Suppurative Otitis Media Research Articles

Efficacy of combination of acetic acid and ciprofloxacin eardrops versus only ciprofloxacin eardrops in achieving dry ears in chronic suppurative otitis media

BackgroundAs per WHO, the chronic inflammatory condition involving the middle ear and mastoid cavity, resulting in recurrent ear discharge, otherwise known as otorrhoea, through perforation of the eardrum or tympanic membrane, is known as chronic suppurative otitis media (CSOM). Recurrent middle ear infections are known to produce a myriad of intracranial and extracranial complications. CSOM is considered a biofilm disease, wherein biofilms are found to be the most prevalent microbial form, playing a crucial role in the chronicity of the infections and observed resistance to antibiotics. Thus disruption of the biofilm layer is necessary for the management of CSOM. This can be achieved by aural toileting and topical 2% acetic ear drops.AimTo study the efficacy of the combination of acetic acid and ciprofloxacin eardrops versus only ciprofloxacin ear drops in achieving dry ears in chronic suppurative otitis media.Materials and methodsSixty-three patients diagnosed with CSOM (mucosal type) were randomly divided into two groups: Group A — who received both 2% acetic acid and ciprofloxacin ear drops and Group B — who received only Ciprofloxacin ear drops; thrice daily. Additionally, both groups received systemic oral antibiotic being tab. ciprofloxacin 500 mg twice daily for 14 days. Weekly follow-up was done for 2 weeks and compared on the basis of otological symptom score.ResultsBoth combination of acetic acid with ciprofloxacin and only ciprofloxacin ear drops significantly reduced the amount of ear discharge (P < 0.001) by the second visit, but the reduction in the amount of otorrhoea in Group A was found to be more significant than in Group B (P = 0.014). Also, the former was significantly more effective in achieving and maintaining dry ears by the third visit (P < 0.001).ConclusionCombination of acetic acid and ciprofloxacin ear drops was found to be more effective than only ciprofloxacin ear drops in achieving and maintaining dry ears while treating CSOM.

Factors Leading to Conductive Hearing Loss among Children Living in Delhi Slum Areas

Background: Middle-ear diseases in children pose a significant burden to the healthcare system. Recurrent upper respiratory tract infections, cold, and cough often initiate middle ear disease. It results in mild to moderate hearing impairment that can be detrimental to the child's linguistic development. It can further lead to behavioural and cognitive problems. The study was designed to establish a relationship between common middle pathologies like CSOM and OME with hearing loss in children.&#x0D; Objective: To determine the prevalence of middle ear pathology and its association with hearing loss in slum children of Delhi.&#x0D; Methods: A study was conducted with 269 children aged five to ten years. The children were screened by otoscopic examination, followed by Tympanometry and then by Pure Tone Audiometry.&#x0D; Results: The prevalence of middle ear problems was 24.2%, out of which the prevalence of Chronic Suppurative Otitis Media (CSOM) was 10.8%, Otitis media with effusion (OME) was 12.3% and Acute Otitis Media (AOM) was 1.1%. A significant correlation (p&lt; 0.005) was found between hearing loss and middle ear pathology like CSOM and OME. Out of the 65 children with ear pathology, hearing loss was detected in 55 children, out of which 29 children with CSOM, moderated conductive hearing loss was detected in 28 children and out of 33 OME children, mild to moderate conductive hearing loss was detected in 26 children.&#x0D; Conclusion: The article highlights the high prevalence of middle ear pathology in underprivileged children. The study also concludes the high probability of conductive hearing loss in these children. It is recommended that there is more need for awareness for early detection and treatment of middle ear infection to avoid any language and behavioural problems in the future. Also, the disparity between children living in urban and rural areas needs to be bridged.

