Retraction Pocket Research Articles

Acquired Cholesteatomas Behind Intact Tympanic Membranes of Adults: A Series of 13 Cases.

Background and Objective: Acquired cholesteatomas behind intact tympanic membrane (ITMC) are rarely encountered in adults in the otology clinic, and the clinical and imaging features of ITMC in adults remain unclear to date. ITMC patients are commonly overlooked because of the absence of both a typical retraction pocket and a tympanic membrane (TM) perforation. The objective of this study was to describe clinical features, pathogenesis, and surgical outcomes in a series of adult patients with acquired ITMC. Materials and Methods: The clinical records of 13 adult patients diagnosed with ITMC were retrospectively reviewed. ITMC were classified into those associated with otitis media with effusion (OME; Group A) and histories of previous perforations (Group B). Results: A total of 13 cases with unilaterally acquired ITMC were included, of which 10 (76.9%) were in Group A and 3 (23.1%) were in Group B. All Group A patients exhibited white masses behind intact TMs, in the anterosuperior quadrants of 6 and the posterior upper quadrants of 4. In Group B patients, white masses in the middle ear were lacking. The TMs were atrophic and white myringosclerotic plaques were evident. The cholesteatomas were confined to the antrum and aditus ad antrum in 2 Group B patients but extended to the epitympanum in 1. All 10 Group A patients had extensive cholesteatomas but intact (noneroded) malleoli. Conclusions: An acquired ITMC should be suspected if symptoms worsen or new symptoms develop in adults with OME or a history of perforation, although the TM is intact with or without pars flaccida retraction, computed tomography/magnetic resonance imaging should be performed. Canal wall up mastoidectomy combined with ventilation tube insertion effectively treated ITMC associated with OME.

Total Transcanal Endoscopic Ear Surgery for Cholesteatoma.

This study aimed to evaluate the outcomes of total transcanal endoscopic cholesteatoma surgery. Twenty-seven cholesteatoma patients that had undergone transcanal endoscopic ear surgery (TEES) were included in the study. Age, sex, operation date of patients, operated side, need for ossiculoplasty, graft material, and surgical technique were recorded. All patients were evaluated through otoscopic, endoscopic, and audiological examinations and followed up for at least five months after surgery. All patients were staged using the European Academy of Otology and Neurotology/Japan Otological Society (EAONO/JOS) Staging System on Middle Ear Cholesteatoma. Mean age of the patients was 36.4 years (range, 4-67 years). According to the EAONO/JOS Staging System, 11 patients were stage 1, while 11 were stage 2, and five were stage 3. Two had lateral semicircular canal defect, one had facial canal dehiscence, and one had oval window defect. The average follow-up period was 19 months (range, 5-41 months), during which two patients experienced retraction pocket and hearing loss and one patient had perforation. One patient underwent revision surgery during follow-up and no recurrence or residual cholesteatoma was observed. The preoperative and postoperative air-bone gaps were 25.14±13.93 dB and 22.22±12.64 dB with no significant difference. TEES is a minimally invasive and safe procedure with low complication and recurrence rates. As with all surgical procedures, experience is essential, and as experience increases, the capability to perform endoscopic otologic surgery on more complex cases may become possible.

Granulomatosis with polyangiitis under the guise of pulmonary tuberculosis: difficulties in diagnosis

