Abstract Introduction Measurement of the electrically-evoked stapedial reflex threshold (ESRT) is an objective tool used to set the comfort levels in pediatric cochlear implant (PCI) users. The levels of ESRT have a strong correlation with comfort levels. However, the clinical utility of ESRT is limited because the ESRT response is not observed in all cochlear implant users. Objective To assess the effects of probe-tone frequency on ESRT and its relationship with the behavioral comfort levels in PCI users. Methods A total of 14 PCI users aged between 5 and 8 years participated in the study. The ESRT levels were measured using high-frequency probe tones (678 Hz and 1,000 Hz), and the default 226 Hz probe tone. The ESRT was measured with single-electrode stimulation across the three electrode locations (basal [E01]; middle [E11]; and apical [E22]). The ESRT levels measured with different probe tone frequencies were compared with the behavioral comfort levels. Results The mean ESRT levels using 1,000Hz and 678 Hz were lower than those measured using 226 Hz, but there was no main effect of probe-tone frequency (p > 0.05). A significantly high incidence of successful ESRT measurements occurred with higher-frequency probe tone (p < 0.039). Additionally, ESRT using higher probe tones significantly correlated with comfort levels. Conclusion The ESRT with higher probe tones was correlated with behavioral comfort levels and increased the success rate of the measurements. Higher-frequency probe tones may be useful whenever ESRT with 226 Hz is not measurable.

Abstract Introduction In the current era, the major indication for septoplasty is nasal obstruction due to deviated nasal septum (DNS). Even though septoplasty is a commonly performed surgery, its effectiveness in relieving nasal obstruction in DNS has not been proven. Objective The present study involved the measurement of both objective (nasal patency) and subjective (quality of life measures) outcome measures for the evaluation of the efficacy of septoplasty as compared with medical management. Methods Patients with DNS presenting with nasal obstruction were included and randomized into a septoplasty group or into a nonsurgical management group, with 70 patients in each group. The improvement in nasal obstruction was assessed subjectively by the visual analogue scale (VAS), and the sino-nasal outcome test-22 (SNOT-22) and the nasal obstruction symptom evaluation (NOSE) questionnaires and was measured objectively by assessment of nasal patency by peak nasal inspiratory flow (PNIF) at 0, 1, 3, and 6 months of treatment in both groups. Results The average VAS, SNOT-22 and NOSE scores for the septoplasty versus the nonsurgical group before treatment were 6.28 versus 6.0, 19.5 versus 15, and 14 versus 12, respectively, and at 6 months post-treatment, the scores were 2.9 versus 5.26, 10 versus 12, and 8 versus 10 (p= 0.001), respectively. The average PNIF scores at 0 and 6 months were 60/50 l/min and 70/60 l/min, respectively, in the septoplasty group (p= 0.001); the scores at 0 and 6 months in the nonsurgical management group were 60/60 l/min and 70/70 l/min, respectively (p= 0.001). Conclusion Surgical correction of DNS by septoplasty improves nasal obstruction better than nonsurgical management at 6 months postsurgery.

Abstract Introduction Chronic suppurative otitis media atticoantral disease (CSOM-AAD) is often associated with ossicular erosion resulting in significant hearing loss. Absence of the stapes suprastructure is a poor prognostic indicator of hearing outcome, which necessitates an effective reconstruction technique for ossicular continuity and restoration of middle ear volume. In the present study, we used a boomerang-shaped conchal cartilage graft. Objective To evaluate the improvement in hearing using a boomerang-shaped conchal cartilage graft for Type III tympanoplasty in cases of CSOM-AAD in which the stapes suprastructure was absent and to study the incidence of intraoperative/postoperative complications of this procedure. Method A total of 21 patients with CSOM-AAD who were found to have absent stapes suprastructure intraoperatively were included. A boomerang-shaped conchal cartilage graft was placed over the stapes footplate for reconstruction following canal wall down mastoidectomy. Pure tone audiogram (500, 1,000, 2,000 and 4,000 Hz) was done preoperatively and at 12 weeks postoperatively. Hearing outcome and incidence of complications were noted. Results There was a statistically significant reduction in the hearing loss for air conduction and air-bone gap (ABG) of 6.1 dB and 6.9 dB respectively (p < 0.05). Air-bone gap < 30 dB could be achieved in 71.4% of the patients as compared with 23.8% preoperatively. No significant difference was noted in the bone conduction threshold (p > 0.05). A better hearing outcome was observed at higher frequencies (2,000, 4,000 Hz). No major complications were encountered. Conclusion A boomerang-shaped conchal cartilage graft is effective when used for Type III tympanoplasty, especially at higher (2,000, 4,000 Hz) frequencies, and is comparable to newer materials such as titanium total ossicular reconstruction prosthesis (TORP). No major intraoperative/postoperative complications were noted.

