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Philipose R, Varghese A, Kumar N, Varghese SS. Determinants of Cochlear Dysfunction in Chronic Otitis Media: Mucosal Disease. Indian J Otolaryngol Head Neck Surg 2023; 75:3733-3738. [PMID: 37974794 PMCID: PMC10646060 DOI: 10.1007/s12070-023-04093-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/14/2023] [Indexed: 11/19/2023] Open
Abstract
The nature of association between chronic otitis media (COM)-mucosal disease and sensorineural hearing loss is controversial. Identifying the risk factors which influence the bone conduction threshold in these patients can help the clinician in counselling the patients for surgery at the earliest to achieve optimum hearing outcomes. The present study was undertaken to determine the association between COM-mucosal disease and cochlear dysfunction. The study also aimed at identifying the determinants and their influence on the bone conduction thresholds of the diseased ear. In this study, 72 patients with unilateral chronic otitis media-mucosal disease were enrolled consecutively. All patients were enquired in detail about their presenting ear symptoms. All the patients underwent a pure tone audiogram in a sound treated room. Patients were categorised into two groups according to the presence of conductive hearing loss only or with a sensorineural component. The bone conduction thresholds were calculated and compared for frequencies at 0.5, 1, 2 and 4 kHz. The average hearing threshold for air conduction and bone conduction were calculated across 0.5, 1 and 2 kHz. Bone conduction threshold more than 20 decibels (dB) in any of the frequencies were considered significant and indicative of having sensorineural hearing loss component. The contralateral healthy ear served as control to cancel out the confounding factors such as presbyacusis, noise induced hearing loss, congenital hearing loss, etc. Multivariate linear regression models were used to evaluate the relationships between bone conduction thresholds and chronic otitis media-mucosal disease. In the present study, 18.05% of participants had a sensorineural component. The difference between the bone conduction threshold in the diseased ear and normal ear ranged from 5.41 dB at 0.5 kHz to 3.77 dB at 4 kHz (p < 0.001). Bone conduction thresholds at 4 kHz were greater than that for speech frequencies (p < 0.5). 84.6% of participants with sensorineural component had a disease duration of less than 5 years and the remaining 15.4% had a duration of greater than 15 years. There was no statistically significant difference in the incidence of sensorineural component based on the site of the perforation (p = 0.341). 21.9% of participants who used topical antibiotic drops developed a sensorineural component, while 15% of participants who did not use antibiotic ear drop preparation developed a sensorineural component. Multivariate linear regression analysis revealed that increasing age was the only factor associated with increase in bone conduction thresholds of the diseased ear (p = 0.002). Chronic otitis media- mucosal disease appears to be associated with higher bone conduction thresholds, signifying cochlear dysfunction. A statistically significant higher bone conduction thresholds are seen across 0.5 to 4 kHz in the diseased ears compared to the normal ears, signifying the vulnerability of the inner ear against chronic otitis media. In our analysis increasing age is the most significant predisposing factor associated with higher bone conduction thresholds. Higher frequencies are more affected than lower speech frequencies. Sensorineural hearing loss can occur early in the disease process and early surgical intervention in COM-mucosal disease is recommended to prevent increase in bone conduction thresholds and achieve optimum hearing outcomes.
