A Cotton Wick Improves Hearing in a Patient with Profound Hearing Loss

Background: A clinical condition known as chronic otitis media (COM) is characterized by tympanic membrane perforation, varying degrees of hearing loss, and otorrhea that lasts for two to six weeks. COM alone or with cholesteatoma may result in ossicular chain discontinuity and ossicular erosion. The hearing restoration procedure includes repairing the eardrum and building the ossicular chain in ears with damaged ossicles. Multiple studies suggest the predictive value of preoperative air-bone gap (ABG) to detect the ossicular chain status can help with proper preoperative planning for surgery.Objective: To determine the degree of hearing improvement and reduction in ABG after tympanoplasty and to investigate the correlation between preoperative ABG and the status of the ossicular chain during surgery.Study design, setting, and date: This retrospective hospital file-based study was conducted at Aseer Central Hospital, Southern Region, Saudi Arabia, between November 2022 and April 2023. Hospital records of patients who underwent tympanoplasty during 2018-2023 were reviewed. Eighty-five patients were diagnosed with chronic suppurative otitis media (CSOM) between 2018 and 2023. A data collection sheet was employed to record extracted data, including the patient’s age, sex, hearing assessment, type of surgical intervention, and outcome. We calculated the average of ABG decibels (dB) by summing the ABG values at 500 Hz, 1000 Hz, and 2000 Hz frequencies and dividing by three.Results: In the present study, data from 85 patients who underwent tympanoplasty were analyzed. Approximately one-third of the patients were in the age group of 31 to 40 years (25, 29.4%), and 50 (58.8%) of them were females. Chronic medical conditions were observed in 30 (35.3%) patients, with diabetes being reported in 19 (63.3%) of those cases. CSOM was found to be present in the left ear of 47 (56.0%) patients. Among the patients, 25 (29.4%) had subtotal perforations, 12 (14.1%) had marginal perforations, and two (2.4%) had total tympanic membrane perforations. The majority of patients (67, 78.8%) exhibited conductive hearing loss, while the remaining 18 (21.2%) had mixed hearing loss. Of the patients, 13 (15.3%) and 20 (23.5%) had fixed and disrupted ossicular chains, respectively. In terms of ossicular disruption, incudostapedial joint (ISJ) fixing (21.2%), fixed stapes (18.2%), and ISJ dislocation (18.2%) were the most prevalent kinds. Prior to operations, the mean ± SD of ABG was 22.6 ± 7.5. ABG values were 19.0 ± 9.3 on average after surgery. The statistical difference between pre- and postoperative ABG was statistically significant (paired t-test, p = 0.007), with a mean difference of -3.7. There were no significant differences between the different statuses of ossicular chains and the type of tympanic membrane perforation.Conclusion: This study suggests that the degree of preoperative ABG (dB) is a valuable predictor of intraoperative ossicular chain status and can aid in preoperative planning for ossicular chain reconstruction. Furthermore, the study found that the type of tympanic membrane perforation preoperatively is not a reliable indicator of the ossicular chain status. Finally, tympanoplasty is considered a beneficial surgical procedure with a significant improvement in hearing status postoperatively.

On the basis of strong research, universal newborn screening should be performed before age 1 month with repeat or follow-up testing for those who do not pass performed before age 3 months and intervention started before age 6 months. On the basis of strong research and consensus statement, tympanostomy tubes should be considered for individuals with bilateral persistent middle ear effusion for 3 months or greater and a documented conductive hearing loss. On the basis of consensus statement, all children with suspected hearing loss should have an age appropriate hearing test. On the basis of strong research, the most common form of congenital hearing loss is genetic. Most of this is nonsyndromic hearing loss.

