Cases Of Chronic Otitis Media Research Articles

A case report on a rare case of primary tuberculous otitis media

Although tuberculosis has become more common in recent years, it still accounts for just a small percentage of cases of chronic otitis media. Common symptoms of tuberculous otitis media (TOM) include otorrhoea, hearing loss, and multiple tympanic membrane perforations. Due to its rarity, the illness is frequently misdiagnosed. When a patient does not improve with standard antibacterial and antifungal treatment, this may be a possible diagnosis to explore. Complete healing is possible if the illness is diagnosed and treated timely to prevent consequences.

Comparison of tympanometric volume measurement with temporal bone CT findings in the assessment of mastoid bone pneumatization in chronic otitis media patients.

Since mastoid bone aeration is a pressure buffer for the middle ear, it can be accepted as a prognostic factor for tympanoplasty. Temporal bone computed tomography (TBCT) is a primary method for estimating mastoid aeration. However, due to the risk of radiation and its high cost, there is a need for a more straightforward, faster, and more reliable method in non-complicated chronic otitis media cases (COM). Tympanometric volume measurement might be used for this purpose. This study investigated tympanometric volume measurement's reliability in showing mastoid bone aeration by comparing tympanometric volume measurement with TBCT aeration grading. Preoperative tympanometric volume measurements were performed in patients who underwent audiological examination and temporal computerized tomography (CT) with the diagnosis of COM and sequela of COM without discharge for the last three months and were indicated for surgery. CT was classified into six grades: grade 0: there is no aeration, sclerotic mastoid; grade 1: pneumatization only in the mastoid antrum; grade 2: <25% pneumatization; grade 3: 25-50% pneumatization; grade 4: >50 pneumatization, grade 5: full pneumatization. Averages of tympanometric volume values were determined according to CT degrees. 48 left and 52 right ears (n: 100) of 81 patients, 24 females and 57 males, were included in the study. The mean age was 37.69±13.38. Mastoid pneumatization grades of patients were 32 grade 0, 23 grade 1, 16 grade 2, 14 grade 3, 11 grade 4, and 4 grade 5, respectively. Each grade's mean tympanometric volume (mL) was grade 0: 1.1594, grade 1: 1.6991, grade 2: 2.2250, grade 3: 3.0471, grade 4: 4.0327, and grade 5: 2.9775. There is a statistically significant relationship between tympanometrically measured ear volume and mastoid degrees of pneumatization on temporal bone tomography. As the degree of mastoid aeration increases, the tympanometric volume also increases. According to the results of this study, tympanometric air volume can be used reliably in the preoperative evaluation of mastoid bone aeration in cases of simple COM without ear drainage.

Application of Belfast 15/30dB Rule of Thumb in Assessing Hearing Benefit in Middle Ear Reconstructive Surgery.

The objective of this study is to assess the concordance between Belfast 15/30dB rule of thumb and subjective hearing benefit in middle ear reconstruction surgery. A total of 105 cases of chronic otitis media (COM) (both mucosal and squamosal type) with conductive hearing loss and who underwent middle ear reconstructive surgery during the study period from January 2019 to January 2022 were included. All cases were followed up at 6week and at 3months of postoperative duration for subjective assessment of hearing with questionnaire and pure tone audiometry as per standard of care and correlated with Belfast 15/30dB rule of thumb. Concordance with Belfast rule of thumb was seen in 73.4% cases of both mucosal and squamosal type of COM. Belfast 15/30dB rule of thumb is a valuable and useful tool to predict hearing benefit following middle ear reconstructive surgery, but, it suffers from the disadvantages of all or none phenomenon and it does not grade the level of hearing improvement. The prediction of postoperative subjective hearing with this Belfast rule of thumb is more reliable in mucosal type of COM than in squamosal type of COM.

