Management evaluation of patients with chronic suppurative otitis media: A retrospective study

Epidemiology of Chronic Suppurative Otitis Media in the United States

OBJECTIVE

This study aimed to evaluate the prevalence, incidence, and associated demographic factors of chronic suppurative otitis media (CSOM), utilizing a nationwide healthcare claims database.

METHODS

This retrospective study utilized outpatient administrative claims data from the IBM MarketScan Research Database from 2007 to 2021. The database (11 246 909 584 claims with 148 147 615 unique patients) includes health data from the private-sector, Medicare/Medicaid, managed care providers, and EMR providers. Included patients had a diagnosis of CSOM based on ICD-9-CM and ICD-10-CM codes. Prevalence and health utilization were estimated by age, gender, and geographic region.

RESULTS

In the United States, the estimated CSOM prevalence and incidence was 0.46% and 0.03%, respectively. Among CSOM patients (n = 679 906), mean age (SD) was 8.1 (15.4) years, and 52.8% were male. Most patients (81.1%) were aged 0 to 10 years. CSOM prevalence was lower in females (OR = 0.64, 95% CI 0.64-0.65, P < .001), less common in older age (OR = 0.94, 95% CI 0.94-0.94, P < .001), and highest in the South region (OR = 2.08, 95% CI 2.06-2.09, P < .001).

CONCLUSION

Our results show CSOM prevalence (0.46%) is similar to other developed countries. CSOM prevalence was highest in those aged 0 to 10 years, in males and in the South region. Of note, prevalence and cost are likely significantly underestimated given limitations in accurate ICD-CM coding and the exclusion of uninsured patients. Further epidemiological studies are warranted to characterize the impact of CSOM on the US healthcare system.

The association of bacterial biofilm and middle ear mucosa in patients with mucosal chronic suppurative otitis media

OBJECTIVES

To evaluate the bacterial biofilm's role in mucosal chronic suppurative otitis media (CSOM) utilizing scanning electron microscopy (SEM).

METHODS

This study involved 123 participating patients with active and inactive mucosal CSOM who underwent tympanomastoid surgery. SEM was used to examine middle ear mucosa biopsies for the development of biofilms. Middle ear discharge or mucosal swabs from patients were cultured to detect any bacterial growth. The biofilm formation was correlated to the culture results.

RESULTS

The biofilm was present in 69.9 % of patients (59% of them were with active mucosal CSOM) and absent in 30.1% of the patients (70% of them were with inactive mucosal CSOM), being more statistically significant in active mucosal CSOM (p-value = 0.003). A correlation that was statistically significant was found between active mucosal CSOM and higher grades (3 and 4) of biofilms (p-value <0.05). The mucosal CSOM type and the results of the culture had a relationship that was statistically significant (p-value <0.001). 60% of patients had positive culture (70% of them were with active mucosal CSOM). There was a statistically significant relation between Pseudomonas aeruginosa bacterial growth and active mucosal CSOM (p-value = 0.004) as well as higher grades of biofilms in mucosal CSOM.

CONCLUSION

Mucosal CSOM, especially the active type, is a biofilm-related disease. There is a significant relation between the state of mucosal CSOM (active or inactive) and culture results with predominance of Pseudomonas aeruginosa bacterial growth in active mucosal CSOM and in higher grades of biofilms in mucosal CSOM.

Janus mesoporous organosilica/platinum nanomotors for active treatment of suppurative otitis media

We report a Janus mesoporous organosilica/platinum (MOS/Pt) nanomotor for active targeted treatment of suppurative otitis media, as a new type of multi-functional ear drop. The efficient propulsion of MOS/Pt nanomotors in hydrogen peroxide ear-cleaning drops significantly improves their binding efficiency with Staphylococcus aureus and enhances their antibacterial efficacy.

Mapping of audiometric analysis with microbiological findings in patients with chronic suppurative otitis media (CSOM): a neglected clinical manifestation

Otitis media (OM) is an umbrella term for a number of conditions associated with middle ear inflammation. Chronic suppurative otitis media (CSOM), a type of OM, is characterized by long-term middle ear infection with perforated ear drum and otorrhea. The most common outcome associated with it is acquired hearing impairment in infected individuals which ultimately affects their cognitive and scholastic developments. Clinically, CSOM is thought to be a sequel of re-occurring episodes of Acute otitis media (AOM). Pseudomonas aeruginosa and Staphylococcus aureus are found to be the predominant pathogenic isolates in these patients. However, with the emergence of antibiotic resistance amongst these pathogens, the adequate evaluation and treatment of this condition has become more problematic. The disease has also been recognized as one of the neglected tropical clinical manifestations with high prevalence in school-age children, especially in poor or underprivileged countries. Moreover, untreated cases have further worsened the situation by contributing to various life-threatening complications. Thus, effective treatment and surgical strategies, as well as strengthening of hearing care algorithms along with the discovery of novel animal models for advanced clinical research, can jointly help to fight this disease. In this regard, mapping of the audiological analysis with microbiological findings in CSOM patients may help elucidate the frequency that favors growth of specific pathogens. Knowledge about this potential correlation can then support timely detection of the infection, which is perceived as one of the emerging approaches for its management. In addition to these strategies, creating a true sense of awareness among people can also help mitigate this pathological condition by facilitating early identification, prevention, and treatment. This review discusses the incidence, pathogenesis, investigations, complications, and available treatment modalities associated with CSOM.

