Type Of Chronic Otitis Media Research Articles

A study on chronic otitis media in tertiary care center

<p class="abstract"><strong>Background:</strong> Chronic otitis media (COM) is a serious healthcare concern worldwide, because of the distress and economic burden to the patient and their family. Temporal bone pneumatization plays an important role in etiology, behaviour, course and outcome of COM. Pneumatisation gets poorer with growing chronicity of the disease<span lang="EN-IN">. </span></p><p class="abstract"><strong>Methods:</strong> A retrospective study was conducted between March 2015-March 2017 on female patients visiting with COM, at ENT department Kasturba Gandhi Hospital, Madras Medical College. The records were analysed of the age, duration of symptoms, associated complaints, pure tone audiogram, computerised tomography of temporal bone, mastoid surgery done according to the disease process affecting the ear<span lang="EN-IN">. </span></p><p class="abstract"><strong>Results:</strong> 35 female COM patients were analysed, most common age group is between 31-40 years in 14 patients. There hearing loss was mild category in 27. There were 27 cases of mucosal type of chronic otitis media and 8 cases of squamous type. The CT scan with sclerosis of mastoid was the common finding<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> In exclusive study on female patients with COM, the mucosal type of COM is common with mild hearing loss and sclerosed mastoid indicating the chronicity<span lang="EN-IN">.</span></p><p class="abstract"> </p>

Comparison of efficacy of myringoplasty in dry and wet ears in chronic otitis media of tubotympanic type

<p class="abstract"><strong>Background:</strong> The objective of the study was to compare the outcome of myringoplasty in dry and wet ears in tubotympanic type of chronic otitis media (COM) with respect to graft uptake and hearing improvement.</p><p class="abstract"><strong>Methods:</strong> This is a prospective study done in department of ENT Bangalore Medical College and Research Institute during the study period of November 2014 to May 2016, wherein a total of 60 patients of tubotympanic type COM with 30 cases each of dry and wet ears, aged 15-60 years were included. The hearing impairment was assessed and recorded by pure tone audiometry (PTA). After obtaining informed written consent the patients underwent myringoplasty (temporalis fascia graft, underlay technique). Microbiological examination of discharge in wet ears was done and histopathology of the excised remnant TM analyzed in both groups. Both groups of patients were followed up for 3 months and assessed for graft uptake and hearing improvement. PTA was repeated at 3 months postoperatively. </p><p class="abstract"><strong>Results:</strong> Our study included 60 patients of tubotympanic type of COM with 30 cases each with dry and wet ears who underwent myringoplasty. Majority of our patients were in second decade in both the groups. There was slight female preponderance in our study with male to female ratio of 0.93:1. Discharge from ears in wet ears was mucoid in consistency and were culture negative. Histopathology of excised remnant TM in wet ears revealed evidence of inflammatory cells and vascularization within stroma of fibroblasts while these were absent in dry ear cases. The overall successful graft uptake following myringoplasty was 88.3% with 86.7% for wet ears and 90% for dry ears with no statistical significance (p value of 0.688>0.05) between the two groups. With respect to hearing improvement post-operatively there was significant hearing improvement in both the groups when compared to preoperative hearing with a mean hearing gain (dB) of 3.43±2.81 in wet ear cases to 3.85±3.05 in dry ear cases, but when compared between the two groups, there was no significant statistical difference (p value of 0.582>0.05).</p><p><strong>Conclusions:</strong> The outcome is equally good for myringoplasty in dry and wet ears in tubotympanic type of chronic otitis media with respect to graft uptake and hearing improvement. </p>

