of dislocated hip joints, first described in 2009, as astandardized surgical technique. Failed closed reduction for congenital hip dislocation. Arthroscopic reduction of the dislocated femoral head using an arthroscopic two-portal technique, ahigh anterolateral and amedial subadductor portal. The arthroscope is inserted through the subadductor portal. The high anterolateral portal serves as working portal. Step-by-step identification and removal of obstacles to reduction such as the ligament of the femoral head, fat tissue, capsular constriction and psoas tendon. Reduction of the femoral head under arthroscopic control. The hip joint is retained in ahip spica cast with the legs in human position. Arthroscopic hip reduction of 20congenital hip dislocations: 13girls and 3boys with an average age at the time of operation of 5.8months (3-9months). All children had multiple, unsuccessful attempts of closed reduction by use of overhead traction, Pavlik harness or closed reduction and hip spica application. According to the Graf classification, there were 20typeIV hips. According to the radiological classification of Tönnis, there were 9 type4, 7 type3, and 4 typeII grades. The obstacles to reduction were capsular constriction, hypertrophic ligament of the femoral head, and an extensively large pulvinar in the acetabulum. An inverted labrum was not seen in any of the cases. In contrast, in 2/3 of the cases, there was considerable retraction of the dorsal edge of the socket due to the ligament of the femoral head expanding right over it. In all cases, postreduction transinguinal ultrasound and MRI were used to check the femoral head position in the cast postoperatively. In all cases there was adeep reduction of the femoral head in the acetabulum. There were no intra- or postoperative complications such as bleeding, infections or nerve lesions. There were no cases of redislocation or decentering of the femoral head, which was also confirmed after an average follow-up of 15months. The mean AC angle at follow-up was 24.5°. There was one coxa magna in the series and one avascular necrosis with afragmented femoral head according to the Salter classification.

Ossicular reconstruction of incudo-stapedial joint by glass ionomer\u2014a study of 24 cases

BackgroundChronic otitis media is one of the major health issues worldwide resulting in partial or complete loss of conductive hearing mechanism including the tympanic membrane and ossicular assembly. The aim of the study is to assess hearing improvement after reconstructing the incudo-stapedial joint with glass ionomer cement. Here, a prospective observational study was done in a tertiary care hospital. Patients of chronic mucosal otitis media were operated, and intraoperatively incudo-stapedial joint discontinuity was restored using glass ionomer cement. Post-operative follow-up was done at 1-month, 3-month, 6-month, and 1-year intervals, and hearing was evaluated by doing pure tone audiometry with air conduction at 0.5, 1, 2, 3, 4, 6, and 8 kHz and bone conduction at 0.5, 1, 2, 3, and 4 kHz. Tabulation was done by calculating the air-bone gap in each patient.ResultsIn our study, the patients showed statistically significant improvement in air conduction thresholds and near closure of air-bone gap post-operatively. The mean AC threshold is 15 dB with 91.67% patients having closure of ABG < 20 dB at the end of the 3rd month. Hearing was also evaluated at 6-month and 1-year intervals, which showed good improvement in hearing levels.ConclusionsGlass ionomer is a simple, physiological, and cost-effective method of tympano-ossicular reconstruction with certain significant post-operative hearing improvement.

Endoscopic transtympanic cartilage push-through myringoplasty without tympanomeatal flap elevation for tympanic membrane perforation

Background The elevation of the tympanomeatal flap in endoscopic myringoplasty will cause considerable tissue damage. Objective To analyze anatomic and audiological results of tympanic membrane perforation underwent endoscopic transtympanic cartilage push-through myringoplasty without tympanomeatal flap elevation (EPM) and their relationship with the size of perforation. Methods A clinical retrospective study was performed on 75 cases of tympanic membrane perforation that underwent EPM from January 2019 to March 2021. Graft success and hearing outcomes were evaluated 3 months after surgery. Results The overall graft success rate for EPM was 94.7% (71/75). The total rate of hearing success, postoperative ABG ≤ 20 dB was achieved in 96.0% (72/75). The overall mean AC threshold of 35.1 ± 5.6 dB was lowered to 25.0 ± 4.8 dB postoperatively (p < .01). The mean pre- and postoperative ABG of all patients were 20.5 ± 4.6 dB and 10.4 ± 3.9 dB (p < .01), respectively. The graft success rates for the small, middle and large perforations groups were 100% (11/11), 100% (34/34) and 86.7% (26/30), respectively. Conclusion It is revealed that EPM is an effective method to repair perforation of tympanic membrane. The size of the tympanic membrane perforation may be a risk factor for perforation healing and hearing recovery, although EPM is available for large perforations.

