Otologic Research Articles

AKT question relating to management of ear problems

AKT question relating to management of ear problems

Kontrollü Hipotansif Anestezi ile Yapılan Timpanoplastilerde Baş Pozisyonunun Serebral Oksijen Saturasyonu Üzerine Etkisi

Objective: Our goal was to examine the impact of head position, which had not been examined before, on cerebral oxygenation in tympanoplasties performed in the reverse Trendelenburg position during controlled hypotension. Methods: This prospective study was conducted in our clinic between July 2020 and November 2020. A total of 81 patients aged 18-59 years, who had an ASA physical condition classification score of 1-2 and were evaluated in two groups according to the type of surgery. In the tympanoplasty group, the head was turned to the contralateral ear and placed in minimal extension while in the septoplasty group, the head was kept in the neutral position. The regional cerebral oxygen saturation (c-rSO2) values of the right and left sides were recorded continuously with O3 regional oximetry probes on both sides throughout the operation. Results: When an overall examination was performed without separating the tympanoplasty group as right/left, the median oxygen saturation level was 69.50% (Q1:61.00-Q3:72.00) for the operated side and 74.00% (Q1:66.00-Q3:79.00) for the contralateral side. The oxygen saturation of the operated side was statistically significant lower (p<0.001). The median oxygen saturation of the operated side in the tympanoplasty group [69.50% (Q1: 61.00- Q3:72.00)] was statistically significantly lower than that of the septoplasty group [72.00% (Q1:65.25-Q3:77.75)] (p=0.004). Conclusion: This study showed that the rotation of the head 45° or above in the revers Trendelenburg supine position causes cerebral desaturation on the opposite side of rotation. Keywords: Anesthesia, blood pressure, ear, intracranial hypotension, otologic surgical procedures

Stroboscopy and acoustic analysis of voice following endotracheal intubation in otological surgeries

BackgroundStroboscopy is an endoscopy that is performed with intermittent light at a frequency that approximates the frequency of a moving object so that it appears in slow motion or motionless. It is used to analyze the structure and motion of the vocal fold.Aim and objectiveTo compare the stroboscopic findings of various vocal parameters such as symmetry, amplitude, periodicity, mucosal wave of vocal folds, and glottis closure before and after elective endotracheal intubation and to compare acoustic analysis of voice using fundamental frequency, intensity, maximum phonation time, and dysphonia severity index in patients before and after elective intubation, who were undergoing otological surgeries. It also assesses the correlation between changes in these vocal and acoustic parameters and the size of the endotracheal tube, duration of intubation, and number of attempts made during intubation. This study creates awareness and provides insights to avoid intubation-related vocal fold injury.MethodsThis was a prospective cohort study involving 31 patients done in a Tertiary Care Centre. All patients who underwent otological surgeries by elective endotracheal intubation were included. All of them underwent stroboscopic and acoustic evaluation preoperatively, 24 h, and 7 days postoperatively.ResultsStatistically significant changes in mucosal wave pattern score were observed in the 1st postoperative day that reverted to normal by the end of 7th postoperative day and in GRBAS which was significant at the end of both 1st and 7th POD. Other parameters like fundamental frequency, intensity, DSI, MPT, amplitude, symmetry, periodicity, and glottis closure remain unaltered. There was a moderate positive correlation between the duration of intubation (minutes) and mucosal wave 1st POD (P-value: 0.003).ConclusionThe majority of the patients (61%) had normal laryngeal structures. A total of 39% had evidence of injury, the most common being right vocal fold hemorrhage improved by the end of 7th postoperative day and became normal.

Penerapan Metode Certainty Factor Dalam Mendiagnosa Penyakit Otitis Eksterna

Otitis externa is a common ear problem that often requires an accurate diagnosis for effective treatment. The Certainty Factor Method is an artificial intelligence approach used to support the diagnostic process. This research aims to apply the Certainty Factor Method in diagnosing otitis externa. Patient data, including symptoms, medical history, and examination results, are used to build a knowledge base that is then utilized in the diagnostic process. This method allows for improved accuracy in determining diagnoses by considering the confidence level associated with each symptom and examination result. Experimental results show that the application of the Certainty Factor Method can assist doctors in diagnosing otitis externa with higher accuracy compared to conventional methods. With this approach, diagnoses are made with higher confidence levels, which can aid in providing accurate and prompt treatment for patients suffering from otitis externa. The Certainty Factor Method has the potential for use in other medical contexts and can make a positive contribution to problem-solving in the healthcare field. This research underscores the importance of technology in supporting ear disease diagnosis and providing more reliable solutions for managing otitis externa. By leveraging the Certainty Factor approach, doctors can be more efficient and effective in responding to patients' conditions, thus reducing the risk of complications and enhancing healthcare quality. Therefore, this study offers a valuable contribution to the fields of medicine and computer science in improving the diagnosis of ear diseases, such as otitis externa, so that patients can receive better and faster care.