Outcome of ear surgeries in dry and wet ear

<p class="abstract"><strong>Background:</strong> Chronic suppurative otitis media (CSOM) can present with dry and wet ear (discharging ear). It’s an accepted fact that an actively draining central perforation is not a contraindication for ear surgery. The discharging ear presents the otologists with the dilemma of operating on it or not, this is due to widespread belief that the success rate while doing ear surgeries on wet ears is decidedly inferior. Hence the present dissertation is intended to find the outcome of ear surgeries in dry and wet ear.</p><p class="abstract"><strong>Methods:</strong> The present study comprises of 60 patients who have undergone type 1 tympanoplasty with cortical mastoidectomy, at Fr Muller’s Medical College, Mangalore. These patients were divided into two groups- Wet and Dry, based on the presence or absence of ear discharge at the time of surgery respectively. Inclusion Criteria: Patients of age group 16-60 years and both sexes, with mucosal type of chronic otitis media who underwent type 1 tympanoplasty with cortical mastoidectomy. Exclusion criteria: Patients with squamosal type of chronic otitis media or with ossicular chain erosion. A comparative analysis was done on the hearing improvement and incidence of the graft uptake postoperatively between the two groups.</p><p class="abstract"><strong>Results:</strong> In dry group, complete graft uptake was seen in 90% cases, whereas in wet group, a graft uptake rate of 86.7% was achieved. The graft take up rate is better in high x socio-economic status. Higher take up rates were seen in small and medium perforation compared to subtotal perforations. Hearing improvement, assessed by mean gain of PTA at the end of 6th month postoperatively, was achieved in 86% cases in Wet group and 90% cases in Dry group. There was an average hearing improvement of 13.08 db in speech frequencies in 88.3% cases. The difference between the two groups was statistically insignificant.</p><p><strong>Conclusions:</strong> In our study, we found no statistically significant differences between the success rates of Wet and Dry group, either in terms of graft uptake or the hearing improvement. Thus, from our study, we conclude that the presence of ear discharge at the time of surgery does not affect the success rate of type 1 tympanoplasty. </p>

Patients’ Satisfaction in Modified Radical Mastoidectomy Done Under Local Anesthesia for Squamous Type of Chronic Otitis Media

Patients’ Satisfaction in Modified Radical Mastoidectomy Done Under Local Anesthesia for Squamous Type of Chronic Otitis Media

Patients’ Satisfaction in Modified Radical Mastoidectomy Done Under Local Anesthesia for Squamous Type of Chronic Otitis Media

Patients’ Satisfaction in Modified Radical Mastoidectomy Done Under Local Anesthesia for Squamous Type of Chronic Otitis Media

Status of contralateral ear in unilateral chronic otitis media

<ul><li><p class="abstract"><strong>Background:</strong> The aim of this study was to clinically, audiologically and radiologically examine the contralateral ear, and compare the findings with squamous and mucosal type of chronic otitis media<span lang="EN-IN">. </span></p><p class="abstract"><strong>Methods:</strong> A prospective study of 15 months between April 2015 to July 2016 was conducted in the Otorhinolaryngology department, enrolling 80 patients with unilateral chronic otitis media. The contralateral ear was defined as the ear with no tympanic membrane perforation. Otoscopy, pure tone audiometry and X-ray mastoid or HRCT temporal bone were done on the patients. The results were recorded and analysed<span lang="EN-IN">. </span></p><p class="abstract"><strong>Results:</strong> Descriptive statistical analysis was done using SPSS software version 22 in Windows 7. It was seen that most of the Tympanic membranes were abnormal, with contralateral ear of squamous disease showing more abnormality. Retraction and thinning were the most common abnormalities. And 14.3% cases of pars tensa retractions in squamous cases were grade 4 retractions. Mastoids were mostly sclerosed or diploeic, and soft tissue was present in the mastoid antrum in a few cases. Hearing loss was seen in contralateral ear of 47% of squamosal disease and in 30.5 % of mucosal disease<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> The contralateral ear is now, what the diseased ear was yesterday. The contralateral ear shows unmistakable predilection towards developing chronic otitis media in the future<span lang="EN-IN">.</span></p></li></ul>

Comparison of outcomes of palisade cartilage with temporalis fascia following tympanoplasty at a tertiary care centre in Nepal

