Chronic Otitis Media Patients Research Articles

Correlation between interleukin 17 (IL-17) levels and malondialdehyde (MDA) levels in patients with chronic suppurative otitis media

Background: Otitis media is one of the most common causes of fever in the pediatric population. CSOM or also called chronic otitis media is an ear disease condition where a chronic infection is found in the middle ear without an intact tympanic membrane. Oxygen free radical levels and deficiency of antioxidant defense complexes may be involved in the pathogenesis of chronic suppurative otitis media. The IL-17 pathway plays an important role in the pathogenesis of otitis media by increasing ROS including MDA levels. Purpose: To analyze the levels of interleukin 17 (IL-17) and malondialdehyde (MDA) in chronic suppurative otitis media patients. Method: Analytical observational research with a cross sectional approach was conducted in December 2022 at RSUD Dr. Moewardi, the research sample was a patient with chronic suppurative otitis media without active phase cholesteatoma. Sampling used consecutive sampling, namely a non-random sampling method, so that a sample size of 40 participants was obtained, divided into two groups, namely the CSOM group and the healthy group. The data analysis used is univariate and bivariate analysis using parametric tests, namely the product moment correlation test and if it is not normally distributed (p-value <0.05) then use the Spearman rank correlation test. Results: The mean IL-17 level in the CSOM group was 78.76 ± 28.01 and the healthy group was 47.68 ± 21.75 with p = 0.000 < 0.05. The mean MDA value in the CSOM group was 138.37 ± 123.96 and in the healthy group was 55.84 ± 47.37 with a p value = 0.008 < 0.05. Because the p value is <0.05 for the IL-7 and MDA variables, there is a significant difference between CSOM and the group of healthy people. The product moment correlation test obtained a correlation coefficient value of 0.623 with a p value = 0.000. Because the p value is <0.05, there is a significant positive relationship between IL-17 levels and MDA in the blood of chronic suppurative otitis media (CSOM) patients. Conclusion: There is a significant positive relationship between IL-17 levels and MDA in the blood of chronic suppurative otitis media (CSOM) patients.

Hearing Recovery Prediction for Patients with Chronic Otitis Media Who Underwent Canal-Wall-Down Mastoidectomy.

Background: Chronic otitis media affects approximately 2% of the global population, causing significant hearing loss and diminishing the quality of life. However, there is a lack of studies focusing on outcome prediction for otitis media patients undergoing canal-wall-down mastoidectomy. Methods: This study proposes a recovery prediction model for chronic otitis media patients undergoing canal-wall-down mastoidectomy, utilizing data from 298 patients treated at Korea University Ansan Hospital between March 2007 and August 2020. Various machine learning techniques, including logistic regression, decision tree, random forest, support vector machine (SVM), extreme gradient boosting (XGBoost), and light gradient boosting machine (light GBM), were employed. Results: The light GBM model achieved a predictive value (PPV) of 0.6945, the decision tree algorithm showed a sensitivity of 0.7574 and an F1 score of 0.6751, and the light GBM algorithm demonstrated the highest AUC-ROC values of 0.7749 for each model. XGBoost had the most efficient PR-AUC curve, with a value of 0.7196. Conclusions: This study presents the first predictive model for chronic otitis media patients undergoing canal-wall-down mastoidectomy. The findings underscore the potential of machine learning techniques in predicting hearing recovery outcomes in this population, offering valuable insights for personalized treatment strategies and improving patient care.

1,8-Cineol Attenuates Checkpoint Molecule PDL-1 and Adhesion Molecule CX3CR1 in Circulating Monocytes in Otitis Media Patients.

