Squamosal Chronic Otitis Media Research Articles

Study of ossicular chain status in chronic otitis media patients at a tertiary care hospital in southern Bihar

Background: The objective is to assess the ossicular status and statistically evaluate the extent of ossicular destruction intraoperatively in chronic otitis media (COM) patients. Knowledge of pattern of involvement of ossicular chain in COM cases may help us to determine the type of reconstruction needed during surgery. The findings of this study could be exploited to predict preoperatively the probability of having ossicular chain destruction in COM ears and thus patients could therefore be properly consented about these potential issues before surgery. Methods: Prospective observational study conducted over 2 years in diagnosed patients posted for surgical management and fulfilling the inclusion criteria. Intraoperative status of ossicles was noted for various types of COM and outcome was evaluated. Results: Out of 92 patients, 59 (64.1%) had mucosal and 33 (35.9%) had squamosal disease. Ossicular chain was eroded in 41 cases (44.6%). 9 out of 59 (15.3%) mucosal cases and 32 out of 33 squamosal cases (97%) reported ossicular erosion. Most frequently involved was long process of incus (44.6%) >stapes (9.8%) >malleus (8.7%). Order of involvement (Austin-Kartush classification) was found as: type A (26.1%)>B (9.8%)>C (8.7%). 67.4% belonged in the group 15-30 years. Male: female ratio=1:1.5. Conclusions: Degree of ossicular destruction is much greater in squamosal COM, owing to overproduction of cytokines and inflammatory mediators and due to presence of cholesteatoma and/or granulations. The long process of incus was found to be most vulnerable. Malleus was found to be the most resilient among all ossicles.

Sensorineural Hearing Loss in Unilateral Mucosal Type of Chronic Otitis Media.

Sensorineural hearing loss is relatively well established in the squamosal chronic otitis media. However, its association with mucosal COM is still debated. The present study aimed at evaluating the prevalence of sensorineural hearing loss in unilateral mucosal COM. The study was conducted at a tertiary care hospital in New Delhi, and 60 patients with unilateral mucosal chronic otitis media were recruited. Pure tone thresholds were ascertained for air and bone conduction in an acoustically treated room and matched against certain patient and disease characteristics. In this study, the combined prevalence of SNHL/Mixed Hearing loss in mucosal COM was found to be 8.3%. A statistically significant association between SNHL/Mixed HL was seen in the 40-50-year age group (p-0.004). Prevalence with a disease duration of more than 10years was 33% (p-0.019). All the patients who presented with SNHL/Mixed HL had an actively discharging ear. 80% of the patients who presented with SNHL/Mixed HL had large perforations. SNHL/Mixed HL prevalence of 28.6% was found in smokers, compared to 5.7% in non-smokers (p-0.039). The risk of developing SNHL/Mixed HL increased with increasing patients' age, disease duration, and size of the perforation and smokers.

Clinical Profile of Squamosal Chronic Otitis Media among Paediatric and Adult Patients in Rural Population of Central India: A Cross-sectional Study

Introduction: Chronic Otitis Media (COM) is one of the major preventable causes of hearing impairment, especially in children. Hearing loss in children affects speech, language, communication, auditory processing, psychosocial and cognitive development, and academic progress. Since studies addressing and comparing COM in the paediatric and adult population are few and far between, present study attempted to fill this research hiatus. Aim: To analyse and compare the clinical profile of squamosal COM in paediatric and adult populations. Materials and Methods: The present cross-sectional study was carried out in the Department of Otorhinolaryngology, Acharya Vinod Bhave Hospital, Sawangi, Wardha, Maharashtra, India, from December 2020 to December 2022. All the selected patients with squamosal COM (active or inactive) in the paediatric age group (0-15 years) and adult age group (16-60 years) was considered in this study. The study included 26 patients and was evaluated based on intraoperative and radiological findings such as grades of retraction pocket, extent of ossicular erosion, extent, and spread of granulation and cholesteatoma, and pneumatisation pattern among both age groups were carefully analysed. Chi-square test (χ2 ) of independence was used to compare data between the two groups. A p-value ≤0.05 was considered statistically significant. Results: Erosion of scutum was predominantly noted in 6 (42.9%) paediatric patients. In both age groups, attic perforation were more common than marginal perforation, which was found to be statistically significant (p-value=0.045). Grade-2 Posterosuperior Retraction Pocket (PSRP) in paediatric (2, 14.2%) and Grade-4 PSRP in adults (4, 33.3%) were commonest whereas none of the paediatric patients showed Grade-4 PSRP. This difference in PSRP grade in both age groups was found statistically significant (p-value=0.038). Short process of incus was more frequently involved in 3 (25.0%) paediatric and long process of incus in 6 (60%) adult (p-value=0.040). There was frequent involvement of protympanum in 7 (50%) paediatric patients (p-value=0.035). Diploic pattern of pneumatisation was least common in both age groups. Conclusion: Greater grades of PSRP were found among adult patients. This might be contributed to the longer duration of exposure to disease pathogenesis in adults. One of the vital features in the ossicular involvement is the total absence of incus and malleus more frequently in paediatric patients indicating its extensiveness

