Bilateral Chronic Suppurative Otitis Media Research Articles

Impact of Chronic Suppurative Otitis Media on Quality of Life and Psychological Well-Being: A Cross-Sectional Study.

Chronic suppurative otitis media (CSOM) is a prevalent and persistent middle ear condition that not only affects auditory health but also potentially influences various aspects of an individual's life. This study explores the correlation between CSOM, depression, anxiety, and stress, using the 21-item Depression, Anxiety, and Stress Scale (DASS 21), also assessing quality of life (QoL) using the Chronic Ear Survey (CES) questionnaire. The primary objective of this study was to gather prospective audiological data along with information on both disease-specific quality of life and psychological well-being, utilizing validated measurement instruments. This cross-sectional study was conducted at a tertiary care center in Central India, involving 182 patients with CSOM. The study included individuals aged 18 years and above diagnosed with CSOM in at least one ear. Patients with a history of psychological disorders, head injury, and those with comorbidities such as diabetes, hypertension, and chronic heart diseases were excluded. Pure tone audiometry was employed for hearing evaluation, while the assessment of psychological well-being utilized the DASS 21questionnaire. Furthermore, the quality of life was evaluated using the CEStool. From the initial cohort of 182 patients diagnosed with CSOM, 32 were excluded based on predefined criteria, resulting in a final sample of 150 patients. The cohort, with a mean age of 34.3 years, exhibited a predominantly female population (63.3%). Psychological assessments using DASS 21 revealeddepression in 22 (14.7%) patients and anxiety in 23 (15.3%) patients. Among those with depression, majority of the participants had mild depression. Similarly, among those with anxiety, the majority were found to be experiencing mild anxiety. Bilateral CSOM demonstrated a higher prevalence of anxiety and depression, establishing a significant association. QoL parameters, assessed by the Chronic Ear Survey, indicated a more adverse impact in bilateral cases across all categories except symptoms. Correlation analysis between psychological well-being, quality of life, and hearing loss severity yielded statistically significant results. CSOM with the symptom of hearing loss can lead to reduced QoL and psychological well-being in the affected individuals. This study highlights the psychological impact of CSOM, particularly in bilateral cases and severe hearing loss. Integrating psychological support into treatment plans is crucial for comprehensive patient care. Regular assessments are essential for guiding timely interventions, ensuring a holistic approach to enhance both quality of life and psychological well-being in individuals affected by CSOM.

Bilateral chronic suppurative otitis media in pediatric patients

Chronic suppurative otitis media (CSOM) is a chronic inflammatory condition of the middle ear characterized by perforation of the tympanic membrane with recurrent or persistent mucopurulent otorrhoea. Otorrhea is the most common complaint of CSOM compared to hearing loss and otalgia. The risk factors for CSOM include allergies, history of acute respiratory infection (ARI), history of AOM, impaired tubal function, and socioeconomic environment. In principle, the diagnosis of CSOM is based on anamnesis and physical examination assisted by supporting examinations. The history generally shows a history of persistent or recurrent otorrhea for more than 2 months. CSOM consists of two types, namely the benign type and the malignant type, which can be distinguished from the presence or absence of cholesteatoma. Treatment of the malignant type of CSOM is surgery to eradicate cholesteatoma. Here we reported a case report of a 16-years old male patient with a chief complaint of discharge from both ears from 8 years ago. The patient was diagnosed as bilateral malignant type of CSOM with predisposing factors of poor socioeconomic and nutrition. The patient underwent left ear radical mastoidectomy under general anesthesia with good results at the follow-up visit and was planned to undergo radical mastoidectomy on the right ear.

The Importance of Duration in the Prognosis of Facial Nerve Palsy and Its Treatment-A Case Report

Background: Facial nerve palsy is considered to be one of the most common consequence of untreated chronic suppurative otitis media. The incidence has significantly reduced over the decade due to better imaging technology and use of early antibiotics and better surgical procedures but if left untreated, it has a significant impact over the patient’s day to day life and markedly affects patient’s social life and causes serious psychological damage. An appropriate and prompt management ensures healing of the palsy without sequelae. Case Report: We report a case of bilateral chronic suppurative otitis media with unilateral right grade 4 facial nerve palsy which happened within a duration of 1 month for which patient underwent right modified radical mastoidectomy following which she had steady improvement. Conclusion: This case highlights that in patients with middle-ear cleft cholesteatoma the surgical approaches vary according to duration of palsy and post-operative improvement in facial nerve function can be anticipated in cases of acute palsy. Surgical interventions have been proved to have a good effect in restoration of facial nerve palsy in cases of shorter duration as compared to those of sudden onset and longer duration.

