Mucosal Chronic Suppurative Otitis Media Research Articles

Does the Location of a Small Tympanic Membrane Perforation Affect the Degree of Hearing Loss in Adult Patients with Inactive Mucosal Chronic Suppurative Otitis Media?

Tympanic membrane perforation due to inactive mucosal chronic suppurative otitis media is a common problem in otolaryngology, with consequent conductive hearing loss. Still, there is controversy about the relationship between the location of the tympanic membrane perforation and the degree of hearing impairment. To assess the correlation between the location of a small tympanic membrane perforation and the degree of conductive hearing loss in adult patients with inactive mucosal chronic suppurative otitis media. A prospective cross-sectional study enrolled 74 adult patients with small tympanic membrane perforations (perforation involves less than one quadrant of the tympanic membrane) and conductive hearing loss (airbone gap ≥ 20 dB HL) due to inactive mucosal chronic suppurative otitis media for at least 3 months. The locations of the tympanic membrane perforations were classified as anterosuperior, anteroinferior, posterosuperior, and poster inferior perforations. Audiometric analysis and a CT scan of the temporal bone were done for all patients. The means of the air and bone conduction pure tone hearing threshold averages at frequencies 500, 1000, 2000, and 4000 Hz were calculated, and consequently, the air-bone gaps were calculated and presented as means. The ANOVA test was used to compare the means of the air-bone gaps, and the Scheffe test was used to determine if there were statistically significant differences regarding the degree of conductive hearing loss in relation to different locations of the tympanic membrane perforation. The ages of the patients ranged from 20 to 43 years (mean = 31.9 ± 6.5 years), of whom 43 (58%) were females and 31 (42%) were males. The means of the air-bone gaps were 32.29 ± 5.41 dB HL, 31.34 ± 4.12 dB HL, 29.87 ± 3.48 dB HL, and 29.30 ± 4.60 dB HL in the posteroinferior, posterosuperior, anteroinferior, and anterosuperior perforations, respectively. Although the air-bone gap's mean was greater in the posteroinferior perforation, statistical analysis showed that it was insignificant (P-value=0.168). In adult patients with inactive chronic suppurative otitis media, the anteroinferior quadrant is the most common location of the tympanic membrane perforation, and there was an insignificant correlation between the location of a small tympanic membrane perforation and the degree of conductive hearing loss.

Comparison of Hearing Outcomes in Patients Undergoing Type I Tympanoplasty With Temporalis Fascia Vs Tensor Fascia Lata Graft

Background: Mucosal type of chronic otitis media is a condition characterized by a central perforation of the tympanic membrane with or without ossicular chain involvement. The perforation is in the pars tensa, and is mostly sequelae to an earlier attack of acute otitis media. The tympanic membrane perforation may be caused by chronic suppurative otitis media (CSOM) or following trauma, mostly resulting in hearing loss. Aim: To compare the hearing outcome in patients undergoing type one tympanoplasty using temporalis fascia versus patients undergoing type one tympanoplasty using fascia lata graft. Method: Patients with mucosal chronic suppurative otitis media were chosen from the OPD or outpatient department of otorhinolaryngology at Dr. DY Patil Hospital; between May 2019 and April 2021. This prospective study includes 50 patients out of which 25 patients were operated for myringoplasty with temporalis fascia and other 25 patients were operated for myringoplasty with fascia lata graft. Pre-operative and post-operative hearing assessment was done by audiometry (AB gap) and improvement in PTA findings were compared. Results: There is a significant improvement in AB gap in patients undergoing type one tympanoplasty with tensor fascia lata as compared to those who underwent the same surgery but with temporalis fascia. Conclusion: As observed by our study, significant improvement in AB gap in patients undergoing type 1 tympanoplasty with tensor fascia lata as compared to those who underwent the same surgery but with temporalis fascia was present. Thus, it can be suggested to perform type one tympanoplasty with tensor fascia lata for better improvement in AB gap.

