Chronic Suppurative Otitis Media Group Research Articles

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

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

The expression of Nrf2 and TLRs in ear effusion in children with different types of otitis media and their relationship with inflammatory factors

ObjectiveThis study aimed to analyze the differences in the expression of Toll-like receptors (TLRs) and nuclear factor erythroid 2-related factor 2 (Nrf2) in ear effusion in children with different types of otitis media (OM), to elaborate the relationship between the expression of TLRs and Nrf2 in ear effusion and the pathogenesis of OM, and to explore the relationship between the two indicators and pro-inflammatory cytokines in children with OM, thereby laying a scientific foundation for revealing the underlying molecular mechanisms of the progression of different types of OM. MethodsA total of 73 children with OM who were treated in our hospital from March 2019 to July 2021 were selected as the study subjects. By using the cross-sectional investigation method, participants were divided into three groups according to the different pathological types, including the secretory OM group (30 cases), the chronic suppurative OM group (27 cases), and the cystic lesional OM group (16 cases). The levels of Nrf2, TLR2, TLR4 and proinflammatory cytokines [interferon-γ (IFN-γ), tumor necrosis factor-α (TNF-α), transforming growth factor-β 1(TGF-β1), procalcitonin (PCT) and interleukin-1β (IL-1β)] were detected in ear effusion of children with different types of OM. Linear regression was used to analyze the correlation between the Nrf2, TLR2 and TLR4 expression levels and pro-inflammatory cytokines in ear effusion. ResultsThe expression levels of TNF-α and PCT in the ear effusion of the children under 3 years old were significantly higher than that of the children between 3 and 5 years old and that of the children between 6 and 8 years old (all P < 0.001). The mRNA levels of Nrf2, TLR2 and TLR4 in the ear effusion of the children from the chronic suppurative OM group were higher than these from the secretory OM group (P < 0.001, P = 0.008 and P = 0.021). The mRNA levels of Nrf2, TLR2, and TLR4 in the ear effusion of the children from the cystic lesional OM group were higher than those from the chronic suppurative OM group (P < 0.001, P = 0.029 and P = 0.018). A prominent increase in the concentrations of IFN-γ, TNF-α, TGF-β1, PCT and IL-1β was found in the ear effusion of children from the chronic suppurative OM group compared to these from the secretory OM group (P = 0.021, P = 0.044, P = 0.048, P = 0.004 and P = 0.001). The concentrations of IFN-γ, TNF-α, TGF-β1, PCT and IL-1β in the ear effusion of the children from the cystic lesional OM group were markedly increased as compared with these from the chronic suppurative OM group (P < 0.001, P = 0.004, P = 0.003, P < 0.001 and P < 0.001). Nrf2, TLR2 and TLR4 were taken as independent variables, and inflammatory indexes, including IFN-γ, TNF-α, TGF-β1, PCT and IL-1β were used as dependent variables for the linear regression analysis. The results showed that Nrf2, TLR2 and TLR4 were positively correlated with the secretion levels of pro-inflammatory cytokines after adjusting for age, sex, course and the OM classification (all P < 0.05). ConclusionThe expressions of Nrf2, TLR2 and TLR4 in the ear effusion of children with different types of OM gradually increased with the severity of the disease, these were significantly positively correlated with the pro-inflammatory cytokines of the children. Nrf2/TLR signaling pathway maintained chronic inflammation in OM, induced damage of middle ear tissue, and promoted the transition from acute OM to chronic OM.

Influence of CX3CR1 Deletion on Cochlear Hair Cell Survival and Macrophage Expression in Chronic Suppurative Otitis Media.

