Annals of Otology and Neurotology最新文献

{"title":"An Unusual Case of Isolated Cryptococcal Osteomyelitis of Mastoid: An Enigma!","authors":"D. Srinivasan, S. Ravichandran, K. Ramasamy, Sivaraman Ganesan, A. Alexander","doi":"10.1055/s-0040-1715294","DOIUrl":"https://doi.org/10.1055/s-0040-1715294","url":null,"abstract":"Abstract Cryptococcosis is a disseminated fungal infection commonly affecting the lungs and the central nervous system in immunocompromised patients. Herein we report a rare case of isolated mastoid osteomyelitis due to Cryptococcus neoformans which was initially not recognized due to its uncommon presentation akin to a Betzold’s abscess. A 61-year-old male presented with complaints of left ear discharge for a 1-month duration associated with a swelling in the left side of the neck for which he underwent incision and drainage without any significant improvement. a contrast-enhanced computed tomography (CT) scan revealed extensive erosion of the left mastoid cavity with a collection. Intraoperatively, red friable granulation tissue was seen within the antrum, histopathology of which revealed capsulated yeast forms. The patient underwent left canal wall down mastoidectomy along with antifungal treatment. Bone involvement is rare in patients with cryptococcal infection with vertebrae being the most common site of cryptococcal osteomyelitis. The clinical presentation is nonspecific and can pose a diagnostic dilemma, as the condition can mimic both Betzold’s abscess as well as malignancy. CT findings and the use of specific fungal stains in histopathology will aid in diagnosing this condition. The purpose of this case report is to establish the first case of isolated cryptococcal mastoid osteomyelitis in the database of fungal osteomyelitis. The confirmation of fungal osteomyelitis should be based on histopathological examination. The possibility of fungal osteomyelitis should be borne in mind in any case of insidiously increasing mass with unclear etiology so that prompt antifungal therapy with surgical debridement is initiated.","PeriodicalId":108664,"journal":{"name":"Annals of Otology and Neurotology","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115773651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Right Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo with to-and-fro Canal Switch to Right Horizontal Semicircular Canal","authors":"A. Vats","doi":"10.1055/s-0040-1702757","DOIUrl":"https://doi.org/10.1055/s-0040-1702757","url":null,"abstract":"Abstract Background Canal switch in BPPV is a phenomenon occurring after therapeutic canalith repositioning maneuvers (CRM), when there is a reflux of the repositioned otoconial debris from utricle to semicircular canal other than the one originally affected. It may be of immediate-type occurring within minutes after CRM or a delayed-type occurring after 2-3 days. Aim The study is a case report. Case Report A 59-year-old female presented with history of severe rotational vertigo as she got up from the bed in the early morning at 5.00 a.m.. Dix-Hallpike test (DHT) on the right elicited an upbeating positional nystagmus (PN). Treatment with multiple consecutive modified right Epley maneuvers (r-MEM) in one session was undertaken. During these maneuvers she continued to have an upbeating PN during the 45-degrees right cervical rotation with the neck in 20-degrees of extension (which is equivalent to right Dix-Hallpike positioning) of the first three sequential r-MEM’s. With the neck maintained in 20-degrees of extension, during fourth consecutive r-MEM, the 45-degrees cervical rotation to right elicited apogeotropic horizontal PN. Supine roll test (SRT) was immediately undertaken. Maximal head yaw positioning to right as well as to the left elicited apogeotropic horizontal PN without torsional component lasting more than one minute, indicating reflux of otoconia from the right P-SCC to the short anterior arm of right H-SCC. She was treated with two sequences of Appiani maneuver and SRT one hour later elicited geotropic upbeating PN with vertigo, indicating second canal switch to P-SCC. It was successfully treated with two sequences of right EM fifteen minutes apart, with instructions to stay upright in between and after the maneuvers. At 24 hours, repeat DHT and SRT were negative and patient was asymptomatic. Conclusion An optimal time delay to perform a verifying positional test after therapeutic session with CRM is crucial to prevent the immediate type of reflux of relocated otoconia from the utricle into a different semicircular canal. In centers, where more than a single EM is performed in a single session of treatment, a delay of 10 to 15 minutes appears to be appropriate between successive maneuvers. A certain period of restraint in the vertical position after CRM may prevent immediate reflux, but this needs to be confirmed by the randomized control trials.","PeriodicalId":108664,"journal":{"name":"Annals of Otology and Neurotology","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130664248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Epidermal Growth Factor on the Outcomes of Myringoplasty","authors":"K. Bongale, V. Bhat, Mona Yadav","doi":"10.1055/s-0040-1715290","DOIUrl":"https://doi.org/10.1055/s-0040-1715290","url":null,"abstract":"Abstract