Abstract Introduction Vitamin D is known to have immunomodulatory functions and has action on chronic inflammatory processes, such as nasal polyposis. Objective The present study assessed the levels of 25-hydroxy vitamin D and high-sensitivity C-reactive protein (hs-CRP) in patients with nasal polyposis, as compared with healthy control subjects, and identified their association with disease severity in nasal polyposis. It further assessed the levels of 25-hydroxyl vitamin D and hs-CRP in patients with nasal polyposis and atopy and compared it with patients with nasal polyposis without atopy. Methods This was a cross-sectional study involving 2 groups: 80 patients with nasal polyposis and 80 healthy subjects. In patients with nasal polyposis, the disease severity is assessed by the sino-nasal outcome test (SNOT20) and by the Lund & Mackay staging system. Levels of 25-hydroxy vitamin D and hs-CRP were measured by enzyme-linked immunosorbent assay (ELISA). Result The mean 25-hydroxyl vitamin D levels (ng/ml) was 12.01 ± 7.29 for cases and 22.87 ± 14.95 for controls, with p< 0.0001. The mean hs-CRP levels (mg/L) was 5.99 ± 2.74 in cases and 2.41 ± 1.95 in controls, with p< 0.0001. The severity of polyposis correlated negatively with serum levels of 25-hydroxy vitamin D and positively with hs-CRP. Conclusion The study has thus shown significant correlation between vitamin D deficiency and inflammation in patients with nasal polyps.

Abstract Introduction Chronic otitis media is a widely prevalent condition in developing countries and is a cause of correctable hearing loss. The most frequent ossicular chain defect found during surgery for chronic otitis media has been a discontinuity of the incudostapedial joint. This study observes the effect of incudostapedial reconstruction using conchal cartilage on the hearing of the patient. Objectives To evaluate improvement in hearing by incudostapedial reconstruction using conchal cartilage interposition graft in tympanoplasty and to identify the independent factors associated with erosion of the long process of incus among patients with chronic suppurative otitis media tubotympanic type. Methods This study was conducted in the department of ear, nose and throat (ENT) amongst 22 patients with tubotympanic-type chronic suppurative otitis media who were found to have erosion of the long process during tympanoplasty. These patients underwent incudostapedial reconstruction using conchal cartilage. Their hearing was again reassessed at 12 weeks postsurgery, and the changes were observed. Results A statistically significant improvement in air conduction by 15.14 dB was found after undergoing incudostapedial reconstruction using conchal cartilage (p < 0.001). There was no statistically significant change in bone conduction (p value > 0.05). A total of 59.1% of patients in the study had an improvement in hearing ranging from11 to 20 dB. It was also found that 50% of the patients had a postoperative hearing of 10 to 20 dB. Conclusion Conchal cartilage interposition graft effectively improved hearing when used for the reconstruction of the incudostapedial joint during tympanoplasty in patients of chronic suppurative otitis media.