Prevalence of chronic suppurative otitis media in schoolgoing children

Introduction: Chronic suppurative otitis media (CSOM) is a major health problem throughout the world in underdeveloped and developing countries including India. The high prevalence of CSOM in school children in India has led us to undertake this study in schoolgoing children of rural and urban areas of Muzaffarnagar, Uttar Pradesh and to find out the various predisposing factors for the development of CSOM. Objectives: The objective is to find out the prevalence of CSOM in schoolgoing children of the rural and urban population about age, sex, and socioeconomic status. Materials and Methods: Students were randomly selected from primary schools in rural and urban areas of Muzaffarnagar, Uttar Pradesh. Cases selected was categorized in relation to age, sex, socioeconomic status, and prevalence of the safe and unsafe type of CSOM. Observations: In the present study, a cross-sectional survey was conducted in 2158 school children between the age group of 5 and 15 years. A total of 1161 children belonged to urban school whereas 997 children were from three adjacent rural government schools. A total of 78 children were found to be suffering from either unilateral or bilateral CSOM. Conclusion: The prevalence of CSOM in urban school children was 2.32%, while for rural children, it was 5.11%. 42.10% of cases of CSOM belonged to upper-lower socioeconomic group followed by lower middle group (31.57%). The tubotympanic disease was present in 87.18% of CSOM cases while 12.82% had atticoantral disease. Active CSOM was found amongst 37.18% while 62.82% had inactive disease. 42.10% had smoking father, 36.84% had indoor cooking with kerosene oil exposure, and 34.21% used unhygienic ear cleaning methods. 31.58% had a history of recurrent URI, 28.95% had chronic tonsillitis, and 21.05% of children had domain name system as associated findings with CSOM.

Outcomes of same-day bilateral endoscopic tympanoplasty

Objective:To investigate the feasibility of simultaneous bilateral endoscopic for tympanoplasty in patients with bilateral chronic suppurative otitis media. Method:Fifteen patients (30 ears) with bilateral chronic suppurative otitis media who underwent bilateral endoscopic transcanal tympanoplasty on the same day were enrolled in this study. The ear with worse-hearing was selected as the first operation side, the contralateral ear as the second one. The operation group consisted of 22 ears of Type 1 tympanoplasty, 5 ears of Type 2 tympanoplasty and 3 ears of Type 3 tympanoplasty. All second sides(15 ears) underwent Type 1 tympanoplasty. The cartilage-perichondrium graft was harvested from the tragal of the first side and was cut in two halves which could be used for the both sides. The graft success and hearing improvement were evaluated at the postoperative 6th month according to the follow up results of the endoscopic image and the pure-tone audiometry. Result:The graft take rate was 96.7%(27/30) without any retraction pockets or displaced grafts. The graft take rate of the first side was 93.3%(14/15), and the one of the second side was 100.0%(15/15). The average air conduction thresholds were (50.9±9.1) dB HL preoperatively and (32.0±6.0) dB HL postoperatively(P<0.01). The average air-bone gap overall improved from (30.2±7.9) dB HL preoperatively to (13.7±6.0) dB HL postoperatively(P<0.01). Conclusion:Bilateral same-day endoscopic tympanoplasty are safe and cost effective in appropriately selected patients. It can offer favorable out-comes in selected patients with chronic suppurative otitis media.

