Chronic Ear Discharge Research Articles

SITE AND RATE OF OSSICULAR CHAIN EROSION IN PATIENTS UNDERWENT TYMPANOMASTOID SURGERY

Background: Chronic suppurative otitis media (CSOM) is a common problem affecting middle ear and it’s commonly presented with chronic ear discharge and decreased hearing. Hearing problem in CSOM is primarily caused perforated tympanic membrane and in some cases by the presence of erosion of the ossicular chain. The study aimed to show the rate and site of ossicular chain erosion in patients with chronic suppurative otitis media underwent tympanomastoid surgery. Patient and methods: a cross sectional study conducted on 87 patients performed tympanomastoid surgery for chronic middle ear infection where their ossicular status has been assessed intraoperatively. Results: our study shows that 40% of the operated ears has at least a single bone erosion and the Incus bone was the most affected ossicle while the Malleus was the least one 54% and 14% respectively. No statistically significant difference was seen between bone erosion and gender as well as the side of operation. Conclusion: ossicular erosion is a common problem affecting patient with chronic suppurative otitis media and the surgeons should be aware about this pathology and they should have the proper skill to correct such problem.

Prevalance of unsafe ear in patients presenting with chronic ear discharge

Objective: The purpose of this study was to determine the frequency of atticoantral/unsafe chronic suppurative otitis media in patients with chronic ear discharge. Materials and Methods: This Cross-sectional study was conducted in the department of ENT and Head and Neck Surgery, Hayatabad Medical Complex and Department of ENT, Naseerullah Khan Babar memorial Hospital, Peshawar from August 2018 to February 2019. In this study 199 patients were enrolled with consecutive sampling. Detailed demographic data like history and physical examination were taken from patients. All patients were subjected to detailed otoscopic examination and pure tone audiometery by a consultant. A detailed performa was designed in which all information of the patients like name, age, gender, duration of symptoms and CSOM were recorded by SPSS analysis. Results: With a standard deviation of ± 10.334, the average age of participants in this study was 29 years. There were more males than women among the patients present, with 60% of them being men. Twelve percent of patients with chronic discharge developed CSOM, compared to 90% of those who didn't have the condition at all. Conclusion: Our study shows that individuals who come with persistent ear drainage frequently have hazardous ears.

Otogenic Brain Abscess in a Child of Third World Country - A Single Stage Transcranial Transmastoid Approach: A Case Report

Brain abscess, though not rare, is an uncommon complication of otitis media. We report a case of 12 years old male for chronic ear discharge, throbbing headache and post aural swelling for three weeks. A detailed history and physical examination of the child was performed and a Magnetic Resonance Imaging (MRI) scan was done. A diagnosis of an intracranial abscess, secondary to the chronic otitis media was made. An emergency craniotomy with drainage of brain abscess was planned and performed by the Neurosurgeon. Otolaryngolgoist performed mastoidectomy, in the same setting. After the surgery, post-operative manage- ment was done and the patient was discharged, uneventfully. The complete management in a single sitting of primary cause and resulting complication with no added expenses is the necessity of a poor country citizen.

Tetanus; a dreadful complication of ear piercing, ear instrumentation and chronic otorrhea in children of Southern Punjab Pakistan.

Objective: Tetanus remains a major public health problem in the developing countries despite the availability of active immunization and passive immunization since long. Non-sterile ear piercing and instrumentation pose a constant threat of developing tetanus associated with morbidity and mortality. Study Design: Retrospective Cross-sectional study. Setting: Department of Pediatric, Bahawal Victoria Hospital Bahawalpur. Period: June 2019 to June 2022. Material & Methods: The data of children admitted with tetanus following ear piercing, ear cleaning/instrumentation and chronic ear discharge was collected. The data included their age, gender, history of ear piercing, instrumentation and chronic ear discharge (otorrhea), duration between piercing/instrumentation and development of signs & symptoms of tetanus, history of tetanus vaccination (during routine childhood EPI vaccination), history of tetanus toxoid administration after the causative event, residence, socioeconomic status, education status of parents and outcome of cases. Results: Total 17 cases of otogenic tetanus (tetanus following ear piercing, ear instrumentation and with chronic otorrhea) were admitted in pediatric department of the hospital during study period. Age range was between 03 to 13 years with mean age 7.71+2.80 years. Of these cases, there were 12 females (70.6%) and 5 males (29.4%). Nine cases developed tetanus after ear piercing, five cases developed tetanus following ear instrumentation and three cases had history of chronic ear discharge. Conclusion: Tetanus is an uncommon but dreadful complication of non-sterile ear piercing, ear instrumentation and chronic discharging ears in chronic otitis media, and is still occurring in our country.