Aim. To present a clinical case of late diagnosis of granulomatosis with polyangiitis (GPA), which for a long time was interpreted as a pulmonary form of tuberculosis with the passage of anti-tuberculosis therapy without effect, which led to severe structural changes and resection of the lungs and deformation of the bones of the facial skeleton.Materials and methods. Patient S., 31 y. o., was hospitalized in the rheumatology department with complaints of bloody discharge from the nose with the formation of crusts, hearing loss on both sides, weakness, nose deformity. From the anamnesis: in 2012, a cough with mucous sputum appeared. During examination at the Center for Combating Tuberculosis, on the basis of multiple rounded foci of both lungs, despite a negative diaskin test and the absence of mycobacterium tuberculosis in the sputum analysis, infiltrative tuberculosis was diagnosed. For two years, combined therapy with anti-tuberculosis drugs was carried out. In 2013, a staged combined resection of the left lung was performed; in 2014, a resection of the lower lobe of the right lung was performed. In 2015, nasal discharge increased, large crusts began to stand out, followed by bleeding, and a change in the shape of the nose was observed. In 2016, due to hearing loss in the left ear, he turned to an otorhinolaryngologist, diagnosed with ulcerative necrotic rhinitis, perforation of the nasal septum. Antibiotic therapy - no effect. Blood tests revealed positive antibodies to proteinase-3. In March 2017, he was hospitalized in the rheumatology department.Results. There were CT signs of fibrotic changes in the lungs with calcifications, areas of compaction of the “frosted glass” type in the upper lobes of the lungs. Laboratory examination revealed positive antibodies to proteinase-3, decreased glomerular filtration and tubular reabsorption. Analysis of the biopsy material from the lung and nasal mucosa revealed morphological signs of granulomatosis with polyangiitis. For the first time in 5 years, granulomatosis with polyangiitis was diagnosed, generalized form, chronic course, moderate activity, with damage to the upper respiratory tract (pansinusitis, rhinitis, chronic bilateral adhesive otitis media), lungs (nonspecific interstitial pneumonia), kidneys (microhematuria, proteinuria), joints (arthralgia). The activity index according to the Birmingham BVAS scale is 16 points, the VDI organ damage index is 6 points. In a retrospective analysis, tuberculosis was not confirmed. Therapy with prednisolone, cyclophosphamide (endoxan), biseptol was carried out, against which the patient's condition improved significantly.Conclusion. The presented clinical case demonstrates the difficulties of differential diagnosis of GPA with other granulomatous processes. Late diagnosis led to damage to vital organs: lungs, kidneys, deformity of the back of the nose, which, most likely, could have been avoided in case of timely diagnosis and early initiation of adequate therapy. As a result of an erroneous diagnosis at the onset of the disease, the patient underwent unjustified resection of both lungs twice. Timely diagnosis of the granulomatous process with the involvement of several pathologists as experts, including those with a torpid course of pulmonary tuberculosis, significantly improves the prognosis of patients and avoids fatal complications.

Single-cell transcriptomics of human cholesteatoma identifies an activin A-producing osteoclastogenic fibroblast subset inducing bone destruction

Cholesteatoma, which potentially results from tympanic membrane retraction, is characterized by intractable local bone erosion and subsequent hearing loss and brain abscess formation. However, the pathophysiological mechanisms underlying bone destruction remain elusive. Here, we performed a single-cell RNA sequencing analysis on human cholesteatoma samples and identify a pathogenic fibroblast subset characterized by abundant expression of inhibin βA. We demonstrate that activin A, a homodimer of inhibin βA, promotes osteoclast differentiation. Furthermore, the deletion of inhibin βA /activin A in these fibroblasts results in decreased osteoclast differentiation in a murine model of cholesteatoma. Moreover, follistatin, an antagonist of activin A, reduces osteoclastogenesis and resultant bone erosion in cholesteatoma. Collectively, these findings indicate that unique activin A-producing fibroblasts present in human cholesteatoma tissues are accountable for bone destruction via the induction of local osteoclastogenesis, suggesting a potential therapeutic target.

A narrative review of the management of pars flaccida tympanic membrane retractions without cholesteatoma.

Review the effectiveness of surgical and non-surgical management strategies for isolated pars flaccida and combined pars tensa and flaccida tympanic membrane retractions in preventing progression or recurrence, improving hearing and preventing development of cholesteatoma. Narrative review. ENT and otology services worldwide. Patients with non-cholesteatoma tympanic membrane retractions. Changes in retraction (progression or resolution, or development of a known sequela such as perforation). Eight full text papers are included: three randomised controlled trials and five case series or cohort studies of more than five patients (a total of 238 ears). Data exists for the use of conservative management, ventilation tubes, laser tympanoplasty, cartilage and fascia tympanoplasty, lateral attic reconstruction as well as mastoid procedures. Few high-quality studies on the management of isolated and combined pars flaccida retractions exist. For isolated pars flaccida retractions deemed to require surgical intervention, this review suggests that lateral attic reconstruction and cartilage tympanoplasty carries least risk of recurrence.

