Chronic Secretory Otitis Media Research Articles

Роль кислотозависимых заболеваний желудочно-кишечного тракта в формировании рецидивирующих и необратимых хронических воспалительных явлений в полости среднего уха

Chronic secretory otitis media is one of the most common multifactorial diseases in the otolaryngology practice. The disease characteristic features are the resumption of inflammation, with the formation of otorrhea, which can lead to a hyperplastic, sclerotic, and destructive changes. Of particular interest is the influence of acid-related diseases of the gastrointestinal tract on the formation of recurrent and irreversible chronic inflammatory phenomena in the middle ear cavity. The study included 152 patients (82 women and 70 men) with chronic secretory otitis media who were treated from 2021 to 2022 in the Department of Otorhinolaryngology of St. Petersburg City Hospital No. 26. 142 patients underwent installation of a tympanostomy tube, 10 people received a course of conservative therapy. Observation over time allowed us to compare various outcomes of inflammation in groups of patients with and without gastrointestinal tract diseases. In the group of patients with gastrointestinal tract diseases, relapses of inflammation were observed in 43 (39,1%) people over a 12-month period. In 5 (4,9%) participants, tympanostomy tube extrusion was recorded by the end of 3 months of observation, with the formation of persistent perforation of the tympanic membrane. Further, in 2 patients with extrusion of tympanostomy tube and perforation of the pars tensa, we observed the formation of retraction pocket type I pars flaccida. This study allows us to conclude that inflammatory recurrent diseases of the upper gastrointestinal tract can not only cause dysfunction of the eustachian tube but also contribute to inflammatory-degenerative diseases of the tympanic cavity.

Хирургическое лечение хронической обструктивной дисфункции слуховых труб ятрогенного происхождения

This article presents a clinical case of surgical treatment for chronic obstruction of the pharyngeal orifice of the Eustachian tube on the right and obliteration of the cartilaginous portion of the Eustachian tube on the left. The cause of this was a previously performed surgical intervention in the nasal cavity, which led to cicatricial fusion of the orifice of the Eustachian tube on the left and to the closure of the pharyngeal orifice of the Eustachian tube on the right by the posterior end of the nasal concha. This condition obviously provoked the development of an unsatisfactory result after reconstructive hearing-improving surgery on the right ear and the appearance of chronic secretory otitis media and retraction of the tympanic membrane on the left ear.

Interleukin-33 and thymic stromal lymphopoietin are primary cytokines involved in the Th1/Th2 inflammatory response in chronic secretory otitis media

Background: T-helper (Th)1/Th2 inflammatory responses are responsible for secretory otitis media (SOM) development. However, the mechanisms underlying these immune responses remain unknown. This study aims to identify the primary cytokines that play essential roles in chronic SOM. Methods: Two groups were established for the present study: chronic SOM group ( n = 21) and control group ( n = 10). The middle ear effusion and serum samples of the expression cytokines (interleukin IL-2, IL-4, IL-5, IL-13, IL-17, IL-25, IL-33, interferon [IFN]-γ, thymic stromal lymphopoietin [TSLP], immunoglobulin IgE, and pepsins) were analyzed by enzyme-linked immunosorbent assay. Results: The levels of IL-4, IL-5, IL-13, IL-17, IL-25, IFN-γ, TLSP, pepsins, IL-2, and IL-33 (all, p < 0.001) were higher in middle ear effusion, when compared to those in serum, in chronic SOM group (non-paired sample). However, there was no significant difference in serum expression for those cytokines compared chronic SOM group and control group. The paired sample expression for IL-33 and TLSP (both, p = 0.046) were higher compared the effusion and serum in chronic SOM group. Conclusions: IL-33 produces inflammatory cytokines, such as IL-1b, IL-6, TNF-α, IL-10, IL-4, and TGF-β, which through nucleus into cytoplasm causing inflammatory responses. The present study revealed that IL-33 also produce IL-17, IL-4, IL-5, and IL-13 inflammatory factors, triggering an inflammatory response. Study reported that the combined stimulation of TSLP and IL-33 elicits an approximately 10-fold increase in cytokine production, when compared to the stimulation of IL-33 alone. This suggests that IL-33 and TLSP may be the primary cytokines involved in Th1/Th2 inflammatory responses in chronic SOM.