<p class="abstract"><strong>Background:</strong> Mucosal type of chronic otitis media is a common disease worldwide with 5.2% prevalence in Nepal. Cartilage material is criticized in terms of hearing results due to its thickness. The objective of this study was to compare graft uptake and post-operative hearing of palisade cartilage with temporalis fascia following tympanoplasty.</p><p class="abstract"><strong>Methods:</strong> A prospective randomized study conducted over 12 months included subjects of chronic otitis media mucosal inactive having dry ear for at least 4 weeks. 76 subjects were enrolled and reviewed on 6<sup>th</sup> post-operative day, 6<sup>th</sup> and 12<sup>th</sup> post-operative week. The graft uptake and post-operative hearing were evaluated. The results were compared within and between the groups. </p><p class="abstract"><strong>Results:</strong> The graft uptake on 42<sup>nd</sup> and 90<sup>th </sup>post-operative days were comparable with no statistical difference. The difference of mean pre-operative, 42<sup>nd </sup>and 90<sup>th</sup> post-operative air bone gaps in palisade cartilage and temporalis fascia were also comparable. The results were statistically significant, showing improvement in hearing after surgery. Closure of air-bone gap within 30 dB was achieved in 71.87% in temporalis fascia and 88.89% in palisade cartilage. The intergroup difference was not statistically significant.</p><p><strong>Conclusions:</strong> The graft uptake rates and hearing results after palisade cartilage are similar to temporalis fascia.</p>

Tuberculous Otitis Media with Facial Paralysis

ABSTRACT Tuberculous otitis media (TOM) can be difficult to diagnose because of its rarity, variable signs and symptoms, and nonspecific manifestations compared with other types of chronic otitis media (COM). Half of the cases have no other evidence of present or past infection, and its diagnosis is often delayed due to the rarity of this disease or its usually indolent course. A middle-aged female came with complaints of left-sided progressive facial weakness, intermittent left ear discharge, evening rise of fever, and hearing loss for 8 months and with a history of chronic cough, loss of appetite, and weight loss for last 1 month. On physical examination, she had left-sided grade V facial paralysis as per House–Brackmann grading system. X-ray of the chest showed prominent hilar shadow with cavitary lesion. A temporal bone computed tomography (CT) scan revealed left-sided mastoiditis. Sputum was found to be positive for acid-fast bacillus. Granulations with cheesy material were present in the mastoid cavity, which were positive for acid-fast bacillus with epithelioid giant cells. During the surgery, dehiscence of the fallopian canal was located in the second genu. The patient responded to antitubercular treatment. How to cite this article Bhardwaj P, Mohan C, Srivastava A. Tuberculous Otitis Media with Facial Paralysis. Int J Adv Integ Med Sci 2016;1(2):69-71.

Comparative Study of Two Different Myringoplasty Techniques in Mucosal Type of Chronic Otitis Media.

Myringoplasty is a surgical procedure used to close the perforation of pars tensa of the tympanic membrane and to improve the hearing loss. To compare the two different techniques of myringoplasty- circumferential subannular grafting technique and conventional underlay technique in cases of chronic otitis media with inactive mucosal disease. This is a prospective study of 12 months (July 2014 to June 2015) duration conducted in Department of Otorhinolaryngology and Head and Neck Surgery, JJM Medical College, Davanagere and data was collected from the 50 patients admitted for myringoplasty, 25 in each group. Results were calculated in terms of graft success rate and improvement in hearing after 3 months postoperatively. A total of 50 cases are included in this study, out of which 21 were males and 29 were females with male to female ratio of 0.72:1. The success rate of graft take up by circumferential subannular grafting technique is 96% and by conventional underlay technique is 76% respectively. In circumferential subannular grafting technique, the pre-op mean PTA was 36.92db, and the post-op mean PTA after 3 months was 25.87 db with a mean difference in PTA (dB) was 11.05 with t value of 7.74. In case of conventional underlay technique, the pre-op mean PTA was 38.24 db, and the post-op mean PTA after 3 months was 30.28 db with a mean difference in PTA (dB) was 7.96 with t-value of 14.39. The study showed that circumferential grafting technique is superior in graft success rate and postoperative hearing improvement when compared to conventional underlay technique.

Study of Myringoplasty in Wet and Dry Ears in Mucosal Type of Chronic Otitis Media.