Chronic suppurative otitis media is one of the common otological conditions in India for which patients seek advice from an otorhinolaryngologist. Chronic suppurative otitis media is recurrent and progressive disease which is characterized with tympanic membrane perforation and suppurative discharge. Pure tone audiometry is the most common test used to evaluate auditory sensitivity. Since hearing loss is a common complication of chronic suppurative otitis media, we designed this study to evaluate preoperative pure tone audiometry findings in patients with chronic suppurative otitis media and its correlation with the intra-operative findings. <strong>Aims and Objectives:</strong> 1] To assess the intra-operative findings in patients with chronic suppurative otitis media. 2] To evaluate the correlation between the preoperative pure tone audiometry findings and intra-operative findings in patients with chronic suppurative otitis media. 3] To assess the type of hearing loss and degree of hearing loss in patients with chronic suppurative otitis media. <strong>Materials and Methods:</strong> This is an Observational study carried over a period of 3 years from August 2011 to August 2013. Total number of patients included in this study was 100. <strong>Result:</strong> Out of 100 patients studied 69 % of patients had Tubo-Tympanic type of CSOM, 31 % of patients had Attico-antral type of CSOM. In patients of Safe CSOM; Central perforation was seen in maximum cases 46.4 %, anterior central perforations was seen in 8.7 % cases, posterior central perforations seen in 20.2 % cases, and subtotal perforations seen in 24.63 % cases. In patients of Unsafe CSOM posterosuperior cholesteatoma was seen in maximum cases 67.74 %, and attic cholesteatoma was seen in 32.2 % cases. In safe CSOM patients all ossicles were intact and mobile whereas in unsafe CSOM patients only 4 patients had intact ossicular chain, while maximum patients had ossicular defect. <strong>Conclusion:</strong> Hearing loss depends on size of perforation. Hearing loss increases as the size of perforation increases. Average air conduction threshold and air bone gap did not differ significantly between various groups of ossicular defect. This shows us that neither air conduction nor air bone gap are reliable parameters on basis of which we can predict ossicular status preoperatively.

Chronic suppurative otitis media is one of the common otological conditions in India for which patients seek advice from an otorhinolaryngologist. Chronic suppurative otitis media is recurrent and progressive disease which is characterized with tympanic membrane perforation and suppurative discharge. Pure tone audiometry is the most common test used to evaluate auditory sensitivity. Since hearing loss is a common complication of chronic suppurative otitis media, we designed this study to evaluate preoperative pure tone audiometry findings in patients with chronic suppurative otitis media and its correlation with the intra-operative findings. Aims and Objectives: 1] To assess the intra-operative findings in patients with chronic suppurative otitis media. 2] To evaluate the correlation between the preoperative pure tone audiometry findings and intra-operative findings in patients with chronic suppurative otitis media. 3] To assess the type of hearing loss and degree of hearing loss in patients with chronic suppurative otitis media. Materials and Methods: This is an Observational study carried over a period of 3 years from August 2011 to August 2013. Total number of patients included in this study was 100. Result: Out of 100 patients studied 69 % of patients had Tubo-Tympanic type of CSOM, 31 % of patients had Attico-antral type of CSOM. In patients of Safe CSOM; Central perforation was seen in maximum cases 46.4 %, anterior central perforations was seen in 8.7 % cases, posterior central perforations seen in 20.2 % cases, and subtotal perforations seen in 24.63 % cases. In patients of Unsafe CSOM posterosuperior cholesteatoma was seen in maximum cases 67.74 %, and attic cholesteatoma was seen in 32.2 % cases. In safe CSOM patients all ossicles were intact and mobile whereas in unsafe CSOM patients only 4 patients had intact ossicular chain, while maximum patients had ossicular defect. Conclusion: Hearing loss depends on size of perforation. Hearing loss increases as the size of perforation increases. Average air conduction threshold and air bone gap did not differ significantly between various groups of ossicular defect. This shows us that neither air conduction nor air bone gap are reliable parameters on basis of which we can predict ossicular status preoperatively.

We are very uncertain whether or not treatment with aural toileting is effective in resolving ear discharge in people with CSOM, due to a lack of data and the poor quality of the available evidence. We also remain uncertain about other outcomes, including adverse events, as these were not well reported. Similarly, we are very uncertain whether daily suction clearance, followed by antibiotic ear drops administered at a clinic, is better than a single episode of suction clearance followed by self-administration of topical antibiotic ear drops.

Chronic Candida albicans otitis media in children with immunodeficiency.

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:

There was a limited amount of low-quality evidence available, from studies completed over 15 years ago, to examine whether topical or systemic antibiotics are more effective in achieving resolution of ear discharge for people with CSOM. However, amongst this uncertainty there is some evidence to suggest that the topical administration of antibiotics may be more effective than systemic administration of antibiotics in achieving resolution of ear discharge (dry ear). There is limited evidence available regarding different types of antibiotics. It is not possible to determine with any certainty whether or not topical quinolones are better or worse than systemic 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.

