Treatment Of Chronic Ear Disease Research Articles

Surgical treatment of chronic ear disease in remote or resource-constrained environments.

Surgery for chronic suppurative otitis media performed in low- and middle-income countries creates specific challenges. This paper describes the equipment and a variety of techniques that we find best suited to these conditions. These have been used over many years in remote areas of Nepal. Extensive chronic suppurative otitis media is frequently encountered, with limited pre-operative investigation or treatment possible. Techniques learnt in better-resourced settings with good follow up need to be modified. The paper describes surgical methods suitable for resource-poor conditions, with rationales. These include methods of tympanoplasty for subtotal wet perforations, hearing reconstruction in wet ears and open cavities, large aural polyps, and canal wall down mastoidectomy with cavity obliteration. Various types of autologous ossiculoplasty are described in detail for use in the absence of prostheses. The following topics are discussed: decision-making for surgery on wet or best hearing ears, children, bilateral surgery, working with local anaesthesia, and obtaining adequate consent in this environment.

Time trend analysis of mastoidectomy procedures performed in Ontario, 1987–2007

Conclusions: There has been a reduction in the number of modified radical mastoidectomy and revision mastoidectomy surgeries per head of population in Ontario between 1987 and 2007, we believe that this represents a true reduction in prevalence of cholesteatoma. The increase of cases performed at the University Hospital Network, Toronto (UHN) may represent a shift to subspecialization in the treatment of chronic ear disease. Objective: To analyze the trends in mastoid operations for chronic middle ear disease in the Canadian province of Ontario between 1987 and 2007 and to determine whether an increasing proportion of these procedures are being performed in tertiary referral centres. Methods: The year on year population and number of mastoid procedures performed per year in Ontario and at the UHN between 1987 and 2007 were obtained from Statistics Canada and the Ministry of Health and Long-Term Care, Ontario, respectively. Population-adjusted rates of mastoid surgery for Ontario and the UHN. These data were collated and graphically represented for trend analysis. Results: The population-adjusted number of mastoid procedures for Ontario declined from 7.1 cases per 100 000 in 1986 to 4.1 cases per 100 000 in 2006. During this time the number of both modified radical mastoidectomies and revision mastoid surgeries at UHN increased.

Cochlear implantation following treatment for medulloblastoma

Medulloblastoma is the most common pediatric malignant tumor of the central nervous system in children. Treatment includes surgical excision, external beam radiation, and multiagent chemotherapy. Otologic sequelae are common and may result from radiation and/or chemotherapy. Profound sensorineural hearing loss (SNHL) is a known complication of neuro-oncologic treatment and may render these patients eligible for cochlear implantation (CI). Issues of CI in this population, including diagnosis, treatment of preoperative middle ear disease, operative and postoperative course, performance data, and long-term tumor surveillance are highlighted and reviewed. Retrospective chart review. Three patients treated for pediatric medulloblastoma with surgical resection, postoperative hyperfractioned craniospinal radiotherapy, and multiagent adjuvant chemotherapy who underwent cochlear implantation were identified. Details of neuro-oncologic treatment and associated otologic complications are presented and analyzed. Primary outcome assessment includes treatment of middle ear pathology, perioperative cochlear implant course, and postimplantation performance data. Each patient required surgical treatment of chronic ear disease 4 to 16 years after chemoradiation. All progressed to profound SNHL and were implanted 8 to 17 years post-neuro-oncologic treatment. There were no intraoperative complications, and full insertion of the cochlear implant electrode array was achieved in each patient. One patient developed postoperative wound dehiscence requiring operative closure. Postimplantation performance data support significant benefit in all patients. Patients treated for pediatric medulloblastoma develop otologic sequelae, including profound SNHL, and may require cochlear implantation. Successful management of middle ear and mastoid pathology involves consideration of potential future cochlear implantation. Postoperative performance data supports cochlear implantation in this population.

Humanitarian otologic missions: Long-term surgical results

The purpose of this study was to determine the efficacy of treating chronic ear disease by performing a single surgical intervention in the austere environment of a developing nation. Data were collected from retrospective chart reviews on 121 patients who underwent surgical treatment of chronic ear disease during humanitarian surgical missions in South and Central America. Surgical outcomes and clinical course were assessed at 10 to 12 months after the initial surgery. A total of 117 patients were included in the study. Follow-up records were available for 75 patients (64%). A total of 20 surgeries were performed for dry perforations (group 1), 30 for chronically draining ears (group 2), and 25 for cholesteatomas (group 3). Surgical success was determined as 60 percent, 74 percent, and 92 percent for groups 1, 2, and 3, respectively. Surgical results during international otologic outreach missions to developing nations fall within the results expected in developed nations.

