Acute Otitis Research Articles

MEGACÓLON PSICOGÊNICO EM PACIENTE PORTADOR DO TRANSTORNO DO ESPECTRO AUTISTA: UM RELATO DE CASO

Introduction: Psychogenic megacolon (PM) is a rare dysfunction usually found during childhood. This condition is characterized as an abnormal and irreversible dilation of the intestinal colon of psychogenic etiology, that is, such motility disorder is linked to some emotional disorder. A full understanding of this disorder is still a long way off due to its scarce description in the medical literature, however, authors such as Liu et al (2019) define it as a persistent dilation of the colon in the absence of any underlying organic or physiological causes, highlighting its diagnosis as purely eliminatory due to its symptomatic similarity with congenital megacolon (Hirschprung's disease). Objectives: The following case report aims at a retrospective and cross-sectional study, arising from the analysis of the patient's medical records, in order to lay scientific foundations for future research addressing the thematic axis of MP in conjunction with the development of new, more effective therapeutic proposals for the disease. Methods: The data provided in this study were obtained from the active collection of information from the patient's medical record, analyzed in line with others extracted from an interview with the person responsible, however, a literature review was carried out using data platforms as sources of good origin such as Scielo Platform, Google Scholar and PubMed. Results: The case describes a 3-year-old male patient, diagnosed with autism spectrum disorder (ASD) and with a history of previous hospitalizations related to urinary tract infection (UTI) and médium acute otitis (MAO). In the current history, the patient was admitted due to an acute infectious condition unrelated to MP, however, a distended and painless abdomen was found with increased peristalsis with decreased frequency of bowel movements and the presence of a large fecal cake. via ultrasound, with the diagnosis of megacolon, the clinic was related to the diagnosis of ASD and the patient's difficulty in adapting to the hospital environment, making the hypothesis of MP very likely. Conclusion: The report above describes a highly suggestive picture for MP, while this study seeks to raise the hypothesis of its correlation with ASD, while this neurodevelopmental disorder can influence the bowel habits of those patients historically included within the age group conducive to the manifestation of this disease.

Incidence and Characteristics of Pediatric Patients with Acute Otitis Hospitalized in a Romanian Infectious Diseases Hospital.

Otic involvement is common in children during acute infectious diseases, and is an important cause of morbidity and health service utilization. We performed a retrospective analysis of pediatric cases hospitalized in the largest infectious disease hospital in Romania between 2018 and 2023, with the aim of quantifying the incidence and impact of acute otitis (AO) according to pediatric age subgroups. A total of 1118 cases diagnosed with AO were eligible and included in the analysis. Acute congestive otitis media was the most common subtype, identified in 53.3% of cases, followed by acute purulent otitis media (APOM) in 26.7% of children. The majority of AO cases (69.9%) were diagnosed in the pre-pandemic period (2018-2019), and infants (10.6%), toddlers (49.4%), and preschoolers (29.2%) were the most affected age groups. A viral infection associated with the AO episode was documented in 49.6% of cases. Influenza viruses were most commonly reported (20.5%), followed by SARS-CoV-2 (5.8%), and adenovirus (4.9%). A total of 38 cases of AO were identified in children with measles. In 15.9% of APOM cases, Streptococcus pneumoniae was isolated by culture from otic secretions. The duration of hospitalization was longer in children with APOM and acute otitis externa compared to the other subtypes of AO (p < 0.001). Our study highlights the importance of ENT (ear, nose, and throat) monitoring in children hospitalized for acute infectious diseases, as the majority of AO cases occur in the context of a viral infection. These findings emphasize the necessity for tailored assessment and intervention in suspected cases of AO, especially in young children under 5 years of age.

Occurrence of acute otitis and sinusitis in patients hospitalized for influenza.

