Tubotympanic Chronic Suppurative Otitis Media Research Articles

Study of Mastoid Antral Changes in Tubotympanic Chronic Supportive Otitis Media

Background: Study of mastoid antrum findings in tubotympanic chronic suppurative otitis media Objectives: To study mastoid antrum findings in tubotympanic CSOM and to determine predictors for performing antrostomy. Methodology: 71 patients with tubotympanic CSQM were selected from OPD and IPD. All patients were subjected to investigations like X—ray mastoid (Schuller’s View), pure tone audiometry and Otoendoscopy. All patients were subjected to mastoid exploration (cortical mastoidectomy or antrostomy) with tympanoplasty. Pre-Operative findings on basis of history, examination and investigations were noted along with intra-operative findings of middle ear and mastoid antrum. Findings were tabulated and statistical tests were applied to determine significant predictors. Results: Mastoid antrum was found to be diseased in 21 patients with pathological findings like mucopus, granulations etc. Recurrent URTI, mastoid pneumatization pattern, pre operative middle ear mucosal status on otoendoscopy, degree of hearing loss and ossicular status were significantly associated with diseased antrum (P-value<0.05). Conclusion: Disease can be found in mastoid antrum in tubotympanic CSOM. Mastoid exploration in form of antrostomy should be done in all cases where certain predictors are present. The predictors for performing antrostomy in tubotympanic disease are presence of recurrent URTI on history, sclerotic mastoid on x—ray mastoid (Schuller’s View), unhealthy middle ear mucosa on otoendoscopy, moderate and moderately severe hearing loss on pure tone audiometry and intra-operative ossicular necrosis and immobility.

Hearing outcomes in pediatric tympanoplasty and factors affecting surgical outcomes in the current era.

Type-1 tympanoplasty continues to be the treatment of choice for tympanic membrane perforations resulting from chronic suppurative otitis media (CSOM) in children, which is a principal cause of correctable hearing loss in the pediatric population. There is an ongoing debate about the surgical success rate, the factors affecting success as well as the best intervention time for this population group. This study assessed the outcome of Type-1 tympanoplasty in children in terms of 1) graft uptake and 2) hearing improvement as assessed by audiology. The study involved 40 patients aged 6 to ≤14 years suffering from tubotympanic chronic suppurative otitis media. The patients in the study had a central perforation of the pars tensa of the tympanic membrane. Pre-op investigations included Pure tone audiometry, Eustachian tube function test and nasopharyngeal x-ray. Type-1 tympanoplasty was performed on all patients. They were followed up at end of two months, six months, and one year postoperatively to assess surgical success and hearing outcomes. Overall graft uptake and the surgical success rate was 80%. Postoperatively air-bone gap closure up to 5dB was achieved in 62.5% of patients at the end of one year. A normal type A tympanometry curve was achieved in 75% of patients. There was a significant reduction in hearing handicap. The best results were obtained in the 9-10 years age group. Tympanoplasty has a high success rate in children. There is a significant improvement in hearing post-surgery. There is a minimal impact of traditionally believed confounding factors. Considering the positive impact of improved hearing and reduced hearing disability, the authors suggest that surgeons should take young children up for tympanoplasty.

Comparision of effectiveness of topical acetic acid instillation with topical antibiotics in madical management of tubotympanic chronic suppurative otitis media (CSOM)

Chronic Suppurative Otitis Media (CSOM) is typically a persistent disease, insidious in onset, often capable of causing irreversible sequel and severe destruction that clinically manifests with discharge and deafness. CSOM is a major health problem in developing countries causing serious local damage and life-threatening complications. In developing countries, it accounts for 60-80% of middle ear diseases. Its incidence to some extent depends on racial and socioeconomic factors. The study was carried out in ENT Department, Sir T Hospital, Bhavnagar. A total of 200 patients having complain of ear discharge were randomly distributed in two groups. In one group (group A) patients were treated with topical acetic acid ear drops and in other (group B) patients were treated with topical antibiotics ear drops. Among 200 patient’s majority of the cases were in age group of 18 to 30 yrs. Male patients are predominantly affected than other patients.The study was prospective and observational based on symptomatic relief of problems caused by the pathogens in CSOM by removing or killing the related pathogens and making the ear dry.