Pediatric Cholesteatoma: An Overview of Presentation, Surgical Strategy and Outcomes of an Individualized Approach.

Pediatric cholesteatomas (PC) have multifactorial aetiology, spread aggressively and there are high chances of residual/ recurrent disease after treatment. The surgical technique to manage this entity has been debatable. This study was done to (i) enumerate the presentation of PC and the surgical techniques adopted (ii) analyse the outcomes viz., residual/ recurrence rates and hearing results. A cross sectional record based study was done on 618 cases of PC operated between 1983 and 2015, at a centre dedicated to otology and lateral skull base surgery. The data which was maintained on the basis of clinical and peri- operative findings was analysed. Otorrhea (59.2%) and hearing loss (54.2%) were the common symptoms. The surgeries done were: canal wall up (CWU) (44.3%), canal wall down (CWD) (41.1%), modified bondy's mastoidectomy (5.7%), radical mastoidectomy (4.9%), trans canal excision (1.8%) and subtotal petrosectomy (2.3%). The residual and recurrence rates were 12.6% and 7.9% respectively. A significant difference between the pre and post operative hearing was observed. The mean improvement in air bone gap was 7.7db. Residual/ recurrent disease were higher in CWU as compared to CWD group. The surgery should be individualised so that the patient remains disease free.

A mouse model of autoimmune inner ear disease without endolymphatic hydrops

Autoimmune inner ear disease (AIED) is an organ-specific disease characterized by irreversible, prolonged, and progressive hearing and equilibrium dysfunctions. The primary symptoms of AIED include asymmetric sensorineural hearing loss accompanied by vertigo, aural fullness, and tinnitus. AIED is divided into primary and secondary types. Research has been conducted using animal models of rheumatoid arthritis (RA), a cause of secondary AIED. However, current models are insufficient to accurately analyze vestibular function, and the mechanism underlying the onset of AIED has not yet been fully elucidated. Elucidation of the mechanism of AIED onset is urgently needed to develop effective treatments. In the present study, we analyzed the pathogenesis of vertigo in autoimmune diseases using a mouse model of type II collagen-induced RA. Auditory brain stem response analysis demonstrated that the RA mouse models exhibited hearing loss, which is the primary symptom of AIED. In addition, our vestibulo-oculomotor reflex analysis, which is an excellent vestibular function test, accurately captured vertigo symptoms in the RA mouse models. Moreover, our results revealed that the cause of hearing loss and vestibular dysfunction was not endolymphatic hydrops, but rather structural destruction of the organ of Corti and the lateral semicircular canal ampulla due to an autoimmune reaction against type II collagen. Overall, we were able to establish a mouse model of AIED without endolymphatic hydrops. Our findings will help elucidate the mechanisms of hearing loss and vertigo associated with AIED and facilitate the development of new therapeutic methods.

Cochlear implantation in patients with autoimmune hearing loss

Autoimmune inner ear disease (AIED) manifests with recurrent fluctuating sensorineural hearing loss and vestibular symptoms. Treatment includes steroids and avariety of immunosuppressants. Despite adequate treatment, sensorineural hearing loss can be progressive to the point of deafness. In these patients, acochlear implant (CI) is indicated. We present the case of a25-year-old male who underwent cochlear implantation in the left ear. After implantation we noticed brisk variations in impedances which were related to application of the previously prescribed tumor necrosis alpha (TNFα) inhibitor adalimumab. Can immunomodulatory therapy in AIED patients after CI fitting affect the quality of hearing rehabilitation? We documented impedances and speech intelligibility (Freiburg monosyllable test) of our patient for 1year in dependence on adalimumab therapy. Directly after implantation, impedances were within the normal range. During the further course, impedances started to rise, and recurrent adjustments of the implant were needed. Adalimumab therapy was reinitiated, which resulted in asubsequent reduction of impedances. Cochlear implantation can be necessary in some AIED patients and poses asufficient method for hearing rehabilitation. Depending on the activity of the underlying disease, arise in impedances may occur. Immunomodulatory treatment may therefore be necessary to maintain adequate hearing results with the CI.