Acute otitis and sinusitis are common complications in patients with influenza and are responsible for increased hospitalization rates. A five-year retrospective study (2018-2023) was conducted including all patients hospitalized for influenza (etiologic diagnosis by RT-PCR) to identify the incidence and characteristics of cases complicated with otitis and/or sinusitis. Cases associated with other viral co-infections were excluded from the analysis. We identified a cumulative rate of 20.6% (324 cases) of acute otitis (AO) and acute sinusitis (AS) among patients with influenza. Of these, 62.3% had AO, 28.1% AS, and 9.6% concomitant AO and AS. Cases of AO were predominant in the pediatric population (97.0%), while cases of AS were more common in adults (56.1%). Influenza A viruses were identified in 67.2% of patients. The infection with influenza B viruses increased the risk of acute congestive otitis media 2.1-fold (p=0.020), and influenza A viruses increased the risk of acute maxillary sinusitis 2.7-fold (p=0.029). Late presentation to the hospital, with a median of 4 days from the onset of influenza symptoms, was identified as a factor in the occurrence of AO and AS. The risk of AO and AS is increased in patients with influenza, especially in the pediatric population and in late hospital presentations. These findings highlight the importance of proper monitoring and management of patients with influenza to prevent the development of complications, as well as the need to better understand the mechanisms whereby influenza viruses contribute to these secondary conditions.

Effects of Total Intravenous Versus Inhalational Anesthesia on Bleeding During Endoscopic Ear Surgery: Preliminary Results From a Case-Control Study.

To assess the impact of the type of maintenance anesthesia on the bleeding conditions of the surgical field and hemodynamic parameters during endoscopic ear surgery (EES), comparing totally intravenous inhalational anesthesia (TIVA) with inhalational anesthesia (IA). Retrospective case-control study. Tertiary referral center. Fifteen consecutive EES cases performed with TIVA between 2019 and 2020 at our Institution were matched to a control group of patients who underwent EES with IA in the same period. Patients with American Society of Anesthesiologists IV grade, acute otitis before surgery, congenital or acquired coagulopathies, use of anti-inflammatory drugs, or antiaggregant or anticoagulant therapy in the 5 days before the intervention were excluded. Both primary and revision tympanoplasty and stapes surgery were considered. Surgical videos were reviewed to quantify the entity of bleeding according to the Modena Bleeding Score. Hemodynamic parameters during surgery were retrospectively collected. A comparison between the two groups was performed. No statistically significant differences between the two groups in terms of bleeding were found at any of time point evaluated. The tympanomeatal flap elevation resulted in the bloodiest step in both groups. Hemodynamic parameters were similar in both groups ( p > 0.05). These preliminary data do not support a significant difference in bleeding conditions and hemodynamic parameters between EES patients receiving TIVA and those receiving IA. Further studies involving a higher number of patients will improve our understanding on how maintenance anesthesia with TIVA may be beneficial in terms of bleeding control as compared with IA for patients undergoing EES.

Transient deficiency of protein S after past infection process, complications and outcome: clinical case

Background. Purpura fulminans (PF) – is an acute rapidly progressive thrombosis of small-diameter blood vessels located mainly on the skin of the extremities. PF is characterized by high mortality rates. Patients can have serious consequences, including amputations and loss of fingers, foots or even extremities in general.Clinical case description. A clinical case of developing transient deficiency of protein S complicated by idiopathic PF on the 7th day after acute otitis in a 3-year-old boy due to past infection is presented. The progression of the disease developed within a few hours. The patient became hemorrhagic elements on the skin of extremities, and later — tissue necrosis. The conducted therapy facilitated to stop the pathological process in the form of PF, and also prevented the development of severe disabling complications in the child.Conclusion. Differential diagnosis and treatment should be fast and accurate, as the development of PF occurs in mere hours. Diagnostics should include expanded panel of coagulological tests and instrumental examinations, which determines the justifiability of a multidisciplinary approach in the patient management with disorders in the hemostatic system.

Safety of direct oral provocation test to delabel reported mild beta-lactam allergy in infants.

