Exacerbation Of Chronic Otitis Media Research Articles

Vestibular Hypofunction Secondary to Topical Use of Aminoglycosides in Ears with Perforated Tympanic Membrane

Introduction: The objective of this study was to identify and clinically characterize patients treated in an Otoneurology Unit who experienced vestibular ototoxicity as a result of using aminoglycoside ear drops during outbreaks of superinfection in chronic otitis media. Material and Methods: An observational retrospective study was conducted, including patients with perforated eardrums who developed vestibular ototoxicity within the past 10 years following the application of topical ear aminoglycosides in a tertiary referral center. The study encompassed the assessment of the clinical presentation, treatment, quality of life, and evolution after treatment of the identified individuals. Results: During the study period, 6 patients, aged between 33 and 71 years, developed vestibular ototoxicity following the use of topical aminoglycoside drops due to infection flares in chronic otitis media. All cases involved the use of gentamicin. Two cases were unilateral, and 4 were unilateral. The onset of symptoms occurred within one to four weeks of using the drops, resulting in all patients experiencing instability without vertigo attacks. After discontinuing the drops and undergoing vestibular rehabilitation, 4 patients experienced sequelae, with 2 patients (both with bilateral vestibular hypofunction) suffering significant impairment in their quality of life. Conclusions: Vestibular ototoxicity due to the topical application of aminoglycosides during acute exacerbations of chronic otitis media is a rare occurrence. However, given its potential for severe consequences and the fact that we are still encountering patients with this condition, healthcare professionals should explore alternative antibacterial agents that offer similar efficacy.

Petrous internal carotid artery aneurysm rupture induced by Eustachian tube catheterisation: case report.

Petrous internal carotid artery aneurysms are very rare vascular lesions, which may present with otalgia and life-threatening massive otorrhoea. An 84-year-old woman presented at a local otolaryngology clinic with progressive otalgia due to an acute exacerbation of chronic otitis media. She was referred with left-sided massive otorrhoea following Eustachian tube catheterisation. She suffered another massive otorrhoea with epistaxis during left-sided ear cleaning at a clinic visit. Contrast-enhanced computed tomography and computed tomography angiography revealed a left-sided aneurysm and adjacent stenosis at the left internal carotid artery. Coil embolisation of the petrous internal carotid artery aneurysm was performed with percutaneous transluminal angioplasty followed by dilatation of the stenosis. Computed tomography angiography should be performed immediately when a patient reports massive otorrhoea. Endovascular occlusion is a treatment option as it avoids complications of open surgical ligation procedures.

Analysis of appeals of patients with sensorineural hearing loss to the otolaryngological department during 2015-2021

Patients with perceptual hearing impairment occupy a significant place among patients of the otolaryngology department. They often have psycho-emotional disorders, social and family disorders. It is important to understand the etiopathogenesis of the disease. Some cases of sensorineural hearing loss (SHL) remain with an unknown etiopathogenetic mechanism of development, which requires more in-depth examination of patients. Aim: to analyze the number and character of appeals of patients with sensorineural hearing impairment to the otolaryngology department of the Alexander Clinical Hospital in Kyiv during 2015-2021. Methods and materials: We analysed 13,147 inpatients 'medical records, from which 1,138 patients' cards with perceptual hearing impairments were selected. Results: According to the analysis, the absolute and relative number of patients in the otolaryngology department of Alexander Clinical Hospital in Kyiv in 2020 and 2021 decreased significantly due to the temporary re-profiling of the otolaryngology department in these years for infectious patients with COVID-19. The most common changes in bone conduction according to audiometry occurred against the background of acute or exacerbation of chronic otitis media (509 cases). But this figure may be due to inflammatory changes, rather than true sensorineural hearing loss. 155 patients could not name a specific cause. These patients required further in-depth examination. In the third most frequent place indicated hypothermia, acute respiratory diseases (135 cases). In 106 patients, acute sensorineural hearing loss was caused by vascular disorders, and 11 patients reported emotional stress as the cause. Acute trauma caused perceptual disorders in 16, surgery in 3, neuroma in 1, barotrauma and rupture of the tympanic membrane in 7, the use of chemotherapy in 3 cases. The average interval between the onset of the first symptoms of SHL and hospitalization in the otolaryngology department of the Alexander Clinical Hospital in Kyiv for 2025-2021 was 8.19 days. The lowest interval was in 2016 – 7.5 days, the largest – 10 days in 2021. The average duration of inpatient treatment of patients for 2015-2021 was 9.4 days. The lowest figure was in 2020 – 8.1 days, the highest – 10.4 days in 2021. There were 495 patients with bilateral lesions and 354 patients with left lesions, 289 patients had lesions on the right side. 39 patients with SHL and type 2 diabetes mellitus had diabetes, 460 had tinnitus and 44 had vestibular disorders. Conclusions: Patients with acute sensorineural hearing loss receive inpatient treatment in the otolaryngology department than with the progression or exacerbation of the chronic form. Otitis media and acute respiratory diseases were the most common disorders of bone conduction, but not all of these cases can be interpreted as sensorineural hearing loss. The average interval for the study period between the onset of the first symptoms and the start of treatment was 8.19 days, which exceeds the recommended time of this indicator. The average duration of inpatient treatment was 9.4 days and did not change significantly during the study period.