Our objective was to determine whether the receptor CX3CR1 is necessary for the recruitment of macrophages to the cochlea in chronic suppurative otitis media (CSOM) and if its deletion can prevent hair cell loss in CSOM. CSOM is a neglected disease that afflicts 330 million people worldwide and is the most common cause of permanent hearing loss among children in the developing world. It is characterized by a chronically discharging infected middle ear. We have previously demonstrated that CSOM causes macrophage associated sensory hearing loss. The receptor CX3CR1 is expressed on macrophages, which have been shown to be increased at the time point of outer hair cell (OHC) loss in CSOM. In this report, we examine the influence of CX3CR1 deletion (CX3CR1-/-) in a validated model of Pseudomonas aeruginosa (PA) CSOM. The data show no difference in OHC loss between the CX3CR1-/- CSOM group and CX3CR1+/+ CSOM group (p = 0.28). We observed partial OHC loss in the cochlear basal turn, no OHC loss in the middle and apical turns in both CX3CR1-/- and CX3CR1+/+ CSOM mice at 14 days after bacterial inoculation. No inner hair cell (IHC) loss was found in all cochlear turns in all groups. We also counted F4/80 labeled macrophages in the spiral ganglion, spiral ligament, stria vascularis and spiral limbus of the basal, middle, and apical turn in cryosections. We did not find a significant difference in the total number of cochlear macrophages between CX3CR1-/- mice and CX3CR1+/+ mice (p = 0.97). The data did not support a role for CX3CR1 macrophage associated HC loss in CSOM.

Evaluation of postural stability and vestibulo-ocular reflex in adults with chronic suppurative otitis media

PurposeTo evaluate the vestibulospinal reflex and vestibulo-ocular reflex (VOR) in patients with chronic suppurative otitis media (CSOM) using posturography and the video head impulse test (vHIT).MethodsSixty-five patients with CSOM and 65 healthy participants as controls were included. Patients with CSOM were instructed to complete the dizziness handicap inventory (DHI). All participants underwent otoscopy, pure-tone audiometry, posturography sensory organization test (SOT), and vHIT.ResultsPatients with CSOM exhibited a high prevalence of dizziness. The CSOM group had poor SOT vestibular scores compared to the control group. Patients with CSOM had worse sways in the antero-posterior and mediolateral planes. The CSOM group was divided into two subgroups according to the type of hearing loss. SOT vestibular scores were significantly poorer in the mixed hearing loss group than those in the conductive hearing loss group. We found a positive correlation between disease duration and poor SOT vestibular scores. Moreover, poor SOT vestibular scores correlated with high DHI scores. We found abnormalities in the vHIT results in the CSOM group in the form of low VOR gain and corrective saccades.ConclusionOur study provides clinical evidence of dizziness, poor postural control, and VOR abnormalities in patients with CSOM. The presence of sensory elements of hearing loss in patients with CSOM appears to be positively associated with vestibular dysfunction.

Application of high resolution computed tomography image assisted classification model of middle ear diseases based on 3D-convolutional neural network.