Around 10% of people report a drug allergy and avoid some medications because of fear of allergic reactions. However, only after a proper diagnostic workup can some of these reactions be confirmed as allergic or nonallergic hypersensitivities. Beta-lactams (BLs) are the most common medication suspected of being involved in drug hypersensivity reactions (DHRs) in children. Recently, direct oral provocation tests (DPT) with BLs gained popularity within pediatric populations as a tool for delabeling children with suspected BL allergies. This study aimed to evaluate the safety of direct provocation tests in infants with mild cutaneous non-immediate reactions to BLs. The authors retrospectively analyzed the data of 151 infants between 2015 and 2022, referred for evaluating a suspected allergy to BLs that occurred before age 24 months. The mean age of the children, including 55% male kids, at the suspected reaction was 15.9 months and the mean age at the time of the DPT was 39.6 months. In most cases, antibiotics were prescribed to treat common upper respiratory infections, such as acute otitis (54.3%) and acute tonsillitis (27.2%). Amoxicillin was considered the culprit drug in 62.9% of the cases, and the combination of amoxicillin-clavulanic acid in the case of 33.8% of children. The most frequent associated cutaneous clinical manifestations were maculopapular exanthema in 74.8% and delayed urticaria/angioedema in 25.2%. Of the 151 infants evaluated, parents of 149 infants agreed for a direct DPT, and only three had a positive test (2%). Symptoms resulting from the DPT were mild and easily treatable. A direct DPT without prior tests is a safe and effective procedure to delabel BL allergy, even in infants. The authors wish to emphasize the importance of properly validating BL allergy suspicions by promoting appropriate diagnostic procedures in infants as, in most cases, DHRs can be excluded and there is no need for further therapeutic restrictions.

Intestinal disorders after acute diarrhea in young children and their coprological predictors

Background. After acute diarrhea in young children, intestinal disturbances and even chronic functional intestinal diseases may occur. To date, no pathogenetically based criteria have been found that would indicate the probability of chronic intestinal disorders, just as the mechanisms of their occurrence after acute diarrhea have not been fully elucidated. The objective: to evaluate the frequency and nature of bowel disorders in children of the younger age group within 6 months after a stay in hospital for acute diarrhea and to establish their relationship with coprological indicators — fecal calprotectin (FCР), the content of carbohydrates (reducing substances, RS), lactic acid (LA) and short-chain fatty acids (SCFA) — acetic, propionic and fatty (butyric). Materials and methods. The study involved 47 children aged 6–24 months who were hospitalized for acute diarrhea. Acute enterocolitis (group I) was diagnosed in 18 patients and was caused by Campylobacter jejuni in 12 cases, Escherichia coli O-18 and Escherichia coli O-44 in 3, Salmonella enteritidis in 2 and Yersinia enterocolitica in one case. Rotaviral gastroenteritis (group II) was diagnosed in 11 patients. Another 11 children had acute symptomatic (parenteral) diarrhea (group III) against the background of intestinal infection — acute otitis, pneumonia, pyelonephritis. In 7 children, diarrhea was classified as functional digestive disorder (group IV). Routine clinical tests were supplemented with an examination of feces for the presence of intestinal parasites, Clostridium difficile A/B toxins, adenoviruses, human hemoglobin, RS, FCP, SCFA and LA. Results. Six-month follow-up established that 14 of 18 children in group I had permanent or temporary loose stools. These complaints in 13 cases were combined with episodes of abdominal pain similar to intestinal colic. The same complaints were much less frequent in children of group II (6 and 3 of 11, respectively), group III (4 and 2 of 11) and group IV (only in 2 of 7 children). The rank correlation analysis did not reveal any significant relationships between the intensity and duration of complaints and FCP, RS, LA, and SCFA in patients of groups I and II. On the contrary, in group III, there were multiple correlations of complaints with FCP, RS, LA, and SCFA. In group IV, the association of loose stools with an increase in LA and acetic acid has been found. Conclusions. According to the 6-month follow-up, 57 % of young children with acute diarrhea complained of loose stools and/or recurrent abdominal pain after discharge from the hospital. Most often, intestinal disorders were detected in children who had acute bacterial enterocolitis. There were no correlations between the intensity of post-infectious (bacterial or viral) disorders with FCP, RS, LA and SCFA during hospitalization. In contrast, such associations were numerous in children with symptomatic (parenteral) and functional diarrhea. It was suggested that the studied coprological parameters can be used to predict the state of the intestine after acute diarrhea.