Comparison of surgical technique and outcomes of phacoemulsification and manual small incision cataract surgery in management of phacomorphic glaucoma and analysis of the risk factors for developing phacomorphic glaucoma

Background: Phacomorphic glaucoma is highly prevalent in developing countries. In India, the prevalence of phacomorphic glaucoma is 3.91%. The definitive treatment of phacomorphic glaucoma is surgery. The purpose of our study was to compare the surgical technique and outcomes of phacoemulsification and manual small incision cataract surgery (MSICS), in management of phacomorphic glaucoma and analysis of the risk factors for developing phacomorphic glaucoma. Methods: This was a hospital based retrospective study done at a tertiary eye care center, over a period of nineteen months. A rigorous protocol to diagnose phacomorphic glaucoma was followed. All patients were given IV mannitol 20%, before surgery. The study patients were divided in to phaco group and MSICS group. The data analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0. Results: Out of 99 phacomorphic glaucoma cases, 37 underwent phacoemulsification and 62 underwent MSICS. The total number of female patients was 66 (66.67%) and that of male was 33 (33.33%) with female to male ratio of 2:1. The mean age of presentation was 63.64±8.27 years. The overall mean IOP was 42.9±9.68 mmHg in both the groups. The mean axial length was 22.47±1.03 mm in study patients and 22.82±0.8 mm in control group, (p=0.0082). The mean AC depth was 2.54±0.53 mm for phacomorphic eyes and 2.69±0.5 mm for control groups, (p=0.04). Conclusions: MSICS is effective, safe and inexpensive in controlling IOP and achieving good visual acuity with minimal complications in the management of phacomorphic glaucoma as compared to phacoemulsification.

The Effect of Interfacial Zone Due to Nanoparticle–Surfactant Interaction on Dielectric Properties of Vegetable Oil Based Nanofluids

Nanoparticles are generally anti-lipophilic and have a tendency to aggregate when they are embedded in nanofluids. Thus, surfactants have a major role in achieving long term dispersion stability of nanofluids through surface modification of nanoparticles. However, the surfactant changes the structure of the interfacial zone around nanoparticles and can have a crucial impact on the dielectric properties of dielectric nanofluids. Accordingly, this paper aims to clarify the role of interfacial zone on dielectric properties of vegetable oil based Al <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</sub> O <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">3</sub> nanofluids including relative permittivity, dissipation factor, and AC breakdown voltage. Moreover, a polarization model of nanofluids was proposed to calculate their relative permittivity considering surfactant effect. Different filler levels ranging from 0.01 wt% to 0.05 wt% were used and various temperature ranges were considered to validate the proposed model. Relative permittivity calculated from the proposed model was almost in line with experimental results. Proposed model depicted that surfactant contributes for orientational polarization of nanoparticles in the relative permittivity calculation. So, improvement in the relative permittivity of dielectric nanofluids has been attained from 0.01 wt% to 0.05 wt% of Al <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</sub> O <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">3</sub> nanoparticles due to both internal and orientational polarization of nanoparticles. Regarding dissipation factor of prepared nanofluids, it decreased against the weight percentage of nanoparticles, while the mean AC breakdown voltage increased against the weight percentage. All these effects were discussed considering the structure of interfacial zone and its impact on the alignment of oil chains and the energy loss of electrons.