Hearing loss in children with Down syndrome

Objective: Previous studies report a 38–78% incidence of hearing loss in children with Down syndrome (DS). The purpose of this study was to establish more up to date information about hearing loss in children with DS. Methods: A 5-year longitudinal study following the otolaryngologic problems seen in children with DS was initiated in February, 1999 at the Children's Hospital Medical Center in Cincinnati, OH. Aggressive, ‘state of the art’ treatment, both medical and surgical, was provided to a group of children, ( n=48), all of whom were entered into the study at an age under 2 years. Specific interventions and treatments were reviewed in regards to following and treating the children's chronic ear disease. Hearing level results at the end of the first year of the study were evaluated in this publication. This includes both pre-treatment and post-treatment audiologic results. Results: After treatment of easily reversible hearing loss from chronic otitis media, either with medical or surgical treatment with PET's, 98% of the children had normal hearing levels. Only two children had residual mild hearing losses after treatment interventions. Conclusion: Aggressive, meticulous and compulsive diagnosis and treatment of chronic ear disease in children with DS, started soon after birth, provides significantly improved hearing levels than reported previously.

CLOSED TYMPANOMASTOIDECTOMY

The role of closed tympanomastoidectomy in the treatment of chronic ear disease continues to be a subject of debate. This article reviews the position of closed tympanomastoidectomy in the armamentarium of the otolaryngologist. In this article the technique is described and indications are reviewed. A brief history of closed tympanomastoidectomy and the issue of outcome from surgery are also addressed.

Thermal imaging of the temporal bone in CO2 laser surgery: an experimental model.

The unique properties of lasers create an enormous potential for specific treatment of chronic ear disease. Despite the widespread acceptance and use of the laser, however, a complete understanding of the time- and space-dependent temperature distribution in otic capsule bone immediately after pulsed laser exposure has not been elucidated. Using a liquid nitrogen-cooled mercury-cadmium telluride infrared detector, the temperature distribution in human cadaveric otic capsule bone was determined immediately after pulsed (100 msec) carbon dioxide laser exposure (0.3 to 4.0 W; 200 microm spot diameter). The time- and space-dependent temperature increases and thermal diffusion were determined as a function of the laser power density and were found to vary linearly.

Thermal imaging of the temporal bone in CO 2 laser surgery: An experimental model

The unique properties of lasers create an enormous potential for specific treatment of chronic ear disease. Despite the widespread acceptance and use of the laser, however, a complete understanding of the time- and space-dependent temperature distribution in otic capsule bone immediately after pulsed laser exposure has not been elucidated. Using a liquid nitrogen-cooled mercury-cadmium telluride infrared detector, the temperature distribution in human cadaveric otic capsule bone was determined immediately after pulsed (100 msec) carbon dioxide laser exposure (0.3 to 4.0 W; 200 μm spot diameter). The time- and space-dependent temperature increases and thermal diffusion were determined as a function of the laser power density and were found to vary linearly. (Otolaryngol Head Neck Surg 1997;117:610-5.)

Ciprofloxacin for the treatment of chronic ear disease

The treatment of chronic ear disease is often difficult and frustrating. Patients typically present with a history of chronic, persistent otorrhea that has failed to respond to multiple topical and oral antibiotics. Organisms that are resistant to multiple antibiotics are common. Ciprofloxacin has been shown to be effective against a wide range of gram-negative and gram-positive organisms. To evaluate the role of ciprofloxacin in the treatment of chronic ear disease, 21 patients who failed routine therapy for chronic ear disease were prospectively treated with oral ciprofloxacin. Prior to therapy, all ear cultures grew Pseudomonas aeruginosa, Staphylococcus aureus or other gram-negative organisms. Ninety-five percent of patients completing therapy showed either improvement or cure. Only one patient failed to improve. Ciprofloxacin has been shown to be effective in the management of chronic ear disease.

Infective Ear Disease in Factory Employees

A serious cause of wastage of man-power in the late war was due to disease of the ear. Thus during February and March, 1943, at four large military hospitals in the United Kingdom 11,956 out-patients were seen, of whom no fewer than 1,517 (12.7%) were suffering from diseases of the ear, nose, or throat. Of these 1,517 cases approximately one-half (6%) were due to all forms of disease of the ear and one-quarter (3%) to chronic suppurative otitis media. Thus it was shown that chronic ear disease caused a serious loss of fighting man-power in time of emergency. There was good reason for believing that this serious state of affairs had its basis in the high rate of ear disease preva lent in the civilian population, and this was strikingly confirmed by the results of a study of the records of the Ministry of Labour and National Service Boards, which revealed that just over 2% of the recruits examined were rejected on account of chronic ear disease, while diseases' of the ear were responsible for 10% of the total number rejected from all causes.J Now chronic ear diseases, in particular C.S.O.M., are well known as potent causes of inefficiency, invalidism, or early death. Occupational groups such as food manufac turers, shops, the General Post Office, and life assurance companies recognize their importance and may penalize the sufferer by refusing him employment or insurance as the case may be. The high incidence of the disease, empha sized by wartime experience, therefore demanded considera tion in the planning of the health services of the country, and the present study of the incidence, prevention, and treatment of chronic ear disease in a sample of the civilian population owes its inception and design to the committee of the Medical Research Council appointed to advise upon the medical and surgical treatment of deafness. Much information about ear disease in children had already been obtained from the school medical services. The methods and results of treatment of the disease in hospital practice were well known among otologists, but little knowledge of the incidence in the adult population was available, and there was general dissatisfaction about the results of treatment. The work carried out during the war by otologists in the armed Forces and the civilian emergency medical service demonstrated on a large scale the validity of previous observations. These showed that good results were obtainable with conservative treatment. Thus by regular daily treatment Banham was able to