Chronic suppurative otitis media (CSOM) and middle ear cholesteatoma (MEC) are the 2 most common chronic middle ear diseases. In the process of diagnosis and treatment, the 2 diseases are prone to misdiagnosis and missed diagnosis due to their similar clinical manifestations. High resolution computed tomography (HRCT) can clearly display the fine anatomical structure of the temporal bone, accurately reflect the middle ear lesions and the extent of the lesions, and has advantages in the differential diagnosis of chronic middle ear diseases. This study aims to develop a deep learning model for automatic information extraction and classification diagnosis of chronic middle ear diseases based on temporal bone HRCT image data to improve the classification and diagnosis efficiency of chronic middle ear diseases in clinical practice and reduce the occurrence of missed diagnosis and misdiagnosis. The clinical records and temporal bone HRCT imaging data for patients with chronic middle ear diseases hospitalized in the Department of Otorhinolaryngology, Xiangya Hospital from January 2018 to October 2020 were retrospectively collected. The patient's medical records were independently reviewed by 2 experienced otorhinolaryngologist and the final diagnosis was reached a consensus. A total of 499 patients (998 ears) were enrolled in this study. The 998 ears were divided into 3 groups: an MEC group (108 ears), a CSOM group (622 ears), and a normal group (268 ears). The Gaussian noise with different variances was used to amplify the samples of the dataset to offset the imbalance in the number of samples between groups. The sample size of the amplified experimental dataset was 1 806 ears. In the study, 75% (1 355) samples were randomly selected for training, 10% (180) samples for validation, and the remaining 15% (271) samples for testing and evaluating the model performance. The overall design for the model was a serial structure, and the deep learning model with 3 different functions was set up. The first model was the regional recommendation network algorithm, which searched the middle ear image from the whole HRCT image, and then cut and saved the image. The second model was image contrast convolutional neural network (CNN) based on twin network structure, which searched the images matching the key layers of HRCT images from the cut images, and constructed 3D data blocks. The third model was based on 3D-CNN operation, which was used for the final classification and diagnosis of the 3D data block construction, and gave the final prediction probability. The special level search network based on twin network structure showed an average AUC of 0.939 on 10 special levels. The overall accuracy of the classification network based on 3D-CNN was 96.5%, the overall recall rate was 96.4%, and the average AUC under the 3 classifications was 0.983. The recall rates of CSOM cases and MEC cases were 93.7% and 97.4%, respectively. In the subsequent comparison experiments, the average accuracy of some classical CNN was 79.3%, and the average recall rate was 87.6%. The precision rate and the recall rate of the deep learning network constructed in this study were about 17.2% and 8.8% higher than those of the common CNN. The deep learning network model proposed in this study can automatically extract 3D data blocks containing middle ear features from the HRCT image data of patients' temporal bone, which can reduce the overall size of the data while preserve the relationship between corresponding images, and further use 3D-CNN for classification and diagnosis of CSOM and MEC. The design of this model is well fitting to the continuous characteristics of HRCT data, and the experimental results show high precision and adaptability, which is better than the current common CNN methods.

Characteristics and differential diagnosis of middle ear cholesteatoma and chronic suppurative otitis media with wideband acoustic immittance

Objective:Through analysis of the sound energy absorbance of wideband acoustic immittance to provide a basis for differential diagnosis of adult acquired secondary cholesteatoma of the middle ear and patients with chronic suppurative otitis media（CSOM）. Methods:38 cases of cholesteatoma and 40 cases of CSOM admitted to the Department of Otolaryngology, Affiliated Hospital of Xuzhou Medical University from September 2020 to December 2021 were selected as the research group, and 30 cases （60 ears） of normal adults were selected as the control group. A total of 16 frequency points were selected, and the energy absorbance of wideband acoustic immittance was taken as the research parameter. The characteristics of energy absorbance under ambient pressure among the three are compared. Then the ROC in the cholesteatoma group was drawn, and by calculating the AUC, the Cut-off values and the corresponding sensitivity and specificity were found. Results:The energy absorbance in CSOM group at 1100-5700 Hz and the cholesteatoma group at 560-5700 Hz was lower than that in the control group, and the difference in some frequency bands was statistically significant. The energy absorbance in the cholesteatoma group at 226-7100 Hz was lower than that in the CSOM group, and the difference between the two groups in many frequency points was statistically significant. The ROC in the research group was drawn and it was found that the AUC in the 560, 710, 890, and 4500 bands was > 0.5, and in the other bands was > 0.7（P<0.05）. The AUC in the 2800 Hz was the largest （0.78）, the Cut-off value was 0.31, the corresponding sensitivity was 78.38%, specificity was 73.33%. Conclusion:Wideband acoustic immittance can be used as an auxiliary method for the differential diagnosis of adult-acquired secondary cholesteatoma of the middle ear and chronic suppurative otitis media in adults.

Silencing Nrf2 attenuates chronic suppurative otitis media by inhibiting pro-inflammatory cytokine secretion through up-regulating TLR4.