Primary Health Care Interventions for Potentially Preventable Ear, Nose, and Throat Conditions in Rural and Remote Areas: A Systematic Review.

Background:Primary and secondary level preventive primary health care programs providing early detection and timely management of ear, nose, and throat (ENT) conditions in rural and remote regions are fundamental to preventing downstream impacts on health, social, and educational outcomes. However, the range and quality of evidence is yet to be reviewed. Objectives: The study objectives were to identify and synthesize the evidence of primary health care interventions for detection and management of ENT conditions in rural and remote areas, and evaluate the quality of the research and effectiveness of interventions. Methods: A systematic literature search of 6 databases (February 2023). The review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement, and the quality appraisal of studies was evaluated using the Mixed Methods Appraisal Tool (initial screening questions: Are there clear research questions? Do the collected data allow to address the research questions?). Results: Ten studies met the inclusion criteria. The results describe interventions for detection and management of respiratory tract infections, otitis media, and ear disease in primary health care settings. No studies met the inclusion criteria for tonsillitis. The role of community-based programs and allied health workers in the detection and management of ENT conditions was found to be effective in rural and remote regions. Only 2 of the studies met the screening criteria for quality appraisal. Conclusions: The study findings may inform future programs and policy development to address detection and management of ENT conditions in rural and remote primary care settings, and supports the need for further research on innovative models of care targeting potentially preventable hospitalizations through primary and secondary level prevention.

Unexpected postoperative atlantoaxial rotatory subluxation after excision of melanocytic nevi of the head and neck in older children: two case reports and literature review.

Postoperative atlantoaxial rotatory subluxation (AARS) is a rare complication that develops almost exclusively in children following oropharyngeal and otologic surgeries, proposing that oropharyngeal inflammatory responses and excessive head rotation are responsible factors. However, there have been no reports of AARS after excision of a nevus on the head and neck. Here, we present two cases of AARS following limited head rotation during simple nevus excision. Patient 1, a 9-year-old girl, complained of neck pain and limited range of motion after excision of the nevus on the neck. After 2 months, computed tomography and magnetic resonance imaging finally revealed AARS with a ruptured transverse atlantal ligament. A month of halo traction was required for the treatment. Patient 2, an 11-year-old girl, presented with immediate pain and limited neck extension after tissue expander insertion under the upper chest and excision of the nevus on her left cheek. The diagnosis was promptly made using cervical spine radiography. A cervical collar was applied for 1 month. Both patients recovered without any complications after treatment. This report highlights the importance of suspicion for AARS after surgery regardless of surgical duration or amount of head rotation.

Association between morphological features in the cochlear promontory and mastoid Process: Implications for Identifying middle ear diseases in human skeletal remains

Infectious Middle Ear Disease (IMED) is a group of infections that frequently afflict individuals across all age groups worldwide. Although in today’s clinical practice IMED is efficiently managed, in the past it probably caused severe complications (e.g., hearing loss, balance problems, and facial nerve paralysis), heavily impacting the everyday life of many people. However, despite the valuable insights that studying ear infections in the past can bring, bioarcheology presently lacks a standardized methodology to assess their prevalence in skeletal populations. This can lead to several issues, including incomparability of results, difficulties in replications, and methodological biases.Recently, straightforward and accessible criteria for the observation of the cochlear promontory were presented to successfully assess IMED on skeletal remains. Yet, as otologists rarely examine the impact of ear infections on the bony structures of the middle ear, the results were not supported clinically, and could therefore not be validated. To fill this gap, we propose a study in which computed tomography (CT) of the mastoid process was utilized on the skulls of 50 individuals to verify the results obtained through gross observation of the cochlear promontory. Statistical analysis revealed significant correlation between hypopneumatization (indicative of childhood IMED) and bony changes of the promontory at the level of the individual. This suggests a potential correlation that warrants further investigation to determine whether the observation of the cochlear promontory should be used as a method for IMED assessment. Overall, our study contributes to the study of IMED in past populations, and underscores the importance of clear, standardized scoring criteria in paleopathology.

Otic Capsule Dehiscences Simulating Other Inner Ear Diseases: Characterization, Clinical Profile, and Follow-Up-Is Ménière's Disease the Sole Cause of Vertigo and Fluctuating Hearing Loss?

