Chronic Suppurative Otitis Media Patients Research Articles

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

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

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

ObjectChronic otitis media (COM) is an inflammatory disease that commonly presents with otorrhea and hearing loss. Bacteria‐induced inflammation can cause inner ear damage, leading to sensorineural hearing loss (SNHL). This study aimed to compare the prevalence and severity of SNHL in patients with gram‐negative versus gram‐positive cultures and examine associations between the concentrations of circulating monocytes and neutrophils with bacteria species and SNHL.MethodsThis was a retrospective study. Cholesteatoma or chronic suppurative otitis media patients with otorrhea were enrolled. Middle ear secretions were collected using sterile swabs under an otoscope, and sent for bacterial detection within 30 min. Pure tone audiometry and circulating leukocyte counts were recorded and analyzed in patients infected with different pathogens. Logistic regression analysis was used to identify the risk factors associated with SNHL.ResultsA total of 137 patients were enrolled, including 45 patients infected with gram‐negative bacteria, 41 with gram‐positive bacteria, 20 with polymicrobial infection, and 31 with no bacterial growth. Logistic regression analysis showed that bacterial culture positive infections (OR = 7.265, 95% CI 2.219–23.786, p = 0.001) were an independent risk factor for SNHL. Patients with gram‐negative bacteria had higher risks of SNHL (p < 0.0001) and more severe hearing loss (p = 0.005) than those with gram‐positive bacteria. COM patients infected with gram‐negative bacteria showed an increase in circulating monocytes, which correlated with the occurrence of SNHL (p = 0.0343).ConclusionGram‐negative bacteria are associated with elevated circulating monocyte counts and have a higher risk of severe SNHL.Level of Evidence4 Laryngoscope, 2024

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

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

Association of iron deficiency with chronic suppurative otitis media in adults

Background Chronic suppurative otitis media (CSOM) is a prevalent chronic inflammatory disease globally. Current research suggests a possible association between anaemia and the development of CSOM. Objectives The objective of this trial was to investigate the relationship between iron metabolism and chronic suppurative otitis media (CSOM) in adults aged 20–60 years. Materials and methods A consecutive sampling case-control study was used. The study participants were divided into a case group (42 children diagnosed with CSOM) and a control group (42 children with normal ears). Haemoglobin (Hb), Hematocrit (Hct), mean corpuscular volume of erythrocytes (MCV), serum iron level (SI), unsaturated iron-binding capacity (UIBC), total iron-binding capacity (TIBC), transferrin (TF), ferritin (Fer) were tested in all the participants, and the results were compared with the normal ranges of the World Health Organization (WHO). The comparative analysis of cases and controls was performed using the Fisher extract test, independence t-test, or Mann–Whitney U test. p-value <.05 was considered statistically significant for correlation. Results There were 61 patients with CSOM and 61 controls included in the study. In the case group, 16 out of 61 patients (26.2%) had low ferritin levels and in the control group, 1 out of 61 patients (1.6%) had low ferritin levels (p < .001). In the case group, 6 (9.8%) of 61 patients had IDA, and in the control group, there were no patients with IDA among 61 patients (p = .027). There were significant differences in SI, UIBC, and Fer parameters between the groups. Conclusions In adult patients, the incidence of iron deficiency was higher in CSOM patients than in controls. Iron deficiency may be considered a potential risk factor for chronic suppurative otitis media, and serum iron parameters should be evaluated in these CSOM patients and further studies should be conducted to better understand the potential link between iron deficiency and CSOM.

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

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

Detection of FOX-AmpC-β-lactamase gene and antibiogram of AmpC-beta-lactamase-producing pathogens isolated from chronic suppurative otitis media patients in Nigeria.