Ультрафонофорез барабанной полости при сохранении целостности тимпанальной мембраны

One of the most common treatments for the middle ear disorders is the injection of medications into the tympanic cavity through the acoustic meatus. This method has proven itself in treatment of the perforated forms of otitis. In cases of preserving the integrity of the tympanic membrane, its efficacy is arguable due to the impossibility of drug direct penetration via the membrane and contact with the mucous membrane. To increase the permeability of the tympanum, the authors used endaural phonophoresis of drugs. The drug penetration into the tympanum was confirmed by multispiral computed tomography (MSCT) of the temporal bones before and after contrasted ultraphonophoresis with tissue contrast. A 5% solution of potassium iodide was used as a contrast substance, as well as a solution of dexamethasone, which served as an intermediate medium in patients with external otitis and a chronic secretory otitis media. The mechanism of penetration was associated with the primary accumulation of the drug in the layers of the tympanic and adjacent mucous membranes with further dissemination into the deeper parts of the tympanic cavity. An additional confirmation of this is the reaction of the mucous membrane of the tympanic cavity, the mastoid process and the airiness restoration during endaural phonophoresis with dexamethasone. Ultraphonophoresis of drugs through the imperforated eardrum can be used in the conservative treatment of protracted forms of secretory otitis media.

Effects of Qing Qiao Capsule in the treatment of chronic secretory otitis media and the levels of serum inflammatory factors

To explore the effects of Qing Qiao Capsule in the treatment of chronic secretory otitis media and the levels of serum inflammatory factors, a total of 50 chronic secretory otitis media patients in the control group were subjected to caefaclor capsule, while the total of 50 cases in the observation group were treated with Qing Qiao Capsule. The traditional Chinese medicine (TCM) syndrome scores, therapeutic effects, and the levels of inflammatory factors were evaluated. After treatment, the scores of deafness, hearing loss, dizziness, soreness and weakness of the waist and knees, and fever is hens in palms and soles were significantly decreased in both groups (all P value <0.05). However, each score in the observation group was markedly less than that of the control group (all P value <0.05). Moreover, the C-reactive protein (CRP), procalcitonin (PCT) and tumor necrosis factor-α (TNF-α) levels measured after treatment were significantly lowered than those before treatment (all P value <0.05). Also, the levels of CRP, PCT and TNF-α in the observation group were obviously less than that of the control group (all P value <0.05). And the total therapeutic efficacy of the observation group was significantly higher than that of the control group (P<0.05). But no significant difference was observed in the rates of adverse reactions between both groups (P>0.05). Application of Qing Qiao Capsule in the treatment of chronic secretory otitis media yields better results, lowers TCM syndrome scores, and alleviates the body's inflammatory response, which is a safe drug in clinical use.

Evaluating short and long term outcomes following pediatric Myringoplasty with Gelfoam graft for tympanic membrane perforation following ventilation tube insertion

BackgroundMyringotomy with ventilation tube (VT) insertion to treat recurrent acute otitis media and chronic secretory otitis media has become one of the most common surgical procedures performed in children. Although contemporary literature has detailed the various patient and perioperative factors that affect successful pediatric myringoplasty, there is still limited evidence surrounding the increasing number of graft material options. In particular, gelfoam patching has arisen as a simple and efficient modality for perforation closure, but has a paucity of evidence particularly in pediatric cohorts. Our study aims to evaluate the clinical and audiometric outcomes following gelfoam myringoplasty for TMP following prolonged VT insertion in an urban pediatric population.MethodsA retrospective review of pediatric patients who underwent myringoplasty between 2013 and 2018 following ventilation tube insertion. Patient demographics, comorbidities, and graft material were correlated with audiometric and clinical outcomes on follow up examination.ResultsOne hundred twenty patients underwent myringoplasty, with 61 (50.8%) males with a mean age of 8.9 years old. 101 (84.2%) of patients eventually underwent successful tympanic membrane (TM) closure, with 93 (77.5%) demonstrating closure at initial follow up. In the gelfoam cohort, 77 (90.6%) of patients demonstrated successful TM closure at initial follow up. Overall mean time to closure was 5.6 (standard error (SE) 0.9) months. A multivariate Cox proportional hazards model demonstrated none of the covariates including graft material significantly affected TM closure. Mean change in air conduction threshold were comparable between graft materials.ConclusionsPediatric myringoplasty with gelfoam graft material is a safe and viable alternative with favorable short and long term clinical and audiometric outcomes.

