Chronic Suppurative Otitis Research Articles

The Impact of Chronic Suppurative Otitis Media with and without Cholesteatoma in Patients from Northeastern Romania.

Quality of life is a widely used concept that tends to become an important part of clinical management. The present study performs an analysis of the impact of suppurative chronic otitis media with and without cholesteatoma on quality of life, using the COMQ-12 questionnaire. It was applied to a group of 40 healthy people and to 40 patients before surgery, and the answers to the questions were analyzed and correlated with socioeconomic factors. After the confirmation of the diagnosis based on clinical and imaging information, the patients completed the COMQ-12 questionnaire. It was observed that the chronic ear problems had negative impacts of varying degrees on daily and long-term activities. The evaluation and analysis of information can be used in setting therapeutic targets.

“The Study of Bacteriological Agents of Chronic Suppurative Otitis Media Aerobic Culture and Antibiotic Sensitivity Testing Pattern at a Tertiary Care Hospital in and around Rajamundry: A cross-sectional study”

Introduction: Chronic suppurative otitis media is a chronic infection of the middle ear and mastoidcavity which if not treated leads to partial or total loss of hearing and even life-threateningcomplications like meningitis and Intracranial abscess. Hence it is important to treat the persistentear discharge in CSOM according to the antimicrobial sensitivity of the organism isolated. Methods:This is a prospective cross-sectional study done in 135 clinically diagnosed patients of CSOM at GSLmedical college and General Hospital, Rajamundry, Andhra Pradesh from May 2019 to October 2019.Sterile swabs were used to collect pus from discharging ear and were inoculated onto Blood andMacConkey agar for 24-48 hrs, and identification of organisms was done by using standardbiochemical reactions and antibiotic sensitivity testing done by using modified Kirby- Bauer methodas per CLSI guidelines. Results: A total of 156 strains were isolated from 135 patients in thepresent study of which Pseudomonas aeruginosa and Staphylococcus aureus were amongst the mostisolated pathogens in culture. Imipenem showed the most sensitivity against Pseudomonas,subsequently levofloxacin and piperacillin. Linezolid was the most sensitive versus Staphylococcusensued by ciprofloxacin and cloxacillin. Conclusions: In the present study of Chronic suppurativeotitis media patients, Pseudomonas and Staphylococcus were highly prevalent and showed increasedresistance to beta-lactams and commonly used antimicrobial drugs. Antimicrobials like imipenem,piperacillin, and quinolones are effective against most cases of chronic suppurative otitis media

Cross-Cultural Adaption and Validation of the Moroccain Arabic Version of the Chronic Ear Survey.

The aim of this study was to translate and verify the psychometric properties of the CES (Chronic Ear Survey Score) in the Moroccan Arabic dialect as well as the evaluation of the quality of life of patients suffering from suppurative chronic otitis media. A cross-sectional study was carried out between 1st April 2016 and 10 January 2017 in ENT department of the 20 August hospital Casablanca. The data were collected using an anonymous questionnaire administered by the physician. The CES scale used has been translated according to international recommendations. Internal Reliability was evaluated by the Cronbach alpha coefficient and validity was calculated through the Spearman coefficient of correlations. Statistical analysis was done using SPSS 20.0. A total of 107 patients were enrolled in the study with an average age of 35years (standard deviation = 13years) with a sex ratio of 0.70. About 35.5% of patients perceived their disease as severe. The mean CES was 48 (standard deviation = 15) indicating a significant decrease in the quality of life of patients suffering from CSOM. Good internal reliability was noted (alpha = 0.72). CES scores increased significantly with perceived severity (p < 0.001). The Arabic version of the CES has good psychometric properties attesting to its reliability and validity. Its use would make it possible to better evaluate the quality of life of patients suffering from chronic otitis media and thus be able to compare and choose the optimal therapeutic methods based on the results of this questionnaire especially before and after surgery.

Способ мирингопластики у больных хроническим гнойным туботимпанальным средним отитом

This article describes the original method of myringoplasty in patients with chronic suppurative tubotimpanal otitis media, aimed at the improvement of efficacy of tympanoplasty. The authors have given a brief description of classical myringoplasty methods, their features and drawbacks depending on the graft location. They have analyzed the specific features of laying the eardrum graft using the authors’ method, which makes it possible to form the anterior meatotympanic angle and prevent the graft from sinkage. The authors’ method was used in surgical treatment of 30 patients of the main group with suppurative tubotimpanal otitis media in the remission stage, whereas 30 patients of the control group were operated on using the classical myringoplasty method; the age of the patients varied from 18 to 60 years. The authors conducted a comparative analysis of morphological and functional results of treatment of the patients in the main and control groups in the early (in 1 and 3 months) and in the late (in 6 and 12 months) postsurgical period and performed a comparative audiological assessment of the functional results of the treatment. Based on the statistical processing of the study results in the early and late postsurgical periods, the article presents the efficacy of using the authors’ myringoplasty method in patients with chronic suppurative tubotimpanal otitis media.