We present a series of six cases whose clinical presentations exhibited audiovestibular manifestations of a third mobile window mechanism, bearing a reasonable resemblance to Ménière's disease and otosclerosis. The occurrence of these cases in such a short period has prompted a review of the underlying causes of its development. Understanding the pathophysiology of third mobile window syndrome and considering these entities in the differential diagnosis of conditions presenting with vertigo and hearing loss with slight air-bone gaps is essential for comprehending this group of pathologies. A descriptive retrospective cohort study of six cases diagnosed at a tertiary center. All of them went through auditive and vestibular examinations before and after a therapeutic strategy was performed. Out of 84 cases of dehiscences described in our center during the period from 2014 to 2024, 78 belonged to superior semicircular canal dehiscence, while 6 were other otic capsule dehiscences. Among these six patients with a mean age of 47.17 years (range: 18-73), all had some form of otic capsule dehiscence with auditory and/or vestibular repercussions, measured through hearing and vestibular tests, with abnormalities in the results in five out of six patients. Two of them were diagnosed with Ménière's disease (MD). Another two had cochleo-vestibular hydrops without meeting the diagnostic criteria for MD. In two cases, the otic capsule dehiscence diagnosis resulted from an intraoperative complication due to a gusher phenomenon, while in one case, it was an accidental radiological finding. All responded well to the proposed treatment, whether medical or surgical, if needed. Otic capsule dehiscences are relatively new and unfamiliar entities that should be considered when faced with cases clinically suggestive of Ménière's disease, with discrepancies in complementary tests or a poor response to treatment. While high-sensitivity and specificity audiovestibular tests exist, completing the study with imaging, especially petrous bone CT scans, is necessary to locate and characterize the otic capsule defect responsible for the clinical presentation.

Polish version of the COMQ-12 questionnaire, a new validated tool for the assessment of the quality of life in patients with chronic otitis media.

<b><br>Introduction:</b> The COMQ-12 questionnaire is a tool to assess the quality of life in patients with chronic otitis media in many countries. The questionnaire consists of 12 questions: seven relating to the severity of symptoms, two regarding the impact of the disease on lifestyle and work, two concerning the impact on the need for healthcare, and one is a general question. Each question is rated on a scale from 0 to 5.</br> <b><br>Aim:</b> To present the validation process and the final version of the Polish version of the COMQ-12 questionnaire.</br> <b><br>Material and methods:</b> The Polish version of the COMQ-12 questionnaire was prepared based on an independent translation of the English version by three physicians (two otolaryngology specialists and one physician in the process of specialization in otolaryngology). The questionnaire was validated in a study including 60 participants: 30 patients with chronic otitis media and 30 volunteers without a history of middle ear diseases or hearing disorders. Each participant was asked to complete the COMQ-12 questionnaire twice at an interval of 4 weeks apart. The internal consistency, reliability, and construct validity of the questionnaire were analyzed using Cronbach's alpha and McDonald's omega coefficients, Spearman's rho correlation coefficient, and the Mann-Whitney test, respectively.</br> <b><br>Results:</b> High internal consistency, reliability, and construct validity of the Polish version of the COMQ-12 questionnaire were shown in the course of statistical analysis. The overall internal consistency was 0.95 and 0.97 as assessed by Cronbach's alpha and McDonald's omega coefficients, respectively. Spearman's rho correlation coefficient was above 0.89 for each question. Statistically significant differences in the COMQ-12 total scores were obtained between patients with chronic otitis media and the control group.</br> <b><br>Conclusions:</b> The Polish version of the COMQ-12 questionnaire can be a valuable clinical tool for the assessment of the quality of life in patients suffering from chronic otitis media.</br&gt.

Recommendations for topical antimicrobial therapy of inflammatory diseases of the middle ear based on the results of evidence-based clinical study