AmpC-producing Gram-negative bacterial (GNB) pathogens are distributed worldwide, especially in clinical settings. This study aimed to determine the antibiogram and the type of AmpC-β-lactamase gene harboured by GNB pathogens implicated in chronic suppurative otitis media (CSOM) cases. Ear swab samples (300) collected from patients with active CSOM were analysed using standard microbiological techniques. Phenotypic and molecular detection of AmpC β-lactamase production was done by cefoxitin/cloxacillin double-disk synergy test and PCR respectively. Antibiogram was determined by disk diffusion technique. Among the GNB pathogens isolated from CSOM patients, P. aeruginosa was the most predominant (36.3%); followed by K. pneumoniae (22.3%), and E. coli (13.7%). Patients with active CSOM showed increased bacteria isolation rate from bilateral ear discharges than unilateral ear discharges. E. coli and P. aeruginosa were more prevalent among patients with duration of discharge >2 weeks; recording 9.0% and 20.3% respectively. AmpC β-lactamase producers accounted for 14.0%; they were highly resistant (60%-100%) to cephalosporins, trimethoprim-sulfamethoxazole, ofloxacin, amoxicillin, and tetracycline, but very susceptible (70.4%-100%) to ciprofloxacin, imipenem, and amikacin. Multiple antibiotic resistance indices of isolates ranged from 0.7-0.8. FOX-AmpC-β-lactamase gene was detected in 3.9% of the isolates. The detection of AmpC β-lactamase-producing multidrug-resistant GNB pathogens harbouring FOX-AmpC-β-lactamase gene among patients with CSOM infections in our study is a serious public health problem which needs urgent intervention.

Effect of Acetic Acid on Clinical Isolated Pseudomonas aeruginosa Biofilm in Chronic Suppurative Otitis Media: In vitro Study

Background: Forming biofilms on bacteria can inhibit the penetration of antimicrobial agents and avoid the immune defence system. It becomes one of the factors causing therapy failure and chronicity of infection. Pseudomonas aeruginosa is the most common bacteria found in Chronic Suppurative Otitis Media (CSOM), which has the virulence ability to form biofilm structures. Some studies have reported that acetic acid can inhibit and eradicate biofilm complexes and is thought to be an alternative to additional therapy against bacterial infections that form biofilms. Objective: to explain the effect of acetic acid inhibiting and eradicating Pseudomonas aeruginosa biofilm in CSOM. Methods: This study used an experimental in vitro laboratory with a post-test-only control group method. Samples were taken from the secretions of the mastoid cavity of CSOM patients. The inhibitory effect of acetic acid was observed by administering acetic acid to Pseudomonas aeruginosa. In contrast, the effect of eradicating biofilm was observed by administering acetic acid to Pseudomonas aeruginosa which had already formed a biofilm. The observations in this study were using the microtiter plate assay method and were measured with an ELISA reader. Data analysis used the One-Way Anova test and multiple comparisons (Tukey HSD Test). Result: The inhibitory effect of acetic acid on the growth of Pseudomonas aeruginosa biofilm was obtained (p=0.000) with significant results (p &lt;0.05) between the positive control group and the concentration group of 0.16%, 0.31%, 0.63%, 1.25%, 2.5%, and 5%. The Minimum Biofilm Inhibitory Concentration (MIBC) value of acetic acid in forming Pseudomonas aeruginosa biofilms was 0.16%. The effect of acetic acid eradication on Pseudomonas aeruginosa biofilms (p=0.000) with significant results (p&lt;0.05) between the positive control group and the concentration group of 0.08%, 0.16%, 0.31%, 0.63%, 1.25%, 2.5%, and 5%. While the minimum value of acetic acid Biofilm Eradication Concentration (MEBC) for Pseudomonas aeruginosa biofilm eradication was 0.08%. Conclusion: Acetic acid inhibits the formation and eradication of Pseudomonas aeruginosa biofilms in CSOM.