Наш способ микроэндоскопического исследования слуховой трубы

help of fine optical systems. The authors suggested various techniques of micro-endoscopic examination of the auditory tube (Chays A., Magnan J.; Kimura et al.; Edelstein et al.; Klug C. et al.; Christopher J. Linstrom, etc.) However, it should be noted that all the previously presented techniques had a number of technical drawbacks, such as: low resolution of optical instruments; imperfection of the method of optical fibers feed the into the auditory tube; contamination of the distal endoscope part with mucous discharge; the absence of easy but reliable methods of controlling the optical fiber position in the middle ear. The article presents our method of micro-endoscopic examination of the auditory tube. Working at this task, we used a flexible unguided micro-endoscope Omex, model OME 400. The device has the following specifications: diameter: 0.78 mm, minimal bending radius: 25 mm, resolution: 15,000 pixels. The insertion of the instrument into the auditory tube was performed by means of a special device for examination and management of the auditory tube diseases and a special elastic catheter. The article provides various options of the auditory tube examination both from the pharyngeal orifice and from the tympanic orifice side during tympanoplasty. The group of authors conducted endoscopic examination of the auditory tube in 90 children aged 3 to 12 years during cold-plasma adenotomy and shunting of the tympanic cavities under general anesthesia. Besides, the examination of the auditory tube in adult patients during tympanoplasty was performed. The total number of examinations was 20 people, males and females, aged 29-61 years. We revealed a number of pathomorphological changes of the auditory tube mucous membrane in chronic secretory otitis media, chronic purulent otitis media. We observed edema, folding of the mucous membrane of the auditory tube in the membranous cartilaginous part; polypus-changed mucous membrane in the area of the auditory tube tympanic orifice; fibrin strands in the area of auditory ossicles and the absence of changes in the auditory tube in the middle ear pathology.

Clinical comparative study of different kind of hormone delivery regimen in the treatment of patients with chronic secretory otitis media

Objective To investigate the clinical effects and safety differences of endoscopic hormone injection by tympanic membrane puncture and eustachian tube in the treatment of patients with chronic secretory otitis media. Methods From January 2015 to September 2016, 90 patients with chronic secretory otitis media in Zhoushan Hospital were chosen.They were randomly divided into two groups according to the digital table.The tympanic membrane puncture group (65 patients) was treated with hormone injection by tympanic membrane puncture and the eustachian tube group(65 patients) was treated with endoscopic hormone injection by eustachian tubeThe total clinical effective rate, the bone conduction threshold value in 1kHz, 2kHz, 4kHz and 8kHz, the ETDQ-7 score and the levels of laboratory index before and after treatment, the secondary tympanic effusion rate and the recurrence rate with follow-up of both groups were compared. Results The total clinical effective rate of the tympanic membrane puncture group and eustachian tube group were 77.78% and 93.33%, respectively.The total clinical effective rate of the eustachian tube group were significant higher than that of the tympanic membrane puncture group(χ2=9.84, P<0.05). The bone conduction threshold value in 1kHz, 2kHz, 4kHz and 8kHz of the tympanic membrane puncture group after treatment were (10.42±1.60)kHz, (12.86±2.50)kHz, (16.09±2.81)kHz, (15.26±2.68)kHz, respectively.The bone conduction threshold value in 1kHz, 2kHz, 4kHz and 8kHz of the eustachian tube group after treatment were (9.75±1.36)kHz, (11.13±2.02)kHz, (14.82±2.44)kHz, (13.78±2.11)kHz, respectively.The bone conduction threshold value in 1kHz, 2kHz, 4kHz and 8kHz of the eustachian tube group after treatment were significant lower than those of the tympanic membrane puncture group and those before treatment(t=3.10, 3.56, 3.29, 3.96, 2.87, 3.15, 2.91, 3.28, 2.67, 2.81, 2.78, 2.50, all P<0.05). The ETDQ-7 scores of the eustachian tube group after treatment were significant lower than those of the tympanic membrane puncture group and those before treatment(t=3.31, 3.87, 2.89, all P<0.05). The levels of laboratory index of the eustachian tube group after treatment were significant higher than those of the tympanic membrane puncture group and those before treatment(t=3.36, 3.77, 3.71, 4.02, 2.83, 3.06, all P<0.05). The secondary tympanic effusion rate and the recurrence rate with follow-up of the eustachian tube group were significant lower than those of the tympanic membrane puncture group(χ2=9.87, 12.33, 10.67, all P<0.05). Conclusion Compared with endoscopic hormone injection by tympanic membrane puncture, endoscopic hormone injection by eustachian tube in the treatment of patients with chronic secretory otitis media possess the advantages including relieve the clinical symptoms, improve the bone conduction threshold and eustachian tube function, regulate the laboratory indexes and reduce the risk of recurrence and effusion. Key words: Otitis media with effusion; Tympanic membrane; Punctures; Eustachian tube; Dexamethasone