Compromised TLR-mediated chronic inflammation contributes to bacterial infection-caused chronic suppurative otitis media, but the mechanisms are unclear. The present study examined the expression status of nuclear erythroid 2-related factor 2 (Nrf2) and TLRs in human middle-ear mucosae tissues collected from patients with chronic suppurative otitis media, chronic otitis media and non-otitis media, and found that Nrf2 was high-expressed, whereas TLR4, instead of other TLRs, was low expressed in chronic suppurative otitis media compared to chronic otitis media and non-chronic otitis media groups. Consistently, inflammatory cytokines were significantly up-regulated in the chronic suppurative otitis media group, instead of the chronic otitis media and non-chronic otitis media groups. Next, LPS-induced acute otitis media and chronic suppurative otitis media models in mice were established, and high levels of inflammatory cytokines were sustained in the mucosae tissues of chronic suppurative otitis media mice compared to the non-otitis media and acute otitis media groups. Interestingly, continuous low-dose LPS stimulation promoted Nrf2 expression, but decreased TLR4 levels in chronic suppurative otitis media mice mucosae. In addition, knock-down of Nrf2 increased TLR4 expression levels in chronic suppurative otitis media mice, and both Nrf2 ablation and TLR4 overexpression inhibited the pro-inflammatory cytokine expression in chronic suppurative otitis media. Finally, we found that both Nrf2 overexpression and TLR4 deficiency promoted chronic inflammation in LPS-induced acute otitis media mice models. Taken together, knock-down of Nrf2 reversed chronic inflammation to attenuate chronic suppurative otitis media by up-regulating TLR4.

Subjective Visual Vertical Testing in Patients With Chronic Suppurative Otitis Media.

To analyze the results of the subjective visual vertical test using the "bucket method" in patients with chronic suppurative otitis media (CSOM). Cross-sectional, controlled study. Outpatient otology clinic in a tertiary care hospital. Patients had CSOM, defined as the presence of chronic infection or inflammation of the middle ear cleft, associated with a perforation of the tympanic membrane, frequent or intractable middle ear suppuration, with or without cholesteatoma. Controls were selected using a nonprobability, purposive sampling method. We excluded patients with neurologic or metabolic diseases, cognitive deficits, otosclerosis, vestibular migraine, Ménière's disease, past use of ototoxic medication, or head and neck cancer. The volunteers were subjected to the subjective visual vertical test using the "bucket method." The results obtained in our study and control groups were analyzed using nonparametric tests. Our study comprised 51 patients with CSOM and 50 controls. In the CSOM group, we observed that 72.5% of the patients had vestibular symptoms in the past year, and 70.5% had abnormalities identified in at least 1 vestibular function test. The subjective visual vertical test revealed that patients with CSOM (with and without cholesteatoma) had significantly higher deviations of the true vertical as compared with controls (CSOM, 3.66°; controls, 0.76°; P < .001). Our results revealed that CSOM was associated with high rates of vestibular symptoms, abnormal vestibular function tests, and abnormal subjective vertical visual results.

Analysis of main pathogenic bacteria and drug sensitivity in patients with chronic suppurative otitis media and middle ear cholesteatoma in China.

Chronic suppurative otitis media (CSOM) and middle ear cholesteatoma (MEC) were classified as different diseases recently. Owing to the difference in pathogeneses, the pathogenic bacteria of the two diseases can be different. However, few studies have compared the two types of pathogenic bacteria. To analyze the main pathogenic bacteria and drug sensitivities in patients of Southwest China with CSOM and MEC and compare the difference of ear dryness rate between empirical and sensitive medication. According to the data of culture of ear discharge and postoperative pathological examination, the patients were divided into CSOM and MEC groups. A cohort study was carried out in 1087 hospitalized patients with CSOM and MEC in the Department of Otolaryngology head and neck surgery, West China Hospital from January 2015 to June 2019. Pathogenic bacteria were detected in 467 of 726 cases of CSOM (64.46%) and in 190 of 361 cases of MEC (52.63%). Of the positive cases, 53.96% involved gram-positive(G+) bacteria and 46.04% involved gram-negative (G-) bacteria in the CSOM group; 41.05% involved G+ bacteria and 58.95% involved G- bacteria in the MEC group (P < 0.05). In the CSOM group, the top four pathogens were Staphylococcus aureus (33.62%), Pseudomonas aeruginosa (23.98%), Proteus (16.92%), and Coagulase-negative Staphylococci (10.28%). The top four pathogens in the MEC group were Proteus (22.11%), S. aureus (21.05%), P. aeruginosa (15.26%), and coagulase-negative staphylococci (8.42%). S. aureus was more sensitive to ciprofloxacin and moxifloxacin in the MEC group than in the CSOM group (= 14.286, P < 0.001; = 8.244, P < 0.01). P. aeruginosa was more sensitive to neomycin and tobramycin in the MEC group than in the CSOM group (= 21.285, P < 0.001; = 4.060, P < 0.05). The sensitivity rate of coagulase-negative staphylococci to neomycin in the MEC group was higher than that in the CSOM group (= 5.126, P < 0.05). The sensitivity of Proteus to piperacillin tazobactam in the CSOM group was higher than that in the MEC group (= 8.881, P < 0.05). The dry ear rate of patients with sensitive drug was significantly higher than the patients with empirical drug (= 19.431, P < 0.001). The detection rate of G+ bacteria in the CSOM group was higher than that in the MEC group. The detection rate of G- bacteria in the CSOM group was lower than that in the MEC group. The main pathogens in the two groups included S. aureus, P. aeruginosa, Proteus and coagulase negative Staphylococcus. The dry ear rate of patients who used sensitive drugs was significantly higher than the patients who used empirical drugs. Reducing the rate of empirical use of antibiotics as much as possible and selecting antibiotics reasonably were beneficial to the improvement of dry ear rate after surgery.