Chronic otitis media is the most common cause of hearing impairment in the developing countries. Hearing loss can have serious effects on day to day life. Ear discharge in chronic otitis media may continue for months to years with increasing hearing impairment and also life threatening infective complications, which is more common in active and also in inactive disease form as well. Myringoplasty is an operative procedure to close the perforation in tympanic membrane. To compare the success rate of graft uptake in dry and wet ears and to compare the postoperative hearing improvement in dry and wet ear following myringoplasty. The comparative study was carried out on total 30 patients with chronic otitis media with central perforation. Of these 15 patients belong to dry ear group and 15 patients with wet ear group. These selected patients on simple random basis were subjected to clinical, audiological, radiological and laboratory investigations and one day before operation, patients were admitted to the hospital and written informed consent was taken in all cases. All patients underwent underlay technique myringoplasty. Postoperatively all patients were evaluated for graft uptake and hearing improvement by pure tone audiometry at 3rd month follow-up. In our study, the successful graft uptake was seen in 80% in dry ear and 73.3% in wet ear, statistically p-value (χ2=1.24) is (p>0.05) which is insignificant. Postoperatively hearing gain was (0-5 dB) in 3 patients (20%) with dry ear and 2 patients (13.5%) with wet ear; (6-10 dB), in 4 patients (26.6%) with dry ear and 6 patients (40%) with wet ear; more than 10 dB in 5 patients (33.3%) with dry ear and 3 patients (20%) with wet ear, statistically p-value is χ2=1.24 (p >0.05) which is not significant. In this study the success rate of graft uptake and hearing improvement is found almost equal in dry and wet ear by using underlay technique of myringoplasty, also found statistically insignificant.

Pneumatization Pattern in Squamousal Type of Chronic Otitis Media.

To study the pneumatization pattern of mastoid bone in cases of squamousal type of chronic otits media and analyze pneumatization pattern of opposite normal ear in cases of unilateral chronic otitis media (COM). A total of 94 patients (104 ears) between the age group of 7-84years attending the E.N.T outpatients, inpatients and casualty of Acharya Vinoba Bhave Rural Hospital, Sawangi (Maghe), Wardha, after applying inclusion and exclusion criteria were found suitable and hence selected for the present study and were subjected to bilateral X-ray mastoid (Schuller's view). HRCT temporal bone done in selected 55 patients. On analyzing patients radiologically (X-ray mastoid), it was found that out 104 ears, mastoid was pneumatized in 2 (1.92%) diploic in 20 (19.23%) and sclerotic in 82 (78.85%) ears. Contralateral mastoid of 70 normal ears, mastoid was pneumatized in 30 (42.86%) diploic in 22 (31.43%) and sclerotic in 18 (25.71%) ears. Most of the diseased ear demonstrated non pneumatized mastoid (98.08%) whereas contra lateral mastoid of 70 normal ear, showed significantly more pneumatization This difference is statistically significant (P value<0.0001). Significantly more sclerosis and non pneumatization in the ear with COM of squamousal type than the healthy contralateral ear supports the environmental theory.

Role of Chlamydia pneumoniae and Helicobacteria pylori in the development of tympanosclerosis.

The etiology of tympanosclerosis (TS) is not known, but TS commonly develops secondary to acute and chronic otitis media (COM). Since calcification process in TS resembles that of atherosclerosis (AS), pathogens that are related to pathogenesis of AS may be involved in development of TS. This prospective and controlled study, performed at a tertiary referral center, investigated a possible relationship between the presence of Chlamydia (C.) pneumoniae and Helicobacter (H.) pylori and the development of a tympanosclerotic plaque. The presence of C. pneumoniae was examined in the surgical specimens of 62 patients (29 females and 33 males; age range 10-70 years, mean age 30.8 ± 13.3 years), including 30 patients with TS, 14 patients with cholesteatoma, and 18 patients with chronic suppurative otitis media (CSOM). The presence of H. pylori was examined in the surgical specimens of 88 patients (41 females and 47 males; age range 6-70 years, mean age 32.5 ± 14.8 years), including 35 patients with TS, 22 patients with cholesteatoma, 20 patients with CSOM, and 11 patients with otosclerosis. Tympanosclerotic plaques and control specimens from the cholesteatoma, polypoid mucosa, or mucosal portion of the perforations and stapes supra structure were examined for the presence of H. pylori and/or C. pneumoniae using real-time polymerase chain reaction analysis. The analysis demonstrated that specimens from the tympanosclerotic plaques and the other types of COM were all negative for C. pneumoniae and H. pylori. An association between C. pneumoniae or H. pylori infection and the development of TS or other types of COM could not be established.