The role of Th1/Th2 cells imbalance in the pathogenesis of secretory otitis media

Objective:The aim of this study is to explore the role of Th1/Th2 cells imbalance in the pathogenesis of secretory otitis media. Method:Ninety secretory otitis media patients were enrolled in observation group. According to medical history, they were divided into acute and chronic group. In addition, 90 healthy volunteers during the same period were selected as the control group. The levels of Th1-type cytokines IFN-γ, Th2-type cytokines interleukin-4 (IL-4) and IFN-γ/IL-4 in peripheral blood were compared between observation group and control group. Compare with acute and chronic secretory otitis media patients IFN-γ, IL-4, IFN-γ/IL-4 levels as well as the compare with middle ear effusion and peripheral blood sIFN-γ, IL-4, IFN-γ/IL-4 levels in observation group. Result:The level of IFN-γ, IL-4 and IFN-γ/IL-4 in the peripheral blood in the observation group were higher than those of the control group (P<0.05). The levels of IFN-γ, IL-4 and IFN-γ/IL-4 in the peripheral blood of patients in the chronic group were higher than those in the acute group. There was no significant difference in IL4, IFN-γ/IL-4 levels between the observation group and the middle ear effusion (P>0.05), IFN-γ levels in peripheral blood were lower than those of the middle ear effusion IFN-γ (P<0.05). Conclusion:Abnormal IFN-γ, IL-4 levels of the peripheral blood and the middle ear effusion have some relationship with secretory otitis media, and Th1/Th2 imbalance may be a risk factor for secretory otitis media.

Could fungi be detected in the fluid of persistent otitis media with effusion?

Abstract Otitis media with effusion (OME) often is considered a direct extension of the inflammatory process that occurs during long-lasting or recurrent episodes of acute otitis media. The observations above suggest that OME has an infectious etiology. Most bacterial and viral cultures of middle ear fluid that had been performed were often negative suggesting that other infectious agents may be involved such as fungi. Thirty patients (group A) suffering from chronic secretory otitis media (OME) were enrolled in this study. Three samples were collected and investigated using PCR assay with universal fungal primers and Sabouraud agar. The first sample was obtained from the fluid of the middle ear before insertion of the ventilation tube; the second sample was obtained from nasal secretions; and the third sample was obtained from the ipsilateral peritubal area of the nasopharynx. Thirty patients (group B) with comparable age group without history of ear diseases scheduled for tonsillectomy or adenotonsillectomy were added as a control group. Samples from peritubal area of the nasopharynx of patients and nasal secretion were tested using PCR assay with universal fungal primers and Sabouraud agar. PCR examination of the middle ear aspirate in group (A) cases was positive in 7 cases (23.3%), in nasal secretions samples 2 cases only (13.3%) were positive and no positive cases were detected in nasopharyngeal swab samples. In group (A), Sabouraud agar culture was positive for fungal culture of middle ear aspirates in 5 cases (16.6%) but in no cases for nasal secretion samples. Group A showed also negative (N0) growth in 30 (100%) patients for nasopharyngeal swab on Sabouraud agar. In group B, the findings of nasopharyngeal swab were negative (N0) growth in all examined samples on Sabouraud agar, and nasal secretions were also negative for fungal DNA detection using PCR assay. In this study, fungal DNA could be detected in the middle ear fluid in seven (23.3%) of 30 patients with persistent OME using PCR assay, and fungi could be detected in five (16.6%) patients on Sabouraud agar. A significant relationship was found between detection of fungi in the middle ear fluid and the duration of the disease, associated adenoid, and history of asthma.

