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Rasheed AM. Does the Location of a Small Tympanic Membrane Perforation Affect the Degree of Hearing Loss in Adult Patients with Inactive Mucosal Chronic Suppurative Otitis Media? Int Tinnitus J 2024; 27:135-140. [PMID: 38507626 DOI: 10.5935/0946-5448.20230021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
BACKGROUND Tympanic membrane perforation due to inactive mucosal chronic suppurative otitis media is a common problem in otolaryngology, with consequent conductive hearing loss. Still, there is controversy about the relationship between the location of the tympanic membrane perforation and the degree of hearing impairment. AIM OF THE STUDY To assess the correlation between the location of a small tympanic membrane perforation and the degree of conductive hearing loss in adult patients with inactive mucosal chronic suppurative otitis media. PATIENTS AND METHODS A prospective cross-sectional study enrolled 74 adult patients with small tympanic membrane perforations (perforation involves less than one quadrant of the tympanic membrane) and conductive hearing loss (airbone gap ≥ 20 dB HL) due to inactive mucosal chronic suppurative otitis media for at least 3 months. The locations of the tympanic membrane perforations were classified as anterosuperior, anteroinferior, posterosuperior, and poster inferior perforations. Audiometric analysis and a CT scan of the temporal bone were done for all patients. The means of the air and bone conduction pure tone hearing threshold averages at frequencies 500, 1000, 2000, and 4000 Hz were calculated, and consequently, the air-bone gaps were calculated and presented as means. The ANOVA test was used to compare the means of the air-bone gaps, and the Scheffe test was used to determine if there were statistically significant differences regarding the degree of conductive hearing loss in relation to different locations of the tympanic membrane perforation. RESULTS The ages of the patients ranged from 20 to 43 years (mean = 31.9 ± 6.5 years), of whom 43 (58%) were females and 31 (42%) were males. The means of the air-bone gaps were 32.29 ± 5.41 dB HL, 31.34 ± 4.12 dB HL, 29.87 ± 3.48 dB HL, and 29.30 ± 4.60 dB HL in the posteroinferior, posterosuperior, anteroinferior, and anterosuperior perforations, respectively. Although the air-bone gap's mean was greater in the posteroinferior perforation, statistical analysis showed that it was insignificant (P-value=0.168). CONCLUSION In adult patients with inactive chronic suppurative otitis media, the anteroinferior quadrant is the most common location of the tympanic membrane perforation, and there was an insignificant correlation between the location of a small tympanic membrane perforation and the degree of conductive hearing loss.
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Affiliation(s)
- Ahmed Muhei Rasheed
- Department of Surgery-Otolaryngology, College of Medicine, University of Baghdad, Baghdad, Iraq
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Bharath J, Niti D, Chauhan S, Manoranjitha Kumari M, Sunitha VC, Nagarajan K. Fatal Infratentorial Subdural Empyema due to Chronic Suppurative Otitis Media and Mastoiditis in a Young Adult. Neurol India 2024; 72:182-185. [PMID: 38443032 DOI: 10.4103/neurol-india.neurol-india-d-23-00066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 03/16/2023] [Indexed: 03/07/2024]
Affiliation(s)
- Jayaraman Bharath
- Department of Radio-Diagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Dinesh Niti
- Department of Radio-Diagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Supriya Chauhan
- Department of Radio-Diagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Mani Manoranjitha Kumari
- Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Vellathussery C Sunitha
- Department of Radio-Diagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - K Nagarajan
- Department of Radio-Diagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
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Cao J, Yang Z, Liu W, Chen S, Qu G, Zhong C. Association of iron deficiency with chronic suppurative otitis media in adults. Acta Otolaryngol 2024; 144:19-22. [PMID: 38315117 DOI: 10.1080/00016489.2024.2310013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 01/17/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Chronic suppurative otitis media (CSOM) is a prevalent chronic inflammatory disease globally. Current research suggests a possible association between anaemia and the development of CSOM. OBJECTIVES The objective of this trial was to investigate the relationship between iron metabolism and chronic suppurative otitis media (CSOM) in adults aged 20-60 years. MATERIALS AND METHODS A consecutive sampling case-control study was used. The study participants were divided into a case group (42 children diagnosed with CSOM) and a control group (42 children with normal ears). Haemoglobin (Hb), Hematocrit (Hct), mean corpuscular volume of erythrocytes (MCV), serum iron level (SI), unsaturated iron-binding capacity (UIBC), total iron-binding capacity (TIBC), transferrin (TF), ferritin (Fer) were tested in all the participants, and the results were compared with the normal ranges of the World Health Organization (WHO). The comparative analysis of cases and controls was performed using the Fisher extract test, independence t-test, or Mann-Whitney U test. p-value <.05 was considered statistically significant for correlation. RESULTS There were 61 patients with CSOM and 61 controls included in the study. In the case group, 16 out of 61 patients (26.2%) had low ferritin levels and in the control group, 1 out of 61 patients (1.6%) had low ferritin levels (p < .001). In the case group, 6 (9.8%) of 61 patients had IDA, and in the control group, there were no patients with IDA among 61 patients (p = .027). There were significant differences in SI, UIBC, and Fer parameters between the groups. CONCLUSIONS In adult patients, the incidence of iron deficiency was higher in CSOM patients than in controls. Iron deficiency may be considered a potential risk factor for chronic suppurative otitis media, and serum iron parameters should be evaluated in these CSOM patients and further studies should be conducted to better understand the potential link between iron deficiency and CSOM.
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Affiliation(s)
- Jingwen Cao
- Otolaryngology-Head and Neck Surgery, The 940th Hospital Joint Logistics Support Force of the Chinese People's Liberation Army, Lanzhou, Gansu, China
- Ningxia Medical University, Ningxia, China
| | - Zixuan Yang
- Otolaryngology-Head and Neck Surgery, The 940th Hospital Joint Logistics Support Force of the Chinese People's Liberation Army, Lanzhou, Gansu, China
| | - Wei Liu
- Otolaryngology-Head and Neck Surgery, The 940th Hospital Joint Logistics Support Force of the Chinese People's Liberation Army, Lanzhou, Gansu, China
| | - Sijing Chen
- Otolaryngology-Head and Neck Surgery, The 940th Hospital Joint Logistics Support Force of the Chinese People's Liberation Army, Lanzhou, Gansu, China
| | - Gaoya Qu
- Otolaryngology-Head and Neck Surgery, The 940th Hospital Joint Logistics Support Force of the Chinese People's Liberation Army, Lanzhou, Gansu, China
| | - Cuiping Zhong
- Otolaryngology-Head and Neck Surgery, The 940th Hospital Joint Logistics Support Force of the Chinese People's Liberation Army, Lanzhou, Gansu, China
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Heward E, Saeed H, Bate S, Rajai A, Molloy J, Isba R, Ashcroft DM, Hay AD, Nichani JR, Bruce IA. Risk factors associated with the development of chronic suppurative otitis media in children: Systematic review and meta-analysis. Clin Otolaryngol 2024; 49:62-73. [PMID: 37794685 DOI: 10.1111/coa.14102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 08/08/2023] [Accepted: 09/21/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVES Chronic suppurative otitis media (CSOM) is defined as persistent discharge through a tympanic membrane perforation for greater than 2 weeks. It is associated with a significant disease burden, including hearing loss, and reducing its incidence could significantly improve short- and long-term health. We aimed to identify risk factors associated with the development of CSOM in children. DESIGN AND SETTING Systematic review and meta-analysis of studies set in community, primary and secondary care settings, identified from Medline, Embase and Cochrane databases from 2000 to 2022. PARTICIPANTS Children 16 years old and below. MAIN OUTCOME MEASURES Clinical diagnosis of CSOM. RESULTS In total, 739 papers were screened, with 12 deemed eligible for inclusion in the systematic review, of which, 10 were included in the meta-analysis. Risk factors examined included perinatal, patient, dietary, environmental and parental factors. Meta-analysis results indicate that atopy (RR = 1.18, 95% CI [1.01-1.37], p = .04, 2 studies); and birth weight <2500 g (RR = 1.79 [1.27-2.50], p < .01, 2 studies) are associated with an increased risk of CSOM development. Factors not associated were male sex (RR = 0.96 [0.82-1.13], p = .62, 8 studies); exposure to passive smoking (RR = 1.27 [0.81-2.01], p = .30, 3 studies); and parental history of otitis media (RR = 1.14 [0.59-2.20], p = .69, 2 studies). CONCLUSION Optimal management of risk factors associated with CSOM development will help reduce the burden of disease and prevent disease progression or recurrence. The current quality of evidence in the literature is variable and heterogeneous. Future studies should aim to use standardised classification systems to define risk factors to allow meta-analysis.
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Affiliation(s)
- Elliot Heward
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, School of Biological Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Research and Innovation, Manchester University NHS Foundation Trust, Manchester, UK
| | - Haroon Saeed
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, School of Biological Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Research and Innovation, Manchester University NHS Foundation Trust, Manchester, UK
| | - Sebastian Bate
- Manchester Academic Health Science Centre, Research and Innovation, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Population Health, Health Services Research, and Primary Care, Centre for Biostatistics, School of Health Sciences, University of Manchester, Manchester, UK
| | - Azita Rajai
- Manchester Academic Health Science Centre, Research and Innovation, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Population Health, Health Services Research, and Primary Care, Centre for Biostatistics, School of Health Sciences, University of Manchester, Manchester, UK
| | - John Molloy
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, School of Biological Sciences, University of Manchester, Manchester, UK
- Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Rachel Isba
- Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
- Lancaster Medical School, Lancaster University, Health Innovation One, Lancaster, UK
| | - Darren M Ashcroft
- Division of Pharmacy & Optometry, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre (PSTRC), University of Manchester, Manchester, UK
| | - Alastair D Hay
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Jaya R Nichani
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, School of Biological Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Research and Innovation, Manchester University NHS Foundation Trust, Manchester, UK
- Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Iain A Bruce
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, School of Biological Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Research and Innovation, Manchester University NHS Foundation Trust, Manchester, UK
- Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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Babajanian E, Nielson C, Zhang C, Shi K, Presson AP, Park AH. Tympanomastoidectomy versus parenteral antibiotic therapy for pediatric otorrhea. Am J Otolaryngol 2024; 45:104024. [PMID: 37647777 PMCID: PMC10841246 DOI: 10.1016/j.amjoto.2023.104024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 08/06/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE To evaluate the efficacy of tympanomastoidectomy versus parenteral antibiotic therapy for otorrhea as a result of chronic suppurative otitis media (CSOM) without cholesteatoma in the pediatric population. METHODS A retrospective review of 221 patients treated for otorrhea at a tertiary academic pediatric hospital was performed to evaluate the impact of tympanomastoidectomy versus parenteral antibiotic therapy on resolution of otorrhea. Inclusion criteria were age 0-18 years, prior treatment with otic and/or oral antibiotic, prior history of tympanostomy tube placement for recurrent otitis media, history of otorrhea, treatment with tympanomastoidectomy or parenteral antibiotic therapy, and follow-up of at least 1 month after intervention. Time to resolution was compared between the two modalities adjusting for age, bilateral ear disease status, and comorbidities using a Cox proportional hazard model. RESULTS Eighty-three ears from 58 children met the inclusion criteria. Ears that initially underwent tympanomastoidectomy had a significantly shorter time to resolution of symptoms (median time to resolution) 9 months (95 % confidence interval CI: 6.2-14.8) vs. 48.5 months (95 % lower CI 9.4, p = 0.006). On multivariate analysis, however, only bilateral ear disease status was independently associated with time to resolution of symptoms (hazard ratio 0.4, 95 % CI 0.2-0.9, p = 0.03). There was no statistically significant difference in the rate of treatment-related complications when comparing tympanomastoidectomy to parenteral antibiotic therapy (p = 0.37). CONCLUSION When adjusting for age, bilateral ear disease status, and comorbidities, there does not appear to be a significant difference in time to resolution of symptoms when comparing parenteral antibiotic therapy to tympanomastoidectomy. An informed discussion regarding risks and benefits of each approach should be employed when deciding on the next step in management for patients with CSOM who have failed more conservative therapies.