Relationship between Eustachian tube function and location of the perforation in chronic otitis media

Background: Eustachian tube function (ETF) has been the center of focus as a prognostic factor because of its presumed primary role in the pathogenesis of otitis media and clearance of the middle ear cavity. There is a general agreement that adequate ETF is necessary for middle ear surgery. In this study, the incidence of ET dysfunction and its patency has been evaluated in inactive mucosal variety of chronic otitis media, in relation to the types of central perforation. Materials and Methods: A cross-sectional study was done with 54 patients presenting with inactive mucosal type of chronic otitis media. All the recruited patients were first examined clinically and under microscope and then their audiological (impedance audiometry) and radiological assessment of mastoid was done. Alongside otoendoscopy, nasal endoscopy, dye test were done. In all these cases, other routine investigations were also performed. Results: Impedance audiometry offers an easy means of assessing ETF. The automatic Toynbee test can be a practical, objective and suitable method to assess ventilatory function of ET. The saccharin test is a simple, cost-effective and is valuable diagnostic tool to assess the mucociliary function of the ET. Mucociliary and ventilatory function may vary in the same patient. Saccharin test and methylene blue tests are comparable. Patients having poor saccharin test, methylene blue test, and ventilatory test are more prone to develop central perforation posterior to the handle of the malleus. The most frequent abnormal finding at nasal endoscopy was edema about the tubal orifice. Conclusion: A clinically useful test for ETF is still lacking. Impedance audiometry offers an easy means of assessing ETF. Ventilatory function of ET which is the single most important contributory factor in the pathogenesis of chronic otitis media should be evaluated with the objective method before tympanoplasty.

Factors influencing ossicular status in mucosal chronic otitis media − An observational study

Objective: To evaluate the influence of preoperative parameters on the status of ossicles in tubotympanic type of chronic suppurative otitis media. Materials and Methods: A total of 47 patients with mucosal type of chronic otitis media were evaluated for factors that influence ossicular status. A total of 14 preoperative parameters that are generally accepted to influence the ossicular status were examined and recorded. The same patients were subjected to surgery and their ossicular status was observed and noted peroperatively. Influence of each of the parameter on ossicular status was analyzed. P < 0.05 was considered as statistically significant. Results: Out of the 14 parameters that were studied, only 3 had a statistically significant influence on the ossicular status. These were, duration of the disease, adherence of the perforation edges to the promontory, pure tone average (PTA) and the air-bone gap (ABG). Duration of disease was significantly associated with ossicular discontinuity (P = 0.026). Adherence of margin of the perforation was seen in eight patients. A total of four among them had ossicular discontuinity and one among those who did not have this finding had ossicular discontinuity (P = 0.003). The mean PTA was 46.2 ± 20.1 db in patients with intact ossicular chain and 65.7 ± 14 db in patients with ossicular discontinuity (P = 0.04). Mean ABG was 23.9 ± 9.8 db in patients with intact ossicular chain and 35.1 ± 10.3 db in those with ossicular discontinuity (P = 0.001). Conclusion: Of the parameters studied, three were reliable to predict ossicular discontinuity in tubotympanic disease viz. duration of the disease, adherence of the margins of perforation to the promontory, PTA, and the ABG.

