Chronic otitis media

Chronic otitis media is classified based on presence or absence of middle ear inflammation and production of discharge into Active and Inactive COM respectively. 2 Myringoplasty is a reconstructive procedure which is limited to repair of tympanic membrane perforation after ABSTRACT

Chronic otitis media is a disease of middle ear cleft with symptoms of ear discharge, hard of hearing, ringing sensation in the ear etc. Though the pathogenesis of COM involves alteration of conductive mechanism of hearing but yet not all patients of COM present with or give history of hard of hearing. In COM as the disease process advances only slowly, the patient appears to adapt to the loss so that thresholds of 30-40 dB HL are common with little complaint from the patient.

Results: A total of 12 patients were enrolled in this study population. Group A consisted of patients with mastoid abscess preceded by acute otitis media, while Group B consisted of patients with mastoid abscess and chronic otitis media. In Group A (n = 7), 4 patients had a pre-morbid immunocompromised condition, but they did not have cholesteatoma. None of the patients in Group B (n = 5) had any pre-morbid illnesses. Out of 12 patients, 7 patients had associated extracranial complications, and 1 patient had intracranial complications. Most patients recovered well after mastoidectomy. Recurrence was noted in 1 patient who had acute lymphoblastic leukaemia.

From this study it is concluded that there is a significant increment in degree of hearing loss in patients with inactive mucosal chronic otitis media with increasing the surface area of tympanic membrane perforation at different frequencies. There is a quantitative relationship between the surface area of perforation and degree of hearing loss from which we can judge whether the patients with inactive mucosal chronic otitis media have a middle ear pathology rather than perforated ear drum. This quantitative relationship ruled by a logarithmic equation as follows:

A total of 20 ancient American Indian skulls were included in this study (Table 1): 1 male, 7 female, and 12 of unknown sex.‍ Fourteen skulls could be assigned a broad age category, with 6 remaining unknown.‍ Five of the 20 specimens (25%) showed evidence of arrested mastoid pneumatization on 1 or both sides (Figs 1 and 2), a finding commonly associated with chronic otitis media.‍ Three of the 20 skulls (15%) exhibited expanded marrow space, or porotic hyperostosis (Figs 3 and 4).‍ Almost all specimens had some degree of flattening of the occiput (Fig 5) caused by carrying infants strapped to cradleboards, a practice that continues in the American Indian culture today.‍

The diagnosis of chronic otitis media (COM) implies a permanent abnormality of the pars tensa or flaccida, most likely as a result of earlier acute otitis media, negative middle ear pressure or otitis media with effusion. The earlier classification of COM into safe and unsafe disease based on anatomical distinction indicating a tubo- tympanic or attico-antral disease is redundant as these terminologies are misleading and complications can occur from any ear with active COM irrespective of its pathology. 1

Background: Computed tomography is the imaging of choice in chronic otitis media (COM) but it is neither available at every centre nor is affordable to masses of economically weaker countries. In this situation where only X- ray facility is available should plain radiographs of mastoid be done ?. If yes then what is the analytical evidence? This study, was conducted to find the utility of plain radiographs of mastoid by comparing radiological findings vis-a- vis operative findings.

ing hearing loss accompanying chronic otitis media was the cause of the delay in language develop- ment found in the experiniental grout). Physicians, parents, and educators need to be a[r]

Background: Unilateral chronic otitis media (COM) is a condition likely to affect the other side also caused by various etiological factors. If diagnosed and intervened in time, the progression of the disease can be prevented and ear can be protected from various sequelae. Hence, it is important to assess and evaluate the contralateral ear (CLE) completely.

Conclusions. There was a significant difference in the proportion of children who were effusion-free immedi- ately after 14 days of treatment with steroid and amoxi- cillin compared with those who were treated only with amoxicillin for 14 days. Within 2 weeks of finishing treatment, there was no longer any significant difference between the 2 groups regardless of whether amoxicillin was continued or not. Therefore, we conclude that treat- ment with the dose and type of steroid used in this study should not be universally recommended for treatment of chronic otitis media with effusion, and treatment with amoxicillin, if used, should not continue beyond 14 days. Pediatrics 2002;110:1071–1080; otitis media, steroid, amoxicillin, middle ear effusion, allergy.