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Affiliation(s)
- Rebecca Philipose
- Department of E.N.T., Christian Medical College, Ludhiana, Punjab India
| | - Ashish Varghese
- Department of E.N.T., Christian Medical College, Ludhiana, Punjab India
| | - Navneet Kumar
- Department of E.N.T., Christian Medical College, Ludhiana, Punjab India
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Mathema L, Adhikari A, Poudyal P, Chalise GB, Chaudhary P, Khatri B. Chronic Otitis Media among Patients Visiting Community-Based Static Outreach Clinics. JNMA J Nepal Med Assoc 2023; 61:923-926. [PMID: 38289754 PMCID: PMC10792720 DOI: 10.31729/jnma.8369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction Chronic otitis media is a chronic inflammation of the middle ear and mastoid cavity, with recurrent ear discharges or otorrhoea through a tympanic perforation for the past 3 months. It is a common cause of hearing impairment, disability, and poor scholastic performance and can lead to fatal intracranial infections and acute mastoiditis. This study aimed to find out the prevalence of chronic otitis media among patients visiting community-based static outreach clinics. Methods A descriptive cross-sectional study was conducted among patients visiting the community-based static outreach clinics from 1 January 2017 to 31 December 2019. The ethical approval was taken from the Ethical Review Board. The diagnosis of chronic otitis media was done using otoscopy. The records of patients coming to outreach clinics visiting for ear, nose and throat care were reviewed using a pre-designed study proforma. A systematic random sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results Among 385 patients, 37 (9.61%) (6.67-12.55, 95% Confidence Interval) had chronic otitis media. The mean age of patients with chronic otitis media was 27.59±13.24 years, with 28 (75.67%) patients aged between 18-60 years. Among them, 30 (81.08%) had unilateral and 34 (91.89%) had a mucosal type. Conclusions The prevalence of chronic otitis media was lower than in other studies done in similar settings. Keywords community health services; otitis media; patients; prevalence.
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Affiliation(s)
- Luna Mathema
- Department of Otolaryngology & HNS, B.P. Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services, Madhyapur Thimi, Bhaktapur, Nepal
| | - Arun Adhikari
- Department of Otolaryngology & HNS, B.P. Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services, Madhyapur Thimi, Bhaktapur, Nepal
| | - Prasanta Poudyal
- Department of Otolaryngology & HNS, B.P. Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services, Madhyapur Thimi, Bhaktapur, Nepal
| | - Ganesh Bahadur Chalise
- Department of Otolaryngology & HNS, B.P. Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services, Madhyapur Thimi, Bhaktapur, Nepal
| | - Preeti Chaudhary
- Department of Otolaryngology & HNS, B.P. Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services, Madhyapur Thimi, Bhaktapur, Nepal
| | - Bijay Khatri
- Academic and Research Department, B.P. Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services, Madhyapur Thimi, Bhaktapur, Nepal
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Lüdke T, Müller C, Zahnert T. [Chronic mesotympanic Otitis media - Part 1: Diagnosis and Medical Treatment]. Laryngorhinootologie 2023; 102:619-628. [PMID: 37536333 DOI: 10.1055/a-1961-5714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Chronic mesotympanal otitis media (CMOM) is a well-developed clinical presentation that is established in diagnostics and therapy. On closer inspection, however, this principle cannot be confirmed in all its facets. Already the physiology and pathophysiology of the middle ear mucosa leave questions unanswered, starting with the distribution of the ciliated epithelium in the middle ear and mastoid to the function of gas exchange.In addition, there are new diagnostic and therapeutic approaches. In the future, optical coherence tomography could help to determine the status of the middle ear mucosa. In addition, there are new findings on the effectiveness of local and systemic antibiotics as well as antiseptics in chronic otorrhea. Other new developments include minimally invasive surgical procedures using endoscopic techniques. All this gives reason to provide an update on the topic of chronic mesotympanal otitis media, which should contribute in preparation for the specialist examination or refreshing.Basics of physiology and pathophysiology as well as new diagnostic approaches and medical treatment were covered in Part 1 of this paper. In Part 2, in addition to established methods, new developments in surgical therapy with minimally invasive surgical procedures are described in more detail.
