Common Ear Disease Research Articles

Chronic Suppurative Otitis Media in urban private school children of Nepal

SummaryChronic suppurative otitis media is one of the common ear diseases of the ear, particularly in childhood. It is the commonest cause of persistent mild to moderate hearing impairment in children and young adults.AimTo find out the prevalence of chronic suppurative otitis media among school children studying in urban private schools of Nepal.Materials and MethodsThis study was carried out among 500 school children aged between 5 -15 years. Students were selected from urban private schools of four districts of Nepal. In all students, history was taken and otoscopic examination done from May 2006 to October 2006. Data were described using frequency and percentage. Study design: Prospective cross sectional study.ResultsResults showed that the prevalence of chronic suppurative otitis media in children studying in urban private schools of Nepal is 5.0%. Unilateral disease was seen in 72.0%, 76.0% had a tubotympanic disease and 24.0% had atticoantral disease.ConclusionThe prevalence of chronic suppurative otitis media in urban private school children in Nepal is higher than other studies done in private school children. Health education, improvement of socioeconomic status and health facilities will be helpful in reducing the prevalence of chronic suppurative otitis media.

Pattern of ear diseases in rural school children: Experiences of free health camps in Nepal

Objective This study was done to find out the prevalence of different types of ear disease in rural school children of Nepal. Material and methods This is a prospective cross-sectional study among 2000 children aged between 5 and 13 years. Children those attending free health camps in rural places of six districts of Nepal were included. These free health camps were organized either by Healthy Human Society (non-governmental organization run by doctors of Nepal) or in association with other organizations. All these children were interviewed and examined otoscopically from January 2006 to December 2008. Informed consent was taken from guardians to participate in this study. Results are expressed in numbers and percentages. Results Out of 2000 children, 64.2% were male and 35.8% female children. The most common ear diseases were wax (62.0%), followed by chronic suppurative otitis media (7.6%) and otitis media with effusion (4.7%). In CSOM, there was 83.0% tubotympanic type. Both the wax and CSOM were common in 5–7 years age group. Overall ear diseases were present in 81.6% children. Conclusion Wax followed by chronic suppurative otitis media and otitis media with effusion were the most common ear diseases in rural school children of Nepal. Improvement of socioeconomic status and health care facilities, such as repetitions of free health camps will be helpful in reducing the prevalence of ear diseases.

Numerical analysis of ossicular chain lesion of human ear

Lesion of ossicular chain is a common ear disease impairing the sense of hearing. A comprehensive numerical model of human ear can provide better understanding of sound transmission. In this study, we propose a three-dimensional finite element model of human ear that incorporates the canal, tympanic membrane, ossicular bones, middle ear suspensory ligaments/muscles, middle ear cavity and inner ear fluid. Numerical analysis is conducted and employed to predict the effects of middle ear cavity, malleus handle defect, hypoplasia of the long process of incus, and stapedial crus defect on sound transmission. The present finite element model is shown to be reasonable in predicting the ossicular mechanics of human ear.

Effects of Endolymphatic Sac Drainage With Steroids for Intractable Ménière's Disease: A Long‐Term Follow‐Up and Randomized Controlled Study