Отогенные тромбозы церебральных венозных синусов у детей

Aim: to study the incidence of pediatric otogenic cerebral sinus thrombosis according to the data of the Pediatric Department of the ENT Diseases (Regional Clinical Hospital No. 2, Tyumen). Patients and Methods: a retrospective analysis of medical records of children with acute otitis media, exacerbation of chronic otitis media, mastoiditis and extra- and intracranial complications was conducted. All children were hospitalized from 2009 to 2019. The following indicators were studied: age and gender characteristics of children with otogenic complications; the parameters of clinical, laboratory, microbiological, X-ray imaging, and the prevalence of pediatric otogenic cerebral sinus thrombosis among all forms of otogenic complications. Results: during the study period, 6123 patients with purulent-inflammatory pathology of the ear were treated. Otogenic complications were verified in 135 children (mean age 5.99±0.34 years), otogenic cerebral venous sinus thrombosis was detected in 17 (12.6%) patients. Parents independently conducted the treatment for 3 (17.6%) children, treatment under the pediatrician supervision was carried out for 6 (35.3%) children, under the otorhinolaryngologist supervision — for 8 (47%) children. In all cases, the anamnesis presented the absence of laboratory and X-ray diagnostics at the stage of treatment and control of the AOM recovery in outpatient conditions. Upon admission, 17 (100%) patients had complaints about the ear pain, 14 (82.3%) patients complainted about the headache, and 4 (23.5%) patients noted the purulent discharge from the ear. Swelling, pitting edema, moderate hyperemia along the posterior edge of the mastoid process were recorded in 5 (29.4%) children, hyperemia, significant tenderness on palpation of the mastoid process tip — in 3 (17.6%) children. The examination and treatment of children was conducted using an interdisciplinary approach. CT and MRI with contrast were performed for suspected intracranial complication and thrombosis. Various types of defects in sigmoid sinus passage of contrast. All children underwent emergency surgical interventions and were prescribed with antibacterial and anticoagulant therapy. All patients were discharged recovered, and the control CT revealed complete recanalization of cerebral vessels. Conclusions: the incidence of otogenic cerebral venous sinus thrombosis was 12.6% of all forms of otogenic complications. Untimely visit to a doctor for otitis media, uncontrolled self-treatment, insufficient alertness of an outpatient doctor were the most common causes of otogenic cerebral venous sinus thrombosis. An interdisciplinary approach allows to reduce the risk of septic complications, adverse outcomes and achieve complete recovery. KEYWORDS: cerebral venous sinus thrombosis, otogenic complications, acute otitis media, chronic otitis media, antromastoidotomy, myringotomy, interdisciplinary approach. FOR CITATION: Kuznetsova N.E., Veshkurtseva I.M., Kuznetsova T.B. Pediatric otogenic cerebral venous sinus thrombosis. Russian Medical Inquiry. 2022;6(7):399–403 (in Russ.). DOI: 10.32364/2587-6821-2022-6-7-399-403.

Analysis of pathogens and antimicrobial treatment in different groups of patients with chronic otitis media.

