Chronic Adhesive Otitis Research Articles

Treatment of Serous Otitis Media

Serous otitis media is a serosal inflammation of the mucous membrane of the auditory tube and the tympanic cavity which develops on the background of Eustachian tube dysfunction. It is characterized by the presence of seromucous exudate in the tympanic cavity. The disease occurs more often in children than adults.
 The objective of the research was to compare the effectiveness of different methods of treating serous otitis media.
 Materials and methods. The study included 46 patients with serous otitis media at the age of 22-55 years. There were 26 females and 20 males who were treated as inpatients and outpatients in the department of microsurgery of ENT-organs in Ivano-Frankivsk Central City Clinical Hospital during 2012-2016. Disease duration ranged from 10-15 days to 1 month. In all the patients, serous otitis media developed on the background of persistent allergic rhinitis. All the patients underwent comprehensive examination: their complaints as well as anamnestic data were analyzed, ENT examination including the endoscopic examination of the nasal cavity and the nasopharynx, otoscopy, audiometry, impedancemetry and laboratory investigations was performed. All patients were divided into 2 groups: Group I included 21 patients receiving conservative therapy for allergic rhinitis and serous otitis media; Group II comprised 25 patients receiving conservative therapy for allergic rhinitis and treatment of serous otitis media applying myringotomy and bypass surgery of the tympanic cavity.
 Results. The analysis of the study revealed that in 9 patients of Group I, an improvement in hearing occurred on the third-fourth days after treatment. In 12 patients, treatment was ineffective. 14 patients of Group II who underwent myringotomy with the evacuation of the fluid from the tympanic cavity and subsequent injection of glucocorticoids into the tympanic cavity noted an improvement in hearing immediately after the procedure or the day after. In 11 patients of Group II, a thick mucous exudate was obtained during myringotomy. These patients underwent bypass surgery. The shunt was removed after a thorough cleaning of the tympanic cavity as well as the restoration of the auditory tube function.
 Conclusions. Myringotomy is more effective and rational method of treating serous otitis media. Myringotomy with subsequent bypass surgery is recommended for patients with a thick mucous exudate in the tympanic cavity in order to prevent chronic adhesive otitis as well as to perform a complete sanation of the tympanic cavity and to restore the auditory tube function.

Impact of pharyngofixation in cleft palate repair surgery on the development of chronic adhesive otitis media.

A significant percentage of children with cleft palate suffer from otitis media with effusion and its consequences, such as deafness, chronic adhesive otitis and cholesteatoma. This study aimed to determine whether these effects can be minimised by selecting pharyngofixation as the surgical technique for cleft palate correction. A retrospective study was performed of 155 patients (308 ears) who underwent surgery from age 5 months to 8 years and were followed up for 36-84 months. In all, 125 ears (41 per cent) had epitympanic retraction, 45 ears (14 per cent) had sinus tympani retraction and 5 patients (3 per cent) had cholesteatoma. Use of the pharyngofixation technique did not significantly correlate with (1) the severity of otological findings or (2) the incidence of retraction pockets in the epitympanum and sinus tympani (p = 0.53). Pharyngofixation did not significantly alter the severity of long-term otological findings.

Clinico-audio-radiological and operative evaluation of otitis media with effusion

Aims: Otitis media with effusion (OME) is a common cause of hearing and speech impairment in children. The correlation of the clinical, audiological, radiological, and intraoperative findings was carried out so as to make a protocol for early diagnosis and management of OME. It will help prevent the more serious sequelae of OME such as tympanosclerosis, chronic adhesive otitis media, and even chronic suppurative otitis media. Methods: 300 clinically diagnosed patients of OME were studied prospectively. Thereafter, patients underwent impedance audiometry, pure tone audiometry, and X-ray soft tissue nasopharynx for adenoids. The patients were given adequate medical treatment for 3 to 6 months, and the patients who did not respond to the treatment were subjected to adenoidectomy with ear examination under magnification and myringotomy with or without grommet insertion. Results: The mean age at presentation was 5.96 years. Only 32% patients gave a history of hearing loss. About 90% patients had mouth breathing, followed by snoring (84%). About 79% ears had abnormal tympanic membrane appearance and mobility; 65.5% had an abnormality on impedance audiometry; and 69.75% had an air condition threshold level of >20 dB. About 78% patients had either Grade III or Grade IV Adenoid hypertrophy. Adenoidectomy was done in all 300 patients with myringotomy in 472 ears. Grommets were inserted in 365 ears. There was a significant reduction in mean air conduction threshold with an improvement of 8.0 dB and 7.5 dB in right and left ears, respectively at 2 months postoperatively. At 6 th month postoperative, the average improvement from baseline dropped to 6.0 dB in right ear and 5.5 dB in the left ear. Conclusion: OME is the most frequent causes of silent hearing impairment in young children which needs a close vigil. All suspected children (on clinical and otoscopic findings) must be subjected to impedance audiometry and X-ray soft tissue nasopharynx for adenoids. After the failure of medical treatment for 3-6 months, the child should be subjected to myringotomy with adenoidectomy in the same sitting. Whenever a child is planned for tonsil or adenoid surgery, he/she must undergo evaluation for OME beforehand so that the child's hearing risk can be simultaneously taken care of in the same sitting.

