Effect of eardrum perforation and chronic otitis media on the results of infrared tympanic thermometer in adults: A systematic review and meta-analysis

BACKGROUND

This study was conducted to determine whether tympanic membrane perforation or chronic otitis media affects the results of an infrared tympanic membrane thermometer in adults.

METHODS

A literature search was performed using PubMed, Embase, Cochrane Library, Web of Science, and Google Scholar.

RESULTS

Four nonrandomized studies were included in the analysis. The temperatures of the bilateral eardrums (one eardrum with normal condition [control group] and the other eardrum with perforation or chronic otitis media [experimental group]) were measured for the same subject in the studies. The mean and standard deviation of the bilateral tympanic membrane temperatures were used to calculate the mean difference (MD) with a corresponding 95% confidence interval (CI). The fixed-effect model was utilized based on the results of the heterogeneity measurement using the Chi2 test and I2 statistic. The results of a meta-analysis in the normal eardrum (control group) and perforated eardrum, chronic suppurative otitis media with tympanic membrane perforation, or chronic otitis media with cholesteatoma (experimental group) were 343 subjects (MD = 0.05; 95% CI = -0.00 to 0.11; P = .06). A meta-analysis of the normal eardrum (control group) and perforated eardrum or chronic suppurative otitis media with tympanic membrane perforation except for cholesteatoma (experimental group) found 296 subjects (MD = 0.05; 95% CI = -0.01 to 0.11; P = .10).

CONCLUSION

When the temperatures of the bilateral eardrums were measured using an infrared tympanic membrane thermometer, no difference was observed between the eardrum with perforation or chronic otitis media and the normal eardrum.

Current trends on subtotal petrosectomy with cochlear implantation in recalcitrant chronic middle ear disorders

Objective

To establish the safety and effectiveness of subtotal petrosectomy with cochlear implantation in patients affected by chronic middle ear disorders to refractory to previous surgical treatments.

Methods

A multicentre, retrospective study was conducted on patients affected by recalcitrant chronic middle ear disorders who underwent cochlear implantation in combination with subtotal petrosectomy. Patients' details were collected from databases of 11 Italian tertiary referral centres. Additionally, a review of the most updated literature was carried out.

Results

55 patients were included with a mean follow-up time of 44 months. Cholesteatoma was the most common middle ear recurrent pathology and 50.9% of patients had an open cavity. 80% of patients underwent a single stage surgery. One case of explantation for device failure was reported among the 7 patients with post-operative complications.

Conclusions

Subtotal petrosectomy with cochlear implantation is a benchmark for management of patients with recalcitrant chronic middle ear disorders. A single stage procedure is the most recommended strategy. Optimal follow-up is still debated. Further studies are required to investigate the role of this surgery in paediatric patients.

[Correlation between acoustic immittance and ETS in eustachian tube function test]

Objective:To investigate the correlation between acoustic immittance and eustachian tube score（ETS） in eustachian tube function test. Methods:124 ears eustachian tube function with tympanic tension perforation of 107 patients with chronic suppurative otitis media were measured by acoustic immittance positive pressure balance method and ETS. According to the positive pressure balance test results of acoustic immittance, the ear eustachian tube open pressure between 100 and 200 daPa is assigned 2, the ear with open pressure between 200 and 300 daPa is assigned 3, the ear with open pressure betwween 300 and 400 daPa is assigned 4, the ear open pressure is greater than 400 daPa but eustachian tube open after swallowing is assigned 5, and the ear which eustachian tube open pressure is greater than 400 daPa and cannot open after swallowing is assigned 6. Then compare the results. Results:In the acoustic immittance test, there was no ears whose eustachian tube opening pressure less than 100 daPa, 10 ears（8.1%） open pressure between 100 and 200 daPa, 16 ears（12.9%） open pressure between 200 and 300 daPa, 46 ears（37.1%） open pressure between 300 and 400 daPa, 19 ears（15.3%） whose eustachian tube don't open pressure at 400 daPa but open after swallowing, and the cumulative percentage of the above was 73.4%. There were 33 ears（26.6%） whose eustachian tubes not opening after receiving maximum pressure（400 daPa） and repeated swallowing. The score of acoustic immittance eustachian tube function test was significantly correlated with the scores of ETS, eustachian tube manometry（TMM） and subjective part of ETS（P<0.05）. The result of acoustic immittance was moderately negatively correlated with ETS（r=-0.439） and TMM（r=-0.425）, and weakly negatively correlated with subjective part of ETS（r=-0.249）. The scores of 2-5 points （the affected ears with open eustachian tube in all acoustic impedance test methods） were defined as the normal group, and the scores of 6 point were defined as the abnormal group. The results of acoustic immittance between the normal group and the abnormal group showed that there were significant differences with the subjective scores of ETS, TMM and ETS. The consistency compared the results of acoustic immittance eustachian tube test with the results of ETS was poor（kappa value was negative）, and the difference was statistically significant. Conclusion:The open pressure of acoustic immittance positive pressure balance method is a good predictor of the subjective scores of ETS, TMM and ETS. The smaller the open pressure is, the better the subjective scores of ETS, TMM and ETS may be. This two methods results are inconsistent and cannot be replaced. More consideration should be given to the middle ear. The open pressure, equilibrium pressure and the difference between them need to be paid attention to at the same time.