Role of Cortical Mastoidectomy in the Management of Mucosal Chronic Suppurative Otitis Media

This is a comparative study done to evaluate outcome of type 1 Tympanoplasty with and without mastoidectomy in terms of hearing improvement and graft uptake. This is a prospective study done in 100 patients at a tertiary care referral centre during November 2018 to march 2020. Patients were divided in two groups, Group A consists of 50 patients in whom type 1 Tympanoplasty was done and in Group B 50 patients were there who had undergone Type 1 Tympanoplasty with cortical mastoidectomy. Patients were evaluated postoperatively at 2nd wk, 4th wk, 2nd month and 3rd month for graft uptake, disease clearance, and hearing improvement. PTA was done at 3rd month postoperatively. In our study we observed graft uptake in 94% of patients in Group A as compared to 98% of patients in Group B and in terms of hearing improvement there is not much difference in both the groups i.e. in Group A it is 13.996 ± 4.235 while in Group B it is 14.172 ± 5.381 P value is 1 which means there is no statistically significant difference in two groups. Though better results were observed for cortical mastoidectomy with Type 1 Tympanoplasty than Type 1 Tympanoplasty alone but the difference was insignificant. Keywords: Cortical Mastoidectomy; Mucosal Chronic Suppurative Otitis Media; CSOM.

TO ASSESS THE OUTCOME OF ENDOSCOPIC INTERLAY TYMPANOPLASTY IN TERTIARY CARE CENTER

Background: Chronic otitis media is an inammatory process in middle ear cleft which is treated by a common otological procedure tympanoplasty to reconstruct the tympanic membrane and to restore sound-conducting mechanism. Rigid endoscope in transcanal interlay tympanoplasty has signicant advantage as it provides magnied, and wide angle view, with better success rate and postoperative hearing gain. The Aims and objectives were to assess the outcome of endoscopic interlay tympanoplasty, in terms of graft uptake, hearing improvement and rate of complications in cases of inactive mucosal chronic suppurative otitis media. Methods: This prospective study was conducted for 1 year at our institution in 50 patients having conductive hearing loss with dry, central perforation. All patients underwent transcanal endoscopic interlay tympanoplasty and were followed up for 3months to determine the graft uptake, hearing improvement and rate of complications. Results: Graft uptake rate in the present study was found to be 98% with residual perforation as a complication in 2% patients and no other complications were encountered. Post operatively air bone gap (ABG) after 12 weeks found to be < 20 dB ABG in 84% patients. Conclusion: Endoscopic interlay tympanoplasty is a effective method with high success rate both in terms of graft uptake as well as post operative hearing improvement and can be implemented in all cases of inactive mucosal COM.

Otoendoscopy and Audiometry Findings as Predictors of Ossicular Dysfunction in Mucosal Chronic Suppurative Otitis Media: A Cohort Study

Otoendoscopy and Audiometry Findings as Predictors of Ossicular Dysfunction in Mucosal Chronic Suppurative Otitis Media: A Cohort Study

Comparing audiological and radiological contralateral ear findings with the type of chronic suppurative otitis media (CSOM): Results from a tertiary care centre of Gwalior

The contralateral ear (CLE) is defined as the asymptomatic ear in unilateral chronic supportive otitis media (CSOM). Prevalence in India was found to be around 7.8% which is highest globally.To compare audio logical and radiological CLE findings with the mucosal and squamosal types of CSOM. Three hundred CSOM patients were studied in the Department of Otorhinolaryngology and Head and Neck Surgery from February 2017 to August 2018. All the patients were examined with otoscope. Pure tone audiometry, X-ray mastoids lateral oblique view, tympanogram and CT scan temporal bone were performed.CSOM was more prevalent among females (54%) of young age group (41.6%).In mucosal CSOM, in diseased ear maximum patients (56.85%)had hearing loss between 25-40 dB, while in squamosal CSOM, majority patients (38.4%)had 40-55 dB hearing loss. In contralateral ear of mucosal CSOM maximum patients (85%) had 15-25 dB hearing loss, while in squamosal CSOM, 71.1% had 15-25 dB hearing loss. In mucosal CSOM, majority had type Atympanogram (79.03%) in CLE whereas in squamosal CSOM, 61.53% had type A tympanogram.Incidence of abnormality in CLE was high in patients of unilateral CSOM. Both ear should be considered together as development of CSOM is a continuous process and can affect both the ears.