Demographical Variations of Sensory Neural Hearing Loss (SNHL) in Chronic Suppurative Otitis Media (CSOM) patients at JPMC Karachi

Objectives: CSOM is significantly associated with SNHL but with mixed demographical associations being reported in literature.To determine the demographical variations (age and gender) of SNHL among CSOM patients Study design and setting: Cross-sectional observational study at Jinnah Postgraduate Medical Center, Karachi, Pakistan. Methodology: Using non-probability convenient sampling, diagnosed CSOM patients within six months between 10-50 years and of either gender were included while patients with history of SNHL previously of using ototoxic drugs, ear trauma or refusing to consent were excluded. SPSS v23.0 was used for analysis of data and chi-square was applied keeping p-value &lt;0.05 as statistically significant. Results: From total 200 patients,60 (30%) patients were between 10-18 years, 120 (60%) between 19-35 years and 35-50 years were 20 (10%) patients. 145 (72.5%) were females while 55 (27.5%) males. SNHL was observed in 36 (18%) of patients. Between 10-18 years age group, 10 (16.7%) patients were reported with SNHL, between 19-35 years age group 22 (18.3%) while between 35-50 years, 4 (20%) of patients were found to have SNHL with an insignificant p-value of 0.934. 28 (19.3%) males were reported to have SNHL while 8 (14.5%) females were observed to have SNHL with CSOM. An insignificant p-value of p-0.434 was reported between the genders. Conclusion: According to the results of this study, SNHL was insignificantly associated with CSOM according to demographics (age and gender). Further studies are required to validate the findings of this study. Keywords: Chronic Suppurative Otitis Media, Sensori Neural Hearing Loss, Otitis Media

Successful Myringoplasty - Do The Site &amp; Size Of TM Perforation Matter?

Objective: To determine the success rate of myringoplasty based on the site and size of tympanic membrane perforation. Study Design: Cross sectional, Descriptive Study Settings: ENT Department Fauji Foundation Hospital, Rawalpindi Study Duration: 30 July 2019 to 29 December 2021. Material and Methods: After approval of Hospital Ethical Committee, a sample size of 100 patients was calculated by using WHO sample size calculator. Patients were selected through Non probability convenient sampling. Informed consent was obtained from all the patients. All the patients were operated upon through post auricular approach using underlay technique and temporalis fascia was used as a graft in all the cases. Success of myringoplasty was assessed one month after surgery. Myringoplasty was considered successful upon complete closure of the defect as assessed under surgical microscope. Data analysis was done for frequencies and percentages using SPSS version 24. Results: There were 52% males and 48% females. Mean age of patients was 35.5 years and they ranged between 17 to 48 years. Overall myringoplasty was successful in 71% patients. Regarding the size of perforation, it was successful in 100% pinhead size perforations, in 86.7% small sized, 89.5% medium sized, 42% large and 6.7% subtotal sized perforations. Regarding site of the perforations, myringoplasty was successful in 96% anterior, 100% posterior, 40% inferior, 40% middle and 8% subtotal/ large perforations. Conclusion: Myringoplasty is an effective surgery for sealing Tympanic Membrane perforations resulting in better quality of life. Success rate of myringoplasty has a definite association with size and site of perforation. The smaller the perforation, the higher would be the success rate. Similarly, anterior and posterior perforations heal better as compared to inferior and mid position perforations. Key words: Myringoplasty, Size and site of Tympanic membrane perforation, Tympanic membrane, Chronic Suppurative Otitis Media.