Microbiota Associated With Cholesteatoma Tissue in Chronic Suppurative Otitis Media

Otitis media (OM), defined as infection or inflammation of the middle ear (ME), remains a major public health problem worldwide. Cholesteatoma is a non-cancerous, cyst-like lesion in the ME that may be acquired due to chronic OM and cause disabling complications. Surgery is required for treatment, with high rates of recurrence. Current antibiotic treatments have been largely targeted to previous culturable bacteria, which may lead to antibiotic resistance or treatment failures. For this study, our goal was to determine the microbiota of cholesteatoma tissue in comparison with other ME tissues in patients with long-standing chronic OM. ME samples including cholesteatoma, granulation tissue, ME mucosa and discharge were collected from patients undergoing tympanomastoidectomy surgery for chronic OM. Bacteria were profiled by 16S rRNA gene sequencing in 103 ME samples from 53 patients. Respiratory viruses were also screened in 115 specimens from 45 patients. Differences in bacterial profiles (beta-diversity) and the relative abundances of individual taxa were observed between cholesteatoma and ME sample-types. Additionally, patient age was associated with differences in overall microbiota composition while numerous individual taxa were differentially abundant across age quartiles. No viruses were identified in screened ME samples. Biodiversity was moderately lower in cholesteatoma and ME discharge compared to ME mucosal tissues. We also present overall bacterial profiles of ME tissues by sample-type, age, cholesteatoma diagnosis and quinolone use, including prevalent bacterial taxa. Our findings will be useful for fine-tuning treatment protocols for cholesteatoma and chronic OM in settings with limited health care resources.

Postauricular swelling secondary to salmonella extradural abscess in a toddler: a near miss condition

Postauricular swelling is usually encountered in an emergency setting in otorhinolaryngology, resulting from complication of acute or chronic suppurative otitis media. Besides that, postauricular swelling may occur secondary to various other conditions including infectious disease, tumour, vascular malformation, granulomatous condition and even trauma. Children less than 2 years old are prone to fall and up to 10% sustain traumatic brain injury without any obvious signs of neurological deficit. We describe a rare case of a postauricular swelling in a toddler which turned out to be salmonella extradural abscess from an infected traumatic haematoma. The importance of high clinical suspicion especially in a child with a history of fall cannot be emphasised more because a missed brain abscess could lead to potentially life-threatening problems. We would like to highlight that meticulous history taking along with prompt assessment and intervention is prudent for a better prognosis and recovery.

Middle east tuberculosis in an immunocompromised patient: Case report and review of the literature

Tuberculosis is an airborne disease caused by Mycobacterium tuberculosis. In 15-20% cases of active disease extrapulmonary tuberculosis may occur, most commonly in the head and neck region. Tuberculous otitis media accounts for 0,1% of the total number of tuberculosis patients. This paper provides insight into current state of literature of tuberculous otitis media. It also includes the case of a 53-year-old patient with tuberculous otitis media. The patient had a liver transplantation and she showed an atypical manifestation of the disease including acute otitis media and coinfection with Achromobacter xylosoxidans. The paper describes in detail the methods of diagnosis and the infection treatment. Considering the polymorphic clinical presentation of tuberculous otitis media in cases with long lasting otorrhoea differential diagnosis should include an infection with Mycobacerium tuberculosis.

Cephalic Tetanus Presenting as Ptosis

A 7-year-old unimmunized boy developed cephalic tetanus following chronic suppurative otitis media. We wish to emphasize that possibility of cephalic tetanus should be considered in an unimmunized child presenting with ptosis.

[Retrospective study on the hearing improvement and postoperative perforation rates in 121 myringoplasty cases]

OBJECTIVE

Retrospectively analyzed the influences of preoperative acoustic immittance pressure balance tests and intraoperative wet ear findings in myringoplasty surgery results.

METHODS

One hundred and twenty-one chronic suppurative otitis media patients underwent myringoplasty surgeries were included and divided into functional group and non-functional group according to preoperative acoustic immittance pressure balance tests. Meanwhile, cases were divided into dry ear group and wet ear group according to intraoperative findings. Postoperative hearing improvement and perforation rate were compared between the two groups.