PC3 - 129 Primary Intracranial Round Cell Sarcoma in an HIV Patient: A Case Report and a Review of Literature

Primary intracranial sarcoma among patients diagnosed with HIV is rare. Case reports published have shown that there is an increasing number of cases of leiomyosarcoma, hemangiopericytoma and rhabdomyosarcoma among these patients. Further, there are also few reports that sarcomas may present atypically, sometimes mimicking a brain abscess. We report a case of a 26 year old male, newly diagnosed HIV, who presented with bilateral chronic suppurative otitis media associated fever, headache and vomiting. Neuroimaging showed with multiple rim enhancing masses on the left temporal, parietal and occipital areas and bilaterally sclerosed mastoid air cells. Initial impression was an otogenic abscess. Burrhole craniotomy and evacuation of the cystic masses was done. Histopathologic examination revealed a small round blue cell sarcoma. Different immunostains were done to differentiate the various subtypes of sarcomas possible. Patient was discharged improved but did not consent to chemotherapy or radiotherapy.

A study on clinical and epidemiological profile of chronic suppurative otitis media (CSOM) at a tertiary care center

Background: Chronic suppurative otitis media (CSOM) is one of the common problems encountered by individuals in India. It can cause permanent hearing loss at a very early age if not treated at earliest. Objective: To study clinical and epidemiological profile of 123 CSOM cases observed at the S.S. Medical College & G.M. Hospital, Rewa. Materials and Methods: The present study was a case series of 123 patients of CSOM who presented to the S.S. Medical College and G.M. Hospital, from November 2012 to February 2013. Result: Male preponderance was seen with age ranging from 1 year to 70 years. Most patients 45(36.59 %) belong to the age group of 10–20 years. Most patients belong to poor socioeconomic status (SES class IV, V comprise more than three-fourth of patients). Most of the patients (81.30%) visited to an ENT specialist for the first time. Most of the patients belonged to rural background (65.04%). Bilateral CSOM was less frequent (only 17.07%). Safe CSOM was more common (89.43%) as compared to cases with unsafe CSOM (10.57%). Hearing complaints were present in 52.85 % cases. Conclusion: CSOM is a common condition in developing countries and requires support and cooperation of both medical professionals and patients for the proper and timely management of the problem.

Microbiological Isolates of Chronic Suppurative Otitis Media at the University Teaching Hospital and Beit Cure Hospital in Lusaka, Zambia

<i>Background:</i> Chronic Suppurative Otitis Media (CSOM) is a common cause of hearing loss and many complications such as meningitis. Many approaches to the treatment of CSOM have been unsatisfactory because CSOM microbiological isolates, as well as their sensitivity patterns, vary from place to place. This study sought to determine the pattern of microbiological isolates of CSOM and the demographic characteristics of patients with CSOM at the University Teaching Hospital, (UTH) and Beit Cure Hospital (BCH) in Lusaka, Zambia. <i>Materials and Methods:</i> The study was a hospital based Cross-sectional descriptive study conducted at the ENT outpatient clinics of UTH and BCH in Lusaka, Zambia.100 CSOM patients were included in the study. Quantitative data on the participants’ demographic details and clinical features were obtained using structured questionnaires. The middle ear discharge was aseptically collected using a sterile cotton swab. In the laboratory, samples were inoculated on agar media to isolate microorganisms and antibiotic susceptibility testing was done using Kirby-Bauer method as per CLSI guidelines. <i>Results:</i> From the findings, out of the 100 CSOM patients studied, 33(33%) were children below 18yrs and 67(67%) were adults. 59(59%) of the patients had unilateral CSOM while 41 had bilateral CSOM which gave a total of 141 ears that were analyzed.119(84.4%) had pure cultures, 20(14.2%) had mixed cultures and 2(1.4%) had no growth. Of the 169 microbiological isolates, the most frequent isolates were <i>Proteus mirabilis</i> 49(29.0%), <i>Pseudomonas aeruginosa</i>, 32(18.9%), coagulase negative <i>Staphylococcus</i> 18(10.7%) and <i>klebsiella pneumoniae</i> 17(10.1%). High sensitivity rates were revealed to Gentamycin (64-100%), meropenem (68-100%), ceftazidime (85-100%), ceftriaxone (64-80%), and ciprofloxacin (66-88%). High resistance rates were recorded to Amoxicillin-clavulanate (as high as 100%), ampicillin (as high as 100%), tetracycline (as high as 91.2%) and cotrimoxazole (as high as 100%) and penicillin (as high as 100%). <i>Conclusion:</i> The study concluded that </i>Proteus mirabilis</i> was the most dominant microbiological isolate followed by <i>Pseudomonas aeruginosa</i>. The isolated microorganisms had high susceptibility rates to gentamycin, meropenem, ceftazidime, ceftriaxone and ciprofloxacin. There were high resistance rates to amoxicillin-clavulanate, ampicillin, tetracycline, cotrimoxazole and penicillin.