Peripheral blood monocytes can be subdivided into different subsets based on the CD14/CD16 surface characteristics. Monocytes are a major source of cytokine secretion of pro-inflammatory immune responses, whereas CD16+ monocyte subsets can also contribute to persistent inflammation in the context of chronic diseases. However, the regulation and cellular characteristics of circulating monocyte subsets in patients with chronic otitis media (COM), one of the largest public health burdens, remains largely unknown. In this study, we analyzed individual distributions of circulating monocyte subsets and associated protein expression levels of adhesion protein and chemokine receptors CD11a (integrin-α L; LFA-1), CD11b (integrin-α M; Mac-1), and CD11c (integrin-α X), CX3CR1 (CX3CL1 receptor), as well as checkpoint molecule PD-L1 (programmed cell death ligand-1), in a gender-balanced cohort of 14 patients with chronic otitis media using flow cytometry, especially in view of the therapeutic impact of the natural plant-derived monoterpene oxide 1,8-Cineol. Furthermore, using the human monocyte cell line THP-1 as a model, we investigated the influence of anti-inflammatory 1,8-Cineol on monocytic cytokine secretion patterns using human cytokine arrays and ELISA measurements. The data revealed significantly elevated expression levels of all analyzed adhesion molecules in certain monocyte subsets in COM patients; CX3CR1 was especially significantly down-regulated in response to 1,8-Cineol administration. Moreover, the data revealed significantly increased monocytic PD-L1 expression levels in circulating classical and intermediate monocyte subsets from COM patients compared to healthy donors, but also a significant decrease in PD-L1 in intermediate monocytes upon 1,8-Cineol therapy compared to the pre-treatment situation. Furthermore, the increased secretion of cytokine CXCL10 by THP-1 monocytes in response to LPS was found to be strongly attenuated by 1,8-Cineol. Plasma levels of CXCL10 were also significantly increased in COM patients, but no significant differences between the pre and post 1,8-Cineol situation were observed. The present study revealed new insights into the bioactive anti-inflammatory effects of 1,8-Cineol in terms of monocyte adhesion and immune regulation. Our data suggest the potential role of cytokine CXCL10 in COM development and maintenance, which is also involved in the activity of its concomitant disease, rheumatoid arthritis.

Bone mineral density of the incus body and long process in patients with chronic otitis media and its relationship with functional outcome in type II tympanoplasty

Background Inflammatory conditions such as chronic otitis media (COM) can cause irreversible impairments in the microarchitecture and functions of the incus, which subsequently leads to conductive hearing loss. Objectives To investigate bone mineral density (BMD) of the incus body (IB) and long process (ILP) on preoperative temporal CT in COM patients with and without incudo-stapedial joint discontinuity (ISJD), and also to determine the association between BMD values and the postoperative air-bone gap (ABG) in the ISJD group. Material and methods The mean IB density (IBD)/occipital bone density (OBD) and ILP density (ILPD)/OBD values were compared between the patients with and without ISJD. The correlation between ABG gain and preoperative incus density values was assessed in the ISJD group. Results The mean IBD/OBD and ILPD/OBD values were significantly higher in patients with intact ISJ. There was a moderate positive correlation between postoperative ABG gain and ILPD/OBD values in the ISJD group. Conclusion and significance The decrease in BMD of the incus may involve ILP as well as IB in patients with ISJD caused by ILP lysis in COM. A higher preoperative ILPD/OBD was correlated with a higher postoperative ABG gain in COM patients with ISJD.

Ossicular Reconstruction With Various Degrees of Malleus Preservation in Patients With Chronic Otitis Media.