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Verma N, Goyal A, Gupta N. Hearing outcomes in pediatric tympanoplasty and factors affecting surgical outcomes in the current era. Int J Pediatr Otorhinolaryngol 2023; 171:111634. [PMID: 37385186 DOI: 10.1016/j.ijporl.2023.111634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/24/2023] [Accepted: 06/11/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVES Type-1 tympanoplasty continues to be the treatment of choice for tympanic membrane perforations resulting from chronic suppurative otitis media (CSOM) in children, which is a principal cause of correctable hearing loss in the pediatric population. There is an ongoing debate about the surgical success rate, the factors affecting success as well as the best intervention time for this population group. This study assessed the outcome of Type-1 tympanoplasty in children in terms of 1) graft uptake and 2) hearing improvement as assessed by audiology. METHODS The study involved 40 patients aged 6 to ≤14 years suffering from tubotympanic chronic suppurative otitis media. The patients in the study had a central perforation of the pars tensa of the tympanic membrane. Pre-op investigations included Pure tone audiometry, Eustachian tube function test and nasopharyngeal x-ray. Type-1 tympanoplasty was performed on all patients. They were followed up at end of two months, six months, and one year postoperatively to assess surgical success and hearing outcomes. RESULTS Overall graft uptake and the surgical success rate was 80%. Postoperatively air-bone gap closure up to 5 dB was achieved in 62.5% of patients at the end of one year. A normal type A tympanometry curve was achieved in 75% of patients. There was a significant reduction in hearing handicap. The best results were obtained in the 9-10 years age group. CONCLUSION Tympanoplasty has a high success rate in children. There is a significant improvement in hearing post-surgery. There is a minimal impact of traditionally believed confounding factors. Considering the positive impact of improved hearing and reduced hearing disability, the authors suggest that surgeons should take young children up for tympanoplasty.
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Affiliation(s)
- Neha Verma
- Department of Otorhinolaryngology, UCMS & GTB Hospital, Dilshad Garden, Delhi, 110095, India.
| | - Arun Goyal
- Department of Otorhinolaryngology, UCMS & GTB Hospital, Dilshad Garden, Delhi, 110095, India.
| | - Neelima Gupta
- Department of Otorhinolaryngology, UCMS & GTB Hospital, Dilshad Garden, Delhi, 110095, India.
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Muacevic A, Adler JR, Khizer MA, Hussain A, Safoor I, Jamal A. Relationship of Hearing Loss and Tympanic Membrane Perforation Characteristics in Chronic Suppurative Otitis Media Patients. Cureus 2022; 14:e32496. [PMID: 36644044 PMCID: PMC9837494 DOI: 10.7759/cureus.32496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 12/15/2022] Open
Abstract
Objective The objective of this study is to assess the relationship between the site of tympanic membrane (TM) perforation and the type and degree of hearing impairment. The secondary objective was to compare the duration of the disease and the degree of hearing loss. Study design This is a prospective observational study. Place and duration of the study This study was carried out in the Department of Otolaryngology/Head and Neck Surgery at the Pakistan Institute of Medical Sciences, Islamabad, from May 2021 to April 2022. Patients and methods Of all the screened patients, 77 fulfilled the inclusion criteria. Patients aged 10-40 years with inactive mucosal chronic otitis media and unilateral perforation in one quadrant were included. The site of TM rupture was observed, and audiometric analysis was performed. Results The mean age of participants was 25 ± 8.61 years, with a preponderance of the female gender (57.1%). A total of 32 (41.6%), 19 (24.7%), 19 (24.7%), and seven (9.1%) perforations involved posterosuperior, anterosuperior, anteroinferior, and posteroinferior quadrants respectively. Conductive, mixed, and sensorineural hearing loss was found in 52 (67.5%), 18 (23.4%), and seven (9.1%) cases, respectively. Of all the subjects, 13 (16.9%) had the disease for < one year, 39 (50.6%) for one to five years, 17 (22.1%) for five to 10 years, and eight (10.4%) for > 10 years. There was a statistically significant association between the degree of hearing loss and the site of perforation. No significant association was found between the site of perforation and the type of hearing loss. Duration of disease and degree of hearing loss also had no significant association. Conclusion The extent of hearing loss was found to be directly influenced by the anatomical site of perforation, with the posterosuperior quadrant perforation producing the greatest degree of impairment.