Comparison of pre-operative temporal bone high resolution CT scan and intraoperative findings in patients with chronic suppurative otitis media

Background and objectives:To compare the findings of high resolution computed tomography of temporal bone with intraoperative findings of patients suffering from chronic suppurative otitis media. Methods:This is a prospective randomize case study which was conducted on 100 patients complaining from chronic ear discharge and hearing impairment. The study was conducted at otolaryngology department, Rizgary Teaching hospital, Erbil City-Iraq from January 2016 to December 2018. The surgical procedures were the same for all patients as mastoid exploration. Based on the intraoperative finding it was decided either to choose canal wall up mastoidectomy or canal wall down mastoidectomy procedure that to be appropriate for particular case with studying and comparing the radiological finding accordingly. Results:Of the 100 patients,47% were males and 53% females. Eighteen cases were diagnosed with cholesteatoma and 82 cases were without. The high resolution computed tomography of temporal bone offered very high sensitivity in detecting erosion of scutum (100%), semicircular canal (100%), ossicles erosion (94%), but it gave low sensitivity 33% regarding prediction of facial nerve canal dehiscence. However, the prediction of the dehiscence of the facial canal should be not excluded regardless of images show intact facial canal in high resolution CT scan. Nearly 100% specificity obtained for erosion of scutum, semicircular canal, dehiscence of facial canal and sigmoid sinus wall. Whereas it is relatively less specific for erosion of ossicles and differentiation between the cholestatoma and granulation tissue. Conclusion:We concluded that high resolution computed tomography scan of temporal bone is a golden investigation before surgery for cases of chronic suppurative otitis media to plan for the type of surgery accordingly

Antibiotic resistance in patients with chronic ear discharge awaiting surgery in Nepal

SETTING:Biratnagar Eye Hospital, Biratnagar, Nepal, which offers ear surgery for chronic suppurative otitis media (CSOM).OBJECTIVE:In patients with CSOM awaiting surgery, to determine the 1) sociodemographic characteristics 2) bacterial isolates and their antibiotic resistance patterns and 3) characteristics of those refused surgery, including antibiotic resistance.DESIGN:A cohort study using hospital data, January 2018–January 2020.RESULTS:Of 117 patients with CSOM and awaiting surgery, 64% were in the 18–35 years age group, and 79% were cross-border from India. Of 118 bacterial isolates, 80% had Pseudomonas aeruginosa and 16% had Staphylococcus aureus. All isolates showed multidrug resistance to nine of the 12 antibiotics tested. The lowest antibiotic resistance in P. aeruginosa was for vancomycin (29%) and moxifloxacin (36%), and for S. aureus, this was vancomycin (9%) and amikacin (17%). Fourteen (12%) patients underwent surgery: myringoplasty (n = 7, 50%), cortical mastoidectomy with tympanostomy (n = 4, 29%) and modified radical mastoidectomy (n = 3, 21%). Those infected with P. aeruginosa and with resistance to over six antibiotics were significantly more likely to be refused for surgery.CONCLUSION:Patients awaiting ear surgery were predominantly infected with multidrug-resistant P. aeruginosa and were consequently refused surgery. This study can help inform efforts for improving surgical uptake and introducing cross-border antimicrobial resistance surveillance.

