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Colvin S, Lepcha A, Augustine AM, Philip A, Mammen MD. A retrospective study on the outcomes of stapedotomy with vein graft interposition and vein graft surround techniques. J Laryngol Otol 2023; 137:1048-1053. [PMID: 37017076 DOI: 10.1017/s0022215123000580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
OBJECTIVE This study evaluated audiological outcomes of stapedotomy using two different techniques, vein graft interposition and vein graft surround, for sealing the stapes fenestra. METHOD A retrospective study of 130 patients who underwent stapedotomy for otosclerosis was performed. A total of 84 patients underwent the vein graft surround procedure and 46 underwent the vein graft interposition procedure. Post-operative hearing outcome was compared between them. RESULTS A total of 55 of 130 patients had a post-operative air-bone gap of less than 10 dB. A total of 57 patients had an air-bone gap within 20 dB. The average air-bone gap was 13.16 dB at 3 months with a mean improvement of 22.06 dB (11.98 dB for vein graft interposition and 13.80 dB for vein graft surround; p = 0.79). CONCLUSION There was no significant difference in hearing outcome between the two techniques. The vein graft interposition technique is preferred for large fenestra or stapedectomy cases and in cerebrospinal fluid gusher cases. The vein graft surround technique is easier to perform and preferred in small fenestra stapedotomy.
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Affiliation(s)
- S Colvin
- Department of ENT, Christian Medical College, Vellore, India
| | - A Lepcha
- Department of ENT, Christian Medical College, Vellore, India
| | - A M Augustine
- Department of ENT, Christian Medical College, Vellore, India
| | - A Philip
- Department of ENT, Christian Medical College, Vellore, India
| | - M D Mammen
- Department of ENT, Christian Medical College, Vellore, India
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Mounika Reddy Y, Lepcha A, Augustine AM, Philip A, Mammen M. Recurrent Meningitis in a Non-user Cochlear Implantee. Indian J Otolaryngol Head Neck Surg 2023; 75:69-72. [PMID: 37206722 PMCID: PMC10188888 DOI: 10.1007/s12070-022-03243-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 10/11/2022] [Indexed: 11/09/2022] Open
Abstract
Meningitis is a known complication in patients with inner ear malformations. Here we present a case of recurrent meningitis following cochlear implantation, in a patient with cochleovestibular anomaly. Good knowledge in radiology to identify the inner ear malformations, presence of cochlea and cochlear nerve is essential before planning cochlear implantation and meningitis can occur several decades after cochlear implantation.
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Affiliation(s)
- Y. Mounika Reddy
- Department of Otolaryngology, Otology, Neurotology and Cochlear Implant Unit, Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Anjali Lepcha
- Department of Otolaryngology, Otology, Neurotology and Cochlear Implant Unit, Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Ann Mary Augustine
- Department of Otolaryngology, Otology, Neurotology and Cochlear Implant Unit, Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Ajay Philip
- Department of Otolaryngology, Otology, Neurotology and Cochlear Implant Unit, Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Manju Mammen
- Department of Otolaryngology, Otology, Neurotology and Cochlear Implant Unit, Christian Medical College, Vellore, Tamil Nadu 632004 India
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Ranju RL, Lepcha A, Mammen MD, Vasanthan LT, Augustine AM, Philip A. An Effective Home-Based Particle Repositioning Procedure for Posterior Canal Benign Paroxysmal Positional Vertigo (BPPV). Indian J Otolaryngol Head Neck Surg 2022; 74:516-523. [PMID: 36514424 PMCID: PMC9741680 DOI: 10.1007/s12070-021-03021-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 11/28/2021] [Indexed: 12/15/2022] Open
Abstract
Patients with benign paroxysmal positional vertigo (BPPV) find it difficult to visit the hospital many times for a standard Epley's maneuver performed only by a specialist. The aim of this study was to compare the efficacy of a home-based particle repositioning procedure (HBPRP) with the standard Epley's maneuver in treating patients with posterior canal BPPV. A prospective non-blinded randomized controlled study was conducted. Patients were randomized into two groups, where one group received the standard treatment and other received a new HBPRP. The vertigo scale, duration of nystagmus during Dix-Hallpike test and frequency of vertigo, were documented on first, second and third visits, with complications noted during the second and third visits. These parameters were compared between both the groups following the treatment, during all visits. The patients were randomized into 2 arms with 15 each. Those belonging to group 1 received Epley's maneuver and group 2 received HBPRP. There was no significant difference in the baseline characteristics of patients in both groups. Both groups of patients had significant improvement of symptoms at the end of the study. A comparison of both groups at 2nd and 3rd visits showed no differences in frequency of vertigo, reduction in vertigo scale and duration of nystagmus following Dix-Hallpike test between both groups. HBPRP is a safe and effective procedure and can be taught as a home-based treatment for patients diagnosed with posterior canal BPPV.