TYMPANOPLASTY AND ITS OUTCOME IN VARIOUS AGE GROUPS USING THE MIDDLE EAR RISK INDEX SCALE AT A TERTIARY CARE CENTRE IN EASTERN NEPAL

Background: Tympanoplasty is done in cases of chronic otitis media. Middle Ear Risk Index (MERI) Scale is used to predict the outcome of tympanoplasty, based on various risk factors like otorrhoea, perforation, ossicular chain status, cholesteatoma, smoking and middle ear granuation/effusion. The objective of the study was to report the success rate of graft uptake, postoperative gain in hearing threshold and to find out the association of success to the different categories of MERI scale. Methods: A prospective study of 75 cases of chronic otitis media who underwent tympanoplasty, was done over one year. Convenience sampling method was done. Clinical and audiological evaluation was done pre- and post- operatively. Risk categorization based on MERI scale was done. Data were recorded and analyzed using SPSS 16. Results: Out of 75 cases, 39 (52%) cases were male and 36 (48%) were female. The mean age was 24.55 years±11.545. Overall, 53 (70.66%) cases had successful graft uptake. MERI 1-3 group had 82.6 % (38/46), MERI 4-7 group had 64.7 % (11/17) and MERI 8-12 group had only 33.33% (4/12) graft uptake, (p-value 0.003). Above-10-year age group had higher graft uptake rate and hearing gain. Graft acceptance was seen equal in dry or wet ear, and in unilateral or bilateral perforation. Conclusions: Tympanoplasty done in cases with lower MERI scale and more than 10 years age group was associated with higher graft acceptance. More than 10 years age group had better hearing gain. The status of middle ear, dry or wet and laterality of perforation had no association for graft acceptance.

Comparison of the Functional and Audiological Success of Temporalis Fascia and Tragal Perichondrium as a Graft in Type 1 Tympanoplasty

Context: Temporalis fascia and tragal perichondrium are the most commonly used graft materials in tympanoplasty, though contradictory reports are available in literature regarding their efficacy. Aims: To investigate the success rates and hearing outcomes of temporalis fascia and tragal perichondrium as grafts used for Type 1 tympanoplasty. Settings and Design: The present prospective study was carried out for a period of 18 months including 60 patients of either sex from 18 to 70 years of age. Subjects and Methods: This prospective study included 60 consecutive cases of chronic otitis media in a tertiary care center randomized in two groups of 30 patients each to be subjected to Type 1 tympanoplasty using either temporalis fascia graft (Group A) or tragal perichondrium (Group B). Graft uptake rates and subjective as well as objective hearing improvement at 1 and 3 months postoperative follow-up were compared. Statistical Analysis Used: IBM-compatible Statistical Package for the Social Sciences (SPSS) version 21.0. Results: The mean age of presentation in Group A was 31.30 years and in Group B was 30.67. In our study, the graft uptake after 3 months of surgery was 87% in the temporalis fascia graft group and 90% in the tragal perichondrium graft group. The mean pre- and postoperative PTA at 1 month and 3rd month postoperatively showed that there was significant improvement in hearing after 1 month in the temporalis fascia graft group compared to the tragal perichondrium graft group. Conclusions: Both temporalis fascia and tragal cartilage perichondrium are suitable graft materials for tympanoplasty. Graft uptake was superior with tragal perichondrium, while hearing improvement was better with temporalis fascia at 1 month postoperatively, although the results were not statistically significant at 3 months postoperative.

Frequency of Sensorineural Hearing Loss in Chronic Otitis Media

Aim: To estimate the frequency of sensorineural hearing loss in chronic otitis media. Study design: Descriptive study. Place and duration of study: Department of ENT, Services Hospital Lahore from 1st June 2021 to 30th November 2021. Methodology: One hundred patients diagnosed with chronic otitis media were enrolled. Their clinical details were documented and audiograms were performed. Frequency of sensorineural hearing loss was determined. Results: Mean age of 27.9±6.1 years with 59% males and 41% females. There were 52% patients who were diagnosed with the sensorineural hearing loss while it was not present in the 48% of the patients whereas significant difference within the positive patients with sensorineural hearing loss and longer duration of infection was observed in comparison to sensorineural hearing loss negative cases. Conclusion: A high frequency of sensorineural hearing loss is presented in chronic otitis media cases. Keywords: Frequency, Sensorineural hearing loss, Chronic otitis media