Surgical Management of Chronic Suppurative Otitis Media with Intracranial Complications

Treatment of CSOM with topical antibiotics (quinolones) probably results in an increase in resolution of ear discharge compared with boric acid at up to two weeks. There was limited evidence for the efficacy of other topical antibiotics or topical antiseptics and so we are unable to draw conclusions. Adverse events were not well reported.

The World Health Organization (WHO) estimated that worldwide, around 65-330 million people suffer from chronic otitis media, of which as high as 50 % suffer impairment in their hearing. Objectives: To determine the association between Sensorineural Hearing Loss (SNHL) in patients with chronic suppurative otitis media (CSOM) in terms of duration of CSOM and type of tympanic membrane perforation. Methods: This multicenter study was conducted at Hamdard University, Karachi, Fatima Jinnah Medical College, Lahore, and Loralai Medical College, Loralai, between March 2024 and February 2025, on patients diagnosed with active chronic otitis media. Patients with a history of meningitis, head trauma, tympano-mastoid surgery, congenital or acquired sudden hearing loss, or post-traumatic tympanic membrane perforation were excluded. Data were analyzed using SPSS version 23.0. Pearson correlation and one-way ANOVA were applied, with a p-value of less than 0.05 considered statistically significant. Results: Most patients were between 12 and 30 years of age. Mean duration of CSOM was 14.85 ± 9.1 months. The most common perforation of the tympanic membrane was marginal, in 204 (50.5%) patients. A significant moderate positive correlation was found between CSOM duration and SNHL (r=0.43, p=0.002). Patients with subtotal perforations (n=32) had the highest mean SNHL (37.1 ± 6.9 dB). The most frequent symptoms were ear discharge (88.1%) and hearing loss (94%). Conclusions: Both the duration of CSOM and the type of tympanic membrane perforation were significantly associated with sensorineural hearing loss. Prolonged disease, marginal perforations and subtotal perforations contributed to greater hearing loss, underscoring the need for early intervention.

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.

Compromised TLR-mediated chronic inflammation contributes to bacterial infection-caused chronic suppurative otitis media, but the mechanisms are unclear. The present study examined the expression status of nuclear erythroid 2-related factor 2 (Nrf2) and TLRs in human middle-ear mucosae tissues collected from patients with chronic suppurative otitis media, chronic otitis media and non-otitis media, and found that Nrf2 was high-expressed, whereas TLR4, instead of other TLRs, was low expressed in chronic suppurative otitis media compared to chronic otitis media and non-chronic otitis media groups. Consistently, inflammatory cytokines were significantly up-regulated in the chronic suppurative otitis media group, instead of the chronic otitis media and non-chronic otitis media groups. Next, LPS-induced acute otitis media and chronic suppurative otitis media models in mice were established, and high levels of inflammatory cytokines were sustained in the mucosae tissues of chronic suppurative otitis media mice compared to the non-otitis media and acute otitis media groups. Interestingly, continuous low-dose LPS stimulation promoted Nrf2 expression, but decreased TLR4 levels in chronic suppurative otitis media mice mucosae. In addition, knock-down of Nrf2 increased TLR4 expression levels in chronic suppurative otitis media mice, and both Nrf2 ablation and TLR4 overexpression inhibited the pro-inflammatory cytokine expression in chronic suppurative otitis media. Finally, we found that both Nrf2 overexpression and TLR4 deficiency promoted chronic inflammation in LPS-induced acute otitis media mice models. Taken together, knock-down of Nrf2 reversed chronic inflammation to attenuate chronic suppurative otitis media by up-regulating TLR4.