Objective: We examined the relationship between factors of middle ear conditions and the outcome of ossiculoplasty in chronic otitis media (COM) by measuring the improvement in the air-bone gap (ABG) and air conduction threshold (TAC). Methods: This retrospective study analyzed 76 patients (77 ears) who underwent ossiculoplasty from among 520 COM patients who underwent tympanoplasty based on the maximum preservation of the original ossicles. The reconstructed ossicular chain was performed by preserving or utilizing the remaining malleus in all cases with the presence of the malleus manubrium. Patients with eardrum adhesion, cholesteatoma, and cholesterol granuloma were defined as having a compromised middle ear condition (Group A), and those without as having an uncompromised middle ear condition (Group B). In each group, pure-tone audiometry was performed preoperatively and postoperatively, and improvements in the ABG and TAC were compared. The effects of the types of tympanoplasty and the method of ossiculoplasty (columella versus incus interposition) on postoperative ABG and TAC were also compared. Results: The postoperative ABG improvement in Group B was significantly higher than that in Group A [β = 7.31, 95% confidence interval (CI) = 1.93-12.69, P < .05]. Type III minor columella tympanoplasty yielded significantly better results than type III major and type Vb tympanoplasty (β = 11.42, 95% CI = 5.16-17.68, P < .01). There were no significant differences in the postoperative ABG or TAC between the reconstruction groups with and without preservation of malleus. Conclusions: Our results indicate that complex cases compromised by adhesions, cholesteatoma, and cholesterol granuloma have worse outcomes regarding hearing improvement and success rates, while those with intact stapes suprastructure have better outcomes. Malleus was maximally preserved in the patients of this study; however, this showed no significant prognostic benefit in hearing.

Gram-negative Bacteria are Associated With Sensorineural Hearing Loss in Chronic Otitis Media.

Chronic otitis media (COM) is an inflammatory disease that commonly presents with otorrhea and hearing loss. Bacteria-induced inflammation can cause inner ear damage, leading to sensorineural hearing loss (SNHL). This study aimed to compare the prevalence and severity of SNHL in patients with gram-negative versus gram-positive cultures and examine associations between the concentrations of circulating monocytes and neutrophils with bacteria species and SNHL. This was a retrospective study. Cholesteatoma or chronic suppurative otitis media patients with otorrhea were enrolled. Middle ear secretions were collected using sterile swabs under an otoscope, and sent for bacterial detection within 30 min. Pure tone audiometry and circulating leukocyte counts were recorded and analyzed in patients infected with different pathogens. Logistic regression analysis was used to identify the risk factors associated with SNHL. A total of 137 patients were enrolled, including 45 patients infected with gram-negative bacteria, 41 with gram-positive bacteria, 20 with polymicrobial infection, and 31 with no bacterial growth. Logistic regression analysis showed that bacterial culture positive infections (OR = 7.265, 95% CI 2.219-23.786, p = 0.001) were an independent risk factor for SNHL. Patients with gram-negative bacteria had higher risks of SNHL (p < 0.0001) and more severe hearing loss (p = 0.005) than those with gram-positive bacteria. COM patients infected with gram-negative bacteria showed an increase in circulating monocytes, which correlated with the occurrence of SNHL (p = 0.0343). Gram-negative bacteria are associated with elevated circulating monocyte counts and have a higher risk of severe SNHL. 4 Laryngoscope, 134:3335-3341, 2024.

Correlation of Tympanomastoidectomy Pathological Findings With Hearing Loss In Chronic Suppurative Otitis Media Patients

Background: Patients with chronic suppurative otitis media (CSOM) often experience hearing loss from mild to very severe degrees. In addition, patients with CSOM often have intraoperative pathological findings. Aims of this study is to determine the correlation between intraoperative tympanomastoidectomy pathological findings with the type and degree of hearing loss using pure tone audiogram images in CSOM patients.&#x0D; Methods: This study is an analytic type study that uses a cross-sectional design. This research was conducted in three hospitals during October 2021 to December 2021. The sample size in this study was 37 patients who would undergo tympanomastodectomy surgery.&#x0D; Results: The most common pathological finding was granulation in 36 patients (97.3%) and followed by sclerotic in 31 patients (83.8%). The average patient had more than 2 pathological findings. Most of patients (78.4%) had conductive hearing loss and most of patients had moderate degree of hearing loss in 25 patients (67.6%). Based on type of hearing loss, there were significant associations with several pathological findings, namely cholesteatoma (p=0.003), defect ossicles (p=0.009), ossicular defects (p=0.001), facial nerve defects (p=0.009). In terms of the number of pathological findings, there was a significant correlation with hearing loss (p=0.004, r=0.467) and the degree of hearing loss (p=0.029, r=0.360).&#x0D; Conclusion: Among the pathological findings by type of hearing loss, a significant correlation was found.