A child’s mysterious ear

<p>Foreign body in ear is an emergency encountered by an otolaryngologist and if not removed it can lead to serious complications. Most commonly foreign body in ear is lodged in external auditory canal while it’s rare to find it in middle ear. We report a case of foreign body in the middle ear in a 3-year-old child who presented to us with chronic discharging ear who was then suspected to be unsafe ear and so was taken up for exploration under microscope. A pink polypoidal mass arising from middle ear mucosa was found and following its removal- to our surprise; a blackish rubbery debris filling the middle ear cavity and attic area along with embedded foreign body was extracted. We conclude that pediatric patients with chronic ear discharge not responding to antibiotics should raise a suspicion of FB in the middle ear and explored timely.</p>

Tubercular otomastoiditis presenting with Citelli’s abscess

<p class="abstract">Tuberculosis (TB) of the temporal bone is a rare condition. Tubercular otomastoiditis presenting with Citelli’s abscess, facial nerve palsy and extensive bone destruction is an unusual condition. As far as we know this maybe the first reported case with the above diagnosis. A 26 year old male patient presented with chronic right ear discharge, decreased hearing and right side facial nerve palsy with tender fluctuant swelling in the right post aural region approximately 10×8 cm in dimension, posterior to the mastoid tip and extending into the occipital region, almost reaching up to the midline posteriorly. High resolution computed tomography (CT) scan of temporal bone and magnetic resonance imaging (MRI) of brain was done. He underwent right side mastoid exploration and drainage of the abscess under general anaesthesia. The specimens sent for investigations revealed acid fast bacilli suggestive of <em>Mycobacterium tuberculosis</em> and the patient was started on anti-tubercular therapy. In all cases of long-standing chronic otitis media (COM) especially in those with complications, possibility of TB should be ruled out. High index of suspicion is needed for early diagnosis and treatment and to prevent dreaded complications in such patients.</p>

Role of 1.5% acetic acid irrigation and medical management in chronic persistent suppurative otitis media

<p><strong>Background</strong>: Chronic ear discharge in chronic suppurative otitis media (CSOM) persisting for more than two weeks has become difficult to treat for ENT specialists due to resistance to the available antibiotics and patient's affordability for its cost. Also, biofilms have been responsible for the disease and cause tympanic membrane perforation and deafness. The use of 1.5% acetic acid irrigation acts as an antiseptic, and altering the middle ear's pH to treat otorrhea in CSOM needs to be studied. Aim of the study to assess results of 1.5% acetic acid irrigation and topical and systemic antibiotic in CSOM and to consider the most appropriate medical management</p><p><strong>Methods</strong>: A total of 100 patients of CSOM was divided equally into two groups. Group 1 patients were treated with 1.5% acetic acid irrigation every other day, and group 2 was treated with topical and systemic antibiotics three drops’ times daily. Follow up of both groups every week up to symptomatic relief.</p><p><strong>Results</strong>: Otorrhoea resolution in the group treated with acetic acid was 88%, and healing of perforation was noted in 28 %, while the failure rate of 12%.</p><p><strong>Conclusions</strong>: Medical management of persistent CSOM with tubotympanic type by frequent aural cleaning, 1.5% acetic acid irrigation can be the more desirable choice than the topical and oral antibiotics. It is safe without any side effects and economical. Alteration of ear canal PH is one of the main factors for healing, in addition to mechanical disruption of biofilm and removal of deep-seated debris.</p><p><strong> </strong></p>

Canal wall down in tuberculosis matoiditis: 4 case series.

BackgroundTuberculosis of the ear and temporal bone is an extremely rare case.MethodsThis case series was reported using the 2020 PROCESS Guideline. The design of this study used a retrospective study during the 2017–2019 period.ResultsFour cases of tuberculosis mastoiditis with age range between 16 and 66 years from 2016 to 2019. All patients presented with chronic ear discharge from chronic ear with signs of mastoiditis with intra- and extra-temporal complications. All patients underwent radical mastoidectomy, and histopathologic examination showed tuberculosis. All patients received anti-tuberculosis drug first and second category.ConclusionClinical features of tuberculosis mastoiditis may vary. The diagnosis of tuberculosis mastoiditis can be examined through histopathologic examination and geneXpert tuberculosis. Surgical treatment and anti-tuberculosis administration are the primary choices in the management of tuberculosis mastoiditis.