Microbial infection plays an important role in exacerbation of chronic otitis media. The aim of this study was to analyse the microbiota in chronic otitis media in the context of local treatment. In this prospective study, samples for microbiological examination were taken from 119 patients who underwent operation because of chronic otitis media. The results were compared between groups depending on the type of operation (none, tympanoplasty or radical), the presence of cholesteatoma or granulomatous tissue or discharge from the ear as a symptom of exacerbation. Antibiotic susceptibility of germs was analysed to define the strategy of treatment. A total of 209 samples were collected from 119 patients with chronic otitis media. Pseudomonas aeruginosa and Staphylococcus aureus were pathogens most frequently identified from the ear in the course of chronic otitis media. Pseudomonas aeruginosa was concerned with major pathology of the middle ear (radical surgery, cholesteatoma or granulomatous tissue, persisting discharge after treatment), whereas Staphylococcus aureus was obtained in dry perforations without other pathology in the middle-ear cavity. Ciprofloxacin was effective against Staphylococcus aureus, but Pseudomonas aeruginosa strains were ciprofloxacin resistant.

Local concentrations of secretory immunoglobulin a in patients with adenoiditis, rhinosinusitis and exacerbation of chronic purulent otitis media when using physiatric methods in complex therapy

Improvement of therapeutic tools is one of topical issues in modern otorhinolaryngology. The article is devoted to the study of the stimulating effect of physical therapy on the concentrations of secretory IgA in nasal secretions, from the entries of auditory tubes and nasopharynx in the patients suffering from adenoiditis, rhinosinusitis, and exacerbation of chronic otitis media. The increase in clinical and immunological efficiency when using low-frequency ultrasonic cavitation therapy in combination with photochromotherapy in combined treatment of these conditions was evaluated in dynamics by measuring concentrations of secretory immunoglobulin levels in nasal secretions using enzyme immunoassay technique (Vector-Best, Russia). The purpose of this study was to improve clinical and immunological effectiveness of treatment of patients with chronic adenoiditis, sinusitis and exacerbation of chronic purulent otitis media when using low-frequency ultrasound cavitation and photochromotherapy in complex therapy. The study involved 54 patients. The control group consisted of 25 patients who received conventional treatment (topical and systemic antibacterial and anti-inflammatory drugs, unloading and elimination procedures, symptomatic and restorative therapy) and the main group of 29 people who, in addition to etiotropic therapy, received low-frequency ultrasound cavitation irrigation of the nasal cavity followed by a course of photochromotherapy. Evaluation of the effectiveness of treatment was carried out by studying the barrier state of the nasal mucosa by the levels of secretory IgA concentration by the method of enzyme immunoassay. The low-frequency ultrasound cavitation in combination with photochromotherapy as an adjunct to etiotropic treatment in patients with adenoiditis, rhinosinusitis and exacerbation of chronic otitis media promotes an earlier increase in secretory IgA concentration of nasal mucosa and entry of the auditory tube when compared to standard treatment methods. The trend to IgA increase by 14 days reached maximal values and was slightly decreased month later. An early increase in the concentration of secretory IgA in nasal secretions and the entry of auditory tube, and positive clinical results of treatment are observed when low-frequency ultrasound cavitation is used in etiotropic therapy in combination with photochromotherapy in patients with adenoiditis, rhinosinusitis and exacerbation of chronic otitis media. The results substantiate the opportunity of introducing these physical methods of physical therapy into complex etiotropic therapy, as a non-invasive and effective method.

The experience of application of the uniflox drops in treatment of patients with inflammatory diseases of external and middle ear

The contemporary approaches to treatment of acute inflammatory diseases of external and middle ear of bacterial nature are based on application of efficient and safe from ototoxic viewpoint antibacterial drugs. The article presents the results of order of Uniflox drops for outpatient treatment of diffuse external otitis, acute otitis media and exacerbation of chronic otitis media. The topical application of the preparation Uniflox made it possible to arrest the main manifestations of inflammatory process in 98% of cases with diffuse otitis externa, in 95% cases of acute otitis media and in 94% patients with acute exacerbation of chronic suppurative otitis media.