Evaluation of audiological profile and graft uptake by endoscopic composite cartilage graft tympanoplasty in chronic otitis media patients

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Transcanal endoscopic ear surgery (TEES) permits wide-angle vision, high resolution, and magnification as well as the direct visualization of hidden areas of the middle ear cavity. The aim of the study was to determine the anatomic and functional results of endoscopic composite cartilage tympanoplasty in chronic otitis media cases with safe central perforation.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This prospective study was conducted on 50 chronic otitis media cases with safe central perforation (small/medium) between February 2020 to July 2021 in a tertiary care center. All the patients were selected as per the described inclusion and exclusion criteria. All cases underwent endoscopic composite cartilage graft tympanoplasty (type-I) under general anesthesia. Audiological outcomes were assessed by comparing mean pure tone average pre-and post-operatively and morphological results (successful graft uptake) were evaluated at 6 months. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The result of this study showed that out of 50 cases 47 had successful graft uptake (94%) while 3 cases were found to have a residual perforation. The pre-operative air conduction threshold (ACT) was 42.82±7.33 dB whereas postoperative ACT was 31.26±7.48 dB, and the difference between the preoperative and postoperative values was found to be statistically significant. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; This study concluded that endoscopic composite cartilage tympanoplasty in chronic otitis media cases with dry central perforations is an effective surgical modality with good audiological and morphological outcomes and negligible post-operative complications.&lt;/p&gt;

Bacterial Agents Causing Chronic Suppurative Otitis Media

Background: Otitis media which is an acute or chronic inflammatory state of the middle ear may be classified as suppurative or non—suppurative.&#x0D; Methods: A total of 100 ear swabs from cases of chronic otitis media were variously collected from patients attending the ENT Clinic. Specimens were immediately transported in a transport medium to the base laboratory of the Department of Microbiology.&#x0D; Results: Out of a total number of 100 cases of chronic otitis media screened for the isolation of bacterial aetiologic agents, 8 different genera comprising 13 bacterial species were isolated. These included S. aureus (39%), Pseudomonas aeruginosa (25%), Proteus mirabilis (16%), Alcaligenes faecalis (5%) and Klebsiella aerogenes (1%). Escherichia coli, Proteus rettgeri, Staphylococcus epidermidis, and Klebsiella pneumoniae, constituted (3%), (3%), (3%) and 1% of isolates in that respective order. From the number of cases screened, it was observed that 54 (54% and 46(46%) were males and females respectively.&#x0D; Conclusion: We conclude that higher prevalence of otitis media among males than females and S. aureus has been identified as the leading pathogen in chronic otitis media.&#x0D; Keywords: Bacterial Infections, Etiology, Otitis Externa.

PREDICTING THE SUBJECTIVE HEARING OUTCOME IN TYPE I TYMPANOPLASTY USING BELFAST 15/30DB RULE OF THUMB.

OBJECTIVE: Both Otologists and patients mutually hope for an improvement in hearing and a functional benet from an ear surgery to correct unilateral conductive hearing loss that has been reported as the closure of air-bone gap or reduction in air conduction thresholds. While these provide a measure of technical success of the operation, they may not always translate into real life benet for the patient. This is because listening is a binaural task and benet to the patient is determined by numerous factors, of paramount importance is hearing in the non-operated ear. With the aim, to estimate patient benet in terms of subjective hearing gain after type I tympanoplasty, we reviewed the Belfast 15/30 dB rule of thumb. METHOD: A 100 cases of chronic otitis media with inactive mucosal disease having conductive hearing loss, who had undergone type I tympanoplasty were included. Hearing was assessed using pure tone audiogram with average of, .5, 1, 2 &amp; 4Hz and a detailed questionnaire regarding the subjective perception of hearing was obtained pre and 6 month post-operatively which was correlated with Belfast 15/30 dB rule of thumb. RESULT: The predictive value as per pure tone audiometry with Belfast 15/30 dB rule of thumb is 89% with a conclusion that the objective hearing improvement (88.1%) does not necessarily transform into patients' perception of hearing improvement (78.4%) CONCLUSION: Hearing is a binaural function and this should always be kept in mind while operating on unilateral/ asymmetric hearing loss patients as mere closure of air-bone gap or reduction in air conduction threshold might not conclude patients' perception of hearing gain. Belfast 15/30 dB rule of thumb has proved to be a valuable tool in predicting the subjective improvement of hearing