Topical versus systemic antibiotics for chronic suppurative otitis media.

Topical versus systemic antibiotics for chronic suppurative otitis media.

Systemic antibiotics for chronic suppurative otitis media.

Systemic antibiotics for chronic suppurative otitis media.

UNSAFE TYPE OF CHRONIC OTITIS MEDIA, HOW PREVALENT IT IS?

Objective: To determine the frequency of unsafe type of chronic otitis media (COM) in patients with chronic ear discharge. Materials and Methods: A cross sectional study was conducted in August 2019 to May 2020 at ENT department, Khyber Teaching Hospital, Peshawar. All patients with more than 3 months history of ear discharge were included in the study. Unsafe COM was defined as persistent foul-smelling ear discharge for at least 3 months with attic or marginal perforation of the pars tensa, suspicious of cholesteatoma and granulation tissues on otoscopy/ otoendoscopy and/ or hearing loss of more than 30 dB on pure tone audiometry. Spss Version 22 was usecd for analysis. Results: Out of total 312 participants, age distribution showed 224 (72%) participants between 18-30 years, while 88(28%) between 31-60 years. Among 312 patients most of the participants 194 (62%) participants were male as compare to female 118 (38%) participants were female. Duration of symptoms showed 46 (15%) with duration of symptoms ≤6 months, 266 (85%) patients had duration of symptoms > 6 months. Mean duration of symptoms was 6 months with SD ± 4.212. Unsafe type COM was found in 44 (14%) participants and 268 (86%) patients did not have unsafe type COM. Conclusion: The frequency of unsafe type of COM is 14% among patients presenting with chronic ear discharge.

Bacteriological profile and drug sensitivity patterns in chronic suppurative otitis media patients at J. L. N. Hospital & Research Centre, Bhilai, Chhattisgarh State, India

Objective: To isolate and identify various bacterial pathogens in positive ear swab cultures of CSOM cases and to determine the antibiotic sensitivity pattern of different bacterial species identified. Study design: Prospective study Setting: J. L. N. Hospital & Research Centre, Bhilai (C.G). Materials and Method: The study was done on the population of Bhilai and surrounding region. A sample size of 120 cases attending the ENT OPD with the diagnosis of Chronic Suppurative Otitis Media and active ear discharge were included in the study. Detailed history, general physical examination, local systemic examination was done along with aural swab for Gram’s staining and aerobic bacterial culture and drug sensitivity . The data were then compared with the relevant & available literature. Results: Most of the patients were in the age group of 11-20 years (38.33%), followed by 21-30 years age group (31.67%). More males (60%) were affected by the disease than females (40%). Unilateral (59.16%) infection was more common than bilateral (40.83%). Incidence of monobacterial (90%) etiology was more common than polymicrobial (9.1%). Staphylococcus aureus 67 (51.53%) was the most commonly isolated bacteria followed by the Pseudomonas 26 (20%). Antibiogram showed the most effective drugs in the present study are clindamycin, cotrimoxazole, ciprofloxacin, amikacin, chloramphenicol and ceftazidime Conclusion: Staphylococcus aureus is the most common pathogen isolated, followed by Pseudomonas. Clindamycin was the most effective antibiotic followed by cotrimoxazole, ciprofloxacin, amikacin, chloramphenicol and ceftazidime. Antibiotic sensitivity of the organisms varies according to geographical area and local practice regarding the choice of antibiotics. A continuous and periodic evaluation of microbiological pattern and their antibiotic sensitivity pattern in local area is helpful in prescribing empirical antibiotics for successful treatment of otitis media and thus minimi

Aural toilet (ear cleaning) for chronic suppurative otitis media.

Aural toilet (ear cleaning) for chronic suppurative otitis media.

Topical antibiotics with steroids for chronic suppurative otitis media.

Topical antibiotics with steroids for chronic suppurative otitis media.

