Chronic Otitis Media Research Articles (Page 1)

This study hypothesized that the expression levels of eosinophil extracellular traps (EETs) in middle ear lavage fluid and serum would correlate with various clinical parameters in otitis media associated with eosinophilic granulomatosis with polyangiitis (EGPA) and eosinophilic otitis media (EOM). The aim of this study was to evaluate the potential utility of EETs as diagnostic and monitoring tools for assessing disease activity and therapeutic response. Exploratory research. Two tertiary referral centers. EGPA and EOM patients were eligible for inclusion. Patients with chronic otitis media (COM) were examined as controls. The middle ear lavage and blood samples were obtained from patients with EGPA, EOM, and COM. The levels of cell-free deoxyribonucleic acid (DNA), citrullinated-histone H3 (cit-H3)-DNA complex, and eosinophil peroxidase (EPO)-DNA complex as EET remnants were quantified using an enzyme-linked immunosorbent assay. Patients with EGPA and EOM showed significantly higher levels of EET remnants in the middle ear lavage compared with controls. In patients with EGPA and EOM, the levels of EET remnants in the middle ear lavage at post-treatment were significantly lower compared with those at pretreatment. Furthermore, the levels of EET remnants in the middle ear lavage were positively correlated with Lund-Mackay scores and temporal bone CT scores. It is noteworthy that EET remnants in the serum of patients with EGPA were found to be elevated and were positively correlated with peripheral blood eosinophil fraction and serum immunoglobulin E levels. These preliminary findings suggest that EET remnants in the middle ear lavage may be potentially useful as biomarkers for the diagnosis and disease activity of otologic lesions in EGPA and EOM. It seems acceptable to measure the levels of EET remnants using blood samples in patients with EGPA.

Background: Allergic rhinosinusitis (ARS) and chronic allergic otitis media are common manifestations of upper airway allergic inflammation. Despite advances in understanding the immunopathogenesis of these conditions, hematological markers reflecting systemic immune activation remain underexplored, particu- larly in combined presentations. To evaluate hematological parameters, with emphasis on leukocyte sub- populations and the eosinophil-lymphocytic index, in patients with allergic rhinosinusitis combined with chronic allergic otitis media compared to non-allergic chronic otitis media. Methods: Archival records of 60 adult patients (33 males, 27 females; mean age 41.2 years) from the Otorhinolaryngology Department of the National Medical Center “Shifobakhsh,” Republic of Tatarstan, were analyzed. Group I (n=30) included ARS with CAOM, and Group II (n=30) included non-allergic COM. Complete blood count (CBC) with leukocyte differential and ELI were assessed and compared de- scriptively. Correlation analysis between leukocyte subpopulations was also performed. Results: Mean total leukocyte count in allergic patients was near the upper normal range (8.9×10⁹/L). Leukocytosis was observed in 16.7% of allergic versus 40% of non-allergic cases. Peripheral eosinophilia (>5%) was observed in 63.3% of patients with allergies, with a mean eosinophil count of 5.8%. Relative lymphocytosis occurred in 40% of allergic and 16.7% of non-allergic patients, while absolute lymphocyte counts were lower in the allergic group. ELI was increased in 43.3% of patients with allergies. Correlation analysis revealed strong relationships (η>0.90) between neutrophils, eosinophils, and monocytes in both groups, indicating coordinated immune responses. Conclusion: Peripheral eosinophilia and elevated ELI serve as indirect hematological markers of systemic allergic sensitization in ARS with CAOM. These findings support using simple blood parameters as adjunc- tive indicators of allergic inflammation when specialized allergy testing is unavailable.