Gas-Forming Intracerebral Abscess with Pediatric Parafalcine Subdural Empyema with Review of Literature

A brain abscess is a focal, intracerebral infection that begins as a localized area of cerebritis and develops into a collection of pus surrounded by a well-vascularized capsule. The incidence of brain abscess varies from 1 to 2% of all intracranial space occupying lesions in developed countries to 8% in the developing countries. We reported a case of an 8-year-old girl who presented with gas-forming intracerebral abscess with parafalcine subdural empyema as a complication of bilateral chronic suppurative otitis media with coalescent mastoiditis and reviewed the literature.

Observations on the current bacteriological profile of chronic suppurative otitis media in South eastern Nigeria.

Background:Chronic suppurative otitis media (CSOM) is a disease well-known for its recurrence and persistence despite treatment. The situation is compounded by the increasing resistance to antimicrobial agents by bacteria these days.Aim:This study was carried out to examine the current local bacteriological profile of CSOM and to compare the profile of either ear in bilaterally discharging ears.Materials and Methods:We carried out a retrospective analysis of ear swab cultures from 133 unilateral and 73 bilateral consecutive tubotympanic CSOM cases seen at the Ear-Nose-Throat clinics of a referral health institution during a 4 year period ending 2013. Sensitivities to eight locally available antibiotics were analyzed. Aerobic bacterial isolates were analyzed separately for the unilateral and bilateral cases. Comparison was made between the ears in the bilateral cases.Results:We analyzed 279 ear swab culture results from 206 patients with age ranging from 5 months to 86 years and a mean of 21.3 (19.5) years. Pseudomonas aeruginosa was the most common isolated bacteria (44% [109/250]) followed by Staphylococcus aureus (17% [42/250]), and Proteus Mirabilis (15% [38/250]). The most and least sensitive bacteria were Klebsiella Spp and Escherichia Coli, respectively. The most effective antibiotics were gentamicin and ciprofloxacin. The two ears differ significantly in the rates of isolation of S. aureus and E. coli (P = 0.01 and P = 0.04, respectively).Conclusion:Pseudomonas is the most common bacteria involved in CSOM in this part of the country. Ciprofloxacin as ear drops is recommended as first-line drug in the management of active CSOM as it is cheap, less ototoxic, and locally available. Separate ear swab culture should be obtained in bilateral CSOM.

Rehabilitative challenges in the bilateral aural stenosis post chronic suppurative otitis media surgery: A case study

Introduction: Chronic suppurative otitis media (CSOM) is an infection characterized by recurrent ear discharge through a persistent tympanic membrane perforation. In cases such as these, an ASLP is concerned with early prevention, assessment and provision of suitable client based rehabilitation options. Case Report: A 3.5yrs old male with bilateral aural stenosis post CSOM surgery reported to clinic with a complaint of reduced hearing sensitivity to soft sounds with delayed in speech and language. A test battery approach for Audiological and Speech and Language evaluation was conducted. Recommendations and referrals were suggested at the end. Discussion: Regardless of all the restrictions, this study highlights the challenges encountered by an ASLP in dealing with post operative aural stenotic case. This case study highlights the occurrence of stenosis post surgery of bilateral CSOM, which is rarely found.

Determinants of non-healing ear discharge in chronic suppurative otitis media in a developing country.

The major burden of chronic suppurative otitis media (CSOM) is the embarrassing ear discharge which may last for few months to many years or even a lifetime with increasing risks of complications. We conducted this study to determine the risk factors for protracted non-healing ear discharge among CSOM patients. We carried out a retrospective analysis of non-cholesteatomatous CSOM patients treated in a tertiary hospital in a developing country. Comparison was made between 128 patients with ear discharge persisting beyond 24 months and 58 patients whose otorrhoea resolved within 6 months in terms of socio-demographic and other potential risk factors. Major risk factors identified by logistic regression analysis were rural residence, multidrug-resistant bacteria, and bilateral CSOM (P = <0.001, 0.001, and 0.008, respectively). Others were onset of ear discharge before the age of 10 years, diabetes mellitus, persistent rhinorrhoea, home >10 miles away from hospital, and >7 persons in a family (P = 0.012, 0.041, 0.013, 0.010, and 0.043, respectively). Age, sex, nasal allergy, and self-medication were not significant risk factors for non-healing ear discharge. Protracted non-healing ear discharge still remains a prominent feature of CSOM in our experience. Rural residence, multidrug resistance, bilateral CSOM, and long distance to health facilities are prime risk factors. Measures to address these risk factors to bring about a decline in the number of non-healing ear discharge among CSOM patients, especially in our rural communities, are urgently needed.