English

An 18 years old female patient came to emergency medicine department on 3rd July 2020 in the evening hours with massive swelling extending in front, above and behind left ear. Associated with severe, throbbing, intermittent headache since past 4 days patient also had high grade fever. Patient also had a history of left ear foul smelling discharge, scanty in amount, non-blood tinged, not aggravated or relieved with upper respiratory tract infection (URTI), not relieved with medications and not associated with giddiness. Clinical examination revealed a swelling in left preauricular region extending to temporoparietal region displacing left pinna downwards and outwards. Bilateral periorbital swelling was present (Figure 2, 3). Mastoid tenderness was conspicuous. Whitish foul smelling, non-blood-tinged discharge was present in left external auditory meatus. Further ear examination was not possible due to oedema, swelling and thick discharge in external auditory canal (EAC). In view of extensive swelling with its epicenter in mastoid region, left unsafe chronic otitis media (COM) with complication was suspected and was admitted to ENT ward. General investigations were normal except leucocytosis. While patient was put on antibiotics, neurosurgical opinion was sought and magnetic resonance imaging (MRI) brain with contrast was planned to map the abscess. MRI (Figure 1) which was suggestive of left squamosal COM and mastoiditis with intracranial extradural abscess in left temporoparietal region. MRI also uncovered large subgaleal abscess in the left temporo-occipito-parietal region along the sternocleidomastoid (SCM) muscle with thrombosis of left transverse and sigmoid sinus. Neurosurgeons found no need for intervention from their side.

Descriptive study of various bacterial flora in chronic otitis media

<p class="abstract"><strong>Background:</strong> Chronic otitis media (COM) is the inflammation of the middle ear, which is characterised by ear discharge due to tympanic membrane perforation, at least for over a month. The inflammation is due to the underlying infection, due to which the middle ear mucosa gets inflamed, leading to discharge and eventual perforation of the tympanic membrane. The aim of the study was to study the microbial flora and its culture and sensitivity from ear discharge in chronic otitis media.</p><p class="abstract"><strong>Methods:</strong> Total of 100 ears with either mucosal COM or squamosal COM were included in this study. Patients coming to the outpatient department (OPD) with discharging ear were subjected to aural suctioning/cleaning with the use of bulls eye lamp. After cleaning the external auditory canal, sterile aural speculum were introduced into the EAC, creating a sterile conduit. Following this, middle ear discharge or the discharge around the tympanic membrane was collected using sterile cotton swabs and sent for laboratory within half an hour for mycological and bacteriological study.</p><p class="abstract"><strong>Results: </strong>Majority of patients were in an age group of 10-20 years, followed by age group of 21-30 years. The male to female ratio was 4.7:5.3. Out of the 100 swabs sent for culture and sensitivity, 6 swabs had no growth whereas <em>Pseudomonas aeroginosa </em>was the highest isolated organism (36 swabs), followed by <em>Proteus mirabilis </em>(23 swabs). Aerobic infection was the commonest, isolated in 47.9% of culture positive swabs. Polymyxin B was the most sensitive antibiotic, whereas cefotaxime was the most resistant antibiotic.</p><p class="abstract"><strong>Conclusions:</strong> <em>Pseudomonas aeruginosa </em>and <em>Proteus mirabilis </em>are the main bacteria isolated in mucosal COM. There is development of drug resistance in the majority of bacteria in chronic otitis media, due to excessive usage of antibiotics, making the treatment much difficult.</p>

Comparative evaluation of mastoid pneumatization pattern using X-ray mastoid and high-resolution computed tomography temporal bone in unilateral squamosal chronic otitis media

<p class="abstract"><strong>Background:</strong> Chronic otitis media (COM) affects 0.5-30% of individuals in any community and over 20 million people are estimated to suffer from this condition worldwide. COM often evolves in a continuum. Squamosal disease is more commonly found in poorly pneumatized bones, but whether the sclerosis is relevant to the etiology of the disease or is caused by it, has not been fully resolved. Our study aimed at comparing the mastoid pneumatization patterns obtained using X-ray mastoid and high-resolution computed tomography (HRCT) temporal bone. It was an interventional study.</p><p class="abstract"><strong>Methods:</strong> Sixty patients of unilateral squamosal COM, aged more than 8 years, underwent X-ray mastoid Schuller’s view and HRCT temporal bone, using Philips extended brilliance 48 slice CT. </p><p class="abstract"><strong>Results:</strong> Upon analysis, in diseased and healthy ears, the coincidence of X-ray and HRCT findings was 63.33% and 80% respectively.</p><p class="abstract"><strong>Conclusions:</strong> HRCT temporal bone should be done in all cases of squamosal COM to know the extent of the disease, pneumatization patterns and the presence of anatomical variations. </p>

Goldenhar Syndrome Presenting As Squamosal Chronic Otitis Media

AbstractGoldenhar syndrome is a rare congenital anomaly involving the eye, ear, vertebra, and the mandible. This anomaly presenting primarily to the ENT outpatient clinic with ear discharge and cholesteatoma is still rarer. Here we describe one such rare case that was a challenge to diagnose as well as manage. We also discuss the various problems in the management and highlight the need for a multispecialty approach to tackling the various pathologies in such a case.