Background Cavernous sinus tuberculosis is an extremely rare manifestation of central nervous system tuberculosis in children, with only two cases reported worldwide. It can mimic malignancy or other inflammatory conditions. Its occurrence in children with primary immunodeficiency, particularly major histocompatibility complex (MHC) class II deficiency, has not yet been described. Case report We report an 11-year-old girl with a history of recurrent infections and chronic otitis media. She presented with right orbital swelling, severe headaches, and exophthalmos. Imaging revealed an extensive mass in the sinonasal and orbital regions, extending to the skull base and cavernous sinus. A computed tomography-guided biopsy and histopathology, supported by PCR testing for Mycobacterium tuberculosis , confirmed extensive orbital and cervicofacial tuberculosis. An immunological evaluation and genetic analysis revealed familial MHC class II deficiency. The patient received anti-tuberculosis therapy [isoniazid, rifampin, pyrazinamide, and ethambutol (HRZE) followed by isoniazid and rifampin (HR)], leading to clinical and radiological improvement. She continues with intravenous immunoglobulin replacement therapy every 21 days while awaiting a bone marrow transplantation. Conclusions This case highlights the importance of considering tuberculosis in atypical cavernous sinus lesions in children, especially in endemic regions. Severe or unusual infections should prompt evaluation for underlying immunodeficiency.

Effect of surgery on vestibular system in pediatric patients with otitis media with effusion.

Aerobic Bacteriological Profile of Ear Swabs from Chronic Suppurative Otitis Media Cases in a Tertiary Care Hospital in Karnataka, India: A Retrospective Study

Abstract Background Chronic otitis media (COM) is one of the leading causes of hearing impairment worldwide, mostly presenting with conductive hearing loss. However, some studies suggest the presence of associated sensorineural hearing loss due to cochlear involvement in a significant proportion of cases. The aim of our study was to analyze the factors associated with the development of sensorineural hearing loss (SNHL) in patients with the mucosal type of COM. Materials and methods Patients with unilateral inactive COM (mucosal type) were identified, and pure tone audiometry was done to find those with sensorineural or mixed hearing loss. A detailed history was taken to document demographic characteristics and various parameters, including duration of disease, tinnitus, frequency of active discharge, and any prior usage of ototoxic ear drops, along with a thorough clinical examination. Results One hundred twenty patients were recruited for the study. Both perforation size and disease duration were significant independent predictors of hearing impairment in the current study population and showed significantly higher odds of worsening the impairment. Duration of tinnitus and frequency of discharge demonstrated high collinearity with disease duration, indicating their dependence on the former. The statistical association was strong for the frequency of otorrhea, while the presence of complications demonstrated a moderate association. Correlation analyses revealed a monotonic, positive, and moderately strong relationship between hearing impairment and size of perforation (Spearman’s ρ = 0.581, 0.3 < ρ < 0.7), overall disease duration (ρ = 0.689), and duration of tinnitus (ρ = 0.378), suggesting a unidirectional worsening of hearing in larger perforations and with prolonged suffering. Conclusion A number of individual parameters were found to be associated with the development of SNHL and mixed hearing impairment in patients with the mucosal type of COM. The identification of these factors may therefore help to predict the risk of progression to mixed hearing loss. Early detection of the disease and prompt initiation of treatment may prove to be beneficial to avoid the same.

Abstract Background A notable complication in cochlear implant (CI) users is Anomalous Facial Nerve Stimulation (AFNS), an unintended stimulation of the facial nerve causing sound-triggered involuntary facial movements. Reported in about 5.6% of users (range 0.68–43%), AFNS risk factors include otologic conditions like otosclerosis or cochlear malformations and device factors such as high stimulation levels. Initial management involves conservative programming adjustments to minimize current spread. If unsuccessful, deactivating offending electrodes is necessary. While often effective, these interventions can occasionally lead to a decline in auditory performance, sometimes resulting in device discontinuation or even explantation. This requires careful clinical consideration to balance optimal hearing outcomes with patient comfort. Case presentation Two clinical cases of CI users with severe-to-profound sensorineural hearing loss are described. The first case, a 57-year-old woman suffering chronic otitis media since childhood, required explantation because of severe AFNS and reimplantation with a device delivering using multi-mode grounding (MMG) stimulation with anodic monophasic pulses (AMP). The AFNS was controlled, and she returned to using CI with acceptable functional gain. The second case, a 27-year-old woman with bilateral otospongiosis, exhibited intraoperative facial nerve stimulation during bipolar monophasic testing, but this was prevented postoperatively using MMG-AMP. Conclusions CI reimplantation with MMG-AMP was effective in managing severe AFNS when conservative measures failed to resolve it. This electrical stimulation pattern should be a viable option for CI candidates with AFNS risk factors (otosclerosis, inner ear malformations, FN dehiscence, cochlear obliteration/ossification) or for those who have an indication for cochlear reimplantation due to severe AFNS. Further studies are required to better explore the use of MMG-AMP in a larger number of subjects.

