Cases Of Chronic Suppurative Otitis Media Research Articles

Role of high resolution computed tomography of temporal bone in preoperative evaluation of chronic suppurative otitis media

<p class="abstract"><strong>Background:</strong> Chronic suppurative otitis media (CSOM) is a common condition seen in patients attending ENT department. The diagnosis of cholesteatoma is usually made on otologic examination. The necessity for HRCT imaging in an uncomplicated case is controversial. The objective was<strong> </strong>to evaluate preoperative HRCT temporal bone and to determine its’ usefulness in patients with Chronic suppurative otitis media (CSOM) undergoing surgery.</p><p class="abstract"><strong>Methods:</strong> This study was a prospective study involving 30 cases of CSOM with cholestaetoma. All the patients underwent pre-operative HRCT screening followed by surgical exploration of middle ear cleft. Pre-operative CT scan and intra-operative findings recorded and compared. </p><p class="abstract"><strong>Results:</strong> Out of total 30 patients of CSOM, 16 (53%) were males and (90%) presented with chief complaints of otorrhoea. HRCT scan was found to be very sensitive (100%) in detecting cholesteatoma in middle ear cleft but differentiation between granulations or cholesteatoma wasn’t possible. HRCT satisfactorily delineated ossicular erosion except stapes suprastructure erosion which had 81.8% sensitivity and specificity 88.88%. For bony boundaries of middle ear, HRCT showed very high sensitivity and specificity for detecting scutum erosion, tegmen erosion, mastoid cortex erosion, jugular bulb dehiscence and bony external auditory canal erosion. It was moderately sensitive for LSCC Erosion (75%), Facial canal erosion (80%) and Sinus plate erosion (85.7%).</p><p class="abstract"><strong>Conclusions:</strong> These results indicate that preoperative CT temporal bone scan of patients with CSOM serves as an important guide in surgical approach for otolaryngologists, although there are limitations in evaluation of the CT results.</p>

Fungal Suppurative Otitis Media (Histopathology) Among Patients in North India.

Chronic suppurative otitis media (CSOM) has a substantial worldwide prevalence and is a major cause of hearing impairment. In cases of CSOM unresponsive to local antibiotics, superimposed fungal infection should be suspected. The aim of the present study was to study the spectrum of cases with fungal otitis media. The study was conducted over a period of 12years (2006-2017). Fifteen cases of CSOM clinically not suspected to be of fungal etiology that underwent surgery with identification of fungal organisms on histopathology were included in the study. Age of the patients ranged from 12 to 75years (mean age: 37.1 ± 22.7years). Of 15 cases, 9 (60.0%) were males and 6 (40.0%) were females. It was a unilateral presentation in all. The complaints observed were ear discharge in all followed by itching (86.7%), pain (46.7%), decreased hearing (26.7%) and blocking sensation (13.3%). Histomorphologic typing of fungus was possible in 13/15 patients. Isolated aspergillus was identified in eight patients while mucor alone was seen in three patients. Mixed infection with Aspergillus + Candida and Aspergillus + Mucor was seen in one patient each. Categorization of fungus could not be done in rest of the two patients due to paucity of fungal profiles. Histopathological identification of fungal organisms in otomycosis provides a quick and fairly reliable diagnosis. Culture is considered the gold standard but it may not always be available or fruitful. Less turnaround time and accurate diagnosis facilitates prompt and optimal therapy in fungal otitis media thus preventing adverse outcomes.

Therapeutic guidelines for antimicrobial use in chronic suppurative otitis media for a tertiary care hospital in Sub Himalayan region