Assessment of Eustachian Tube Function for Successful Tympanoplasty in Chronic Otitis Media

Introduction: Eustachian tube function (ETF) has been the focus of attention as a prognostic factor for successful tympanoplasty surgery, due to its supposed primary pathogenic role in otitis media. Poor Eustachian tube (ET) function has been blamed to many diseases of middle ear cleft extending from serous otitis media to the squamosal type of chronic otitis media (COM). The objective of this study was to evaluate the effect of ETF on tympanoplasty outcome in the mucosal type of COM patients. Materials and Methods: An observational study was conducted for the patients admitted to the department of ENT and HNS with COM, mucosal type. The study was done from April 2021 to March 2022. ETF was assessed with the Toynbee test and saccharin time test. Results: The mean saccharin clearance time was found to be 17 min. Tympanoplasty was performed on 55 patients; 91.1% of patients showed successful outcome with good graft uptake who had normal ETF; out of 20 patients with partial dysfunction, 12 patients had successful graft uptake, and eight patients showed graft rejection. Conclusion: The automatic Toynbee test can be a practical, objective, and suitable method to assess the ventilatory function of ET. The saccharin test is an easy, cost-effective, and useful diagnostic tool to assess the mucociliary function of the ET. The ventilatory function of ET which is the single most important contributory factor in the pathogenesis of COM should be evaluated with the objective method before tympanoplasty.

Mean Platelet Volume (MPV) Value In Chronic Suppurative Otitis Media Patients at Sanglah General Hospital For The 2019-2021 Period

Otitis media supuratif kronis (OMSK) merupakan peradangan kronis pada telinga bagian tengah dengan perforasi membran timpani dan otorea selama lebih dari dua bulan. MPV merupakan indikator aktivasi platelet yang memberikan gambaran rata-rata ukuran platelet dan mudah diperoleh melalui darah tepi dengan pemeriksaan darah lengkap. MPV dapat digunakan sebagai prediktor inflamasi akibat adanya peningkatan aktivitas platelet pada kondisi inflamasi. Penelitian ini bertujuan untuk mengetahui karakteristik nilai MPV pada pasien OMSK di Rumah Sakit Umum Pusat Sanglah pada periode 2019-2021. Penelitian ini menggunakan metode descriptive cross-sectional dengan mengambil data sekunder yang diperoleh dari rekam medis dan hasil pemeriksaan darah lengkap pasien OMSK. Teknik pengumpulan sampel pada penelitian ini menggunakan total sampling. Dari 74 sampel yang didapatkan, diperoleh pasien OMSK terbanyak adalah pasien laki-laki, usia 10-20 tahun, dan mengalami tipe berbahaya. Peningkatan nilai MPV paling banyak ditemukan pada pasien laki-laki sedangkan penurunan nilai MPV paling banyak ditemukan pada pasien perempuan. Peningkatan nilai MPV juga paling banyak pada rentang usia 10-20 dan 20-30 tahun. Ditijau dari tipe OMSK, peningkatan dan penurunan nilai MPV paling banyak pada tipe berbahaya.&#x0D; Kata kunci : OMSK, MPV, RSUP Sanglah

Intra-Operative Ossicular Chain Status in Patients with Chronic Otitis Media.

The Objective of the study was to assess the ossicular status in chronic otitis media (COM)-mucosal and squamosal type and statistically evaluate the extent of ossicular destruction intraoperatively in COM patients. The findings of this study could help us to predict preoperatively the probability of having ossicular chain destruction in COM ears and thus patients could therefore be properly consented about these potential issues before surgery. The study was carried out in ENT department of tertiary health care hospital, between January 2019 to January 2020. All patients of all age groups and both genders, diagnosed with COM Mucosal and Squamosal Type with complaints of ear discharge and hearing loss with good cochlear reserve and requiring surgery were included in the study, after taking informed written consent in vernacular language. All the patients included in the study were evaluated with detailed history, clinical examination including otomicroscopy, tuning fork tests and pure tone audiometry. The patients were then posted for ear surgery and the middle ear status and ossicular chain status were assessed using a microscope intraoperatively. Out of 98 patients, 45(45.9%) had mucosal and 53 (54.08%) had squamosal disease. Ossicular chain was eroded in 69 cases (70.5%). 23 out of 45 (51.1%) mucosal cases and 46 out of 53 squamosal cases (86.7%) reported ossicular erosion. Most frequently involved was long process of incus > stapes > malleus. From our study, we concluded that there is a significant relationship between type of disease pathology in middle ear and ossicular erosion being higher in Squamosal type of COM, with malleus being the most resistant and incus being the most susceptible ossicle.