Otogenic Sinus Thrombosis and Hemophilia: A Clinical Case

Background. Patients with hemophilia are protected from thrombosis by a deficiency of one of coagulation factors, therefore thrombotic complications are rare in them. Currently, few descriptions of spontaneous venous thrombosis in adult hemophiliacs can be found in the literature. Even fewer data of thromboembolic complications are reported in pediatric practice. At present, no clear recommendations are given for the management of thrombotic complications in children with hemophilia, which requires further study of this issue to develop prevention and treatment regimens, including otogenic sinus thrombosis in this category of patients.Case description. A 7-year-old boy was transferred from the Somatic Hospital to the Intensive Care Unit of Regional Clinical Hospital No. 2 in Tyumen (Russia) with an Otorhinolaryngology Unit. He was diagnosed with non-perforative form of acute right-sided suppurative otitis media, acute right-sided mastoiditis, thrombosis of the right sigmoid sinus. The anamnesis shows that the child is diagnosed with hemophilia A, of moderate severity (factor VIII level — 5%), for which he has been receiving factor VIII replacement therapy for the last year. Upon admission, a general blood test revealed no abnormalities, with a slight increase in acute-phase parameters: C-reactive protein, fibrinogen, signs of hypocoagulation. Due to negative dynamics, the child underwent anthromastoidotomy against the background of intensive replacement therapy. Surgery revealed the presence of granulation tissue with hemorrhagic thrombi in the antrum and aditus. In the postoperative period, replacement therapy was accompanied with antibacterial and anticoagulant therapy.Conclusion. The management of patients with otogenic sinus thrombosis against the background of hereditary factor VIII deficiency is a difficult task. On the one hand, it requires surgical intervention and anticoagulant therapy in order to prevent further thrombosis, on the other hand — intensive replacement therapy in order to reduce the risks of hemorrhagic complications. The described case demonstrates the need for an interdisciplinary approach to the diagnosis and treatment of a patient with otogenic thrombosis of lateral sinus against the background of hemophilia A. The approach is to minimize the risks of intraoperative complications and insure a favorable outcome.

A Comparative Study to Determine Hearing Outcome in Type 1 Tympanoplasty With and Without Canaloplasty in Tubotympanic Type of Chronic Suppurative Otitis Media.

Chronic suppurative Otitis Media is a common ear infection in India. Canaloplasty done with tympanoplasty helps to remove bony overhangs and provide complete visibility of fibrous annulus of tympanic membrane. 1. To determine the hearing outcome in chronic otitis media (mucosal type) patients undergoing type 1 tympanoplasty with canaloplasty. 2. To determine the hearing outcome in chronic otitis media (mucosal type) patients undergoing type 1 tympanoplasty without canaloplasty. 3. To compare the hearing outcome in the above mentioned 2 groups of patients. 56 patients of 15-60 years of age with mucosal type of Chronic otitis media, with central dry perforation and intact ossicles were included in our study. They were divided into group 1 (type 1 tympanoplasty + canaloplasty) and group 2 (type 1 tympanoplasty without canaloplasty), on alternate basis. AC, BC, Air bone gap avg was assessed via pure tone audiometry at 4 frequencies preoperatively and postoperatively at 3rd and 6th month, % closure of ABG average was calculated. Type 1 tympanoplasty along with canaloplasty has better hearing improvement in pure tone audiometry compared to type 1 tympanoplasty alone, as % closure of ABG at postoperative 3rd and 6th month holds significant. The canaloplasty provides better surgical exposure via removing bony overhangs, aids in excellent functional outcome in the form of % closure of ABG. Hence canaloplasty is added as an adjunct to routinely performed aural surgeries to enhance hearing outcome.

Prevalance of unsafe ear in patients presenting with chronic ear discharge

Objective: The purpose of this study was to determine the frequency of atticoantral/unsafe chronic suppurative otitis media in patients with chronic ear discharge. Materials and Methods: This Cross-sectional study was conducted in the department of ENT and Head and Neck Surgery, Hayatabad Medical Complex and Department of ENT, Naseerullah Khan Babar memorial Hospital, Peshawar from August 2018 to February 2019. In this study 199 patients were enrolled with consecutive sampling. Detailed demographic data like history and physical examination were taken from patients. All patients were subjected to detailed otoscopic examination and pure tone audiometery by a consultant. A detailed performa was designed in which all information of the patients like name, age, gender, duration of symptoms and CSOM were recorded by SPSS analysis. Results: With a standard deviation of ± 10.334, the average age of participants in this study was 29 years. There were more males than women among the patients present, with 60% of them being men. Twelve percent of patients with chronic discharge developed CSOM, compared to 90% of those who didn't have the condition at all. Conclusion: Our study shows that individuals who come with persistent ear drainage frequently have hazardous ears.