English

BACKGROUND Chronic suppurative otitis media (CSOM) is defined as a chronic inflammation of the middle ear and mastoid cavity. The disease usually begins in childhood. We need to study the prevalence and risk factors of chronic suppurative otitis media in a teaching hospital in Telangana. METHODS This was a cross sectional study done among patients with CSOM attending the Department of ENT for a duration of one year from January 2019 to December 2019. Detailed history, otoscopic examination and culture sensitivity tests of ear discharge were done. RESULTS The sample size was 150. The prevalence of CSOM was reported to be 7.5 %. Majority of the cases were in the 11 - 15 years age group, i.e., 56.6 %. Tubotympanic type was most commonly reported and accounted for 80 % (100 / 150) whereas atticoantral type was 20 %. Pseudomonas aeruginosa was the most commonly isolated organism from the ear discharge. Most of the CSOM cases presented with upper respiratory tract infection i.e., 20 %. CONCLUSIONS The prevalence of CSOM in our study was 7.5 % and it was more common in the younger age group. CSOM was more common in the lower socioeconomic class. Upper respiratory tract infection is a frequent mode of presentation of CSOM. KEYWORDS CSOM, Ear Discharge, Tubotympanic CSOM, Atticoantral CSOM

Staphylococcus aureus and Pseudomonas aeruginosa in Tubotympanic Chronic Suppurative Otitis Media Patients in Purwokerto, Indonesia

BACKGROUND: Chronic Suppurative Otitis Media (CSOM) causes hearing impairment and frequently occurred in low-income country where medical care and personal hygiene are poor. Staphylococcus aureus and Pseudomonas aeruginosa are the most common cause of CSOM. We investigated prevalence and antimicrobial susceptibility of S. aureus and P. aeruginosa from tubotympanic CSOM patients in tertiary hospital, Purwokerto, Indonesia in 2016-2017.METHODS: Ear swab specimens were collected from patients with tubotympanic CSOM. S. aureus and P. aeruginosa were isolated and identified by culture, matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS), and molecular tools. Antimicrobial susceptibility testing was performed using the disk diffusion method.RESULTS: Out of ear swabs from 34 patients with tubotympanic CSOM, P. aeruginosa and S. aureus were identified in 35%patients. No Methicillin-resistant S. aureus (MRSA) strain was found from the ear swabs of the patients with tubotympanic CSOM. Bacterial identification using the MALDI-TOF MS was concordantly with culture and molecular tools. All S. aureus isolates showed full susceptibility to cefoxitin and trimethoprim-sulphamethoxazole. Resistance to tetracycline was common with only 64% of S. aureus strains being susceptible. Meanwhile, all P. aeruginosa strains were susceptible to cefepime, cetazidime, meropenem, gentamicin, and tobramycin.CONCLUSION: S. aureus and P. aeruginosa are found in patients with tubotympanic CSOM and still susceptible to different antibiotic agents. MALDI-TOF MS demonstrate rapid, accurate and robust to detect S. aureus and P. aeruginosa.KEYWORDS: Staphylococcus aureus, Pseudomonas aeruginosa, chronic tubotympanic suppurative otitis media

English

English

Correlation of intraoperative and HRCT of temporal bone findings in CSOM

Introduction: The aim of the study was to assess diagnostic role of High Resolution Multi-detector Computed Tomography (HRMDCT) of temporal bone in the evaluation of Chronic Suppurative Otitis Media (CSOM) and to correlate intraoperative and HRCT findings in CSOM in selective cases. Material and Methods: 57 patients presented with CSOM in ENT department, referred to Radio diagnosis department were included in this study. The suspected patients were subjected to HRCT of Temporal bone using GE Bright speed Elite16 multi slice CT machine with 0.6mm plain axial and coronal slices with multi planar reformations. Results: The reported findings were correlated with clinical and surgical findings in subset of cases. Sensitivity, Specificity of HRMDCT with respect to clinical and surgical correlation in selective cases was evaluated. Among 30 surgical cases, most of them were atticoantral (53.4%) followed by tubotympanic CSOM (46.6%). On surgical correlation, HRCT has a high sensitivity (84.36%), specificity (80%), PPV of 90.4% and accuracy of 90% in the diagnosis of type of CSOM. A significant association with p value Conclusion: a good sensitivity, specificity of HRCT of temporal bone has a major role in the diagnosis of type of CSOM with respect to surgical correlation. HRCT of Temporal bone affords essential information regarding the disease extent, associated complications, aiding clinicians in deciding the appropriate surgical planning and management, thereby making HRMDCT an essential pre workup diagnostic tool. Keywords: Temporal bone, Cholesteatoma, HRCT, Facial canal dehiscence.