Otite adhésive

Chronic adhesive otitis is the final stage of the pars tensa atelectasis. It should be differentiated from the fibro-adhesive otitis which results from chronic mucosal inflammation in the tympanic cavity, which leads to productive fibrosis in the middle ear cavity. The pathogenesis of chronic adhesive otitis is complex and it has not been completely explained yet. Its therapeutic management is essentially preventive, consisting in early treatment of the tympanic membrane retraction.

Gas exchange function through the mastoid mucosa in ears after surgery.

Gas exchange function through the mastoid mucosa was investigated in ears after surgery using nitrous oxide. Increase in the mastoid pressure was assessed by a micropressure sensor placed in the mastoid cavity during the second-stage revision operation performed under general anesthesia using 67% nitrous oxide, 33% oxygen, and sevoflurane on 14 ears with chronic adhesive otitis media or cholesteatoma as well as on seven ears without inflammation as controls. All seven control ears showed pressure increase in the mastoid in various degrees. In the 14 postoperative ears, nine of the 10 ears on which the mastoid mucosa had previously been able to be preserved in various degrees showed pressure increase in the mastoid, but none of the remaining four ears, which had previously had mastoidectomy, showed any pressure increase. The presence or absence of the mastoid pressure increase of those ears was also found to be correlated well with the presence or absence of mastoid aeration on computed tomography examined just before the second-stage operation. These results appear to indicate that, in ears after surgery, recovery of both the gas exchange function and aeration in the mastoid is expected only when the mastoid mucosa can be preserved even partially.

The effectiveness of the intentional lateralization of the tympanic membrane for the treatment of chronic adhesive otitis media

The effectiveness of the intentional lateralization of the tympanic membrane for the treatment of chronic adhesive otitis media

Assessment of the gas exchange function of the middle ear using nitrous oxide. A preliminary study.

A method for assessing the gas exchange through the middle ear (ME) mucosa using nitrous oxide is introduced. Increases in the ME pressure was determined by a tympanogram or a micropressure sensor inserted into the mastoid cavity during ear surgery under general anesthesia using 67% nitrous oxide, 33% oxygen, and sevoflurane on 30 normal ears, 12 ears with otitis media with effusion (OME), and 3 postoperative ears with chronic adhesive otitis media or cholesteatoma. All the 30 normal ears except one showed varying pressure increase, and an inverse correlation was observed between pressure increase and area of mastoid on radiographs. Pressure increase was observed in 6 (50%) ears with OME, and this finding correlated well with the presence or absence of air space in the ME on computed tomography images examined preoperatively, on ears which had ear surgery, the presence or absence of pressure increase correlated with the degree of previous surgical intervention on the mastoid. The rationale and possibility of clinical application of this method is discussed.

Surgery of chronic adhesive otitis media.

The results of tympanoplasty operations in 55 ears with chronic adhesive otitis media were analysed. In 34% of the ears, the tympanic cavity was found to be aerated on follow-up examination. Hearing improved significantly in only 13 ears (24%). There were severe complications of surgery in two ears (3.6%): one ear became totally deaf and an iatrogenic cholesteatoma developed in the other. Because of these poor results, tympanoplasty is not recommended in the treatment of chronic adhesive otitis media.

Postinflammatory ossicular fixation: CT analysis with surgical correlation.