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Affiliation(s)
- Eric Babajanian
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, United States of America
| | - Christopher Nielson
- University of Utah School of Medicine, Salt Lake City, UT, United States of America
| | - Chong Zhang
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States of America
| | - Kevin Shi
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, United States of America
| | - Angela P Presson
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States of America
| | - Albert H Park
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, United States of America.
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Peñaranda D, García-Chabur MA, Pérez-Herrera LC, Moreno-López S, Otoya-Tono AM, García JM, Peñaranda A. Analysis of tinnitus severity and associated factors in patients with chronic otitis media in a low- to middle-income country. Int J Audiol 2023; 62:913-919. [PMID: 35792723 DOI: 10.1080/14992027.2022.2089926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 06/10/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This study aimed to describe the tinnitus severity in patients with chronic otitis media (COM) and describe the sociodemographic and clinical variables associated with tinnitus severity. DESIGN Cross-sectional study. Two otology-referral centers in Bogotá (Colombia) were included. Sociodemographic, clinical associated factors and quality of life questionnaires were applied. Otoscopic evaluation and audiometric data were collected. STUDY SAMPLE About 231 adults with COM. RESULTS Up to 51.5% of the patients reported severe tinnitus discomfort, 21.7% moderate discomfort, and 26.8% minor discomfort. Factor associated with increased tinnitus severity in patients with COM were older age (aOR: 1.02; 95% CI: 1.01-1.05), higher education (aOR: 2.24; 95% CI: 1.03-4.87), ear discharge during childhood (aOR: 1.88; 95% CI: 1.02-3.45), cholesteatoma in one ear (aOR: 2.26; 95% CI: 1.05-4.88), and pure-tone air average over 15 dB (aOR: 2.08; 95% CI: 1.28-3.36). Differences of 10-points in symptoms severity and 15-points in the total score of the "Chronic Suppurative Otitis Media Questionnaire-12" were found between the tinnitus severity groups. CONCLUSIONS Our results highlight the need for further research on the associated factors of tinnitus severity on COM patients. COM patients with higher tinnitus severity presented worse audiometric results and worse quality of life outcomes.
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Affiliation(s)
- Daniel Peñaranda
- Otolaryngology Department, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
- Otolaryngology and Allergy Research groups, Unidad Médico Quirúrgica de Otorrinolaringología (UNIMEQ-ORL), Bogotá, Colombia
| | - María A García-Chabur
- Otolaryngology Department, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
- Otolaryngology and Allergy Research groups, Unidad Médico Quirúrgica de Otorrinolaringología (UNIMEQ-ORL), Bogotá, Colombia
| | - Lucia C Pérez-Herrera
- Otolaryngology and Allergy Research groups, Unidad Médico Quirúrgica de Otorrinolaringología (UNIMEQ-ORL), Bogotá, Colombia
- School of medicine, Universidad de Los Andes, Bogotá, Colombia
| | - Sergio Moreno-López
- Otolaryngology and Allergy Research groups, Unidad Médico Quirúrgica de Otorrinolaringología (UNIMEQ-ORL), Bogotá, Colombia
- School of medicine, Universidad de Los Andes, Bogotá, Colombia
| | - Ana M Otoya-Tono
- Otolaryngology Department, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
- Otolaryngology and Allergy Research groups, Unidad Médico Quirúrgica de Otorrinolaringología (UNIMEQ-ORL), Bogotá, Colombia
| | - Juan M García
- Otolaryngology Department, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
- Otolaryngology and Allergy Research groups, Unidad Médico Quirúrgica de Otorrinolaringología (UNIMEQ-ORL), Bogotá, Colombia
- School of medicine, Universidad de Los Andes, Bogotá, Colombia
- Otolaryngology Department, Bogotá, Colombia
| | - Augusto Peñaranda
- Otolaryngology and Allergy Research groups, Unidad Médico Quirúrgica de Otorrinolaringología (UNIMEQ-ORL), Bogotá, Colombia
- School of medicine, Universidad de Los Andes, Bogotá, Colombia
- Otolaryngology Department, Bogotá, Colombia
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Kavya S, Arvinda HR, Veenakumari HB, PrabuRaj AR, Smitha NR, Jyothi D, Dwarakanath S, Nagarathna S. Pertinence of Streptococcus anginosus group in intracerebral abscesses in the era of extended antibiotic resistance. Indian J Med Microbiol 2023; 45:100395. [PMID: 37573041 DOI: 10.1016/j.ijmmb.2023.100395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 03/30/2023] [Accepted: 05/26/2023] [Indexed: 08/14/2023]
Abstract
AIMS • To study the incidence of Streptococcus anginosus group (SAG) in pyogenic or community acquired intra cerebral abscess. • To understand the risk factors for the same. • To analyze the specific radiological features and clinical outcome after surgery and antibiotic therapy. METHODS This is a retrospective observational study of case series over a period of one year. Patients diagnosed with intracerebral abscess were included in the study. Pus collected from were received in the laboratory and processed according to the standard protocols. Data regarding the clinical findings and demographics were collected from medical records. FINDINGS A total of 202 samples were studied. 103 were found to be pyogenic. SAG were isolated from 21 samples (20.38%) and all the isolates were sensitive to Penicillin. Age of the patients ranged from 18months to 68years. Male preponderance was noted with male to female ratio of 4:1. Otogenic infections were the most common predisposing factors and focus of infection could not be ascertained in 5 patients. All patients were treated with surgical intervention and antibiotics (Vancomycin, Amikacin and Metronidazole) for 6 weeks and recovery was remarkable. One patient succumbed to the illness. CONCLUSION SAG can be an aggressive pathogen with propensity for abscess formation. Chronic Suppurative Otitis Media (CSOM) is still a major cause of intracerebral abscess in developing country like India which is a benign and curable disease and should not be neglected. Injudicious use of antibiotics and negligence regarding the dose and duration of therapy from both patients and health care providers is the major cause for common infections to become more difficult to treat and succumbing to complications.
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Affiliation(s)
- S Kavya
- Department of Neuromicrobiology, NIMHANS, India
| | - H R Arvinda
- Department of Neuro Imaging and Interventional Radiology, NIMHANS, India
| | | | | | - N R Smitha
- Department of Neuromicrobiology, NIMHANS, India
| | | | | | - S Nagarathna
- Department of Neuromicrobiology, NIMHANS, India.
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Vâţă A, Irimie-Băluţă E, Roşu FM, Onofrei IM, Loghin II, Perţea M, Avădanei AN, Miron M, Rădulescu L, Eşanu I, Luca CM. Polymicrobial Bacterial Meningitis in a Patient with Chronic Suppurative Otitis Media: Case Report and Literature Review. Medicina (Kaunas) 2023; 59:1428. [PMID: 37629718 PMCID: PMC10456347 DOI: 10.3390/medicina59081428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023]
Abstract
Polymicrobial meningitis is a rare entity in the adult population, especially in the antibiotic era. However, disorders such as chronic suppurative otitis media (CSOM) or even poor oral hygiene are considered risk factors for the development of such cerebral infection. We report a case of polymicrobial meningitis associated with oto-mastoiditis in a 64-year-old female patient known to have CSOM. The patient presented atypical symptoms for community-acquired meningitis, showing subacute evolution of headache, without fever or neck stiffness. The aerobe microorganisms Streptococcus anginosus and Corynebacterium spp., sensitive to beta-lactamines, and the anaerobe Prevotella spp., resistant to penicillin and metronidazole, were isolated from CSF specimens, while Proteus mirabilis and Enterococcus faecalis were identified from the ear drainage. The diversity of pathogens identified in our case led us to the hypothesis of two different sources of meningitis: otogenic and/or odontogenic. Favorable evolution was obtained after a multi-disciplinary approach, combining surgery and broad-spectrum antibiotics. In addition, we performed a literature review that highlights the low incidence of polymicrobial mixed aerobe-anaerobe meningitis.
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Affiliation(s)
- Andrei Vâţă
- Department of Infectious Diseases, “Grigore T. Popa” University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (A.V.); (E.I.-B.); (I.M.O.); (C.M.L.)
- Clinic of Infectious Diseases, “Sf. Parascheva” Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania;
| | - Erika Irimie-Băluţă
- Department of Infectious Diseases, “Grigore T. Popa” University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (A.V.); (E.I.-B.); (I.M.O.); (C.M.L.)
| | - Florin Manuel Roşu
- Clinic of Infectious Diseases, “Sf. Parascheva” Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania;
- Department of Dento-Alveolar Surgery, Anesthesia, Sedation, and Medical-Surgical Emergencies, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ioana Maria Onofrei
- Department of Infectious Diseases, “Grigore T. Popa” University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (A.V.); (E.I.-B.); (I.M.O.); (C.M.L.)
- Clinic of Infectious Diseases, “Sf. Parascheva” Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania;
| | - Isabela Ioana Loghin
- Department of Infectious Diseases, “Grigore T. Popa” University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (A.V.); (E.I.-B.); (I.M.O.); (C.M.L.)
- Clinic of Infectious Diseases, “Sf. Parascheva” Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania;
| | - Mihaela Perţea
- Department of Surgery 1, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania;
| | | | - Mihnea Miron
- Intensive Care Department, “Sf. Spiridon” Emergency Hospital, 700115 Iasi, Romania;
| | - Luminiţa Rădulescu
- ENT Surgery Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Irina Eşanu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania;
| | - Cătălina Mihaela Luca
- Department of Infectious Diseases, “Grigore T. Popa” University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (A.V.); (E.I.-B.); (I.M.O.); (C.M.L.)
- Clinic of Infectious Diseases, “Sf. Parascheva” Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania;
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Shibamiya N, Yamauchi M, Kuratomi Y, Komune S. Cerebellar Abscess Induced by Cochlear Fistula due to Chronic Suppurative Otitis Media. ORL J Otorhinolaryngol Relat Spec 2023; 85:238-242. [PMID: 37423215 DOI: 10.1159/000531252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/16/2023] [Indexed: 07/11/2023]
Abstract
Cochlear fistulas with cholesteatoma as the primary disease have been reported frequently in the relevant literature. However, there are no reports of cochlear fistula without cholesteatoma due to chronic suppurative otitis media with intracranial complications. We report a case of cochlear fistula due to chronic otitis media that was diagnosed after the onset of a cerebellar abscess. The patient was a 25-year-old man with severe autism. He was admitted to our hospital with otorrhea from his left ear, emesis, and impaired consciousness. Computed tomography (CT) of the head showed left suppurative otitis media, left cerebellar abscess, and brainstem compression due to hydrocephalus. Right extra-ventricular drainage and brain abscess drainage were urgently performed. The next day, foramen magnum decompression and abscess drainage with partial resection of the swollen cerebellum were performed for decompression purposes. He was subsequently treated with antimicrobial therapy, but magnetic resonance imaging of the head showed an increase in the size of the cerebellar abscess. Re-examination of the temporal bone CT scans revealed a bony defect in the left cochlear promontory angle. We assumed that the cochlear fistula was responsible for the otogenic brain abscess. Thus, the patient underwent surgical closure of the cochlear fistula. After the operation, the cerebellar abscess lesion gradually shrank, and his general condition stabilized. Cochlear fistula should be considered in the management of patients with inflammatory middle ear disease associated with otogenic intracranial complications in the middle ear.