A study on endoscopic type 1 tympanoplasty in tubotympanic chronic suppurative otitis media

<p class="abstract"><strong>Background:</strong> Chronic suppurative otitis media (CSOM) attributes to 71.6% of hearing impairment in which most of them only have central perforation without any ossicular erosion or middle ear pathology. Tympanoplasty has evolved to provide and reconstruct better hearing mechanism, avoid complications as well as recurrence. Traditionally over the decades, tympanoplasty has been done using an operating microscope. Middle ear endoscopy was first introduced by Mer and colleagues in 1967, since then middle ear surgeries which were traditionally done using the microscope can be done using the endoscope also.</p><p class="abstract"><strong>Methods:</strong> This prospective study was conducted at Basaweshwar Teaching and General Hospital, Kalaburagi between March 2016 to November 2017. Endoscopic type 1 tympanoplasty was performed in all the cases using temporalis fascia.</p><p class="abstract"><strong>Results:</strong> There were 30 patients between 15-65 years with average being 29.6 years in which 17 were females and 13 were males. Pre and post-operative PTA at 1, 3 and 6 months were analyzed. The mean duration of surgery was 50.13 mins. The mean duration of hospital stay was 2.23 days. The mean duration of wound healing was 12.23 days. The average pre-operative PTA was 32.47±4.79 dBHL and postoperative PTA at 1, 3 and 6 months was18.3±3.22 dbHL, 16.5±2.2 dbHL and 16.35±2.22 dBHL. The graft uptake at end of 6 months was 100%.</p><p class="abstract"><strong>Conclusions:</strong> We here by conclude that endoscope can be a better alternative for microscope in type 1 tympanoplasty as it provides a wide panoramic view, less operating time and hospital stay with minimal visible scar post operatively.</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>

Correlation Between Role of Preoperative Computerized Tomography and Intraoperative Findings in Revision Myringoplasty

Background: The goals of tympanic membrane repair in tubotympanic chronic suppurative otitis media are to close the perforation, remove the disease, and improve hearing of the patient. Myringoplasty is an operation used to repair a perforation of the tympanic membrane and this improves the patient hearing and decreases susceptibility of infection. Objective: To correlate the radiological findings of preoperative CT with intra-operative findings in revision myringoplasty. Patients and Methods: This study included 30 patients suffering from safe type of chronic suppurative otitis media with central tympanic membrane perforations. 23 patients were subjected to underlay revision myringoplasty and 7 patients were subjected to cortical mastoidectomy based on the preoperative CT findings. Diagnosis of the disease was established by clinical, otoscopic, microscopic and endoscopic examination. All patients were studied prospectively. Preoperative history taking, ENT examination, general examination, and assessment of hearing were performed for all cases. All patients complained of history of ear discharge and deterioration of hearing. Surgery was done; operative details were recorded and postoperative follow up was done. Results: This study showed that CT scan temporal bone is 100% accurate in assessment of ossicular chain, aditus ad antrum patency and mastoid pneumatization. While, CT accuracy in assessment of middle ear spaces, middle ear mucosa and fibrous adhesions is 76.7%. Conclusion: Comparing these results with those of other researches using similar techniques, revealed that they are almost similar regarding the accuracy of CT scanning and success rate.

Effect of adding platelet-rich plasma to fat grafts in myringoplasty

BackgroundPlatelet-rich plasma (PRP) is an autologous product derived from whole blood through the process of gradient density centrifugation. Autologous PRP, with growth factors up to 8 times that of normal serum, has been shown to be safe and effective in promoting natural processes of wound healing. Our study aims to examine the effect of combining the fat graft with PRP in myringoplasty procedures indicated for TMP secondary to chronic suppurative otitis media (CSOM) and whether it can significantly promotes Tympanic membrane (TM) healing.MethodsThis prospective study included forty patients, presenting with dry tympanic membrane secondary to tubo-tympanic CSOM. Half the patients underwent fat graft Myringoplasty with PRP application (group A), while others served as control and received the fat graft only, without PRP (group B).ResultsIn group A, eighteen cases (90%) significantly showed an intact tympanic membrane, while Eleven cases (55%) were successful in group B. P=0.044.ConclusionTopical autologous PRP application during fat plug Myringoplasty is highly successful with no reported postoperative infections and minimal morbidity.