CLL-069 Diagnosis and Management of Infectious Complications in Chronic Lymphocytic Leukemia

Chronic lymphocytic leukemia (CLL) is an actual issue of oncology due to the increase of morbidity, frequent and therapy-resistant relapses, the development of infectious complications, commonly leading to the unfavorable prognosis. The identification of diagnostic features and management outcomes of infectious complications in CLL. We realized the case-control study of 82 CLL patients, who were treated at the Institute of Oncology in Moldova between 2000-2021. The diagnosis was proved according to the IWCLL criteria based on the complete blood count with the detection of lymphocytosis ≥ 5×109/l, bone marrow aspiration with lymphocytic infiltration ≥30% and immunophenotyping. The study was related to the outpatient and hospitalized care. The study included CLL patients of 45-86 years old (median age 66.2 years). There were 47 men (57.3%) and 35 women (42.7%). According to the Binet Classification, 54 (65.9%) patients were placed in stage A and 28 (34.1%) in stage B. The overall survival (OS) estimated the long-term results. The study of the age structure revealed the predominance of patients of 60-79 years old. Twenty-two (40.8%) stage A patients experienced the CLL transformation into stage B. Transformation into stage C was observed in 10 (35.7%) patients. The respiratory bacterial infections turned out to be frequently diagnosed (29 patients, or 80.6%): acute pneumonia in 10 (27.8%), acute bronchitis in 7 (19.4%), relapse of chronic bronchitis in 11 (30.6%), and tuberculosis in 1 (2.8%) patient. Viral herpetic complications were diagnosed in 2 (5.6%) cases. Infectious complications of the other systems were detected in 5 (13.8%) patients: nephro-urinary infections in 3 (8.2%) and acute otitis in 2 (5.6%). Death occurred over a period of 3-19 years in 16 (19.5%) patients, due to infectious complications in 6 (37.5%), as a result of CLL progression in 5 (31.3%), due to the secondary tumors in 4 (25.0%), and acute cerebrovascular accident in 1 (6.2%). The 3- and 5-year OS was 100% and 95.7% in patients with stage A and 84.8% and 55.4% in stage B. Infectious complications are frequent manifestations and cause of death in CLL, especially in stage B.

INFECTIOUS COMPLICATIONS IN CHRONIC LYMPHOCYTIC LEUKEMIA – CHALLENGING ISSUES OF HEMATO-ONCOLOGY

Theaim of the study was to identify the diagnosis features and origin of the infectious complications in chronic lymphocytic leukemia (CLL). Our observational study enrolled 82 patients (pts) with different CLL phases, who were managed at the Institute of Oncology of Moldova from 2000 to 2022. The pts age ranged between 45-86 years (median age 66.2 years). There were 47 (57.3%) males and 35 (42.7%) females. The diagnosis was proved by histopathological, immunohistochemical, cytological and immunophenotyping examinations. We used IWCLL criteria on a basis of lymphoid cells rate in the blood count and bone marrow aspirate. Accordingto Binet classification, stage A was revealed in 54 (65.9%) pts, stage B – in 28 (34.1%). Infectious complications developed in 36 (43.9%) cases. Respiratory bacterial infections were diagnosed in 29 (80.6%) pts, commonly comprised the relapses of chronic bronchitis - in 11 (30.6%) and acute pneumonia - in 10 (27.8%). Herpetic infection was diagnosed in 2 (5.6%) cases. Other infectious complications included nephro-urinary tract in 3 (8.2%) pts and acute otitis in 2 (5.6%). Fatal outcomes occurred in 16 (19.5%) pts, including 6 (37.5%) with infections, 5 (31.3%) with CLL progression. The infectious complications proved to be the common manifestations and causes of death in CLL, especially in stage B.

Risk Analysis of Otitis Externa (Swimmer’s Ear) in Children Pool Swimmers: A Case Study from Greece

Otitis is an ear inflammation characterized by an accumulation of polluted fluids in the ear, inflating the drum, causing ear pain, and draining the mucous membrane (pus) into the ear canal if the drum is perforated. Swimmer’s otitis, also known as acute external otitis, is a medical condition that frequently affects competitive swimmers. The risk factor analysis study was based on data obtained between May 2018 and May 2019 from four public swimming pools in Patras, Achaia. A checklist was created to evaluate the pools’ operational conditions, and it included information on the pools’ sanitation as well as swimming pool hygiene guidelines. In addition, a questionnaire was devised to collect data on pool swimmers’ use of the pools. Microbiological testing of the pool water was done ahead of time, and data on external otitis cases from hospitals was gathered. Based on this information, a risk factor analysis was conducted. Gender, weight, and age do not appear to have an impact on the number of otitis media cases that occur because of swimming in the pools. There is also no statistically significant link between episodes and the frequency of otitis events in locker rooms, restrooms, or swimming pools. The frequency with which swimmers utilize the pool, rather than the pool’s microbial burden, is the most significant determinant in otitis episodes. Furthermore, there is no statistically significant link between chlorine odor and otitis episodes. Additionally, several abnormalities in the ear or the child’s history do not appear to affect otitis episodes. More research is needed to determine whether infections are linked to microbial load or if other factors are responsible for the emergence of waterborne infections.