Meniere's disease is a common inner ear disease with an incidence of 15 to 50 per 100,000 population. Since Meniere's disease is thought to be triggered by an immune insult to the inner ear, we examined intraendolymphatic sac application of steroids as a new therapeutic strategy for intractable Meniere's disease. Prospective randomized controlled study. Between 1996 and 2005, we enrolled and assigned 197 intractable Meniere's patients to three groups in a randomized controlled trial: Group I (G-I)- patients who underwent endolymphatic sac drainage and steroid-instillation; Group II (G-II)-those who underwent endolymphatic sac drainage without steroid-instillation; and Group III (G-III)-those who declined endolymphatic sac drainage. Definitive spells and hearing in all three groups were determined for 2 to 7 years after treatment. According to the 1995 American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) criteria, 2-year results demonstrated that vertigo was completely controlled in 88.0% of patients in G-I (n = 100), 85.1% of patients in G-II (n = 47), and 8.0% in G-III (n = 50). Statistically, G-I = G-II>G-III. Hearing was improved in 49.0% of patients in G-I, 31.9% in G-II, and 6.0% in G-III (G-I>G-II>G-III). Results after 7 years showed that vertigo was completely controlled in 78.8% of patients in G-I, 79.2% in G-II, and 25.0% in G-III (G-I = G-II>G-III). Hearing improved in 36.5% of patients in G-I, 8.3% in G-II, and 0.0% in G-III (G-I>G-II = G-III). From non-surgical observation in G-III for at least 7 years after treatment, steroids instilled into endolymphatic sac in G-I patients significantly improved hearing in intractable Meniere's patients, more so than endolymphatic sac drainage without steroids in G-II patients.

Th1/Th2 and Regulatory Cytokines in Adults With Otitis Media With Effusion

Otitis media with effusion is one of the most common and intractable ear diseases. However, the role of Th1, Th2, and immunoregulatory cytokines on the pathogenesis of the disease in adult patients remains to be determined. The aim of this study is to disclose the cytokine expression in middle ear effusions (MEEs) in adults and to compare the profile on the basis of the presence of allergic rhinitis and the type of effusions. A prospective controlled clinical study. MEEs were collected from 80 adult subjects. The concentration of interleukin (IL)-2, IL-4, IL-5, IL-10, IL-12, and interferon (IFN)-gamma in MEEs were determined by using enzyme-linked immunosorbent assay. IL-2, IL-4, IL-5, IL-10, IL-12, and IFN-gamma in MEEs were detected in 60 (75.0%), 33 (41.3%), 42 (52.5%), 14 (17.5%), 80 (100%), and 66 (82.5%) samples, respectively. Among these cytokines, only the concentration of IL-4 in the allergic rhinitis-positive group was significantly higher than that in the allergic rhinitis-negative group. On the other hand, IL-2, IL-12, and IFN-gamma were detected, regardless of the presence of allergic rhinitis, and the concentration of these cytokines correlated with each other. The correlation between the concentration of IL-4 and IL-5 was also detected. In addition, both the incidence rate and the concentration of IL-10 in MEEs were significantly higher in the mucoid type compared with those in the serous type effusions. Regardless of allergic status, IL-12 may play a critical role in the pathogenesis of otitis media with effusion by affecting the production of IL-2 and IFN-gamma. In addition, IL-4 may have some impact on the immunologic condition in adults with allergic rhinitis. IL-10 potentially affects the viscosity of MEEs.

Ear Diseases in Elderly Hospital Patients in Nigeria

Little information is available about the pattern of ear diseases in the elderly population. Therefore, the present study aims to determine the pattern of ear diseases among elderly Nigerians, so as to provide an objective basis for cost-effective health care planning for the emerging geriatric population. A retrospective study of 320 patients aged 60 years or older presenting with ear diseases at the University of Ilorin Teaching Hospital, Ilorin, Nigeria, between January 1996 and December 2001 was carried out. Impacted cerumen was the most common ear disease, occurring in 110 (34.4%) patients of the study population. Chronic suppurative otitis media (CSOM) was the most common infectious disease, affecting 28 (8.8%) patients. Of the 88 patients with hearing loss, 63 (71.6%) had sensorineural, 20 (22.7%) had presbycusis, 1 (1.1%) had conductive, and 4 (4.6%) had mixed hearing loss. Our data suggest that impacted cerumen, hearing loss, and infections (notably CSOM), are the common ear diseases among elderly Nigerians.

Role of macrophage migration inhibitory factor in otitis media with effusion in adults.