Correlation between degree of hearing loss and intraoperative findings in tubotympanic type of chronic suppurative otitis media

<p class="abstract"><strong>Background:</strong> The aim of tympanoplasty done for tubotympanic type of chronic suppurative otitis media (CSOM) should not only be to achieve a dry ear, but also to give hearing improvement to the patient. Aim of this study was to determine the correlation between size and site of tympanic membrane perforation with degree of hearing loss and correlation between ossicular chain status and degree of hearing loss on pure tone audiometry.</p><p class="abstract"><strong>Methods:</strong> Patients with tubotympanic CSOM with hearing loss upto 60 dBHL undergoing tympanoplasty were examined to know the site and size of tympanic membrane(TM) perforation. Intraoperative findings pertaining to middle ear and ossicles were noted. </p><p class="abstract"><strong>Results:</strong> Out of 52 patients of tubotympanic type of CSOM, hearing loss was least (31.18±7.46 dBHL) in small perforations of the TM and highest in subtotal perforations (48.74±7.83 dBHL) which was statistically significant. Hearing loss was significantly more in posterior perforation (46.61±7.02 dBHL) than in anterior perforation of TM (32.65±8.77 dBHL).<strong> </strong>There was a statistically significant difference in pure tone average hearing loss between intact ossicle group (32.87±9.77 dBHL)<strong> </strong>and eroded ossicle group (43.39±9.60dBHL). Difference in air bone gap was also significant between intact ossicle group (24.09±9.56 dB) and eroded ossicle group (31.02±9.83 dB). Multiple ossicles were eroded in nineteen patients with incus being the most commonly eroded ossicle.</p><p><strong>Conclusions:</strong> In this study, hearing loss increased with increased size of TM perforation and also with posterior perforation. Incus was found to be the most commonly eroded ossicle. Multiple ossicles were seen eroded most commonly when hearing loss was moderate. The surgeon will be better equipped to do ossiculoplasty in view of these preoperative findings and also to counsel the patient better about their expectation of hearing improvement following surgery. </p>

The Role of Mannose-Binding Lectin Serum Level in Tubotympanic Chronic Suppurative Otitis Media.

Background Chronic suppurative otitis media (CSOM) is a common public health problem worldwide and a major cause of hearing impairment especially in developing countries. The role of Mannose-Binding Lectin (MBL), a component of innate immunity, in CSOM has not been studied. The aim of the study was to examine whether MBL deficiency was more frequently present in cases group of tubotympanic CSOM patients rather than healthy subjects. Material and Methods This was an analytic observational study. Subjects were enrolled in the Otorhinolaryngology Clinic at Margono Soekarjo Hospital, Purwokerto, Indonesia. An independent t-test was used to compare the mean of MBL serum concentration between tubotympanic CSOM subjects and control. Results From 36 tubotympanic CSOM patients, there were 8 (22.22%) patients with MBL deficiency (MBL level < 100 ng/ml), while no deficiency was found in the control group. The mean of MBL level in cases group was 354.88 ng/ml, with the lowest level being 0.001 ng/ml and the highest level 690.24 ng/ml, while in the control group MBL level mean was 376.27 with the lowest level being 188.71 and the highest level 794.54 ng/ml. Conclusion There was no significant difference of MBL serum level between tubotympanic CSOM and control group. However, the presence of subjects with MBL deficiency in the tubotympanic CSOM group might be considered as playing a role in the tubotympanic CSOM.

Expression of tumor necrosis factor - α (TNF-α) and interleukin 1-β (IL1-β) in chronic tubotympanic suppurative otitis media

Chronic Suppurative Otitis Media (CSOM) is a common public health problem worldwide and a major cause of hearing impairment. It is also one of the neglected disease especially in developing countries. Cytokines are a group of glycoproteins that play a role in strengthening the immune and inflammatory reactions in various diseases, including inflammation of the middle ear. Some of the important inflammatory mediators found in middle ear fluids are Tumor Necrosis Factor-α (TNF-α) and Interleukin-1β (IL-1β). Cytokines are thought to play a role in the ongoing inflammatory regulation. The aim of this study was to compare the expression of TNF-α and IL-1β in tubotympanic CSOM and in healthy control group. The mean of TNF-α serum level in tubotympanic CSOM was 0,553±1,59 pg/ ml, and 0,587±2,13 pg/ ml in control group. There was no statistically different of TNF-α between two groups (P > 0,05). Mean of IL-1β serum level in the tubotympanic CSOM and control group were 0,633±0,92 and 0,302±0,48, respectively. Although IL-1β levels were higher in the patient group, the difference was not statistically significant (P > 0,05).