Diffusely erythematous and hemorrhagic gingiva

A 60-year-old woman was referred for evaluation of diffusely hemorrhagic and erythematous lesions of the maxillary and mandibular attached gingiva. The patient had no known allergies, was not a tobacco user, and denied alcohol use. Her medical history was significant for suppurative otitis media, obstructive sleep apnea, hypertension, coronary artery disease, and recurrent pulmonary emboli. Her daily medications included apixaban. Her family history was significant for a first-degree relative (mother) with polycythemia vera. Dr. Keteyian is a resident, Department of Oral and Maxillofacial Surgery, Geisinger Health System, Danville, PA. Dr. Shem is a resident, Division of Oral and Maxillofacial Pathology, Columbia University Irving Medical Center, New York, NY. Dr. Shupak is an assistant professor, Department of Oral Medicine and Maxillofacial Surgery, Geisinger Commonwealth School of Medicine, Geisinger Health System, Danville, PA. Dr. Peters was an assistant professor of dental medicine, Division of Oral and Maxillofacial Pathology, Columbia University Irving Medical Center, New York, NY, when the work described in this article was conducted. He now is an associate professor, Department of Oral and Maxillofacial Pathology, Geisinger Commonwealth School of Medicine, Geisinger Health System, Danville, PA.

Pertinence of Streptococcus anginosus group in intracerebral abscesses in the era of extended antibiotic resistance

Aims• To study the incidence of Streptococcus anginosus group (SAG) in pyogenic or community acquired intra cerebral abscess.• To understand the risk factors for the same.• To analyze the specific radiological features and clinical outcome after surgery and antibiotic therapy. MethodsThis is a retrospective observational study of case series over a period of one year. Patients diagnosed with intracerebral abscess were included in the study. Pus collected from were received in the laboratory and processed according to the standard protocols. Data regarding the clinical findings and demographics were collected from medical records. FindingsA total of 202 samples were studied. 103 were found to be pyogenic. SAG were isolated from 21 samples (20.38%) and all the isolates were sensitive to Penicillin. Age of the patients ranged from 18months to 68years. Male preponderance was noted with male to female ratio of 4:1. Otogenic infections were the most common predisposing factors and focus of infection could not be ascertained in 5 patients. All patients were treated with surgical intervention and antibiotics (Vancomycin, Amikacin and Metronidazole) for 6 weeks and recovery was remarkable. One patient succumbed to the illness. ConclusionSAG can be an aggressive pathogen with propensity for abscess formation. Chronic Suppurative Otitis Media (CSOM) is still a major cause of intracerebral abscess in developing country like India which is a benign and curable disease and should not be neglected. Injudicious use of antibiotics and negligence regarding the dose and duration of therapy from both patients and health care providers is the major cause for common infections to become more difficult to treat and succumbing to complications.

Evaluation of the Current Bacterial Pathogens and Antibiogram of Chronic Suppurative Otitis Media in Adults

Evaluation of the Current Bacterial Pathogens and Antibiogram of Chronic Suppurative Otitis Media in Adults

Research progress on biofilm microecology in chronic suppurative otitis media

慢性化脓性中耳炎（chronic suppurative otitis media，CSOM）的治疗中，尽管可以根据药敏实验结果选择敏感性抗菌药物，但往往并不一定能取得良好疗效。目前普遍认为是因为细菌在此过程中产生了生物膜，生物膜微生态的相互作用使细菌的毒力、抗性和耐药性增强，从而造成抗菌药物疗效不佳，使得中耳炎慢性化、反复化以及迁延不愈。本文分析了铜绿假单胞菌（Pseudomonas aeruginosa，PA）和金黄色葡萄球菌（Staphylococcus aureus，SA）这2种CSOM中的常见细菌，在细菌与环境之间、细菌与细菌之间以及细菌与宿主之间的相互作用及研究进展，有助于阐明CSOM发病机制及研发相关抗菌策略。.

