Status and Depth of Mastoid Antrum and the Pattern of Mastoid Pneumatization in Cases of Large, Subtotal Perforations and Posterosuperior Retraction Pockets (PSRP)

The present study aimed to evaluate the pneumatization status of the mastoid air cells in general with the depth and status of mastoid antrum in particular, in patients of chronic otitis media (COM). This is an observational cross-sectional study in sample size of 60 participants with large, subtotal perforation and posterosuperior retraction pocket (PSRP). Mean age with large central and subtotal perforation combined was 35.78 years, compared to 32.13 years in PSRP. Granulations seen in antrum in 71.6% and cholesteatoma observed in 15%. Mean depth of the mastoid antrum was 17.27 mm. A well pneumatized mastoid in 21.6%, diploic 28.3% and sclerotic in 50% was noted in this study. Chronic otitis media affects temporal bone pneumatization, particularly the mastoid antrum. Our findings indicate that the depth of the mastoid antrum is slightly greater in cholesteatoma cases due to bone erosion. As early intervention enhances postoperative quality of life by preserving or restoring auditory function, understanding the mastoid pneumatization and antrum depth is crucial for managing chronic otitis media effectively.

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.

A contemporary overview on the enigma of managing recalcitrant or intractable post-operative otorrhoea following middle-ear surgery: perspectives, principles and practices

Background

A common problem in otological surgeries is the persistence of ear discharge in a patient who has undergone middle-ear reconstructive surgery, despite an intact graft. There is a dearth of knowledge in the literature on treatment strategies in such post-operative cases of recalcitrant otorrhoea.

Method

This was a retrospective observational descriptive study conducted on 45 patients who fitted the criteria for recalcitrant post-operative otorrhoea. All 45 patients showed no response to conservative treatment for 14 days from onset of discharge. Therefore, these patients were then given antiseptic ear drops.

Results

Thirty patients out of 45 showed a good response to antiseptic ear drops and achieved a dry ear at the end of the treatment.

Conclusion

In patients with recalcitrant otorrhoea with or without granulations after middle-ear reconstruction surgery, this study found that topical antiseptic ear drops, particularly those using boric acid powder, are more effective than topical antibiotic drops.

Application of biomaterials in periodontal tissue repair and reconstruction in the presence of inflammation under periodontitis through the foreign body response: Recent progress and perspectives

Periodontitis would cause dental tissue damage locally. Biomaterials substantially affect the surrounding immune microenvironment through treatment-oriented local inflammatory remodeling in dental periodontitis. This remodeling process is conducive to wound healing and periodontal tissue regeneration. Recent progress in understanding the foreign body response (FBR) and immune regulation, including cell heterogeneity, and cell-cell and cell-material interactions, has provided new insights into the design criteria for biomaterials applied in treatment of periodontitis. This review discusses recent progress and perspectives in the immune regulation effects of biomaterials to augment or reconstruct soft and hard tissue in an inflammatory microenvironment of periodontitis.

Chronic suppurative otomastoiditis due to nontuberculous mycobacteria: A case series

INTRODUCTION

Eight new cases of chronic otomastoiditis due to nontuberculous mycobacteria were reported at Center Hospitalier Universitaire Sainte-Justine (CHUSJ) between 2008 and 2018. In the literature, only 89 cases have been described since 1972. This case series aims to define the clinical presentation, infectious pathogens, as well as diagnostic and therapeutic means employed in cases of nontuberculous mycobacteria otitis media encountered in our tertiary pediatric reference center.

METHODS

All cases of otitis media caused by nontuberculous mycobacteria diagnosed at Sainte-Justine between 2008 and 2018 were reviewed. Species identification was retrieved from the Laboratoire de Santé Publique du Québec, Quebec's provincial public health and reference laboratory.

RESULTS

All 8 cases occurred in immunocompetent children. Clinical features on presentation were chronic tympanostomy tube otorrhea with abundant granulation tissue in 7 cases. CT scan demonstrated coalescent mastoiditis in 3 cases. The median delay between initial presentation and identification of nontuberculous mycobacteria was 81 days. Seven patients had a Mycobacterium (M.) abscessus complex infection. Treatment consisted of weekly microscopic granulation debridement, a combined systemic antibiotic therapy for an average duration of 21 weeks, as well as instillation of boric acid into the middle ear. While 3 cases required at least one mastoidectomy, 2 cases were treated only medically.

CONCLUSION

Nontuberculous mycobacteria otitis media is a rare clinical entity, for which high clinical suspicion and specific microbiological analyses could minimize diagnostic delay. The use of boric acid as a desiccating agent may allow for a better local control.