Introduction Chronic otitis media is a widespread disease of developing countries. The burden of the disease continues to be high and so is the demand for surgical myringoplasty. This pilot study aimed to compare in adults the outcomes of myringoplasty with and without the application of epidermal growth factor gel (EGF) with respect to the time taken for graft uptake, improvement of hearing, and complications. Materials and Methods This randomized controlled study was undertaken in a tertiary referral public hospital in a span of 2 years with a sample size of 60 patients. All of them underwent diagnostic nasal endoscopy, otoendoscopy, and pure tone audiometry and treated with conventional underlay myringoplasty using temporalis fascia (Group A—30 cases with EGF, Group B—30 controls without EGF). Patients were followed-up at 15, 30, 90 days postoperatively. Results The average time taken for closure of tympanic perforation and graft uptake by group A was lesser than group B. This difference was found to be statistically significant. Residual perforation at 1 month was commoner in group B as compared with group A. The final improvement of the hearing was the same in both the groups in the healed cases. Conclusion The EGF can be used to improve the outcomes of myringoplasty. It can hasten the closure of tympanic membrane perforation and increase the success rates of the surgery.","PeriodicalId":108664,"journal":{"name":"Annals of Otology and Neurotology","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129819143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of High-Resolution CT and MRI in Predicting the Degree of Difficulty in Patients undergoing Cochlear Implant Surgery: An Institutional Experience","authors":"P. Tiwari, Sheo Kumar, Prabhaker Mishra, R. Jain, N. Mohindra, Archana Gupta, A. Keshri","doi":"10.1055/s-0040-1715552","DOIUrl":"https://doi.org/10.1055/s-0040-1715552","url":null,"abstract":"Abstract Introduction Preoperative imaging is a standard practice for cochlear implant candidacy. We are discussing association between surgical feasibility and various anatomical details of middle and inner ear by both high-resolution computed tomography (HRCT) and 3T magnetic resonance imaging (MRI) in patients with bilateral sensorineural hearing loss (SNHL) and are used as a guide during surgery as well as foresee complications in cochlear implantation. Materials and Methods A total of 56 patients of aged 1 to 5 years (prelingual) and > 1 years (postlingual or perilingual) having bilateral SNHL were included in the study. HRCT temporal bone and MRI head was done in all candidates. Based on the imaging findings of CT and MRI, patients were divided into two categories (normal and abnormal). Demographic and clinical values were compared between two groups. Binary logistic regression analysis was used to identify the predictors of the outcome variable (surgical difficulty). Results Out of 56 patients, 55 underwent cochlear implantation by Veria technique, one patient having Michel’s deformity was denied surgery and was advised brain stem implant. Note that 69.1% patients had no radiological abnormality, while 30.9% patients showed abnormality including acquired disease and malformation. Out of the total study patients, 18% (n = 10) showed various type of congenital inner ear malformation. Large size of the external auditory canal (EAC), high basal turn angle (BTA), and increased distance between tympanic segment of facial canal to EAC (midpoint between level of I-S joint corresponding to EAC and exit of chordae tympanic at level of EAC), all these factors showed inverse relationship with difficulty in surgery, which were found to be statistically significant. Conclusion The imaging in cochlear implant patients is an essential tool for preoperative assessment of candidacy, surgical planning, and avoid intra- and postoperative complications. BTA and distance between tympanic segment of facial nerve and EAC (midpoint between level of I-S joint corresponding to EAC and exit of chordae tympanic at level of EAC) are important predictors for evaluating intra- and postoperative complications.","PeriodicalId":108664,"journal":{"name":"Annals of Otology and Neurotology","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125117176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the Surgical Approach: A Comparative Study between Transcanal and Posterior Tympanotomy Approach for Cochlear Implantation","authors":"N. Suri, S. Sandilya, R. Sayani, A. Anand","doi":"10.1055/s-0040-1715293","DOIUrl":"https://doi.org/10.1055/s-0040-1715293","url":null,"abstract":"Abstract Introduction The aim of our study is to compare the surgical complications of the transcanal and posterior tympanotomy approach and to evaluate the advantages and disadvantages of both techniques. Materials and Methods It is a prospective study involving 252 pediatric cochlear implant patients operated in the Department of ENT, GMERS Medical College and General Hospital, Gandhinagar, Gujarat, India. Out of these, 126 patients were operated by transcanal approach (group A) and 126 patients were operated by posterior tympanotomy approach (group B). Results No significant