Assessment of Vitamin D Levels in Children With Chronic Suppurative Otitis Media

Assessment of Vitamin D Levels in Children With Chronic Suppurative Otitis Media

INCREASING SOCIETY AWARENESS REGARDING EARLY DETECTION OF HEARING DISTURBANCE IN TUBAN REGENCY, EAST JAVA

Hearing loss can interfere with communication, affecting social, school, and work environments. Hearing loss can be prevented by early detection and management of hearing loss. Tuban is one of the districts in East Java; the case data was obtained on the ear as a hearing organ, namely otitis externa (25.56%). acute otitis media (22.46%), cerumen obturation (16.15%), chronic suppurative otitis media (7.56%), and sensorineural deafness (5.72%). The early detection and management skills of hearing loss are mandatory for doctors working in primary health care, so a series of activities are needed to improve this knowledge and skills. Activities outside the network include lecture methods, question-and-answer discussions and training. The activity was attended by 52 participants with details of 48 doctors and four health workers. Most recent education is S1 or equivalent (96.1 most occupations are general practitioners (92.30%), and most workplace public health centers (69.23%). The pre-test score was 47, and the post-test value was 57.

Characteristics of Poly ENT HN Patients at Umbu Rara Meha Hospital and Physical Examination Features Obtained in Cases of Chronic Suppurative Otitis Media (CSOM) Benign Type and Malignant Type

Introduction: Chronic suppurative otitis media (CSOM) is a chronic infection of the middle ear which has been in the process for more than 2 months, which is characterized by a perforation of the tympanic membrane and continuous or intermittent discharge from the ear canal. In developing countries like Indonesia, the incidence of CSOM is quite high. Objective: to find out the characteristics of patient visits to the ENT polyclinic at Umbu Rara Meha Hospital and to find differences in the results of physical examinations for the Benign/ Benign type CSOM and the Danger/Malignant type of CSOM. Method: The type of research used is observational analytics with a cross sectional design. Results and Discussion: based on the characteristics of patients visiting the ENT HN polyclinic, it was found that the dominant patients visiting the ENT HN polyclinic were male patients 50.7%, the age group 21-30 years 23% and ages 0-10 years 18.4%, most residents in cities who visiting Kambajawa 16.2%, high school education level 34.6%, Christianity 62.5%, using BPJS payments 51.5% and coming from the Sumba tribe 54.4%. The top 3 diseases in the ENT HN field are obturan cerumen 18.36%, rhinosinusitis 13.97% and cases of CSOM 12.2%. Conclusion: CSOM is included in the top three lists of the ten most common diseases at Umbu Rara Meha Hospital, determining the type of CSOM including the Benign or benign type or the malignant or malignant type will determine the appropriate therapeutic action and the prognosis of the patient's disease.

A PROSPECTIVE OBSERVATIONAL COMPARATIVE STUDY FOR POST OPERATIVE RESULTS IN ENDOSCOPIC TYMPANOPLASTY V/S MICROSCOPIC TYMPANOPLASTY

Objective: Chronic suppurative otitis media is a widespread disease in developing countries. Hence treating CSOM with surgical treatment by tympanoplasty is the commonest procedure in ENT practice. In this study we aim to study the advantages and disadvantages of microscopic and endoscopic tympanoplasty. This study also aims to compare the merits and demerits of microscopic and endoscopic tympanoplasty. A Prospective Subjects And Methods: observational study for endoscopic tympanoplasty and microscopic tympanoplasty was conducted on 102 patients of age 20-60 years attending OPD and admissions under the Department of otorhinolaryngology and M.Y.H Hospital, Indore. Subjects with dry central perforation due to CSOM were selected for microscopic tympanoplasty. Similar subjects were selected for Endoscopic tympanoplasty except those with tortuous anatomy of external ear canal. Patients with unsafe CSOM, SNHL, and active infection were excluded. In our study majority (44%) of patients Results: belonged to age group of 25-35 years. Most of the patients were having medium central perforation ( MCP) (32%) followed by subtotal perforation (22.5%). Small central perforation (SCO) 19%, Large central perforation (LCP) 18%, Total perforation 10% respectively. According to quadrant involving perforation which is mainly AIQ, followed by Anterior superior quadrant ( ASQ), Posterior inferior quadrant (PIQ) and posterior superior quadrant (PSQ). Mean operative time for Endoscopic tympanoplasty procedure was 56+/-15 mins with SD of 12.05 and for microscopic tympanoplasty procedure was 117.8+/- 20 mins with SD of 7.17 having a p value (0.0003) which was found to be significant. Conclusion: In our study, we have concluded that endoscopic tympanoplasty scores over microscopic tympanoplasty. Endoscopic tympanoplasty has helped patients achieve faster recovery, a shorter hospital stay, and a lower financial burden, which was especially helpful for developing countries like ours. Unlike the microscope, the endoscope is easily transportable and hence is ideal for use in remote places to conduct ear surgery camps.

