Recurrent Serous Otitis Media Research Articles

Early extrusion and infection of ventilation tubes of otitis media with effusion; alpha-mannosidosis: A report of two siblings

Abstract Alpha-mannosidosis is an autosomal recessive lysosomal storage disease caused by deficiency of the enzyme acid-mannosidase. We present a case of two children with alpha-mannosidosis and bilateral recurrent serous otitis media. Six years of female and four-year-old male siblings referred to our department of otolaryngology clinic with fluid in the middle ear. Both of them had large head with prominent forehead, flat and wide nasal bridge, mental retardation, widely spaced teeth. Based on the otolaryngological examination and tests the pre-diagnosis of alpha-mannosidosis was suspected. Measuring acid alpha-mannosidase activity in leukocytes made for diagnosis. If the patient have early extrusion and infection of ventilation tubes of otitis media with effusion and other syndromally findings, one should take into account alpha-mannosidosis.

Otolicuorrea espontánea en el adulto. Presentación de dos casos y revisión de la literatura

Spontaneous cerebrospinal fluid otorrhea is a relatively rare entity and can be easily missed in adults. Every adult older than 50 years with a negative history of otologic disease who has recurrent serous otitis media should be evaluated for this pathology. Meningitis is the most serious complication, so there is no doubt that the condition needs immediate attention and correction. We present two patients who were diagnosed with spontaneous CSF otorrhea and make a review of what is reported about this topic. Surgical repair is mandatory to seal these nontraumatic CSF leaks. There are two main surgical approaches, the middle fossa craniotomy and the transmastoid approach. A multilayered closure technique in which autologous and artificial materials are combined is considered to result in the highest rate of success.

Clinical Analysis of Cholesterol Granuloma in the Middle Ear

Background and Objectives The Cholesterol granuloma is often observed in middle ear surgeries. In the clinic, it can be found in a normal ear, but also as a recurrent serous otitis media in non-responding medical therapy. The purpose of this study is to analyze the clinical characteristics of cholesterol granuloma with or without cholesteatoma. Subjects and Method We performed a retrospective study of 40 patients who underwent tympanomastoidectomy between January, 2000 and January, 2009 for cholesterol granuloma. We divided patients into a non-cholesteatoma group and a cholesteatoma group and observed the following clinical manifestations: initial symptom findings, ear drum findings, preoperative audiogram, postoperative audiogram, operative technique and operative findings. Results Cholesterol granuloma was found in 10.2% of 393 cases (40 cases) who underwent chronic otitis media surgery. Of these, 5.3% (21 cases) was diagnosed with non-cholesteatoma group and 4.8% (19 cases) was diagnosed in the cholesteatoma group. Chief complaints were the difficulty of hearing in the non-cholesteatoma group and otorrhea in the cholesteatoma group. Ear drums were nearly retracted and perforated in both groups, although the cholesteatoma group had more damaged ear drum. Distinctive features of hearing were the conductive type with a moderate degree and ossicular destruction showed missing or eroded incus. Major sites of cholesterol granuloma were antrum, air cells and epitympanum. Conclusion Although ear drum was relatively preserved in the non-cholesteatoma group of cholesterol granuloma, the hearing level and the degree of ossicular destruction were not so much different between the two groups. Therefore, a complete removal of cholesterol granuloma and ossiculoplasty should be considered for better hearing restoration.

Candida and stapedial otosclerosis: histopathological findings.

The stapes of 6 patients with stapedial otosclerosis was found to contain fungus hyphae (Candida) in the sectioned specimens. The footplate of all cases and the head of the stapes in 2 of the cases revealed single or multiple erosion cavities containing numerous thin branching PAS-positive fungus hyphae with swollen terminal endings and scanty blastospores. Osteoclasts were not observed; occasional osteoblasts, blue mantles and otosclerotic foci were seen. Four patients had been treated for several years with antibiotics and corticosteroids for recurrent serous otitis media and 1 patient had had frequent catheterization of the eustachian tube. It may be suggested that the Candida infection was a secondary event induced by a general and/or local immunodepressed condition.

Comprehensive treatment of children with recurrent serous otitis media.

Myringotomy and tube procedures provide effective relief in the majority of cases of serous otitis media, but at least 14% of children are estimated to have recurrence. These children may be at risk for language delays that have been suspected of causing later language problems. After three months' duration of serous otitis, a language evaluation should be given the infant or child. Any language delay should be promptly treated with a home language stimulation program and, in more extreme cases, there should be a consideration of hearing aid use.

Unresponsive unilateral serous otitis: harbinger of malignancy?

In adults with persistent (three to five weeks' duration) or recurrent serous otitis media, the possibility of an underlying malignancy in the nasopharynx should be considered. Alertness to this and other clues, such as atypical facial pain, will result in appropriate investigation and earlier diagnosis and treatment.