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Affiliation(s)
- Natsuko Shibamiya
- Department of Otolaryngology-Head and Neck Surgery, Saga University Faculty of Medicine, Saga, Japan
| | - Moriyasu Yamauchi
- Department of Otolaryngology-Head and Neck Surgery, Saga University Faculty of Medicine, Saga, Japan
| | - Yuichiro Kuratomi
- Department of Otolaryngology-Head and Neck Surgery, Saga University Faculty of Medicine, Saga, Japan
| | - Shizuo Komune
- Division of Otolaryngology-Head and Neck Surgery, Yuaikai Oda Hospital, Kashima, Japan
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10
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Mileshina NA, Kurbatova EV, Osipenkov SS, Dobryakova MM. [Acute purulent otitis media in children]. Vestn Otorinolaringol 2023; 88:38-41. [PMID: 38153891 DOI: 10.17116/otorino20238806138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
OBJECTIVE Improving the effectiveness of inpatient care for children with acute purulent otitis media. MATERIAL AND METHODS 100 children at the age from 0 to 18 years were inspected from January to August 2021. The main diagnostic methods included otoscopy, pharyngoscopy, rhinoscopy. Bacteriological examination of the pus from the ear was done for all patients. RESULTS Acute purulent otitis media is a common cause of hospitalization in children aged 0 to 3 years. The main causative agents of the disease in toddlers are Staphylococcus aureus and pneumococcus (38%), in preschoolers and primary school children - pyogenic streptococcus and pneumococcus (30%), in high school students - Staphylococcus aureus.
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Affiliation(s)
- N A Mileshina
- Research Institute of Otorhinolaryngology, Moscow, Russia
- Russian Medical Academy of Continuous Professionel Education, Moscow, Russia
| | - E V Kurbatova
- Research Institute of Otorhinolaryngology, Moscow, Russia
| | - S S Osipenkov
- Research Institute of Otorhinolaryngology, Moscow, Russia
| | - M M Dobryakova
- Russian Medical Academy of Continuous Professionel Education, Moscow, Russia
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11
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Polunin MM, Zelikovich EI, Kulmakov SA, Amirbekov MA, Patrik YA. [Partial sequestration of the labyrinth in a child with chronic suppurative otitis media with cholesteatoma]. Vestn Otorinolaringol 2023; 88:69-72. [PMID: 37450394 DOI: 10.17116/otorino20228803169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
A clinical case of a 16-year-old child with chronic suppurative otitis media with cholesteatoma complicated by partial labyrinth sequestration is presented. The case describes is a rare disorder. Computed tomography of temporal bones consistent with intraoperative data was decisive in establishing the diagnosis and the surgery extent.
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Affiliation(s)
- M M Polunin
- Pirogov Russian National Research Medical University, Moscow, Russia
- Yu.E. Veltischev Research Clinical Institute of Pediatrics Pirogov Russian National Research Medical University, Moscow, Russia
| | - E I Zelikovich
- L.I. Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - S A Kulmakov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - M A Amirbekov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Ya A Patrik
- Pirogov Russian National Research Medical University, Moscow, Russia
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12
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Dvoryanchikov VV, Khamgushkeeva NN, Anikin IA, Nacharov PV, Knyazev AD, Mamedova AD. [Choristoma of the middle ear]. Vestn Otorinolaringol 2023; 88:73-77. [PMID: 37450395 DOI: 10.17116/otorino20228803173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Choristoma is one of the varieties of congenital developmental anomalies, where one or another normal tissue of the body is located in an atypical place for itself. The short literary review of choristoma of middle ear is presented in article. A rare clinical cases of salivary gland choristoma of the middle ear (5-year-old girl with left-sided conductive hearing loss of III degree) and glial choristoma of the mastoid (19-year-old man with signs of chronic suppurative otitis media of the right ear) are described.
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Affiliation(s)
- V V Dvoryanchikov
- Saint Petersburg ENT and Speech Research Institute, St. Petersburg, Russia
| | - N N Khamgushkeeva
- Saint Petersburg ENT and Speech Research Institute, St. Petersburg, Russia
| | - I A Anikin
- Saint Petersburg ENT and Speech Research Institute, St. Petersburg, Russia
| | - P V Nacharov
- Saint Petersburg ENT and Speech Research Institute, St. Petersburg, Russia
| | - A D Knyazev
- Saint Petersburg ENT and Speech Research Institute, St. Petersburg, Russia
| | - A D Mamedova
- Saint Petersburg ENT and Speech Research Institute, St. Petersburg, Russia
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Restuti RD, Sriyana AA, Priyono H, Saleh-Saleh RR, Airlangga TJ, Zizlavsky S, Suwento R, Yasin FH. Chronic suppurative otitis media and immunocompromised status in paediatric patients. Med J Malaysia 2022; 77:619-621. [PMID: 36169076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
INTRODUCTION The role of immunodeficiency in the development of chronic suppurative otitis media (CSOM), especially in paediatric populations, have yet to be fully elucidated. The purposesof this study is to investigate the association between immunocompromised status and CSOM among paediatric population in a tertiary hospital in Indonesia. MATERIALS AND METHODS A cross-sectional study was performed by retrieving medical records of paediatric patients, with and without CSOM (age 0-18 years), visiting otorhinolaryngology (ENT-HNS) outpatient clinic in a tertiary hospital in Indonesia (2018-2020). We collected data on comorbidities causing immunosuppression such as HIV status, tuberculosis, and cancer. RESULTS Among the 1018 included patients (50 immunocompromised children), HIV infection was the most common cause of immunodeficiency in the CSOM group (24 patients, 60%), and cancer in the non-CSOM group (10 patients, 100%). We found a significant association between immunocompromised hosts and CSOM (odds ratio 19.5 [95% confidence interval: 9.5-39.9], p<0.001). CONCLUSION Immunocompromised children with HIV, tuberculosis, or cancer may be more vulnerable to CSOM. Further research is required to explore the association between other immunocompromised conditions and CSOM in paediatric populations.
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Affiliation(s)
- R D Restuti
- Dr. Cipto Mangunkusumo General Hospital-Faculty of Medicine University of Indonesia, Ear Nose Throat Head and Neck Surgery Department, Jakarta, Indonesia.
| | - A A Sriyana
- Dr. Cipto Mangunkusumo General Hospital-Faculty of Medicine University of Indonesia, Ear Nose Throat Head and Neck Surgery Department, Jakarta, Indonesia
| | - H Priyono
- Dr. Cipto Mangunkusumo General Hospital-Faculty of Medicine University of Indonesia, Ear Nose Throat Head and Neck Surgery Department, Jakarta, Indonesia
| | - R R Saleh-Saleh
- Dr. Cipto Mangunkusumo General Hospital-Faculty of Medicine University of Indonesia, Ear Nose Throat Head and Neck Surgery Department, Jakarta, Indonesia
| | - T J Airlangga
- Dr. Cipto Mangunkusumo General Hospital-Faculty of Medicine University of Indonesia, Ear Nose Throat Head and Neck Surgery Department, Jakarta, Indonesia
| | - S Zizlavsky
- Dr. Cipto Mangunkusumo General Hospital-Faculty of Medicine University of Indonesia, Ear Nose Throat Head and Neck Surgery Department, Jakarta, Indonesia
| | - R Suwento
- Dr. Cipto Mangunkusumo General Hospital-Faculty of Medicine University of Indonesia, Ear Nose Throat Head and Neck Surgery Department, Jakarta, Indonesia
| | - F H Yasin
- Dr. Cipto Mangunkusumo General Hospital-Faculty of Medicine University of Indonesia, Ear Nose Throat Head and Neck Surgery Department, Jakarta, Indonesia
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Kryukov AI, Garov EV, Moseikina LA, Kurilenkov GV, Chugunova MA, Pryakhina MA, Saydulaev VA. [A case of hearing preservation during surgical treatment of distributed fistula labyrinth in a patient with chronic purulent means otitis and cholesteatoma]. Vestn Otorinolaringol 2022; 87:99-106. [PMID: 35818953 DOI: 10.17116/otorino20228703199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The article provides a brief overview of the epidemiology, diagnosis, clinical manifestations and surgical methods of treatment of labyrinthine fistulas (LF) in patients with chronic suppurative otitis media (CSOM) with cholesteatoma. The efficacy of various LF treatment techniques, their complications, and the principles of prevention of cochleovestibular disorders during surgical treatment are described. The prognostic criteria for the deterioration of bone conduction thresholds during LF surgery, which include a large LF size, the opening of the membranous labyrinth, and the extent of damage to the structures of the inner ear, are presented. A clinical case of surgical treatment of widespread LF in CSOM with cholesteatoma is presented, which proves the possibility of preserving the auditory and vestibular functions while observing the stages of sanitation, manipulations on the LF and obliteration of semicircular canals defects with auto tissues. Combined surgery of such a plan must certainly be accompanied by local instillation of solutions of hormonal preparations in case of a deficiency of perilymphatic fluid in the labyrinth and postoperative antibacterial and hormonal therapy.
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Affiliation(s)
- A I Kryukov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - E V Garov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - L A Moseikina
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - G V Kurilenkov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - M A Chugunova
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - M A Pryakhina
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - V A Saydulaev
- National medical reserch center of Otorhinolaryngology Moscow, Moscow, Russia
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15
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Krasnozhen VN, Andreeva IG, Mamleev RN, Damineva AR. [Rare observation of petrositis complicated by parapharyngeal abscess in an 8-year-old patient]. Vestn Otorinolaringol 2022; 87:107-112. [PMID: 36107190 DOI: 10.17116/otorino202287041107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
A clinical case of diagnosis and treatment of an 8-year-old patient with bilateral acute suppurative otitis media (ASOM) complicated by left mastoiditis and petrositis is presented. By itself, such a rare complication of ASOM as petrositis manifested itself not in the form of the classic Gradenigo triad, but as a parapharyngeal abscess (PPA), due to the destruction of the lower wall of the temporal bone pyramid. Complications arose as a result of contact and hematogenous pathways for the spread of the infection, which debuted in the middle ear cavities 1 month before the patient was admitted to the hospital. The combination of factors such as an aggressive pathogen, the anatomical structure of the middle ear, a decrease in the immune reactivity of the child's body, the spread of infection through the lower cells of the temporal bone pyramid and the lack of timely antibiotic therapy, led to destructive changes in the bony walls of the temporal bone and the spread of a purulent process to the temporal pyramid bones, and then to the parapharyngeal space. The destruction by inflammation of the lower wall of the pyramid of the temporal bone led to the development of PPA, and not meningoencephalitis, which could have fatal consequences.