Abstract Introduction Chronic suppurative otitis media is a common ailment in developing countries, and it generally presents with otorrhea and hearing loss. Different surgical procedures have been used to treat otitis media; among them is myringoplasty, which is a procedure that includes repair of the tympanic membrane. Platelet concentrates have been used widely in different types of wounds and are found to improve wound healing. Hence, the use of platelet-rich fibrin in myringoplasty will also improve the tympanic membrane healing. Objectives To assess the safety and efficacy of autologous platelet-rich fibrin on graft uptake in myringoplasty. Methods Eighty-six patients were observed during the study period of two years. Forty-three patients in the study group underwent myringoplasty aided with plateletrich fibrin, and 43 patients in the control group went through the same procedure but without the platelet-rich fibrin. The patients were observed for three months postoperatively by a blinded observer. Results A total of 4.7% of the patients in the study group had postoperative infection, compared with a rate of 19% in the control group (p = 0.039). The graft uptake success rate was found to be 97.7% in the study group as compared with 81% in control group (p = 0.012). The results were found to be statistically significant. Conclusion Being autologous in nature, and by comparing the groups, platelet-rich fibrin is safe for patients. The postoperative graft uptake rate is better in cases in which plateletrich fibrin was used. The postoperative infection rate was also lower in the same group.

Abstract Introduction Otogenic lateral sinus thrombosis is a rare intracranial complication of otitis media in the modern age of antibiotic treatment, but it is potentially a dangerous complication. Objectives The aim of this study is to focus on the various clinical presentations, management options and sequelae in a series of fifteen patients with otogenic lateral sinus thrombosis. Methods Retrospective chart review of inpatients treated for otogenic lateral sinus thrombosis at our tertiary care institution between 2010 and 2015. Results A total of 15 patients (11 males and 4 females) with ages ranging from 9 to 60 years were diagnosed with otogenic lateral sinus thrombosis. The most commonly reported symptoms were headache, ear discharge and hard of hearing, which were experienced by all 15 (100%) patients. In contrast to previous studies found in the literature, 7 (47%) patients in our series presented with neck pain and neck abscess. Imaging studies and microbiological cultures were performed for all patients, who also underwent a mastoidectomy procedure. Internal jugular vein ligation was performed on 5 (33%) patients. Incision and drainage of the neck abscess was performed on 7 (47%) patients. All patients had a satisfactory resolution of their symptoms, and the mortality rate was of 0%. Conclusions Otogenic lateral sinus thrombosis, though a rare complication, can still occur; therefore, keeping a high level of suspicion is important, especially in developing countries. We also describe the patients with neck abscess associated with this rare condition. Combining parenteral antibiotics with surgical intervention is the treatment of choice.

Abstract Introduction Eustachian tube (ET) dysfunction plays an important role not only in the pathophysiology of various middle ear disorders, but also in predicting the outcome of the treatment. As there is no single test that assesses both the anatomic and physiological functions of the ET, a combination of tympanometry and dynamic slow motion video endoscopy may improve the sensitivity of ET function assessment. Objective To find out if there is any correlation between dynamic slow motion nasal video endoscopy and impedance audiometry in assessing ET function in patients with middle ear diseases. Methods Ours was a descriptive study performed with 106 patients attending the Ear, Nose and Throat (ENT) Outpatient Department of a tertiary care center in South India with features suggestive ofmiddle ear disease. All patients underwent impedance audiometry and dynamic slow motion nasal video endoscopy, and were graded based on the severity of the ET pathology. Results A total of 47 out of 97 patients with abnormal endoscopy findings also had abnormal impedance audiometry. The correlation was greater among the patients with higher grades of ET dysfunction. The endoscopy findings of 106 cases, when correlated with middle ear manometry, revealed that 56 cases showed complete agreement, and 50 cases showed disagreement. The nasal endoscopy results, when correlated with middle ear manometry studies by using McNemar’s chi-squared (χ2) test, showed a significant association between the 2 tests (p = 0.017). Conclusion There is a significant alteration in middle ear pressure as the severity of the ET tube dysfunction increases. Impedance audiometry and nasal endoscopy provide a better measure of ET function.