Cholesteatoma Otitis Research Articles

Automastoidectomy — a case report

BackgroundAutomastoidectomy denotes extensive destruction of the middle ear cavity and the mastoid air cells, mimicking the appearance of a reminiscent image of the post-mastoidectomy cavity. This condition, although rare, might occur as a unique complication of chronic otitis media with cholesteatoma with subsequent destruction of the posterior wall of the external auditory canal and spontaneous partial or complete evacuation of the cholesteatoma through the canal.Case presentationSeventy-year-old gentleman, a retired soldier, presented to us in the ENT OPD with right ear pain for more than a year, right ear discharge for 9 months, and a decrease in the hearing of the right ear for 6 months. The condition started 18 months ago with intermittent right otalgia; Dull aching in nature. Ten months later, the patient started to experience right-sided otorrhoea which was profuse, offensive, mucopurulent, and yellowish in color. Later on, he noticed a gradually deteriorating hearing.On examination of the right ear, there is a fleshy mass obstructing the EAC, no auricular deformity tenderness, no preauricular swelling, sinus, or deformity, and there is thinning of the skin in the right postauricular region with mild tenderness but no swelling or sinus and preserved sulcus. Otoscopic examination shows a mass obstructing the EAC found to be an everted skin tag from the posteroinferior wall of the canal. There was a widening of the canal with the destruction of the walls and the absence of the TM, the annulus tympanicum, and the ossicles with polypoidal mucosa all over the middle ear cavity.InvestigationHRCT scan of the temporal bone shows destruction of the air cells of the right mastoid cavity with the absence of the ossicles and destruction of the posterior EAC walls.ConclusionAlthough uncommon it is considered to be a known complication of Cholesteatomatous otitis media and sometime keratosis obturates with the main feature of osteogenic destruction of the posterior wall of the EAC.

Bacteriology and trends of antimicrobial resistance of Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus in otitis media: A retrospective data analysis.

Otitis media (OM) has a high prevalence worldwide and the treatment is crucial because hearing loss in children can lead to growth disorders such as language development disorders. The aim of this study is to analyse the changes in bacterial strains and the trends of antibiotic susceptibility in otitis media with effusion (OME), chronic otitis media (COM) and cholesteatomatous otitis media (Chole OM). This retrospective study involved 2926 patients diagnosed with OME, COM, or Chole OM between January 2000 and December 2020. The clinical data were collected and analysed through chart review from May 2021 to July 2021. Two tertiary medical centres. The 2926 OM patients. An otorrhea sample was collected on the first day of their hospital visit. Middle ear fluid samples for bacterial culture and antibiotics susceptibility test were collected from patients during middle ear surgery, including ventilation tube insertion. In each type of OM, the distribution of bacterial strains in the 2000s and the 2010s was compared. In addition, changes in the detection rate of methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa (PA) and trends in their antibiotic susceptibility over the last 10 years were analysed. The most frequently detected bacterial strains in OME, COM and Chole OM over the study period were coagulase-negative Staphylococcus (CNS) (29.6%), MRSA (24.1%), and PA (20.1%). Compared to the 2000s, the proportion of non-typable Haemophilus influenzae in OME and MRSA in COM increased in the 2010s (27.4%-31.6% and 1.5%-29.5%, respectively). In total three types of OM, although there was no significant trend of change in detection rates of MRSA, PA, and multidrug resistant-P. aeruginosa (MDR-PA) during the last 10 years, resistance to the Quinolone class of MRSA and PA tended to increase (P < .05). The composition of bacterial strains in each types of OM has changed over the past 20 years. Additionally, the antibiotic resistance of MRSA and PA has increased in the last decade. Therefore, when using empirical antibiotics in necessary situations, it is necessary to change to an appropriate antibiotic through a bacterial culture test and antimicrobial susceptibility test.

Outcomes and Review in Surgery of Lateral Semicircular Canal Dehiscence in Cholesteatomatous Otitis Media: A Case Series.