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Affiliation(s)
- V N Krasnozhen
- Kazan State Medical Academy - Branch of the Russian Medical Academy for Continuous Professional Education, Kazan, Russia
| | - I G Andreeva
- Children's Republican Clinical Hospital of the Ministry of Health of the Republic of Tatarstan, Kazan, Russia
| | - R N Mamleev
- Kazan State Medical University, Kazan, Russia
| | - A R Damineva
- Children's Republican Clinical Hospital of the Ministry of Health of the Republic of Tatarstan, Kazan, Russia
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16
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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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17
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Mehboob S, Saleem DM, Mehjabeen , Mehboob M, Jahan N, Perveen S, Tariq Rafi SM, Anser H, Owais F. Hepatotoxicity induced by chronic suppurative otitis media in rats and effects of ceftazidime and amikacin on it. Pak J Pharm Sci 2021; 34:1243-1248. [PMID: 34602395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Chronic suppurative otitis media (CSOM) is the chronic inflammation with perforation of middle ear. If CSOM is not treated, it may cause secondary inflammation of liver with elevated liver enzymes and histological changes. Present study is aimed to observe the hepatotoxic effects due chronic suppurative otitis media (CSOM) in CSOM induced rats and alsoto observe the effects of ceftazidime and amikacin to attenuate hepatotoxicity due to CSOM. Liver enzyme tests and histological examinations were performed on rats divided into different groups as G1 (negative control), G2 (positive control), G3 ceftizidime (15mg/kgintraperitonelly) and G4 amikacin (15mg/kg). One-way ANOVA showed that liver enzymes were significantly increased (p=0.000 and F value 6.899) except gamma glutamic transferase in G2 (rats with CSOM without treatment) from G1 (negative control without CSOM) with histological damage of liver. These hepatotoxic effects were attenuated or recover with proper treatment with potent antibiotics (ceftazidime and amikacin). Therefore, study showed that chronic suppurative otitis media can induce hepatic toxicity including elevated liver enzymes level and inflammation, aggregation or infiltration in liver cells in rat model with reversible hepatic damage. If CSOM is treated with adult dose of ceftazidime or amikacin, it may attenuate the damage and prevent risk of liver damage.
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Affiliation(s)
- Shafaque Mehboob
- Department of Pharmaceutical Chemistry, Institute of Pharmaceutical sciences, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Darakhshan M Saleem
- Biomedical Engineering Department, Sir Syed University of Engineering & Technology, Karachi, Karachi, Pakistan
| | - - Mehjabeen
- Department of Pharmacology, Faculty of Pharmaceutical Sciences, Federal Urdu University of Arts, Science and Technology, Karachi, Pakistan
| | - Moona Mehboob
- Department of Pharmaceutical Chemistry, School of Pharmacy, Dow University of Health Science, Karachi, Pakistan
| | - Noor Jahan
- Department of Pharmacology, School of Pharmacy, Dow University of Health Science, Karachi, Pakistan
| | - Shaheen Perveen
- Department of Pharmaceutics, Institute of Pharmaceutical Sciences, Jinnah Sindh Medical University, Karachi, Pakistan
| | - S M Tariq Rafi
- Department of ENT, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Humaira Anser
- Department of Pharmacology, Institute of Pharmaceutical Sciences, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Farah Owais
- Department of Pharmacology, Faculty of Pharmaceutical Sciences, Federal Urdu University of Arts, Science and Technology, Karachi, Pakistan
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Chong LY, Head K, Webster KE, Dew J, Richmond P, Snelling T, Bhutta MF, Schilder AG, Burton MJ, Brennan-Jones CG. Systemic antibiotics for chronic suppurative otitis media. Cochrane Database Syst Rev 2021; 2:CD013052. [PMID: 35819801 PMCID: PMC8094871 DOI: 10.1002/14651858.cd013052.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Chronic suppurative otitis media (CSOM) is a chronic inflammation and infection of the middle ear and mastoid cavity, characterised by ear discharge (otorrhoea) through a perforated tympanic membrane. The predominant symptoms of CSOM are ear discharge and hearing loss. Systemic antibiotics are a commonly used treatment option for CSOM, which act to kill or inhibit the growth of micro-organisms that may be responsible for the infection. Antibiotics can be used alone or in addition to other treatments for CSOM. OBJECTIVES To assess the effects of systemic antibiotics for people with CSOM. SEARCH METHODS The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Central Register of Controlled Trials (CENTRAL via the Cochrane Register of Studies); Ovid MEDLINE; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 16 March 2020. SELECTION CRITERIA We included randomised controlled trials comparing systemic antibiotics (oral, injection) against placebo/no treatment or other systemic antibiotics with at least a one-week follow-up period, involving patients with chronic (at least two weeks) ear discharge of unknown cause or due to CSOM. Other treatments were allowed if both treatment and control arms also received it. DATA COLLECTION AND ANALYSIS We used the standard Cochrane methodological procedures. We used GRADE to assess the certainty of the evidence for each outcome. Our primary outcomes were: resolution of ear discharge or 'dry ear' (whether otoscopically confirmed or not, measured at between one week and up to two weeks, two weeks to up to four weeks, and after four weeks); health-related quality of life using a validated instrument; ear pain (otalgia) or discomfort or local irritation. Secondary outcomes included hearing, serious complications and ototoxicity measured in several ways. MAIN RESULTS We included 18 studies (2135 participants) with unclear or high risk of bias. 1. Systemic antibiotics versus no treatment/placebo It is very uncertain if there is a difference between systemic (intravenous) antibiotics and placebo in the resolution of ear discharge at between one and two weeks (risk ratio (RR) 8.47, 95% confidence interval (CI) 1.88 to 38.21; 33 participants; 1 study; very low-certainty evidence). The study did not report results for resolution of ear discharge after two weeks. Health-related quality of life was not reported. The evidence is very uncertain for hearing and serious (intracranial) complications. Ear pain and suspected ototoxicity were not reported. 2. Systemic antibiotics versus no treatment/placebo (both study arms received topical antibiotics) Six studies were included of which five presented useable data. There may be little or no difference in the resolution of ear discharge at between one to two weeks for oral ciprofloxacin compared to placebo or no treatment when ciprofloxacin ear drops were used in both intervention arms (RR 1.02, 95% CI 0.93 to 1.12; 390 participants; low-certainty evidence). No results after two weeks were reported. Health-related quality of life was not reported. The evidence is very uncertain for ear pain, serious complications and suspected ototoxicity. 3. Systemic antibiotics versus no treatment/placebo (both study arms received other background treatments) Two studies used topical antibiotics plus steroids as background treatment in both arms. It is very uncertain if there is a difference in resolution of ear discharge between metronidazole and placebo at four weeks (RR 0.91, 95% CI 0.51 to 1.65; 40 participants; 1 study; very low-certainty evidence). This study did not report other outcomes. It is also very uncertain if resolution of ear discharge at six weeks was improved with co-trimoxazole compared to placebo (RR 1.54, 95% CI 1.09 to 2.16; 98 participants; 1 study; very low-certainty evidence). Resolution of ear discharge was not reported at other time points. From the narrative report there was no evidence of a difference between groups for health-related quality of life, hearing or serious complications (very low-certainty evidence). One study (136 participants) used topical antiseptics as background treatment in both arms and found similar resolution of ear discharge between the amoxicillin and no treatment groups at three to four months (RR 1.03, 95% CI 0.75 to 1.41; 136 participants; 1 study; very low-certainty evidence). The narrative report indicated no evidence of differences in hearing or suspected ototoxicity (both very low-certainty evidence). No other outcomes were reported. 4. Different types of systemic antibiotics This is a summary of four comparisons, where different antibiotics were compared to each other. Eight studies compared different types of systemic antibiotics against each other: quinolones against beta-lactams (four studies), lincosamides against nitroimidazoles (one study) and comparisons of different types of beta-lactams (three studies). It was not possible to conclude if there was one class or type of systemic antibiotic that was better in terms of resolution of ear discharge. The studies did not report adverse events well. AUTHORS' CONCLUSIONS There was a limited amount of evidence available to examine whether systemic antibiotics are effective in achieving resolution of ear discharge for people with CSOM. When used alone (with or without aural toileting), we are very uncertain if systemic antibiotics are more effective than placebo or no treatment. When added to an effective intervention such as topical antibiotics, there seems to be little or no difference in resolution of ear discharge (low-certainty evidence). Data were only available for certain classes of antibiotics and it is very uncertain whether one class of systemic antibiotic may be more effective than another. Adverse effects of systemic antibiotics were poorly reported in the studies included. As we found very sparse evidence for their efficacy, the possibility of adverse events may detract from their use for CSOM.
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Affiliation(s)
- Lee-Yee Chong
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Karen Head
- Cochrane ENT, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Katie E Webster
- Cochrane ENT, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Jessica Dew
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Peter Richmond
- Division of Paediatrics, The University of Western Australia, Perth, Australia
| | - Tom Snelling
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
| | - Mahmood F Bhutta
- Department of Otolaryngology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Anne Gm Schilder
- evidENT, Ear Institute, University College London, London, UK
- National Institute of Health Research, University College London Hospitals Biomedical Research Centre, London, UK
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Parelkar K, Thorawade V, Marfatia H, Shere D. Endoscopic cartilage tympanoplasty: full thickness and partial thickness tragal graft. Braz J Otorhinolaryngol 2020; 86:308-314. [PMID: 30837190 PMCID: PMC9422511 DOI: 10.1016/j.bjorl.2018.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 11/22/2018] [Accepted: 12/11/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction Cartilage is the grafting material of choice for certain disorders of the middle ear. The indications for its routine use remain controversial due to the possible detrimental effect on post-operative hearing. Objective The present study was carried out to report a personal experience with “tragal cartilage shield” tympanoplasty to compare the results, in terms of graft uptake and hearing improvement, of endoscopic cartilage shield technique using either partial thickness or full thickness tragal cartilage for type 1 tympanoplasty and to highlight the tips for single-handed endoscopic ear surgery. Methods Fifty patients with safe chronic suppurative otitis media, assisted at out-patient department from February 2014 to September 2015 were selected. They were randomly allocated into two groups, 25 patients were included in group A where a full thickness tragal cartilage was used and 25 patients included in group B where a partial thickness tragal cartilage was used. Audiometry was performed 2 months after the surgery in all cases and the patients were followed for one year. Results Out of the total of 50 patients 39 (78%) had a successful graft take up, amongst these 22 belonged to group A and 17 belonged to the group B. The hearing improvement was similar in both groups. Conclusion This study reveals that endoscopic tragal cartilage shield tympanoplasty is a reliable technique; with a high degree of graft take and good hearing results, irrespective of the thickness. Furthermore, the tragal cartilage is easily accessible, adaptable, resistant to resorption and single-handed endoscopic ear surgery is minimally invasive, sutureless and provides a panoramic view of the middle ear.