Tympanoplasty and mastoidectomy are the surgical interventions for chronic infection of the middle ear. Tympanoplasty is employed to eradicate the infections of the middle ear and to reconstruct the hearing mechanism. Otolaryngologists might also conduct mastoidectomyin addition to tympanoplasty when they are doubtful about the complete elimination of pathology, based on the preoperative audiometry and intraoperative observations. Mastoidectomy is also conducted to remove the granulation tissue of cholesteatoma and chronic refractory infections; however, there is controversy regarding the success of tympanoplasty with or without mastoidectomy when there is only a simple perforation in the eardrum without active infection or cholesteatoma. This study aimed to compare the effectiveness of tympanoplasty with and without mastoidectomyin patients with dry chronic otitis media. Seventy-six patients with dry chronic otitis media which had simple perforated tympanic membrane were randomly allocated in 2 groups (1:1 ratio) of intervention. Group one underwent tympanoplastyalone with graft (TP) and group two underwent tympanoplasty with mastoidectomy (T&M) surgery. The success rates of surgeries were compared between the intervention groups two month postoperatively. The success rates of TP group and T&M group were 57.9% and 65.8%, respectively. There were no significant differences between intervention groups regarding the improvements in hearing impairment and amount of graft uptake. Mastoidectomy with tympanoplasty was not superior regarding the success of surgical intervention in dry chronic otitis media, as compared to tympanoplasty without mastoidectomy.

Sensorineural hearing loss due chronic otitis media has been reported as a definite pathologic entity, but its prevalence remains controversial. 7 In patients having chronic suppurative otitis media higher frequencies were more effected than the lower frequencies, however the patient’s age and duration of otorrhea seems not to have any correlation with the degree of sensorineural hearing loss. 8 In a study it was found that 34.56% of school children had different grades of hearing impairment and 16.95% having chronic suppurative otitis media had mild to moderate hearing loss (41-60 dB).

The questionnaire was re-applied at two months post- operatively (follow-up score) to a group of children with an indication for tympanostomy tube insertion, aimed at meas- uring any change in quality of life with surgery. The ques- tionnaire was self-administered and completed by caregiv- ers throughout the study. Follow-up and baseline scores were obtained from the same caregiver in all cases. Data regarding middle ear pathology and demographic data were obtained: age, gender, diagnosis (COME; RAOM; chronic otitis media with effusion and concomitant recurrent acute otitis media), results of tympanometry, presence of conductive hearing loss in pure-tone audiometry (air con- duction isolated threshold elevation, with air-bone gap ≥ 15 dB), history of tympanostomy tube insertion associated to postoperative otorrhoea.

A detailed history with regard to ear discharge, deafness, tinnitus, earache, vertigo, headache and fever was taken, and recorded in a systematic order, with special consideration of associated symptomatology suggestive of any impending or already established complication of chronic otitis media. All patients’ ears were examined under microscope before surgery. A thorough clinical evaluation of patients was performed. Hearing status was assessed by pure tone audiometry (PTA). High-resolution CT images for all patients were obtained in axial plane with thin sections (0.6 mm). Scanning commenced from the lower margin of the external auditory meatus and extended upward to the arcuate eminence of the superior semicircular canal. Coronal and sagittal reconstructions were made and images were analysed.