Postinflammatory ossicular fixation is a common problem encountered by the otologic surgeon upon exploration because of conductive hearing loss in patients with chronic otitis media. These nonotosclerotic noncongenital lesions take three pathologic forms: fibrous tissue fixation (chronic adhesive otitis media), hyalinization of collagen (tympanosclerosis), and new bone formation (fibro-osseous sclerosis). Fibrous tissue fixation appears on CT as nonbony, noncalcific soft-tissue debris encasing some or all of the ossicular chain. Tympanosclerosis appears as unifocal or multifocal punctate or weblike calcifications in the middle ear cavity or on the tympanic membrane. This debris may be in direct apposition to the ossicular chain or may replace the suspensory ligaments in symptomatic patients. New bone formation has been identified only in the attic and is the least common manifestation. Thick bony webs or generalized bony encasement may be present at CT. More than 300 patients with the clinical diagnosis of chronic otitis media have been examined. This study encompasses 23 proved cases.

Permanent middle-ear aeration.

A new method using a flanged silicone-rubber (Silastic) tube inserted through a hole in the bony external canal, has been developed in an effort to create a permanent air-containing middle ear space. This method may be indicated when there is persistent and refractory malfunction or nonfunction of the eustachian tube in the following conditions: (1) chronic secretory otitis media; (2) chronic adhesive otitis media; (3) atrophic tympanic membranes that will not hold an indwelling pressure-equalizing tube; and (4) during or following tympanoplasty procedures for chronic suppurative otitis media.

Results of Tympanoplasty in Chronic Adhesive Otitis Media

Results of Tympanoplasty in Chronic Adhesive Otitis Media

Tympanoplasty for bony ossicular fixation.

Of 686 patients who underwent tympanoplasty, 45 had nonotosclerotic bony fixation of the ossicular chain (malleus, 17; incus, 10; stapes, 4; malleus and incus, 11; all ossicles, 1). Two patients had bony fixation of autografts. The incus and malleus may be fixed in various sites in the epitympanum. The most common causes were cholesteatoma and sequelae of otitis, in particular, of mastoidectomy. Bony fixation was also found as a mild solitary congenital anomaly, in atresia of the auditory meatus, traumatic ossicular dislocation due to fracture of the petrous portion of the temporal bone, tympanosclerosis, chronic adhesive otitis media, and chronic granulating otitis.

Middle ear pressures in eustachian tube malfunction: manometric studies.

AbstractWe made direct measurements of the difference in pressure between the middle ear and the ambient atmosphere in 300 ears affected with chronic adhesive otitis media (CAOM), serous otitis media (SOM), and similar disorders of the ear caused by eustachian tube malfunction.We utilized a narrow bore, open U‐tube manometer made of No. 205 polyethylene tubing which was connected to a 20 or 22 gauge spinal needle. The needle was passed through the intact tympanic membrane and the displacement of the column of 95 percent alcohol in the manometer was noted and recorded.Our results showed that in 101 ears with CAOM, the average negative pressure difference between the middle ear and the ambient atmosphere was 9 mm 95 percent alcohol, equivalent to 7 mm of H2O.In 136 ears with SOM, the average negative middle ear pressure was 8 mm 95 percent alcohol, equivalent to 6.5 mm H2O.In 80 of the 300 diseased ears we tested, the middle and ambient atmospheric pressures were equal.Direct readings of the middle ear pressure tell us the status of the middle ear ventilation at the moment of the measurement.

Density of mucous glands in chronic adhesive otitis media

In the course of tympanoplasty on 48 ears with chronic adhesive otitis media 600 mucosal biopsies were taken, stained by the PAS-alcian blue whole-mount method, and the density of mucous glands in the middle-ear mucosa was determined quantitatively. The mean density proved to be high, 4.4 glands/mm2, ranging from 1 to 16.7 glands/mm2. The glands were studied in 15 different localities of the middle ear, and in each locality the density was determined. It was highest in the round window niche, around the chorda tympani, and in the adhesions around the stapes. The distribution of the glands was irregular, the density varying widely within the various localities. Differential counts showed that 11% of the glands were still active with well-preserved secretory epithelium, whereas the remainder were inactive, either transitional varieties or completely degenerated glands. Quantitative studies of the glands revealed that the mucous glands produce the tenacious mucous secretion found in the middle ear in chronic secretory otitis, that all glands are primarily active, that gradually they degenerate and become inactive, whereupon gradual improvement of the condition occurs spontaneously, provided that adhesive changes have not arisen already.

Tympanoplasty in chronic adhesive otitis media.

