Type Of Suppurative Otitis Media Research Articles

Eustachian tube mucociuary transport in chronic suppurative otitis media

Eustachian tube dysfunction is one of the well-known factors leading to development of chronic suppurative otitis media. Tube mucociliary transport is important for elimination of the inflammation products from the middle ear enabling recovery of the affected mucosa of the middle ear, local circulation and restoration of normal air pressure in the middle ear. The study was aimed at determining: 1. whether perforation site on the tympanic membrane influences tube mucociliary transport time in individuals with traumatic rupture of the eardrum; 2. possible time difference of tube mucociliary transport between group of patients with chronic suppurative otitis media and group of patients with traumatic rupture of the tympanic membrane; 3. possible time difference of tube mucociliary transport between chronic tubotympanic type of suppurative otitis media, so called tubotympanic otitis media and atticoantral type of chronic suppurative otitis media, the so called atticoantral otitis; 4. the association between the degree of defect of the tympanic membrane mucosa and time of tube mucociliary transport in each individual type of chronic suppurative inflammation of the middle ear. Eustachian tube mucociliary transport was studied in 16 patients with tubotympanic otitis, in 13 patients with atticoantral otitis and in 9 patients with traumatic rupture of the eardrum (control group of patients). All patients were treated at the Institute of Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia in Belgrade during 2002. Tube mucociliary transport was studied upon instillation of 10 microl 5% sterile saccharine solution through the existing eardrum perforation in the course of preoperative preparation of the patient for surgical intervention. The time interval from the moment of sterile saccharine solution application till perception of the sweet taste in the mouth and pharynx was measured in studied patients. The obtained results were analyzed using the methods of descriptive and analytical statistics (t-test for small independent samples). The mean time of tube mucociliary transport in patients with traumatic rupture of the tympanic membrane was 7.6 minutes. The mean time of tube mucociliary transport in tubotympanic otitis with normal mucosa of the tympanic cavity promontorium was 15 minutes, while mean time of tube mucociliary transport in tubotympanic otitis with polypoid changes of the promontory mucosa was 24 minutes (t = 5.218; p < 0.01). Mean time of tube mucociliary transport in atticoantral otitis with normal promontory mucosa of the tympanic cavity was 35.5 minutes, while mean time of mucociliary tube transport in atticoantral otitis with polypold changes of promontory mucosa was 48 minutes (t = 6.99; p < 0.01). In the irreversibly changed tympanic cavity mucosa, tube clearance saccharine test was negative even after one hour. The results of our study indicate the possibility that prolonged mucociliary tube transport has greater influence to development of atticoantral otitis rather than to development of tubotympanic otitis. The association between the degree of mucosal defect and time of mucocillary transport was evidenced in both types of chronic suppurative inflammation of the middle ear.

MODIFIED RADICAL MASTOIDECTOMY: Preservation of the Cholesteatoma Matrix; a Method of Making a Flap in the Endaural Technic

THERE IS little that can be said about the modified radical mastoidectomy (modified tympanomastoidectomy, atticomastoidectomy, semiradical mastoidectomy, Heath mastoidectomy, Bondy mastoidectomy) that has not been said before. All that has been written, however, has not produced uniformity in the treatment of patients who present chronic otorrhea. While I was on active duty with the United States Navy and closely associated with a considerable variety of specialists, it occurred to me that the differences of opinion were more extreme than seemed reasonable. As examples: Dangerous types of suppurative otitis media were dallied with when surgical intervention was indicated; the radical mastoidectomy was done on nondangerous ears when local treatment should have been more persistent; the radical mastoidectomy was done when the modified radical mastoidectomy would have sufficed. These divergent views are responsible for the present discourse. The literature is full of opposing points of view relative to the treatment and the