CHARACTERISTICS OF CHRONIC SUPPURATIVE OTITIS MEDIA SUFFERERS AT WAIKABUBAK HOSPITAL

&#x0D; &#x0D; &#x0D; &#x0D; Chronic suppurative otitis media (CSOM) is one of the most common ear diseases in developing countries, one of which is Indonesia. CSOM is the stage of middle ear disease where there is chronic inflammation of the middle ear and mastoid and tympanic membrane that is not intact (perforation) and found secretions (otorrhea), purulent intermittent, said to be chronic if the disease is intermittent or persists for 2 months or more. Prevalence surveys around the world, show the incidence of CSOM is 65-330 million sufferers with watery ears where 60% of them have conductive hearing loss. This is an important issue for dealing with deafness in developing countries. This study aims to determine the distribution of CSOM sufferers at Waikabubak Hospital in September 2022 – February 2023 based on age, sex, side of the ear infected and type of otorrhea. This research was conducted at the ENT-KL Clinic at Waikabubak Hospital in February 2023 using secondary data from the patient register book. There were 85 CSOM patients recorded in September 2022 - February 2023. The most common incidence happen in adult age 26-45 years old with the number of 30 patients (35.3%). CSOM is more common in women than men with an the number of incidence 43 patients (50.6%). Based on the side of the ear infected with CSOM, it was more common on the unilateral side, with the number of 72 patients (84.7%) and based on the type of otorrhea, the active type was more frequent, with the number of 67 patients (78.8%).&#x0D; &#x0D; &#x0D; &#x0D;

High TNF-α Levels in Active Phase Chronic Suppurative Otitis Media Caused by Gram-positive Bacteria

Background: Chronic suppurative otitis media (CSOM) is a persistent inflammatory disease of the middle ear and mastoid cavity caused by pathogenic infection. CSOM has a fairly high incidence in developing countries and is the main cause of acquired hearing loss in children. Tumor necrosis factor alpha (TNF-α) is a significant inflammatory mediator in CSOM. This study aimed to analyze TNF-α levels in ear discharge and blood serum in active phase CSOM caused by Gram-positive and Gram-negative bacteria.Materials and Methods: This research was an analytical observational study with a cross sectional design. Blood serum and ear discharge from CSOM patients were used in this study. Blood serum and ear discharge TNF-α levels were measured using enzyme-linked immunosorbent assay.Results: From 26 CSOM subjects, 13 subjects were infected with Gram-positive bacteria and the 13 others were infected with Gram-negative bacteria. The majority of the subjects were male (53.8%) with an age range from 36-45 years (42.3%). The most common species of bacteria was Pseudomonas aeruginosa. Blood serum and ear discharge TNF-α levels were higher in samples that contained Gram-positive bacteria.Conclusion: TNF-α levels in active phase CSOM caused by Gram-positive bacteria are higher than those which are caused by Gram-negative bacteria.Keywords: chronic suppurative otitis media, TNF-α, gram-positive, gram-negative

Comparison between Eustachian tube angle and length in chronic otitis media and contralateral ear

Background: Chronic suppurative otitis media (CSOM) is still a significant public health problem, especially in developing countries. Eustachian tube dysfunction is one of the factors that influence the occurrence of CSOM. The pathogenesis of acute and chronic otitis media is initiated by negative pressure in the middle ear. One theory of the event of CSOM is the continuum theory. The eustachian tube as one of the factors that influence the occurrence of CSOM has been proven from various studies comparing CSOM patients and the average population and CSOM with and without cholesteatoma. With the advanced technology, CT scan helps diagnose pathological conditions in the ear as a diagnostic tool and evaluation modality. CT scan imaging with a multiplanar reconstruction technique can provide a clear image of the anatomical shape of the Eustachian tube. Objective: This study aims to determine the relationship between the angle and length of the Eustachian tube in the ear with CSOM and the contralateral ear's angle and length. Method: An analytic study with a cross-sectional design involving 30 samples of CSOM patients with the contralateral ear. The measurement of the angle and length of the Eustachian tube using the multiplanar HRCT temporal reconstruction technique. Result: Statistical analysis with paired t-test showed that the Eustachian tube angle was significantly more horizontal in the CSOM ear than the contralateral ear (p&lt;0.05). Eustachian tube length was shorter in CSOM than contralateral (p&lt;0.05). Conclusion: The angle of the eustachian tube in the CSOM ear is smaller (more horizontal) and shorter than the contralateral ear.