Role of pure tone audiometry in assessing ossicular status in patients with mucosal type of chronic otitis media

<p class="abstract"><strong>Background:</strong> Chronic suppurative otitis media (CSOM) is the disease of the middle ear cleft, which presents as hearing loss and ear discharge. This study aimed to assess the role of pure tone audiometry (PTA) in analysing the ossicular erosion in mucosal type of CSOM subjects.</p><p class="abstract"><strong>Methods:</strong> The current cross-sectional study was conducted among 60 people with mucosal CSOM. Preoperative hearing was assessed by PTA. The surgeries were done and intra operative ossicular status were recorded. IBM SPSS 20 software was used for the analysis. Student t-test was used to correlate ossicular status and PTA findings. </p><p class="abstract"><strong>Results:</strong> Among 60 subjects, 12 (20%) patients had eroded incus and 53 (88.3%) had normal stapes. The malleus was preserved in all patients. The result of our study showed that an average ABG of 58 dB at 500 Hz, 47 dB at 1 kHz, 41 dB at 2 kHz and 41 dB at 4 kHz in patients with ossicular erosion. ABG for 500 Hz and 1 kHz were statistically significant for eroded incus. ABG for 500 Hz, 1 kHz, 2 kHz and 4 kHz were all statistically significant for eroded stapes.</p><p class="abstract"><strong>Conclusions:</strong> There is a significant difference between the PTA findings at different frequencies between intact and eroded ossicular chain. Pre-operative ABG helps us to assess the status of incus and stapes.</p>

Study of outcome of tympanoplasty with and without mastoid antrum exploration in patients with mucosal CSOM

<p class="abstract"><strong>Background:</strong> Chronic suppurative otitis media (CSOM) is a major cause of acquired hearing impairment in children. Standard medical treatment of tubotympanic CSOM is aural toilet, topical antibiotics, systemic antibiotics and dry ear precautions. Surgical intervention for safe / tubotympanic CSOM is tympanoplasty. Otologists currently remain divided as to the importance of antrum exploration in the treatment of tubotympanic CSOM. The aim of the study was to evaluate the outcomes of tympanoplasties with and without antrum exploration in cases of tubotympanic CSOM in terms of graft uptake rate and hearing improvement.</p><p class="abstract"><strong>Methods:</strong> The present study included 60 patients of CSOM with central perforation who underwent surgery at JNU IMSRC from January 2016 to July 2016. Detailed history, clinical examination including tuning fork test, pure tone audiometry was done. All patients were followed up for a period of 3 months. </p><p class="abstract"><strong>Results:</strong> Out of the 60 cases of tubotympanic CSOM graft uptake was seen in 53 cases (88.33%). Graft uptake rate was 96.6% in patients who underwent tympanoplasty with antrum exploration which was significantly higher than those who underwent tympanoplasty alone (80%). Hearing improvement was seen in 93.10% of patients who underwent tympanoplasty with antrum exploration as compared to 83.33% of patients of tympanoplasty which was not statistically significant (p=0.263).</p><strong>Conclusions:</strong>Tympanoplasty with antrum exploration is recommended in all patients of CSOM as it inhances the chances of graft uptake. <p> </p>

Efficacy of Boric Acid as a Treatment of Choice for Chronic Suppurative Otitis Media and Its Ototoxicity.

Chronic suppurative otitis media (CSOM) is one of the most common chronic infectious diseases worldwide, especially affecting children. The patients or the parents of the affected children are often worried about the cost of medical visits, prescription medicines, or inconsistently effective medication. The complications of CSOM have been greatly reduced because of the development of antibiotics; however, the irrational use of antibiotics has led to the emergence of organisms resistant to the commonly used drugs. Owing to the increase in antibiotic resistance, the development of new treatments that will efficiently eradicate infectious microorganisms has become imperative. Boric acid solutions are effective in the treatment of CSOM because of their acidic effect. Various databases, such as the PubMed, The Cochrane Library, and SciELO, were searched for references related to the efficacy of boric acid in the treatment of mucosal CSOM, as well as its ototoxicity. The search revealed that boric acid is relatively effective in treating CSOM, especially at a high concentration. Boric acid in distilled water was found safe in animal studies. However, the ototoxicity of boric acid concentrations higher than 4% needs further evaluation, considering the effectivity of boric acid at high concentrations.

Assessment of short term hearing improvement in patients of cartilage interposition ossiculoplasty for lenticular process of incus necrosis in cases of chronic suppurative otitis media: mucosal disease

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Chronic suppurative otitis media is a highly prevalent disease in developing countries. Hearing loss associated with this disease is significantly more in cases associated with ossicular necrosis along with tympanic membrane perforation. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">We would like to present a study of such cases of mucosal chronic suppurative otitis media associated with lenticular process necrosis treated by cartilage interposition ossiculoplasty. The patients were followed up for a minimum period of 6 months and their pre op and post op hearing was documented and analyzed. </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">An average air bone gap of 39.07 decibels in pre op was reduced to 18.13 decibels in post-operative period and these improvements persisted over 6 months of follow-up. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">We have hereby concluded that the hearing improvement is comparable to other methods of ossiculoplasty with minimum disruption of natural hearing assembly in lenticular process of incus necrosis.</span></p><p class="abstract"> </p>