TO COMPARE ESTIMATION OF GESTATIONAL AGE BY FOETAL TRANSCEREBELLAR DIAMETER WITH BIPARIETAL DIAMETER`, FEMUR LENGTH, ABDOMINAL CIRCUMFERENCE, HEAD CIRCUMFERENCE AT DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY AT SMS MEDICAL COLLEGE, JAIPUR

Background: Ultrasonographic assessment of gestational age by using different foetal parameter such as BPD, FL, AC are highly reliable in first and second trimester in pregnancy. In third trimester reliability of any single parameter has limitations.&#x0D; Methods: This was a hospital based comparative cross-sectional study done in the Department of Obstetrics and Gynaecology, S.M.S. Medical College and attached hospitals, Jaipur, Rajasthan. The period of study was from June 2018 to October 2019.&#x0D; Results: The mean TCD at 15 weeks and 40 weeks was 15.00 ± 0.00mm and 53.33±1.155mm respectively. The mean BPD at 16 weeks and 40 weeks was 33.50±0.70mm and 93±1.528mm respectively. The mean HC at 15 weeks and 40 weeks was 111.00±1,41mm and 340±2.00mm respectively. The mean FL at 15 weeks and 40 weeks was 18.50±0.70mm and 77.67±1.528mm respectively. The mean AC at 15 weeks and 40 weeks was 99.00±1.41mm and 365.33±8.32mm respectively.&#x0D; Conclusion: We conclude that foetal transcerebellar diameter can thus be used as an alternative foetal parameter to assess gestational age and can be used in cases of wrong dates or when other routine parameters are not conclusive or did not accurately predict gestational age for e.g. in cases of hydrocephalus, brachycephaly, dolicocephaly, intrauterine growth restriction, achondroplasia or short limb dwarfism.&#x0D; Keywords: Gestational age, Linear regression, BPD

Long-term Audiometric Outcomes After Atresiaplasty for Congenital Aural Atresia.

Describe long-term trends and stability of hearing outcomes for patients undergoing primary congenital aural atresia (CAA) repair. Retrospective chart review. Single academic, tertiary referral center. Children and adults who underwent primary CAA repair between 1980 and 2017. CAA repair. Long-term (> 1 yr) postoperative three-tone (500, 1000, 2000 Hz) air conduction pure-tone average (AC PTA) compared with the immediate (within 90 d of surgery) postoperative audiogram. The mean preoperative AC PTA was 59.6 dB HL. CAA repair improved hearing an average of 30.5 dB, but hearing declined by 8.2 dB over the long-term follow-up period (mean 4.4 yr; range 1-15.7 yr), leaving a final mean improvement of 22.2 dB (final mean AC PTA 37.3 dB HL). Two-thirds (92 of 138 ears) had an AC PTA ≤ 30 dB HL recorded in the first year after surgery. At the last follow-up test, 64% had "stable" hearing defined as no more than a 10 dB decline in AC PTA compared with the immediate postoperative audiogram; 21% had a 10 to 20 dB decline, 8% a 20 to 30 dB decline, and 7% declined > 30 dB. All patients enjoyed improvement in AC PTA after surgery (preoperative minus the best postoperative PTA, mean = 34 dB, range = 3.3-52 dB). Hearing declined by an average 8.2 dB over the long-term leaving a final average AC PTA of 37.4 dB HL. Sixty-four percent of patients exhibited stable (< 10 dB loss) hearing over time; 36% lost 10 dB or more over the long-term follow-up period. Hearing results typically stabilize over time with most of the change occurring in the first 3 years after CAA repair. Bone conduction thresholds remained stable over the study period.

The Clinical Implications of Simultaneous Bilateral Chronic Ear Surgery for Patients with Asymmetric Hearing