Introduction. In conditions of widespread resistance of pathogens to traditional antimicrobial drugs, active attention is paid to the development of topical antimicrobial drugs for the effective treatment of inflammatory pathology of the middle ear.Aim. To study the efficacy and safety of a new dosage form of the drug Dioxydin® (2.5 mg/ml ear drops) in the treatment of patients with acute purulent otitis media and exacerbation of chronic purulent otitis media in comparison with ear drops containing 0.3% ciprofloxacin solution.Materials and methods. A multicenter randomized comparative clinical trial included adults with acute purulent otitis media or exacerbation of chronic purulent otitis media and during 6 face-to-face visits (days 1st, 3rd, 6th, 9th, as well as a therapy completion visit and a follow-up visit), the effect of drugs was evaluated according to examination, otoscopy, microbiological and audiometric examinations. Safety was assessed by the frequency of adverse events and the results of blood, urine tests and vital signs.Results. The achievement of the primary criteria was evaluated among 164 participants randomized into 2 groups: the proportion of patients with no indications for systemic antibacterial therapy at Visit 2 and with no ear pain at Visit 4, Dioxydin® ear drops had no less effectiveness than the comparison drug (64.6 and 89.9% versus 68.3 and 87.3%, respectively). In terms of the frequency of elimination of the pathogen and improvement of air conduction, the compared drugs also had no statistically significant differences, and according to some secondary criteria, Dioxydin® significantly exceeded 0.3% ciprofloxacin solution (the proportion of patients with a pronounced decrease in pain and congestion in the ear, as well as hyperemia of the eardrum). According to the safety criteria, the compared drugs had no significant differences.Conclusions. The results of the study confirmed the high efficacy and safety of Dioxydin® ear drops in the treatment of otitis media in adults.

The presence of a submucous cleft palate in patients with isolated cleft lip and middle ear dysfunction

PurposeRecent studies have suggested that children with an isolated cleft lip (CL) are more likely to develop middle ear disease and eustachian tube dysfunction (ETD) compared to the general population. This may be related to abnormal palatal musculature or an undiagnosed submucosal cleft palate (SMCP). We aim to determine the prevalence of SMCP in patients with CL who exhibit ETD. Materials and methodsA retrospective chart review was performed for children with an isolated CL requiring tympanostomy tubes over a 20-year period at an academic tertiary care medical center. Demographic, clinical, and surgical data were collected. ResultsThree hundred twelve patients had an isolated CL, and 29 (9.3 %) children required tympanostomy tubes. Of those, nine (31 %) were found to have a SMCP (7 males, 6 Caucasian). The average age at CL repair was 3.94 ± 1.03 months, and the average age at tympanostomy tube placement was 13.68 ± 13.8 months. All nine patients had chronic otitis media, with four having mild conductive hearing loss and three having moderate conductive hearing loss. The SMCP was diagnosed at the time of CL diagnosis (4), after CL diagnosis with the diagnosis of chronic otitis media/ETD (2) and after a diagnosis of chronic otitis media/ETD. ConclusionMiddle ear disease or eustachian tube dysfunction in a patient with an isolated cleft lip should raise suspicion for an accompanying undiagnosed SMCP.

Auditory Changes in Occupational Health Associated With Metabolic Diseases in Adult Workers

Introduction: The most common hearing losses in the population are associated with genetic conditions, use of ototoxic substances or medications, infectious diseases, metabolic diseases and chronic ear diseases and the association of exposure to occupational risks or the natural aging process. Objective: Verify the association between hearing loss in workers and metabolic diseases. Method: Retrospective cross-sectional study with analysis of secondary data of subjects exposed to occupational noise and undergoing drug treatment for metabolic disease, attended in two occupational health clinics (C1 and C2) from January 2020 to December 2022, considering the data of reference examinations from the year 2005. Results: Of the n = 97 subjects evaluated, 73.20% were male, exposed to occupational noise (64.90%), with medication use for treating cardiovascular diseases (89.70%). The most recurrent auditory complaint was tinnitus (28.90%), n = 53 subjects presented sensorineural hearing loss with a statistical association between the decline of hearing loss and medications used for metabolic and hormonal regulation. Conclusion: Here was a higher frequency in the use of medications for treating cardiovascular diseases with a risk of triggering or worsening hearing loss in these subjects and greater impairment and decline of hearing thresholds were observed in the results of C2.

Overlapping otolaryngologic surgery: Safety and efficacy

BackgroundSurgical procedures scheduled staggered between two operating rooms increase efficiency by eliminating turnover time. However, the practice might increase the surgeon's fatigue. Overlapping surgery has been assumed to be safe because no critical portions of procedures are performed simultaneously in two rooms, but there is little evidence in the literature to support that assumption for otolaryngologic surgery, and there is no evidence comparing non-overlapping and overlapping surgical outcomes for a single surgeon with all confounding factors controlled. MethodsRetrospective cohort study that included a consecutive sample of adult subjects who underwent otolaryngologic laryngeal or otologic surgery between June 2013 and March 2016. All procedures were performed by the same surgical team and surgeon who had block time with 2-rooms every other week and 1-room on alternate weeks. The incidence of surgical complications was assessed in the perioperative period. Duration of surgery and time-in-room also were evaluated, as were surgical outcomes. ResultsA total of 496 surgeries were assigned to either overlapping-surgery (n = 346) or non-overlapping-surgery (n = 150) cohorts. Overlapping-surgery was a significant predictor for increased time-in-room on multivariate analysis but was not a significant predictor for surgery duration. Rate of complications, hospital readmission, emergency department visit, reoperation, mortality, and patient satisfaction did not differ significantly between cohorts. ConclusionsOverlapping surgery does not hinder patient safety or functional outcomes in patients undergoing otolaryngologic operations such as voice or ear surgery.