Otitis media with effusion (OME) is one of the most common ear diseases. Bacterial endotoxins and several inflammatory cytokines appear to be involved in the pathogenesis of OME in children; however, little is known of the immunological aspects of the onset of OME in adults. We sought to determine the presence of macrophage migration inhibitory factor (MIF) as well as interleukin 1beta (IL-1beta), tumor necrosis factor alpha (TNF-alpha), RANTES (regulated upon activation, normal T-cell expressed and presumably secreted), and endotoxin in middle ear effusions (MEEs) from adult patients with OME. In addition, the levels of MIF in MEEs from adults and children were compared. MEE was obtained from 95 adults and 11 children. The levels of MIF, IL-1beta, TNF-alpha, and RANTES were determined by enzyme-linked immunosorbent assay, and the concentrations of endotoxin and total protein were determined by the Endospec assay and bicinchoninic acid assay, respectively. MIF was detected in 97.9% of the MEEs from adults, while endotoxin, IL-1beta, TNF-alpha, and RANTES were detected in 96.8, 12.6, 5.3, and 43.9%, respectively. In addition, the level of MIF was significantly higher than those of endotoxin, IL-1beta, and TNF-alpha. A positive correlation between the levels of MIF and endotoxin was observed. MIF and endotoxin were detected in 81.8 and 72.7%, respectively, of the MEEs from the children. The level of MIF was significantly higher in the children, and conversely that of endotoxin was significantly higher in the adults. These results suggest that the interaction between MIF and endotoxin may promote fluid collection in the middle ear, particularly in adults.

Use of ototopical antibiotics in treating 3 common ear diseases

Prompted by rising rates of antibiotic resistance, lack of standardized treatment regimens, and new treatment alternatives, the American Academy of Otolaryngology–Head and Neck Surgery convened an expert consensus panel to consider recommendations for the responsible use of antibiotics in chronic suppurative otitis media, tympanostomy tube otorrhea, and otitis externa. The Panel concluded that in the absence of systemic infection or serious underlying disease, topical antibiotics alone constitute first-line treatment for most patients with these conditions, finding no evidence that systemic antibiotics alone or in combination with topical preparations improve treatment outcomes compared with topical antibiotics alone. Topical preparations should be selected on the basis of expected bacteriology and informed knowledge of the risk-benefit of each available preparation. The use of nonototoxic preparations in treating acute otitis externa (when the tympanic membrane is perforated or its status is unknown), chronic suppurative otitis media, and tympanostomy tube otorrhea should be considered. (Otolaryngol Head Neck Surg 2000;122:934-40.)

Cholesteatomas.

1. Jerome W. Thompson, MD* 1. 2. *Associate Professor of Otolaryngology, University of Tennessee, Memphis, TN. After completing this article, readers should be able to: 1. Describe the classic appearance and location of congenital cholesteatomas. 2. List the two broad categories of cholesteatomas. 3. Describe what response to multiple courses of antibiotics should raise the index of suspicion for cholesteatoma. 4. Describe the treatment that always is required for cholesteatoma. 5. Describe the common prognosis for cholesteatoma. At the turn of the century, medical texts described cholesteatomas as destructive processes that were the primary cause of frequent and usually fatal intracranial complications of common ear disease. These lesions are far less deadly today, in large part due to better antibiotics, imaging techniques, and surgical management, but they remain common. Simply stated, a cholesteatoma is a benign skin tumor, usually occurring in the middle ear and mastoid spaces. Sometimes it can be difficult to diagnose early through the hand-held otoscope. The characteristic glistening white growths can appear as vague, irregular, unremarkable whitish structures that resemble tympanosclerosis, but they can be distinguished more easily under high-power microscopy. Cholesteatomas were described initially late in the 19th century and misnamed because of their resemblance to cholesterol deposits in the large vessels. In reality, they contain no more cholesterol than the skin cells of which they are made. A cholesteatoma is a hamartomatous-like, keratin-producing squamous epithelial lesion that is constructed very much like an onion, in layers. The bulk of these tumors consists of desquamated skin deposited into a core of shed dead cells called …