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Affiliation(s)
- R. L. Ranju
- Department of ENT (Otology, Neurotology and Cochlear Implant Unit), Christian Medical College, Vellore, 632004 India
| | - Anjali Lepcha
- Department of ENT (Otology, Neurotology and Cochlear Implant Unit), Christian Medical College, Vellore, 632004 India
| | - Manju Deena Mammen
- Department of ENT (Otology, Neurotology and Cochlear Implant Unit), Christian Medical College, Vellore, 632004 India
| | - Lenny T. Vasanthan
- Department of Physiotherapy (Vestibular Physiotherapy), Christian Medical College, Vellore, India
| | - Ann Mary Augustine
- Department of ENT (Otology, Neurotology and Cochlear Implant Unit), Christian Medical College, Vellore, 632004 India
| | - Ajay Philip
- Department of ENT (Otology, Neurotology and Cochlear Implant Unit), Christian Medical College, Vellore, 632004 India
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Thomas L, Lepcha A, Reka K, Augustine AM, Alex A, Philip A, Mammen MD. Comparing Intratympanic Gentamicin with Methylprednisolone in Meniere's Disease with Non-Serviceable Hearing. Indian J Otolaryngol Head Neck Surg 2022; 74:3738-3745. [PMID: 36742746 PMCID: PMC9895489 DOI: 10.1007/s12070-021-02528-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 03/22/2021] [Indexed: 02/07/2023] Open
Abstract
Abstract To compare the effectiveness of high dose fixed alternate day intratympanic gentamicin with methylprednisolone in the treatment of patients with unilateral, intractable Meniere's disease with poor hearing. Randomized single blind prospective parallel group trial in a tertiary referral centre. Twenty-two patients with definite unilateral Meniere's disease with average pure tone thresholds worse than 50 dB in the affected ear were enrolled. Eleven patients were treated with intratympanic buffered gentamicin and the other eleven were administered intratympanic methylprednisolone (both 4 injections, 40 mg/ml, on alternate days). Patients were assessed pre-intervention, 3 months post intervention and subsequently followed up for 2-4 years. Both groups of patients had significant control of vertigo, DHI scores and THI scores after treatment while the functional scores in the methylprednisolone group was not better than the pre- treatment scores in the long-term follow-up. 9 of 11(82%) patients in gentamicin group and 3 of 11(27%) patients in the methylprednisolone group achieved Class A vertigo control. The gentamicin group had better post intervention DHI scores (p = 0.016, 3 months and p = 0.046, long term) and Functional score (p = 0.014, 3 months and p = 0.05, long term). The hearing in both groups and THI scores, post intervention was similar between both groups. In patients with unilateral intractable MD with non-serviceable hearing, high fixed doses of both intratympanic gentamicin and methylprednisolone are effective in alleviating disease symptoms in long term follow-up. However, intratympanic gentamicin resulted in better control of vertigo, total DHI score and functional level scores than intratympanic methylprednisolone with no significant difference in hearing levels. Trail Registration Number Clinical Trials Registry of India (CTRI- REF/2016/10/012363).