Background: The battle against micro-organisms, in their role as primary cause of the disease and infective complications of medical and surgical techniques, has not decreased in spite of modern antimicrobial therapy. Chronic suppurative otitis media (CSOM) is a disease with worldwide prevalence having potentially serious long term effects. The disease remains an important global public health problem leading to hearing impairment, and due to wide spread irrational use microbial resistance is very common to these antibiotics, thereby leading to treatment failure. Hence it is important to know the type of bacteria and their sensitivity pattern so that appropriate antibiotics may be given for treatment and prevention of complications.Methods: 428 patients of otitis media were enrolled from ENT OPD of Tertiary Care Hospital. Ear swab was taken from diagnosed cases of CSOM and culture and sensitivity were done.Results: The microbiology of the swab showed no growth in (25.4%) of samples. Staphylococcus aureus (26%) and Pseudomonas (25%) were the main organisms isolated. Staphylococcus aureus isolated was sensitive to vancomycin, clindamycin, cefixime, gentamicin and cefipime in descending order. Pseudomonas aeruginosa was sensitive to ceftazidime, imipenem, piperacillin, gentamicin, cefipime. In the present study Staph. aureus and Pseudomonas were the predominant bacteria, it is suggested to undertake a gram staining in all patients. If gram positive organisms are isolated it is suggested that presumptive treatment should be directed against Staphylococcus aureus and if gram negative then against Pseudomonas aeruginosa. Such a treatment is not only likely to be effective but will also go a long way in preventing emergence of drug resistance.Conclusions: The antimicrobial therapy should be based on locally determined microbiological isolates and local sensitivity patterns to a particular antimicrobial agent. The presumptive antimicrobial therapy should therefore be directed against these organisms.

Evaluation of the hearing results after mastoidotympanoplasty operation with or without ossiculoplasty: A percentage change versus absolute change; a different methodology

Purpose: Our article provides a comprehensive review of parameters of percentage change of the results regarding the documented hearing results (not based on any particular classification) in ear surgeries in chronic suppurative otitis media (CSOM) cases. Materials and Methods: Our series is a prospective cohort observational study in 230 cases of CSOM from 2009 to 2016 wherein we have evaluated the hearing improvement with a parameter of percentage change of hearing improvement between preoperative and postoperative period in various types of ear surgeries. Statistics and Results: A statistically significant difference was seen in 4 out of the 14 surgical groups, namely, in mastoidotympanoplasty, modified radical mastoidectomy (MRM), and MRM with tympanoplasty and in tympanoplasty. The rest of the 10 surgical groups had

Prevalence of chronic suppurative otitis media in schoolgoing children

Introduction: Chronic suppurative otitis media (CSOM) is a major health problem throughout the world in underdeveloped and developing countries including India. The high prevalence of CSOM in school children in India has led us to undertake this study in schoolgoing children of rural and urban areas of Muzaffarnagar, Uttar Pradesh and to find out the various predisposing factors for the development of CSOM. Objectives: The objective is to find out the prevalence of CSOM in schoolgoing children of the rural and urban population about age, sex, and socioeconomic status. Materials and Methods: Students were randomly selected from primary schools in rural and urban areas of Muzaffarnagar, Uttar Pradesh. Cases selected was categorized in relation to age, sex, socioeconomic status, and prevalence of the safe and unsafe type of CSOM. Observations: In the present study, a cross-sectional survey was conducted in 2158 school children between the age group of 5 and 15 years. A total of 1161 children belonged to urban school whereas 997 children were from three adjacent rural government schools. A total of 78 children were found to be suffering from either unilateral or bilateral CSOM. Conclusion: The prevalence of CSOM in urban school children was 2.32%, while for rural children, it was 5.11%. 42.10% of cases of CSOM belonged to upper-lower socioeconomic group followed by lower middle group (31.57%). The tubotympanic disease was present in 87.18% of CSOM cases while 12.82% had atticoantral disease. Active CSOM was found amongst 37.18% while 62.82% had inactive disease. 42.10% had smoking father, 36.84% had indoor cooking with kerosene oil exposure, and 34.21% used unhygienic ear cleaning methods. 31.58% had a history of recurrent URI, 28.95% had chronic tonsillitis, and 21.05% of children had domain name system as associated findings with CSOM.