Postoperative change in wideband absorbance after tympanoplasty in chronic suppurative otitis media

ObjectiveTo identify the wideband absorbance (WBA) of reconstructed TM comparing with perforated and normal TM, and to investigate the efficacy of WBA to predict postoperative hearing outcome. MethodsNinety-eight adults (128 ears) with normal TM and 40 patients (40 ears) who were diagnosed with chronic suppurative otitis media (CSOM) and underwent tympanoplasty type 1 were enrolled. Pure tone audiometry and WBA were measured before and 6 and 12 months after surgery. Finally, only 29 patients in CSOM group completed all the tests. ResultsSignificant differences in WBA were observed between normal ears, CSOM, and reconstructed ears at middle to high frequencies. During follow-up, absorbance decreased at low frequencies and increased at middle to high. Significant positive correlation at low to middle frequency was observed between change in air-bone gaps (ABG) and absorbance at corresponding frequencies. ConclusionWBA in patients with CSOM was significantly different from normal TM, and a significant change in WBA was observed after tympanoplasty with improvement of ABG. WBA may be a useful tool for monitoring the postoperative change in absorbance of sound energy in the middle ear.

Clinimetric evaluation and clinical outcomes of the Dutch version of the Chronic Ear Survey

BackgroundTo validate and evaluate the reliability of the Dutch version of the Chronic Ear Survey (CES) in patients suffering from Chronic Suppurative Otitis Media (CSOM) and to evaluate clinical outcomes of surgery using this questionnaire.MethodsWe developed the Dutch version of the CES (D-CES) using forward-backward translation of the original CES into the Dutch language. Next, patients with CSOM and controls completed the D-CES pre- and postoperatively. Internal consistency, test-retest reliability, known-group validity and convergent validity were evaluated. In addition to the D-CES, the Short Form 36 (SF-36) was administered to all participants to correlate D-CES data to quality of life.ResultsA total of 29 patients with CSOM scheduled for ear surgery were included. Our control group consisted of 26 patients scheduled for eye surgery, all without signs and symptoms of CSOM. Cronbachs’ α of the complete questionnaire was 0.69. The Intraclass Correlation Coefficients (ICCs), reflecting test-retest reliability, ranged between 0.69 and 0.82. Scores differed significantly between CSOM patients and controls with substantial lower (more impaired) D-CES scores in the CSOM group. Duration of complaints preoperatively and the presence of a dry ear and/or improvement of hearing postoperatively all had a significant impact on D-CES improvement scores. Small to moderate correlations were found between D-CES subscales and matching subscales of the SF-36.ConclusionThe D-CES is an appropriate disease specific questionnaire to assess a patient’s perceived functional health in CSOM.

The Value of Diffusion-Weighted MRI in the Long-term follow-up After Subtotal Petrosectomy for Extensive Cholesteatoma and Chronic Suppurative Otitis Media.