Management of recurrent chronic suppurative otitis media with cholesteatoma

Background: Chronic suppurative otitis media (CSOM) is a chronic inflammation involving the middle ear space and it became a burden especially in developing countries. Mastoidectomy remains the main treatment in CSOM with cholesteatoma. Recurrent cholesteatoma and suppurating process indicated the need of revision mastoidectomy. Purpose: Until now, study about the mechanism of recurrent cholesteatoma and its management still need further research. Case report: This paper reports a case of chronic suppurative otitis media with recurrent cholesteatoma which underwent revision mastoidectomy. Clinical Question : What are the factors associated with the occurrence of recurrent cholesteatoma and how to managed it? Methods: Evidence base literature study about chronic suppurative otitis media with recurrent cholesteatoma and surgery treatment was performed through PubMed, ProQuest, and Google Scholar database. Results: Recurrent cholesteatoma that occurred after mastoidectomy can be caused by residue of the cholesteatoma itself or new forming of retraction pocket. Revision mastoidectomy is necessary to evacuated the cholesteatoma and provide good drainage to the mastoid. Conclusion: Routine follow up after mastoidectomy is an important thing to help prevent recurrence of CSOM especially with cholesteatoma.

Association of various factors related to mastoid buffer and middle ear ventilation in etiopathogenesis of squamous chronic otitis media—a cross-sectional study

BackgroundActive squamous chronic otitis media (COM) is an entity with a deep retraction pocket of the pars tensa or flaccida that has retained debris of squamous epithelial where the fundus cannot be visualized involving the pars flaccida or pars tensa, associated with cholesteatoma. Eustachian tube dysfunction (ETD) is a known etiological factor for squamous COM, based on Wittmack’s theory; however, there are very few recent studies in this regard. Contracted mastoid pneumatisation (diploic or primary sclerosis) and presence of Korner’s septum have also been implicated to be associated with middle ear pathology, with conflicting results.Hence, the present study was undertaken to find out the association of three important factors, namely eustachian tube dysfunction, type of mastoid pneumatisation, and Korner’s septum related to mastoid buffer and middle ear ventilation in etiopathogenesis of active squamous chronic otitis media. The study also attempted to identify various conditions of nose and nasopharynx associated with ETD. This would enable us in appropriate surgical decision making with long term benefits in term of hearing and disease outcomes.ResultsOut of the total 37 patients, with active squamous chronic otitis media, it was observed that Eustachian tube dysfunction was found to be associated with 23 (62.16%). The majority of patients had a diploic/primary sclerosed mastoid pneumatization pattern which is 32 (86.48%) of patients. Korner’s septum was found to be associated with 13 (35.13%) patients of the total 37 patients with active squamous chronic otitis media. All these findings were found to be statistically significant.ConclusionIn this study, we found that there was a statistically significant positive association of all etiological factors namely Eustachian tube dysfunction, contracted mastoid (diploic/primary sclerotic mastoid), and the presence of Korner’s septum with causation of active squamous otitis media. Out of these factors, occurrence of diploic mastoid seemed to be the most constant association. Eustachian tube dysfunction of mechanical type, associated with various nasal pathologies, most common was, deviated nasal septum.

Management of attic retraction pockets.

Attic retraction pockets, classified by degree of invasion and erosion, are reconstructed here as outlined by attic retraction pocket grade. Attic retraction pocket grade, surgical management, subsequent conditions of tympanic membrane and middle ear, and improvement of air-bone gap pure tone average were recorded. Our management strategy, based on attic retraction pocket grade, was applied to 200 ears: 44 grade I ears had non-surgical management and 156 grade II-V ears had surgical management. All 200 ears were followed up for 36-240 months, showing only 1 attic retraction pocket reformation and 1 adhesive otitis media (complication rate of 1 per cent), and improved air-bone gaps (p < 0.05). An earlier series of 50 grade IV attic retraction pockets used atticotomy with epitympanic reconstruction. These showed attic retraction pocket recurrence or cholesteatoma onset in 34 ears (68 per cent). When these ears were revised per protocol, there was no evidence of cholesteatoma thereafter. Reconstruction of the ossicles and scutal defect according to attic retraction pocket grade shows long-term stability of the tympanic membrane, middle ear and hearing.