Chronic mastoiditis is rare in children due to early treatment of otitis media. We report a 13-year-old female with chronic suppurative otitis media, mastoid sclerosis, and subtotal tympanic membrane perforation presenting with persistent mucoid otorrhoea. Audiometry showed mild hearing loss, and CT revealed mastoid sclerosis. Preoperative findings of hypokalemia and ECG changes posed anesthetic challenges. She underwent right cortical mastoidectomy with tympanoplasty. This case underscores the importance of timely diagnosis in pediatric otitis media, the role of multidisciplinary care, and the contributions of clinical pharmacists in perioperative management.

Objectives: This study aimed to investigate the effects of trigeminal nerve (TN)-related somatosensory stimulation on the psychoacoustic parameters of tinnitus. Patients and Methods: This prospective observational study was conducted at the Audiology Unit of İstanbul Medipol University Hospital between August 01, 2021 and April 01, 2022. Twenty-eight patients (21 females, 7 males; mean age: 39±0.5 years; range, 18 to 65 years) with unilateral subjective tinnitus were included. The patients underwent psychoacoustic assessments under five conditions: the standard model, the mastoid model, and trigeminal stimulation at the ophthalmic (V1; forehead), maxillary (V2; maxilla), and mandibular (V3; preauricular) branches of the TN. Pitch matching, loudness matching, minimum masking level (MML), and residual inhibition (RI) were measured in each condition. Results: Significant correlations were observed between psychoacoustic parameters across different models (p<0.05). Tinnitus pitch did not differ significantly between models (p>0.05). Loudness and MML values were significantly higher in the standard model compared to other models (p<0.05). Residual inhibition rates in the preauricular (V3) model did not significantly differ from the standard model (p>0.05), despite lower MML values. The tinnitus intensities and MMLs measured in the standard model were significantly higher than the other models (p<0.05). The RIs of preauricular model was not significantly different from the other models (p>0.05). Similar RI rates were measured despite the lower MML levels in the preauricular model in comparison with the standard model. Conclusion: Somatosensory stimulation via the V3 branch of the TN may influence tinnitus loudness and MML without altering pitch perception. The preauricular model may serve as an alternative to the standard model, offering similar RI outcomes at lower MMLs. This approach could be particularly advantageous in patients with conductive hearing pathologies such as chronic otitis media, otosclerosis, or aural atresia.

Decades in the Making: A Rare Case of Mastoid Squamous Cell Carcinoma Following Chronic Otitis Media and Mastoidectomy

Patients with profound hearing loss and chronic otitis media are promising candidates for cochlear implantation, but they require meticulous attention from the specialists monitoring them. Recently, chronic otitis media was considered as a contraindication for cochlear implantation due to the risk of developing a number of complications. Despite these potential problems, performing CI is the only solution to help patients with chronic otitis media and sensorineural hearing loss IV. There are various methods for managing the above-mentioned group of patients. Some authors describe performance of CI with middle ear surgery in one stage, while other authors - in several stages. The issue of cochlear implantation in patients suffering from chronic suppurative otitis media always arouse discussion among otosurgeons. The purpose of the study was to share the experience of cochlear implantation in patients with chronic otitis media. The materials and methods in this article are the clinical cases of 10 patients with chronic otitis media, who underwent middle ear surgery and cochlear implantation. Conclusions. One-stage CI and middle ear surgery can be considered as a technique that enhances auditory and speech rehabilitation of patients with sensorineural hearing loss IV and chronic otitis media, which is especially important for patients with acquired inner ear pathology and the risk of ossification of the cochlea spiral canal.