To Evaluate the Correlation between Preoperative Otoscopic Features, Pure Tone Audiometric Findings and Intraoperative Ossicular Chain Status in Patients with Chronic Otitis Media

Aim: Chronic otitis media (COM) is chronic muco purulent discharge through a perforated tympanic membrane. Theossicular chain damage is found in both mucosal and squamosal types of COM. We aim to evaluate relationship between preoperative otologic features, pure tone audiometric findings and intraoperative ossicular chain status in patients with chronic otitis media. Material and Methods: 100 patients of either sex aged between 12 to 60 years operated for active or inactive, squamosal or mucosal chronic otitis media attending Ram Lal Eye and ENT Hospital, Government Medical College Amritsar were taken. The preoperative ossicular chain status based on set parameters was compared with the intraoperative ossicular chain status. Results: The ossicular chain integrity is more commonly compromised in squamosal COM and the most common ossicle eroded is Incus. Pure tone audiogram has got a very important role in determining the ossicular chain integrity preoperatively and must be done in all cases with accuracy. Conclusion: It is concluded that on the basis of otoscopic examination and pure tone audiometry values, we can accurately classify the COM as mucosal or squamosal type and get an idea of the ossicular chain integrity preoperatively hence planning the extent of surgery.

Evaluating Success of Surgery in Mucosal and Squamosal Chronic Otitis Media: A Retrospective Study

This study attempted to document success of surgery postoperatively, be it type I tympanoplasty or type III tympanoplasty with or without modified radical mastoidectomy.
 Materials and Methods
 This retrospective study involved 90 patients of Chronic Otitis Media who underwent surgery in the Department of Otorhinolaryngology in a tertiary care centre in the state of Uttar Pradesh. 
 Results 
 At 3 week postoperatively, 83 patients (92.22%) had successful uptake of graft. Overall successful graft uptake was reduced to 87.78% (79 patients) after 3 months. Postoperatively, after 3 months, 90% of the patients (n=81) reported improvement in hearing. Preoperatively, 89.71 % patients of mucosal disease and 63.64% of squamosal disease had 21-40 dB hearing loss. Postoperatively, 88.24% patients with mucosal disease and 63.64% of squamosal disease had no conductive hearing loss. There was statistically significant gain in air conduction postoperatively. Average improvement in AB gap was also notably significant postoperatively in both subgroups.
 Conclusion
 Both type I and type III tympanoplasty give excellent response in term of graft uptake and postoperative hearing.
 Abbreviations: COM-Chronic Otitis Media, AC-Air Conduction, AB-Air Bone, TP-Tympanoplasty, MRM-Modified Radical Mastoidectomy

A comparison of autograft incus and titanium prostheses in primary ossiculoplasty in modified radical mastoidectomy

Background: Numerous graft materials are available for ossicular reconstruction yet, no single option is considered ideal. This study aims to analyze and compare the outcome of primary ossiculoplasty in terms of hearing gain using autograft incus and titanium (Ti) prostheses in patients with active squamosal chronic otitis media (COM) undergoing modified radical mastoidectomy (MRM). Study Design: Randomized study. Materials and Methods: Sixty patients with active squamosal COM with ossicular chain erosion undergoing MRM were divided into two equal groups. First group underwent ossiculoplasty with autograft incus and the second group received Ti prostheses. Follow-up was done over a period of 6 months and hearing thresholds were evaluated postoperatively at 3rd and 6th month at the four frequency average of 0.5/1/2/4 KHz. Results: There was no significant difference in air conduction (AC) gain when the inter-group comparison is made (P > 0.05 at 3rd and 6th month), however, intra-group AC gain was significant in both groups, at the end of the 3rd month and 6th month (P < 0.05). Conclusion: Autograft incus and Ti prostheses both give a comparable hearing gain in ossicular reconstruction. Ti prostheses are a good alternative in longstanding cases of active squamous COM without any available ossicular autograft for hearing reconstruction.

Correlation of high-resolution computed tomography temporal bone findings with intra-operative findings in patients with cholesteatoma

Aim: To evaluate the role of high-resolution computed tomography (HRCT) temporal bone in patients with active squamosal chronic otitis media (COM). Materials and Methods: Totally, 47 patients with active squamosal COM underwent preoperative HRCT temporal bone followed by surgery. Their intra-operative findings were considered as the gold standard and were compared and correlated with the radiological findings, to calculate the sensitivity, specificity, positive and negative predictive value of HRCT temporal bone. Results: According to the present study, HRCT was highly sensitive for detecting mastoid pneumatization, soft tissue extension, ossicular erosion, tegmen and sigmoid sinus erosion, and less sensitive for fallopian canal erosion and lateral sinus fistula. It was specific for all these parameters. Conclusion: The present study concludes that HRCT can be recommended not only in cases suspected with potential complications but also in all cases of COM to know the extent of disease, varied pneumatization, and the presence of anatomical variations, which should alert the clinician and guide in surgical approach and treatment plan.