Importance of mastoid pneumatization on secretory otitis media

Secretory otitis media is the most common middle ear disease of childhood. It heals spontaneously, by medical therapy or by minor surgical procedures in most of the cases. Sequelae such as retraction pockets and adhesive otitis that lead to cholesteatoma rarely occur, but initialy it is hard to diagnose which patient will acquire a sequela. It is well known that mastoid pneumatization is poor in the patients who had complications like retraction pocket, adhesive otitis and cholesterol granuloma. The aim of this study was to determine if any relationship exists between mastoid pneumatization and secretory otitis media. Lateral mastoid X-rays of 47 children with secretory otitis media were evaluated. After 2 months of follow-up with medical therapy, 30 of the 47 patients needed ventilation tube insertion. The remaining 17 patients showed total recovery with medicines only. Control X-rays of the operated patients were taken 6 months after the operation. Mastoid pneumatizations of patients healed with medicine were compared with the operated patients. There were statistically significant differences between the mastoid pneumatizations of surgically and medically treated groups. In addition we observed a statistically significant difference between the mastoid areas of the preoperative and the postoperative X-rays. We concluded that mastoid pneumatization might be considered as a prognostic indicator in secretory otitis media. The estimated prognosis is poor when the mastoid pneumatization is poor.

突発難聴を初発症状とした聴神経腫よう症例

Acoustic tumor (AT) most commonly arises from the inferior vestibular nerve and its initial symptom is sensori-neural hearing loss. This hearing loss is progressive with a gradual onset in the majority of cases. Since Cushing's report (1917), however, it is also known that some patients present with sudden hearing loss which may or not be temporary. Since 1978, unilateral AT has been diagnosed in 157 patients in our clinic, and in 19 of them the hearing loss of sudden onset was the chief complaint. Hearing was restored in 6 but was permanent in 13 patients. Although there were no significant differences in clinical and otoneurological findings between AT patients with gradual onset and those with sudden hearing loss without recovery, the patients with sudden onset followed by recovery of hearing showed several findings different from the other two groups: smaller tumor, trough type hearing loss and higher percentage of normal or slightly abnormal responses in caloric tests, X ray examinations and auditory brainstem response. In a review of the available literature, we found 22 AT cases in which sudden onset hearing loss followed by recovery had been reported with sufficient clinical information. The clinical and otoneurological findings in those cases were quite similar to our own. The most common ear disease with hearing loss of sudden onset is sudden deafness and the estimated incidence is 16, 663 every year. Although AT patients with sudden onset of hearing loss followed by recovery are very few (estimated 31 to 62/year), it is extremely important for otolaryngologists to consider the possibility of AT, when patients present with sudden hearing loss.

Ear disease in a group general practice

This five-year survey of ear disease in a London population of 10,000 is considered to be a valid description of the incidence of ear disease presenting in a general practice community, since all patients were examined and diagnosed either by the author or by the district hospital Ear, Nose and Throat Department. The results agreed generally with the findings of the National Morbidity Surveys, but a more comprehensive range of ear disease is described. There is general agreement, between this and other surveys in the United Kingdom and the United States, that the most common ear diseases presenting in general practice populations are acute suppurative otitis media and impacted wax, followed by presbyacusis, secretory otitis media, chronic suppurative otitis media, vertigo and traumatic deafness due to noise, blast or head injury. However, the incidence of these and other diseases differs greatly in many countries throughout the world and some aetiological factors are suggested. The evidence in this paper points to the continuing need for the investigation of the incidence and aetiology of some ear diseases in many parts of the world.

Common ear diseases: recognition and management.

External otitis is directly related to patient habit patterns. It is easily treated, but the habits must be changed to effect permanent cure. Serous otitis media is the most common cause of conductive hearing loss, and its presence my predispose to development of purulent otitis media. Removal of middle ear fluid may be advisable in persistent serous otitis and is recommended in acute purulent otitis.