Non-prescription treatments for childhood infections: an Austrian, monocentric, cross-sectional questionnaire study

BackgroundInfectious diseases like the common cold, otitis media, or gastroenteritis frequently occur in childhood. In addition to prescription drugs, parents often use supplementary over-the-counter (OTC) products recommended by pharmacists and other non-medical professionals to relieve their children’s symptoms. However, the efficacy of such alternative treatments lacks conclusive evidence.The objective of this study was to investigate the use of OTC products and related active ingredients in children, and the motivations behind this choice.MethodsThe present study included 215 children aged between 1 and 14 years with an acute respiratory tract infection, e.g., common cold, bronchitis, otitis media, tonsillitis, or gastroenteritis. During their visit to the pediatric practice, parents filled in a self-administered questionnaire about their child’s diagnosis, additional treatment options, and motivations to integrate supplementary medicinal products after their first visit for acute infection or follow-up examination. Children with chronic illnesses and patients visiting for a routine maternal and child health program check-up were excluded. ResultsThe study included 111 (51.6%) males and 104 (48.4%) females. Median age was 3.00 (IQR 2.0 – 5.0) years. The most common reason for a visit was a respiratory tract infection (78.6%). Out of 215 parents, 182 (84.7%) resorted to non-prescription remedies to alleviate their child’s symptoms. Teas (45.1%), and home remedies (43.3%) were the most popular. At total 133 (74.3%) followed recommendations from friends and family regarding additional medications usage. Parents with previous experience with complementary medicine tended to prefer this approach to treat their children (p.adjust = 0.08).ConclusionThe use of non-prescription medicine is increasing as well as the range of related information sources. Evidence-based recommendations in this field might improve pediatric care.

Effect Analysis of Levofloxacin Hydrochloride Ear Drops on Acute Suppurative Otitis Media

Effect Analysis of Levofloxacin Hydrochloride Ear Drops on Acute Suppurative Otitis Media

Evaluation of vestibular function in children with purulent media otitis by computer stabilometry

The aim of the research – assessment of vestibular function in children with acute purulent otitis media by computer static stabilometry compared with typically developed children of the same age.&#x0D; Materials and methods: 22 children with purulent otitis media aged 4 to 7 years and 30 practically healthy peers were examined by static stabilometry on the device “MPFI stabilograph 1” (Kharkiv, Ukraine). Indicators of variation and shape of the pressure center distribution, spectral-correlation indicators of stabilograms, as well as integral indicators of stability (length, velocity and angle of postural oscillations) were taken into account and the equilibrium functions of the two sensory states (open and closed eyes) are calculated in the StabiliS software.&#x0D; Results: purulent otitis media causes posterior displacement of the absolute coordinates of the pressure center. In the state with closed eyes, children with purulent otitis differ from their healthy coevals by 14 of 24 stabilometric parameters, including stabilogram length, speed, angle and amplitude of oscillations, giving way to them in the stability of equilibrium. Children with purulent otitis media are more sensitive to the visual canal of postural control than their coevals. Involvement of visual afferents in postural control significantly improves balance maintenance in children with purulent otitis by reducing deviations of postural oscillations, which is reflected in the probable changes of 9 out of 24 stabilometric parameters compared to control.&#x0D; Conclusions: In preschool age, purulent otitis media leads to latent vestibular dysfunction, which is manifested by a violation of the stability of the vertical posture in a state with closed eyes and is compensated by visual-vestibulo-proprioceptive integration in the process of postural control.