The online version contains supplementary material available at 10.1007/s12070-023-03973-1.

COMPLICATIONS OF CHRONIC CHOLESTEATOMATOUS OTITIS MEDIA AT THE UNIVERSITY HOSPITAL CENTER OF ANDOHATAPENAKA ANTANANARIVO MADAGASCAR

Chronic cholesteatomatous otitis media is the particularly aggressive form of chronic otitis media.This ear infection can lead to functional impairment of the ear and exposes you to serious complications that can be life-threatening. The purpose of this work was to list the complications of cholesteatomatous otitis in our hospital center. Patients And Method: This is a descriptive retrospective study of cases of complicated cholesteatomatous otitis. The study was carried out within the university hospital center Andohatapenaka from January 2015 to December 2019 (5 years). Complications of chronic not cholesteatomatous otitis media have been ruled out. Results: The frequency of cholesteatomatous otitis media is 2.57%. It mainly affects patients between 10 and 20 years old with a male predominance. Extra-cranial complications are more frequent (78.94%) compared to intracranial complications. The circumstances of discovery are dominated by otorrhea (31.57%) and retro-auricular swelling (21.05%). The clinical signs are variable and depend on the complications. The otological history badly or not treated (60.52%) remains a predictive factor of these complications. Computed tomography has a very important place in the diagnostic component. Conclusion : Cholesteatomatous otitis media is always at risk of serious complications in the absence of well-adapted treatments.Complications can be functional which blames the hearing or vital following the endocranial extension

Bone Auditory Thresholds Variations in Cholesteatoma Middle Ear Surgery

Objective: To investigate the changes of bone auditory thresholds variations in cholesteatoma middle ear surgery and its related factors and its related factors. Methods: 122 cases (122 ears) of unilateral cholesteatoma otitis media were treated by mastoidectomy and/or tympanoplasty plus stage I tympanoplasty, and tragus cartilage ring-cartilage membrane (Referred to as cartilage group, 62 ears) and temporalis muscle fascia (Referred to as fascia group, 60 ears) were used as tympanic membrane grafts respectively. The changes of bone conduction hearing threshold were compared between the two groups before and 1, 3, 6 months and 1, 3 years after operation. And compare the difference in the incidence of ossicular chain fixation or necrosis, vestibular window or cochlear window dysfunction between the two groups of patients with increased (positive) and decreased (negative) bone conduction threshold before operation. Results: Compared with the healthy side, 95 ears of 122 ears in the two groups had higher bone conduction hearing threshold before operation. Among them, 48 ears were in cartilage group and 47 ears were in fascia group; In 72 ears (76.34%) of these cases, the bone conduction hearing threshold decreased after operation, and the difference between the two groups was statistically significant (P < 0.01). During operation, 57 ears (79.17%, 57/72) were found to have ossicular chain or two windows dysfunction, including 30 ears in cartilage group and 27 ears in fascia group. Of the 27 patients with normal hearing threshold, 5 had the above-mentioned lesions, including 3 in cartilage group and 2 in fascia group. Conclusion: The improvement of bone conduction hearing threshold in patients with cholesteatoma otitis media is mainly related to the fixation or necrosis of ossicular chain and the dysfunction of two windows. The tragus cartilage ring-perichondrium tympanoplasty can not only reduce the air-bone conduction difference, but also reduce the bone conduction hearing threshold, which has the advantage of stable and lasting hearing improvement.

Investigation of EGF, IL1-α and IL-6 levels and selected hematological parameters (NLR, MPV) in patients with the chronic cholesteatomatous otitis media.