Otogenic brain abscesses: A systematic review.

ObjectiveOtogenic brain abscesses are one of the most significant life‐threatening complications of otologic infections. Given their low prevalence, otogenic brain abscesses require a high index of suspicion for diagnosis. In this systematic review, we aim to provide an analysis of otogenic brain abscesses and describe common clinical signs and symptoms, bacteriology, location, treatment options, morbidity, and mortality.Data SourcesPubMed, Cochrane CENTRAL database, Google Scholar, and Scopus.MethodsA systematic review of literature was performed using the Preferred Reporting Items for Systematic Reviews and Meta‐analyses recommendations. Variables assessed included clinical signs and symptoms, bacteriology, location, treatment, morbidity, and mortality.ResultsTwenty‐nine studies met inclusion and exclusion criteria, corresponding to a total of 1307 otogenic abscess cases for review. Fifty‐five percent of abscesses were found in the temporal lobe and 28% in the cerebellum. Most patients (88.3%) had a history of suppurative chronic otitis media. The most common symptoms were headache, altered mental status, papilledema, and meningeal irritation. Fever, nausea, and vomiting affected about 40% of patients. The most commonly cultured bacterial species was Proteus mirabilis. In addition to antibiotics, most otogenic brain abscesses were treated by burr hole aspiration. Average mortality following advent of computed tomography was 8.11%.ConclusionAlthough rare, otogenic brain abscesses may occur as a complication of suppurative otitis media and require a high index of suspicion. Appropriate imaging studies and multidisciplinary expertise are crucial in the diagnosis and management.Level of Evidence4.

The medical assistance seeking behaviour of the patients presenting with suppurative chronic otitis media and their treatment in Moscow

The objective of the present study was the analysis of the medical assistance seeking behaviour of the patients presenting with suppurative chronic otitis media (CSOM) and their treatment in Moscow during the period from 2009 till 2016. The incidence of suppurative chronic otitis media in the city of Moscow in 2016 was estimated to be 0.14 per 1000 population, its prevalence 1.23 per 1000 population. The materials of the statistical reports of Moscow ENT clinics give evidence of the considerable growth in the number of the admitted patients suffering from ear diseases including suppurative chronic otitis media (mean 5.5). The surgical activity of the ENT clinics with respect to CSOM amounted to 46%. The overall increase in the number of surgical interventions is attributable to a rise in the frequency of reconstructive operations. These data give evidence of excellent continuity in the work of outpatient facilities and ENT clinics, intensification of their activities, and a change of the people's attitude toward the care for their health. Suppurative chronic otitis media is the commonest pathology encountered in the specialized ENT hospitals where it accounts for 59.8% of the total number of ENT diseases. The frequency of the surgical interventions performed for the treatment of CSOM amounts to 98.9%. The enhanced attention given to the patients with this pathology resulted in the two-fold increase of the specialized medical assistance provided to the patients presenting with suppurative chronic otitis media. The most frequently practiced form of the surgical treatment employed for the management of CSOM is tympanoplasty (in 72% of the patients on the average). The 'closed' variants of sanitizing operations are performed in 59.8% of the patients presenting with chronic suppurative otitis media and concomitant cholesteatoma whereas the 'open' interventions are used to treat 45.1% of the patients in need of tympano- and mastoidoplasty. On the whole, the priority surgical treatment of the patients with chronic suppurative otitis media in specialized medical facilities is reconstructive operations intended to simultaneously reach the beneficial sanative and functional effects without deterioration of the quality of life of the patients suffering from chronic suppurative otitis media.

Tuberculosis: An Unusual Cause of Otitis Media and Mastoiditis in Children

Tuberculous otitis media (TOM) is a rare cause of chronic suppurative infection of the middle ear. Clinical symptoms are nonspecific making delayed diagnosis. We present the case of an infant, aged 22 months, having immune deficiency, who was admitted for a left externalized otomastoiditis. The radiological assessment confirmed this diagnosis. The child had a surgical drainage of the collection with biopsy of granulation tissue whose histopathological examination found a caseo-follicular tuberculosis. Despite its rarity, TOM is associated with a high rate of complications. The diagnosis should be considered in any suppurative chronic otitis resistant to standard treatment.