Detection of bacterial biofilms in different types of chronic otitis media

Biofilms are organized bacterial communities that may be homogeneous or heterogeneous. They play a significant role in the pathogenesis of chronic nasal sinusitis, chronic tonsillitis, cholesteatomas, and device-related infections. Despite this, few studies have been done that examine the presence of bacterial biofilms in tissues from patients with different types of COM or middle ear cholesteatomas. In the current study, we examined the presence of biofilms in surgical tissue specimens from humans with chronic ear infections using scanning electron microscopy (SEM). We hypothesize that bacterial biofilms present differently in patients with different types of chronic otitis media. Our results provide new insights regarding treatment of chronic otitis media. A prospective study was conducted in which middle ear tissues were obtained from 38 patients who underwent tympanoplasty and/or tympanomastoid surgery due to chronic ear infections. A total of 50 middle and mastoid tissue samples were processed for SEM analysis. In addition, 38 middle ear secretion specimens were obtained for routine bacterial culture analysis. Bacterial biofilms were present in 85 % (11 of 13) of patients with middle ear cholesteatoma, 92 % (12/13) of patients with chronic otitis suppurative media (CSOM), and 16 % of patients (2/12) with tympanic membrane perforation (TMP). Fungal biofilms were found in two cases of cholesteatoma. The positive coincidence rate between bacterial biofilms visualized by SEM and bacteria detected by culture was 82 %. Our findings suggest that bacterial biofilms are very common in CSOM and middle ear cholesteatomas. Positive bacterial cultures imply the presence of biofilm formation in CSOM and cholesteatomas. As such, our results provide new insights regarding treatment of chronic otitis media.

Participation of mast cells in chronic otitis media

In the pathogenesis of chronic otitis media (COM), much attention is paid to the molecular mechanisms of local inflammatory reactions in which mast cells (MCs) may be involved due to their role not only in allergic but also inflammatory processes. The aim of this study was to assess the density of mast cells in chronic otitis media in relationship to different clinical courses of COM, bacterial infections and types of disease. The MCs expression was measured immunohistochemically in paraffin-embedded granulation tissue specimens taken during surgery, by staining with a monoclonal antibody against tryptase. The density of tryptase-positive mast cells was lower in tissue samples from the group with a good clinical course than in those from the group with poor healing and recurrence (p = 0.006). There were no differences between the groups of patients with granulomatous and cholesteatomatous chronic otitis media (p = 0.66) or between the groups of patients with and without bacterial infection (p = 0.30), although the density of mast cells was lower for those with Pseudomonas aeruginosa/Proteus sp./ /Staphylococcus MRSA infection. In conclusion, the expression of mast cells in chronic otitis media granulation tissue was found to differ depending on the clinical course of the disease, but not on bacterial infection or type of COM. This may suggest that mast cells contribute to the maintenance of the inflammatory process, but not to antibacterial defense in chronic otitis media.

Otolaryngological Features of ANCA Associated Vasculitis

Objective: ANCA-associated vasculitis (AAV) is characterized by systemic necrotizing vasculitis. AAV is composed of proteinase 3 (PR3)-ANCA and myeloperoxidase (MPO)-ANCA. Because infections are a trigger of AAV, the upper airway areas are the favorite sites of AAV. In this study, we compare the otolaryngological features of AAV between patients with PR3-ANCA and patients with MPO-ANCA. Method: Retrospective case series study. Thirty-four patients enrolled in this study. All patients were diagnosed with AAV at Hokkaido University between 2002 and 2009. We evaluated clinical otologic and rhinologic manifestation of AAV and compared the difference between 2 different ANCA positive patients. Results: The otologic symptoms were divided into 3 types: chronic otitis media (COM), secretory otitis media (SOM), and sensory nerve hearing loss (SNHL). The COM type was more frequently found in patients with PR3-ANCA ( P &lt; .05). Conclusion: A large difference was observed in the disease spectrum between patients with PR3-ANCA and those with MPO-ANCA. In particular, the discrepancy in the granuloma formation between these 2 ANCAs was thought to be the main reason for these clinical feature differences in the otolaryngological field.

Microbiological profile with antibiotic sensitivity pattern of cholesteatomatous chronic suppurative otitis media among children