Intracranial Spread of Infections Among the Patients of Chronic Suppurative Otitis Media

Objective: To determine the frequency of intracranial spread of infections among the patients of chronic suppurative otitis media presenting at a tertiary care hospital in Karachi.Study Design: Cross-Sectional Study.Place and Duration of Study: The study was carried out at the Department of ENT, Head and Neck Surgery, Dow Medical College, Dr. K.M Ruth Pfau Civil Hospital, Karachi, Pakistan, from January 2021 to January 2022.Methods: Out of 87 patients with Chronic Suppurative Otitis Media were included using a non-probability sampling technique. Possible routes of spread of infections were identified based on per operative findings. The Descriptive statistics were applied to all parameters. On inferential statistics, Chi-square test was used for stratification, considering p-value ≤0.05 as significant.Results: 75 (86.2%) were male and 12 (13.8%) were female. 21 (24.1%) patients were found with meningitis, 11 (12.6%) with lateral sinus thrombosis, and 2 (2.3%) with otitis hydrocephalus. As far as signs and symptoms are concerned, 87 (100%) patients had a headache, 74 (85.1%) had nausea and vomiting, 44 (50.6%) patients had vertigo, 43 (49.4%) had a fever, 18 (20.7%) had diplopia, and 73 (83.9%) had altered consciousness. 69 (79.3%) of patients' route of infection in the patients of chronic suppurative otitis media had bone erosion, 12 (13.8%) had thrombophlebitis, and 6 (6.9%) had anatomical pathways. Among different sites of spread of infection, the most common site was sinodural angle 45 (51.72%).Conclusion: Bone erosion, with 79.3%, was the most prevalent route of intracranial spread, followed by thrombophlebitis and anatomical pathways.&#x0D; How to cite this: Malik MI, Naqvi AF, Naqvi SU, Khan N, Ali A, Abbas N. Routes and Sites of Intracranial Spread of Infections Among the Patients of Chronic Suppurative Otitis Media. Life and Science.2023; 4(4): 476-482. doi: http://doi.org/10.37185/LnS.1.1.476

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.

Functional and anatomical outcomes following cartilage myringoplasty

Background: Myringoplasty using cartilage graft is being popular in recent years because of its better graft uptake and optimal hearing outcome. Thickness plays an important role in achieving optimal hearing outcome and although studies have shown 0.5 mm thickness to give better hearing results, concrete studies are lacking. Methods: A prospective study was conducted in the department of otorhinolaryngology at a tertiary-referral-hospital in North-Karnataka; India between January-December 2019, on 25 patients of chronic otitis media; mucosal inactive or quiescent with conductive hearing loss and intact ossicular chain who underwent cartilage myringoplasty using conchal cartilage of 0.5 mm thickness. Follow-up was done at 3, 4½ and 6 months postoperatively to assess graft uptake. Hearing assessment was performed at the end of 6 months postoperative period with pure-tone audiometry. Results: The preoperative mean pure tone average was 33.64±9.42 dB which improved to 22.56±7.41 dB at 6 months. At 3 months and 4½ months, there were 21casess (84%) of complete graft uptake, 3 cases of partial graft uptake (12%) and one case of total graft rejection (4%). Whereas, at 6 months postoperative period complete graft uptake was seen in 22 cases (88%) with 1 case of total rejection (4%) and 2 cases of partial uptake (8%). Conclusions: Cartilage myringoplasty using 0.5 mm thickness conchal cartilage offers good hearing outcome in addition to significant graft uptake. As the conchal cartilage can be easily harvested from the site of incision for the surgery it can be an important primary alternative to temporalis fascia.