Unusual Malignant External Otitis in Mastoidectomized Temporal Bone: A Case Report

We here report an unusual case of malignant external otitis (MEO) in mastoidectomized temporal bone, and discuss its diagnosis and treatment course. A 67-year-old man with a history of diabetes mellitus (DM) and mastoidectomy presented with persistent right earache and discharge. The condition was first misdiagnosed as acute exacerbation of chronic otitis media. After revision mastoidectomy failed, a correct diagnosis of MEO was made. Intravenous ciprofloxacin and cefepime as well as concurrent hyperbaric oxygen (HBO) therapy were administered for 7 weeks. Surgical debridement in the form of mastoid exteriorization was also performed. Diagnosis of MEO in mastoidectomized temporal bone was difficult, and the relatively successful control of DM and negative bacterial culture from ear discharge further masked MEO. Mastoid cavity exteriorization in addition to prolonged administration of antibiotics and HBO therapy might be useful for MEO management.

Shewanella algae: A Rare Cause of Necrotizing Fasciitis

The genus Shewanella consists of motile, gram-negative, facultative anaerobes found in marine environments. Shewanella putrefaciens and Shewanella algae are the two species with documented pathogenicity in human beings. Most documented cases of S. algae infection worldwide have been reported in the context of bacteremia, cellulitis, and acute exacerbations of chronic otitis media in predisposed individuals. We report a rare case of necrotizing soft tissue infection by S. algae in an immunocompetent individual. The infection followed exposure to S. algae in contaminated water in New York City, New York. We reviewed the English-language literature on similar cases of soft tissue infection using PubMed. Search terms included "Shewanella algae" and "Shewanella putrefaciens" in conjunction with "necrotizing" and "infection." Cognizant that this search method may not have yielded early (pre-1985) reports about Shewanella because of changes in classification and nomenclature, we also searched for "Pseudomonas putrefaciens." After prompt surgical debridement and culture-directed antibiotic therapy, the patient recovered from his infection without the need for re-intervention. This case may reflect the geographic spread and emergence of S. algae infection in the United States. Clinicians should be aware of the virulence of S. algae and potential for the rapid clinical deterioration of persons it infects even among immunocompetent individuals.

急性化膿性中耳炎および慢性化膿性中耳炎急性増悪症に対するSBTPC(Sultamicillin) の薬効評価

急性化膿性中耳炎および慢性化膿性中耳炎急性増悪症に対するSBTPC(Sultamicillin) の薬効評価

Management and Outcomes of Chronic Otitis Media in Patients Who Received Solid Organ Transplantation

Control of perioperative infection can increase the success rate of organ transplant. The incidence, clinical features, and optimal management of chronic otitis media (COM) in solid organ transplant recipients have not been adequately evaluated. We therefore assessed the incidence and clinical course of COM in solid-organ transplant recipients. Case series with chart review. Tertiary referral center. We reviewed the medical records of 3278 patients who underwent solid organ transplantations between February 1995 and December 2007 to identify those diagnosed with COM before and after transplant. We analyzed the long-term clinical course and management of COM in these patients. Of 3278 solid organ transplant recipients, 65 (2.0%) were diagnosed with pretransplant COM with a perforated ear drum, including 31 liver, 28 renal, and 6 heart transplant recipients. The primary symptom was otorrhea, followed by hearing disturbance, otalgia, and tinnitus. Middle ear swab culture showed bacterial growth in 17 of the 40 patients (42.5%) with suppurative COM. Of these 40 patients, 14 underwent tympanomastoid surgery (operation group) and 26 were prescribed antibiotics (medication group). The remaining 25 patients, with dry perforated ear drums and well-pneumatized mastoids, were observed without treatment (observation group). After transplantation, the incidence of otorrhea was significantly lower in the operation group (11.1%) than in either the medication (26.9%) or observation (26.7%) group (P = .040, .048, respectively). Precise diagnosis and proper surgical intervention for COM may reduce the rate of otorrhea and exacerbation of COM in solid organ transplant recipients.