Introduction Chronic suppurative otitis media (CSOM) is the most common cause of childhood hearing impairment in the developing countries and atticoantral type is associated with increased incidence of intracranial and extracranial complications. This study was undertaken to define the microbiology of atticoantral type of chronic otitis media and the antibiotic sensitivity pattern, thereby reducing the potential risks of complications. Materials and methods A retrospective study was done in the Department of Otolaryngology, JIPMER, Puducherry from the year August 2003 to October 2009 using the medical record department database to retrieve the patient details. During this study period, 223 children with atticoantral type CSOM consisting of 126 males and 97 females with an age range of 1–14 years were assessed. Patients with persistent otorrhea for more than 3 months with atticoantral type of chronic otitis media were selected. The exudates were collected under sterile conditions and inoculated onto culture media; bacterial growth and antibiotic sensitivity pattern were studied. Results Nine species of micro organisms were isolated from the middle ear aspirate, Pseudomonas aeruginosa being the most predominant isolate constituting about 32% (72 discharging ears) of the total isolates followed by Proteus mirabilis (20% of isolates) and Staphylococcus aureus (19% of isolates). Gram negative organisms accounted 58% of total isolates and gram positive organisms constituted 22% isolates. Candida albicans and methicillin resistant S. aureus were identified in 4% and 2% of isolates, respectively. 100% of Pseudomonas isolates showed susceptibility to ceftazidime and a high sensitivity (92% of isolates) to ciprofloxacin and 88% isolates were sensitive to amikacin. 100% of P. mirabilis isolated from inoculates showed sensitivity to ceftazidime and ciprofloxacin. It also showed 87–97% sensitivity to ceftriaxone, amikacin and ampicillin. All (100%) of the Staphylococcus isolates were sensitive to vancomycin and 84–86% were sensitive to ciprofloxacin and erythromycin. In general, gram negative organisms showed increased sensitivity to ceftazidime, ciprofloxacin and amikacin, while gram positive organisms to vancomycin, erythromycin and ciprofoxacin. Conclusion Continuous and periodic evaluation of microbiological pattern and antibiotic sensitivity of cholesteatomatous CSOM is necessary to decrease the potential risks of complications by early institution of appropriate systemic and topical antibiotic alongside mastoid exploration. We believe that our data may contribute to an effective medical management of chronic suppurative otitis media with cholesteatoma. Since the most common organisms in our clinical set up being P. aeruginosa, P. mirabilis and S. aureus, which showed a percentage susceptibility of 100% to ceftazidime and vancomycin, thus making it an empirical antibiotic combination therapy of choice in the recent times.

Status Of Contralateral Ear In Patients With Chronic Otitis Media

Objective: To study the status of contralateral ear in patients with chronic otitis media.Materials and Methods: This is a prospective study in patients attending GMS Memorial Academy of ENT and Head and Neck Studies, Kathmandu between July 2008 and December 2008. There were 750 patients diagnosed as having chronic otitis media (COM) squamous and mucosal type. Otoscopy was performed in all patients in such ears and the status of contralateral ear was noted. Statistical analysis was performed by simple manual analysis using frequency and percentage. Results: Out of 750 patients, 64.4% were male and 35.6% were female. Regarding types of COM, 36.0% were squamous type. In 68.4% of the patient, the contralateral ear was found to have some form of abnormalities. In mucosal type of COM, 62.9% patients had abnormal contralateral ear while in squamous type, 71.4% patients had abnormal contralateral ear. The most common findings on contralateral ear in both group of patients was retraction of the tympanic membrane.Conclusion: Patients with COM in one ear are more likely to develop some degree of disease in the contralateral ear. The squamous type of chronic otitis media had a greater chance of contralateral ear involvement.

Eosinophilic otitis media: A new middle ear disease entity

Eosinophilic otitis media (EOM) is intractable otitis media characterized by the presence of a highly viscous yellow effusion containing eosinophils. It occurs mainly in patients with bronchial asthma and is resistant to conventional treatments for otitis media. Here we discuss the clinical features, pathogenesis, and management of EOM. EOM predominantly affects women and presents most often in patients in their 50s. The clinical features of the middle ear in EOM are roughly divided into the otitis media with effusion type and chronic otitis media type. The latter is further divided into two subtypes: simple perforation and granulation tissue formation. EOM is often complicated by rhinosinusitis (eosinophilic sinusitis). High-tone loss is more frequently found and more severe in EOM patients than in chronic otitis media control patients, and EOM patients sometimes become deaf suddenly. Systemic or topical steroid administration is the most effective treatment for patients with EOM. The instillation of triamcinolone acetonide, a suspension of steroids, into the middle ear is very effective for controlling eosinophilic inflammation. It is very important to explain to patients with EOM that the disease may last for a long period and that progressive and sudden hearing loss may occur.