Pathophysiological to Clinical Aspects of Chronic Suppurative Otitis Media (CSOM): Narrative Literature Review

Chronic suppurative Otitis Media (CSOM) is inflammation of the middle ear mucosa and mastoid space that lasts more than 2 months characterized by perforation of the tympanic membrane and continuous or intermittent discharge from the ear canal. Secretion in the form of watery or thick clear or pus. CSOM with cholesteatoma is characterized by a perforation that is located marginally or can be tampered with the bone and often causes dangerous complications. CSOM is still a major health problem, especially in developing countries. The incidence of CSOM cases is estimated at more than 20 million people worldwide. Of these, approximately 5 million patients suffer from chronic otitis media with cholesteatoma, although the overall number of cases of chronic otitis media with cholesteatoma appears to be decreasing. The prevalence of CSOM worldwide is around 65-330 million people with complaints of watery ears, 60% of them (39-200 million) suffer from significant hearing loss. The incidence of chronic otitis media with cholesteatoma is 3 in 100,000 in children and 9.2 in 100,000 adults.

Comparative study of outcomes of type 1 tympanoplasty with and without anterior tucking

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Type-1 tympanoplasty is the functional restoration of the normal middle ear by repairing the tympanic membrane (TM). Different techniques are still evolving to devise a way to give optimal graft uptake and hearing improvement with minimal instrumentation. Various studies have been done to assess the role of anterior tucking in type-1 tympanoplasty and to assess its superiority over other methods in repairing subtotal perforations and large perforations involving the anterior quadrant.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This study was done to compare the outcomes of endoscopic type-1 tympanoplasty with and without anterior tucking. 60 cases of chronic otitis media (COM) mucosal type were divided into 2 groups of 30 patients each. Group 1 underwent endoscopic type-1 tympanoplasty with anterior tucking and group 2 underwent endoscopic type-1 tympanoplasty without anterior tucking. The outcomes were evaluated after 6 months and compared in terms of graft uptake and hearing gain.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The mean air-bone gap improvement was 13.16±2.65 in group 1 and 12.90±3.78 in group 2, which had statistically insignificant differences indicating similar hearing outcomes in both the groups. 96.7% successful graft uptake was achieved in group 1 and 90% in group 2, showing statistically insignificant differences indicating similar graft uptake rates in both the groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Anterior tucking with endoscopic type-1 tympanoplasty could provide good graft support and efficient hearing improvement but cannot be labelled as a mandatory step in repairing subtotal perforations or large perforations involving anterior quadrant as the outcomes are comparable to the endoscopic type-1 tympanoplasty done without anterior tucking. &lt;/p&gt;

Comparative Evaluation of Hearing in Cartilage Umbrella, Boomerang and Torp in Chronic Otitis Media Cases with Absent Stapes Suprastructure: Our Experience.

Ossicular discontinuity is one of the most common causes of conductive hearing loss. Ossicular chain reconstruction improves conductive hearing loss. With no additional cost, cartilage ossiculoplasty is easy to perform, and also the cartilage is well tolerated being an autograft. In this study we compared the audiological outcome in ossiculoplasty done by cartilage umbrella, cartilage boomerang and alloplastic TORP. 75 patients of age group 10-50years clinically diagnosed with chronic otitis media with conductive hearing loss and an air bone gap (ABG) of at least 20dB posted for surgery were included. Ossiculoplasty was done in three groups with autologous cartilage boomerang, cartilage umbrella and alloplastic TORP. In mucosal disease hearing gain was better in umbrella technique (17.66 ± 1.1) dB than Boomerang (16.9 ± 0.8) dB and TORP (10.68 ± 0.9) dB. ABG closure was higher in Boomerang and TORP. Hearing improvement in patients with squamosal disease managed by canal wall up surgery was 25.01 ± 1.1dB, 27.73 ± 3.1dB and 20.12 ± 1.8dB in Boomerang, Umbrella and TORP group respectively showing that umbrella method gave maximum improvement. ABG closure was better in TORP group. In canal wall down surgery patient's maximum improvement was seen in Boomerang (29.51 ± 0.9) dB followed by Umbrella (26.67 ± 1.2) dB and TORP (25.27 ± 0.8) dB group. ABG closure was higher in Boomerang group. Cartilage ossiculoplasty is a reliable and effective method of ossicular chain reconstruction for both mucosal and squamosal disease. Cartilage ossiculoplasty has the added advantage of reduced chances of prosthesis extrusion as compared to TORP.