Classification of pathological epidermization (cholesteatoma) of the middle ear NMAO

The periodicals published over the past 5 years showed that interest in the issue of surgical treatment of chronic otitis media, including one complicated by cholesteatoma, did not wane despite the large accumulated experience of schools in otosurgery around the globe. In our opinion, there are currently some significant problems of terminology in the clinical anatomy of the ear, in particular, the nomenclature of the upper floor of tympanic cavity, which negatively affects the comparison and reproducibility of the results of surgical treatment of chronic otitis media. The critical analysis of the current classification of middle ear cholesteatoma proposed in 2017 and validated in Russia in 2021 demonstrates certain difficulties in using the pathohistological term “cholesteatoma”, as well as the basic inaccuracy in defining the concept and structure of the anterior parts of the epitympanum. The work aims to develop and present a new classification of pathological middle ear epidermization (cholesteatoma), which is based on the pathophysiology of middle ear ventilation. The modern concepts on the mechanisms of middle ear ventilation reveal its important role in developing the pathological epidermization and secondary cholesteatoma. The use of three-dimensional modelling of airway ventilation makes it substantially easier to follow the pathophysiological mechanisms of development of tympanic membrane retraction. The tympanic diaphragm consists of more than 10 composite elements. Understanding the pathophysiological principles underlies the proposed classification of pathological middle ear epidermization (cholesteatoma), which is based on the prevalence of middle ear and surrounding anatomical formation injuries. The pathological process area is coded using the abbreviation of the National Medical Association of Otorhinolaryngologists. In this abbreviation, each letter corresponds to a specific anatomical region. The tympanic diaphragm represents the boundary between the regions. Each letter is assigned an index corresponding to the degree of pathological epidermization invasion into the structures of the middle ear, temporal bone and cranial cavity. The authors provide a table, which serves as a visual aid for ease of coding the diagnosis. Examples of how to formulate a diagnosis in accordance with otoscopic illustrations are given.

Correlation between chronic suppurative otitis media and deviated nasal septum of the ipsilateral side

Background: Chronic suppurative otitis media (CSOM) is a long standing infection of middle ear with permanent defect in tympanic membrane with or without ear discharge, frequently have an underlying nasal pathology, which can worsen the middle ear disease secondary to Eustachian tube dysfunction, leading to negative middle ear pressure, tympanic membrane retraction, chronic otitis media with effusion and/or cholesteatoma. Present study was conducted to study the correlation of a etiopathogenesis, bacteriology of CSOM with the deviation of the nasal septum (DNS) of the ipsilateral side. Methods: Study was conducted in ENT department, AJ institute of medical science, Mangalore, Karnataka. Study group included 120 patients having CSOM, selected randomly from outpatient department (Time bound cross-sectional study). Predesigned proforma was used. Detailed history taken, followed by a thorough ENT examination. Relevant investigations were performed. Results: In this study, the prevalence of nasal disease (DNS) in patients with CSOM was 73.33%. Out of 120 CSOM patients, 88 patients had co-existent nasal disease (DNS). Among the 88 cases; 71 (59.2%) patients showed direct correlation with CSOM. Culture swabs showed similar bacterial isolates in aural and nasal swabs indicating, there may be retrograde spread of pathogens from nasopharynx to middle ear via Eustachian tube. Conclusions: A significant correlation was established between CSOM and DNS of the ipsilateral side. DNS played a key role in persistence of CSOM. A conscientious evaluation of nose and paranasal sinuses diseases is essential and we thus endorse management of nasal disease prior to the surgical treatment of ear disease, for meritful postoperative results.