In this study we aimed to investigate epidermal growth factor (EGF), interleukin (IL1)-α and IL-6 levels, and hematological parameters in the serum samples of patients with chronic cholesteatomatous otitis media (CCOM). This prospective included 40 patients who underwent surgery due to CCOM between June 2020 and May 2021. The stage of middle ear cholesteatoma was determined on each chart using the EAONO/JOS system. The control group comprised of 30 adults who were scheduled for septoplasty over the same period in our hospital, had no otological complaints, and had normal otological findings. The demographic, clinical, and laboratory data of the patients were obtained from the electronic medical record system of our hospital. The serum EGF, IL1-α and IL-6 levels, and hematological parameters (neutrophil-lymphocyte ratio (NLR) and mean platelet volume (MPV)) were compared between the CCOM and control groups. Seven patients had Stage 1 and 33 patients had Stage 2 middle ear cholestatoma. There was no statistically significant difference between the CCOM and control groups in terms of age and gender (p=0.092 and p=0.616, respectively). The serum EGF and IL1-α levels of the CCOM group were statistically significantly higher than those of the control group (p=0.047 and p=0.013, respectively). No statistically significant difference was observed in the serum IL-6 levels of the CCOM and control groups (p=0.675). There was also no significant difference between the CCOM and control groups in terms of the mean NLR and MPV values ​​(p=0.887 and p=0.164, respectively). There was no significant difference between the Stage 1 and Stage 2 cholesteatoma subgroups in terms of the mean EGF, IL1-α, IL-6 levels (p=0.204, p=0.557 and p=0.613, respectively), and the mean NLR and MPV values (p=0.487, p=0.439, respectively). Increased serum EGF and IL1-α levels in patients with CCOM suggest that these cytokines may play a role in cholesteatomatous epithelial hyperproliferation.

Features of combined endoscopic tympanoplasty in children with chronic otitis media with cholesteatoma

Topicality: Chronic purulent otitis media is a disease that is often encountered in everyday practice by otolaryngologists. To date, the full rehabilitation of the middle ear in pediatric practice has caused much debate about the method of surgery and remains a difficult surgical task. Aim: to develop a more effective combined method of endoscopic microsurgery in children with chronic otitis media with cholesteatoma. Materials and methods: examined 52 children aged from 2 to 12 years, operated on a closed variant of tympanoplasty for cholesteatoma otitis. Patients were divided into 2 groups: 1st group (comparison), which used the standard technique of closed variant of surgery with retroauricular incision using an operating microscope (33 patients); and the 2nd group (main), where the combined surgery with retroauricular incision with the using of a microscope and endoscope and endoaural drainage of the antrum was performed in 19 patients. Results: We conducted an analysis of different types of tympanoplasty in a closed variant of tympanoplasty in children with cholesteatoma otitis and endoaural drainage of the antrum or without it. In the main group, the number of secondary engraftment of the neotympanic membrane decreased 3.4 times, residual perforations – 2.9 times, residual cholesteatoma – 2.9 times, the number of repeated operations – 3.5 times relative to the comparison group. Conclusion: At the combined surgery of cholesteatoma otitis with endoscopic support at patients of the main group the percent of residual cholesteatoma is lower. The endoaural drainage of the antrum provides additional ventilation and drainage of the reconstructed cavities of a middle ear in the early postoperative period, increases the number of primary engraftment of the neotympanic membrane and reduces the percentage of residual perforations.

Correlation of intraoperative middle ear status and hearing results in single-stage canal wall down tympanomastoidectomy with PORP\u2014a prospective study