成人の中耳炎に対するメシル酸ガレノキサシン（ＧＲＮＸ）の有効性

Background: Garenoxacin mesilate (GRNX) is a novel oral des-fluoro(6) quinolone with potent antimicrobial activity against common respiratory pathogens, including resistant strains. Some researchers showed high efficacy of GRNX for acute otolaryngological infectious diseases. However, there are few reports on its efficacy in the treatment of adult otitis media. Objective: The aim of this study was to investigate the effectiveness of GRNX for adult otitis media. Material and Method: We reviewed thirty adult patients with acute exacerbation of chronic otitis media and seven adult patients with acute otitis media from June 2008 to July 2009. We examined the clinical efficacy and biological response of GRNX in these patients. Results: Clinical efficacy rates were 93% in acute exacerbation of chronic otitis media and 100% in acute otitis media. In acute exacerbation of chronic otitis media, bacteriological eradication rates were 9/12 in MSSA, 2/2 in MRSA, 1/2 in P. aeruginosa, 1/1 in P. mirabilis and 1/1 in S. marcescens. The overall eradication rate in acute exacerbation of chronic otitis media was 75%. In acute otitis media, four strains were isolated: CNS, S. pyogenes, M. catarrhalis and PSSP. These were all eradicated. Conclusion: The clinical efficacy of GRNX for adult otitis media in this study was superior to those of previous reports. GRNX is very useful for the treatment of acute exacerbation of chronic otitis media and acute otitis media in adults.

Comparison of levofloxacin 200mg bid and 100mg tid for the treatment of an acute exacerbation of chronic otitis media and acute otitis media

Comparison of levofloxacin 200mg bid and 100mg tid for the treatment of an acute exacerbation of chronic otitis media and acute otitis media

中耳炎および副鼻腔炎に対するＬＶＦＸ（クラビット）の効果―１日４００ｍｇ分２投与の有用性―

Twenty-six adult cases of acute exacerbation of chronic otitis media (COM) and twenty cases of acute exacerbation of chronic sinusitis (CS) were treated by Levofloxacin (LVFX) 400mg a day in two divided portions. The clinical efficacy rates were 84.6% for COM and 85% for CS. Bacteriolgical therapeutic failures in treatment were observed in four COM and three CS patients. Adverse response and abnormal laboratory findings were not observed. LVFX was more effective when given at 400mg a day in two divided portions.

Topical Ofloxacin for Chronic Suppurative Otitis Media and Acute Exacerbation of Chronic Otitis Media: Optimum Duration of Treatment

To assess the optimum duration of topical ofloxacin therapy for chronic otitis media and to compare the response between patients with chronic suppurative otitis media (CSOM) and acute exacerbation of chronic otitis media (AE). Prospective observational study. Five university hospitals and 30 affiliated institutions. A total of 294 patients who presented to the participating institutions with CSOM were enrolled. Among them, 268 patients were evaluable for safety and 237 were evaluable for efficacy (64 with CSOM and 173 with AE . Ofloxacin otic solution was administered for as long as 4 weeks. Clinical and bacteriologic assessment was done weekly during the treatment period. The clinical response was assessed on the basis of the symptom scores. There were no differences between CSOM and AE patients with respect to sex, age, and severity. The most common bacterial isolate from middle ear discharge was Staphylococcus aureus. The clinical response rates in patients with CSOM and AE were 39.1% and 61.3% after 2 weeks of treatment and 57.8% and 75.1% after 4 weeks, respectively, and the bacterial eradication rate was 91.0% at 2 weeks and 94.6% at 4 weeks. Detection of new fungal infection did not increase as the duration of therapy was prolonged. No serious adverse events were reported. The duration of treatment was shorter and the clinical response was higher in AE patients than in CSOM patients. The standard topical ofloxacin regimen for chronic otitis media should consist of a 2-week course from the aspect of bacteriologic efficacy, although patients showing insufficient symptomatic improvement after 2 weeks may benefit from another 1 or 2 weeks of therapy. Administration of this drug for as long as 4 weeks can increase the clinical efficacy without causing safety problems.