English

Chronic suppurative otitis media is defined as inflammation of the mucoperiosteal lining of the middle ear cleft. In chronic suppurative otitis media with central perforation the pathologic process may be due to one of the three types : tubo tympanic, tympanomastoid or permanent perforation syndrome due to epitheliasation of the edges of the perforation. In our study we analyse cases of tubo tympanic type only. Chronic sinusitis acts as a focus of sepsis in the development of chronic suppurative otitis media of tubo tympanic type. That such an inter relationship exists is supported by clinical experience. In the adult population sinusitis is the most important cause of persistent ear discharge in tubotympanic disease. Unilateral ear discharge is associated with sinusitis only on the corresponding side, which is in concurrence with our study. Deviated nasal septum, medialised uncinate and enlarged bulla in order of frequency are the most common anatomical variants of nose and paranasal sinuses predisposing to sinusitis. The clearance of sinusitis has a favourable effect on improving the middle ear mucosal status. The clearance of sinusitis by endoscopic sinus surgery in tubotympanic patients results in good outcome of tubotympanic disease clearance. Functional endoscopic sinus surgery has emerged as an effective and reliable procedure for clearance of sinusitis.

Kajian Drug Related Problems Pasien Otitis Media Supuratif Kronis di Bangsal THT RSUP. Dr. M. Djamil Padang

Telah dilakukan penelitian kajian drug related problems pada pasien otitis media supuratif kronik rawat inap di bangsal THT RSUP Dr. M. Djamil Padang. Penelitian ini dilakukan secara retrospektif dan prospektif melalui penelusuran terhadap kondisi pasien, catatan rekam medik, Kartu Instruksi Obat (KIO) dan catatan asuhan keperawatan pada pasien otitis media supuratif kronik. Data yang diperoleh selanjutnya di analisis secara deskriptif. Hasil penelitian menunjukkan bahwa kategori DRPs yang paling banyak terjadi adalah interaksi obat. Dari data retrospektif terdapat 10 kasus interaksi obat dari 11 kejadian DRPs dan data prospektif terdapat 5 kasus interaksi obat dari 10 kejadian DRPs pada pasien otitis media supuratif kronik rawat inap dibangsal THT RSUP Dr. M. Djamil padang. Kategori DRPs yang lain adalah dari data retrospektif dosis kurang 1 kasus (3,84%), Dan dari data prospektif reaksi obat yang merugikan 5 kasus (45,45%). Dari hasil penelitian ini dapat disimpulkan bahwa kategori drug related problems yang ditemukan pada pasien otitis media supuratif kronik rawat inap di bangsal THT RSUP Dr. M. Djamil Padang adalah interaksi obat, dosis kurang dan reaksi obat yang merugikan.

Suppurative chronic otitis media complicated with meningoencephalitis and cerebral abscess. Case report

Although cerebral otogenic abscess is a rare complication of chronic otitis media, it is the second most frequent complication after otogenic meningitis. This paper presents a case of cerebral otogenic abscess in the temporal lobe, in a patient who suffered from suppurative chronic otitis media.

Hearing outcomes after suppurative chronic otitis media surgery.

This study aims to compare the hearing outcomes after canal wall up mastoidectomy (CWUM) and canal wall down mastoidectomy (CWDM). Ninety-two patients (74 males, 18 females; mean age 30.1 years; range 9 to 67 years) who were diagnosed with chronic suppurative otitis media (CSOM) between January 2009 and May 2011 were enrolled in this retrospective study. Based on hospital data, patients were separated into two groups as having mucosal or squamous disease. Patients were also categorized into two groups based on the type of mastoidectomy: CWUM (n=51) and CWDM (n=41). Hearing results between the groups were evaluated using the air-bone gap (ABG) recorded by audiogram before surgery and at three months after ossiculoplasty. Relationship between obtained hearing results and performed ossiculoplasty techniques were also discussed. We were able to perform ossiculoplasty in 42.3% (n=39) of patients diagnosed with CSOM. Presurgical ABG in CWUM and CWDM groups were 35.38±10.82 dB and 37.92±5.80 dB, respectively. Postsurgical ABG value was ≤20 dB in 27% of CWUM patients and 7.7% of CWDM patients. Mean hearing gain of patients with active squamous disease was 3.8 dB in CWUM group and 11.9 dB in CWDM group (p<0.5). The pathology affecting the middle ear had influence on the hearing results of the two groups. Canal wall down mastoidectomy may be a beneficial procedure to improve hearing in patients with CSOM.