On the issue of preoperative preparation of patients with chronic suppurative otitis media

Introduction. In the otosurgeon practice, there are often cases of exacerbation of chronic suppurative otitis media (CSOM) refractory to conservative therapy. The direct irritant effect of gastric contents due to the gastroesophageal reflux disease (GERD) often leads to alteration of the middle ear mucosa and persistence of the inflammation process.Aim. To substantiate the significance of GERD therapy in the treatment of CSOM exacerbation refractory to the standard conservative therapy protocols.Materials and methods. The study group included 42 patients aged 19 to 67 years (mean age 47.6 years), 13 men and 29 women, who received treatment and daily observations of the attending otorhinolaryngologist. Of these, 31 patients were users of oral nicotine products (chewing gum, smoking, tobacco heating systems). The conservative treatment of CSOM was carried out in accordance with the medical care standards and clinical guidelines as in force on the time of the treatment process. The conservative treatment of GERD was carried out in accordance with the clinical guidelines approved by the Russian Gastroenterological Association.Results and discussion. 25 patients were diagnosed with isolated incompetence of the gastric cardia, 13 — with incompetence of the gastric cardia accompanied by reflux esophagitis, 4 — with hiatal hernia. The efficacy of anti-reflux therapy for chronic otitis media exacerbation was assessed on Day 10 after start of the therapy. Due to the gastroenterological therapy, the “dry” ear status could be achieved in 34 patients, which made it possible to offer them reconstructive intervention in the future. 5 patients achieved the CSOM remission by the end of the first month of anti-reflux therapy. 3 patients failed to achieve the state of CSOM remissionConclusions. The high efficacy of anti-reflux therapy for the management of CHSO exacerbation refractory to the standard conservative therapy regimens at the level of 81% allows us to recommend further research to prove the causal relationship between GERD and ineffectiveness of treatment of ear pathology.

Structure-constrained deep feature fusion for chronic otitis media and cholesteatoma identification.

Chronic suppurative otitis media (CSOM) and middle ear cholesteatoma (MEC) were two most common chronic middle ear disease(MED) clinically. Accurate differential diagnosis between these two diseases is of high clinical importance given the difference in etiologies, lesion manifestations and treatments. The high-resolution computed tomography (CT) scanning of the temporal bone presents a better view of auditory structures, which is currently regarded as the first-line diagnostic imaging modality in the case of MED. In this paper, we first used a region-of-interest (ROI) network to find the area of the middle ear in the entire temporal bone CT image and segment it to a size of 100*100 pixels. Then, we used a structure-constrained deep feature fusion algorithm to convert different characteristic features of the middle ear in three groups as suppurative otitis media (CSOM), middle ear cholesteatoma (MEC) and normal patches. To fuse structure information, we introduced a graph isomorphism network that implements a feature vector from neighbourhoods and the coordinate distance between vertices. Finally, we construct a classifier named the "otitis media, cholesteatoma and normal identification classifier" (OMCNIC). The experimental results achieved by the graph isomorphism network revealed a 96.36% accuracy in all CSOM and MEC classifications. The experimental results indicate that our structure-constrained deep feature fusion algorithm can quickly and effectively classify CSOM and MEC. It will help otologist in the selection of the most appropriate treatment, and the complications can also be reduced.