Comparative assessment of hearing in various tympanic membrane perforations in patients at Bhuj, Kutch, Gujarat, India: a cross sectional study

<p class="abstract"><strong>Background:</strong> The objective of the present study was to correlate the size and site of perforation with hearing loss in chronic suppurative otitis media (CSOM).</p><p class="abstract"><strong>Methods:</strong> The cross sectional study was conducted among a<strong> </strong>purposive sample of first 100 consecutive patients of unilateral<strong> </strong>inactive mucosal CSOM, who underwent myringoplasty at Department of otorhinolaryngology and Head and Neck Surgery Gujarat Adani Institute of Medical Science, Bhuj, Kutch, Gujarat. One hundred consecutive patients fulfilling the inclusion criteria were included in the study. In all the patients, a detailed history and a thorough ENT examination was followed by hearing assessment and measurement of the size of the perforation. </p><p class="abstract"><strong>Results:</strong> Infection was the most common etiology of tympanic membrane perforation in 92 (92%) cases and trauma in 08 (08%) with otorrhea as the most common presenting complaint. Half of the cases were in the age group of 20–30 years. Seventy-nine percentage cases had mild hearing loss whereas 19% had moderate hearing loss. Anterior quadrant perforations on an average had 31.4 dB hearing loss, whereas there was 43.9 dB average hearing loss in posterior quadrant perforations.</p><p class="abstract"><strong>Conclusions:</strong> It was observed that there is direct relationship between size and site of perforation and loss of hearing. There was less hearing loss in small sized perforations. Posterior quadrant perforations and malleolar perforations (MLs) had a greater hearing loss than anterior, multiple quadrant, or non‑MLs.</p>

Prevalence and associated risk factors of otitis media and its subtypes in South Indian population

Background: Otitis media is a common inflammatory disorder caused by the effusion of fluids or pathological changes in the tympanic membrane of middle ear that leads to hearing loss in all age groups which may be either temporary or permanent. Objective: The present study aimed to identify the risk factors responsible for the onset and progression of otitis media and its subtypes as well as its associated co-morbidities in the South Indian population. Subjects and methods: The study constituted 2602 subjects including children and adults affected with OM and the diagnosis was confirmed by ENT specialists using all the required otorhinolaryngological tests. The study was carried out by the institutional ethical clearance. The data were coded and evaluations were performed using the Statistical Package for Social Sciences, PASW STATISTICS 18.0 software (SPSS Inc., Chicago, IL, USA). Results: squamous-chronic suppurative otitis media was highly prevalent (47.3%) followed by mucosal-chronic suppurative otitis media (18.5%), acute suppurative otitis media (17.6%), and otitis media with effusion (16.6%). The multinomial logistic regression analysis showed significant association of tinnitus with squamous-chronic suppurative otitis media; bilaterality, tinnitus and vertigo with mucosal-chronic suppurative otitis media while bilaterality, adenoids, tinnitus and snoring with otitis media with effusion. Significant differences were observed in different forms of hearing loss at higher frequency within the subtypes of otitis media. Conclusions: The study has revealed that otitis media predominantly affects all age groups and has a serious health concern in cases affected with hearing loss and its associated co-morbidities.

Paediatric tympanoplasty.

Much debate exists over the management of mucosal chronic suppurative otitis media in children, with the majority of it centred around the correct timing to perform either a myringoplasty (an operative repair of the tympanic membrane) or type I tympanoplasty (reconstruction of the tympanic membrane when there is an intact and mobile ossicular chain). Further discussion will use the term tympanoplasty to mean both of the above definitions. We present the findings of a recent survey of UK ENT consultants questioning their opinions on various management aspects of mucosal CSOM in the paediatric population. We also present an extensive review of the literature to provide us with published evidence in order to analyse the results of the questionnaire.

Topical aminoglycosides in the management of active mucosal chronic suppurative otitis media.

Debate has currently re-emerged following a renewed warning issued from the Committee on the Safety of Medicines (CSM) regarding the relative risk of ototoxicity from the use of aminoglycoside-containing drops in patients with tympanic membrane perforations. We present the findings of a survey of ENT consultants, questioning their views and current practice, and we add to the debate by means of a review and discussion of the literature.