The clinical status of the eardrum: An inclusion criterion for the treatment of chronic secretory otitis media in children

Objective To investigate if the clinical status of the eardrum could be an inclusion criterion for the therapy of chronic secretory otitis media (CSOM). To compare the results of treating CSOM by adenoidectomy and by adenoidectomy in combination with tympanostomy tubes in two groups of patients chosen according to that criterion. Methods 161 ears in 87 children were treated for CSOM. An otomicroscopic examination showed there were no pathological changes on the tympanic membrane (signs of adhesive process, malleus rotation, and dangerous attic retractions). The patients were randomly divided into two groups: the first group of 59 ears was treated by myringotomy and tympanostomy tubes and adenoidectomy, while the other group of 102 ears was treated only by adenoidectomy. At least 6 months after the treatment, otomicroscopy and audiological assessments were performed in order to show the resolution of the middle ear effusion (MEE), audiological results and incidence of clinical sequelae of the eardrum. Results The resolution of MEE by adenoidectomy alone was not significantly different from the results of treatment by adenoidectomy and tympanostomy tubes ( z = 1.565; p = 0.0587). There were no differences in pure tone audiometry between the two methods of treatment. Only at the frequency of 2000 Hz ( t = 2.173; p = 0.031) in treatment with adenoidectomy and tympanostomy tubes the values of air-bone gap (ABG) were lower. Sequelae: scars of the eardrum (chi-square = 28.107; ss = 1; p < 0.001) and attic retractions (chi-square = 4.592; ss = 1; p = 0.032) were more often in treatment with tubes. The incidence of clinical sequelae on the eardrum after treatment by tubes was commented on. Conclusion A criterion that could influence the approach to the therapy of CSOM in children.

Audiometric Changes in Chronic Secretory Otitis Media Due to Nasal Allergy

To investigate the possible role of nasal allergy on hearing levels in chronic otitis media with effusion (OME). In 87 adults who had chronic OME, 185 nasal challenges with allergen were performed using rhinomanometry combined with tympanometry and pure-tone audiometry (PTA). Of the 87 patients, 71 developed 131 positive nasal responses (NRs; p < 0.01), 119 of which were associated with significant changes in middle ear pressure (p < 0.01) and 96 with significant changes in PTA (p < 0.01). The hearing threshold increased significantly (>30 dB) at tone frequencies of 2,000 Hz during 63 NRs (p < 0.05) and at tone frequencies of 4,000 Hz during 93 NRs (p < 0.01). Nasal allergy can affect Eustachian tube function, leading to the changes in the middle ear pressure and resulting in hearing impairment. Nasal challenges with allergen performed using rhinomanometry combined with tympanometry and PTA may be a useful diagnostic supplement in chronic OME patients.

Many a slip?

Cystic fibrosis (CF) is a common disease (up to 1 in 2,000 in some populations), and there is a simple, cheap and reliable diagnostic test which is within the compass of a hospital of any size. Yet even so, wrong diagnoses are not uncommon, because there is a long list of causes of a false-positive elevation in sweat electrolytes 1. The most important problem is lack of experience and attention to detail by the operator. Furthermore, borderline cases may need sophisticated testing to establish the diagnosis, such as nasal potential differences or complete sequencing of the CF gene. The consequences of a wrong diagnosis of CF are potentially serious, including the prescription of inappropriate medications, and the generation of a great deal of anxiety. The situation with primary ciliary dyskinesia (PCD) is even more complex. The prevalence is debated, and although probably less than CF, PCD is still an important diagnosis to make. Diagnosis is delayed to a greater extent than CF 2, in part because many of the symptoms (cough and a runny nose) are common in normal children 3. The diagnosis is important; treatment leads to stabilisation of lung function, and those diagnosed late have worse spirometry 4, 5. Furthermore, PCD upper airway disease, specifically chronic secretory otitis media, has different implications than the same problem in otherwise normal children 6, 7. However, the diagnostic difficulties, particularly in terms of false positives, are much greater in …