The Compatibility of Preoperative Temporal Bone CT Scan Interpretation and Intraoperative Findings in Chronic Suppurative Otitis Media at Dr. Zainoel Abidin Hospital Banda Aceh

Introduction: Chronic suppurative otitis media (CSOM) is middle ear and mastoid infection that causes hearing loss globally. Computed Tomography (CT)-Scan of the temporal bone is useful for assessing the pathogenesis of the disease and estimating the prognosis. In addition, evaluation of CT-Scan in patients with CSOM is useful for selecting the appropriate surgical procedure to minimize post-surgical complications. This study aims to assess the suitability of temporal CT-Scan interpretation to intraoperatif findings in CSOM patients. Methods: This is an observational study with cross-sectional design conducted at the dr. Zainoel Abidin General Hospital, Banda Aceh. The components of suitability evaluation include cholesteatoma, scutum erosion, ossicles, tegmen tympani, facial canal, posterior wall and sigmoid sinus wall. The interpretation suitability of temporal CT-Scan and intraoperatif findings was performed using the Kappa test. Results: A total of 18 CSOM patients were involved in this study with a mean age of 32.44 years and dominated by the safe type with a percentage of 55.6%. Interpretation of ossicular erosion based on temporal CT scan has very strong suitability with the intraoperatif findings with k=0.88 followed by posterior wall erosion (k=0.684), scutum erosion (k=0.679), tympanic tegmen erosion (k=0.455) and facial canal erosion (k=0.341). The findings of cholesteatoma and erosion of the sigmoid sinus wall had a very low suitability (k&lt;0.001). Conclusion: Temporal CT scan in CSOM patients has relatively good suitability with intraoperatif findings in evaluating erosion of the ossicles, posterior wall, and scutum. Another examination modality is necessary to assess and improve the accuracy of disease pathogenesis.

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

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

The Relationship between Cholesteatoma Stage and Hearing Bone Erosion Degree in Chronic Suppurative Otitis Media Patients with Cholesteatoma at Dr. M. Djamil General Hospital, Padang, Indonesia

Introduction: Chronic suppurative otitis media (CSOM) is a chronic inflammation of the middle ear mucosa and mastoid space. Cholesteatoma is an ectopic keratinized epithelial tissue that develops through the mucosa of the middle ear cavity and desquamates, resulting in the accumulation of keratin and epithelial debris. This study aimed to determine the relationship between the stage of cholesteatoma and the degree of erosion of the ossicles in patients CSOM with cholesteatoma at Dr. M. Djamil General Hospital, Padang, Indonesia.&#x0D; Methods: This study was an observational case series study. A total of 70 research subjects were included in this study, and the research subjects met the inclusion criteria. The inclusion criteria in this study were patients with a diagnosis of CSOM with cholesteatoma at Dr. M. Djamil General Hospital, Padang, Indonesia and have complete medical record data. Data analysis was carried out using SPSS software version 25. Correlation analysis between cholesteatoma stage and degree of osseous erosion was performed using the Spearman correlation test, p&lt;0.05.&#x0D; Results: The majority of research subjects were aged 21-30 years (28.6%) and were male (51.4%). Based on clinical symptoms, the majority of patients experience otorrhoea for 5 to 10 years (47.1%), perforated type membrane total tympani (54.3%), degree of erosion of the ossicles type D (48.6%), stage 4 cholesteatoma (61.4%) and granulation tissue (81.4%).&#x0D; Conclusion: There is a relationship between the stage of cholesteatoma and the degree of erosion of the ossicles in patients with CSOM (chronic suppurative otitis media) with cholesteatoma at Dr. M. Djamil General Hospital, Padang, Indonesia.