The results of tympanoplasty on 56 patients with chronic adhesive otitis media are presented. the principle of the method was radical removal of the diseased parts of the drum, preservation of the mucosa, inspection and opening of the tubal orifice with bougienage of the tube, mobilization of the ossicles, ossiculoplasties increasing the height of the tympanic cavity, insertion of silastic film around the stapes, and tubulation. the mean hearing gain in the frequency range 500-2 000 cps 3-9 months after the operation was 23.5 dB, postoperative hearing 35 dB and air-bone gap 15.6 dB. in 80% of the cases the tympanoplasty proved successful, and 86% of the patients obtained a hearing gain exceeding 10 dB. the most favourable results were observed in cases tubulated at the time of the tympanoplasty. the results are analysed in relation to tubal passage, assessed by the Valsalva manoeuvre before and after the operation. the best results were obtained when the tube was passable before and after the operation in...

Permanent middle ear aeration.

A new method using a flanged silicone-rubber (Silastic) tube inserted through a hole in the bony external canal, has been developed in an effort to create a permanent air-containing middle ear space. This method may be indicated when there is persistent and refractory malfunction or nonfunction of the eustachian tube in the following conditions: (1) chronic secretory otitis media; (2) chronic adhesive otitis media; (3) atrophic tympanic membranes that will not hold an indwelling pressure-equalizing tube; and (4) during or following tympanoplasty procedures for chronic suppurative otitis media.

Otitis media and its complications (1967 and 1968).

THE purpose of this review of selected articles is to stress the need for otolaryngologists to continually reexamine their concepts of middle ear disease in the light of the current literature and to stimulate effective research in deficient areas. The close follow-up of hearing problems detected in pediatric populations will provide one of our best sources of information concerning the diagnosis, therapy, and prognosis in cases of otitis media. Serous Otitis Media Everberg 1 found that 288 grade-school children out of a total population of 2,700 studied had a hearing loss. Three quarters of the conductive hearing losses were due to serous otitis media. Nineteen children with serous otitis media required myringotomy for the removal of persistent tenacious middle ear fluid. Fluid analysis revealed a very high albumen content. The author suggested that this medium could encourage fibroblast proliferation leading to chronic adhesive otitis media. Comment.—This supposition was not

La Pathologie de L'Oreille Moyenne et le Travail Dans le Bruit

The deafness caused by professional noise is a professional disease in France. The problems about its prophylaxis have not yet been completely solved. Since 1957 in the Audio-Phonology Institute at Lyon work has been done as to now to the effects of the diseases of the middle ear after determinating professional deafness. These observations enabled us to assert that a chronic injury of the middle ear (chronic otorrhea, otosclerosis or adhesive otitis) is not a determinating element for a patient who is exposed to noise. These diseases of the middle ear being exposed to professional noise do not show a greater labyrinthic injury than those which are not exposed to noise.

Serous Otitis Media

Serous otitis media is arousing increasing interest among otologists, partly because the incidence of the disease seems to have grown and partly because its treatment in many cases affords difficult problems. If left untreated, it changes into chronic adhesive otitis and resultant severely impaired hearing. Treatment must be started before irreversible changes have occurred in the tympanum and the eustachian tube. Chronic cases of serous otitis media which are often refractory to all conventional therapy can be successfully treated by an indwelling plastic tube in the tympanum. The latent mastoiditis which frequently accompanies the condition must first be cured.

A STUDY ON THE IMPEDANCE OF THE MIDDLE EAR

An apparatus for the measurement of the acoustic impedance of the middle ear at the tympanic membrane was described. The measurement of fers a possibility of studying the acoustic structure of the middle ear, which contains not a single but several anti-resonance peaks. The method employed makes use of a main rigid-walled tube linked to an exponential horn with an extended tube of 4.7em length which is inserted into the auditory canal. The source of sound is attached to the main rigid-walled tube which incorporates a travelling probe microphone which is operated by a hand crank. The results of measurements in normal subjects sand in those with conduction affections exhibi. ted acoustic impedance ranging from 900 to 3000cps according to specific property of the exponential horn. The normal impedance is higher in a lower frequency range and lower in a higher frequency range, and is lower than that of otosclerotie ears with fixed stapes, chronic adhesive otitis or tubal occlusion. On the other hand the impedance of the ears with an interrupted ossicular chain is markedly low compared with that of the normal ears. Consequently, results obtained in the living subject can be applied clinically to the assessment of middle ear functions.