Management of tympanic retraction pockets: case of Mali

Background: This study aims to study the epidemiological and therapeutic aspects of tympanic retraction pockets in the ENT-CCF department of the CHU GT. Method: This was a descriptive prospective study. Results: A total of 9400 patients consulted during the study period. A retraction pocket was diagnosed in 70 patients, i.e., 0.74% of all consultations. The most represented age group was that of [25-39 years]. The average age was 45.71 years. The extremes of ages were 10 years and 81 years. The female gender was the most represented, i.e., 60% with a sex ratio꞊0.67. CT of the petrous bone was performed in two patients. Medical treatment based on systemic corticosteroids and nasal decongestant was initiated in all our patients associated with quarterly monitoring for stage I charachon. The placement of a tympanostomy tube was performed in 8 patients classified (stage II of charachon). Cartilaginous tympanoplasty was performed in one patient, antroatticotomy associated with reinforcement tympanoplasty was performed in one patient (1.43%). Conclusions: The pockets of tympanic retraction constitute a particular nosological entity which deserves rigorous monitoring. The ENT surgeon will be faced with two major challenges: the erosion of the ossicular chain and their potential risk of progression towards cholesteatoma. The diversity of therapeutic options represents an issue that makes this entity a hot topic.

A Case of Reconstruction of Large Defect in Posterior Wall of Bony External Auditory Canal Using Cavum Conchal Cartilage

External auditory canal (EAC) wall defect may occur due to cholesteatoma, and surgeries for chronic ear diseases, trauma, neoplasm or idiopathic. Conservative treatment is available if the severity of the symptom is mild or asymptomatic. However, these defects require repairment not only to attain relief from intermittent otologic symptoms but also to prevent retraction pockets and sequential cholesteatoma. There have been no reported cases of reconstruction of EAC wall defect by cartilage with perichondrium and groove of wall defect by drilling. We manipulated the conchal cartilage so that it could effectively provide robust reconstruction of the canal wall defect. Herein we report a case of EAC reconstruction with mastoidectomy with no further complications.

High frequency hearing 25 years after transmyringeal ventilation tube treatment.

The main aim of the study was to compare hearing outcome between a healthy control group and patients treated with transmyringeal ventilation tubes, 25 years after primary surgery. Another aim was to analyse the relation between ventilation tube treatment in childhood and the occurrence of persistent middle ear pathology 25 years later. In 1996, children treated with transmyringeal ventilation tubes were recruited for a prospective study on the outcome of ventilation tube treatment. In 2006, a healthy control group were recruited and examined together with the original participants (case group). All participants in the 2006 follow-up were eligible for this study. A clinical ear microscopy examination including eardrum pathology grading and high frequency audiometry (10-16kHz) was carried out. A total of 52 participants were available for analysis. Hearing outcome was worse in the treatment group (n=29) compared to the control group (n=29), both in regard to standard frequency range hearing, (0.5-4kHz), and high frequency hearing (HPTA3 10-16kHz). Almost half the case group (48%) had eardrum retraction to some extent, compared to 10% in the control group. No case of cholesteatoma was found in this study and eardrum perforation was rare (<2%). In the long term, high frequency hearing (HPTA3 10-16kHz) was more often affected in the patients with transmyringeal ventilation tube treatment during childhood compared with the healthy controls. Middle ear pathology of greater clinical significance was rare.

The Rate of Eustachian Tube Dysfunction in Adult Patients With Chronic Inflammatory Middle Ear Disease Is Low.