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Affiliation(s)
- Leah Thomas
- Christian Medical College Vellore, Chittoor Campus, Chittoor, Andhra Pradesh India
| | - Anjali Lepcha
- Department of ENT, Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - K. Reka
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu 632 002 India
| | - Ann Mary Augustine
- Department of ENT, Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Anu Alex
- Department of ENT, Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Ajay Philip
- Department of ENT, Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Manju Deena Mammen
- Department of ENT, Christian Medical College, Vellore, Tamil Nadu 632004 India
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Reddy YM, Lepcha A, Augustine AM, Philip A. Cochlear Implant in Klippel-Feil Syndrome: Challenges and Concerns. Indian J Otolaryngol Head Neck Surg 2022; 74:3901-3905. [PMID: 36742773 PMCID: PMC9895708 DOI: 10.1007/s12070-021-02728-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 06/27/2021] [Indexed: 02/07/2023] Open
Abstract
Cochlear implantation (CI) can be safely performed in patients with syndromic hearing loss. Here we present a case of CI in a child with Klippel-Feil syndrome with various skeletal, extraskeletal, cochleovestibular and Arnold-Chiari malformations. Multidisciplinary approach and good preoperative imaging play a key role in planning for surgery.
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Affiliation(s)
- Y. Mounika Reddy
- Department of Otolaryngology, Otology, Neurotology and Cochlear Implant Unit, Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Anjali Lepcha
- Department of Otolaryngology, Otology, Neurotology and Cochlear Implant Unit, Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Ann Mary Augustine
- Department of Otolaryngology, Otology, Neurotology and Cochlear Implant Unit, Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Ajay Philip
- Department of Otolaryngology, Otology, Neurotology and Cochlear Implant Unit, Christian Medical College, Vellore, Tamil Nadu 632004 India
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Paulose AA, Ranju RL, Lepcha A, Augustine AM, Philip A, Mammen MD, Irodi A. Etiopathology and Prevalence of Pulsatile Tinnitus in a Tertiary Care Referral Hospital. Indian J Otolaryngol Head Neck Surg 2022; 74:3939-3946. [PMID: 36742888 PMCID: PMC9895516 DOI: 10.1007/s12070-021-02761-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/04/2021] [Indexed: 02/07/2023] Open
Abstract
The diverse etiopathogenesis of pulsatile tinnitus (PT) makes it a difficult condition to diagnose and treat. To describe the clinical features, investigations and diagnosis of patients presenting with pulsatile tinnitus (PT). Retrospective chart review in an otology unit of a tertiary care referral centre. All medical records of patients who had a complaint of pulsatile tinnitus during the period 1st January 2014-1st May 2020 were included in the study. Data regarding history, characteristics of tinnitus, examination findings, investigations and diagnosis were collected and analyzed. Sixty-four patients with complaints of PT presented to our clinic during this time period and were included in the study giving a prevalence of 0.09%. Definite diagnosis was made in 62 (96.8%) cases with a detailed history, clinical examination and tailored investigations. Pathologies diagnosed were paraganglioma (25%), superior semicircular canal dehiscence (20.3%), anterior inferior cerebellar artery loop (7.8%), sigmoid sinus wall dehiscence (10.9%), sigmoid sinus diverticulum (6.25%), jugular bulb anomalies (7.8%) and hyperpneumatised petrous apex (3.1%) among others. Rare causes encountered were IgG4 disease, far advanced otosclerosis, vestibular aqueduct dehiscence and idiopathic intracranial hypertension. Pulsatile tinnitus is a rare complaint in the Otology clinic. Almost all cases of PT can be diagnosed correctly and appropriate treatment initiated with a logical approach to investigations.