A study on status of contralateral ear in unilateral chronic suppurative otitis media

Aims and ObjectivesStudying the anatomical and functional changes in contralateral ear with unilateral chronic suppurative otitis media.Comparing the findings in contralateral ear with squamous and mucosal type of chronic suppurative otitis media.Materials and Methods: 100 patients in age group between 15 years and 50 years, with unilateral chronic ear discharge consulting department of ENT at Dr VRK Womens Medical College were evaluated from November 2018 to May 2020.Clinical examination and audio logical evaluation were done for all patients. Procedure like Diagnostic nasal endoscopy, Otoendoscopy, Otomicroscopy and radiological evaluation were also included.Results: Out of 100 patients most (90) of the patients were tubotympanic type and few (10) were atticoantral type of CSOM. Contralateral ear finding of TTD type of CSOM were retraction of tympanic membrane, tympanoscerosis and thin membrane. Contralateral ear finding of AAD type of CSOM were retraction of tympanic membrane, granulation tissue. Patient had conductive hearing loss in the contralateral ear. Radiologically also had a evidence of disease in the contralateral ear.Conclusion: Patients with COM in one ear are more likely to develop some degree of disease in the contralateral ear. The results of this study showed that we should not consider COM as a disease limited to one ear because in many cases the occurrence of this disease can affect both ears. This issue should always be clarified in patients in order to achieve effective therapeutic planning. Consequently, the contralateral ear should always be evaluated comprehensively in patients with unilateral COM to efficiently diagnose any alterations and, provide timely therapeutic intervention.

Comparision of Allogenic Cartilage and Autologous Cortical Bone in Ossicular Reconstruction: A Comparative Study.

Ossicular discontinuity is the most common cause of conductive hearing loss. The use of ossicular graft material in ossicular chain reconstruction significantly improves the result in hearing. This study was conducted to compare and analyze the outcome of ossicular reconstruction using allogenic septal spur cartilage and autologous cortical bone in terms of hearing results and graft uptake rates. Study design: randomized clinical trial. Study included 112 patients visiting our ENT department. Patients between 16 and 50years of age with history of chronic ear discharge and air-bone-gap (ABG) of > 35dB and ossicular involvement were included in the study. The patients underwent detailed ENT examination, audiological and radiological assessment of temporal bone and those patients with evidence of ossicular erosion were subjected to ossiculoplasty with allogenic septal spur cartilage (group I) and autologous cortical bone (group II) randomly. The patients were followed up to 6months to analyze functional and anatomical results. 50 patients out of 56 patients (90%) from group I who underwent allogenic septal cartilage ossicular reconstruction showed significant improvement in hearing as assessed by pure tone audiogram after 3months and 6months. Remaining 10% of patients who did not show hearing improvement on PTA were reopened after 6months. It was observed that the stapes head got necrosed in them. 40 patients (72%) out of 56 patients (50%) from group II who underwent autologous cortical bone reconstruction showed hearing improvement. Remaining 16 patients (28%) showed no hearing improvement. They were reopened and ankylosis, dislocation of ossicle and extrusion were noted. In our study, graft uptake rates, formation of retraction pockets, and hearing improvements were analyzed. Complications like ankylosis formation, dislocation of ossicle and extrusion rates were more in the group II compared to group I. Hearing results of group I are better compared to group II and the allogenic septal cartilage being readily available is a good option for ossicular reconstruction.

Otogenic abscess: rarity and reality

Introduction: Otogenic abscess is a complication commonly arising from active squamous chronic otitis media. It is rare (1:10000) but in fact are a dangerous reality to be managed promptly. Materials and Methods: A retrospective study of 82 cases of otogenic abscesses were studied over a period 24 years by simple random sampling. Cases of ear malignancy, previously operated mastoidectomy were excluded from study. All postop cases were analysed. Result: Most commonly affected were male (63.4%) in the second decade (34.1%) of life. Commonest bacterial infection was staphylococcus aureus (31.7%). Conclusion: Otogenic abscess though rare, are a reality and should be suspected when the patient with chronic ear discharge has high grade fever, severe headache and does not respond to best medical line of treatment. All these patients were subjected to imaging neurosurgical I&D of brain abscess followed by canal wall down tympano-mastoidectomy.