Clinical Study of Intratemporal Facial Nerve Palsy - The Causes and Outcome

Paralysis of the seventh cranial nerve, the facial nerve, is usually immediately obvious. It results in weakness of the musculature of the face, impacting verbal communication, social interaction with respect to facial expression, oral competence, taste and most importantly, protection of the cornea, ocular globe and vision. Palsy of the facial nerve in its intratemporal course leads to ipsilateral lower motor neuron facial palsy. Objectives: 1. To study 100 cases of facial nerve palsy due to pathology in the intratemporal course of the nerve. 2. To identify the frequent causes, course of palsy, treatment modality and recovery during a period of 3 months follow-up. Materials &amp; Methods: 100 patents with facial nerve palsy with an intratemporal pathology were analysed. Detailed history was taken. Patients were subjected to complete clinical evaluation of ear and cranial nerves, radiological evaluation was also done to confirm the diagnosis. Patients were treated appropriately. The facial nerve function was graded again during follow up after 3 months. Results: 46% patients were diagnosed with Bells palsy, 26% with chronic suppurative otitis media/cholesteatoma, 17% with trauma leading to palsy and 4% patients had tumours that lead to the palsy. Males were more affected (58%) than females. 39% patients were in the age bracket of 21 to 30 years. 25% of cases had Grade 3 palsy at presentation, 40% of cases had Grade 4, 13% had grade 5 and 8% had grade 6 palsy. After 3 months 82% cases showed complete recovery following appropriate treatment.

Cochlear implantation in chronic suppurative otitis media

Patients with chronic serous or suppurative otitis media (CSOM) requiring cochlear implantation present a management challenge. Treatment protocols are emerging for cochlear implantation in CSOM. Elimination of infection and protection of the cochlear implant electrode array are the principle goals, although prevention of infection, including the potential for intracranial involvement, takes precedence over early implantation. In some cases of active disease, a staged procedure may be required. Here, we review the literature, discuss management of cochlear implantation in CSOM, and provide a management algorithm to guide decision-making.

Chronic Suppurative Otitis Media in Cleft Palate: Microorganism Etiology and Susceptibilities

To investigate the microbial etiology of suppurative chronic otitis media (SCOM) in patients with complete cleft lip and palate and isolated cleft palate and to determine the sensitivity of isolated microorganisms to antibiotics by drug diffusion from impregnated discs in agar and the minimum inhibitory concentration of each drug to these microorganisms by drug dilution in agar. Effusion samples of SCOM obtained from 40 patients with cleft lip and palate registered at the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, at Bauru, Brazil, were bacteriologically analyzed by cultures. The isolated bacteria were submitted to an in vitro susceptibility test to clinically used drugs. Positive cultures were obtained in 100% of studied cases. Among the 57 strains observed, the most frequent were Pseudomonas aeruginosa (35%), Staphylococcus aureus (15.5%), Enterococcus faecalis (14%), and Proteus mirabilis (12%). The frequency of Gram-negative bacilli (enterobacteriaceae and nonfermentative bacilli) was 67%. Pseudomonas aeruginosa presented the highest sensitivity to ciprofloxacin, and enterobacteriaceae exhibited the highest sensitivity to gentamicin. The strains of S. aureus and E. faecalis presented the highest sensitivity to imipenem and sulfamethoxazole/trimethoprim, respectively. Patients with cleft lip and palate presenting with SCOM exhibited 100% positive cultures, with the highest frequency of Pseudomonas and enterobacteriaceae. With regard to the action of antibiotics, imipenem was effective against the four species of isolated microorganisms, followed by ciprofloxacin, which was effective against 75% of isolated species.