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Affiliation(s)
- Antony Abraham Paulose
- Department of ENT-Otology, Neurotology and Cochlear Implant Unit, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu 632004 India
| | - R. L. Ranju
- Department of ENT, Christian Medical College, Vellore, India
| | - Anjali Lepcha
- Department of ENT-Otology, Neurotology and Cochlear Implant Unit, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu 632004 India
| | - Ann Mary Augustine
- Department of ENT-Otology, Neurotology and Cochlear Implant Unit, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu 632004 India
| | - Ajay Philip
- Department of ENT-Otology, Neurotology and Cochlear Implant Unit, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu 632004 India
| | - Manju Deena Mammen
- Department of ENT-Otology, Neurotology and Cochlear Implant Unit, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu 632004 India
| | - Aparna Irodi
- Department of Radiodiagnosis, Christian Medical College, Vellore, India
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Abraham L, Philip A, Lepcha A, Augustine AM, Mathews SS, Paul RR, Mammen MD. A Comparative Study of Outcomes and Quality of Life in Canal Wall up Mastoidectomies and Canal Wall down Mastoidectomies. Indian J Otolaryngol Head Neck Surg 2022; 74:600-607. [PMID: 36032861 PMCID: PMC9411485 DOI: 10.1007/s12070-021-02424-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 01/25/2021] [Indexed: 10/22/2022] Open
Abstract
Abstract Chronic Otitis Media (COM) of the squamosal type was primarily managed by performing a canal wall down mastoidectomy; however, the latter era otolaryngologist envisioned benefits in preserving the posterior canal wall. Our primary objective was to assess the disease specific quality of life following canal wall up (CWU) mastoidectomy and canal wall down (CWD) mastoidectomy surgery after a 6 month post-operative period. A prospective observational study was done from September 2017 to August 2018 where the charts of 380 patients from Christian Medical College, Vellore were reviewed. Details of patients above 18 years who had undergone the above surgeries for COM active squamosal disease from the period of January 2014 to December 2016; and had their post-operative follow up (average of 16 months) during the period of study were looked at. The CWU group had a significantly better disease-specific quality of life in the symptoms subscale than the CWD group (p value < 0.01). The CWU group showed a significant air-bone gap closure to 23.3 dB as compared to 27.7 dB in CWD (p value = 0.005). The recurrence rates were 4.5% (9 cases) in the CWU group and 3.9% (7 cases) in the CWD group, which was not statistically significant. Both CWU and CWD methods of mastoidectomy for COM squamosal type give comparable outcomes in terms of recurrence with the CWU group having a better disease-specific quality of life after surgery. Level of Evidence 2a.
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Gismondi M, Augustine AM, Tahir Khokhar MAR, Khokhar HT, Twentyman KE, Florea ID, Grigore M. Are Medical Students from Across the World Aware of Cervical Cancer, HPV Infection and Vaccination? A Cross-Sectional Comparative Study. J Cancer Educ 2021; 36:682-688. [PMID: 31912468 DOI: 10.1007/s13187-019-01686-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study aims to understand and compare the level of knowledge, the attitude and the awareness of cervical cancer, HPV infection and vaccination among medical students from across the globe. It was conducted by sharing a questionnaire on medical students' Facebook groups. We successfully analysed 736 responses, of which 74.3% were females and 25.7% males. Their mean age was 23.14. As regards to the respondents' knowledge of the risk factors for cervical cancer, 28.8% of the participants identified HPV, 23.5% chose "Having many sexual partners", 15.4% identified "Starting the sexual life at a young age", 14.7% chose HIV and 13.3% answered smoking. Regarding the knowledge of the Pap test, 92.4% of the students stated that they knew what it is, although 98.5% of these respondents chose the correct answer. Concerning the knowledge of early warning signs of cervical cancer, 34.4% recognised vaginal bleeding. According to our research, American, Eastern and Western European students had more knowledge regarding the risk factors, early signs of cervical cancer and Pap test than African and Asian students. A total of 50% of the sexually active females had gone at least once to be screened by the means of a Pap test. A total of 39.8% of the participants stated that they had received the HPV vaccine. The findings of our research highlight the need for additional education measures to improve knowledge and awareness regarding HPV infection, especially among medical students, since they will be future healthcare providers.