To report the long-term follow-up with diffusion-weighted magnetic resonance imaging (DW MRI) after subtotal petrosectomy (SP) with blind sac closure of the external auditory canal for extensive cholesteatoma and chronic suppurative otitis media. Retrospective clinical record study. Tertiary referral center. Thirty-one patients (31 ears) with extensive cholesteatoma and 17 patients (19 ears) with chronic suppurative otitis media without cholesteatoma who underwent SP between July 1995 and December 2015. All 48 patients were followed clinically and with DW MRI to rule out residual cholesteatoma. Residual cholesteatoma, indicated by a marked hyperintensity on non-echoplanar (non-EP) DW MRI. In the cholesteatoma group the mean interval between surgery and the latest DW MRI was 3.9 years. Seven patients presented with a residual cholesteatoma pearl. The mean interval between surgery and detection of residual disease was 3.7 years. In the chronic suppurative otitis media group the mean interval between surgery and the latest DW MRI was 5.3 years. Residual cholesteatoma was found in three patients. Mean interval between surgery and the detection of disease was 4.5 years. This study shows the importance of DW MRI in the follow-up after SP for cholesteatoma and chronic suppurative otitis media. A little higher residual cholesteatoma rate was found compared with earlier studies, where patients were followed only clinically. One may wonder whether reintervention is always needed or whether in selected cases with small pearls, one may still observe these by a watchful waiting policy with DW MRI.

The Role of Mannose-Binding Lectin Serum Level in Tubotympanic Chronic Suppurative Otitis Media.

Background Chronic suppurative otitis media (CSOM) is a common public health problem worldwide and a major cause of hearing impairment especially in developing countries. The role of Mannose-Binding Lectin (MBL), a component of innate immunity, in CSOM has not been studied. The aim of the study was to examine whether MBL deficiency was more frequently present in cases group of tubotympanic CSOM patients rather than healthy subjects. Material and Methods This was an analytic observational study. Subjects were enrolled in the Otorhinolaryngology Clinic at Margono Soekarjo Hospital, Purwokerto, Indonesia. An independent t-test was used to compare the mean of MBL serum concentration between tubotympanic CSOM subjects and control. Results From 36 tubotympanic CSOM patients, there were 8 (22.22%) patients with MBL deficiency (MBL level < 100 ng/ml), while no deficiency was found in the control group. The mean of MBL level in cases group was 354.88 ng/ml, with the lowest level being 0.001 ng/ml and the highest level 690.24 ng/ml, while in the control group MBL level mean was 376.27 with the lowest level being 188.71 and the highest level 794.54 ng/ml. Conclusion There was no significant difference of MBL serum level between tubotympanic CSOM and control group. However, the presence of subjects with MBL deficiency in the tubotympanic CSOM group might be considered as playing a role in the tubotympanic CSOM.

Expression of tumor necrosis factor - α (TNF-α) and interleukin 1-β (IL1-β) in chronic tubotympanic suppurative otitis media

Chronic Suppurative Otitis Media (CSOM) is a common public health problem worldwide and a major cause of hearing impairment. It is also one of the neglected disease especially in developing countries. Cytokines are a group of glycoproteins that play a role in strengthening the immune and inflammatory reactions in various diseases, including inflammation of the middle ear. Some of the important inflammatory mediators found in middle ear fluids are Tumor Necrosis Factor-α (TNF-α) and Interleukin-1β (IL-1β). Cytokines are thought to play a role in the ongoing inflammatory regulation. The aim of this study was to compare the expression of TNF-α and IL-1β in tubotympanic CSOM and in healthy control group. The mean of TNF-α serum level in tubotympanic CSOM was 0,553±1,59 pg/ ml, and 0,587±2,13 pg/ ml in control group. There was no statistically different of TNF-α between two groups (P > 0,05). Mean of IL-1β serum level in the tubotympanic CSOM and control group were 0,633±0,92 and 0,302±0,48, respectively. Although IL-1β levels were higher in the patient group, the difference was not statistically significant (P > 0,05).