Introduction: Chronic suppurative otitis media is one of the most common conditions encountered by Otologists in daily practice. Conventionally hearing loss in CSOM is conductive in nature, but it has been observed that some patient displayed an additional sensorineural component to their conductive hearing loss (mixed hearing loss). Material and Methods: A prospective cohort observational study on 100 Cases in two groups of 50 each who had safe CSOM and 50 unsafe CSOM conducted over a period of July 2011 to September 2013 at the Department of Otorhinolaryngology, Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Centre (DPU), Pimpri, Pune. Detailed history, complete ENT examination was done. They were then subjected to Puretone audiometry; air and bone conduction thresholds were tested and plotted on the audiogram. Univariate and multivariate logistic regression (odds ratio) analyses were used. Results: Incidence of hearing loss is 72%for conductive type and 28% is of mixed type, in which 72% are of safe conductive, 18% safe mixed type and 64% are of unsafe conductive, 36% are in unsafe mixed type. Incidence of SNHL increases as age increases being maximum in age group of 41-50 years i.e. 37.50% and minimum in 11-20 years i.e. 5.71%. 14% cases of unsafe chronic suppurative otitis media were found to be associated with labyrinthine fistula. This proved to be the commonest cause of sensorineural component in unsafe chronic suppurative otitis media followed by granulation over oval window (8%) and cholesteatoma extending to round window in 4 % of cases. Conclusion: In the present study incidence of sensorineural hearing loss increased with advancing age, showing that age is a risk factor for sensorineural component of hearing loss in CSOM though conductive hearing loss is more common. CSOM is associated with mixed hearing loss mainly >35dB, higher frequencies were involved.

Chronic suppurative otitis media (CSOM), sometimes referred to as chronic otitis media (COM), 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. Topical antiseptics, one of the possible treatments for CSOM, inhibit the micro-organisms that may be responsible for the infection. Antiseptics can be used alone or in addition to other treatments for CSOM, such as antibiotics or ear cleaning (aural toileting). Antiseptics or their application can cause irritation of the skin of the outer ear, manifesting as discomfort, pain or itching. Some antiseptics (such as alcohol) may have the potential to be toxic to the inner ear (ototoxicity), with a possible increased risk of causing sensorineural hearing loss, dizziness or tinnitus. To assess the effects of topical antiseptics for people with chronic suppurative otitis media. The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Central Register of Controlled Trials (CENTRAL; 2019, Issue 4, 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. We included randomised controlled trials (RCTs) with at least a one-week follow-up involving patients (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 antiseptic agent of any class, applied directly into the ear canal as ear drops, powders or irrigations, or as part of an aural toileting procedure. Two main comparisons were topical antiseptics compared to: a) placebo or no intervention; and b) another topical antiseptic (e.g. topical antiseptic A versus topical antiseptic B). Within each comparison we separated studies where both groups of patients had received topical antiseptics a) alone or with aural toileting and b) on top of antibiotic treatment. 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. Five studies were included. It was not possible to calculate the total number of participants as two studies only provided the number of ears included in the study. A. Topical antiseptic (boric acid) versus placebo or no treatment (all patients had aural toileting) Three studies compared topical antiseptics with no treatment, with one study reporting results we could use (254 children; cluster-RCT). This compared the instillation of boric acid in alcohol drops versus no ear drops for one month (both arms used daily dry mopping). We made adjustments to the data to account for the intra-cluster correlation. The very low certainty of the evidence means it is uncertain whether or not treatment with an antiseptic leads to an increase in resolution of ear discharge at both four weeks (risk ratio (RR) 1.94, 95% confidence interval (CI) 1.20 to 3.16; 174 participants) and at three to four months (RR 1.73, 95% CI 1.21 to 2.47; 180 participants). This study narratively described no differences in suspected ototoxicity or hearing outcomes between the arms (very low-certainty evidence). None of the studies reported results for health-related quality of life, adverse effects or serious complications. B. Topical antiseptic A versus topical antiseptic B Two studies compared different antiseptics but only one (93 participants), comparing a single instillation of boric acid powder with daily acetic acid ear drops, provided any information for this comparison. The very low certainty of the evidence means that it is uncertain whether more patients had resolution of ear discharge with boric acid powder compared to acetic acid at four weeks (RR 2.61, 95% CI 1.51 to 4.53; 93 participants), or whether there was a difference between the arms with respect to ear discomfort due to the low number of reported events (RR 0.10, 95% CI 0.01 to 1.81; 93 participants). Narratively, the study reported no difference in hearing outcomes between the groups. None of the included studies reported any of the other primary or secondary outcomes. Due to paucity of the evidence and the very low certainty of that which is available the effectiveness and safety profile of antiseptics in the treatment of CSOM is uncertain.