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Affiliation(s)
- Kartik Parelkar
- Grant Government Medical College & Sir J.J. Hospitals, Mumbai, India.
| | - Vandana Thorawade
- Grant Government Medical College & Sir J.J. Hospitals, Mumbai, India
| | - Hetal Marfatia
- K.E.M. Hospital, Department of ENT, Parel, Mumbai, India
| | - Devika Shere
- Rajiv Gandhi Medical College & Chhatrapati Shivaji Maharaj Hospital, Kalwa, Thane, India
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20
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Abstract
BACKGROUND Chronic suppurative otitis media (CSOM), sometimes referred to as chronic otitis media (COM), is a chronic inflammation and often polymicrobial infection (involving more than one micro-organism) of the middle ear and mastoid cavity, characterised by ear discharge (otorrhoea) through a perforated tympanic membrane. The predominant symptoms of CSOM are ear discharge and hearing loss. Topical antibiotics, the most common treatment for CSOM, act to kill or inhibit the growth of micro-organisms that may be responsible for the infection. Antibiotics can be used alone or in addition to other treatments for CSOM, such as antiseptics or ear cleaning (aural toileting). OBJECTIVES To assess the effects of topical antibiotics (without steroids) for people with CSOM. SEARCH METHODS The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Central Register of Controlled Trials (CENTRAL via the Cochrane Register of Studies); Ovid MEDLINE; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 1 April 2019. SELECTION CRITERIA We included randomised controlled trials (RCTs) with at least a one-week follow-up involving participants (adults and children) who had chronic ear discharge of unknown cause or CSOM, where the ear discharge had continued for more than two weeks. The interventions were any single, or combination of, topical antibiotic agent(s) of any class, applied directly into the ear canal as ear drops, powders or irrigations, or as part of an aural toileting procedure. The two main comparisons were topical antibiotic compared to a) placebo or no intervention and b) another topical antibiotic (e.g. topical antibiotic A versus topical antibiotic B). Within each comparison we separated studies where both groups of participants had received topical antibiotic a) alone or with aural toileting and b) on top of background treatment (such as systemic antibiotics). DATA COLLECTION AND ANALYSIS We used the standard Cochrane methodological procedures. We used GRADE to assess the certainty of the evidence for each outcome. Our primary outcomes were: resolution of ear discharge or 'dry ear' (whether otoscopically confirmed or not), measured at between one week and up to two weeks, two weeks to up to four weeks and after four weeks; health-related quality of life using a validated instrument; ear pain (otalgia) or discomfort or local irritation. Secondary outcomes included hearing, serious complications and ototoxicity measured in several ways. MAIN RESULTS We included 17 studies with a total of 2198 participants. Twelve studies reported the sample size in terms of participants (not ears); these had a total of 1797 participants. The remaining five studies reported both the number of participants and ears, representing 401 participants, or 510 ears. A: Topical antibiotics versus placebo or no treatment (with aural toilet in both arms and no other background treatment) One small study compared a topical antibiotic (ciprofloxacin) with placebo (saline). All participants received aural toilet. Although ciprofloxacin was better than saline in terms of resolution of discharge at one to two weeks: 84% versus 12% (risk ratio (RR) 6.74, 95% confidence interval (CI) 1.82 to 24.99; 35 participants, very low-certainty evidence), the very low certainty of the evidence means that it is very uncertain whether or not one intervention is better or worse than the other. The study authors reported that "no medical side-effects and worsening of audiological measurements related to this topical medication were detected" (very low-certainty evidence). B: Topical antibiotics versus placebo or no treatment (with use of oral antibiotics in both arms) Four studies compared topical ciprofloxacin to no treatment (three studies; 190 participants) or topical ceftizoxime to no treatment (one study; 248 participants). In each study all participants received the same antibiotic systemically (oral ciprofloxacin, injected ceftizoxime). In at least one study all participants received aural toilet. Useable data were only available from the first three studies; ciprofloxacin was better than no treatment, resolution of discharge occurring in 88.2% versus 60% at one to two weeks (RR 1.47, 95% CI 1.20 to 1.80; 2 studies, 150 participants; low-certainty evidence). None of the studies reported ear pain or discomfort/local irritation. C: Comparisons of different topical antibiotics The certainty of evidence for all outcomes in these comparisons is very low. Quinolones versus aminoglycosides Seven studies compared an aminoglycoside (gentamicin, neomycin or tobramycin) with ciprofloxacin (734 participants) or ofloxacin (214 participants). Whilst resolution of discharge at one to two weeks was higher in the quinolones group the very low certainty of the evidence means that it is very uncertain whether or not one intervention is better or worse than the other (RR 1.95, 95% CI 0.88 to 4.29; 6 studies, 694 participants). One study measured ear pain and reported no difference between the groups. Quinolones versus aminoglycosides/polymyxin B combination ±gramicidin We identified three studies but data on our primary outcome were only available in one study. Comparing ciprofloxacin to a neomycin/polymyxin B/gramicidin combination, for an unknown treatment duration (likely four weeks), ciprofloxacin was better (RR 1.12, 95% CI 1.03 to 1.22, 186 participants). A "few" patients experienced local irritation upon the first instillation of topical treatment (numbers/groups not stated). Others Other studies examined topical gentamicin versus a trimethoprim/sulphacetamide/polymixin B combination (91 participants) and rifampicin versus chloramphenicol (160 participants). Limited data were available and the findings were very uncertain. AUTHORS' CONCLUSIONS We are uncertain about the effectiveness of topical antibiotics in improving resolution of ear discharge in patients with CSOM because of the limited amount of low-quality evidence available. However, amongst this uncertainty there is some evidence to suggest that the use of topical antibiotics may be effective when compared to placebo, or when used in addition to a systemic antibiotic. There is also uncertainty about the relative effectiveness of different types of antibiotics; it is not possible to determine with any certainty whether or not quinolones are better or worse than aminoglycosides. These two groups of compounds have different adverse effect profiles, but there is insufficient evidence from the included studies to make any comment about these. In general, adverse effects were poorly reported.
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Affiliation(s)
- Christopher G Brennan‐Jones
- Telethon Kids Institute, The University of Western Australia15 Hospital AvenuePerthWestern AustraliaAustralia6009
| | - Karen Head
- Nuffield Department of Surgical Sciences, University of OxfordCochrane ENTUK Cochrane Centre, Summertown Pavilion18 ‐ 24 Middle WayOxfordUK
| | - Lee‐Yee Chong
- Nuffield Department of Surgical Sciences, University of OxfordCochrane ENTUK Cochrane Centre, Summertown Pavilion18 ‐ 24 Middle WayOxfordUK
| | - Martin J Burton
- Cochrane UKSummertown Pavilion18 ‐ 24 Middle WayOxfordUKOX2 7LG
| | - Anne GM Schilder
- Faculty of Brain Sciences, University College LondonevidENT, Ear Institute330 Grays Inn RoadLondonUKWC1X 8DA
| | - Mahmood F Bhutta
- Brighton and Sussex University Hospitals NHS TrustDepartment of OtolaryngologyEastern RoadBrightonUKBN2 5BE
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Mohd Khairi MD, Shahrjerdi B, Ramiza RR, Normastura R. The association of allergy and chronic suppurative otitis media: A study in a tropical country. Med J Malaysia 2019; 74:205-208. [PMID: 31256174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Chronic suppurative otitis media (CSOM) usually begins as a spontaneous perforation of tympanic membrane due to an acute infection of the middle ear. This study was aimed to evaluate the association between allergy and CSOM. METHODS A case-control study was carried out among patients with CSOM (cases) and controls were those with no ear pathology. The presence of CSOM was made through a medical history and otoscopic examination. Allergen testing was done by the skin prick test. RESULTS In all 124 subjects were recruited in this study with equal number of the cases and controls. The commonest positive reaction in the skin prick test in both groups was to house dust mites. Among CSOM cases, half (50%) of them had an allergy to Blomia tropicalis and 48.4% to Dermatophagoides while in the control group, 27.4% to Dermatophagoides and 25.8% to B. tropicalis. There were significant associations between CSOM and allergy to B. tropicalis (p=0.005), Dermatophagoides (p=0.016) and Felis domesticus (p=0.040). The prevalence of allergy at 95% confidence interval (95%CI) in CSOM and control groups were demonstrated as 59.7% (95%CI: 47.5, 71.9) and 30.6 % (95%CI: 19.1, 42.1) respectively. There was a significant association between allergy and CSOM (p=0.001). CONCLUSION Indoor allergens are the most prevalent in our environment and therefore good control may difficult to achieve. The hypersensitivity states of the subject are likely to have a role in the pathogenesis of CSOM especially in the tropical countries where allergy occurs perennially.
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Affiliation(s)
- M D Mohd Khairi
- Universiti Sains Malaysia, School of Medical Sciences, Department of Otorhinolaryngology, Health Campus, Kota Bharu, Kelantan, Malaysia.
| | - B Shahrjerdi
- Universiti Sains Malaysia, School of Medical Sciences, Department of Otorhinolaryngology, Health Campus, Kota Bharu, Kelantan, Malaysia
| | - R R Ramiza
- Universiti Sains Malaysia, School of Medical Sciences, Department of Otorhinolaryngology, Health Campus, Kota Bharu, Kelantan, Malaysia
| | - R Normastura
- Universiti Sains Malaysia, School of Dental Sciences, Health Campus, Kota Bharu, Kelantan, Malaysia
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Abstract
Objectives: To assess the outcome of a myringoplasty procedure during a 5-year period at a tertiary teaching hospital in Abha, Kingdom of Saudi Arabia. Methods: All patients with chronic suppurative otitis media (CSOM) who underwent elective myringoplasty between August 2012 and February 2018 were included in the study. Patients were investigated preoperatively and postoperatively by pure tone audiometry (PTA). The patients’ demographic data were collected together with the surgical outcome. Postoperatively, patients were followed at the first week, at 6 weeks and then every 3 months, thereafter for one year. Results: A total of 67 myringoplasty procedures were performed during the period of study. There were 41 females and 26 males, and they had an age range of 16-60 years and a mean age of 32.37±12.95 years. Preoperative PTA indicated that 58 (86.6%) patients had a hearing gap >20 dB. However, after surgery, only 9 (13.4%) patients remained with hearing gaps >20 dB. The success rate of graft stability at the end of one year was 94% with significant difference p=0.0001. However, one patient of the 4 patients with failed graft stability demonstrated graft atrophy, and the remaining 3 developed graft infection. Conclusion: Myringoplasty remains a useful technique for the management of CSOM. However, it depends on the surgeon’s skills and expertise and on the site of perforation. The success rate of myringoplasty in this study was comparable with that of the quoted literature.
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Affiliation(s)
- Salmah M Alharbi
- Department of Otolaryngology, Head and Neck Surgery, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia. E-mail.