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Affiliation(s)
- M Gismondi
- University of Medicine and Pharmacy "Grigore T.Popa", Iasi, Romania
| | - A M Augustine
- University of Medicine and Pharmacy "Grigore T.Popa", Iasi, Romania
| | | | - H T Khokhar
- University of Medicine and Pharmacy "Grigore T.Popa", Iasi, Romania
| | | | - I D Florea
- University of Medicine and Pharmacy "Grigore T.Popa", Iasi, Romania
| | - M Grigore
- University of Medicine and Pharmacy "Grigore T.Popa", Iasi, Romania.
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Haripriya GR, Lepcha A, Augustine AM, John M, Philip A, Mammen MD. Prevalence, clinical profile, and diagnosis of pediatric dizziness in a tertiary care hospital. Int J Pediatr Otorhinolaryngol 2021; 146:110761. [PMID: 34000496 DOI: 10.1016/j.ijporl.2021.110761] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/14/2021] [Accepted: 05/06/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Pediatric dizziness is an uncommon complaint presenting to the Otolaryngology clinic. While the term dizziness may be used to describe any altered sensation of orientation to the environment which includes presyncope, light-headedness and ataxia, vertigo refers to a false sensation of motion of self or surroundings. Although a variety of etiologies are known to cause dizziness and vertigo, evaluation of this symptom becomes challenging in children who are unable to clearly explain what they experience, the provoking factors, associated symptoms and the duration of attacks. Vestibular tests are also difficult to conduct in the pediatric age group leading to apathy from the clinician. OBJECTIVES To ascertain the prevalence of pediatric vertigo in children under 18 years of age, presenting to the Otolaryngology Clinic of a tertiary care hospital, and to describe the clinical profile, investigations and diagnosis in these children. METHODS A prospective cross-sectional, descriptive clinical study was undertaken from January 1, 2018 to April 30, 2019. All children below the age of 18 years presenting to our department with primary complaints of dizziness were included in the study. After a thorough history and physical examination, screening methods and diagnostic tests were conducted to make a diagnosis. Referrals were sought from other specialties when necessary. RESULTS The number of children visiting the Department for various ENT ailments during the study period was 10,950. Among these 89 children presented with a primary complaint of dizziness. Their ages ranged from 3 to 18 years; mean age was 11.42 years (SD 3.45). A diagnosis was made in all except two children. The most common cause of dizziness in the age group less than 6 years was benign paroxysmal vertigo of childhood (BPVC) and in the older children was migraine associated vertigo, which was also the commonest overall diagnosis made (28.1%). This was followed by circulation related dizziness like orthostatic hypotension and vasovagal syncope (15.7%). CONCLUSIONS The prevalence of pediatric dizziness in children presenting to the Otolaryngology clinic was 0.8%. The diagnosis of pediatric vertigo may be challenging, but careful history and examination along with guided investigations and referrals results in correct diagnosis in almost all patients.
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Affiliation(s)
- G R Haripriya
- Otorhinolaryngology, MGM Healthcare Hospital, Chennai, Tamil Nadu, 600029, India.
| | - Anjali Lepcha
- Department of Otorhinolarynglogy Unit IV, Christian Medical College Vellore, Ida Scudder Road, Vellore, Tamil Nadu, 632004, India
| | - Ann Mary Augustine
- Department of Otorhinolarynglogy Unit IV, Christian Medical College Vellore, Ida Scudder Road, Vellore, Tamil Nadu, 632004, India
| | - Mary John
- Department of Otorhinolarynglogy Unit IV, Christian Medical College Vellore, Ida Scudder Road, Vellore, Tamil Nadu, 632004, India
| | - Ajay Philip
- Department of Otorhinolarynglogy Unit IV, Christian Medical College Vellore, Ida Scudder Road, Vellore, Tamil Nadu, 632004, India
| | - Manju Deena Mammen
- Department of Otorhinolarynglogy Unit IV, Christian Medical College Vellore, Ida Scudder Road, Vellore, Tamil Nadu, 632004, India
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10
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Reddy Y M, Lepcha A, Augustine AM, Philip A, Thomas P. Standard Programming of Retrograde Electrode Insertion via Middle-Turn Cochleostomy in Labyrinthitis Ossificans. Ear Nose Throat J 2020; 101:581-583. [PMID: 33226852 DOI: 10.1177/0145561320974864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Successful cochlear implantation in the setting of labyrinthitis ossificans is challenging. Various surgical techniques are described to circumvent the region of ossification and retrograde insertion of the electrode array is one such option. While reverse programming is often recommended in the case of retrograde electrode insertion, we present our experience of retrograde electrode insertion for labyrinthitis ossificans, where standard programming was adopted due to patient preference and provided satisfactory outcomes.