To assess the rate of dilatory (chronic obstructive) eustachian tube dysfunction (ETD) in adult patients scheduled for surgery for chronic inflammatory middle ear disease. We included adult patients with chronic inflammatory middle ear disease (chronic suppurative otitis media, adhesive otitis media [middle ear atelectasis], cholesteatoma). We excluded patients with pathologies that do not stem from ETD (e.g., noninflammatory chronic middle ear disease [e.g., otosclerosis], tumors, solely external auditory canal conditions), patients scheduled for implantable electronic hearing devices independent of disease, patients with otitis media with effusion and scheduled paracentesis or ventilation tubes only, patients with previous radiotherapy or previous balloon eustachian tuboplasty, and children and patients unable to complete questionnaires. We evaluated ETD with Valsalva maneuver and in case of negative or unclear Valsalva with the eustachian tube score (ETS). A negative Valsalva maneuver and an ETS score of 5 or lower were used to define dilatory (chronic obstructive) ETD. Rate of ETD in the included patients. From a total of 482 consecutive patients, 350 patients had positive Valsalva maneuver or ETS score higher than 5. From the 193 patients with negative or unclear Valsalva maneuver, 77 patients had an ETS score of 5 or lower, and 55 rejected further diagnostics with ETS. Based on a large cohort of adult patients with chronic inflammatory middle ear disease scheduled for middle ear surgery, the majority (82%) seems to have no dilatory (chronic obstructive) ETD that can be detected with current routine clinical methods and tubomanometry. Common pathophysiological explanations should be questioned critically, especially in the context of communication with patients.

Tympanoplasty in the Setting of Complex Middle Ear Pathology: A Systematic Review.

To assess the prognostic factors for anatomic and hearing success after tympanoplasty in the setting of complex middle ear pathology. A systematic review was performed in January 2022. English-language articles describing outcome data for tympanoplasty repair variables including underlying pathology, perforation location, smoking status, graft technique, reconstruction material, anatomic success, and hearing success were extracted. Articles were included when tympanosclerosis, retraction pockets, adhesions, cholesteatoma, chronic suppurative otitis media, anterior perforations, and smoking were included. Underlying pathology, perforation location, smoking status, graft technique, reconstruction material, anatomic success, and hearing success were extracted. Any factors analyzed as potential indicators of success were sought out. Data sources included PubMed, OVID, Cochrane, Web of Science, Scopus, and manual search of bibliographies. Ninety-three articles met final criteria, which accounted for 6685 patients. Fifty articles presented data on both anatomic and hearing outcomes, 32 articles presented data on anatomic outcomes only, and 11 articles presented data on hearing outcomes only. This systematic review found that adhesions and tympanosclerosis were prognostic factors for poorer hearing. Additionally, smoking and tympanosclerosis may be predictive of anatomic failure; however, the significance of this finding was mixed in included studies. This analysis is significantly limited by both the heterogeneity within the patients and the lack of controls. Adhesions and tympanosclerosis were prognostic factors for poorer hearing. Clearly documented methods and outcomes for the included pathologies could lead to more definitive conclusions regarding prognostic factors for success. 3B.

Endoscopic transcanal surgery of pars tensa cholesteatoma: Preliminary results

Introduction and objectivesThe aim of the present study is the assessment of exclusive endoscopic ear surgery for the management of primarily acquired pars tensa cholesteatoma, which is commonly linked to the failure of the Eustachian tube leading to the formation of retraction pockets. Materials and methodsPatients suffering from primarily acquired pars tensa cholesteatoma, who underwent primary surgery in our clinic, between 2014 and 2018 were included in this retrospective study. The disease was classified according to the EAONO/JOS system. Exclusive endoscopic ear surgery was performed for patients without mastoid involvement, while a microscopic–endoscopic tympanoplasty was carried out in case of mastoid extension. We assessed the recidivism rate during the follow-up. ResultsCholesteatomas belonged to stage I in 28% of cases, to stage II in 68% and only one patient was stage III. Only a portion of the pars tensa was involved in 13 instances, the whole pars tensa in 3 and both the tensa and the flaccida in 9. 17 out of 25 patients underwent exclusive endoscopic ear surgery and 8 needed a combined approach. We discovered 1 recurrence and 6 residual diseases. ConclusionsWith only one case of recurrence in our series, we showed how pars tensa cholesteatoma cannot be exclusively explained through Eustachian tube dysfunction, but also through a ventilation blockage between the Eustachian tube and other mesotympanic areas due to the formation of intratympanic folds. Endoscopic ear surgery proved highly effective in the control of recurrences and it should be considered the treatment of choice.