difference in the mean duration of surgery (p > 0.064) was observed in both the groups. Major complications occurred in 60.2% of group A and 3.1% of group B and minor complications occurred in 65% of group A and 3.1% in group B, which is highly significant (p < 0.0134). The categories of auditory perception, speech intelligibility rating scales, meaningful auditory integration scale, and meaningful use of speech scale were assessed in both groups. Conclusion Complication rate in the transcanal approach is higher as compared with posterior tympanotomy approach. A complete alignment and introduction of electrode array into the basal turn of cochlea is more favorable in the posterior tympanotomy approach. Transcanal technique even as an alternative may not be useful. Outcomes may be affected depending upon the technique chosen.","PeriodicalId":108664,"journal":{"name":"Annals of Otology and Neurotology","volume":"60 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121016647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Hearing Loss in Patients Receiving Chemoradiotherapy in Adjuvant Setting for Head and Neck Malignancy","authors":"V. Gupta, M. Bhat, V. Rao, V. Surendra","doi":"10.1055/s-0040-1715289","DOIUrl":"https://doi.org/10.1055/s-0040-1715289","url":null,"abstract":"Abstract Introduction The aim of the study is to assess the hearing loss in patients who receive chemoradiation (chemoradiotherapy or CTRT) for head and neck malignancies. Materials and Methods Prospective study was conducted in the Department of ENT of a tertiary care center from September 2013 to August 2014. Forty patients suffering from head and neck malignancies (histologically proven) were included in the study. Patients with pre-existing hearing loss were excluded. All patients received radiotherapy dose of 66 to 70 Gy given as 2 Gy/d, 5 d/wk and chemotherapy dose of cisplatin 35 mg/m2 once a week for 6 weeks. Hearing was assessed by pure tone audiometry (PTA) and impedance audiometry conducted at regular intervals. Mcnemars chi-square test was used to compare the impedance and paired t-test and Pearson’s correlation were used to compare PTA at various stages. Results Predominantly male patients (28) falling in the age group of 40 to 60 years, suffered from various head and neck cancer, most common being oropharynx (14). Twenty patients developed sensorineural hearing loss (SNHL)—11(55%) had mild, seven (35%) had moderate, and two (10%) had severe grade of SNHL. Majority of these patients, 12 (60%) started developing SNHL mid-therapy, five (25%) at the completion of therapy and three (15%) 3 months post-therapy. Hearing loss was found to be more with two-dimensional radiotherapy (2DRT) and three-dimensional radiotherapy (3DRT) than with intensity-modulated radiotherapy (IMRT) as assessed by serial PTA. The average dose of radiation to right and left ears, respectively were 27.10 and 24.66 Gy. The incidence of otitis media with effusion increased during the treatment accounting for the conductive hearing loss irrespective of the modality of radiation used. Conclusion CTRT causes significant hearing loss in patients suffering from head and neck malignancies leading to further increase in the morbidity. Screening audiological assessment would be helpful to know the pretherapy status of the ear. Using newer modalities like IMRT can reduce hearing loss. Regular audiological screening can catch it at its onset and help in early use of hearing aids.","PeriodicalId":108664,"journal":{"name":"Annals of Otology and Neurotology","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132022385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pale Mass behind Intact Tympanic Membrane: An Otologic Puzzle to Solve","authors":"G. Nayak, Manjul Muraleedharan, K. Arora, R. Virk, D. Chatterjee","doi":"10.1055/s-0040-1715291","DOIUrl":"https://doi.org/10.1055/s-0040-1715291","url":null,"abstract":"Abstract Whitish pale looking mass in the middle ear space is a diagnostic challenge not only to a novice otologic surgeon but also for an experienced surgeon. The array of differentials should be known for appropriate site of origin and its true nature. We have discussed a case of pale looking tympanic paraganglioma behind an intact tympanic membrane with few differentials to consider.","PeriodicalId":108664,"journal":{"name":"Annals of Otology and Neurotology","volume":"107 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115119022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MRI T2-Weighted Cochlear Intensity as a Predictor of Hearing Loss with Vestibular Schwannoma Patients","authors":"Peter Luong, C. Cabrera, N. Patil, Hammad A. Khan, C. Lagman, T. Ostergard, Gary Huang, Nicholas C. Bambikidas, Sarah E. Mowry","doi":"10.1055/s-0041-1735394","DOIUrl":"https://doi.org/10.1055/s-0041-1735394","url":null,"abstract":"Abstract Objective It is difficult to predict how hearing loss will progress with vestibular schwannomas (VSs) and to determine the optimal time for hearing preservation interventions. This study investigated the relationship between cochlear intensity on T2-weighted magnetic resonance imaging and hearing loss in VS patients over time. Design Retrospective cohort study. Setting Single major academic