Correlation between chronic suppurative otitis media and deviated nasal septum of the ipsilateral side

Background: Chronic suppurative otitis media (CSOM) is a long standing infection of middle ear with permanent defect in tympanic membrane with or without ear discharge, frequently have an underlying nasal pathology, which can worsen the middle ear disease secondary to Eustachian tube dysfunction, leading to negative middle ear pressure, tympanic membrane retraction, chronic otitis media with effusion and/or cholesteatoma. Present study was conducted to study the correlation of a etiopathogenesis, bacteriology of CSOM with the deviation of the nasal septum (DNS) of the ipsilateral side. Methods: Study was conducted in ENT department, AJ institute of medical science, Mangalore, Karnataka. Study group included 120 patients having CSOM, selected randomly from outpatient department (Time bound cross-sectional study). Predesigned proforma was used. Detailed history taken, followed by a thorough ENT examination. Relevant investigations were performed. Results: In this study, the prevalence of nasal disease (DNS) in patients with CSOM was 73.33%. Out of 120 CSOM patients, 88 patients had co-existent nasal disease (DNS). Among the 88 cases; 71 (59.2%) patients showed direct correlation with CSOM. Culture swabs showed similar bacterial isolates in aural and nasal swabs indicating, there may be retrograde spread of pathogens from nasopharynx to middle ear via Eustachian tube. Conclusions: A significant correlation was established between CSOM and DNS of the ipsilateral side. DNS played a key role in persistence of CSOM. A conscientious evaluation of nose and paranasal sinuses diseases is essential and we thus endorse management of nasal disease prior to the surgical treatment of ear disease, for meritful postoperative results.

Evaluation of hearing limits post tympanoplasty in patients with chronic suppurative otitis media

Link of Video Abstract: https://youtu.be/Nr9MKgu2v2E Background: Chronic suppurative otitis media (CSOM) causes partial or complete damage to the tympanic membrane and ossicles, causing hearing loss in the form of conductive and mixed hearing loss with a decrease of up to 60 dB. This study aimed to evaluate the hearing threshold before and after tympanoplasty surgery in CSOM patients. Methods: This type of research was carried out in a retrospective descriptive manner. The materials in this study were the medical records of CSOM patients who underwent canal wall up (CWU) tympanoplasty and canal wall down (CWD) tympanoplasty at the outpatients of ear, nose, and throat – head and neck surgery (ENT-HNS) Otology Division Dr. Soetomo Hospital Surabaya for the period January 1, 2018 to December 31, 2018 with a total of 51 patients. This study analyzed with the Wilcoxon test. Results: The mean age was 30.96 years (51% female and 49% male). Postoperatively 40 (78.5%) patients experienced an increase in hearing threshold, 10 (19.6%) patients experienced a decrease and 1 (1.9%) patient remained. The average increase in air-bone gap (ABG) pre and post tympanoplasty surgery was 9.78 dB, from 38.92 dB to 29.14 dB. Conclusion: There was an increase in hearing threshold after tympanoplasty.

DISCERNING THE EFFICACY OF TOPICAL 2% ACETIC ACID IN CHRONIC SUPPURATIVE OTITIS MEDIA USING OTOLOGICAL SYMPTOMS SCORE: A PROSPECTIVE STUDY.