IntroductionChronic otitis media with effusion (COME) can adversely affect childhood development, and while the adenoid has been considered a reservoir for bacterial pathogens contributing to the pathogenesis of COME, the role of the adenoid microbiome in COME remains unclear. This study analyzed both the adenoid and gut microbiome in children with and without COME to identify their potential roles in the disease’s pathogenesis.MethodsAdenoid samples were collected during surgery for adenoid microbiome analysis, while fecal samples were collected for gut microbiome analysis. Microbiome was analyzed using whole metagenome sequencing and subsequent bioinformatic analysis.ResultsA significant association between the adenoid microbiome and COME was detected, while no such association observed for the gut microbiome. The adenoid microbiome varied by age in the control group, but this age-dependent variation was perturbed in the COME group. Notably, in children aged 6–12 years, the adenoid microbiome was significantly associated with COME based on the type of middle ear fluid, where Streptococcus pneumoniae and Haemophilus influenzae were prominent indicators in the mucoid form of COME. The proliferation of these species in mucoid COME group was correlated with indicators for the serous COME group. The altered microbiome in COME patients may influence immune responses through the synthesis of spermidine and acetate, contributing to disease development.DiscussionThis study highlights the age-dependent contribution of the adenoid microbiome–particularly in children aged 6 to 12 years–to the pathogenesis of COME.

Moraxella catarrhalis is an important cause of infectious exacerbations of chronic obstructive pulmonary disease and otitis media. To investigate the population structure of M. catarrhalis, we developed a core-genome multilocus sequence typing (cgMLST) scheme using 1319 core genes, and a life identification number (LIN) barcode classification system. Whole-genome analyses of nearly 2000 genomes confirmed divergent seroresistant (SR) and serosensitive (SS) M. catarrhalis lineages with distinct evolutionary trajectories. SR genomes are more conserved, while SS genomes exhibited greater genetic variability. Virulence gene analyses revealed lineage-specific variations in ubiquitous surface proteins (UspA1 and UspA2) and lipooligosaccharide (LOS) types. The bro β-lactamase, and mcb bacteriocin cluster, are more common in SR lineages, which suggested different selective pressures and adaptation. Here, we show that this cgMLST scheme and LIN code system provide a robust method for characterising M. catarrhalis, distinguish between SR and SS lineages, and offer a unified framework for population structure analyses.

Background: Ear, Nose, and Throat (ENT) diseases pose a significant public health challenge, affecting a large number of patients worldwide. The study was conducted to assess the prevalence of ear, nose, and throat (ENT) disorders among patients visiting at Shalakya Outpatient Department of Ayurveda hospital Kirtipur. Materials & Methods: It was an analytical retrospective study OPD data record of Shalakya Department in the fiscal year 2081-82 BS. Main focus was outpatient department and Ayurveda therapeutic treatment of Shalakya department in ENT diseases diagnosed patients only. All the patients who came with ENT problem were enrolled in the record of Shalakya OPD data of one year from 2081 Baishak- 2082 Baishak and those data were taken for the study. Results and Discussion: The majority of the patients 47.5% were from 21-40 year age group and mean age is 39.0 years. More patient visited to OPD were from Kathmandu 34.3%. The maximum number of 50.9% that is more than half of patient had case of nose problem, 25.0% of cases were related to ear diseases, while 14.4 % of cases were related to throat problems. The majority of the patients who presented with nose problem 159 (27.7%) were suffering from allergic rhinitis followed by rhinosinusitis 74 (12.9%). Most common ear problem was tinnitus 54 (9.4%) followed by otalgia and chronic suppurative otitis media both 4.2%. Ayurveda therapeutic applied to cure ENT diseases in Ayurveda Teaching Hospital like Nasya was advice in the maximum patients 63.3%, followed by Karnapuran in 19.9%. Conclusion: Total patient visited to Shalakya OPD were 573 and total diseases diagnosed was 623 because multiple diseases were found in single patients. Most common disease was Allergic rhinitis because Kathmandu is the most polluted city in Nepal so maximum people suffer by allergic Rhinitis.