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Affiliation(s)
- Mounika Reddy Y
- Department of Otorhinolaryngology, Otology, Neurotology and Cochlear Implant Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anjali Lepcha
- Department of Otorhinolaryngology, Otology, Neurotology and Cochlear Implant Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ann Mary Augustine
- Department of Otorhinolaryngology, Otology, Neurotology and Cochlear Implant Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ajay Philip
- Department of Otorhinolaryngology, Otology, Neurotology and Cochlear Implant Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Philip Thomas
- Department of Otorhinolaryngology, Otology, Neurotology and Cochlear Implant Unit, Christian Medical College, Vellore, Tamil Nadu, India
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Bandaru SV, Augustine AM, Lepcha A, Sebastian S, Gowri M, Philip A, Mammen MD. The effects of N95 mask and face shield on speech perception among healthcare workers in the coronavirus disease 2019 pandemic scenario. J Laryngol Otol 2020; 134:1-4. [PMID: 32981539 PMCID: PMC7542317 DOI: 10.1017/s0022215120002108] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The current circumstances of the coronavirus disease 2019 pandemic necessitate the use of personal protective equipment in hospitals. N95 masks and face shields are being used as personal protective equipment to protect from aerosol-related spread of infection. Personal protective equipment, however, hampers communication. This study aimed to assess the effect of using an N95 mask and face shield on speech perception among healthcare workers with normal hearing. METHODS Twenty healthcare workers were recruited for the study. Pure tone audiometry was conducted to ensure normal hearing. Speech reception threshold and speech discrimination score were obtained, first without using personal protective equipment and then repeated with the audiologist wearing an N95 mask and face shield. RESULTS A statistically significant increase in speech reception threshold (mean of 12.4 dB) and decrease in speech discrimination score (mean of 7 per cent) was found while using the personal protective equipment. CONCLUSION Use of personal protective equipment significantly impairs speech perception. Alternate communication strategies should be developed for effective communication.
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Affiliation(s)
- S V Bandaru
- Department of Otorhinolaryngology, Christian Medical College, Vellore, India
| | - A M Augustine
- Department of Otorhinolaryngology, Christian Medical College, Vellore, India
| | - A Lepcha
- Department of Otorhinolaryngology, Christian Medical College, Vellore, India
| | - S Sebastian
- Department of Audiology, Christian Medical College, Vellore, India
| | - M Gowri
- Department of Biostatistics, Christian Medical College, Vellore, India
| | - A Philip
- Department of Otorhinolaryngology, Christian Medical College, Vellore, India
| | - M D Mammen
- Department of Otorhinolaryngology, Christian Medical College, Vellore, India
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12
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Abstract
OBJECTIVE To assess the functional status of the otolithic pathway in vestibular migraine by comparing the results of static and dynamic subjective visual vertical and horizontal [subjective visual vertical (SVV) and subjective visual horizontal (SVH)] testing in patients with vestibular migraine with that of normal individuals. MATERIALS AND METHODS This hospital-based prospective study was conducted in 82 normal adults and 66 adults with vestibular migraine. The SVV and SVH angles were measured under static and dynamic conditions using a software-based test protocol. The arithmetic mean of six readings in each situation was considered. The results were further analyzed by stratifying cases and controls into two age groups 20-40 years and 41-60 years and into gender. RESULTS The clinical profile of the patients with vestibular migraine was comparable to the available literature. The dynamic SVV and SVH in both age groups and the static SVH in the 41-60 years age group were significantly higher compared to normal individuals (p<0.05). The dynamic SVV and SVH were significantly higher in the cases compared to controls among both males and females (p<0.05). CONCLUSION There is evidence of otolithic pathway abnormalities in individuals with vestibular migraine. The inclusion of SVV and SVH testing for the evaluation of patients with vestibular migraine may be useful in the interpretation and rehabilitation of symptoms in these patients.