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Elzinga HBE, van Oorschot HD, Stegeman I, Smit AL. Relation between otitis media and sensorineural hearing loss: a systematic review. BMJ Open 2021; 11:e050108. [PMID: 34385254 PMCID: PMC8362691 DOI: 10.1136/bmjopen-2021-050108] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 07/26/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES This systematic review summarises the evidence on the correlation between recurrent acute otitis media (rAOM) or chronic suppurative otitis media (CSOM) and sensorineural hearing loss (SNHL). RESEARCH METHODS PubMed, Embase and Cochrane Library databases were searched from inception to 15 January 2021. Two authors independently identified articles, extracted data and performed quality assessment for included studies. Studies comparing the sensorineural hearing levels of patients with a history of rAOM/CSOM for >3 months to a control group were included. RESULTS Screening of 4168 articles lead to inclusion of two case-control studies (control-group: patients non-OM) and seven cohort-studies (control group: contralateral ear). Quality assessment indicated considerable risk of bias in all studies. Reported populations varied (sample size 13-607, mean age 22-41.5 years, mean duration of disease 6.1-12.4 years). The OR for SNHL in the OM-group was 3.30-7.86 (95% CI 1.16 to 9.40, p<0.05) in cohort studies (n=2), and 0.05 (95% CI 0 to 0.78, p<0.05) in a case-control study. Mean/median bone conduction thresholds were respectively 1.19-32.21/0-10 dB higher on all frequencies (0.5-4 kHz) for the OM-group in four cohort studies (p<0.05). Two other studies reported no statistical test outcomes. CONCLUSION Due to the high risk of bias of included studies, effect estimates heterogeneity and suboptimal research designs, no conclusion on the correlation between OM and SNHL can be made. It emphasises the need for future prognostic studies.
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Affiliation(s)
| | | | - Inge Stegeman
- Department of Otorhinolaryngology, Head and Neck Surgery, UMC Utrecht, Utrecht, The Netherlands
- Department of Translational Neuroscience, UMC Utrecht Brain Center, Utrecht, The Netherlands
| | - Adriana L Smit
- Department of Otorhinolaryngology, Head and Neck Surgery, UMC Utrecht, Utrecht, The Netherlands
- Department of Translational Neuroscience, UMC Utrecht Brain Center, Utrecht, The Netherlands
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Kombade SP, Kaur N, Patro SK, Nag VL. Clinico-bacteriological and antibiotic drug resistance profile of chronic suppurative otitis media at a tertiary care hospital in Western Rajasthan. J Family Med Prim Care 2021; 10:2572-2579. [PMID: 34568138 PMCID: PMC8415651 DOI: 10.4103/jfmpc.jfmpc_2480_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/21/2021] [Accepted: 04/09/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Chronic suppurative otitis media (CSOM) is a major cause of hearing disability and morbidity in poor socioeconomic developing countries with prevalence of 4%. Indiscriminate use of antibiotics and poor follow up of patients has resulted in treatment failure, emergence of resistant strains, super infection, intra-cranial and extra-cranial complications in CSOM patients. Staphylococcus aureus, P. aeruginosa, Proteus spp. and Klebsiella spp. are most common organisms causing infection. Knowledge of microbial profile and susceptibility pattern is essential for efficacious treatment of this disorder. OBJECTIVE To determine the clinico-bacteriological profile of CSOM, to analyze the susceptibility pattern of various antibiotics and to evaluate the in vitro efficacy of aminoglycosides over fluoroquinolones against the aerobic bacterial isolates from CSOM. METHODS We studied 153 clinically suspected CSOM cases from March 2018 to October 2018 in Microbiology and Otorhinolaryngology department. The ear swabs were aerobically cultured and identification of the isolate was done by standard bacteriological methods. RESULTS Safe type CSOM was a major cause of disease. Moderate (35.3%) and mild degree (32.7%) of hearing loss was seen in most of the CSOM cases. The culture positivity rate was 82.4% and the most common isolate was P. aeruginosa (55.8%) followed by S. aureus (27.5%). P. aeruginosa, A. baumannii and Enterobacteriaceae spp. showed high sensitivity to colistin, piperacillin-tazobactam, ceftazidime-tazobactam and good sensitivity for cefepime and amikacin; 33.3% S. aureus isolates were Methicillin-resistant which was sensitive to gentamicin, vancomycin and linezolid. CONCLUSION Knowledge of the spectrum of microorganisms causing ear discharge is important for effective treatment.
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Affiliation(s)
| | - Navneet Kaur
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sourabha Kumar Patro
- Department of Otorhinolaryngology, Post Graduate Institute of Medical Sciences, Chandigarh, India
| | - Vijaya Lakshmi Nag
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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