Frequency of Different Bacterial Species and their Antibiogram among Patients with Chronic Otitis Media

Aim: To find out the frequency of different bacterial species and their antibiogram among the patients of chronic suppurative otitis media.&#x0D; Study Design: Descriptivecross-sectional.&#x0D; Place and Duration of Study: The study was conducted at the ENT department of Bahawal Victoria hospital between July to December 2020.&#x0D; Methodology: About 50 patients presented with unilateral or bilateral ear discharge and diagnosed as a case of chronic suppurative otitis media were included in the study. The disk diffusion method was used on Mueller-Hinton Agar to detect antimicrobial susceptibility. Multipledrugs were tested for checking antimicrobial susceptibility. The data were analyzed by using Statistical Package for the Social Sciences (SPSS) version 20.&#x0D; Results: The mean age of the study participants was 13.89 ± 12.37 years. The majority of participants were froma younger age group i.e. less than10 years of age with female predominance. It had been found that the majority of cases (51%) were having Staphylococcus aureus infestation followed by Pseudomonas aeruginosa, Escherichia coli and very few with Proteus mirabilis. On the other hand, multiple drugs were tested to find out the antimicrobial susceptibility among the cases of chronic otitis media and the results reported that all the bacterial species were susceptible to Ceftriaxone while the other antibiotics were havinga variable response for different strains of bacteria.&#x0D; Conclusion: Results concluded that the Staphylococcus aureus was the most common organism followed by Pseudomonas aeruginosa, Escherichia coli and very few with Proteus mirabilis. It is important to identify the pathogenic organism and its sensitivity pattern before prescribing any antibiotic.

Clinicoradiological correlation between preoperative high-resolution computed tomography findings and intraoperative findings in chronic otitis media (squamous type)

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Chronic otitis media is a major health problem with significant morbidity. High-resolution computed tomography (HRCT) is extremely useful for middle ear pathology and extension of the disease. The objective was to study the correlation between preoperative HRCT and intraoperative findings in chronic suppurative otitis media (squamous type).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This analytical study included 61 cases of chronic otitis media (squamous type). Preoperative HRCT findings were correlated with intraoperative findings. Sensitivity, specificity, PPV, NPV and kappa value were estimated.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of 61 cases 32 were males and 29 were females. Presence of cholesteatoma found on HRCT with 80% sensitivity with k value 0.83 suggesting very good agreement. About ossicular status k value of incus, malleus and stapes were 0.76, 0.65 and 0.54 respectively with sensitivity of 91%, 85% and 58% respectively. Other critical areas on HRCT like sigmoid sinus plate erosion, tegmen tympani dehiscence, scutum erosion, lateral semicircular canal erosion, facial canal erosion and jugular bulb were seen with k value was about 1, 0.8, 0.9, 0.82, 0.72 and 0.65 respectively. So, HRCT shows perfect radiosurgical agreement for sinus plate erosion, very good agreement for disease extension, incus erosion, tegmen tympani erosion, scutum erosion and LSCC erosion and fair agreement for malleus erosion, facial canal erosion and jugular bulb dehiscence and poor agreement for stapes erosion.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; HRCT is a reliable preoperative investigation in cases of chronic otitis media, squamosal type which would provide a bird’s eye view in the disease process in the ear.&lt;/p&gt;

In Saving the Canal Wall, can MERI and Otoendoscopes Help Take a Call?