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Affiliation(s)
- Gaurav Ashish
- Department of Ear Nose and Throat, Vellore Ear Nose and Throat Center, Patna, India.
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Thanooja CV, Augustine AM, Lepcha A, Sandhya P, Tyagi AK, Danda D, Balraj A. Audiological Profile in Primary Sjögren's Syndrome in a Tertiary Care Setting and its Clinical Implications. Indian J Otolaryngol Head Neck Surg 2015; 70:59-65. [PMID: 29456945 DOI: 10.1007/s12070-015-0956-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 12/10/2015] [Indexed: 11/29/2022] Open
Abstract
This study aims to assess the frequency and the profile of hearing loss among patients with primary Sjögren's syndrome in a tertiary care hospital in India and to look for an association between hearing loss and immunological parameters (anti-SSA antibody, anti-SSB antibody, anticardiolipin antibodies, complements C3 and C4). This prospective observational study was done from January 2011 to October 2011 on consecutive patients diagnosed with primary Sjögren's syndrome in our tertiary care hospital. All patients underwent a puretone audiogram, tympanogram and acoustic reflex testing. The results of the tests were correlated with clinical and immunological findings. The frequency of audiometrically confirmed hearing loss in primary Sjögren's syndrome was estimated to be 78.38 %, though only 17.24 % complained of hearing loss; minimal to mild sensorineural hearing loss were the most common varieties. The commonest finding on tympanometry was 'A' type curve and acoustic reflex was absent in 18.92 % of cases. There was no association between hearing loss and age, sicca symptoms, systemic symptoms or immunological test results in primary Sjögren's syndrome. There was a high prevalence of hearing loss among patients with primary Sjögren's syndrome, but most patients were unaware of this. Hearing assessment and regular monitoring of hearing thresholds is advisable for all patients with primary Sjögren's syndrome.
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Affiliation(s)
- C V Thanooja
- 1Department of ENT, Christian Medical College, Vellore, India
| | | | - Anjali Lepcha
- 1Department of ENT, Christian Medical College, Vellore, India
| | - Pulukool Sandhya
- 2Department of Rheumatology, Christian Medical College, Vellore, India
| | | | - Debashish Danda
- 2Department of Rheumatology, Christian Medical College, Vellore, India
| | - Achamma Balraj
- 1Department of ENT, Christian Medical College, Vellore, India
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Augustine AM, Chrysolyte SB, Thenmozhi K, Rupa V. Assessment of auditory and psychosocial handicap associated with unilateral hearing loss among Indian patients. Indian J Otolaryngol Head Neck Surg 2014; 65:120-5. [PMID: 24427551 DOI: 10.1007/s12070-012-0586-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 10/18/2012] [Indexed: 11/26/2022] Open
Abstract
In order to assess psychosocial and auditory handicap in Indian patients with unilateral sensorineural hearing loss (USNHL), a prospective study was conducted on 50 adults with USNHL in the ENT Outpatient clinic of a tertiary care centre. The hearing handicap inventory for adults (HHIA) as well as speech in noise and sound localization tests were administered to patients with USNHL. An equal number of age-matched, normal controls also underwent the speech and sound localization tests. The results showed that HHIA scores ranged from 0 to 60 (mean 20.7). Most patients (84.8 %) had either mild to moderate or no handicap. Emotional subscale scores were higher than social subscale scores (p = 0.01). When the effect of sociodemographic factors on HHIA scores was analysed, educated individuals were found to have higher social subscale scores (p = 0.04). Age, sex, side and duration of hearing loss, occupation and income did not affect HHIA scores. Speech in noise and sound localization were significantly poorer in cases compared to controls (p < 0.001). About 75 % of patients refused a rehabilitative device. We conclude that USNHL in Indian adults does not usually produce severe handicap. When present, the handicap is more emotional than social. USNHL significantly affects sound localization and speech in noise. Yet, affected patients seldom seek a rehabilitative device.