Evaluation of simultaneous bilateral same day tympanoplasty type I in chronic suppurative otitis media

To evaluate the concept of bilateral same day tympanoplasty type I (BSDT) in accordance with the principle of evidence based medicine. A study with control was carried out in a tertiary care setting in a sample size of 60 patients suffering from chronic suppurative otitis media (CSOM). The patients were divided into two groups of 30 patients each, group-A comprised of unilateral CSOM cases and group-B comprised of bilateral CSOM cases. All the patients underwent tympanoplasty type I by post auricular inlay technique using temporalis fascia graft. BSDT was done in group-B. Graft and audiological success rates were tabulated and put to statistical examination using Student's 't' test. In addition, post-operative pain was measured by visual analogue scale and statistically analyzed. A graft uptake of 90% and 93% was recorded in group-A and B, respectively. 27 (90%) patients reported an air-bone gap of less than 20 dB post-operatively in group-A and 94% (56 of the operated 60 ears) had an air bone gap less than 20 dB post-operatively in group-B. No case of iatrogenic sensorinueral hearing loss was recorded in this study. Further, pain was not found to be a statistically significant factor detrimental to BSDT. Bilateral same day tympanoplasty type I is a feasible treatment option in modern otology for a specific group of patients suffering from CSOM.

Complications of Chronic Suppurative Otitis Media: A Left Otogenic Brain Abscess and a right Mastoid Fistula

Otogenic brain abscess and postauricular fistula are complications of chronic suppurative otitis media. We describe a rare case of bilateral chronic suppurative otitis media that caused a left temporal lobe abscess and a right mastoid fistula.

AURAL REHABILITATION OF CHILDREN WITH PERSISTENT CONDUCTIVE HEARING IMPAIRMENT

The authors analyzed the issue of children with persistent conductive hearing impairment rehabilitation in cases when traditional prosthetics with parotid and entotic hearing aids is impossible or contra-indicated. The previous and modern methods of rehabilitation as well as the own authors’ experience of aural rehabilitation of children with external and middle ear malformations and bilateral chronic suppurative otitis media with the help of bone anchored hearing aids with covered implants are described in the article.

Chronic suppurative otitis media in children of Luanda, Angola

Evaluation of clinical characteristics, bacteriology and hearing in paediatric patients with and without chronic suppurative otitis media (CSOM) in Luanda, Angola. Interview, clinical examination, ear-discharge culture, open air pure-tone audiometry and brainstem auditory-evoked potentials of 23 outpatients with CSOM and 23 controls in a paediatric hospital. Of the CSOM vs. control children, 35% vs. 26% had running water, 70% vs. 70% electricity, 64% vs. 0% HIV (p<0.0001) and 36% vs. 0% tuberculosis in history (p=0.002). Ten (43%) children had bilateral CSOM. The major ear-discharge pathogens were Proteus spp. (44%) and Pseudomonas (22%). Hearing impairment of >25 dB was present in 52% of CSOM-affected ears and bilateral hearing loss in 7 (30%) CSOM children vs. zero control child (p=0.009). Only one hearing-impaired child's family had previously detected the handicap. CSOM occurred in children with high co-morbidity. Persistent otorrhoea was usually caused by Proteus spp. or Pseudomonas, and often suggestive of either HIV or hearing impairment. In the developing countries, prompt diagnosis and treatment of CSOM would enhance the children's linguistic and academic development.