Introduction The study was aimed to find out whether any correlation exists between Middle Ear Risk Index (MERI) and the diagnostic ability of otoendoscopes to help in the decision making to preserve the posterior canal wall in management of cases of chronic otitis media(COM) squamous type. Materials and Methods Patients of chronic otitis media squamous active type were subjected to tympanomastoid surgery under the microscope and adjunctive use of otoendoscope. After proper disease clearance under microscope, otoendoscopes were taken as an adjunct to find out whether any residual disease was being left behind and to confirm whether the posterior canal wall could be preserved. Dubious cases in which the canal wall could be saved due to conclusive evidence of disease removal through the endoscope were taken as the ones being influenced by otoendoscopic decision-making. Results Patients having moderate MERI score were likely to have their canal walls spared by endoscopic evaluation. Discussion The percentage of residual disease detected with otoendoscopes were concurrent with other studies reporting similar figures. Conclusion The otoendoscope is decidedly more helpful in conclusive decision making in preserving the posterior canal wall in a case of chronic otitis media.

The practices and philosophies of cartilage tympanoplasty in difficult and challenging circumstances: audiological and morphological perspectives

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The main objective of the study was to assess the anatomical and functional results of cartilage tympanoplasty using full thickness cartilage graft (with or without perichondrium) reinforced with fascia in high risk situations.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This prospective non-controlled, non-randomized study included 124 cases of chronic otitis media who underwent cartilage (reinforcement) tympanoplasty (underlay) and ossicular reconstruction with or without mastoidectomy in following seven groups: revision cases, atelectatic cases, subtotal perforation (dry), larger anterior perforations (dry), tympanosclerosis, cholesteatomatous ear, and wet (discharging) ears . Graft success was accepted labelled as an intact graft at the end of six month postoperatively. At the same time, hearing results were also assessed by comparing pre- and post-operative pure tone average air-bone gap (PTA-ABG) of each group using Student “t” test and p&amp;lt;0.05 was considered statistically significant for the hearing outcomes. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Anatomical success rate in this series was 94.36%. The overall mean pre- and post- operative pure tone average air-bone gap (PTA-ABG) were 31.33±10.41 dB and 19.55±12.04 dB, respectively and the difference was statistically significant (p&amp;lt;0.05). Best take up rates were observed in atelectatic and tympanosclerotic group i.e., 100% and 96.55% respectively.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; This study discusses the results of cartilage tympanoplasty in specifically indicated seven situation and reveals good anatomic results in each group (minimum success rate was 86.66% in wet ears) and statistically significant differences in mean pre- and post op PTA-ABG in groups except cholesteatoma and wet ear group.&lt;/p&gt;

Tubercular otitis media: demystifying its nuances and an update on the tenets of emerging perspectives

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Tuberculous otitis media (TOM), a rare cause of chronic otitis media, is easily confused with nonspecific chronic otitis media owing to its unexpectedly changing and variable presentation, low suspicion and low prevalence which causes difficulty in its early diagnosis. The purpose of this study was to analyze its changing clinical pattern and to formulate an acceptable management protocol.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective observational, descriptive study included 457 cases of Chronic otitis media who were operated between January 2017 to July 2020 in a tertiary care center. Histo-pathological examination of tissue from the middle ear and mastoid were sent and positive results were corroborated retrospectively to the clinical findings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; Diagnosis of TOM was established post-operatively in five cases (1.09%) with a positive histopathology report in four out of five cases and by polymerase chain reaction (PCR) in one case. Three cases (60%) presented with facial palsy and one with profound hearing loss (20%). All cases received 6 months course of anti-tubercular therapy postoperatively and were in regular follow up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Tuberculosis of the middle ear can present unexpectedly either as a complication or completely as a non-specific chronic otitis media. The extent of pathological findings might not be in commensuration with the clinical features. In operated chronic otitis media cases, specimen for histopathological examination must be sent in all cases and further specific microbiological investigations may as well be advised accordingly.&lt;/p&gt;