Determination of Minimum Inhibitory Concentration of Different Antibiotics against Pseudomonas aeruginosa by E- test at a Tertiary Care Hospital

Background: Antimicrobial drug resistance is a matter of worldwide concern. Different microorganisms, including bacteria, are becoming more resistant day by day. So it is of utmost importance to know the antimicrobial susceptibility pattern not only for initiation of treatment but also for prevention of drug resistance. By determining minimum inhibitory concentration (MIC) by Epsilometer-test (E-test), we can determine the exact dose of a particular drug.&#x0D; Aims: The study is aimed to determine the MIC of different antibiotics against intermediate isolates of P. aeruginosa isolated from clinically suspected patients of chronic suppurative otitis media (CSOM).&#x0D; Materials and Methods: A cross-sectional type of descriptive study was conducted in the Department of Microbiology, Rajshahi Medical College, Rajshahi, during the period of January 2019 to December 2019 to identify the causative bacteria of CSOM with their antibiotic susceptibility pattern. A total of 96 aural swabs were collected from clinically suspected cases of CSOM, irrespective of age and sex, in the ENT department of Rajshahi Medical College Hospital, Rajshahi. Isolation and identification of bacteria were made as per standard procedure, and then antimicrobial susceptibility testing was performed by the disc diffusion method. At last, E-test was performed on different antibiotics against intermediate isolates of P. aeruginosa.&#x0D; Results: Among 73 isolates, 37 showed intermediate susceptibility towards selected antibiotics such as beta-lactams (Ceftazidime, Ceftriaxone), aminoglycosides (Gentamicin), and quinolones (Ciprofloxacin) by disc diffusion method. Among 37 intermediate isolates, P. aeruginosa was 14 in number. Regarding MIC breakpoints in terms of susceptibility, out of 14 intermediate isolates of P. aeruginosa, 09(64.28%) isolates were susceptible, 03(21.43%) intermediate, and 2(14.28%) were resistant to different antibiotics by E-test.&#x0D; Conclusion: In this study, higher susceptibility of different antibiotics against intermediate isolates of P. aeruginosa was observed by E-test than the disc diffusion method.&#x0D; TAJ 2022; 36: No-1: 47-54

Comparison of temporalis muscle fascia and cartilage grafts for primary type 1 tympanoplasty: a meta-analysis of randomized controlled trials.

To compare the efficacy and safety of temporalis fascia (TF) with cartilage grafts for primary type 1 tympanoplasty in chronic otitis media (COM) patients. Computerized search was performed in MEDLINE, Embase, and CENTRAL. Eligible for inclusion were randomized controlled trials (RCTs) comparing TF and cartilage grafts in individuals with non-cholesteatoma COM and intact ossicles requiring type 1 tympanoplasty. Primary outcomes were graft success and hearing improvement, measured by the air-bone gap (ABG) closure. The secondary outcome was the occurrence of complications. Standardized mean differences (SMD) and odds ratios (OR) with 95% confidence intervals were calculated. Eighteen RCTs that enrolled 1273 participants were found eligible. Data were reported at follow-up periods ranging from 6weeks to 24months. The pooled effect estimate revealed a higher and statistically significant graft success favoring cartilage grafts at 12months (OR = 2.24, 95% CI 1.33-3.78) and 24months (OR = 2.96, 95% CI 1.18-7.43). There was no significant difference between both grafts in post-operative ABG closure across all follow-up periods (6weeks to 12months). Compared to TF, primary type 1 cartilage tympanoplasty offers better graft uptake rates and comparable postoperative hearing outcomes for COM patients.

