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Abstract Introduction Chronic otitis media (COM) with a central perforation or a concomitant cholesteatoma are both inflammatory lesions, however, with different etiologies. Both entities may present with an intact chain, and the final reconstruction is quite similar. Does it also apply for the hearing outcome? Objectives In a retrospective analysis, we investigated the preoperative hearing and the final hearing outcome of two groups of patients: those with COM and those with cholesteatoma, and compared various factors. Methods Patients operated between 2010 and 2019 were entered prospectively into a research database, and the integrity of the ossicular chain, the extent of the cholesteatoma, and the findings on computed tomography (CT) scans were retrospectively analyzed and correlated to the final hearing outcome. Results Out of 210 tympanoplasties for COM, 162 (80%) presented with an intact chain, and 85 (40%) ears could be analyzed. Out of 283 cholesteatoma surgeries, 53 (19%) ears presented with an intact chain. The preoperative air-bone gap (ABG) was worse in the COM group, but the postoperative ABG over the frequencies of 0.5 kHz and 4 kHz was the same (10 dB to 12 dB) in both groups, and remained within 20 dB in 90% (40 and 78 patients, respectively). The extension of the disease was rather limited in the cholesteatoma group (stages Ch1a and 1b), and better pneumatization and ventilation were beneficial for a good result. Postoperatively, the frequency of 4 kHz had the largest ABG (14 dB and 18 dB). Conclusion Overall, 80% of the patients with COM and less than 20% of those with cholesteatoma had an intact and mobile chain at surgery. Using equivalent surgical techniques for the tympanoplasty, the final outcome was almost the same for both groups, with a mean ABG of 10 dB to 12 dB.
ABSTRACT
- Introdução: A otite média serosa ou otite média com efusão é uma importante causa de perda auditiva na infância. Apesar de alguns estudos demonstrarem a presença de bactérias ou fragmentos bacterianos na secreção na orelha média, ainda há alguma controvérsia sobre a sua presença nessa região. Objetivo:pesquisar a ocorrência de microorganismos no aspirado de orelha média nos pacientes com otite média com efusão. Métodos: Foram selecionados pacientes de um ambulatório de otorrinolaringologia com diagnóstico de otite média com efusão e com indicação de tratamento cirúrgico.No intra-operatório, foi realizada a timpanotomia para colocação do tubo de ventilação, e aspirado o conteúdo presente na orelha média, quando este esteve presente. No aspirado foi realizado análise microbiológica e cultura e antibiograma. Resultados:foram analisados 10 aspirados de orelha média, e o resultado foi negativo em todos os exames para o crescimento de bactérias.Conclusão:A amostra deste estudo demonstrou ausência do crescimento de bactérias, reforçando a linha de hipóteses de que a otite média com efusão não seria exatamente uma doença infecciosa, mas provavelmente inflamatória, reacional ou obstrutiva
Introduction:Glue ear or otitis media with effusion (OME) is an important cause of hearing loss in childhood. Although some studies have shown the presence of bacterial or bacterial fragments in the middle ear effusion, there is still some controversy about its presence in the ear. Objective: To investigate the occurrence of microorganisms in the middle ear aspirate from patients with OME. Methods: Patients were selected from an otorhinolaryngology outpatient clinic with diagnosis of OME and with indication of surgical treatment. In the intraoperative time, the tympanotomy was performed in order to place the ventilation tube, and the contents present in the middle ear were aspirated. Was carried out microbiological analysis and culture and antibiogram of the effusion. Results: 10 middle ear effusions were analyzed, and the result was negative in all tests for the growth of bacteria. Conclusion: this study demonstrated the absence of bacterial growth, justifying the hypothesis that OME is not an infectious disease but probably inflammatory, reactive and obstructive disease