Evaluation of graft uptake in underlay myringoplasty using dry and wet temporalis fascia graft

Chronic otitis media (COM) is a vital cause of deafness worldwide. Myringoplasty is one of the best treatment options for COM (inactive mucosal variety). Temporalis Fascia is the most favored grafting material among various autografts, which can be used as dry or wet depending upon the Surgeon's choice. The main focus of this study is to compare the graft uptake rate by using dry and wet temporalis fascia by underlay technique. This cross-sectional comparative study was directed from January 2018 to June 2019 at the Department of Otolaryngology-Head &amp; Neck Surgery of BSMMU, Dhaka. All consecutive cases of COM (inactive mucosal) who underwent surgery were randomly assigned either into the dry (Group-A) or wet temporalis fascia group (Group-B). At 12 weeks follow-up, the density of graft failure (4.4% vs. 8.8%) and retraction pocket (0% vs. 2.2%) were higher in the wet procedure. However anterior blunting (2.2% vs. 2.2%) were the same in both procedures, and medialization (2.2% vs. 0%) were more in the dry procedure. Air Bone Gap (ABG) improved significantly in both groups following operation but reduced in Group-A more significantly than Group-B. On the other hand, there was no remarkable difference in successful graft uptake between the groups (Dry group-91.12% vs. wet group-84.44%, p&gt;0.05). No graft material is superior to others in terms of graft uptake. BSMMU J 2022; 15(2): 84-89

STATE OF HEARING FUNCTION AND EUSTACHIAN TONSILS IN PATIENTS WITH SECRETORY OTITIS MEDIA AT DIFFERENT STAGES OF ITS DEVELOPMENT

The problem of hearing pathology is relevant as we have seen the number of those patients increasing yearly. According to the literature, about 30% of all cases of hearing loss are related to middle ear pathology. The cause of the development of many forms of hearing loss is the dysfunction of the Eustachian tube which can lead to retraction of the tympanic membrane, development of secretory otitis media or even adhesive otitis media that can be the reason for constant conductive hearing loss, and require surgical intervention to restore mechanism of sound conduction.&#x0D; Prevention and treatment of hearing disorders is not only a medical, but also a social-economic problem. In our researches, we’ve decided to study the peculiarities of hearing impairment in patients with secretory otitis media in different stages of its development, depending on the condition of the tubal tonsils and lymphoid tissue around the orifice of the Eustachian tube.&#x0D; The aim. Study the relationship between the state of auditory function and pathomorphological changes of the tubal tonsils and lymphoid tissue around the orifice of the Eustachian tube in patients with secretory otitis media in different stages of its development.&#x0D; Material and methods. There were examined 89 patients, age between 18 and 65 years old, with secretory otitis media. All patients were performed a detailed collection of complaints, disease anamnesis, examination of the ENT-organs – by a routine method and with the help of endoscopic and microscopic equipment, as well as pure-tone audiometry and tympanometry. Patients were divided into III groups. Group I – 21 patients with catarrhal stage of secretory otitis media, group II – 38 patients with serous stage, group III – 30 patients with mucous stage.&#x0D; The results. When examining patients with secretory otitis media during nasopharyngeal endoscopy, the changes in the tubal tonsils and surrounding area in the form of inflammation, hypertrophy, or hyperplasia were found. The form of these changes affects the nature of the disease stage. According to pure-tone audiometry, the average hearing thresholds at speech frequencies by air conductivity in all patients were significantly increased. At the same time, in patients of group III with mucous exudate in the middle ear space, average hearing thresholds by bone conduction were slightly increased, which is associated with significantly restricted or absent movement of the tympanic membrane and ossicular chain in the presence of thick mucous exudate.&#x0D; Conclusions. Analyzing the patients’ complaints, clinical picture, data of otoscopy, endoscopy of the nasal cavity and nasopharynx, data of pure-tone audiometry and tympanometry – there was determined a cause-and-effect relationship between the condition of the tubal tonsils, the stage of secretory otitis media and, accordingly, hearing impairment in the examined patients. The performed studies indicate that one of the reasons for the development of secretory otitis media in adults may be pathomorphological changes in the tubal tonsils and lymphoid tissue surrounding the orifice of the Eustachian tube, namely their pathomorphological changes: inflammation, hypertrophy, or hyperplasia. Inflammation of the tubal tonsils, as a rule, is the cause of the development of the catarrhal and serous stage of secretory otitis media, and their hypertrophy or hyperplasia leads to the long-term dysfunction of the Eustachian tube, which in turn is the cause of the mucous stage of secretory otitis media.