Balloon Eustachian Tuboplasty and Grommet Insertion: A Combined Surgical Treatment for Chronic Suppurative Otitis Media with Eustachian Tube Dysfunction

Objectives. This study aims to evaluate the effectiveness of Balloon Eustachian tuboplasty (BET) and grommet insertion in patients having chronic suppurative otitis media combined with eustachian tube dysfunction (CSOM-ETD). Methods. We evaluated the data of CSOM-ETD patients (n = 96) from January 2019 to January 2021, who were divided into the following groups: 48 cases underwent BET (BET group) and 48 cases underwent BET plus Grommet insertion (BET + Grommet group). The air-bone gap (ABG), Eustachian Tube Dysfunction Questionnaire (ETDQ‐7) score, Eustachian tube inflammation scale, Chronic Otitis Media Outcome Test 15 (COMOT-15), Valsalva maneuver, and patient satisfaction were evaluated after surgery. Results. The postoperative ABG in the BET + Grommet group was better than that in the BET. In addition, the ABG was improved obviously in the BET + Grommet group at 6 and 12 months after the corresponding surgery. Moreover, the Eustachian tube inflammation scale, ETDQ-7, and COMOT-15 scores were reduced after the treatment with the combination of BET and Grommet insertion at 6 and 12 months. The postoperative ETDQ-7 score, Eustachian tube inflammation scale, and COMOT-15 score were lower in the BET + Grommet group than that in the BET group. The percentage of patients who could perform a positive Valsalva maneuver was significantly higher in the BET + Grommet group than that in the BET group at 6 months and 12 months after surgery with increased patient satisfaction. Conclusion. Our results demonstrate that BET plus Grommet insertion showed better treatment efficacy for patients with CSOM-ETD than BET alone via improving the Eustachian tube function hearing outcome and quality of life with less Eustachian tube inflammation.

Impact of the COVID-19 pandemic on the volume of chronic suppurative otitis media surgeries

Background

Chronic suppurative otitis media (CSOM) is a case of ear infection which prevalence is still relatively high, especially in developing countries. Surgery is the definitive management for CSOM that aims to eradicate the infection and improve the hearing conduction system. The COVID-19 pandemic has put enormous pressure on the global health care system, including limitations on elective surgical procedure at most hospital at the beginning of the pandemic.

Objective

This study aimed to assess the impact of the Covid-19 pandemic on the volume of chronic suppurative otitis media surgeries.

Methods

A retrospective study on 236 chronic suppurative otitis media patients. The number of surgeries collected from April to December 2019 and 2020 was compared. Statistical analysis used the t-independence and linear regression test with p < 0.05.

Results

The otologic surgeries decreased by 83.7% between 2019 and 2020. There were 203 surgeries (2019) vs 33 (2020). The average number of surgeries per month in 2019 and 2020 was 23 ± 6 patients and 4 ± 2 patients, respectively (t = 2.365; p < 0.001). All cases that underwent surgery in 2020 were cases with complications. Special consent and preparation must be completed before surgery.

Conclusion

The number of otitis media surgeries significantly decreases during the COVID-19 pandemic.

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The COVID-19 pandemic affects the quality of otorhinolaryngology, head, and surgery services.

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There was a decrease in the number of patients in surgery otology, but disease severity increased during the COVID-19 pandemic.

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Significant differences between before and during the COVID-19 pandemic otology services in Indonesia.

Chronic Suppurative Otitis Media Characteristic in Secondary Hospital in Yogyakarta

BACKGROUND: Chronic suppurative otitis media (CSOM) is the most common ear infection that causes hearing loss and affects the quality of life worldwide. AIM: The study aimed to describe the risk factor of CSOM patients at a private hospital in Yogyakarta, Indonesia, from March to June 2021. METHODS: This study was an observational analytical study with a case–control design. The respondents were 55 patients with CSOM who met inclusion criteria and 56 respondents as controls. A checklist interview was conducted to determine the present and past history of diseases, and the relationship among potential risk factors was analyzed using bivariate analysis. A bivariate analysis was used to specify the odds ratios, 95% confidence intervals, and the relationship between risk factors and the incidence of CSMO. RESULTS: The characteristic cases were as follows: Majority age over 20 years, 56% male, 47% university degree, 29% history of allergy, 25% history of acute respiratory infection, 56% complain of discharge from the ear, 31% snoring, 67% cigarette consumption, 42% earn 2–5 million rupiahs per month, and 73% of their homes are closed to health-care facilities. Four risk factors for CSOM omit this included: Education, medical history from the ear, snoring, and income per month (p < 0.05). CONCLUSION: According to the results, the majority of CSOM patients to be treated at a private clinic in Yogyakarta were male at productive age, had university education, had no history of allergies and acute respiratory infections, and had a history of secrete from the ear, exposure to cigarettes, and median income per month.