BACKGROUND: Chronic suppurative otitis media (CSOM)- mucosal type is “dened as a chronic inammation of the middle ear and mastoid cavity, which presents with recurrent ear discharges or otorrhoea through a tympanic perforation.” Acetic acid demonstrates antimicrobial, antipersister and antibiolm potential. The objective of our study is to nd out the efcacy of medical treatment using acetic acid for patients of CSOM. This prospec RESULTS: tive study comprised of 100 patients suffering from CSOM who presented to the Department of ENT, HSK Hospital, Bagalkot from July 2021 to December 2022. The patients with chronic otitis media mucosal type with active discharge were enrolled in our study as per the inclusion and exclusion criteria. They underwent complete evaluation including otomicroscopy and pure tone audiometry to determine the nature of disease and its severity. Otological symptom score was calculated in all patients at the time of presentation. They were treated conservatively with topical 2% Acetic acid ear drops. Scores were assessed based on clinical ndings at day 7, day 14, day 21 and day 30 follow-up visit. Patients were segregated into those with clinical cure (&lt;3), clinical improvement (3-5) and treatment failure (&gt;5) as per their score. Achieving “treatment success” at the end of the study was considered as an effective parameter to measure effectiveness of topical acetic acid ear drops. 'Treatment success” i.e. either clinical cure or clinical improvement was seen in 95% patients after using acetic acid, whereas “treatment failure” was seen in 5% patients at the end of 1 month. In CONCLUSION: the present study using topical preparation of 2% acetic acid, the resolution of CSOM was shown with success rate in 95% patients. This shows that acetic acid was effective in reducing the symptoms of CSOM.

Extended High-frequency Hearing Loss in Chronic Suppurative Otitis Media Patients Complaining of Tinnitus but with Normal Cochlear Function on Conventional Pure-tone Audiometry

Objective: The aim of the study is to find the incidence of extended high-frequency hearing loss (EHFHL) in chronic suppurative otitis media (CSOM) patients complaining of tinnitus but with normal cochlear function on conventional pure-tone audiometry (PTA). CSOM often results in conductive hearing loss, but recent studies have shown sensorineural hearing loss, thus indicating inner ear damage. Study Design: The stud design was a prospective study. Setting: The study was conducted at a tertiary care hospital. Methods: In a prospective observational study, a total of 141 patients with CSOM were reviewed. Seventy-four CSOM patients presented with tinnitus, and the mean age of presentation was 31.4 ± 6.82 years. Only those with normal cochlear function based on PTA (250 Hz to 8 kHz) were included. They were further tested at extended frequencies of up to 12 kHz. The severity of tinnitus was assessed using the Tinnitus Handicap Index Questionnaire. Results: The prevalence of EHFHL in the normal cochlear function CSOM patients with tinnitus was 68.9%, whereas the prevalence in the tinnitus negative group was 22.38%. EHFHL and tinnitus in CSOM patients show statistically significant association (P &lt; 0.05). Furthermore, there was a significant association between the severity of tinnitus and EHFHL. Conclusion: The findings demonstrate that the patients of CSOM with tinnitus and normal hearing in conventional PTA have EHFHL that indicates damage has occurred in the inner ear. The severity of the tinnitus can be predicted by the degree of higher frequency hearing loss.

Hearing outcomes after incudo-stapedial rebridging versus partial ossicular replacement prosthesis in chronic suppurative otitis media

Aim: To evaluate the early postoperative hearing results after Incudo-stapedial rebridging versus partial ossicular replacement prosthesis application in cases of incudo-stapedial discontinuity due to chronic suppurative otitis media.Study Design: A prospective randomized comparative clinical trial.Place and Duration of Study: Otolaryngology Department, Tanta University, Egypt from January 2018 to June 2021.Methodology: Inclusion criterion was cases with CSOM with ABG more than 30 dB and adequate cochlear reserve. Study population were sixty consecutive cases with incudo-stapedial erosion more than 2-millimeter gap. Thirty of them were candidates for incudo-stapedial rebridging using tragal cartilage strip graft and glass ionomer bone cement. The other thirty patients were candidates for PORP. Tympanoplasty was done for each case of the two groups.Main Outcome Measures: hearing assessment following surgical procedures.Results: Postoperative air conduction significantly decreased compared to baseline in each group. By comparing the results of both techniques, pre and postoperative air conduction were insignificantly different.ABG significantly decreased postoperatively compared to baseline in each group. By comparing between both techniques, pre and postoperative ABG were insignificantly different.Conclusions: Among chronic suppurative otitis media patients with ossicular erosion, our study showed that PORP and cartilage graft with glass ionomer bone cement effectively improved hearing levels when used for the reconstruction of the incudostapedial joint during tympanoplasty.