Update in Primary Ciliary Dyskinesia

In Brief The spectrum of ciliary disease has widened from a primary upper and lower respiratory tract problem with the appreciation of the key role of sensory cilia. Five disease causing mutations have been discovered, but given the complexity of cilia, many more are likely to be found in the future. Primary ciliary dyskinesia may present with upper or lower airway disease, or be diagnosed after the discovery of associated conditions such as heterotaxy, complex congenital heart disease, and severe esophageal disease. Screening tests include nasal nitric oxide and in vivo measurements of mucociliary transport. Definitive diagnosis is by ciliary biopsy with measurement of ciliary beat frequency and pattern, followed by electron microscopy. Ciliary culture may help distinguish primary ciliary dyskinesia from ciliary abnormalities secondary to infection. Increasingly, genetic testing is becoming available. Once diagnosed, the severity is assessed, and follow-up should be in clinics with expertise in all areas of the condition. The evidence base for current treatment is weak, with no randomized controlled trials; all therapies are directed at complications, not the underlying abnormality. Lower airway disease is treated with airway clearance, antibiotics, and encouragement of exercise. A conservative approach to chronic secretory otitis media is advised. Although in many cases the patient is stabilized by medical therapy, some will go on to lung transplantation. In the future, specific therapies to reverse the ciliary dysfunction may become available. This article reviews recent advances in the genetics of primary ciliary dyskinesia and discuss the expanding spectrum of ciliopathy. We discuss the state of the art diagnostic tests, and review the age-related presentations. Finally, we discuss the management of the condition.

The ciliary beat frequency of middle ear mucosa in children with chronic secretory otitis media

The chronic secretory otitis media (CSOM) is a common disease in children. Its cardinal symptoms are recurrent middle ear effusions and conductive hearing loss. Until today, the pathophysiological mechanism of this disease remains unknown. The correlation with adenoids and tubal dysfunction during childhood seems to be obvious, but the origin of middle ear effusions still has to be clarified. It is known that the CSOM affects the mucociliary system in several ways. In order to find out more about these correlations, the ciliary beat frequency was examined in 123 samples of infantile middle ear mucosa suffering from CSOM. Samples were surveyed using a stroboscopic microscopy method. The results of this study showed a significant decrease of ciliary beat frequency (CBF) to an average of 7.4 s(-1) in children with a CSOM. The healthy group of control showed a frequency of 10.1 s(-1). The measured CBF dataset was correlated with microbiological findings. We found a typical bacterial profile in nearly all the cases that were examined but were unable to find a specific bacterium decreasing CBF. This study provides evidence for the diminution of CBF in cases of CSOM in comparison to a healthy control group. Our findings emphasize the importance of stopping the vicious circle of recurrent effusions by paracentesis or grommet insertion.

Role of nasal allergy in chronic secretory otitis media

Nasal allergy seems to be one of the important causes of chronic secretory otitis media (SOM) in children and adults. Chronic SOM is unequivocally related to disturbed function of the eustachian tube, which facilitates communication of the middle ear with the nasopharynx, nasal cavity, and indirectly with paranasal sinuses. The most serious consequences of chronic SOM are decreased elasticity of the tympanic membrane and hearing impairment. Allergic reactions in the nasal mucosa leading to release of various mediators result in development of three types of nasal response characterized predominantly by nasal obstruction. Eustachian tube functions can be affected directly by the mediators released in the nasal mucosa or indirectly by the nasal obstruction. Nasal challenges with allergens performed by rhinomanometry, combined with tympanometry and eventually audiometry, may be a useful diagnostic supplement for this disorder.

The role of nasal allergy in chronic secretory otitis media

Chronic secretory otitis media (SOM) has multifactorial causes, and nasal allergy is suspected as one of these causative factors. To investigate the possible role of nasal allergy in SOM in adults and to determine the diagnostic value of nasal challenges with allergens (nasal provocation tests) combined with tympanometry for the diagnosis of this disorder. In 69 young adults with chronic or recurrent SOM, 173 nasal challenges with allergens were performed by anterior rhinomanometry combined with tympanometry (pure-tone air conduction tympanometry). In 42 control subjects with only allergic rhinitis and no history of middle ear disease, 42 nasal challenges with allergens were repeated and combined with tympanometry. The study design was a placebo-controlled comparison. Of the 69 patients, 54 developed 129 positive nasal responses of various types (P < .01), 117 of which were accompanied by significant changes in middle ear pressure (P < .01). No significant tympanometric changes (P > .10) were recorded during the 42 positive nasal responses in control subjects. These results may confirm the occurrence of chronic SOM in some adult patients and the possible involvement of nasal allergy in chronic SOM. The nasal challenges with allergen performed by rhinomanometry, combined with tympanometry, seem to be a valuable supplementary tool for the diagnosis of this disorder.