Existing research suggests a potential link between gastroesophageal reflux disease (GERD) and Otitis media (OM). Nevertheless, the specifics of this correlation are not clearly defined. In order to explore the genetic link between GERD and OM, this study engaged a 2-sample Mendelian randomization methodology. Initial steps comprised careful selection of instrumental variables, namely the single-nucleotide polymorphisms (SNPs), following strict quality control guidelines. The selected SNPs underwent MR analyses involving inverse variance weighting, MR-Egger, weighted median, and simple mode. Horizontal pleiotropy was checked through MR-Egger intercept and the inverse variance weighted tests. To probe the robustness of the observed link and certify result reliability, a leave-one-out analysis was carried out. Using the inverse variance weighted approach, higher genetic liability to GERD was associated with increased risk of acute suppurative OM, chronic suppurative OM, and suppurative and unspecified OM. Concordant evidence was obtained with the weighted median and MR-Egger estimators. Across data sources, heterogeneity tests were not significant (P > .05), and the MR-Egger intercept did not indicate directional pleiotropy (P > .05), suggesting that horizontal pleiotropy is unlikely to bias the causal estimates. Leave-one-out analyses showed negligible changes when any single SNP was removed, supporting robustness.

IntroductionCholesteatoma remains a serious condition that poses a challenge to otolaryngologists around the world. It is found to be more aggressive in the pediatric group than in adults. If left untreated, the disease can be dangerous due to its ability to expand and destroy bones, leading to complications such as hearing loss, vestibular dysfunction, facial paralysis, and intracranial infections.ObjectiveTo find out the prevalence of cholesteatoma in the school-aged children of Nepal.MethodsThis is a retrospective study conducted within a span of 10 years from 2014 to 2024 in which all medical records of the school-based ear screening programs were studied. Data including personal details, brief history, and ear and audiometry findings were recorded. All suspected cases of cholesteatoma were reexamined under microscope at our institute, and only those with confirmed diagnosis of chronic otitis media (COM) with cholesteatoma were included in the study.ResultsOut of the total of 143,544 children screened, COM with cholesteatoma was diagnosed in 0.20% (n = 282), and COM in total in 7.56% (n = 10,853). Hearing loss was seen in 273 (96.81%) of the 282 cases, with conductive hearing loss being the most common type of hearing loss.ConclusionThere is a higher prevalence of cholesteatoma in Nepalese children. Early diagnosis with proper management helps reduce the chances of life-threatening complications. Thus, having regular screening programs in school children will help in reducing morbidity.

Push-Through Endoscopic Myringoplasty for Chronic Otitis Media Mucosal Disease: Our Clinical Experience

Background: Chronic Suppurative Otitis Media (CSOM) is a persistent middle ear infection that significantly contributes to global hearing loss and reduced quality of life, yet recent epidemiological data from major Indonesian cities such as Makassar remain scarce. Objective: To identify risk factor characteristics, including age, gender, and CSOM type (benign or malignant), among patients diagnosed at Ibnu Sina Hospital, Makassar, from 2022 to 2023. Methods: A quantitative descriptive study with a retrospective design was conducted using total sampling of 31 patient medical records meeting inclusion criteria, and data were analyzed univariately to present frequency distributions and percentages. Results: The 17–25-year age group had the highest CSOM prevalence (35.48%), followed by the 0–5-year group (16.13%). Female patients accounted for 51.61%, showing a nearly equal gender distribution. The majority of cases were benign CSOM (96.77%), with only 3.23% classified as malignant. These findings indicate that young adults represent the most affected demographic, likely due to environmental exposure and untreated upper respiratory infections, while malignant CSOM remains rare. Conclusion: Age is the primary risk factor for CSOM in this population, with young adults being the most vulnerable, underscoring the importance of targeted preventive measures and early ear health education.