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Lin YJ, Wu XQ, Ma X, Lai RZ. [The investigation rate and influence factors of tinnitus with chronic suppurative otitis media]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2018; 32:579-583. [PMID: 29798139 DOI: 10.13201/j.issn.1001-1781.2018.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Indexed: 06/08/2023]
Abstract
Objective:To investigate the incidence of tinnitus and its influencing factors in patients with chronic suppurative otitis media, and to provide clinical data for the study of the pathogenesis of tinnitus.Method:The clinical data of 77 patients with chronic suppurative otitis media who underwent modified radical mastoidectomy and tympanoplasty were investigated. When tinnitus and otitis media happened in the same side,then the tinnitus is judged to be otitis media related. Patients were further divided into otitis media related tinnitus and the no tinnitus groups. The differences of tinnitus severity, sleep disturbance, migraine (migraine features), snoring and gastroesophageal reflux were compared between the two groups in tinnitus occurrence and classification.Result:The incidence of otitis media related tinnitus was 55.8%(43/77). Most of the tinnitus happened(33/43) later than the occurrence of otitis media for several years or even decades. There were 43 cases of tinnitus associated with otitis media, and 31 cases without tinnitus. Between the groups, significant differences were observed in migraine features, and the P value is 0.011, while no significant differences were noticed in the severity of hearing loss and sleep disorders, snoring, gastroesophageal reflux. Ranking of otitis media related tinnitus was positively related to the degree of hearing loss, especially the bone conduction threshold. With Spearman rank correlation test,P values of mean value(250Hz,500Hz,1kHz,2kHz,4kHz), middle frequency (1kHz, 2kHz)and high frequency (4kHz) of bone conduction threshold were 0.010,0.019 and 0.003, and the correlation coefficients were 0.391,0.356 and 0.443, respectively.Conclusion:The occurrence of tinnitus in patients with otitis media may not be consistent with the time of otitis media, and theoretically later than the occurrence of otitis media is more reasonable. Whether tinnitus occurs in patients with otitis media is not related to sleep disorders, the degree of air conduction and bone conduction hearing loss, but is related to migraine features. The severity of tinnitus associated with otitis media is associated with bone conduction hearing loss.
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Affiliation(s)
- Y J Lin
- Department of Otolaryngology, Peking University International Hospital, Beijing, 102206, China
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Singer AEA, Abdel-Naby Awad OG, El-Kader RMA, Mohamed AR. Risk factors of sensorineural hearing loss in patients with unilateral safe chronic suppurative otitis media. Am J Otolaryngol 2018; 39:88-93. [PMID: 29331307 DOI: 10.1016/j.amjoto.2018.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 01/01/2018] [Accepted: 01/03/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE Chronic suppurative otitis media (CSOM) is the major cause of hearing impairment, especially conductive hearing loss. Few patients also had sensorineural component, the sensorineural hearing loss (SNHL) in CSOM is controversial, especially for safe mucosal type. This study aims to assess the relationship between the frequency of SNHL development in patients with safe mucosal CSOM and its relation to patient's age, sex, duration of disease, size of perforation and different audiological findings. MATERIAL AND METHODS This is a prospective study conducted from June 2016 to June 2017 in a tertiary referral hospital. 200 patients with unilateral mucosal type of CSOM with normal contralateral ear were included in the study. The diseased ears were taken as study ears and normal ears as control ears in all patients. Detailed otologic history, clinical and audiometric findings were recorded and analyzed. Results were statistically compared in all patients for both study and control ears using different parameters. RESULTS Twenty patients had an average bone conduction threshold of all frequencies above 25dB, which implies SNHL (10%). The incidence of SNHL was statistically significant at higher speech frequencies. The incidence increased with the presence of Diabetes Mellitus, smoking, duration of disease, presence of active discharge and the increase in size of perforation. However, it is not age dependent and there was no difference between males and females. CONCLUSION Safe mucosal CSOM can cause SNHL with multiple predisposing factors.
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Affiliation(s)
| | | | | | - Ahmed Rabeh Mohamed
- Otolaryngology, Head and Neck Department, Police Academy Hospital, Cairo, Egypt
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Hunt L, Mulwafu W, Knott V, Ndamala CB, Naunje AW, Dewhurst S, Hall A, Mortimer K. Prevalence of paediatric chronic suppurative otitis media and hearing impairment in rural Malawi: A cross-sectional survey. PLoS One 2017; 12:e0188950. [PMID: 29267304 PMCID: PMC5739401 DOI: 10.1371/journal.pone.0188950] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 11/16/2017] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of World Health Organization-defined chronic suppurative otitis media (CSOM) and mild hearing impairment in a population representative sample of school-entry age children in rural Malawi. A secondary objective was to explore factors associated with CSOM in this population. METHODS We performed a community-based cross-sectional study of children aged 4-6 years in Chikhwawa District, Southern Malawi, utilising a village-level cluster design. Participants underwent a structured clinical assessment, including video-otoscopy and screening audiometry. Diagnoses were made remotely by two otolaryngologists who independently reviewed clinical data and images collected in the field. Hearing impairment was classified as failure to hear a pure tone of 25dB or greater at 1, 2 or 4kHz. RESULTS We recruited 281 children across 10 clusters. The prevalence estimates of CSOM, unilateral hearing impairment and bilateral hearing impairment were 5.4% (95%CI 2.2-8.6), 24.5% (95%CI 16.3-30.0), and 12.5% (95%CI 6.2-16.9) respectively. Middle ear disease was seen in 46.9% of children with hearing impairment. A trend towards increased risk of CSOM was observed with sleeping in a house with >2 other children. INTERPRETATION We found a high burden of middle ear disease and preventable hearing impairment in our sample of school-entry age children in rural Malawi. There are important public health implications of these findings as CSOM and hearing impairment can affect educational outcomes, and may impact subsequent development. The identification and management of middle ear disease and hearing impairment represent major unmet needs in this population.
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Affiliation(s)
- Luke Hunt
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Victoria Knott
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | | | - Andrew W. Naunje
- Malawi-Liverpool-Wellcome Trust Clinical Research Program, Blantyre, Malawi
| | - Sam Dewhurst
- University Hospitals Leicester NHS Foundation Trust, Leicester, United Kingdom
| | - Andrew Hall
- Independent Scholar, Sheffield, United Kingdom
| | - Kevin Mortimer
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Sarmento KMA, Sampaio ALL, Santos TGT, de Oliveira CACP. High-frequency conductive hearing loss as a diagnostic test for incomplete ossicular discontinuity in non-cholesteatomatous chronic suppurative otitis media. PLoS One 2017; 12:e0189997. [PMID: 29267386 PMCID: PMC5739461 DOI: 10.1371/journal.pone.0189997] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 12/06/2017] [Indexed: 11/19/2022] Open
Abstract
Chronic suppurative otitis media, with or without cholesteatoma, may lead to erosion of the ossicles and discontinuity of the ossicular chain. In incomplete ossicular discontinuity (IOD), partial erosion of the ossicles occurs, but some sound transmission is noted throughout the ossicular chain. High-frequency conductive hearing loss (HfCHL) has been considered a hallmark of incomplete ossicular discontinuity. This study aims to evaluate the use of HfCHL as a preoperative predictor of IOD in patients with non-cholesteatomatous chronic suppurative otitis media. The HfCHL test was defined as the preoperative air-bone gap (ABG) at 4 kHz minus the average of the ABG at 0.25 and 0.5 kHz. The test was applied in 328 patients before surgery and compared to intraoperative findings as the gold standard. At surgery, 201 (61.3%) patients had an intact ossicular chain, 44 (13.4%) had a complete ossicular discontinuity, and 83 (25.3%) exhibited an IOD. The best cutoff level was calculated as 10 dB. The HfCHL test to diagnose IOD had a sensitivity of 83% and a specificity of 92% with a post-test probability of 78% and a likelihood ratio of 10.2. We concluded that the HfCHL test is highly effective in predicting IOD in patients with non-cholesteatomatous chronic suppurative otitis media and that it should be used routinely as a screening test prior to surgery.
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Affiliation(s)
- Krishnamurti M. A. Sarmento
- Department of Otolaryngology, Brasilia Military Police Hospital, Brasilia, DF, Brazil
- Affiliated Center of the Fisch International Microsurgery Foundation (FIMF), Brasilia, DF, Brazil
- * E-mail:
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Ali Zaidi SS, Pasha HA, Suhail A, Qureshi TA. Frequency of Sensorineural hearing loss in chronic suppurative otitis media. J PAK MED ASSOC 2016; 66(Suppl 3):S42-S44. [PMID: 27895351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Chronic suppurative otitis media (CSOM) is defined as chronic otorrhea (i.e., lasting > 6-12 weeks) through a perforated tympanic membrane. It is generally associated with some degree of conductive hearing loss. However, recurrent ear infections due to perforated eardrum result in absorption of toxins and macromolecules into the cochlea leading to sensorineural hearing loss (SNHL). We planned to determine the frequency of sensorineural hearing loss in chronic suppurative otitis media. A descriptive cross-sectional study was conducted at Aga Kgan University Hospital, Karachi, from October 2013 to March 2014. Average threshold of speech frequencies was calculated via pure tone audiogram for both diseased and normal contralateral ear.A mean of >25db in diseased ear was labelled as positive case for SNHL. SNHL was reported in 64(52%) patients and the frequency was found to increase with increasing duration. Patients with CSOM should be counselled regarding the risk of developing SNHL if left untreated.
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Affiliation(s)
- Syed Sajjad Ali Zaidi
- Department of Otolaryngology, Head and Neck Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Hamdan Ahmed Pasha
- Department of Otolaryngology, Head and Neck Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Anwar Suhail
- Department of Otolaryngology, Head and Neck Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Talha Ahmed Qureshi
- Department of Otolaryngology, Head and Neck Surgery, Aga Khan University Hospital, Karachi, Pakistan
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Baike EV. [The comparative analysis of the clinical and morphological picture of the various forms of chronic suppurative otitis media]. Vestn Otorinolaringol 2016; 81:30-33. [PMID: 27213652 DOI: 10.17116/otorino201681230-33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We present the results of the surgical treatment of 300 patients presenting with chronic suppurative otitis media. The changes in the mucous membrane of the tympanic cavity were revealed in 61% of the patients with mesotympanitis while spreading cholesteatoma occurred in 48% of the cases of «dry» perforations. The cholesteatomic process was documented in 64% of the patients with epitympanitis, the remaining patients presented with the pyo-carious process. The efficiency of the surgical intervention on the «dry» ear of the patients with the tubotympanic form of chronic suppurative otitis media (CSOM) amounted to 91.4% compared with 85% in the case of the altered mucous membrane of the tympanic cavity, 85.5% and 92.9% in the patients with the pyo-carious and cholesteatomic forms of the tympano-antral lesions, respectively. Residual cholesteatomas were found in 7.8% of the patients suffering from epitympanitis during the three year follow-up period. It is concluded that the results of clinical and morphological observations taken together with intraoperative findings give reason to consider mesotympanitis to be a prognosticallyunfavourable form of chronic suppurative otitis media.
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Affiliation(s)
- E V Baike
- Chita State Medical Academy, Chita, Russia, 672090
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Tos M. Etiologic factors in secretory otitis. Adv Otorhinolaryngol 2015; 40:57-64. [PMID: 3389231 DOI: 10.1159/000415673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- M Tos
- ENT Department, Gentofte University Hospital, Hellerup, Denmark
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Krivopalov AA, Yanov YK, Astashchenko SV, Shcherbuk AY, Artyushkin SA, Vakhrushev SG, Piskunov IS, Piskunov VS, Tuzikov NA. [FEATURES OF OTOGENIC INTRACRANIAL COMPLICATIONS AT THE PRESENT STAGE]. Vestn Khir Im I I Grek 2015; 174:68-79. [PMID: 27066663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A retrospective analysis of treatment was made in 127 adult patients with acute and chronic otitis media complicated by suppurative-inflammatory pathology of the brain. Purulent meningitis was revealed in 52 (40.9%) of hospitalized patients. Meningoencephalitis was often diagnosed in the cases of acute otitis media (15.4%) and in cases of chronic otitis (22.7%). The otogenic brain abscess was detected in 13.5% of otitis media cases and it was noted to be twice frequent (33.3%) in cases of purulent otitis media. The patients 124 (97.6%) have been operated. An extended mastoidotomy and antromastoidotomy were performed in the acute purulent otitis media. An extended radical operation on the ear was applied in case of chronic otitis media. Performance of craniotomy and complete removal of the abscess using modern systems of neuronavigation showed a higher clinical efficacy as compared with transtemporal approach during sanitizing intervention on the ear including the opening and abscess drainage in surgery of otogenic abscesses of the brain.