English

BACKGROUND The complicated middle and inner ear anatomy challenge the diagnostic ease in radiological evaluation of the temporal bone. Their tiny dimension and close neighbouring of the structures limited the successful imaging facilities for long periods of time. Conventional radiological procedures have been inadequate for diagnostic imaging but recently multidirectional tomography and high-resolution computed tomography (HRCT) has gained importance. Inflammatory and infectious diseases of the temporal bone are a major indication to perform highresolution CT. Such studies allow one to evaluate the extent of the disease in the soft tissues and in the bony structures of the temporal bone. The purpose of this study was to evaluate temporal bone infectious pathologies using high resolution computed tomography (HRCT). METHODS The study is completely observational &amp; retrospective type of study. HRCT of temporal bone was carried out on 50 cases with SIEMENS SOMATOM emotion 16 slice CT scan machine, GMERS Medical College &amp; Hospital, Valsad, Gujarat depending upon the availability from February 2019 to January 2020 including all age groups, both sexes with suspicion of temporal bone infective pathologies based on sign and symptoms. RESULTS Out of 50 patients, 38 patients were diagnosed with chronic suppurative otitis media (CSOM) and 12 patients were diagnosed with acute suppurative otitis media (ASOM), of which 65 % of CSOM showed cholesteatoma formation. All the patients with ASOM showed air-fluid levels. Male to female ratio was nearly 1.77 : 1. Out of which, 52 % were paediatric patients. Common symptoms were ear, discharge, headache and deafness. Most commonly affected site was right side. There were 6 extra cranial and 2 intracranial complications seen. CONCLUSIONS Due to the ability to delineate the bony and soft tissue anatomy with high accuracy, high-resolution CT is the imaging modality of choice for topographic evaluation of temporal infective pathologies and their extracranial and intracranial complications. KEYWORDS ASOM, CSOM, Cholesteatoma, Air Fluid Level, Pneumatization, Ossicles, Middle Ear, Inner Ear, Complications

Impact of the COVID-19 pandemic on consultations and diagnosis in ENT practices in Germany

During the first months of the COVID-19 pandemic, there was a significant reduction in the frequency of visits to healthcare institutions. This circumstance influenced the timely diagnosis and subsequential initiation of therapy in almost all specialties. The aim of the present study is to evaluate a hypothetical change in health awareness with regard to outpatient consultations of ENT physicians in Germany. This study used anonymized data from 146 ENT practices in Germany and included 162,724 patients in Q2 2019, 158,077 in Q3 2019, 128,342 in Q2 2020, and 149,153 in Q3 2020. The first outcome was the difference in the number of patients with at least one visit to these practices between the second and third quarters of 2019 and the second and third quarters of 2020. The second outcome was the number of patients with new diagnoses per practice, defined as diagnoses not previously documented in the database for a given patient. The number of patients per practice was significantly lower in Q2 2020 compared to Q2 2019 (879 versus 1108, p<0.001). There were no significant differences when comparing Q3 2020 to Q3 2019 (1022 versus 1083, p=0.261). Diagnoses of otitis media (-43%), acute upper respiratory tract infections (-42%), chronic upper respiratory tract diseases: (-21%), hearing loss (-20%) decreased significantly in Q2 2020 compared to Q2 2019. There was still a significant decrease in patient numbers for acute upper respiratory tract infections (-26%) and otitis media (-25%) in Q3 2020 compared to Q3 2019. The presented results are attributable to several facts. Avoidance of doctor´s visits by the patients, reduction of allocation of appointments by practices and consistent obeying of distance and hygiene measures in terms of wearing filtering face masks (e.g. FFP2/KN95).

UNILATERAL CHRONIC SUPPURATIVE OTITIS MEDIA: EFFECT OF NASAL SEPTAL DEVIATION

Background:Otitis media is an inflammation of part or all of the mucoperiosteal lining of the middle ear cleft. It can be acute, subacute and chronic otitis media infection. Septal deviation has got many unwanted changes such as: nasal obstruction, mucosal changes. Methodology:A descriptive clinical study, carried out on adult patients consulting ENT department at medical city. Those patients have a unilateral chronic suppurative otitis media. Results:The unilateral CSOM can affect any age group, with a slightly higher prevalence in the age group (21-30) year forming 29% of the total patients.Male to female ratio was 1.2:1. Eighty-nine patients presented with aural discharge. Patients with tubotympanic having only perforation and associated with septal deviation forming 68.1% of the patients. Patients with atticoantral having only perforation and associated with septal deviation 63.2% of patients. Conclusion: Unilateral chronic suppurative otitis media can affect all age group and both sexes. The tubotympanic type is mor prevalent. Nasal septal deviation is commonly found in patients with unilateral chronic suppurative otitis media.