Prevalence of Pseudomonas aeruginosa in CSOM cases at a tertiary care centre

<p class="abstract"><strong>Background:</strong> Chronic suppurative otitis media (CSOM) is an infectious chronic ear disease in India characterised by discharge from ear. This is the commonest infection in children more so in low socio economic group. CSOM is caused by various gram positive and gram negative organisms.</p><p class="abstract"><strong>Methods:</strong> Study group includes CSOM patients coming to ENT Department of Kamineni Institute of Medical Sciences, Narketpally, Telangana, India. Swabs were taken from discharging ears and sent for Gram’s staining, culture and antibiotic sensitivity. The results were analysed and a protocol was devised for effective treatment of <em>Pseudomonas aeruginosa</em>. </p><p class="abstract"><strong>Results:</strong> Total numbers of study group were 180 of. 180 patients, 84 were males and 96 were females. CSOM infection was found to be more common in 11-30 yrs age group. When the ear discharge was sent for culture and sensitivity only 106 patients out of 180, showed culture positivity. <em>Pseudomonas aeruginosa</em> was the most common organism identified. Its prevalence in the present study was 23%. <em>Methicillin Resistant Staphylococcus aureus </em>(MRSA) and <em>Klebsiella sps</em> were the next common isolates, whose prevalence was detected to be 10% and 8% respectively. <em>Pseudomonas</em> is resistant to all routine broad spectrum antibiotics like amoxicillin, ampicillin and amoxycillin - clavulanate and cephalosporins, but sensitive to ciprofloxacin, gentamycin, imipenem, meropenem, piperacillin.</p><p><strong>Conclusions:</strong> CSOM is common among children and young adults. <em>Pseudomonas aeruginosa</em> was the most common isolate (23%) in our study. As<em> Pseudomonas</em> was found to be resistant to routine antibiotics, inadvertent use of routine antibiotics will lead to the development of multidrug resistant strains in the community which are difficult to treat. Specific antibiotic treatment should be started based on the culture and antibiotic sensitivity report of the swab.</p>

To Evaluate and Compare the Result of Ossiculoplasty Using Different Types of Graft Materials and Prosthesis in Cases of Ossicular Discontinuity in Chronic Suppurative Otitis Media Cases.

Chronic suppurative otitis media, with and without cholesteatoma, frequently results in disruption of the ossicular chain. The present study was designed to compare the outcome using autologous ossicle and titanium prosthesis in two groups of suitable patients presenting with chronic suppurative otitis media for middle ear reconstructive surgeries. A prospective study done from July 2012 to December 2013, at Mahatma Gandhi Medical College and Hospital, Sitapura, Jaipur (Rajasthan). The target group included patients with chronic suppurative otitis media admitted and planned for reconstructive middle ear surgery. The study group patients among the target group requiring certain ossicular reconstruction. The patients included were patients with CSOM with or without cholesteatoma in which there was ossicular discontinuity. The patients were divided in two groups A and B. In group A patients autologous incus was used and in group B titanium prosthesis either TORP or PORP was used for ossicular replacement. Out of 340 patients as target group, 88 patients were included in study group. Further 88 patients of study group, 51 patients were included in group A; rest 37 patients were included in group B. In group B patients partial ossicular replacement platinum prosthesis was used in 31 patients while in rest 6 patients a total ossicular replacement prosthesis was used. Out of 88 patients, 79 were primary cases and 9 were revision cases. Pre and post operative air bone gap were noted. Pre operatively both of the groups were identical in relation to air-bone gap. The postoperative air-bone gap was calculated as the difference between postoperative air conduction and preoperative bone conduction. On comparison of preoperative and post-operative hearing results there was improvement in air conduction threshold and air bone gap in both the groups. Post operatively difference in air bone gap closure between group A and group B was found statistically significant (P value=0.032) suggesting better hearing outcomes after using titanium ossicular replacement prosthesis. On comparing partial or total ossicular replacement prosthesis no significant difference was found for the audiological outcome (P=0.434). Various prognostic factors were also noted for air bone gap closure. Titanium ossicular replacement prosthesis have better outcome, and no significant difference found in audiological outcome for TORP and PORP.

