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Drug Levels of Colistin and Meropenem in Critically Ill Children with Carbapenem Resistant Infection and Its Association with Microbiological Eradication
No full textCorrelation between CT Grading and Pre and Post Operative Pure Tone Audiometric Thresholds in Patients with Otosclerosis
No full textINTRODUCTION:
Disabling hearing loss (>35dB in better ear) requiring rehabilitation is estimated to affect nearly 5% of the world population and causes significant impact in the - being and
more importantly in communication needs. Otosclerosis is one of the more common causes of adult-onset hearing loss. The incidence of clinically confirmed otosclerosis is 13.7 per 100,000 population. It has a multifactorial aetiology, hence
the primary prevention of the disease and the resultant hearing loss is unattainable.
Early diagnosis and appropriate stage-based management is necessary in rehabilitation of hearing loss. The disease has varied symptom in addition to the classical progressive bilateral conductive hearing loss up to about 50 dB to 60 dB, which are sensory hearing loss, tinnitus and vertigo.
AIMS AND OBJECTIVES:
Primary objective:
To study correlation between post-operative change in air conduction and bone conduction thresholds and air bone gap with HRCT grading of Otosclerosis.
Secondary objective:
1. To study the correlation between HRCT grading of otosclerosis and preoperative air and bone conduction thresholds.
2. To study the interobserver agreement between radiologists in grading of otosclerosis on HRCT temporal bone as per the Symons and Fanning grading system.
MATERIALS AND METHODOLOGY:
STUDY DESIGN:
The study was a retrospective observational study.
STUDY SETTING:
The study was conducted at a tertiary care hospital in south India, by collecting
data from medical records, of all patients who underwent stapedotomy under the
otology unit of the department of Otorhinolaryngology between January 2014 to
March 2021. The study was carried out after obtaining Institutional Review Board and
ethical committee clearance (IRB no: 12361).
SAMPLE SIZE CALCULATION:
Marx et al. on evaluating pre- and post-operative hearing thresholds in those with isolated fenestral otosclerosis vs extensive otosclerosis, found preoperative mean air conduction thresholds to be 49.9±14.9dB among the isolated fenestral otosclerosis group and 59.9±22.4dB in the extensive otosclerosis group(71). With a Mean difference of 10 units, alpha error at 5% and power at 80% for a two-sided test at least 57 samples were required in each group. The total sample size required was therefore 114 ears. A sample size of 50 ears was used for the calculation of interobserver agreement of radiological grading.
Eligibility criteria:
● Patients in the age group of 18 to 60 years who underwent stapedotomy.
● Pre-operative audiometry and HRCT temporal bone should be done within 6 months prior to surgery.
Exclusion criteria:
● Patients with known intra or post-operative complication
● Patients with co-existent middle ear pathology.
● Patient who underwent stapedectomy for otosclerosis in the same ear.
METHODOLOGY:
The data of the patients who underwent surgery from January 2014 till March of 2021, fulfilling the eligibility criteria were collected and were entered in a data sheet. The radiologist R1 reviewed the high resolution computed tomographic images of all samples and graded them. The radiologist R2 was blinded to the grading of R1 and was given 50 samples, randomly selected with www.random.org, for the purpose of studying interobserver agreement. The audiometric thresholds at each frequency, 250Hz, 500 Hz, 1kHz, 2kHz and 4kHz were tabulated.
LIMITATIONS:
❖ The sample size of 114 for analysing the post operative hearing thresholds could not be achieved due to the current pandemic situation and travel restrictions which resulted in significant loss to follow up. A study with adequate sample size may have been suitable to assess statistical significance more reliably.
❖ Few groups of CT grades had a smaller number of samples due to which our analysis was limited. A larger sample size is required to clarify correlation in these grades.
❖ In view of our study being conducted retrospectively, details of presenting symptoms and family history were not documented uniformly. A prospective study would have helped better documentation. Further, a prospective study would have provided uniformity and enabled shorter time duration between HRCT, pre-operative audiogram and surgery.
❖ Further, for the purpose of assessing the correlation of HRCT grades with postop audiometric threshold improvement, cases operated by a single surgeon will help in assessing the correlation factor more precisely.
CONCLUSION:
HRCT grading of otosclerosis by Symons and Fanning is a clinically useful tool in the pre-operative evaluation of otosclerosis. Our study has demonstrated a good correlation between this grading system and pre-operative bone conduction thresholds and post-operative audiometric outcomes. It can therefore be used to counsel patients prior to surgery regarding hearing outcomes. The grading system
shows a good interobserver agreement further making it a reliable tool. The study was limited by its retrospective study design and significant loss to follow-up. A further
study with larger sample size will be useful to qualify these results
Comparison of Efficacy of Onlay Vs Pre-Peritoneal (Sublay) Mesh Repair in the Treatment of Ventral Hernias (RCT)
No full textA Comparative study on Psychiatric Morbidities, Quality of Life and Coping Strategies in Amputees and Post-Stroke Paresis Patients
No full textA Study on Mean Corpuscular Volume and Red Cell Distribution Width in the Diagnosis of Iron Deficiency Anemia
No full textA Comprehensive study of Fournier’s Gangrene at KAPV Government Medical College, Tiruchirappalli
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