BackgroundMastoidectomy is one of the common surgical procedures performed by the otologist. It is commonly done for cholesteatomatous chronic otitis media (CCOM) and can be performed as either canal wall up or down techniques. Most of the CCOM is associated with ossicular erosions which require ossicular chain reconstruction (OCR) which can be done either in one stage or multiple stages.A multitude of factors affects postoperative OCR results with tympanomastoidectomy. Among various factors, the status of the tympanic membrane and middle ear mucosa is quite essential. To date, there are no randomized or prospective studies assessing the integrity of pars tensa and status of the middle ear mucosa in hearing outcomes in single-stage tympanomastoidectomy using partial ossicular replacement prosthesis (PORP) in the literature. Therefore, this study is performed to correlate the integrity of pars tensa and middle ear mucosa condition with postoperative hearing results of single-stage canal wall down (CWD) tympanomastoidectomy with PORP.ResultsForty-two patients with cholesteatomatous chronic otitis media underwent single-stage canal wall down mastoidectomy (CWD) and partial ossicular replacement prosthesis (PORP) placement. The statistical analysis was done to compare the results of postoperative hearing with the intraoperative integrity of pars tensa and middle ear mucosa status. The mean pre- and postoperative air-bone gaps (ABGs) of all cases were 23.9 dB and 21 dB, respectively, with no statistically significant difference. In the pars tensa intact group, the mean pre- and postoperative ABGs were 21.5 dB and 18.5 dB, respectively, and in the pars tensa not intact group, the mean pre- and postoperative ABGs were 25.7 dB and 22.8 dB, respectively, and both groups had statistically insignificant difference. The pre- and postoperative ABGs in the healthy middle ear mucosa group were 20.7 dB and 19 dB, respectively. Similarly, the pre- and postoperative ABGs in non-healthy middle ear mucosa were 24.4 dB and 21.2 dB, respectively. The differences were not statistically significant in both groups.ConclusionThere was a statistically significant improvement in postoperative air conduction threshold (ACT) in all cases. The integrity of pars tensa and middle ear mucosa status did not affect the postoperative hearing outcome in single-stage CWD tympanomastoidecomty using PORP.

Fistulae of the Canal Lateral Due to Cholasteatomatous Otitis About 5 Cases

Our study is retrospective on 5 cases of fistulae of the lateral semi-circular duct (CSCL) complicating chronic cholesteatomatous otitis media, operated in the otolaryngology department of the CHU HASSAN II of Fez, over a period of 4 years from January 2014 to December 2017. The age of our patients ranged from 6 years to 65 years with a mean of 26 years, and a clear male predominance. The consultation period ranged from 1 year to 15 years. Othorrhea and vertigo were consistent in all our patients, combined with mixed deafness in 3 patients. The otoscopy revealed several aspects; going from image Typical a cholesteatoma of the middle ear with epidermal scales in the middle ear emerging from a perforation or a tympanic retraction pocket, or an attical cholesteatoma on a stage III retraction pocket. Ossicular lysis was evident in 3 of patients. Peripheral vestibular syndrome was noted in all of our patients. Neurological examination found a case of facial paralysis. Concerning the functional impairment; 2 of our patients had pure transmissive deafness, the remaining 03 patients had mixed deafness. Diagnosis labyrinthine fistulae has been clinically evoked and surgically confirmed. All our patients received preoperative CT scan. MRI has a complementary and fundamental role in the diagnosis of some internal ear disorders, it was requested in one patient. Treatment of fistulae (CSCL) was achieved by plugging the breach with temporal aponevrosis associated with the treatment of Chronic cholesteatomatous otitis. In our series, all our patients received general antibiotic therapy adapted to the antibiogram, 3 patients received treatment with open tympanoplasty wall down patients received tympanoplasty by closed technique. The surgical follow-ups were simple.

The Effect of Zbxz23ir-21 NANO(nanomaterials) Delivery Vector on Apoptosis and PTEN(phosphatase and tensin homolog deleted on chromosome ten)/PI3K(Intracellular phosphatidylinositol kinase)/AKT(related to the A and C kinase) in Children with CHOLESTEATOMA in Middle Ear