A cross sectional study to assess effects of mastoid drill on hearing levels in chronic suppurative otitis media cases in a tertiary care hospital in northern Maharashtra

<p class="abstract"><strong>Background:</strong> Chronic suppurative otitis media (CSOM) is most common middle ear disease that is encountered in daily practice. It is accepted that middle ear surgery carries a small risk of sensorineural hearing loss. The present study was done to assess the effects of mastoid drilling on hearing loss in operating ear and contralateral ear in cases of CSOM.</p><p class="abstract"><strong>Methods:</strong> 80 patients with CSOM (with or without complications) age group 15 - 60 years attended the ENT outpatient department of Government Medical College and Hospital after taking consent were selected for the study using universal sampling technique, between August 2014 to August 2016. </p><p class="abstract"><strong>Results:</strong> The study was conducted on 80 patients, aged between 15 to 60 years, who underwent ear surgery for CSOM at Government Medical College Hospital, from August 2014 to August 2016. We found no postoperative SNHL in 28 patients, while 52 patients (48 patients with temporary SNHL & 4 patients with permanent SNHL) had suffered from development of mild SNHL after middle ear surgery.</p><p><strong>Conclusions:</strong> Mastoid drilling used during ear surgery can cause mild sensorineural hearing loss in immediate postoperative period in operated ear. </p>

Comparison of myringostapediopexy and malleostapediopexy tympanoplasty with sculptured incus in case of hearing reconstruction in tubotympanic chronic otitis media: A case series

Introduction: Chronic suppurative otitis media (CSOM) is a burden on Indian population due to hearing loss due to deformation of the ossicular chain which needs reconstruction (ossiculoplasty). This study is an attempt to analyze the use of autogenous incus in ossiculoplasty for the same. Aim: The aim of this study is comparison of malleostapediopexy and myringostapediopexy in seventy cases of tubotympanic CSOM. Materials and Methods: Seventy patients with CSOM were operated and tympanoplasty was done. Ossiculoplasty was done using incus interposition as malleostapediopexy and myringostapediopexy and results analyzed. Results: In the present study, the pre- and post-operative air-bone gap values for myringostapediopexy cases were 38.00 ± 6.84 and 27.28 ± 5.12, respectively, and for type malleostapediopexy were 37.95 ± 7.51 and 18.08 ± 4.34, respectively. Statistical Test Used: Unpaired t-test. Conclusion: A better outcome was seen in malleostapediopexy than myringostapediopexy.

A comparative study of middle ear evaluation by otomicroscopy and otoendoscopy in cases of chronic suppurative otitis media

Purpose: Chronic suppurative otitis media (CSOM) is one of the common causes for hearing impairment and disability. Despite continuous technical improvements, the basic optical principles and their limitations have remained the same over the past three decades. This study was aimed at visualizing and evaluating the middle ear structures with the aid of an otomicroscope and 0, 30 and 70 degree-angled endoscopes in cases of chronic suppurative otitis media. Methods: In this prospective study, 100 patients (63 males and 37 females) above the age of 10 years with CSOM were subjected to both otomicroscopy and otoendoscopy. The visualizations of middle ear structures were compared and statistically analyzed. Results: Middle ear structures were better evaluated with 30 and 70 degree endoscopes (p 0.05) advantage of endoscopes over microscopes was detected in examining middle ear mucosa. However, the microscope was better than a 70 degree endoscope in visualization of the mouth of the retraction pocket. Conclusion: Endoscopy provided a significantly better visualization for all the parameters studied versus a microscope. It is desirable to study the role of the endoscope in more cases of unsafe CSOM and also intraoperatively.

Radiological changes in anatomy of temporal bone in cases of unsafe chronic suppurative otitis media: A retrospective study

Introduction: The ability of high-resolution computed tomography (HRCT) to depict the status of structure of the temporal bone represents a major advance in delineating pathology before surgical exploration of ear in cases of unsafe chronic suppurative otitis media (CSOM) or cholesteatoma. Aims and Objectives: The aim of this study was to evaluate the role of HRCT temporal bone in cases of unsafe CSOM and to assess the erosion of various structures in middle ear cleft. Study Design: This was a retrospective analysis. Materials and Methods: Fifty HRCT scans of temporal bone of the patients who were diagnosed as case of unsafe CSOM were selected and analyzed retrospectively. Criterion for inclusion was CSOM with cholesteatoma or granulations or polyp or posterior canal wall sagging or foul smelling discharge. In HRCT scans, 1 mm thickness sections were studied in both axial and coronal planes. Criterion for exclusion was history of previous ear surgery, history suggestive of head injury or skull base trauma in the past or known cases of temporal bone neoplastic pathology. Results: Maximum number of patients belonged to the age group of 21–30 years. Ossicular erosion was the most common (90%) finding followed by scutum erosion (84%). Erosion of sigmoid sinus plate was seen in only one case (2%). Cochlear promontory fistula was seen in none of the computed tomography scans. In ossicular chain, incus was the most common ossicle to be necrosed (92%) followed by malleus (66%). Conclusion: HRCT temporal bone delineates the location and extent of the disease and provides information on anatomical variations and complications.