409 Automated Prediction of Bone Volume Removed During Cortical Mastoidectomy Using Deep Learning

OBJECTIVES/GOALS: Patient-specific definition of extent of surgical excision is foundational to the safety offered by computer assisted interventions. Consequently, this study aims to develop a pipeline for automated segmentation of bone removed during cortical mastoidectomy, a technically complex otologic surgery. METHODS/STUDY POPULATION: A simulator, previously developed in our lab, allows fully immersive simulation of mastoidectomy using segmented temporal bones generated from CT data. Using the simulator, one attending surgeon will perform three trials of mastoidectomy on 20 different temporal bones. From the simulator we will obtain data on the volume of bone removed for a specific anatomy, averaged between trials. No new U-net (nnU-net), an open-source three-dimensional segmentation network, will then be trained to predict the volume of bone removed using segmented pre-operative CT imaging. Segmentation accuracy will be evaluated with the Dice coefficient, modified Hausdorff distance (mHD), sensitivity and specificity. RESULTS/ANTICIPATED RESULTS: We expect the mean pairwise Dice coefficient to be high indicating relative similarity of volume removed between trials. Moreover, we predict that following five-fold cross-validation the best model will result in a Dice coefficient, mHD, sensitivity, and specificity indicative of volume removed predictions consistent with surgeon-generated data. Finally, given that network training will penalize overlap of the predicted excised bone segment and previously segmented anatomic structures, we expect that no critical anatomical structures will be marked as tissue removed. DISCUSSION/SIGNIFICANCE: We hope to show that deep learning architectures can accurately predict bone removed during mastoidectomy. These predictions can be used for preoperative planning, as clinical endpoints in surgical simulators, or be used in conjunction with surgical robots, all ultimately improving patient safety.

The Reliability and Diagnostic Concordance of Tele-otology Web Application for Diagnosis of Ear Diseases

The Reliability and Diagnostic Concordance of Tele-otology Web Application for Diagnosis of Ear Diseases

Influence of Different Noise Types on Hearing Function in Patients Treated for Mild Otitis Media.

Otitis media (OM) refers to a common clinical ear disease. Noise seriously damages human hearing function. This study aimed to investigate the effects of various noise types on the hearing function of patients who have recovered from mild OM. A total of 160 patients with mild OM treated at our hospital from May 2020 to May 2023 were retrospectively selected for this study. Based on clinical data, the patients were divided into the non-noise group (n = 80) and the noise (n = 80) group. The hearing thresholds of the two groups were compared across various noise types at 500, 1000, and 2000 Hz. In addition, the hearing thresholds of the noise group were compared under the same conditions. The noise group exhibited significantly higher hearing thresholds at 500, 1000, and 2000 Hz than the non-noise group (P < 0.05). Under traffic, urban construction, and industrial noises, the auditory thresholds at 500, 1000, and 2000 Hz in the noise group were significantly higher than those observed under domestic and speech noises (P < 0.05). Noise shows a close relationship with the hearing function of patients with OM. Traffic, urban construction, and industrial noises greatly influence the hearing function of patients who have recovered from mild OM.

From silence to sound – a case of autoimmune ear disease

Autoimmune inner ear disease (AIED) is a rare rheumatological cause of sensorineural hearing loss, accounting for less than 1% of worldwide hearing loss. It presents with rapidly progressive, unilateral or bilateral SNHL, often fluctuating. The progression is over weeks to months, along with vestibular symptoms. Diagnosing the condition is challenging because no adopted standardized tests are available. Hence, AIED is a challenging diagnosis based on exclusion. Clinical characteristics and how the patients respond to immunosuppressive agents are used for the diagnoses of AIED. Only a few cases have been reported in India till now. Here, we present a rare case of Autoimmune Ear Disease without any underlying systemic autoimmune disease.