Chronic suppurative inflammation of the middle ear in children

Chronic suppurative inflammation of the middle ear (HGO) in children represents one of the most frequent infections in childhood, even in children from developed industrial countries. We can distinguish two types of chronic suppurative inflammation: first--HGO without cholesteatoma and second HGO with cholesteatoma. The objective of the paper was to point out the characteristics of chronic suppurative inflammation of the middle ear in children and possible methods of treatment. From 2000 to 2005, our retrospective study involved 92 children, aged 2 to 16 years, treated for chronic suppurative inflammation of the middle ear and subsequent otogenic complications. The diagnosis was established based on clinical symptoms, otoscopic and otomicroscopic findings. Treatment included the removal of the pathological process, reconstruction of the hearing chain and prevention recurrence. We performed 111 surgical interventions. Children were divided into two groups: in the first group, we performed 56 surgical interventions in 48 children diagnosed with chronic suppurative otitis without cholesteatoma, and in the second group we performed 55 surgical interventions in 44 children who were diagnosed with chronic otitis with cholesteatoma. In the first group we performed mastoidectomy in 17 (32.5%) children, mastoidectomy and posterior aticotomy in 5 (9.5%), miringoplasty in 22 (35.8%), timpanoplasty type II in 5 (9.5%), timpanoplasty type III in 3 (5.6%) and timpanomastoidectomy in 4 (7.1%) children. In the second group, consisting of children diagnosed with cholesteatoma of the middle ear, we performed 47 first act surgeries, using closed technique in 17, and open in 30 cases. We performed timpanoplasty type III in 17 (30.9%) and timpanomastoidectomy in 17 (30.9%), and timpanoplasty type II in 9 (16.4%), timpanoplasty type IV in 10 (18.2%) and mastoidectomy in 2 (3.6%) children. In the group treated by closed surgical technique recurrence occurred in 5 (29.4%), and in those treated by open technique in 3 (10.3%). Two children had bilateral cholesteatoma. Further research should be directed toward the identification of different types of factors and pathogenesis of HGO. Treatment of this decease is still considered controversial. Hinolon drops could represent a promising option in the treatment of HGO. The main objective in the treatment of cholesteatoma should be the improvement of the open technique to prevent retraction pockets, decrease of the rate of residual or atelectatic process and the improvement of hearing results.

The role of allergic rhinitis in suppurative chronic otitis media, prelaminary reports

The role of allergic rhinitis in suppurative chronic otitis media, prelaminary reports

Influence of Sampling Technique on Detection of Potential Pathogens in the Nasopharynx

To determine the optimal approach for nasopharyngeal culture and to establish which approach children tolerate best. Cross-sectional study. A pediatric otolaryngology department of a Dutch tertiary care hospital. A cohort of 42 children with chronic suppurative otitis media. Paired nasopharyngeal samples were collected transorally and transnasally and cultured for potential aerobic pathogens. The isolation rate of both samples and the amount of discomfort measured by the visual analog scale. Forty-six (87%) of 53 samples obtained transnasally were culture positive vs 40 (75%) of 53 samples obtained transorally (P = .20). Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus were found more frequently with the transnasal than with the transoral approach: 34% vs 13% (P = .003), 62% vs 51% (P = .20), 30% vs 19% (P = .15), and 21% vs 11% (P = .18), respectively. Mean (SD) visual analog scale scores were 5.3 (1.0) and 3.4 (1.7) (P<.001) for the transnasal and transoral approaches, respectively. Although the transoral approach is better tolerated in children, the isolation rate of the transnasal approach is higher, especially for S. pneumoniae. The transnasal sampling technique should therefore be the preferred approach for detection of potential pathogens in the nasopharynx in children.