Intraoperative findings during Open mastoido-epitympanectomy at a tertiary center

Introduction: Chronic otitis media is a common entity in our country. Surgical eradication of disease is the treatment of choice for squamous chronic otitis media. The objective of this study was to assess the pathology, its extent and associated complications in patients who underwent open mastoido-epitympanectomy for chronic otitis media squamous at a tertiary care center (Dhulikhel Hospital) in Nepal. Materials and methods: Medical records of 111 patients who underwent OMET at our center from June 2017 to June 2021 were analyzed retrospectively. Demographic parameters, clinical presentation, audiometric data, intraoperative pathology and their distribution, involvement of bony landmarks and ossicular chain status were recorded and analyzed. Results: There were 64 male and 47 female patients included in our study. Their age ranged from 6 to 69 years. The commonest finding during examination under microscopy was posterosuperior retraction pocket (42.3%). Cholesteatoma was the commonest intraoperative pathology (86.5%), majority with cholesteatoma widespread involving both tympanic and mastoid cavities. Ossicular chain erosion was reported in 96.4% patients. Conclusion: Squamosal otitis media is common in our setup, with extensive distribution of pathology in middle ear cleft, and possible bony landmarks erosion.

Clinical Profile of Squamosal Chronic Otitis Media among Paediatric and Adult Patients in Rural Population of Central India: A Cross-sectional Study

Introduction: Chronic Otitis Media (COM) is one of the major preventable causes of hearing impairment, especially in children. Hearing loss in children affects speech, language, communication, auditory processing, psychosocial and cognitive development, and academic progress. Since studies addressing and comparing COM in the paediatric and adult population are few and far between, present study attempted to fill this research hiatus. Aim: To analyse and compare the clinical profile of squamosal COM in paediatric and adult populations. Materials and Methods: The present cross-sectional study was carried out in the Department of Otorhinolaryngology, Acharya Vinod Bhave Hospital, Sawangi, Wardha, Maharashtra, India, from December 2020 to December 2022. All the selected patients with squamosal COM (active or inactive) in the paediatric age group (0-15 years) and adult age group (16-60 years) was considered in this study. The study included 26 patients and was evaluated based on intraoperative and radiological findings such as grades of retraction pocket, extent of ossicular erosion, extent, and spread of granulation and cholesteatoma, and pneumatisation pattern among both age groups were carefully analysed. Chi-square test (χ2 ) of independence was used to compare data between the two groups. A p-value ≤0.05 was considered statistically significant. Results: Erosion of scutum was predominantly noted in 6 (42.9%) paediatric patients. In both age groups, attic perforation were more common than marginal perforation, which was found to be statistically significant (p-value=0.045). Grade-2 Posterosuperior Retraction Pocket (PSRP) in paediatric (2, 14.2%) and Grade-4 PSRP in adults (4, 33.3%) were commonest whereas none of the paediatric patients showed Grade-4 PSRP. This difference in PSRP grade in both age groups was found statistically significant (p-value=0.038). Short process of incus was more frequently involved in 3 (25.0%) paediatric and long process of incus in 6 (60%) adult (p-value=0.040). There was frequent involvement of protympanum in 7 (50%) paediatric patients (p-value=0.035). Diploic pattern of pneumatisation was least common in both age groups. Conclusion: Greater grades of PSRP were found among adult patients. This might be contributed to the longer duration of exposure to disease pathogenesis in adults. One of the vital features in the ossicular involvement is the total absence of incus and malleus more frequently in paediatric patients indicating its extensiveness