Present scenario of microbiological pattern in chronic suppurative otitis media and its management guidelines

AIMS: Chronic suppurative otitis media (CSOM) is a common infectious chronic ear disease in India resulting in serious complications, especially hearing impairment. Irrational use of antibiotics for its management has led to the emergence of multidrug-resistant bacterial strains. Considering this, this study was conducted to know the pattern of causative organisms associated with CSOM and their antimicrobial sensitivity. Materials and Methods: Ear discharge from 200 clinically diagnosed cases of CSOM was collected by suction using sterile techniques in a sterilised test tube on wash bottle principle consisting of a glass tube made air tight with the help of a cork with an inlet and outlet facility. All samples were processed in the department of microbiology for the identification of bacterial and fungal isolates and their antimicrobial sensitivity testing. Results: Among the 200 samples of ear discharge, 127 were from ear having tubotympanic (mucosal or safe) type of CSOM while 73 were from ear with attico-antral (squamosal or unsafe) CSOM. Among aerobic isolates, Pseudomonas aeruginosa (35%) was most common followed by Staphylococcus aureus. Other aerobes isolated were Klebsiella spp., coagulase-negative Staphylococcus, Proteus spp. and Escherichia coli. Fungus was isolated in tubotympanic (9.45%) CSOM only. Among anaerobic isolates, Peptostreptococcus (1%) was most common. Conclusion: Monomicrobial isolates, especially P. aeruginosa and Staphylococcus species, were found to be most common in our study. Therefore, evaluation of microbiological pattern and their antibiotic sensitivity pattern in local area becomes helpful in prescribing empirical antibiotics for successful treatment of CSOM.

Prevalence and antibiotic susceptibility of Pseudomonas aeruginosa isolated from chronic suppurative otitis media

<p class="abstract"><strong>Background:</strong> Chronic suppurative otitis media (CSOM) is the most common middle ear infection characterized by recurrent ear discharges or otorrhoea through a tympanic perforation from the middle ear. The organisms isolated from CSOM include both aerobic and anaerobic bacteria. Among the bacteria, <em>Pseudomonas aeruginosa</em> (<em>P. aeruginosa</em>) has been particularly blamed for deep seated and progressive destruction of middle ear and mastoid structures through its toxins and enzymes. The present study was done to determine the prevalence and antibiotic susceptibility of <em>P. aeruginosa</em> isolated from CSOM.</p><p class="abstract"><strong>Methods:</strong> This was a retrospective study conducted in a tertiary care hospital in South India in March 2016. Data was obtained from the microbiology records from January 2014 to January 2016. Patients who had active ear discharge for at least three months were included in the study. <em>P. aeruginosa</em> was identified by colony morphology, pigment production, characteristic musty or earthy odor. The identification was confirmed by motility and standard biochemical tests. </p><p class="abstract"><strong>Results:</strong> A total of 293 cases of CSOM were included in the study. Microbial growth was seen in 248 (84.6%) cases and remaining 45 cases did not show any growth. Among 248 bacterial growth, 87 (35%) were positive for P. aeruginosa. Most common organism was <em>P. aeruginosa</em> followed by <em>Staphylococcus aureus</em>. Highest resistance was seen with Gentamicin and Ofloxacin and least resistance with Imipenem. The increased resistance to Cephalosporin group is warning sign, as these are potent anti-Psuedomals.</p><p><strong>Conclusions:</strong> <em>P. aeruginosa</em> and Staphylococcus aureus were found to be the common cause of CSOM in the present study. <em>P. aeruginosa </em>was resistant to commonly used antimicrobials. There was no resistance seen with Imipenem and only two strains were resistant to Piperacillin+tazobactum. Regular evaluation of the microbiological pattern and antibiogram of isolates will help in decreasing the complications of CSOM. </p>