Controlled, double-blind, randomized comparison of nimesulide β-cyclodextrin and morniflumate in acute otitis

Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) act on cyclooxygenase (COX), a key enzyme in the synthesis of prostaglandins and thromboxanes that exists in 2 isoforms—COX-1 and COX-2. Nimesulide is a COX-2-selective NSAID that has a more favorable safety profile than the nonselective NSAIDs. Nimesulide has been combined with β-cyclodextrin to achieve a faster analgesic and anti-inflammatory effect. Objective: The aim of this study was to compare the speed of onset of the analgesic and anti-inflammatory effect of nimesulide β-cyclodextrin with that of morniflumate, an NSAID commonly used in clinical practice, in the treatment of symptoms of acute otitis. Methods: This was a multicenter, double-blind, randomized study that enrolled patients with otitis externa, acute otitis media, or exacerbations of chronic otitis media. Patients received either 400 mg nimesulide β-cyclodextrin (equivalent to 100 mg standard nimesulide) or 700 mg morniflumate every 12 hours for up to 10 days. The primary efficacy criterion was the intensity of otalgia, assessed on a visual analogue scale, in the 3 hours following the first administration of study drug. The total decrease in pain, percentage of responders, mean time to produce 50% reduction in pain, changes in associated symptoms, and global efficacy assessment were also recorded. Tolerability was evaluated by reporting of adverse events and patient and investigator assessments. Results: A total of 316 patients were randomized to receive nimesulide β-cyclodextrin (n = 156) or morniflumate (n = 160). The reduction in pain intensity was significantly greater with nimesulide β-cyclodextrin than with morniflumate from 30 minutes after administration ( P < 0.05). The total decrease in pain was also significantly greater and more rapid with nimesulide β-cyclodextrin than with morniflumate ( P < 0.05). The mean time to achieve a 50% reduction in pain from baseline was 117.0 minutes for patients receiving nimesulide β-cyclodextrin and 180 minutes for patients receiving morniflumate ( P < 0.05). Nimesulide β-cyclodextrin was globally assessed as having superior efficacy by both patients ( P < 0.05) and investigators ( P < 0.01). The tolerability of nimesulide β-cyclodextrin was significantly ( P < 0.05) better than that of morniflumate. Two patients (1.3%) receiving β-cyclodextrin reported adverse events compared with 13 patients (8.1%) in the morniflumate group. Conclusions: Both drugs were effective in the treatment of pain due to acute otitis, with nimesulide β-cyclodextrin showing faster onset of action, overall better analgesic effect, and superior tolerability.

慢性中耳炎に対するクラビットの効果

慢性中耳炎に対するクラビットの効果

A comparative study of the effect of Ofloxacin on acute otitis media and the acute exacerbation of chronic otitis media between oral medicine and otic solution

A comparative study of the effect of Ofloxacin on acute otitis media and the acute exacerbation of chronic otitis media between oral medicine and otic solution

中耳炎，副鼻腔炎に対するＣｅｆｉｘｉｍｅの有用性

Cefixime (CFIX) was administered to 22 patients with acute otitis media, 43 patients with acute exacerbation of chronic otitis media, 27 patients with acute paranasal sinusitis and 14 patients with acute exacerbation of chronic paranasal sinusitis.1. It was effective in 81.0 00 of those with acute otitis media, in 54.$ % of those with acute exacerbation of chronic otitis media, in 65.400 of those with acute paranasal sinusitis, and in 100.0 % of those with acute exacerbation of chronic paranasal sinusitis.2. Bacteriological studies showed an elimination rate of 59.5% (47/79).3. No side effect was noted.4. The above results indicate that CFIX is a very useful antibiotic in the treatment of otitis media and paranasal sinusitis.

耳鼻咽喉科感染症に対するＡＺＴ，ＦＯＭ併用療法

Infections of the ears, nose and thsoat are caused by a variety of pathogens at different sites and under various pathological conditions. Therefore, treatment with one antibiotic agent is sometimes not effective. In this study we evaluated the clinical and bacteriological results of combination therapy with aztreonam (AZT) and fosfomycin (FOM) in 4g patients with an acute exacerbation of chronic otitis media, chronic sinusitis or chronic tonsillitis.The clinical effectiveness was 80.4%. Of the 41 strains of bacteria isolated, disappeared, 6 decreased and 9 were unchanged after the treatmedt of AZT and FOM. No side effects were observed.