Menin-MLL inhibitor blocks progression of middle ear cholesteatoma in vivo

ObjectiveCholesteatoma is an epithelial lesion that expands into the middle ear, resulting in bone destruction. The acceleration of the proliferative activity of epithelial stem/progenitor cells is involved in the pathogenesis of cholesteatoma. Recently, the use of a menin-mixed lineage leukemia 1 (MLL1) inhibitor, MI503, in experiments has resulted in inhibition of the growth of tumors under histone modification. In this study, we investigated the effects of the menin-MLL inhibitor against cholesteatoma growth in an in vivo model. MethodsWe first correlated the expression level of histone H3 trimethylation at lysine 4 (H3K4me3) among cholesteatoma cases, chronic otitis media cases and normal skin tissues. Based on the role of keratinocyte growth factor (KGF) in the development of cholesteatoma, KGF-expression vector was transfected into the ear and we analyzed the expression level of H3K4me3. After cholesteatoma was induced, MI503 was administered daily into the ear for 14 days. ResultsWe detected the highest labeling index of H3K4me3 in the cholesteatoma specimens. After KGF-expression vector transfection in the mouse ear, a high expression level of H3K4me3 was observed in the epithelial layers. The use of MI503 reduced cholesteatoma in the in vivo model and decreased the proliferation of epithelial stem/progenitor cells in a dose-dependent manner. ConclusionWe demonstrated that inhibition of the menin-MLL interaction may be a potentially useful strategy in the conservative treatment of cholesteatoma.

Microbiological Profile and Drug Sensitivity Pattern in Persistently Discharging Ears: A Tertiary Level Hospital Based Retrospective Study

Introduction Antimicrobial resistance is an emerging issue resulting from the misuse of antibiotics in today’s world. As an effect of it, cases with persistent ear discharge not responding to the conventional oral antibiotics prescribed in ear pathologies are seen increasing in our day to-day practice. This study aims to review the microbiological growth and the pattern of their antibiotic sensitivity in this group of population.&#x0D; MethodsThis was a retrospective study which was conducted at the Department of ENT-HNS of Tribhuvan University Teaching Hospital. Record files of all cases who presented with persistently discharging ear for more than 2 weeks and not responding to oral antibiotics, between January 2017 to March 2020 were assessed. Cases of chronic otitis media (COM) squamous with persistent discharge were excluded as most of the times it is the disease process rather than type of organism which causes the persistence of ear discharge despite the use of antibiotics.&#x0D; ResultsCOM mucosal and cavity infection following modified radical mastoidectomy (MRM) were the commonest pathologies. Pseudomonas aeruginosa (PA) and Coagulase negative Staphylococcus (CoNS) were the commonest bacterial isolates. Pseudomonas aeruginosa showed a good sensitivity to antibiotics like Tazobactam and Piperacillin and resistance to conventionally used antibiotics like Ciprofloxacin and Levofloxacin. Similarly, CoNS had good sensitivity to antibiotics like Oxacillin and Levofloxacin and resistance to conventionally used antibiotics like Amoxicillin.&#x0D; ConclusionCOM mucosal and post MRM cavity infection are the commonest pathologies presenting with persistent ear discharge with PA and CoNS as the predominant isolates. Pseudomonas aeruginosa holds a good sensitivity to drugs like Tazobactam and Piperacillin; and CoNS to drugs like Oxacillin and Levofloxacin.

Changing Scenario in Tympanoplasty: Endoscopic Versus Microscopic Approach.

Tympanoplasty is the most common surgery performed for Chronic Otitis Media. Here we have compared the minimally invasive endoscopic tympanoplasty with the conventional microscopic tympanoplasty. It's a comparative prospective study, involving cases of Chronic otitis media with dry perforation analysed from January 2009 to October 2019. Equally 312 patients were divided into two groups, 156 in each group and subjected for Endoscopic and Microscopic Tympanoplasty. Various parameters were studied. Graft success rate of 98.08% and 93.58% in group A and B respectively were comparable, hearing improvement in both groups was not statistically significant with p-value > 0.05, whereas the postoperative hearing improved significantly to preoperative in both groups. Endoscopic and Microscopic tympanoplasty has similar outcomes, in terms of graft success rate, hearing and duration of surgery. Cosmetic results were better in Endoscopic group whereas canalplasty rates were evident in Microscopic group.