A study on clinical and epidemiological profile of chronic suppurative otitis media (CSOM) at a tertiary care center

Background: Chronic suppurative otitis media (CSOM) is one of the common problems encountered by individuals in India. It can cause permanent hearing loss at a very early age if not treated at earliest. Objective: To study clinical and epidemiological profile of 123 CSOM cases observed at the S.S. Medical College & G.M. Hospital, Rewa. Materials and Methods: The present study was a case series of 123 patients of CSOM who presented to the S.S. Medical College and G.M. Hospital, from November 2012 to February 2013. Result: Male preponderance was seen with age ranging from 1 year to 70 years. Most patients 45(36.59 %) belong to the age group of 10–20 years. Most patients belong to poor socioeconomic status (SES class IV, V comprise more than three-fourth of patients). Most of the patients (81.30%) visited to an ENT specialist for the first time. Most of the patients belonged to rural background (65.04%). Bilateral CSOM was less frequent (only 17.07%). Safe CSOM was more common (89.43%) as compared to cases with unsafe CSOM (10.57%). Hearing complaints were present in 52.85 % cases. Conclusion: CSOM is a common condition in developing countries and requires support and cooperation of both medical professionals and patients for the proper and timely management of the problem.

Hearing results of tympanoplasty with attic reconstruction vs. obliteration in attic cholesteatoma

INTRODUCTION: The aim of the study was to compare hearing results between tympanoplasty with attic wall reconstruction and attic obliteration. MATERIAL AND METHODS: A prospective study included 88 patients who were operated for chronic suppurative otitis media (CSOM) and cholesteatoma in the ENT Department University Clinic Center Banja Luka from 2006 to 2011. Analysis of variance (ANOVA) was conducted to assess the impact of two different techniques of tympanoplasty: attic wall reconstruction and attic wall obliteration on patients` hearing. Hearing outcome was measured comparing preoperative to postoperative pure-tone average (PTA) and postoperative air-bone gap (ABG). RESULTS: Cholesteatoma was found in 54 (61.4%) patients: 31 (35.2%) sinus cholesteatoma, 20 (22.7%) attic cholesteatoma, 3 (3.4%) tensa tympanic cholesteatoma, and 34 cases (38.6%) of CSOM. Lateral attic wall and ossicular chain reconstruction was performed in 33 cases with subsequent attic reconstruction if the long process of the incus and the incudo-stapedial joint were missing. A mixed between-within-subjects analysis of variance showed significant improvement of PTA postoperatively in comparison to preoperative levels: Wilk`s Lambda=0.33, F(1,86)=172.1, p<0.001. ANOVA showed significant improvement of ABG postoperatively in comparison to preoperative levels: Wilk`s Lambda=0.23, F(1,86)=286.3, p<0.001. Hearing improvement was measured in both cases, the ABG closure and mean PTA improvement was larger in the attic reconstruction compared to attic obliteration technique. CONCLUSION: Attic wall reconstruction with cartilage provides better postoperative hearing compared to attic obliteration. Attic reconstruction in revision cases for cholesteatoma recurrence is not recommended.

Prevalence of Chronic Suppurative Otitis Media (CSOM) and Associated Hearing Impairment Among School-aged Children in Yemen.

Chronic suppurative otitis media (CSOM) is one of the leading causes of preventable disabling hearing impairment (DHI) in developing countries. Early detection and management complements advances made in other survival programs, improves work capacity, and enhances learning opportunities for school children. We aimed to determine the prevalence of CSOM and associated DHI among school children aged six to 16 years in Socotra Island, Yemen. We conducted a cross-sectional community-based survey, from 20 April 2011 to 20 June 2011. The study procedures involved completing a questionnaire, an otoscopic ear examination, an audiometric test of hearing, and tuning fork tests for the type of DHI. A total of 686 children were interviewed and examined for CSOM and associated DHI of CSOM cases. The prevalence of CSOM was 7.4%, (95% CI 5.5-9.4). CSOM status was significantly associated with DHI (p=0.001), but no significant associations were found between demographic characteristics and CSOM status. Logistic regression identified four significant independent contributing factors: history of ear discharge in the last 12 months (odds ratio (OR) 7.8, 95% CI 3.9-15.6); swimming in local pools (OR 6.0, 95% CI 1.4-25.4); recurrent respiratory tract infection more than three times per year (OR 5.3, 95% CI 2.5-11.0); and overcrowding with more than three families per house (OR 4.4, 95% CI 1.7-11.5). . The burden of CSOM in the children studied indicates a high level of DHI in these communities within Yemen. A history of ear discharge, swimming in local pools, recurrent respiratory infections, and overcrowded housing were the strongest predictors for CSOM. There is a need for better ear care and screening programs for early detection and management of this disease.