Background and Objectives Surgery for bilateral chronic otitis media (COM) is usually performed sequentially, not simultaneously. The main reason is to prevent iatrogenic bilateral conductive hearing loss during recovery period. However, with asymmetric hearing loss, the difference in patient inconvenience between sequential and simultaneous surgery may be the same. This study evaluates the efficacy of simultaneous COM surgery in patients with asymmetric hearing.Subjects Materials and Method From 2012 to 2018, 9 patients underwent simultaneous bilateral COM surgery. The period of patients’ hospital stay, the success rate of tympanoplasty, tolerability for operation, and hearing thresholds were analyzed statistically.Results For the 8 same-day surgery patients, the mean hospital period was 4.4±0.7 days, which was much shorter than that of sequential surgery (8 days). Tympanoplasty was successful in all patients without complications. In the better side, the preoperative/postoperative mean air conduction thresholds (AC) were 62.97±12.89 dB/47.81±19.07 dB (p=0.017), the bone conduction thresholds (BC) were 46.72±10.31 dB/37.66±16.99 dB (p=0.161) and the air-bone gaps (ABG) were 16.25±8.81 dB/10.16±7.78 dB (p=0.176). In the worse side, the preoperative/ postoperative mean AC were 86.56±18.22 dB/72.18±29.43 dB (p=0.035), BC were 53.28± 11.10 dB/48.13±18.41 dB (p=0.173), and ABG were 33.28±11.22 dB/24.06±14.80 dB (p=0.500). In both ear, the postoperative AC and BC were better than or equivocal to those of the preoperative value, and the result was similar with each of the unilateral ear audiological results.Conclusion Despite the fact that there is no complete consensus to date, simultaneous bilateral COM surgery can be an option when patients have asymmetric hearing loss. Simultaneous bilateral COM surgery could save time, cost, and lead to similar results with sequential surgery, so it could be a considerable surgical option for patients with bilateral COM.

Relation between the duration of disease and audiogram findings in tubotympanic type of chronic suppurative otitis media after myringoplasty

Introduction: Chronic Suppurative Otitis Media (CSOM) has been an important cause of hearing loss and ear discharge in people affected by it for a significant time now. Its prevalence is more in developing countries where the socioeconomic status is low. Poor and overcrowded living conditions, poor hygiene and nutrition have been suggested as a basis for the widespread prevalence of CSOM in developing countries. Pure Tone Audiometry is the easiest and the most basic procedure which needs to be performed on any patient who has history of hearing loss irrespective of the nature of the disease and the cause surrounding it. Every initial evaluation for CSOM should include audiometric testing via air and bone along with pure tone thresholds. Aims & Objectives: To co-relate the hearing loss to the duration of the disease in the ear in patients with CSOM and to also associate the same to the corresponding hearing changes after Myringoplasty. Materials & Methods: Sixty patients were taken to be part of the study after following a strict inclusion and exclusion criteria. With proper consent, they underwent Pure Tone Audiogram and Myringoplasty. Their Air Bone Gap and Air Conduction Threshold results were tabulated with the duration of the disease and a consensus was reached at. Observations & Results: It was observed that the hearing loss was much lesser if the duration of the disease was lesser than one year. As the diagnosis was delayed, both the AB gap and the mean AC threshold went up. The early closure of the perforation can significantly bridge the AB gap but the same cannot be said about the AC threshold as it seemed to be lesser affected by the duration. Conclusion: It can thus be concluded that AC threshold is quietly independent of the changes in the diseased middle ear as compared to the AB gap. This makes it a stronger tool in the assessment of hearing. The early diagnosis and management of Tubotympanic type of CSOM can not only help in preventing complications but also aid in better hearing protection which in-turn helps in better social survival.

084 Separating stroke from vestibular neuritis by vestibular function test parameters

IntroductionVestibular neuritis (VN) and posterior circulation stroke (PCS) are the commonest causes of acute vestibular syndrome (AVS). We aim to identify discriminators of VN from PCS by testing all five vestibular end-organs in patients presenting with AVS.MethodsThree-dimensional video-head impulse test (v-HIT), cervical and ocular-vestibular evoked myogenic potentials (c-and oVEMP) and subjective visual horizontal (SVH) tests were performed in 22 patients with VN and 22 with PCS. Ipsilesional horizontal, anterior and posterior canal (HC, AC, PC) v-HIT gain and first catch-up saccade characteristics, VEMP amplitude asymmetry-ratios were compared.ResultsAll VN and 6 PCS patients had positive clinical HIT. Mean time to testing was 4.7 days for VN, 7.0 days for PCS. VN mean ipsilesional HC and AC first saccade amplitude was larger, peak-velocities faster and onset latencies earlier compared to PCS (p&lt;0.05). No significant difference between VN and PCS in first saccade characteristics was found in PC. Ipsilesional first saccade amplitude, peak-velocity and duration were significantly different between PCS and controls for all canals (p&lt;0.05). A gain &lt;0.68 and first saccade amplitudes &gt;2.2°separated VN from PCS with sensitivities of 95.5% and 86.4% and specificities of 72.7% and 63.6%. First saccade amplitude of &gt;0.91°identified PCS from controls with sensitivity of 68.2% and specificity of 70%. Abnormality rates for AC cVEMP, BC oVEMP and SVH were 42.9%, 50% and 91% for VN and 38.1%, 9% 72% for PCS.Conclusion v-HIT gain and catch-up saccade metrics are useful separators of VN from PCS. Detailed saccade analysis complements existing vestibular tests.