Efficacy of topical povidone iodine ear drops 5% in chronic suppurative otitis media

Background: Povidone Iodine (PVP-I) is a well-known antiseptic and chemical compound to kill and inhibit the growth of microorganisms. Povidone Iodine 5% antiseptics are expected to have similar or better clinical efficacy compared with topical antibiotics in Chronic Suppurate Otitis Media (CSOM) patients but this is not fully clear. Topical antibiotics can also come in the form of ear drops. Topical antibiotics are the standard in CSOM patient therapy. This study aimed to discover Povidone Iodine 5% in terms of clinical efficacy in CSOM patients. Method: This research was conducted in accordance with the Cochrane Handbook for Systematic Review and Intervention, in adherence with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. All clinical trial studies comparing Povidone Iodine with topical antibiotics in CSOM management were performed in several databases including Google Scholar, PubMed, Springer Link, and Cochrane. The collected data from a number of samples have improved each study, seen by the clinical signs and symptoms. Results: A total of 407 research articles were included in this analysis then we had 24 works of literature. Final decision, only 2 literature met the criteria to review. Al-Abbasi et al study, PVP-I 5% recovered 13/16 (81.2%), Neomycin + Dexamethasone 11/16 (68.7%) and saline 4/16 (25%). Jaya et al study, PVP-I-5% recovered: 16/18 (88.8%), Ciprofloxacin 0.3%: 19/21 (90.4%), and no side effects were found in both studies. Conclusion: Our analysis revealed that PVP-I 5% have similar treatment as great as the efficacy of topical antibiotics, and there were no side effects of treatment. More evidence-based research is needed to determine the effectiveness of topical PVP-I 5% in the treatment of CSOM.

Study of ossicular chain status in chronic otitis media patients at a tertiary care hospital in southern Bihar

Background: The objective is to assess the ossicular status and statistically evaluate the extent of ossicular destruction intraoperatively in chronic otitis media (COM) patients. Knowledge of pattern of involvement of ossicular chain in COM cases may help us to determine the type of reconstruction needed during surgery. The findings of this study could be exploited to predict preoperatively the probability of having ossicular chain destruction in COM ears and thus patients could therefore be properly consented about these potential issues before surgery. Methods: Prospective observational study conducted over 2 years in diagnosed patients posted for surgical management and fulfilling the inclusion criteria. Intraoperative status of ossicles was noted for various types of COM and outcome was evaluated. Results: Out of 92 patients, 59 (64.1%) had mucosal and 33 (35.9%) had squamosal disease. Ossicular chain was eroded in 41 cases (44.6%). 9 out of 59 (15.3%) mucosal cases and 32 out of 33 squamosal cases (97%) reported ossicular erosion. Most frequently involved was long process of incus (44.6%) &gt;stapes (9.8%) &gt;malleus (8.7%). Order of involvement (Austin-Kartush classification) was found as: type A (26.1%)&gt;B (9.8%)&gt;C (8.7%). 67.4% belonged in the group 15-30 years. Male: female ratio=1:1.5. Conclusions: Degree of ossicular destruction is much greater in squamosal COM, owing to overproduction of cytokines and inflammatory mediators and due to presence of cholesteatoma and/or granulations. The long process of incus was found to be most vulnerable. Malleus was found to be the most resilient among all ossicles.

A comparative evaluation of graft uptake and audiological results of temporalis fascia graft vs reinforced sliced tragal cartilage in type 1 tympanoplasty