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Affiliation(s)
- Ann Mary Augustine
- Department of ENT, Unit III, Speech and Hearing, Christian Medical College, Vellore, 632004 Tamil Nadu India
| | - Shipra B Chrysolyte
- Department of ENT, Unit III, Speech and Hearing, Christian Medical College, Vellore, 632004 Tamil Nadu India
| | - K Thenmozhi
- Department of ENT, Unit III, Speech and Hearing, Christian Medical College, Vellore, 632004 Tamil Nadu India
| | - V Rupa
- Department of ENT, Unit III, Speech and Hearing, Christian Medical College, Vellore, 632004 Tamil Nadu India
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Schretlen D, Pearlson GD, Anthony JC, Aylward EH, Augustine AM, Davis A, Barta P. Elucidating the contributions of processing speed, executive ability, and frontal lobe volume to normal age-related differences in fluid intelligence. J Int Neuropsychol Soc 2000; 6:52-61. [PMID: 10761367 DOI: 10.1017/s1355617700611062] [Citation(s) in RCA: 128] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
One theory of normal cognitive aging asserts that decreases in simple processing speed mediate the age-related decline of fluid intelligence. Another possibility is that age-related atrophic changes in frontal brain structures undermine the functioning of executive abilities, thereby producing the same decline. In this study, we used principal components analysis to derive a measure of fluid-spatial intelligence in 197 normal adults between 20 and 92 years of age. Measures of perceptual comparison speed, working memory, and executive ability, as well as regional brain volumes based on high resolution magnetic resonance imaging were obtained from a subsample of 112 participants. We then conducted a series of hierarchical multiple regression analyses to test whether (1) the processing speed theory, (2) frontal-executive theory, or (3) some combination of these best accounted for age-related variation in fluid intelligence. The results showed that perceptual comparison speed, executive ability, and frontal lobe volume each made significant contributions to a regression equation that explained 57% of the variance in fluid intelligence. These findings suggest that both the processing speed and frontal-executive theory of cognitive aging are partially correct and complement one another.
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Affiliation(s)
- D Schretlen
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Aylward EH, Minshew NJ, Goldstein G, Honeycutt NA, Augustine AM, Yates KO, Barta PE, Pearlson GD. MRI volumes of amygdala and hippocampus in non-mentally retarded autistic adolescents and adults. Neurology 1999; 53:2145-50. [PMID: 10599796 DOI: 10.1212/wnl.53.9.2145] [Citation(s) in RCA: 357] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether volumes of hippocampus and amygdala are abnormal in people with autism. BACKGROUND Neuropathologic studies of the limbic system in autism have found decreased neuronal size, increased neuronal packing density, and decreased complexity of dendritic arbors in hippocampus, amygdala, and other limbic structures. These findings are suggestive of a developmental curtailment in the maturation of the neurons and neuropil. METHODS Measurement of hippocampus, amygdala, and total brain volumes from 1.5-mm coronal, spoiled gradient-recalled echo MRI scans in 14 non-mentally retarded autistic male adolescents and young adults and 14 individually matched, healthy community volunteers. RESULTS Amygdala volume was significantly smaller in the autistic subjects, both with (p = 0.006) and without (p = 0.01) correcting for total brain volume. Total brain volume and absolute hippocampal volume did not differ significantly between groups, but hippocampal volume, when corrected for total brain volume, was significantly reduced (p = 0.04) in the autistic subjects. CONCLUSIONS There is a reduction in the volume of amygdala and hippocampus in people with autism, particularly in relation to total brain volume. The histopathology of autism suggests that these volume reductions are related to a reduction in dendritic tree and neuropil development, and likely reflect the underdevelopment of the neural connections of limbic structures with other parts of the brain, particularly cerebral cortex.
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Affiliation(s)
- E H Aylward
- Department of Radiology, University of Washington School of Medicine, Seattle 98195, USA.
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