Results of stapedotomy in otosurgical treatment of adult patients with osteogenesis imperfecta

ObjectiveThis is a retrospective study of hearing results and characteristics of osteogenesis imperfecta (OI) patients treated for hearing loss by stapedotomy at tertiary reference center. MethodsThis study enrolled 20 patients with a clinical diagnosis of OI- (11M:9F). 18 patients (90%) underwent surgery due to hearing loss in the period 2003–16. The audiometric analysis provides the pure tone audiometry results of stapedotomy in adult patients in 2 periods (≤12 months and >12 months).Air-bone gap (ABG), hearing gain (HG), and changes in air and bone conduction thresholds after surgical treatment were analyzed. ResultsIn short-time follow-up we noted statistically significant improvement in mean AC thresholds and ABG (p < 0.001 for both), change in mean BC thresholds was statistically negligible. Comparing the observation periods short-term and long-term, it was found that AC thresholds, ABG, HG, ABG closure did not significantly change, although BC thresholds and BC closure deteriorated significantly (p < 0.05). ConclusionStapes surgery for OI can be considered as a method of treating the conductive and/or mixed hearing loss suffered by these patients; however, the surgery is more difficult than that for otosclerosis because OI cases often have extremely difficult anatomical conditions. The hearing results of OI stapes surgery differ from typical otosclerosis cases, with the ABG closure not being as good. In addition, sensorineural hearing loss inevitably progresses.

Titanium ossicular chain reconstruction in single stage canal wall down tympanoplasty for chronic otitis media with mucosa defect.

To evaluate surgical outcomes for chronic otitis media with mucosa defect underwent titanium ossicular chain reconstruction (OCR) in single stage canal wall down tympanoplasty (CWD). A clinical retrospective study was performed on 83 cases of the chronic otitis media with mucosa defect and 123 ears with mucosa integrity according to intraoperative findings that underwent synchronous titanium OCR in single stage CWD form January 2012 to January 2018. Pre- and postoperative air conduction threshold (AC), air-bone gap (ABG) and ABG closure at 0.5, 1, 2, and 4 kHz were investigated. The overall mean AC threshold of 53.4 ± 16.5 dB was lowered to 41.2 ± 15.9 dB postoperatively (p < 0.01). The mean pre- and postoperative ABG of all patients were 27.9 ± 9.9 dB and 17.2 ± 9.3 dB (p < 0.01), respectively, with a mean ABG closure of 10.7 ± 8.4 dB. The total rate of success, postoperative ABG ≤ 20 dB was achieved in 71.4%. In the mucosa defect group underwent TORP, the mean pre- and postoperative ABG were 28.1 ± 9.8 dB and 20.1 ± 9.0 dB (p < 0.01), respectively, with the ABG closure was 8.0 ± 7.9 dB. In the mucosa defect group underwent PORP, the mean pre- and postoperative ABG were 27.9 ± 10.1 dB and 16.5 ± 9.1 dB (p < 0.01), respectively, with the ABG closure was 11.4 ± 8.6 dB. Furthermore, in the mucosa defect group, there was significant difference in success rate of achieved postoperative ABG ≤ 20 dB between the TORP (48.9%) and PORP (77.5%) (p < 0.05). It is revealed PORP in single stage CWD tympanoplasty for the patients suffered from chronic otitis media with mucosa defect is favored.