Background: Numerous grafting materials have been applied for repair of tympanic membrane (TM) in chronic otitis media patients. This study aimed to compare the anatomical and audiological results of temporalis fascia alone versus reinforced sliced cartilage in type 1 tympanoplasty. Methods: A prospective study was conducted on 50 patients of age group 15-55 years. Patients were randomly divided into two groups, each group having 25 patients. In group I patients under went type I tympanoplasty with temporalis muscle fascia alone and group II patients with sliced tragal cartilage reinforced to temporalis fascia. Post operatively all patients were followed on 30th, 60th and 90th day. In the last follow up, assessment of graft uptake was done and pure-tone audiometry was performed to evaluate air-bone gap closure. The data so obtained were collected and analysed using appropriate statistical tests. Results: Overall graft uptake rate in group I (TF alone) was 84%, whereas in group II (TF+ reinforced sliced cartilage) was 92% (p=0.5). The mean post op ABG improved to 16.17±6.26 dB and 16.56±5.25 dB respectively in group I and II. There was significant hearing improvement in each group but no statistical significant difference was observed in post-op ABG between the two groups. Conclusions: Reinforced sliced tragal cartilage technique is a good alternative to temporalis fascia alone in terms of graft uptake and prevention of disease recurrence, especially for large and subtotal perforations but additive effect of cartilage slicing in hearing gain still remains little controversial.

Demographical Variations of Sensory Neural Hearing Loss (SNHL) in Chronic Suppurative Otitis Media (CSOM) patients at JPMC Karachi

Objectives: CSOM is significantly associated with SNHL but with mixed demographical associations being reported in literature.To determine the demographical variations (age and gender) of SNHL among CSOM patients Study design and setting: Cross-sectional observational study at Jinnah Postgraduate Medical Center, Karachi, Pakistan. Methodology: Using non-probability convenient sampling, diagnosed CSOM patients within six months between 10-50 years and of either gender were included while patients with history of SNHL previously of using ototoxic drugs, ear trauma or refusing to consent were excluded. SPSS v23.0 was used for analysis of data and chi-square was applied keeping p-value &lt;0.05 as statistically significant. Results: From total 200 patients,60 (30%) patients were between 10-18 years, 120 (60%) between 19-35 years and 35-50 years were 20 (10%) patients. 145 (72.5%) were females while 55 (27.5%) males. SNHL was observed in 36 (18%) of patients. Between 10-18 years age group, 10 (16.7%) patients were reported with SNHL, between 19-35 years age group 22 (18.3%) while between 35-50 years, 4 (20%) of patients were found to have SNHL with an insignificant p-value of 0.934. 28 (19.3%) males were reported to have SNHL while 8 (14.5%) females were observed to have SNHL with CSOM. An insignificant p-value of p-0.434 was reported between the genders. Conclusion: According to the results of this study, SNHL was insignificantly associated with CSOM according to demographics (age and gender). Further studies are required to validate the findings of this study. Keywords: Chronic Suppurative Otitis Media, Sensori Neural Hearing Loss, Otitis Media

A Comparative Study to Determine Hearing Outcome in Type 1 Tympanoplasty With and Without Canaloplasty in Tubotympanic Type of Chronic Suppurative Otitis Media.

Chronic suppurative Otitis Media is a common ear infection in India. Canaloplasty done with tympanoplasty helps to remove bony overhangs and provide complete visibility of fibrous annulus of tympanic membrane. 1. To determine the hearing outcome in chronic otitis media (mucosal type) patients undergoing type 1 tympanoplasty with canaloplasty. 2. To determine the hearing outcome in chronic otitis media (mucosal type) patients undergoing type 1 tympanoplasty without canaloplasty. 3. To compare the hearing outcome in the above mentioned 2 groups of patients. 56 patients of 15-60 years of age with mucosal type of Chronic otitis media, with central dry perforation and intact ossicles were included in our study. They were divided into group 1 (type 1 tympanoplasty + canaloplasty) and group 2 (type 1 tympanoplasty without canaloplasty), on alternate basis. AC, BC, Air bone gap avg was assessed via pure tone audiometry at 4 frequencies preoperatively and postoperatively at 3rd and 6th month, % closure of ABG average was calculated. Type 1 tympanoplasty along with canaloplasty has better hearing improvement in pure tone audiometry compared to type 1 tympanoplasty alone, as % closure of ABG at postoperative 3rd and 6th month holds significant. The canaloplasty provides better surgical exposure via removing bony overhangs, aids in excellent functional outcome in the form of % closure of ABG. Hence canaloplasty is added as an adjunct to routinely performed aural surgeries to enhance hearing outcome.