ABSTRACT Cholesteatoma of the middle ear is a kind of cystic disease with clear boundary formed by the abnormal growth of keratosquamous epithelium in temporal bone. Cholesteatoma otitis caused by it is a common disease in otorhinolaryngology. The EPR effect promotes the selective distribution of macromolecular substances in tumor tissues, which can increase drug efficacy. The purpose of this paper is to prepare and deliver the mir34a small molecule regulator, rubine, by nanotechnology, and to deliver it to the cells successfully. It can passively target tumor tissue through EPR effect, and play its regulatory role on miR-34a, thus inhibiting the growth of cholesteatoma cells. The effects of nano delivery on apoptosis and PIEN/P13K/AKt of children with middle ear choledochoma were tested in this paper. The experimental results were conducted on cholesteatoma cells as cell lines and balb/c nude mice as experimental objects. The expression of PTEN/PI3K/AKT in experimental group and control group was detected by immunohistochemistry. Apoptosis was discussed by cell activity detection. The physical and chemical properties, encapsulation efficiency, drug release ability in vitro and antitumor activity of nanoparticles in vitro and in vivo were studied. The results of cell level experiments in vitro showed that free RUBINE caused about 15% apoptosis, which was not different from RC NPs. The results showed that the nanoparticles could improve the expression of miR-34 in the cells, and then regulate the expression of Bcl-2, Cdk6 and CyclinD1, and play the inhibitory effect of miR-34a on the proliferation and migration of tumor cells.

Middle Ear and Mastoid Diseases: Literature Review and New Classification Proposal.

There are many classifications for cholesteatomatous otitis media but none correspond exactly to the formulation of a surgical protocol for the middle ear and mastoid nor are any specific for the extension of the otitis media, making it difficult to interpret the published results. All the available classifications are limited to the cholesteatoma and, moreover, the variety of the reported studies in literature does not allow a standardization to define middle ear pathology and surgical procedures. The aim of this paper is to propose a novel staging system for middle ear diseases paying attention to the involvement of tympanic Cavity (C), Attic (A), and Mastoid (M): the CAM classification.In particular, CAM classification is composed of three symbols (0 / + / ρ) and two letters (t and m, tiny and ivory mastoid cases) related to the alphabetic initial of the macroscopic region, being able to allow a clear and specific description of the local situation. Moreover, the possibility to describe the temporal bone and the potential use of sub-groups to specifically define the involvement of the tympanic cavity and the attic could allow the creation of a common otologic language among all the different centres.

Sensorineural Hearing Loss After Surgery to Treat Chronic Otitis Media.

We investigated the incidence of sensorineural hearing loss (SNHL) after chronic otitis media (COM) surgery and determined the associated factors. Data were collected via retrospective medical chart review. Of the 192 patients, 82 underwent tympanoplasty, 26 underwent canal wall up mastoidectomy with tympanoplasty, and 84 underwent canal wall down mastoidectomy with tympanoplasty. After surgery, the average air conduction (AC) hearing threshold improved significantly, from 125 to 1000 Hz, but the average high-frequency AC and bone conduction (BC) hearing thresholds deteriorated significantly. In 21 (11%) cases, the BC hearing threshold worsened by more than 15 dB at 4000 Hz. When we compared these 21 cases to patients in whom hearing was preserved, the former group was found to be significantly younger and had a higher frequency of cholesteatomatous otitis media. However, when comparing the severity of inflammation in patients with temporal bone computed tomography, there was no significant difference between the 2 groups. High-frequency SNHL may develop after surgery to treat COM, especially in young patients with cholesteatoma.

Bacteriological and Antibiotic Sensitivity Profile of Cholesteatomatous Otitis Media in Pediatric and Adult Population: Prevailing Scenario in Northern India.

The bacteriological and antimicrobial sensitivity profile of chronic otitis media (COM) varies from region to region and from time to time and may vary among different age group as well. It was against this backdrop of the changing bacteriological profile and sensitivity pattern together with the paucity of categorically separated data of pediatric and adult population, that the present study was undertaken. A total of 193 patients of clinical diagnosis of cholesteatomatous COM with ear discharge and positive culture results were included in the study. Pus sample was collected under aseptic conditions and cultured on solid media and broth. Isolates were identified via standard biochemical tests and sensitivity patterns analysed. Chi square (χ2) test was used to analyse the significance. Pseudomonas was the most common isolate in both the pediatric (37.80%) and adult (51.46%) population. Methicillin sensitive staph aureus (MSSA) was found exclusively in pediatric population (p = 0.003).Piperacillin-Tazobactam combination was the single most effective drug regimen overall. 75% of pseudomonas isolates in pediatric and 87.5% in adults were sensitive to this regimen in vitro. Amikacin was the next most effective drug with 56.69% sensitivity in pediatric and 64.08% sensitivity in adult population. The present study finds piperacillin-tazobactam as the most effective therapy and pseudomonas as the most common isolate in the study population.In order to address the varying and changing bacteriological and sensitivity profile of chronic otitis media occurring among different geographical regions and also within a region over time, the authors recommend its periodic evaluation.