Complications of Chronic Suppurative Otitis Media and Their Management: A Single Institution 12 Years Experience.

To determine the incidence of otogenic complications of Chronic suppurative otitis media (CSOM) and its management. The study was conducted at the tertiary referral centre and teaching hospital. An analysis was made about the clinical and operative findings, surgical techniques and approaches, the overall management and recovery of the patient. The data were then compared with the relevant and available literature. Over the study period of 12years, a total 45 cases of CSOM with complications were reviewed. Out of these 45 cases, 20 cases had extracranial (EC) while 25 cases had intracranial (IC) complications. The prevalence of each complication was 0.17 and 0.13%, IC and EC respectively. The commonly encountered IC complications were brain abscess, meningitis and lateral sinus thrombophlebitis. Among the EC complications, mastoid abscess followed by labyrinthitis and facial nerve palsy were encountered. The reliable warning signs and symptoms of IC complications were fever, headache, earache vestibular symptoms, meningeal signs and impairment of consciousness. Proteus mirabilis, Pseudomonas aeruginosa, Staphylococcus epidermidis were the common organism isolated. Cholesteatoma and granulation in the middle ear were the major findings in both groups of cases. Surgery was main modality of management of these conditions. We observed that two patients fail to regain full facial nerve function despite of surgery. Mortality rate was zero but morbidity was seen in 15% (3) and 28% (7) of cases in EC and IC group respectively. The epidemiological presentation, clinical features and results of treatment are discussed. CSOM complications, despite its reduced incidence still pose a great challenge in developing countries, as the disease present in the advanced stage leading to difficulty in management and consequently higher morbidity. In this study we emphasize the importance of the accurate and early diagnosis followed by adequate surgical therapy with multidisciplinary approach.

Observations on the current bacteriological profile of chronic suppurative otitis media in South eastern Nigeria.

Background:Chronic suppurative otitis media (CSOM) is a disease well-known for its recurrence and persistence despite treatment. The situation is compounded by the increasing resistance to antimicrobial agents by bacteria these days.Aim:This study was carried out to examine the current local bacteriological profile of CSOM and to compare the profile of either ear in bilaterally discharging ears.Materials and Methods:We carried out a retrospective analysis of ear swab cultures from 133 unilateral and 73 bilateral consecutive tubotympanic CSOM cases seen at the Ear-Nose-Throat clinics of a referral health institution during a 4 year period ending 2013. Sensitivities to eight locally available antibiotics were analyzed. Aerobic bacterial isolates were analyzed separately for the unilateral and bilateral cases. Comparison was made between the ears in the bilateral cases.Results:We analyzed 279 ear swab culture results from 206 patients with age ranging from 5 months to 86 years and a mean of 21.3 (19.5) years. Pseudomonas aeruginosa was the most common isolated bacteria (44% [109/250]) followed by Staphylococcus aureus (17% [42/250]), and Proteus Mirabilis (15% [38/250]). The most and least sensitive bacteria were Klebsiella Spp and Escherichia Coli, respectively. The most effective antibiotics were gentamicin and ciprofloxacin. The two ears differ significantly in the rates of isolation of S. aureus and E. coli (P = 0.01 and P = 0.04, respectively).Conclusion:Pseudomonas is the most common bacteria involved in CSOM in this part of the country. Ciprofloxacin as ear drops is recommended as first-line drug in the management of active CSOM as it is cheap, less ototoxic, and locally available. Separate ear swab culture should be obtained in bilateral CSOM.