Is Mastoidectomy Indispensable in Cochlear Implant Surgery?

To challenge the need for mastoidectomy in cochlear implant (CI) surgery by comparing the advantages and disadvantages of the classic technique for CI, the mastoidectomy posterior tympanotomy approach (MPTA), with the suprameatal approach (SMA), a nonmastoidectomy approach. A retrospective study of 290 patients who underwent cochlear implantation in our department between 1989 and 2002. One hundred fifty-seven of them underwent the MPTA and 133 underwent the SMA. The ability of the electrode to expand in the MPTA patients who were reoperated on was examined, as was the influence of mastoidectomy on the course of chronic secretory otitis media (SOM) in a group of 56 children who suffered from chronic SOM prior to implantation. In all 4 reoperated children, in whom the MPTA was used, the mastoid was completely closed by bony regrowth on the cortical portion of the mastoid and the mastoid cavity was obliterated. The electrode had been embedded in dense fibrous tissue and bony spicule, preventing electrode expansion. Mastoidectomy was found to have no influence on the course of chronic SOM. The rate of postoperative SOM was found to be equal in 40 children who were operated on using the MPTA compared with 16 operated on using the SMA. Using a nonmastoidectomy approach, such as the SMA, provides a wide exposure of the middle ear and promontory and thus enables a well-controlled cochleostomy site and safe insertion of the electrode into the cochlea. Mastoidectomy in CI surgery is not indispensable; it may cause more disadvantages than advantages.

Eustachian tube function and tympanic membrane findings after chronic secretory otitis media

Objective: The etiology of secretory otitis media (SOM) is multifactorial. The main factors discussed are infection and tubal dysfunction. This study aimed to detect poor tubal function and tympanic membrane pathology in young adults after extremely long-standing SOM. Methods: Thirty-four patients, 16–25 years old, with previous chronic SOM persisting at least 6 years (mean 11.2 years, range 6.2–18.6 years), were retrospectively examined at a mean of 18 years after their first myringotomy or tube insertion and comparison was made with 15 controls. The medical records were scrutinized, otomicroscopic examination was performed and the Eustachian tube function was studied in a mini pressure chamber. Results: The mean age at SOM onset was 2.4 years (range 0.5–8.4 years) and the mean period from the last myringotomy or when the last tube had disappeared to follow-up was 6.7 years (range 1.3–12.8 years). Tympanic membrane pathology was found in 76% of the ears of SOM patients and in none (0%) of controls ( P<0.001). The youngest patients had more atrophy than the older patients ( P<0.05) and more myringosclerosis was observed in patients with shorter interval between SOM ending and examination. The patients were found to have significantly poorer active tubal function; i.e. higher inability to equilibrate negative or negative and positive middle ear pressure, compared with controls ( P<0.001). The majority of the patients (74%) still experienced some kind of discomfort in their ears at the time of examination. Conclusions: Still in adulthood patients with chronic SOM during childhood exhibit dysfunction of the tube and tympanic membrane pathology to a high extent.

The Role of Mastoidectomy in Cochlear Implant Surgery

Objective—The classical technique for cochlear implantation (CI) involves mastoidectomy and posterior tympanotomy. The question raised in this work is whether mastoidectomy is indispensable in CI surgery.Material and Methods—The advantages and disadvantages of performing mastoidectomy during CI surgery were weighed, in particular the effect of mastoidectomy on chronic secretory otitis media (SOM) and the ability of the electrode to expand in the mastoid during skull growth.Results—No effect of mastoidectomy on chronic SOM was found and the assumption that the electrode in the mastoid cavity has the ability to expand during skull growth was not proven. Eliminating mastoidectomy in CI surgery simplifies the procedure, shortens the duration of surgery, minimizes the amount of drilling and provides broader, better exposure of the middle ear and promontory. Mastoidectomy was found not to be obligatory in CI surgery and in fact may have more disadvantages than advantages.Conclusion—The development of alternative CI techniques which eliminate the need for mastoidectomy is justified.