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Wang J, Wang J. [Temporal bone CT digital on chronic suppurative otitis media with cholesteatoma navigation assessment]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2014; 28:1799-1800. [PMID: 25752120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Jang CH, Choi YH, Jeon ES, Yang HC, Cho YB. Extradural granulation complicated by chronic suppurative otitis media with cholesteatoma. In Vivo 2014; 28:651-655. [PMID: 24982237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Extrdural granulation or abscess is a possible complication of chronic suppurative otitis media (CSOM) with cholesteatoma. However, due to development of newer antibiotics and advances in bacteriology and imaging techniques, the incidence of extradural granulation or abscess has significantly decreased. The present study analyzed the clinical presentation, imaging findings, and surgical treatment of eight patients with CSOM with cholesteatoma extending to the cranial fossa. PATIENTS AND METHODS From 2000 to 2012, 1,010 patients were surgically treated for CSOM with cholesteatoma. Patients with extension to the cranial fossa were studied. Clinical presentation, imaging studies, operative findings, surgical treatment, and postoperative results were evaluated. RESULTS Twenty cases (1.9%) in a series of 1,010 patients with CSOM with cholesteatoma had bony destruction of the cranial fossa in the temporal bone computed tomography (cr). Of the 20 cases, eight (0.79%) were identified as extradural granulation by magnetic resonance imaging. One patient exhibited nodular enhancement, but it disappeared on preoperative antibiotic treatment. Surgical access for removal of cholesteatoma with extradural granulation was accomplished through canal wall-down tympanomastoidectomy. CONCLUSION CSOM with cholesteatoma can extend to either the middle or posterior cranial fossa. While CT is sufficient to reveal bony destruction of the cranial fossa, magnetic resonance imaging is required to differentiate and define intracranial extension of CSOM with cholesteatoma.
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Affiliation(s)
- Chul Ho Jang
- Department of Otolaryngology, Chonnam National University Medical School, Gwawngju, Republic of Korea
| | - Yong Ho Choi
- Department of Otolaryngology, Chonnam National University Medical School, Gwawngju, Republic of Korea
| | - Eun Sun Jeon
- Department of Otolaryngology, Chonnam National University Medical School, Gwawngju, Republic of Korea
| | - Hyung Chae Yang
- Department of Otolaryngology, Chonnam National University Medical School, Gwawngju, Republic of Korea
| | - Yong Beom Cho
- Department of Otolaryngology, Chonnam National University Medical School, Gwawngju, Republic of Korea
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Gupta M, Singh S, Singh H, Chauhan B. To study the role of antibiotic+steroid irrigation of the middle ear in active chronic otitis media with small perforation and pulsatile discharge. B-ENT 2014; 10:35-40. [PMID: 24765827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVE To evaluate the usefulness of antibiotic+steroid irrigation of the middle ear in patients with otitis media with small perforation and pulsatile discharge. METHOD A prospective, randomised, evaluator-blinded study was carried at a single tertiary care centre over eight years, looking at 100 patients with chronic suppurative otitis media involving small tympanic membrane perforations and pulsatile mucopurulent discharge. The patients were randomised and divided into two groups. In group A, the examination under microscope, with suction cleaning of the external canal, was followed by irrigation of the middle ear with antibiotic+steroid solution for up to one week, while group B was prescribed self-administration of the same drops with systemic antibiotics. The patients were followed up daily for 10 days to monitor otorrhoea relief and on a weekly basis subsequently to monitor the healing of the tympanic membrane. RESULTS Forty-nine patients in group A had a dry ear after 3-7 days of daily suction and the irrigation of middle ear with the antibiotic+steroid solution and 44 had a healed tympanic membrane after an average three months of follow-up. Five patients with dry ear but persistent perforation underwent tympanoplasty, while only one patient with a persistent ear discharge underwent mastoid exploration. In group B, eight patients on oral antibiotics and self-administration of the same drops had dry ear while 34 had dry ear after receiving intravenous antibiotics. Thirty perforations healed spontaneously and 12 required tympanoplasty. In 8 patients, the tympano-mastoid was explored and these patients had dry, hearing ears only after surgery. CONCLUSION Patients with chronic suppurative otitis media involving small perforations and pulsatile discharge can be managed conservatively with simple suction cleaning + middle ear irrigation with antibiotics + steroid drops.
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Orziev SK, Karabaev KÉ, Saatov TS. [The alteration of the parameters of lipid peroxidation and the antioxidative system in the children presenting with pyo-inflammatory diseases of the middle ear]. Vestn Otorinolaringol 2014:39-40. [PMID: 25246208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The objective of the present study was to determine the amount of products of lipid peroxidation (dienic conjugates and malonic dialdehydes) together with antioxidative enzymes (catalase and superoxide dismutase) in 47 children presenting with acute pyo-inflammatory otitis media (APIOM) and 125 patients with chronic suppurative mesotympanitis (CSMT). In addition, 49 children presenting with chronic suppurative epitympanitis (CSET) and chronic suppurative epimesotympanitis (CSEMT) were included in the study. The data obtained were analysed and compared with the similar characteristics of 28 healthy children of the same age comprising the control group. The age of the children in different groups varied between 2 and 14 years. The study revealed the increase in the amount of lipid peroxidation products in all the groups with the simultaneous reduction of the activity of antioxidative enzymes; moreover, these values changed depending on the form and clinical course of the disease.
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Riffat F, Forer M, Wignall A, Veivers D, Patel N. Intracranial and internal jugular vein thrombosis secondary to ENT infections: a report of 3 cases. Ear Nose Throat J 2013; 92:E25. [PMID: 24170472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
We report 3 cases of rare, life-threatening intracranial and internal jugular vein (IJV) thrombosis that were caused by common ENT infections. These infections included otitis media in a 6-year-old girl, tonsillitis in a 21-year-old woman, and odontogenic sepsis in a 56-year-old woman. All 3 patients were treated with culture-directed systemic antibiotics; 2 of them also required surgical drainage (the child and the older adult). The 2 adults also received therapeutic anticoagulation, which was continued until venous recanalization was documented; the duration of combined antibiotic and anticoagulation treatment was 6 weeks. All 3 patients made uneventful recoveries. Significant morbidities associated with intracranial and IJV thrombosis were avoided as a result of prompt diagnosis and judicious treatment.
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Affiliation(s)
- Faruque Riffat
- Department of Surgery, Westmead Hospital, PO Box 533, Wentworthville 2145, NSW, Australia.
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Yu F. A novel technique for reconstruction of the posterior wall of the external auditory canal and tympanum using pedicled temporalis myofascia. Acta Otolaryngol 2013; 133:699-707. [PMID: 23441810 DOI: 10.3109/00016489.2013.767987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS The procedure cleared the lesion completely and preserved the physiological function of the external auditory canal. OBJECTIVE To develop a novel surgical procedure to treat chronic suppurative otitis media (CSOM). To explore the merit of using pedicled temporalis myofascia (PTM) and reconstruction of the posterior wall of the external auditory canal with pedicled postauricular periosteal flap and intact skin of the external auditory canal. METHODS Forty-seven patients with CSOM were chosen. Open radical mastoidectomy was used to complete clean-up lesions; the fascia of PTM was used to repair the tympanic membrane. The PTM, pedicled postauricular periosteal flap, and intact skin of the external auditory canal were used in the reconstruction of the posterior wall of the external auditory canal. All subjects were followed up for over 2 years. Hearing thresholds, including air conduction (AC), bone conduction (BC), and air-bone gap (ABG) before and after surgery, and after follow-up, were compared. RESULTS The healing rate of postoperated tympanic membrane was 95.74% and the 2-year healing rate of tympanic membrane perforation was 95.65%. The 46 ears included in the 2-year follow-up showed significant improvement between preoperative and postoperative AC and ABG values.
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Affiliation(s)
- Feng Yu
- Department of Otorhinolaryngology, Guangzhou Ear Nose Throat Neck Surgery Hospital, Guangzhou, China.
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Yorgancilar E, Akkus Z, Gun R, Yildirim M, Bakir S, Kinis V, Meric F, Topcu I. Temporal bone erosion in patients with chronic suppurative otitis media. B-ENT 2013; 9:17-22. [PMID: 23641586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
OBJECTIVES To analyse temporal bone erosion sites (including scutum, labyrinth, facial canal, mastoid tegmen, posterior fossa dural plate and sigmoid sinus plate) in patients with chronic suppurative otitis media (CSOM). METHODOLOGY Retrospective case review in a tertiary referral centre. Medical records were reviewed from 905 patients (121 complicated; 784 non-complicated) who received a mastoidectomy as a minimum intervention for the treatment of CSOM. RESULTS All types of temporal bone erosion were found to be more frequent in patients with complicated CSOM. Erosion in the scutum, mastoid tegmen, posterior fossa dural plate and labyrinth was observed significantly more frequently in complicated-CSOM patients with a cholesteatoma. Granulation/polyp tissue invaded the sigmoid sinus and facial canal at a rate similar to cholesteatoma. CONCLUSIONS Our study demonstrates that bone erosion is more frequent in complicated-CSOM patients. Temporal bone erosion can be seen in both cholesteatomatous and non-cholesteatomatous CSOM patients. Granulation/polyp tissue was as important as cholesteatoma in the erosion of the facial canal and sigmoid sinus plate.
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Affiliation(s)
- E Yorgancilar
- Department of Otorhinolaryngology and Head and Neck Surgery, Dicle University School of Medicine, Diyarbakir, Turkey.
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Izvin AI, Kuznetsova NE, Siniakov AI. [Intracranial complication of acute purulent otitis media in a child presenting with the visceral form of toxocarosis]. Vestn Otorinolaringol 2013:69-70. [PMID: 23715495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Khorov OG, Plavskiĭ DM. [The results of primary tympanoplasty of extended tympanic defects in the patients presenting with chronic mesotympanitis]. Vestn Otorinolaringol 2013:54-57. [PMID: 23528466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The objective of the present study was to estimate the results of primary tympanoplasty of extended tympanic defects in the patients presenting with chronic mesotympanitis. The results of the surgical treatment of 68 patients with chronic suppurative otitis media (mesotympanitis) by primary tympanoplasty of extended tympanic defects. Tympanoplasty was performed with the use of a 0.2-0.3 mm cartilage plate from which a number of fragments mobile relative to one another were formed by an original method. Good clinical and anatomical results were obtained in 90.4% of the treated patients within 24 months after surgery. Moreover, the number of patients with socially adequate hearing increased up to 86.5% during the same period. The bone-air interval was reduced from 30 to 10 dB at all observation time-points.
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Chew YK, Cheong JP, Khir A, Brito-Mutunayagam S, Prepageran N. Complications of chronic suppurative otitis media: a left otogenic brain abscess and a right mastoid fistula. Ear Nose Throat J 2012; 91:428-430. [PMID: 23076851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Otogenic brain abscess and postauricular fistula are complications of chronic suppurative otitis media. We describe a rare case of bilateral chronic suppurative otitis media that caused a left temporal lobe abscess and a right mastoid fistula.