RESULTS

Functional group had 72 cases, including 58 dry ears and 14 wet ears. Non-functional group had 46 cases, including 19 dry ears and 27 wet ears. Postoperative hearing improvement rate in functional group was 85.5% (59/69), and 72.1% (31/43) in non-functional group (χ(2) = 2.230, P = 0.093). Perforation rate in functional group was 16.7% (12/72), significant higher when compared with 2.2% (1/46) in non-functional group (χ(2) = 4.626, P = 0.015). Postoperative hearing improvement rate in dry ear group was 85.3% (64/75), and 71.8% (28/39) in wet ear group (χ(2) = 2.213, P = 0.085) . Perforation rate in dry ear group was 12.8% (10/78), and 7.0% (3/43) in wet ear group (χ(2) = 0.472, P = 0.377).

CONCLUSIONS

Non-functional result of preoperative acoustic immittance pressure balance test had significant relationship with the intraoperative wet ear findings. It may result in lower postoperative hearing level, and lower perforation rate. Large sample studies should be carried out in future.

[Incidence of facial nerve dehiscence in mastoidectomy]

OBJECTIVE

To describe the incidence and location of the facial nerve dehiscence (FND) in chronic suppurative otitis media patients with and without cholesteatoma.

METHODS

360 patients (370 ears) who received canal wall down tympanomastoidectomy due to otitis media(145 ears without cholesteatoma and 225 ears with cholesteatoma) were analyzed retrospectively, in which the incidence and locations of FND was studied, and the relevance for FND, clinical features (age, disease duration, preoperative facial paralysis) and intraoperative findings (state of FND and lateral semicircular canal fistula), were analyzed.

RESULTS

The presence of FND was 31.6% of total surgical procedures and the locations of FND were the tympanic segment. The dehiscence was detected 28.4% (94/334) in adults, but 61.1% (22/36) in the patients 18 years and younger, the differences were statistical significance (P < 0.05). The dehiscence rate was 37.1% (104/280) and 14.4% (13/90) respectively, in the cases of disease duration more than and less than 5 years, with significant difference (P < 0.05). Facial nerve dehiscence was detected in 29 patients (20.0%) and 89(39.1%) in cases without and with cholesteatoma respectively (P < 0.05). Facial nerve prolapse over the oval window was 11.4% (42/370), with FND of 83.3% (35/42). The incidence of lateral semicircular canal fistula was 7.8% (29/370), with FND of 65.5% (19/29). The presence of preoperative facial paralysis with FND was 75.0% (18/24), and that without FND was 28.6% (99/346), the differences were statistical significance (P < 0.05).

CONCLUSIONS

The incidence of FND most commonly located at the tympanic segment. The facial nerves should be taken much care in mastoidectomy for patients with cholesteatoma, preoperative facial paralysis and lateral semicircular canal fistula, as well as long disease duration.

Pattern of geriatric otolaryngological diseases in Port Harcourt

BACKGROUND

There is an emerging population of senior citizens with improving standard of living and health facilities. The aim of this to document the pattern of Geriatric Otorhinolaryngological diseases in Port Harcourt.

PATIENTS AND METHOD

This is a ten-year retrospective review of patients aged 60 years and above seen between January 1994 and December 2003 at the ENT Surgery Department of the University of Port Harcourt Teaching Hospital.

RESULTS

Nine hundred and seventy two patients out of a total patient population of 20,600 were found to be 60 years and above. The geriatric population was thus 4.7% of our total patients. Otological disease predominated with 537 (55.2%), followed by Rhinological disease with 180 (18.5%) before Laryngological pathologies with 154 (16.4%). 65(6.7%) had unspecified diseases. CSOM was the commonest otological (25%) and Otorhinolaryngological (13.78%) problem, followed by Otomycosis Externa 94 (17.5%) and Cerumen Auris 82 (15.3%). Allergic Rhinitis was the commonest Rhinological pathology with 110 (58%) of Rhinological cases, while Chronic Pharyngitis topped the list of diseases of the throat with 62 (34.4%).

CONCLUSION

This report does not differ significantly from what is reported elsewhere. The only outstanding difference is the emergence of CSOM as the most common ear disease.

[Clinical analysis of chronic suppurative otitis media in adults and children]

OBJECTIVE

To explore the differences and common features between adults and children with chronic suppurative otitis media in the course of disease, clinical characteristics and operation.

METHOD

To compare and analyze the clinical information before the operation, the range of lesion and ossicular chain damage in adults group (85 cases) and children group (66 cases).

RESULT

The morbidity of complications in children group was higher than that in adults group,with few intracranial otogenic complications in children group. The granuloma in external acoustic meatus was common in children group. The range of lesion in children group fixed with granuloma and cholesteatoma was more extensive than that in adults group. The complications in children group were more than those in adults group.

CONCLUSION

There are more complications and more extensive lesion in children patients than those in adults patients with chronic suppurative otitis media. The operation of clearing lesion and retaining or reconstructing hearing are regarded as the first choice in the children patients.