Chronic Suppurative Otitis Media Contributory Factors and their Prevention

Background: Chronic suppurative otitis media has declined in the developed countries because of better health resources and better socioeconomic status of the people, but it still remains a major health problem in developing countries like Pakistan. Chronic suppurative otitis media (CSOM) is relatively common among illiterate people having poor socioeconomic status residing in the rural areas. Objective: To identify the contributory factors responsible for chronic suppurative otitis media and to devise strategies to prevent them. Study Design: Cross sectional observational study. Settings: This study was conducted in the department of ENT and Head &amp; Neck surgery allied hospital (FMU) Faisalabad Pakistan. Duration: Two years from September 2016 to August 2018. Methodology: A total of 150 patients with CSOM, both tubotympanic and atticoantral types, were included. The patients of either gender with CSOM, both tubotympanic and atticoantral types, ranging from 03 to 64 years and giving consent for any surgical intervention if required were included in the study. Patients below 03years and above 64 years, having acute suppurative otitis media with complication, and patients not willing for any surgical intervention were excluded from the study. Results: Out of 150 patients of the study 60% patients were males and 40% were females with male : female ratio of 1.5 : 1. The age range was found to be 3-64 years with mean age of 28.9 years. Socioeconomic status showed that 62.8% patients with CSOM belonged to poor class (tubotympanic-46.8% &amp; atticoantral -16%), 23.9% patients had middle class (tubotympanic-16.6% &amp; atticoantral-7.3%) and 13.3% patients belonged to upper class (tubotympanic - 11.3% &amp; atticoantral – 2%). 84 patients (56%) were under matric (tubotympanic-42% &amp; atticoantral – 14%). 57.2% patients were rural residents and 42.8% patients were urban residents in case of tubotypmpanic type of CSOM while 55.2% patients were rural and 44.8% patients were urban in case of atticoantral type of CSOM. SPSS software version 10 was used to analyse the data. Chi square test was applied for analysis. Tubotympanic type of CSOM cases were treated conservatively along with surgical treatment where indicated. All cases of atticoantral type of CSOM were treated by surgery. Conclusion: CSOM is still an important public health problem in developing countries like Pakistan due to poverty, illiteracy, malnutrition, lack of health education and people living in substandard &amp; rural areas. It is the need of the hour that health education programs should be organized to raise the awareness about the disease among the people.

Modified planar sensors for determination of some cephalosporin antibiotics in biological and medicinal media

Pluripotential cephalosporin antibiotics of different generations active against Gram-negative bacteria are used when treating urinary tract infections, mild and moderate pyelonephritis, acute otitis in children, etc. Rapid determination of cephalosporin antibiotics in the biological fluids is important to evaluate physiological and biochemical processes resulting from their metabolism in a human organism. Planar potentiometric sensors of different types — unmodified and modified with polyaniline (0.3 – 1%), NiZnFeO nanoparticles, and their binary mixes — are developed on the basis of associates of tetradecylammonium (TDA) with complex compounds silver (I) — β -lactam [Ag (I) – ( β -lac) 2 ] which are sensitive to some cephalosporin antibiotics, i.e., cefazoline (Cef), cefuroksime (Cefur) and ceftriaksone (Ceftr). In the sensors of type I, electrode-active components (EAC) and modifiers were added to carbon-containing ink, whereas in type II sensors the polyvinylchloride plasticized unmodified and modified membranes based on [Ag 2 (Ceftr) 2 ] 2 · 2TDA were used. Electroanalytic and operational characteristics of unmodified and modified planar sensors in aqueous solutions of cefazoline, cefuroxime, ceftriaxone and against the background of oral fluid were estimated. It is shown that introduction of the modifiers into sensor membranes leads to stabilization of their potential, increases angular coefficients of electrode functions, decreases the antibiotic detection limit to 1.7 Ч 10 –5 M, reduces the response time and potential drift. Nanoparticles of NiZnFeO appeared to be the most effective modifier. For the sensors of type II linearity of electrode functions is observed in the range of ceftriaxone concentrations of 3.1 Ч 10 –5 – 0.1 Ч 10 –1 M. Depending on the content of the electrode active components in the membrane phase of the unmodified planar sensors, the values of the angular coefficients of the electrode functions vary within 25 – 27 mV/p C and correspond to the values of the non-static value for doubly-charged ions. The linearity intervals of sensor electrode functions are identical at all EAC concentrations under study; as Ceas increases, potential drift and response time decreases. The developed planar sensors were used for determination of cephalosporin antibiotics in model aqueous solutions, medicinal preparations and oral fluid.