Topical antiseptics for chronic suppurative otitis media.

Chronic suppurative otitis media (CSOM), sometimes referred to as chronic otitis media (COM), is a chronic inflammation and infection of the middle ear and mastoid cavity, characterised by ear discharge (otorrhoea) through a perforated tympanic membrane. The predominant symptoms of CSOM are ear discharge and hearing loss. Topical antiseptics, one of the possible treatments for CSOM, inhibit the micro-organisms that may be responsible for the infection. Antiseptics can be used alone or in addition to other treatments for CSOM, such as antibiotics or ear cleaning (aural toileting). Antiseptics or their application can cause irritation of the skin of the outer ear, manifesting as discomfort, pain or itching. Some antiseptics (such as alcohol) may have the potential to be toxic to the inner ear (ototoxicity), with a possible increased risk of causing sensorineural hearing loss, dizziness or tinnitus. To assess the effects of topical antiseptics for people with chronic suppurative otitis media. The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Central Register of Controlled Trials (CENTRAL; 2019, Issue 4, via the Cochrane Register of Studies); Ovid MEDLINE; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 1 April 2019. We included randomised controlled trials (RCTs) with at least a one-week follow-up involving patients (adults and children) who had chronic ear discharge of unknown cause or CSOM, where the ear discharge had continued for more than two weeks. The interventions were any single, or combination of, topical antiseptic agent of any class, applied directly into the ear canal as ear drops, powders or irrigations, or as part of an aural toileting procedure. Two main comparisons were topical antiseptics compared to: a) placebo or no intervention; and b) another topical antiseptic (e.g. topical antiseptic A versus topical antiseptic B). Within each comparison we separated studies where both groups of patients had received topical antiseptics a) alone or with aural toileting and b) on top of antibiotic treatment. We used the standard Cochrane methodological procedures. We used GRADE to assess the certainty of the evidence for each outcome. Our primary outcomes were: resolution of ear discharge or 'dry ear' (whether otoscopically confirmed or not), measured at between one week and up to two weeks, two weeks to up to four weeks, and after four weeks; health-related quality of life using a validated instrument; ear pain (otalgia) or discomfort or local irritation. Secondary outcomes included hearing, serious complications and ototoxicity measured in several ways. Five studies were included. It was not possible to calculate the total number of participants as two studies only provided the number of ears included in the study. A. Topical antiseptic (boric acid) versus placebo or no treatment (all patients had aural toileting) Three studies compared topical antiseptics with no treatment, with one study reporting results we could use (254 children; cluster-RCT). This compared the instillation of boric acid in alcohol drops versus no ear drops for one month (both arms used daily dry mopping). We made adjustments to the data to account for the intra-cluster correlation. The very low certainty of the evidence means it is uncertain whether or not treatment with an antiseptic leads to an increase in resolution of ear discharge at both four weeks (risk ratio (RR) 1.94, 95% confidence interval (CI) 1.20 to 3.16; 174 participants) and at three to four months (RR 1.73, 95% CI 1.21 to 2.47; 180 participants). This study narratively described no differences in suspected ototoxicity or hearing outcomes between the arms (very low-certainty evidence). None of the studies reported results for health-related quality of life, adverse effects or serious complications. B. Topical antiseptic A versus topical antiseptic B Two studies compared different antiseptics but only one (93 participants), comparing a single instillation of boric acid powder with daily acetic acid ear drops, provided any information for this comparison. The very low certainty of the evidence means that it is uncertain whether more patients had resolution of ear discharge with boric acid powder compared to acetic acid at four weeks (RR 2.61, 95% CI 1.51 to 4.53; 93 participants), or whether there was a difference between the arms with respect to ear discomfort due to the low number of reported events (RR 0.10, 95% CI 0.01 to 1.81; 93 participants). Narratively, the study reported no difference in hearing outcomes between the groups. None of the included studies reported any of the other primary or secondary outcomes. Due to paucity of the evidence and the very low certainty of that which is available the effectiveness and safety profile of antiseptics in the treatment of CSOM is uncertain.