Mastoiditis: Culture Early in the Era of Antibiotic Resistance

Otolaryngology| September 01 2002 Mastoiditis: Culture Early in the Era of Antibiotic Resistance AAP Grand Rounds (2002) 8 (3): 32–33. https://doi.org/10.1542/gr.8-3-32 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Mastoiditis: Culture Early in the Era of Antibiotic Resistance. AAP Grand Rounds September 2002; 8 (3): 32–33. https://doi.org/10.1542/gr.8-3-32 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: antibiotic resistance, bacterial, mastoiditis Source: Zapalac JS, Billings KR, Schwade ND, et al. Suppurative complications of acute otitis media in the era of antibiotic resistance. Arch Otolaryngol. 2002;128:660–663. Some reports have noted an increase in suppurative complications of acute otitis media (AOM) and have suggested a possible association with increasing prevalence of antibiotic-resistant pneumococci.1–,3 These authors from Dallas Southwestern Medical Center, Dallas, TX, performed a retrospective chart review of all children with suppurative complications of AOM admitted to a pediatric tertiary care center from January 1993 through June 2000. They searched “databases” for the inpatient diagnostic codes for acute mastoiditis, subperiosteal abscess, facial nerve paralysis, labyrinthitis, petrositis, otitic hydrocephalus, sigmoid sinus thrombosis, or intracranial abscess, and confirmed complications of AOM by chart review. Patients with chronic suppurative otitis or known cholesteatoma were excluded. During the 7½-year study period, 90 patients aged 3 months to 16 years (mean 45 months) were treated for 104 suppurative complications of AOM. Mastoiditis was classified as non-coalescent or coalescent, representing a continuum of the disease process. Coalescent mastoiditis typically portends a worse prognosis and requires surgery.4 The complications observed were non-coalescent mastoiditis (51), coalescent mastoiditis with extension of disease externally forming a subperiosteal abscess over the mastoid bone (20), coalescent mastoiditis without extension (4), facial nerve paralysis (14), epidural abscess (7), sigmoid sinus thromboses (5), apical petrositis (2), and suppurative labyrinthitis (1). Of the 40 cases of non-coalescent mastoiditis where a culture of the middle ear or mastoid was obtained, bacteria were isolated in 77%: coagulase (-) staphylococcus (n=10), Group A streptococcus (n=6), Streptococcus pneumoniae (n=5), Staphylococcus aureus (n=3), and other (n=7). Of the 24 cases of coalescent mastoiditis, bacteria were isolated in 83%: S pneumoniae (n=10), Group A streptococcus (n=4), coagulase (-) staphylococcus (n=2), Haemophilus influenzae (n=1), and other (n=3). In the non-coalescent group, 3 of 5 isolates of S pneumoniae were reported as resistant, as were 6 of 10 isolates in the coalescent group. The authors do not specify whether these were multi-drug resistant organisms. Resistant S pneumoniae were collected primarily from children aged 4–24 months (mean 11.9). Forty-six (90%) of non-coalescent cases were treated with intravenous antibiotics alone or in combination with myringotomy and tubes (5 patients). The remaining 5 patients required surgery because of disease progression. All patients who exhibited radiographic features of coalescence underwent mastoidectomy. A linear trend approaching statistical significance was observed for increases in the rate of suppurative complications during the study period (P=.11), surgical intervention (P=.17), and S pneumoniae resistance (P=.15). The authors recommend early acquisition of middle ear cultures in patients with suppurative complications of AOM. This report augments the evidence that acute mastoiditis in children may be increasing nationally due, in part, to increasing antibiotic resistance and virulence of organisms. Acute mastoiditis due to resistant S pneumoniae may be in- creasing in children under age 2 years due to acquisition of virulent resistant organisms in daycare and preschool.5 Limitations of this study include... You do not currently have access to this content.

Multicenter study of the efficacy and safety of oral ciprofloxacin in the treatment of chronic suppurative otitis media in adults

Chronic suppurative otitis media is a common and potentially dangerous clinical condition that is difficult to treat because the most common infecting organisms are often resistant to many antibiotics. Recently, fluoroquinolones such as ciprofloxacin have provided a new therapeutic possibility, offering a wide range of antibacterial activity and proven concentration in the middle ear. Therefore in the current study, we assessed the efficacy and safety of oral ciprofloxacin (500 mg twice daily for 10 days) in the treatment of suppurative chronic otitis media in adults. One hundred sixty-four patients were enrolled during a 3-month period by 49 ear, nose, and throat physicians in general practice. The mean duration of symptoms was 158 months, with the acute exacerbation lasting 72.5 days. Staphylococcus aureus, Pseudomonas aeruginosa, and Proteus mirabilis were most commonly isolated. At the end of treatment, the otorrhea had disappeared in 104 of the 155 (67.1%) evaluated patients. The bacteriologic eradication rate was 64.5%. After 4 weeks of follow-up care, 93.2% of patients had no recurrence of infection. In 4 patients, treatment was discontinued prematurely after an adverse event. We conclude that ciprofloxacin is an effective and well-tolerated general practice treatment for suppurative chronic otitis media in adults. (Otolaryngol Head Neck Surg 1997;117:83-90.)

The bone anchored hearing aid—The third option for otosclerosis

The bone anchored hearing aid (BAHA) has mainly been used for the treatment of hearing loss in patients with congenital conductive problems or chronic suppurative otitis media. In a five-year period, 32 otosclerotic patients have been referred to the Queen Elizabeth Hospital for consideration of a BAHA. Ten of these patients have been fitted and gained benefit compared to their previous hearing aid. The benefits are not necessarily those in hearing ability but in some cases relate to cosmetic or comfort improvements. This paper demonstrates that the BAHA offers a third treatment option for otosclerosis in patients who cannot or will not undergo stapedectomy and experience difficulty with conventional hearing aids.