BADANIE MIOGENNYCH PRZEDSIONKOWYCH POTENCJAŁÓW WYWOŁANYCH DLA PRZEWODNICTWA POWIETRZNEGO I KOSTNEGO W CHRONICZNYM ROPNYM ZAPALENIU UCHA ŚRODKOWEGO PRZED I PO OPERACJI

BackgroundVestibular evoked myogenic potentials (VEMPs) are reflex myogenic potentials of the neck muscles elicited by stimulating the vestibular system with a click or tone burst sound stimulus. VEMP responses depend on good energy transfer of sound from the middle ear to the inner ear and are presumed absent in the presence of a conductive hearing loss (CHL) of more than 20 dB air-bone gap (ABG). The aim of this study was to evaluate VEMPs in patients with chronic suppurative otitis media (CSOM) before and after surgery.Material and MethodsThe study was conducted on 20 patients with CSOM preoperatively and postoperatively and on 20 controls. Their ages ranged from 20 to 50 years. Each subject underwent history taking, otologic examination, basic audiological evaluation, and air- and bone-conducted VEMP testing.ResultsAll perforated ears showed a lost air conduction VEMP response pre-operatively without any post-operative improvement. This can be attributed to the absence of any statistically significant differences between the pre-operative and post-operative ABGs at all tested frequencies. Bone conduction VEMP was preserved in all CSOM cases pre-operatively and post-operatively. There were no statistically significant differences between the air conduction and bone conduction VEMP parameters in the controls except for a significantly smaller P13–N23 amplitude of bone conduction VEMP compared to air conduction VEMP. There was no statistically significant differences between the pre-operative perforated ears of CSOM cases and their controls regarding bone conduction P13, N23 latencies, or P13–N23 amplitude. There was a significantly delayed P13 latency and greater P13–N23 amplitude of bone conduction VEMP post-operatively compared to pre-operatively. But there was no statistically significant difference between pre-operative and post-operative bone conduction N23 VEMP latency or interaural amplitude difference. Bone conduction VEMP results were pre-operatively affected by the ABG and bone conduction, but not post-operatively.ConclusionsAir conduction VEMP in patients with CSOM showed a zero-percent response rate pre-operatively that did not change post-operatively, whereas bone conduction VEMP showed a 100% response rate pre- and post-operatively. We therefore recommend using bone rather than air conduction VEMP for assessment of the sacculo-collic reflex in patients with CSOM who complain of balance problems.

English

INTRODUCTION: Chronic Suppurative otitis media (CSOM) is the most common condition encountered by otolaryngologists in day to day practice. The importance of chronic otitis media lies in its dreaded complications and deafness. AIM: This study was under taken to identify the microbiological isolates of the ear discharge in CSOM cases and their sensitivity to antibiotics. SETTINGS AND DESIGN: Tertiary care hospital in north costal Andhra Pradesh. It was a Prospective study. MATERIALS & METHODS: About 100 patients having ear discharge who attended ENT outpatient department from July 2013 to Feb 2014 for a period of 8months were studied. Aural swabs were sent to microbiology lab for culture &sensitivity. RESULTS: Culture reports showed aerobic bacterial isolates in 85 cases, fungi in 7 cases and sterile in 8 cases. Of the 85 cases of aerobic bacteria, staphylococcus aureus was isolated in 34 cases (40%) followed by Pseudomonas aeruginosa in 29 cases (34%), klebsiella in 16 cases (18.8%), E.coli in 4 cases (4.7%) and proteus in 2 cases. Antibiotic sensitivity reports showed Staphylococcus was more susceptible to netilmycin (97%), amoxiclav (91.7%) and least sensitive to ceftazidime (64.7%). Pseudomonas was more sensitive to amikacin (96.5%), gentamycin (93.1%) and least sensitive to amoxyclav (79.3%), ampicillin + sulbactum (82.75%). CONCLUSION: Mono microbial etiology, especially Staphylococcus species was found to be the most common organism causing chronic otitis media. Knowledge of the prevailing flora and their susceptibility to antimicrobials will guide the clinicians for early and effective treatment thereby avoiding complications.