Changing trends in microbiological profile in patients with active chronic suppurative otitis media in rural based tertiary care hospital

Background: Chronic suppurative otitis media (CSOM) is a major health issue in developing countries causing persistant problem and may lead to life-threatening complications. This major health issue and its complications can be best avoided by early and effective treatment based on the knowledge of causative micro-organisms and their antimicrobial sensitivity which ensures prompt clinical recovery. Aims and Objectives: The aim is to study the recent microbiological pattern of patients with active CSOM and to determine the in vitro antibiotic sensitivity pattern in order to scientifically guide the patient management rather than trying emperical therapy alone. Materials and Methods: This prospective study was conducted in Otorhinolaryngology and Microbiology Department of a Burdwan Medical College and Hospital, Burdwan, a tertiary care hospital in Burdwan from January 2019 to December 2020 and 117 clinically diagnosed cases of COM were included in this study after through history taking and meticulous clinical examination. Two Aural swabs were collected from the affected ear by an ENT specialist as outpatient department procedure, under strict aseptic precautions using sterile swabs, after cleaning external auditory canal with a spirit swab. In cases with bilateral disease, ear swabs were taken separately from both the ears. Pus swabs collected were immediately sent to microbiology department for aerobic culture and sensitivity as well as mycological study as per standard procedure. Results: In the present study, the predominant organism which was isolated from the ear swabs of this region was Pseudomonas aeruginosa, followed by Staphylococcus aureus, Proteus mirabilis, Klebsiella pneumoniae, and Escherichia coli. P. aeruginosa showed maximum susceptibility to Colistin, Aztreonam, Piperacillin, and Tazobactum, Polymixin B in decreasing order and showed moderate sensitivity to Levofloxacin and Ceftazidime. Amikacin is found to be the most effective antibiotic against Proteus and Klebsiella spp. isolated from CSOM patients. Conclusion: Knowledge of the local microorganism pattern and their antibiotic sensitivity is essential to allow effective and cost saving treatment to patients who will lead to reduction in morbidity and mortality.

Antibiogram and molecular characterization of extended-spectrum β-lactamase-producing pathogens implicated in chronic suppurative otitis media.

beta-lactamase-producing bacteria, especially extended-spectrum beta-lactamase (ESBL) producers have strong clinical relevance and have been implicated in chronic suppurative otitis media (CSOM) treatment failures. This study aimed to determine the frequency, antibiogram, and molecular characteristics of ESBL-producing gram-negative bacterial (GNB) pathogens isolated from patients with CSOM. three hundred (300) ear swab samples collected from patients with active CSOM were analysed using standard microbiological techniques. Antibiogram of pathogens was determined by Kirby-Bauer disk diffusion technique. Phenotypic detection and molecular characterization of ESBL-producing GNB pathogens were performed by double disk synergy test (DDST) and polymerase chain reaction (PCR). Escherichia coli and P. aeruginosa were more prevalent among CSOM patients with a duration of discharge >2 weeks. The frequency of ESBL producers among the GNB pathogens was 18.3%. Isolates were generally multidrug-resistant but very susceptible (100% - 70.4%) to ciprofloxacin, imipenem, and amikacin. Multiple antibiotic resistance values of the isolates ranged from 0.7-0.8. Polymerase chain reaction showed that blaSHV (47.6%) was the most predominant ESBL genotype. This was followed by blaTEM (25.2%) and blaCTX-M (10.7%) as the least predominant ESBL gene. Concomitant expression of ESBL gene was observed in 13.6% of the isolates. this study reported the occurrence and spread of β-lactamase-producing bacteria in patients with CSOM infections. It is therefore very crucial to screen for antibiotic-resistant pathogens at early stages of CSOM infections, for proper antimicrobial therapy and to curb the increasing spread of antimicrobial resistance.