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Affiliation(s)
- Yok Kuan Chew
- Department of Otorhinolaryngology, Hospital Sultanah Aminah, 81000 Johor Bahru, Malaysia.
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Wang G, Yang W, Zhang Y. [Chronic suppurative otitis media induced subarachnoid hemorrhage: case analysis]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2012; 26:760-762. [PMID: 23213763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We present a case of subarachnoid hemorrhage induced by chronic suppurative otitis media and discuss the possible mechanism here. Chronic suppurative otitis media is a common suppurative inflammation of middle ear, which can cause sorts of extracranial and intracranial complications in the situation of lower resistance or higher virulence. However, the condition of subarachnoid haemorrhage caused by chronic suppurative otitis media is quite rare. According to this case and previously published articles, we consider that meningitis may be the main reason of subarachnoid hemorrhage induced by chronic suppurative otitis media.
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Yorgancılar E, Yildirim M, Gun R, Bakir S, Tekin R, Gocmez C, Meric F, Topcu I. Complications of chronic suppurative otitis media: a retrospective review. Eur Arch Otorhinolaryngol 2012; 270:69-76. [PMID: 22249835 DOI: 10.1007/s00405-012-1924-8] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 01/03/2012] [Indexed: 12/11/2022]
Abstract
The purpose of this study was to review our patients with complications of chronic suppurative otitis media (CSOM) and compare with literature. This retrospective study was performed over 10 years in our tertiary referral university hospital. During this period 4,630 patients with CSOM were admitted to the department and 906 patients underwent a surgery. From the records of the 4,630 patients, 121 patients (2.6%) with complications were identified. Of the 906 CSOM patients that underwent a surgery, 511 had cholesteatoma, and 395 had granulation and/or polyp tissue. Ninety-four of 511 (18.4%) patients with cholesteatoma and 27 of 395 (6.8%) patients with granulation and/or polyp tissue had a complication. Of the 121 complicated CSOM patients, 57 extracranial (47.1%) and 37 intracranial (30.6%). Multiple combined complications were occurred in 27 (22.3%) patients. The mastoid abscess was the commonest extracranial complication (28.3%); it was followed by labyrinthitis (9%), facial nerve paralysis (8.4%), and Bezold's abscess (1.3%). The most common intracranial complication was lateral sinus thrombophlebitis (19.5%), followed by perisigmoid sinus abscess (13.5%), meningitis (9%), brain abscess (6.5%), and extradural abscess (4.5%). Most frequent intraoperative finding of complicated CSOM patients was cholesteatoma, with the exception of patients with facial nerve paralysis. There was no mortality in any of our patients. The additional morbidities were recorded in 25 patients (20.6%). In this study, we emphasize the importance of an accurate and early diagnosis, followed by adequate surgical therapy and a multidisciplinary approach.
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Affiliation(s)
- E Yorgancılar
- Department of Otorhinolaryngology, Dicle University School of Medicine, Diyarbakir, 21280, Turkey.
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Schmitz J, West KP, Khatry SK, Wu L, Leclerq SC, Karna SL, Katz J, Sommer A, Pillion J. Vitamin A supplementation in preschool children and risk of hearing loss as adolescents and young adults in rural Nepal: randomised trial cohort follow-up study. BMJ 2012; 344:d7962. [PMID: 22234907 PMCID: PMC3254201 DOI: 10.1136/bmj.d7962] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine whether vitamin A supplementation administered in the preschool years can lower the risk of hearing loss in adolescence and adulthood. DESIGN Follow-up study of adolescents and young adults who, as preschool aged children in 1989, were enrolled into a cluster randomised, double blinded, placebo controlled trial of vitamin A supplementation. SETTING South central, rural Nepal. PARTICIPANTS 2378 adolescents and young adults aged 14 to 23, representing 51% of those who finished the original trial and 71% of those living in the study area in 2006. INTERVENTIONS Every four months for 16 months preschool children were visited at home, given an oral 200,000 IU dose of vitamin A (half dose at age 1-11 months, quarter dose at <1 month) or placebo and the parents were queried about any childhood illnesses in the previous week, including purulent discharge from the ears. MAIN OUTCOME MEASURES Prevalence of mild or worse hearing loss (≥ 30 dB) in the most affected ear and tympanometric measures of middle ear function (peak height, ear canal volume, and gradient). RESULTS During the original trial, the prevalence of middle ear infection during the preschool years did not differ between the supplement groups. By adolescence and early adulthood, a non-significant 17% reduction in hearing loss occurred among those who had periodically received vitamin A compared with placebo as preschool aged children (odds ratio 0.83, 95% confidence interval 0.62 to 1.12). Among participants with any ear discharge in early childhood, vitamin A supplementation was associated with a reduced risk of hearing loss, by 42% (0.58, 0.37 to 0.92) compared with controls, after adjusting the confidence interval for the design effect of the original trial. Abnormal tympanometric peak height of the middle ear system was less likely among participants supplemented with vitamin A in childhood. CONCLUSION In undernourished settings, periodic, high dose vitamin A supplementation may reduce the risk of hearing loss associated with purulent ear infections in early childhood.
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Affiliation(s)
- Jane Schmitz
- Institute for Global Health and Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
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Garov EV, Antonian RG, Sheremet AS, Garova EE. [The retrospective clinical study of labyrinthine fistula associated with chronic suppurative otitis media and their treatment]. Vestn Otorinolaringol 2012:20-26. [PMID: 23250520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The objective of the present retrospective study was to estimate the efficacy of various surgical techniques employed to treat the patients presenting with chronic suppurative otitis media (CSOM) and concomitant cholesteatoma complicated by labyrinthine fistula. The authors present an overview of the literature concerning diagnostics and results of the surgical treatment of labyrinthine fistula (LF) in the patients with CSOM and concomitant cholesteatoma. The original studies included 157 patients with this condition complicated by labyrinthine fistula. The latter was diagnosed based on the data from medical histories, subjective complaints of the patients, results of otomicroscopy, the presence of fistula symptom verified by the pressure test, results of audiological and vestibulometric studies, and computed tomography (CT) of the temporal bones. Late outcomes of the surgical treatment in the patients presenting with CSOM and concomitant cholesteatoma complicated by LF. All the patients underwent sanitation surgery on the middle ear and revision of the mastoidal portion of the cavity. In 48 of them, cholesteatoma matrix on the fistula in situ was preserved (group 1), in 56 ones the removal of the matrix was followed by plastic correction of labyrinthine fistula using various autogenous tissues (group 2), in 53 patients the cholesteatoma matrix was either removed or preserved with the subsequent sealing of the semicircular canal and selective laser destruction of the labyrinth (LDL) (group 3). 79% of the patients in group 1 had no complaints of dizziness during the postoperative period. There were 78.5% and 96.5% of the patients without such complaints in groups 2 and 3 respectively. The elevation of the hearing threshold following the surgical treatment was documented in 10 (6.4%) patients; it resulted in the deafness in 5 (3%) patients.
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Kochergin GA, Ianov IK, Isachenko VS. [One-step rhinootosurgery. Clinical, economic and social aspects]. Vestn Otorinolaringol 2012:13-15. [PMID: 23011360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The objective of this work was to estimate from the clinical, economic, and social standpoints the efficacy of medical aid provided to the patients with chronic suppurative otitis media (CSOM) and concomitant pathology of the nasal cavity by means of the one-step surgical intervention. The study included a total of 208 patients presenting with CSOM of whom 108 ones were treated by the traditional multistage method and the remaining 108 by simultaneous rhinootosurgery. The latter approach was shown to be much more efficacious in terms of clinical, economic, and social considerations.
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Khaĭmanova IV, Kosiakov SI. [The influence of chronic otitis media on the sensorineural component of hearing]. Vestn Otorinolaringol 2012:7-10. [PMID: 22951675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The objective of the present study was to estimate the influence of chronic suppurative otitis media (CSOM) on the sensorineural component of deafness in the patients presenting with unilateral otitis media. A total of 49 patients with this pathology were included in the study. The bone conduction thresholds at the affected side were measured at a frequency of 500, 1000, 2000, and 4000 Hz and compared with those in the unaffected ear. The loss of hearing was especially well-apparent in the examination at higher frequencies and significantly deteriorated with age. The study did not reveal a marked influence of duration of the disease on the development of the sensorineural component of deafness.
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Ageenko IV. [Transmeatal aerodynamical otoendoscopy for otitis media]. Vestn Otorinolaringol 2012:31-33. [PMID: 23250522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This study was designed to compare the efficacy of various methods of transmeatal aerodynamical otoendoscopy based on the examination of 60 patients presenting with acute suppurative otitis media (CSOM), chronic suppurative otitis media (CSOM), exudative and adhesive otitis media. Transmeatal aerodynamical otoendoscopy was performed with the use of otobarohydroendoscope. The results of the study demonstrate the advantages of the transmeatal aerodynamical otoendoscopic technique for the examination of the patients presenting with different clinical forms of otitis media.
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Kulakova LA, Triakina EG, Bodrova IV. [A case of successful surgical treatment of labyrinth fistula in the sole hearing ear]. Vestn Otorinolaringol 2012:71-72. [PMID: 22810645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The objective of this communication is to demonstrate success of the surgical intervention on the sole hearing ear in the presence of absolute indications for such treatment, viz. the presence of cholesteatoma and labyrinth fistula (LF). The sensorineural loss of hearing is a rather common serious complication of LF surgery in the patients with cholesteatoma. The present observation concerns a 41 year-old woman with the history of an episode of suppurative otitis media experienced in the childhood. After a period of prolonged remission, she suffered systemic dizziness despite the intact tympanic membranes. The patient was examined with the use of multispiral computed tomography (MSCT) that revealed serious lesions in the middle ear (labyrinth fistula). It made possible careful planning and performing sanation surgery on the middle ear including tympano- and mastoidoplasty. This treatment produced good morphological and functional result.
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Abstract
AIM Evaluation of clinical characteristics, bacteriology and hearing in paediatric patients with and without chronic suppurative otitis media (CSOM) in Luanda, Angola. METHODS Interview, clinical examination, ear-discharge culture, open air pure-tone audiometry and brainstem auditory-evoked potentials of 23 outpatients with CSOM and 23 controls in a paediatric hospital. RESULTS Of the CSOM vs. control children, 35% vs. 26% had running water, 70% vs. 70% electricity, 64% vs. 0% HIV (p<0.0001) and 36% vs. 0% tuberculosis in history (p=0.002). Ten (43%) children had bilateral CSOM. The major ear-discharge pathogens were Proteus spp. (44%) and Pseudomonas (22%). Hearing impairment of >25 dB was present in 52% of CSOM-affected ears and bilateral hearing loss in 7 (30%) CSOM children vs. zero control child (p=0.009). Only one hearing-impaired child's family had previously detected the handicap. CONCLUSION CSOM occurred in children with high co-morbidity. Persistent otorrhoea was usually caused by Proteus spp. or Pseudomonas, and often suggestive of either HIV or hearing impairment. In the developing countries, prompt diagnosis and treatment of CSOM would enhance the children's linguistic and academic development.
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Affiliation(s)
- Anni Taipale
- Department of Otorhinolaryngology, Helsinki University Central Hospital, Helsinki University, Medical Faculty, Helsinki, Finland.
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