Etiopathogenesis of Tampal Perforations. Methods of Restorative Treatment

The eardrum is an elastic partition between the outer and middle ear that participates in the perception and conduction of sound waves and provides protection of the middle ear from external influences. The eardrum disintegration is called perforation. The main causes of tympanic perforations are injuries (after acoustic shock, altitude trauma, foreign body ingress, careless conduct of some medical manipulations) and inflammations occurring after purulent otitis media or, less often, acute catarrhal otitis. Clinically, tympanic perforation is manifested by hearing loss, ear congestion, tinnitus. In case of an injury, blood or liquorrhea (if the skull base is fractured) may be discharged from the ear. In the case of inflammatory perforation accompanied by purulent otitis, otorrhea may occur, and the pain syndrome severity is reduced. In about 70% of cases, the eardrum defect heals by itself; but in some cases, surgery is required with reconstructive repair (tympanoplasty).

Effect of ultrasonic cavitation on pro-inflammatory cytokine profile in complex therapy of patients with acute rhinosinusitis and exacerbation of chronic suppurative otitis media

Patients with exacerbated chronic suppurative otitis media occurring in subjects with acute rhinosinusitis often consulted by ENT spacialists. A literature review has shown that much attention is paid to improving conservative therapy for such patients, and non-drug techniques remain applied rarely. In this context, based on a detailed study of biophysical characteristics, an opportunity of using low-frequency ultrasonic cavitation in combination therapy to increase local immunological resistance of mucous membranes in ENT organ cavities is justified. The aim of the study was to increase clinical therapeutic effectiveness of acute rhinosinusitis and exacerbated chronic suppurative otitis media based on examining timeframe necessary for normalization of pro-inflammatory cytokine profile after using low-frequency ultrasonic cavitation in combination therapy. 63 patients were enrolled to the study. The control group (n = 15) consisted of healthy volunteers, whereas main group had 48 patients with acute rhinosinusitis and exacerbated chronic suppurative otitis media, subdivided into 2 subgroups: subgroup 1 (n = 20) – patients receiving conventional treatment methods (elimination, unloading, local and systemic antibacterial therapy, puncture and anti-inflammatory treatment), subgroup 2 (n = 28) – patients underwent low-frequency ultrasonic cavitation (frequency 29 kHz, amplitude 25 μm) in combination therapy. Washouts from the surface mucous membranes of nasal cavity and nasopharynx were examined for level of IL-1β, IL-2, IL-8, IL-10, TNFα, IFNγ levels before treatment, at day 2, 7, 10 days and in one month after treatment. Application of low-frequency ultrasonic cavitation in combination therapy in patients with acute rhinosinusitis associated with exacerbated chronic suppurative otitis media is accompanied by early recovery of balance in pro-inflammatory cytokines comparewd with conventional treatment methods. Data analysis showed that positive and satisfactory treatment result was achieved in 11 (56.2%) and 22 (78.2%) as well as 7 (36.2%) and 6 (21.8%) patients from subgroup 1 and 2, respectively. In two patients from subgroup 1 the result was noted as unsatisfactory. Early recovery in balance of pro-inflammatory cytokines, improvement of clinical results and shortened treatment duration were observed after using low-frequency ultrasonic cavitation in combination therapy of patients with acute rhinosinusitis and exacerbated chronic purulent otitis. The data obtained may serve to justify introduction of low-frequency ultrasonic cavitation into combination conservative therapy of infected nasal and middle ear cavities as an effective and non-invasive approach.