Efficacy of Empirical Therapy With Combined Ciprofloxacin Versus Topical Drops Alone in Patients With Tubotympanic Chronic Suppurative Otitis Media: A Randomized Double-Blind Controlled Trial.

Background:One of the prevailing otologic infections in our country is chronic suppurative otitis media, especially the tubotympanic type for which various treatment protocols are followed. Usually, oral and topical antibiotics (mainly quinolones) are given alone or in combination. There is a lack of consensus as to whether topical drops alone are effective or a combined oral and systemic therapy should be prescribed. In our study, we have attempted to observe the efficacy of empirical therapy with combined ciprofloxacin versus topical drops only in patients with tubotympanic chronic suppurative otitis media for control of infection.Methodology:A total of 100 patients visiting the outpatient ENT department at our tertiary care hospital with clinically diagnosed chronic suppurative otitis media (tubotympanic type) were enrolled in our study. The study was reviewed and accepted by the ethical review committee. A detailed proforma was filled for all patients. All patients after aural toilet were subjected randomly to one of the 2 treatment methods, ie, topical ciprofloxacin ear drops plus an oral placebo or combined oral and topical ciprofloxacin. These patients were reviewed after 1 week of treatment.Results:It was observed that 48 of 50 (96%) patients responded to treatment in the group receiving topical ciprofloxacin, whereas 49 of 50 (98%) patients responded in the group receiving combined therapy. This difference was not significant. Moreover, age, sex, and duration of discharge did not have any effect on treatment. There were minimal side effects in both groups, which were also not significant and disappeared after discontinuation of treatment.Conclusions:The results of this study show that topical ciprofloxacin drops were as effective as combined oral and topical ciprofloxacin and that the addition of oral drug did not have any beneficial effect and added only to the cost of treatment.

Present scenario of microbiological pattern in chronic suppurative otitis media and its management guidelines

AIMS: Chronic suppurative otitis media (CSOM) is a common infectious chronic ear disease in India resulting in serious complications, especially hearing impairment. Irrational use of antibiotics for its management has led to the emergence of multidrug-resistant bacterial strains. Considering this, this study was conducted to know the pattern of causative organisms associated with CSOM and their antimicrobial sensitivity. Materials and Methods: Ear discharge from 200 clinically diagnosed cases of CSOM was collected by suction using sterile techniques in a sterilised test tube on wash bottle principle consisting of a glass tube made air tight with the help of a cork with an inlet and outlet facility. All samples were processed in the department of microbiology for the identification of bacterial and fungal isolates and their antimicrobial sensitivity testing. Results: Among the 200 samples of ear discharge, 127 were from ear having tubotympanic (mucosal or safe) type of CSOM while 73 were from ear with attico-antral (squamosal or unsafe) CSOM. Among aerobic isolates, Pseudomonas aeruginosa (35%) was most common followed by Staphylococcus aureus. Other aerobes isolated were Klebsiella spp., coagulase-negative Staphylococcus, Proteus spp. and Escherichia coli. Fungus was isolated in tubotympanic (9.45%) CSOM only. Among anaerobic isolates, Peptostreptococcus (1%) was most common. Conclusion: Monomicrobial isolates, especially P. aeruginosa and Staphylococcus species, were found to be most common in our study. Therefore, evaluation of microbiological pattern and their antibiotic sensitivity pattern in local area becomes helpful in prescribing empirical antibiotics for successful treatment of CSOM.