center. Participants Patients with a diagnosis of VS from 2007 to 2018. Main Outcome Measures Pure tone average (PTA) and cochlear-to-pontine relative signal intensity (RSI) measured at two time points. Results Fifty patients were included in the final analysis. For both affected and unaffected ears, the trend in PTA increased from baseline to follow-up. For affected ears, the trend in RSI increased from baseline to follow-up, while for the unaffected ears RSI decreased. There was a significant positive correlation between the initial RSI value in the ipsilateral ear when compared with the change in PTA from baseline to follow-up (r = 0.28, p = 0.048). Conclusion There is a trend between initial RSI and how hearing changes in the affected ears of patients with VS. Additional studies are needed to explore how this relationship may be better used to predict hearing loss.","PeriodicalId":108664,"journal":{"name":"Annals of Otology and Neurotology","volume":"67 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128814132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glioblastoma in the Cerebellopontine Angle in a Patient with Neurofibromatosis Type I: A Case Report and Review of the Literature","authors":"M. Shukairy, Andrea Ziegler, Douglas Anderson, J. Leonetti","doi":"10.1055/s-0040-1708563","DOIUrl":"https://doi.org/10.1055/s-0040-1708563","url":null,"abstract":"Abstract Introduction Glioblastoma multiforme (GBM) is the most common primary brain malignancy in adults and is typically in the supratentorial cerebral hemispheres. It has been reported to occur in the posterior fossa at the cerebellopontine angle (CPA), but the incidence is extremely rare. Case Report We report a case of a patient with a history of neurofibromatosis type I (NFI) diagnosed with a GBM arising in the CPA after presenting with facial numbness and pain. Patients with NFI are known to have an increased risk of developing both benign and malignant tumors, including a propensity for brainstem gliomas. However, there is no known association between NFI and tumors of the CPA. We believe this is the first reported case of a GBM of the CPA in a patient with NFI. Conclusion Although rare, GBM should be included in the differential diagnosis of a patient with a CPA tumor, especially in patients with increased risk of malignant pathology.","PeriodicalId":108664,"journal":{"name":"Annals of Otology and Neurotology","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132352641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unveiling Positioning Nystagmus in Patients of Horizontal Semicircular Canal Benign Paroxysmal Positional Vertigo by Diagnostic Head-Shaking in the Yaw Plane","authors":"A. Vats","doi":"10.1055/s-0039-1695678","DOIUrl":"https://doi.org/10.1055/s-0039-1695678","url":null,"abstract":"Abstract Introduction The diagnosis of benign paroxysmal positional vertigo (BPPV) is largely dependent on elicitation of positioning nystagmus on the diagnostic positional tests, namely Dix-Hallpike and supine roll tests (DHT and SRT, respectively), in patients complaining of vertigo, which occurs when patient’s head moves relative to the gravity. The pattern of elicited positioning nystagmus localizes as well as lateralizes the diseased canal, and the therapeutic positioning maneuver is accordingly undertaken. Objective The diagnostic positional tests, at times fail to elicit positional nystagmus, leaving clinician in a state of dilemma, when examining a patient who is currently experiencing paroxysms of vertigo triggered by positional change. In two patients with history consistent with BPPV but with negative positional tests initially, head shaking for 10 seconds in the yaw axis was done, and Dix-Hallpike and supine roll tests were repeated. The aim of head shaking for 10 seconds was to unveil positional nystagmus, to precisely localize and lateralize the diseased semicircular canal. Results and Discussion In the two cases of horizontal semicircular canal BPPV (HSC-BPPV) reported here, the DHT and/or SRT initially failed to elicit positional nystagmus but head shaking for 10 seconds in the left Dix–Hallpike position in case one and with the head anteflexed 30-degrees in the sitting position in the case two, unveiled horizontal positional nystagmus on ensuing SRT. The use of head-shaking in the yaw plane to unveil a horizontal positioning nystagmus in cases where a conventional positional test (DHT and SRT) has failed to elicit the PN, has not been reported in the literature hitherto. Conclusion After precise localization and lateralization of the diseased canal, both patients successfully underwent successful treatment with Gufoni maneuver. A verifying SRT done at 1 hour and/or at 24 hours follow-up was negative. In patients, who are currently experiencing paroxysms of vertigo triggered by the change of position of head relative to the gravity; head-shaking for few seconds just prior to the positioning test, can unveil positional nystagmus not elucidated with the conventionally performed positional tests.","PeriodicalId":108664,"journal":{"name":"Annals of Otology and Neurotology","volume":"121 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134569472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}