Comparison of bacteriology in bilaterally discharging ears in chronic suppurative otitis media

Chronic suppurative otitis media is a disease with worldwide prevalence having potentially serious long term effects. It is a disease well known for its recurrence and persistence despite treatment. A study on culture and sensitivity of aural discharge collected from 40 cases of bilateral chronic suppurative otitis media was done to compare the bacteriological profile of either ear. Pseudomonas aeruginosa was the major organism isolated in both ears and was sensitive to Amikacin and newer drugs like Gatifloxacin. It was concluded that the infecting organisms in case of bilateral chronic suppurative otitis media are remarkably similar. If adequate treatment is instituted early, it can go a long way in reducing the prevalence of this socially embarrassing disease.

Mobile, one stage, bilateral ear surgery for chronic otitis media patients in remote areas

We evaluated the results of mobile, one stage, bilateral ear surgery conducted in Greenland, where chronic otitis media with and without suppuration is prevalent. The study aimed to increase the number of operations conducted and to reduce the cost of ear surgery in remote areas. The study was longitudinal and prospective, with a two-year follow up. Seventeen East Greenlandic patients with bilateral chronic suppurative otitis media or chronic otitis media were selected. Their median age was 16 years; 53 per cent were female and 47 per cent male. Hearing was assessed using median air conduction pure tone average gain, and the 'take rate' (i.e. the percentage of total ears with a closed perforation) was evaluated. All patients attended for follow up. Eighty-two per cent had at least one perforation closed, and the overall take rate was 65 per cent of the 34 ears. The median air conduction pure tone average gain after two years was 18 dB and 13 dB for the right and left ears, respectively. Fourteen patients (82 per cent) obtained an air conduction pure tone average hearing level of < or =25 dB in at least one ear. In total, 71 per cent of the patients were satisfied. There were no hearing hazards. The results of mobile, one stage, bilateral ear surgery conducted in Greenland for long-lasting chronic suppurative otitis media and chronic otitis media were acceptable and safe, and more ears underwent surgery at reduced cost compared with unilateral ear surgery.

Otitis media as a cause of significant hearing loss among Nigerians

Mild or worse hearing loss, defined as pure tone average >25 decibel, is seen commonly with preventable etiologies. A tertiary care, urban referral hospital. Retrospective analysis of prospectively collected data of individuals attending the hearing loss clinic of National Hospital, Abuja, between May 2005 and April 2007. Data matching the diagnosis of acute otitis media (AOM), otitis media with effusion (OME) and chronic suppurative otitis media (CSOM) were extracted from the database and analyzed. A total of 298 cases with primary presenting complaints of hard of hearing were seen. A total of 77 cases had hearing loss due to otitis media. 44 (57.1%) had OME, 26 (33.8%) had CSOM, while 7 (9.1%) had AOM. The observed distribution of the OME was left OME (18.1%, n=14), right OME (9.1%, n=7) and bilateral OME (29.9%, n=23), while the CSOM is distributed into left CSOM (15.5%, n=12), bilateral CSOM (11.7%, n=9) and right CSOM (6.4%, n=5), and AOM is distributed into right AOM (2.6%, n=2), left AOM (3.9%, n=3), and bilateral AOM (2.6%, n=2). The mean pure tone averages for the three groups are AOM (30.5dB), OME (41.5dB) and CSOM (56.9dB). Otitis media is an important cause of preventable hearing loss in developing countries, and the predominance of unilateral otitis media in the left ear observed in this study deserves further studies.

Sensorineural hearing loss in otitis media.

Additional evidence is presented to support the hypothesis that both acute purulent otitis media (POM) and chronic suppurative otitis media (COM) can cause high frequency sensorineural hearing loss. In selected patients and in animals (chinchillas) in a pilot study using electrophysiological methods, both temporary threshold shifts and permanent threshold shifts of basal cochlear turn involvement were demonstrated in POM. Data of cochlear involvement in 475 ears with bilateral COM, 607 ears with unilateral COM, and 607 ears serving as controls were obtained from six centers in five countries. In group 1 (15 dB or greater), 43% of ears with unilateral COM and 42% of ears with bilateral COM showed losses, for a combined odds ratio eight times that in controls. In group 2 (30 dB or greater), 16% of ears with unilateral COM and 17% of ears with bilateral COM demonstrated, respectively, seven and ten times that in controls. These statistically significant findings influence clinical considerations.