Acute or recurrent infection of the middle ear cleft may cause irreversible inflammatory changes termed as chronic otomastoiditis. 1 Chronic Otitis media is one of the most common infectious diseases with dreaded complications and considerable morbidity. This is of particular importance in a developing country such as India with its huge disease prevalence, wherein it translates to significant amount of loss of labour, leading to financial burden on the society. Hence it becomes important to detect the disease in its earliest stages and treat it accordingly. This is particularly true in cases of

Otitis media, an inflammation of the middle ear, is quite common in the developing world. 1 Based on the duration of symptoms, like ear discharge or perforation of the tympanic membrane, it is labelled as chronic otitis media when the symptoms are present beyond 12 weeks. Chronic suppurative otitis media (CSOM) is inflammation of the middle ear cleft and its contents which are classically divided into a tubo-tympanic type affecting the middle ear mucoperiosteum and an attico- antral type which is an active squamous disease within a growth of squamous epithelium into the middle ear

Otitis media, an inflammation of the middle ear, is a common illness in childhood and also occurs in adults. This study aimed to investigate the correlation between chronic otitis media (COM) and acute otitis media (AOM) and the levels of serum Interleukin-6 (IL-6) and C- reactive protein (CRP) in patients contact clinics in Damascus hospital in period 2013–2014.This study involved 77 patients with otitis Media (OM), (COM: 45 vs AOM: 32) and 22 healthy people as a control group (age: 2-70 year). The results showed that both IL-6 and CRP were significantly increased (p<0.05) in serum of COM patients (Pseudomonas aeruginosa: 5.12±0.664 pg/ml, 6.72±0.624 mg/l) and in serum of AOM patients(Streptococcus pneumonia: 48.60±3.35pg/ml, 63.88±3.102mg/l)as compared to healthy controls. The serum IL-6 and CRP levels from bacterial COM patients showed a little elevations. Contrarily, the serumIL-6 and CRP levels from bacterial AOM patients showed increased elevations especially in streptococcal AOM patients. Therefore, serum IL-6 and CRP would be a diagnostic biomarkers for bacterial otitis media.

of all these complications, hearing loss is the most common and preventable one. Moreover, in children hearing loss can also lead to failure of development of communication, language development and cognitive development. So, it is very important for the clinician to know about the bacteriology and sensitivity pattern for management of chronic otitis media, as antimicrobial susceptibility profile of bacteria varies in different geographical area due to local antimicrobial prescribing practices and prevalence of resistant bacterial strains. The objective of this study was to determine the bacteriological profile and the susceptibility pattern of CSOM patients as the knowledge of the local pattern of infections is essential to enable efficacious treatment and to achieve a dry ear, improve hearing and to prevent complications.

It has previously been assumed that a healthy individual’s ear is sterile (22, 23). Infections in the middle ear are thought to occur when pathogens enter the middle ear through the external ear canal or Eustachian tube. Other theories to explain the persistent nature of this disease and repeated infection include toxin produc- tion by P. aeruginosa (24), microbes embedding within the dead/ damaged tissue (cholesteatoma) (16, 18), formation of biofilms (25, 26), recurrent bacterial infection from the nasopharynx not covered by the antibiotics prescribed (21), or development of an- tibiotic resistance (20, 27). Fluorescence in situ hybridization (FISH) has previously shown S. aureus biofilms to be present within the tissue of CSOM patients (28). Biofilm has also been demonstrated on the middle ear mucosa of children with chronic otitis media (23) and in middle ear effusions from children with recurrent AOM (29, 30), which is a likely risk factor for CSOM.

There is a general agreement that adequate eustachian tube function is necessary for successful middle ear surgery. 10 Opinions have differed on the value of preoperative tubal function tests in chronic otitis media. Studies of eustachian tube patency have been studied by the Politzer, Valsalva, and Toynbee maneuvers. In other cases it has been accomplished by testing air transport through the eustachian tube by tympanometry, sonotubometry, and air pressure equalization technique. However, these methods do not evaluate the drainage function, which may be impaired even though the tube is anatomically open. 11 The saccharin test seems to provide adequate information of the mucociliary function and patency of the ET. As of today only very few studies had been conducted in assessing the eustachian tube functions prior to tympanoplasty surgeries and so the present study was undertaken in assessing the ET function by using saccharine perception time and methylene blue clearance time before performing tympanoplasty surgery and assessing the post-surgical impact based on the ET function.