Analysis of hearing outcome following canal wall up and canal wall down mastoidectomy in squamosal type of chronic suppurative otitis media: A comparative study

Background: Chronic suppurative otitis media (CSOM) is a major health issue in developing countries causing persistent problem and may lead to life-threatening complications. This major health issue and its complications can be best avoided by early and effective treatment. Aims and Objectives: The aim is to compare the outcome in terms of hearing improvement following canal wall up and canal wall down mastoid surgery. Materials and Methods: This prospective study was conducted in Otorhinolaryngology Department of a Burdwan Medical College and Hospital, Burdwan, a tertiary care hospital in Burdwan from April 2019 to August 2020 and 50 clinically diagnosed cases of COM (Squamous type) were included in this study after through history taking and meticulous clinical examination. Patients were divided in two Groups (Group-A and Group-B) with 25 patients in each group randomly and Group-A patients undergone canal wall up mastoidectomy and Group-B patients undergone canal wall down mastoidectomy (CWDM). Now, before performing surgery, a pre-operative pure tone audiometry was performed for each of the patients and a follow-up pure tone audiometry was done again, 2-month post-operative period. These results were compared to assess the degree of hearing improvement in the two different operative procedures, namely, canal wall up and CWDM. Results: In Group-A, the mean hearing gain (mean±SD) of patients was 12.5700±0.9856. In Group-B, the mean hearing gain (mean±SD) of patients was 8.4200±5.0051. Difference of mean hearing gain with both groups was statistically significant (P=0.0002). Chi-square value: 0.1678; P=0.9195. Conclusion: Hearing gain was more with canal wall up compared to CWDM in CSOM which was statistically significant.

Evaluation of Microbial Agents in Patients with Chronic Suppurative Otitis Media

Evaluation of Microbial Agents in Patients with Chronic Suppurative Otitis Media

A study of outcome of ossiculoplasty using autologous cartilage, refashioned incus, and polytetrafluoroethylene (Teflon) prosthesis in patients of chronic suppurative otitis media

AimTo find out the mean air conduction thresholds (ACT) and air–bone gap (ABG) closure across the treatment groups at the end of 3 and 6 months of follow-up.Material and methodsSixty patients diagnosed with COM with conductive hearing loss were included in the study. Air conduction threshold (ACT) and air–bone gap were calculated and recorded pre-operatively. Surgery was done with clearance of disease followed by reconstruction of hearing in single-stage operation using autologous conchal cartilage, refashioned incus, and polytetrafluoroethylene (Teflon) prosthesis (PORP, TORP) depending upon the intraoperative findings during surgery. Patients were followed for up to 6 months for assessing the hearing outcome in terms of the mean air conduction threshold and mean air–bone gap closure for each group separately.ResultsThe outcome of each ossiculoplasty material was calculated in terms of mean air conduction threshold and mean AB gap closure. Preoperative and postoperative air conduction threshold (ACT) at 3 months and 6 months follow-up of each group was as follows: for the autologous conchal cartilage group, 41.3 (± SD 6.69), 29.2 (± SD 5.39), and 21 (± SD 4.66); for autologous refashioned incus group, 40.4 (± SD 5.43), 28.4 (± SD 6.73), and 20.8 (± SD 4.33); for the Teflon PORP group, 42.9 (± SD 5.68), 31.4 (± SD 6.86), and 34.9 (± SD 6.37); and for the Teflon TORP group, 43.1 (± SD 5.40), 32.5 (± SD 5.91), and 36.2 (± SD 5.31). The mean air–bone gap preoperatively and postoperatively at 3 months and 6 months respectively were as follows: for autologous conchal cartilage, 40.6 (± SD 4.57), 23.7 (± SD 4.48), and 20 (± SD 5.28); for autologous refashioned incus, 39.3(± SD 4.92), 21.9 (± SD 5.61), and 19.4 (± SD 5.82); for Teflon PORP 43.0 (± SD 4.48), 32.8 (± SD 4.84), and 36.3 (± SD 5.56); and for Teflon TORP, 44.5 (± SD 5.56), 33.2 (± SD 5.53), and 35.2 (± SD 5.10).ConclusionThe hearing outcome of ossiculoplasty varies with the type of ossiculoplasty material used. Most favorable results were obtained with refashioned autologous incus followed by autologous conchal cartilage. Teflon prosthesis has a significant improvement in hearing outcomes although the results are less favorable.