Cholesteatoma Versus Granulations: Changing Incidence Trends and Association with Age and Complications

Purpose

CSOM is a common disease in lower socio-economic set-ups. Its incidence has decreased over time due to improved hygiene status increased use of antibiotics. It can be associated with cholesteatoma or granulation tissue as far as unsafe ears are considered. Cholesteatoma is defined as a well demarcated noncancerous cystic lesion derived from an abnormal growth of keratinising squamous epithelium in the temporal bone, commonly characterised as skin in the wrong place. Granulations are defined as the inflammatory response of middle ear mucosa to toxic insults. Overtime the incidence of granulations has increased. This study aims to observe the incidence trends of cholesteatoma in comparison to granulation tissue as intraoperative finding in CSOM patients and the association of these two with the age of the patient and associated complications if present.

Materials and Methods

All the patients admitted to E.N.T ward of M.D.M. Hospital, Jodhpur, Rajasthan, India undergoing mastoid exploration surgery between the time period of 1 year from September 2017 to August 2018 were observed and their clinical findings along with patients data including age and sex were recorded and studied in regard with incidence of cholesteatoma, granulation tissue or both simultaneously along with associated complications.

Results

Majority of the patients who required mastoid exploration surgery had the presence of granulation tissue as intraoperative finding (55.07%). The incidence of cholesteatoma and both cholesteatoma and granulations together was (21.73%) and (23.18%) respectively. Complication percentage was highest with that of cholesteatoma patients (44.45%). Most of the patients presented in the 3rd-4th decade of their lives (63.77%) and the incidence was low amongst the children (30.43%) and the elderly (5.8%). The complication rate was higher in children (55.56%).

Conclusion

Granulation tissue showed an increased incidence trend as compared with cholesteatoma; although complication rate was higher in the latter. Incidence as a function of age was maximum in the middle ages but the complication rate was more amongst the children.

Management of granular myringitis: A systematic review

Introduction:

Granular myringitis is a chronic disorder characterised by lateral squamous de-epithelialisation and granulation of the tympanic membrane. Untreated, granular myringitis can lead to post-inflammatory medial external auditory canal fibrosis, acquired canal atresia and inflammatory infiltration of the deep canal.

Aim:

This study aimed to establish optimal management strategies which could be applied to clinical practice, through systematic review of the current literature.

Methods:

Current literature was obtained by searching evidence-based medical databases, the Cochrane database, the Database of Abstracts of Reviews of Effects, the Cochrane controlled trials register, Ovid Medline, the variousBritish Medical Journalimprint journals, individual journal websites and citation indexes, and by hand-searching current journals. Detailed inclusion criteria were set. Data were retrieved from the selected studies and checked for accuracy and consistency. The primary outcome measured was the effect of the proposed intervention on recurrence of granular myringitis, compared with empirical antibiotic therapy.

Results:

Fifty-eight publications were identified, dating from 1964 to 2005; 46 of these were potentially relevant. After assessment using the preset inclusion criteria, only two studies remained. El-Seifi and Fouad (2000) found that surgical excision of granulation tissue resulted in an 80 per cent reduction in recurrence of granular myringitis when compared with conventional antibiotic therapy. However, Junget al.(2002) demonstrated a 96 per cent reduction in granular myringitis recurrence when managed with dilute vinegar solution.

Conclusions:

There was a reduced recurrence of granular myringitis in both studies' intervention groups, although neither study was randomised or blinded, making it difficult to assess the clinical relevance of the results. However, the following conclusions can be inferred. (1) Conventional topical antibiotic and steroid drops appear to be less efficacious and more likely to lead to recurrence of symptoms, compared with other proposed treatment modalities. (2) Treatment with dilute vinegar solution presents a logical, unharmful alternative to conventional antibiotic drops. Further research of high value is needed.

Management of the draining ear in children

There are a variety of causes of otorrhea in children. The most important factor in reaching the proper diagnosis and providing relief of the problem is aural toilet. Once adequate debridement has been performed, the diagnosis is usually clearer, and treatment with ototopicals is significantly more effective. Most cases of otorrhea are due to infection or granulation tissue and can be managed initially with appropriately selected ototopical medication, thereby avoiding the risks and side effects of systemic therapy and the need for referral to a specialist. However, otorrhea in children that is refractory to medical therapy may be due to retained tympanostomy tubes or insidious pathology such as cholesteatoma or malignancy. In such cases, prompt referral to the otolaryngologist can facilitate accurate diagnosis and successful management.