Comparison of myringostapediopexy and malleostapediopexy tympanoplasty with sculptured incus in case of hearing reconstruction in tubotympanic chronic otitis media: A case series

Introduction: Chronic suppurative otitis media (CSOM) is a burden on Indian population due to hearing loss due to deformation of the ossicular chain which needs reconstruction (ossiculoplasty). This study is an attempt to analyze the use of autogenous incus in ossiculoplasty for the same. Aim: The aim of this study is comparison of malleostapediopexy and myringostapediopexy in seventy cases of tubotympanic CSOM. Materials and Methods: Seventy patients with CSOM were operated and tympanoplasty was done. Ossiculoplasty was done using incus interposition as malleostapediopexy and myringostapediopexy and results analyzed. Results: In the present study, the pre- and post-operative air-bone gap values for myringostapediopexy cases were 38.00 ± 6.84 and 27.28 ± 5.12, respectively, and for type malleostapediopexy were 37.95 ± 7.51 and 18.08 ± 4.34, respectively. Statistical Test Used: Unpaired t-test. Conclusion: A better outcome was seen in malleostapediopexy than myringostapediopexy.

Sensorineural hearing loss following tympanoplasty surgery: a prospective cohort study

Abstract Sensorineural hearing loss (SNHL) subsequent to middle-ear surgery is an important yet under-reported complication. Our aim is to assess the prevalence of this complication and to identify the risk factors for SNHL after type 1 tympanoplasties. In this prospective cohort study, a total of 312 patients with tubotympanic chronic suppurative otitis media and pure conductive hearing loss were included. The patients were evaluated using case histories, clinical examinations, preoperative and postoperative (3, 6, and 12 months) audiograms, and laboratory investigations. All patients underwent type 1 tympanoplasties, the surgical details were noted, and the prevalence of SNHL as a consequence of the surgical procedure was recorded. Sixteen patients (5.1%) developed SNHL. Fifteen operations were performed by residents, and one was performed by a consultant. We concluded that the most important factor in the development of SNHL after a type 1 tympanoplasty is the surgeon’s experience.

Endoscopic evaluation of the patency of the aditus in tubotympanic type of chronic suppurative otitis media

Abstract Endoscopic evaluation of the aditus in tubo-tympanic chronic suppurative otitis media (CSOM). Prospective escriptive study. This study carried out on 50 patients presenting with inactive tubo-tympanic CSOM with only mild or moderate conductive hearing loss, attending the Alexandria university hospital (tertiary referral center). Tympanoplasty was done for all patients. The patency and dimensions of the aditus were assessed by performing antral window through which 30Ί endoscope was introduced. Biopsy was taken from unhealthy mucosa to detect the presence of hidden cholesteatoma or granulation tissue. Ten out of 50 (20%) patients had blocked aditus. The dimensions of the aditus were measured. Biopsy taken from these cases revealed a granulation tissue in all cases. No hidden cholesteatoma was detected. In inactive tubo-tympanic CSOM with mild or moderate conductive hearing, the aditus was not always patent. It was obstructed in 20% of our study.

Observations on the current bacteriological profile of chronic suppurative otitis media in South eastern Nigeria.

Background:Chronic suppurative otitis media (CSOM) is a disease well-known for its recurrence and persistence despite treatment. The situation is compounded by the increasing resistance to antimicrobial agents by bacteria these days.Aim:This study was carried out to examine the current local bacteriological profile of CSOM and to compare the profile of either ear in bilaterally discharging ears.Materials and Methods:We carried out a retrospective analysis of ear swab cultures from 133 unilateral and 73 bilateral consecutive tubotympanic CSOM cases seen at the Ear-Nose-Throat clinics of a referral health institution during a 4 year period ending 2013. Sensitivities to eight locally available antibiotics were analyzed. Aerobic bacterial isolates were analyzed separately for the unilateral and bilateral cases. Comparison was made between the ears in the bilateral cases.Results:We analyzed 279 ear swab culture results from 206 patients with age ranging from 5 months to 86 years and a mean of 21.3 (19.5) years. Pseudomonas aeruginosa was the most common isolated bacteria (44% [109/250]) followed by Staphylococcus aureus (17% [42/250]), and Proteus Mirabilis (15% [38/250]). The most and least sensitive bacteria were Klebsiella Spp and Escherichia Coli, respectively. The most effective antibiotics were gentamicin and ciprofloxacin. The two ears differ significantly in the rates of isolation of S. aureus and E. coli (P = 0.01 and P = 0.04, respectively).Conclusion:Pseudomonas is the most common bacteria involved in CSOM in this part of the country. Ciprofloxacin as ear drops is recommended as first-line drug in the management of active CSOM as it is cheap, less ototoxic, and locally available. Separate ear swab culture should be obtained in bilateral CSOM.