Tympanic membrane perforation in the province of: A retrospective study

In the current study, a retrospective scan was made of patients presenting at our clinic over the last 10 years and those diagnosed with tympanic membrane perforation were evaluated in 2 separate groups as patients with Chronic suppurative otitis media (CSOM) and Traumatic tympanic membrane perforations (TTMP). In this study patients with tympanic membrane perforation were evaluated through a retrospective examination of patients presenting at the Ear, Nose and Throat Clinic between May 2006 and May 2016. The tympanic membrane perforations were examined in two separate groups; CSOM and TTMP. When these patients were grouped according to the diagnosis criteria, the CSOM group comprised 8,335 (1.13%) patients and the TTMP group 422 (0.06%) patients. These two groups were compared in respect of the items stated age, gender, laterality. When the considerable number of patients is taken into consideration, although the results do not completely show a prevalence rate, they can give preliminary information.

The Diffrentiation of the Angles of Eustachian Tubes In the Patient Chronic Suppurative Otitis Media With and without Cholesteatoma

Background: Chronic Suppurative Otitis Media (CSOM) is one of the major health problems found in many populations in the world and a cause of high morbidity and high mortality. However, there is no single theory that explains how and why chronic otitis media occurs. There are many studies on the function of Eustachian tube. However, the role of the Eustachian tube angle and the relationship with the occurrence of CSOM has not been widely studied. This study aimed to evaluate the mean of Eustachian tube angle and to examine the diffrentiation between angle of Eustachian tube in Chronic Suppurative Otitis Media (CSOM) patient with and without cholesteatoma. Subjects and Methods: This research is a case-control study. Study group consist of 27 patients of CSOM with cholesteatoma and 27 patients of CSOM without cholesteatoma included as controlling. All patients are examined by using CT temporal and measured the angle of Eustachian tube using Multiplanar Reconstruction (MPR) technique on osirix program. The data was analyzed using independent T test Results: The mean of the Eustachian tube angle in CSOM with cholesteatoma in female patients was 28.69 0 and male 27.78 0 whereas in the CSOM group without cholesteatoma in female patients was 33.81 0 and men 31.87 0 . The mean of Eustachian tube angle in CSOM patients with cholesteatoma is 28.22 0 and CSOM without cholesteatoma is 33.00 0 . In independent T test, the result showed significant differentiation (p= 0.001) between the angle of Eustachian tube in patients CSOM with and without cholesteatoma. Conclusion: The advance of technology makes easier to measure of Eustachian tube angle. In men found that the Eustachian tube angle is more horizontal than women. There is diffrence between the angle of the Eustachian tube with the occurrence of cholesteatoma in CSOM. Keywords: angle of Eustachian tube, CSOM Correspondence: Rissa Ardika Nasution. RSUP H. Adam Malik, Medan. FK USU, Jln. Sembada Pasar V no. 27 P. Bulan Medan. Email: nrissaardika@yahoo.com. Mobile: 082277767660. Indonesian Journal of Medicine (2017), 2(1): 73-78 https://doi.org/10.26911/theijmed.2017.02.01.08

Attenuated TLRs in middle ear mucosa contributes to susceptibility of chronic suppurative otitis media

The variability in the recovery of otitis media (OM) is not well understood. Recent data have shown a critical role for toll-like receptors (TLRs) in inflammatory responses to bacteria. It remains unclear whether TLRs-mediated mucosal immunity plays a role in the OM recovery. The etiology, pathological profile, expression levels of TLR2, TLR4, TLR5, TLR9 and proinflammatory cytokines were measured in human middle-ear mucosae sampled from three subject groups: non-OM group, chronic otitis-media (COM) group, and chronic suppurative otitis-media (CSOM) group. Of the 72 ears, 86.11% CSOM patients were positive for bacteria. The cellular makeup of the middle ear mucosa differs among the three groups. Mucosae from the CSOM group presented chronic inflammation or suppurative inflammation in the rudimentary stroma, mainly with infiltration of monocytes and macrophages. The mRNA and protein levels of TLR2, TLR4, and TLR5 exhibited no difference between the non-OM and COM groups but were significantly lower in the CSOM group. Conversely, there was no significant difference in the TLR9 level among the three groups. Furthermore, proinflammatory cytokines TNF-α, IL-1β, IFN-γ, IL-6 were up-regulated in the CSOM group. This study provides evidence that the variability in clinical otitis media recovery might be associated with the variability in the expression of mucosal TLRs. Reduced TLR levels in the middle-ear mucosa might cause weak host response to bacteria, persistent inflammation and susceptibility to CSOM.