Importance of signal intensity on T1-weighted spin-echo sequence for the diagnosis of chronic cholesteatomatous otitis.

The aim of our study was to evaluate the importance of a non-injected T1-weighted spin-echo sequence (T1WSE) combined with a non-echo-planar diffusion-weighted (non-EPDW) sequence for the pre-operative detection of cholesteatoma by the radiologist on MRI, compared to surgery. In this retrospective case review, 113 patients with chronic otitis underwent surgery (gold standard) for a clinical suspicion of cholesteatoma. Our primary outcome was to compare non-EPDW images + a contrast-free T1WSE sequence for cholesteatoma detection. Our secondary outcome was to quantify the signal intensity value of the suspected lesions, relative to the signal intensity of the cerebellum (Sic) to calculate Signal Intensity Ratios (SIR = SI/Sic). The SIR values of cholesteatomatous and non-cholesteatomatous tissue were compared to surgical findings. Receiver-operating characteristic curve analysis determined an optimum SIR cut-off value for the prediction of cholesteatoma. The sensitivity (96.9%) of non-EPDW for the diagnosis of cholesteatoma was high, with good specificity (74.2%), and increased to 85.5% when combined to a T1WSE sequence. Additionally, the mean SIR values (on T1WSE) of cholesteatoma were significantly lower than non-cholesteatomatous tissue (p < 0.05). When nonEPDW and T1WSE were combined, a cut-off SIR value < 1.04, diagnosed cholesteatoma pre-operatively with very high specificity and sensibility (92.7% and 90.3% respectively). Our study showed that combining a nonEPDW sequence with the quantitative analysis of contrast-free T1W SE sequence in pre-operative patients enables the correct diagnosis of cholesteatoma with good sensitivity and specificity (> 90%) and reduces risks of false-positive cases for surgeons.

Comparison of surgical outcomes in tympanoplasty with and without cortical mastoidectomy in non cholesteatomatous chronic otitis media with subtotal perforation

Comparison of surgical outcomes in tympanoplasty with and without cortical mastoidectomy in non cholesteatomatous chronic otitis media with subtotal perforation

A case of recurrent cholesteatoma otitis media accompanied by intraoperative cerebrospinal fluid leakage and postoperative bacterial meningitis

A case of recurrent cholesteatoma otitis media accompanied by intraoperative cerebrospinal fluid leakage and postoperative bacterial meningitis

A Case of Bacterial Meningitis Caused by Cholesteatoma Otitis Media

A Case of Bacterial Meningitis Caused by Cholesteatoma Otitis Media

Chemically Assisted Dissection With Sodium 2-Mercaptoethanesulfonate (MESNA) in the Surgical Management of Pediatric Cholesteatoma.

To evaluate the effectiveness of the chemically assisted dissection with sodium 2-mercaptoethanesulfonate (MESNA), in the reduction of residual and recurrent cholesteatoma after mastoidectomy in children with chronic cholesteatomatous otitis media (CCOM). Retrospective case-control study. Tertiary referral center. One hundred forty mastoidectomies performed in patients under 18 years of age for the treatment of CCOM. Chemically assisted dissection (CAD) with MESNA compared with surgical dissection without MESNA. Recidivism of cholesteatoma (recurrence and residual disease), variations in the average of bone conduction threshold after treatment, and complications. Recidivism of cholesteatoma was significantly lower when CAD with MESNA was used (p < 0.0001). No difference was found in the mean variation of the average of bone conduction thresholds between the groups, confirming its safety profile regarding auditory function. Meatoplasty stenosis after surgery was more prevalent within CAD with MESNA group (p: 0.049). Recurrent and residual cholesteatoma remains a problem, especially in children and despite surgical techniques such as canal wall down mastoidectomy and endoscopic ear surgery. CAD with MESNA can be safe and effective to reduce recurrence rates. Multicenter and prospective studies with larger number of patients are needed to validate these findings. The higher rate of meatoplasty stenosis after CAD with MESNA merits additional clinical research to confirm these findings, as well as in vitro studies evaluating the effect of the drug on the activity of fibroblasts and other growth factors that may be involved.