The association of iron deficiency anemia on chronic suppurative otitis media in children: A case-control study

Background

Chronic suppurative otitis media (CSOM) is the most common infectious disease in the world and the leading cause of hearing loss in children in developing countries. Iron deficiency anemia (IDA) is often found in children with CSOM.

Objective

This study was conducted to determine the association between IDA and the incidence of CSOM in children.

Method

This research is a case-control study using consecutive sampling. Participants were divided into case group which are children diagnosed with CSOM (n = 42) and control group which are children with normal ear (n = 42). All participants were examined for serum iron (FE), hemoglobin (Hb), total iron-binding capacity (TIBC), and ferritin levels. The analysis used in this study includes the chi-square test or fisher extract test and independence t-test or Man Whitney test with p < 0.05.

Result

The measurement results obtained values of Hb (13.00 ± 1.34 g/dL; p < 0.001), FE (95.13 ± 40.84 g/dL; p < 0.001), TIBC (354.18 ± 62.44 g/dL; p = 0.016), and ferritin levels (17.57 ± 8.55 g/dL; p < 0.001). Participants who experienced IDA were 21.43% which in the case group was 31.0% and control group was 11.9% (OR = 3.32; p = 0.033).

Conclusion

IDA can increase the incidence of CSOM in children.

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Iron deficiency anemia is a risk factor for CSOM in Children.

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Children with iron deficiency anemia have a 3-fold risk of experiencing CSOM.

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Supplement iron needs to be given as a preventative for CSOM in children.

Surgical treatment of external auditory canal cholesteatoma in congenital malformation of the ear: A case series

Background

External auditory canal (EAC) cholesteatoma is a lesion lined with stratified squamous epithelium containing proliferative keratin with bony erosion in EAC which can spread to the tympanic cavity, mastoid, and surrounding organ. External cholesteatoma can occur in patients with congenital abnormalities such as congenital aural atresia (CAA).

Method

This case series was reported using the 2020 PROCESS Guideline. The design of this study used a retrospective study during the 2015–2020 period.

Result

3 participants aged 10.67 ± 2.31 years with CAA had other complaints of ear infections. All participants experienced sensorineural hearing loss with an average threshold of 59.33 ± 36.68 dB and suspicious cholesteatoma from a CT scan. Canal wall down, meatoplasty, and/or canaloplasty were performed based on the findings.

Conclusion

Surgical procedure in CAA with cholesteatoma aimed on preventing further complications and recurrence.

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Congenital aural atresia (CAA) is a condition where the patent external auditory canal is not formed.

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Canaloplasty and meatoplasty is the management of congenital aural atresia (CAA).

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Canal wall down effective management of CAA with grade IV.

Efficacy of Otomicroscopy Combined with Otoendoscopy Double-Lens Technology-Assisted Tympanic Membrane Repair on Elderly Patients with Chronic Suppurative Otitis Media

Objective

To investigate the effect of otomicroscopy combined with otoendoscopy double-lens technology-assisted tympanic membrane repair on elderly patients chronic suppurative otitis media (CSOM).

Methods

120 elderly CSOM patients from January 2017 to July 2019 were selected and divided into the otomicroscopy group (n = 40), the otoendoscopy group (n = 40), and the double-lens group (n = 40) by the random number method. All patients were treated with tympanic membrane repair. The otomicroscopy group was assisted by otomicroscopy, the otoendoscopy group was assisted by otoendoscopy. and the double-lens group was assisted by otomicroscopy combined with otoendoscopy. The three groups of operations status, clinical efficacy, the incidence of adverse reactions, hearing improvement rate, and satisfaction rate with incision after 6 months were compared.

Results

The operation time, intraoperative blood loss, hospitalization time, and VAS score of the otoendoscopy group and the double-lens group were all lower than those of the otoendoscopy group, and the operation time of the double-lens group was lower than that of the otoendoscopy group (P < 0.05). The clinical efficacy of the double-lens group was better than that of the otomicroscopy group and otoendoscopy group (P < 0.05). The adverse reaction rate of the otoendoscopy group and the double-lens group was lower than that of the otomicroscopy group, and the average postoperative air-bone conductance of the double-lens group was lower than that of the otomicroscopy group and the otoendoscopy group, and the hearing improvement rate was higher than that of the otomicroscopy and otoendoscopy groups (P < 0.05). The satisfaction rate with postoperative incision in the otoendoscopy group and double-lens group was higher than that in the otomicroscopy group (P < 0.05).

Conclusion

The double-lens technology-assisted tympanic membrane repair has an obvious effect on elderly patients with CSOM. Compared with the single-use otomicroscopy, the operation time, intraoperative blood loss, hospitalization time, patient's dry ear condition, degree of surgical pain, clinical efficacy, adverse reaction rate, hearing improvement rate, and patient's incision satisfaction of the double-lens technology are better. Compared with the single-use otoendoscopy, the operation time, clinical efficacy, and hearing improvement rate of the double-lens technology are better.