Otoacoustic Emissions in Otitis Media with Effusion: Do They Carry any Clinical Significance?

Otoacoustic emissions have been advocated in the management of otitis media with effusion. However, otoacoustic emissions cannot differentiate different types of hearing loss. This study was conducted to find factor that can differentiate otitis media with effusion from other common causes of hearing loss in children. Children were enrolled in the study and divided in four groups consisting of 25 ears each after pure tone and impedance audiometry: (1) Otitis media with effusion group, (2) Normal ear group, (3) Sensory-neural hearing loss group, (4) Chronic suppurative otitis media group. Otoacoustic emissions were recorded and results were analyzed statistically. The normal hearing group had significant difference from other groups but total band reproducibility of transient evoked otoacoustic emissions did not show any statistical difference in the cases groups. In distortion product otoacoustic emissions, group 1 showed significant difference from group 3 and group 1 had significant difference from all other groups at 4kHz. The study did not find any factor that differentiates otitis media with effusion from other diseases. Although, distortion product otoacoustic emissions can indicate otitis media with effusion but impedance audiometry should be the main tool in the management of otitis media with effusion.

Mastoid Biofilm in Chronic Otitis Media

We designed a study to determine the role of mastoid mucosal biofilm in chronic otitis media (COM). Biofilm formation has been found in several chronic airway infections. COM is associated with chronic, recalcitrant infection of the mastoid mucosa, and surgery often is required. COM patients were divided into 2 groups: one with chronic suppurative otitis media (CSOM) and one with cholesteatoma presence. All COM patients had mastoid involvement in a preoperative computed tomographic scan. The control group consisted of patients undergoing cochlear implantation, with no previous history of chronic otitis media. Mastoid mucosa samples were harvested during mastoidectomy. The samples were studied with multiplex-polymerase chain reaction and with CSLM using BacLight Live/Dead stain. Routine bacterial culture was performed in selected cases. A total of 29 COM patients underwent mastoidectomy. Mastoid mucosal biofilm formation could be found in 19 (66%) of these patients. In the control group, there were 11 cases of cochlear implantation, and 1 patient (9%) presented mastoid mucosal biofilm. In the cholesteatoma group, there were 17 patients, of which, 14 (82%) presented biofilm, whereas in the CSOM group, 5 (42%) of 12 patients presented biofilm. The correlation between COM and biofilm was statistically significant (Fisher's exact test, p = 0.003), as was the correlation between cholesteatoma and biofilm, in comparison with the CSOM group (Fisher's exact test, p = 0.046). Mastoid mucosal biofilm could be seen in patients with COM with or without cholesteatoma. The role of mastoid biofilm in the development of cholesteatoma should be studied further.

Analysis of sensorineural hearing loss in chronic suppurative otitis media with and without cholesteatoma

Background: Chronic suppurative otitis media (CSOM) still remains a major cause of conductive hearing loss in our country. On contrary a few patients also display an added sensorineural component. Materials and Methods: Hundred patients with unilateral CSOM undergoing ear surgery at our department were included in the study. The affected ears formed the 'CSOM group' and the normal ears formed the 'Control group'. Detailed otologic history, clinical, surgical, and audiometric findings were recorded and analyzed. Results: It was inferred that though CSOM is associated with sensorineural (SN) loss in small majority of patients only. No co-relation was established between the duration of discharge and SN loss. Conclusions: Though, greater SN loss was seen in patients of CSOM with cholesteatoma but it was not statistically significant. It can be further studied that whether an early surgery in CSOM can prevent SN loss or not.