To compare postoperative complications between staged versus unstaged tympanoplasty and subtotal petrosectomy (STP) in adults undergoing cochlear implants with noncholesteatoma chronic otitis media (NCCOM) and tympanic membrane perforation. PubMed/MEDLINE, Cochrane CENTRAL, Embase, CINAHL, Web of Science, WHO Global Index Medicus, ClinicalTrials.gov, and WHO ICTRP. A systematic search of databases was conducted by a research librarian from inception through November 18, 2024. Eligible studies for inclusion must have reported on adult cochlear implant recipients undergoing surgical management of NCCOM with perforation. Using a random effects model, complication rates were pooled and compared between staged and unstaged surgeries using relative risk (RR) with 95% CI. Of 1265 studies identified, 19 met inclusion criteria (n = 84). Fifty three (63.1%) patients underwent unstaged surgery. Amongst all patients, STP was performed more than tympanoplasty (72.6%, 61/84 vs 27.4%, 23/84), and the overall complication rate was 11.9% (10/84). There was no significant difference in complication rates between combined staged and unstaged surgeries [RR: 1.13 (95% CI, 0.18-7.04)] as well staged and unstaged tympanoplasty [RR: 0.34 (95% CI, 0.11-0.1.01)]. However, complication rates were lower for staged than unstaged STP [RR: 0 (95% CI, 0.0-0.07)]. Staged and unstaged surgery for NCCOM and cochlear implant may result in comparable complication rates, however the wide CIs for RR statistics in comparisons between combined staged and unstaged procedures as well as staged and unstaged tympanoplasty indicate a need for similar studies of larger populations.

Objective: To investigate the clinical features, imaging characteristics, surgical strategies, and therapeutic outcomes of otitis media complicated with inflammatory response of local meninges. Methods: A retrospective analysis was conducted on the clinical data of 8 patients with chronic suppurative otitis media complicated with inflammatory response of local meninges, treated by the Department of Otolaryngology, Head and Neck Surgery, PLA General Hospital from 2019 to 2023. Appropriate surgical strategies were selected based on the patient's clinical manifestations, imaging characteristics, extent of lesions, and facial nerve function. Follow-up was performed postoperatively to assess the therapeutic outcomes. Results: Among the eight patients, there were six males and two females, with an average age of (55.9±12.6) years old. The primary clinical manifestations included otorrhea, hearing loss, facial paralysis, earache, headache, and fever. All patients had a history of chronic suppurative otitis media and tympanic membrane perforation, with varying degrees and types of hearing loss. Seven patients presented with peripheral facial palsy preoperatively, with the House-Brackmann (H-B) grading scale as follows: 4 cases (4/7) in grade Ⅳ, 1 case (1/7) in grade Ⅴ, and 2 cases (2/7) in grade Ⅵ. The mean duration of otorrhea and/or hearing loss was (24.68±12.18) years, while, the average duration of severe headache, aggravated otorrhea and facial paralysis was (2.73±3.92) months. Preoperative high-resolution CT scan of the temporal bone revealed soft tissue shadow in the middle ear and mastoid process, with partial defects in the mastoid cortex. Cranial MRI T1WI showed high signal in the meninges on the affected side, with contrast-enhanced MRI indicating localized meningeal thickening. Four patients (4/8) had diabetes mellitus, and 2 patients (2/8) had a history of middle ear/mastoid surgery. All patients underwent surgical treatment, including thorough removal of lesions, adequate drainage, and facial nerve decompression. Tympanoplasty and hearing reconstruction were performed when conditions permitted. Specifically, 5 patients underwent intact canal wall radical mastoidectomy with facial nerve decompression and tympanoplasty, 2 patients underwent canal wall down mastoidectomy with facial nerve exploration decompression, and 1 patient underwent modified radical mastoidectomy. Postoperatively, patients experienced significant relief and gradual disappearance of ear and head pain. The postoperative H-B grading scale of facial nerve function was as follows: 4 cases in grade Ⅰ (4/8, including 1 case without preoperatively facial palsy), 2 cases (2/8) in grade Ⅱ, and 2 cases (2/8) in grade Ⅲ. Postoperative cranial MRI showed a significant reduction in localized meningeal thickening on the affected side. Conclusions: Patients with long-term chronic suppurative otitis media and/or cholesteatoma who suddenly presented with headache, fever, aggravated otorrhea, and facial paralysis should be suspected of having inflammatory response of local meninges. High-resolution CT of temporal bone and cranial MRI provide crucial diagnostic information. Early surgical exploration and thorough lesion removal are effective treatment methods.