Comparison of surgical field visibility during propofol or desflurane anesthesia for middle ear microsurgery

BackgroundTo compare surgical field visibility between patients given propofol/remifentanil (PR) or desflurane/remifentanil (DR) anesthesia.MethodsA total of 80 adult patients undergoing middle ear microsurgery due to cholesteatoma otitis media with American Society of Anesthesiologists physical status I and II were randomly assigned to the PR or DR groups. The depth of anesthesia was titrated to maintain a Bispectral index (BIS) between 40 and 50. Remifentanil was titrated to maintain the mean blood pressure within ±30% change of the pre-induction value. Surgical field visibility was rated at several timepoints by the surgeons using the Boezaart scores.ResultsAverage Boezaart scores for surgical field visibility at different time points were < 2 in both PR and DR groups. Surgical field visibility score was lower in the PR group than in the DR group. Requirement for remifentanil was higher in the PR group (850 (488/1330) μg) than in the DR group (258 (143/399) μg, P < 0.0001). The site effect concentration of remifentanil was higher in the PR group (3.6(2.8/5.0)ng/ml) than in the DR group (1.7 (1.0/1.6) ng/ml, P < 0.0001). Hemodynamic profile (i.e., heart rate and mean blood pressure) was similar between groups (P > 0.05). Extubation time (PR group, 21 min vs. DR group, 19 min; P = 0.199) and post-anesthesia care unit time (PR group, 37 min vs. DR group, 34 min; P = 0.324) were comparable between groups.ConclusionAlthough PR anesthesia resulted in lower surgical field visibility scores than DR anesthesia, both groups had scores < 2, meaning no clinical differences between the two groups. DR provided acceptable operative conditions as well, albeit more remifentanil consumption was noted in the DR group.Trial registrationChina Clinical Research Information Service, ChiCTR-1,800,015,537. Registered 5 April 2018. Date of enrolment of the first participant to the trial: 2 May 2018.

Chronic Otitis Media with Granulation Is a Poor Prognostic Factor for Hearing Improvement and Development of Intracranial Complications

Different types of chronic otitis media are distinguished based on the observed lesions in the middle ear mucous. Hearing improvement is a measurable effect of the surgical treatment of patients with chronic otitis media. Chronic cholesteatoma otitis media and chronic otitis media with inflammatory granulation have a tendency to damage the bone tissue, leading to the development of intratemporal and intracranial complications. A prospective analysis of patients who underwent surgery for the first time due to chronic otitis media from 2009 to 2012 was performed. Patients were divided into groups according to the abnormalities of the middle ear mucous observed during otosurgery. Special attention was given to patients diagnosed with chronic otitis media with inflammatory granulation and chronic cholesteatoma otitis media, which are characterized by a tendency to damage the bone tissue. A total of 293 individuals met the criteria for inclusion in the study. The analysis showed that chronic otitis media with inflammatory granulation had an unfavorable effect on hearing improvement prognosticated postoperatively. Defects in the middle cranial fossa were observed to occur five times more often than defects in the posterior cranial fossa. These defects were usually observed with granulation tissue and rarely with the concurrence of cholesteatoma and granulation tissue. The presence of granulation tissue is an unfavorable prognostic factor for improvement in air and bone conduction. The probability of exposing the dura mater of the brain is higher in cases with granulation tissue than in cases with cholesteatoma.