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Introduction: The tympanic cavity contains three ossicles in humans, the malleus, incus and stapes. These ossicles form a chain across the tympanic cavity from the tympanic membrane to fenestra vestibuli respectively. They develop from mesenchymal condensation of tubotympanic recess at the 6th week of intrauterine life. Later due to programmed cell death a part of tissue remains as ossicles. It attains adult size in the fetal life itself. However, studies have shown gain in size and weight even 2 years after birth. The ossicles help in sound conducting mechanism in hearing. These ossicles are vulnerable to damage in the various diseases of the middle ear cleft resulting into either partial or total loss. Incus is the most, followed by stapes and least by malleus. 20% mucosal diseases show ossicular damage, while squamous epithelial disease involve in 80% [1,2]. The integrity of the ossicular chain is most important for the transmission mechanism of external sounds to the inner ear fluids. Objectives: 1. To study the percentage of ossicular damage in the diseases of the middle ear cleft among the patients being operated for chronic suppurative otitis media in our tertiary care hospital. 2.To assess the extent and frequency of individual ossicular chain involvement in simple mucosal disease and squamous epithelial diseases. Methods: A prospective clinical study was conducted in our tertiary care hospital over a period of five and a half years in our tertiary care hospital among 100 cases of chronic suppurative otitis media after ethical committee clearance. Detailed clinical and radiological examinations of the patients were done and ossicular chain status was noted on table. Patients were also called up for regular follow up. Results: Ossicular chain erosion was mostly seen in squamosal disease, with incus and incudo-stapedial joint being the most common sites for ossicular erosion. Conclusion: it was concluded that long process of incus was the most commonly eroded structure, with the incus being the most commonly involved ossicle Few factors that were found to be associated with ossicular erosion were atticoantral disease, pediatric age group and bigger tympanic membrane perforations.
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In Ayurveda, Karnasrava is mentioned as Vata Pradhan Tridoshaja and Sadhya Vyadhi in Shalakya Tantra. The term Karnasrava is self explainatory itself, which means Srava (discharge) from Karna (ear). For this study 30 patients were registered from OPD/IPD of Gurukul Campus, Haridwar; who were clinically diagnosed patients of Karnasrava/CSOM. There was only one group, so combined effect of Bala Taila Nasya and Rasnadi Guggulu was seen in patients. Results of the study indicates that highly significant result was seen in earache, Karnasrava (quantity of discharge), tenderness over mastoid antrum and consistency of discharge. Not significant result was seen in degree of hearing loss while in T.M. perforation size result was only significant.
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@#<p><strong>Objective:</strong> To determine the prevalence of hearing loss and otologic diseases among Filipinos living in the Southern Tagalog Region IV-A: CALABARZON (Cavite, Laguna, Batangas, Rizal and Quezon), Philippines.</p><p><strong>Methods:</strong></p><p><strong> Design:</strong> Retrospective Review of Community Survey Data</p><p><strong> Setting:</strong> Communities in Region IV-A provinces, Philippines</p><p><strong> Participants:</strong> 3267 residents of the five provinces aged 0 months and above</p><p> <strong>Results:</strong> About 71.29% and 74.60% had at least mild hearing loss, in right and left ears, respectively. For disabling hearing impairment, overall prevalence was 26.33%, distributed into 11.87% among 4 to 18-year-olds; 8.97% for 19 to 64-year-olds; and 3.17% for 65-year-olds and above. Absence of prevalent and hearing loss-associated diseases: serous otitis media [OR 0.362, 95% CI 0.167 to 0.782, p = .010], CSOM [OR 0.407, 95% CI 0.236 to 0.703, p = .001] COM [OR 0.229, 95% CI 0.106 to 0.494, p < .001] can decrease the risk for hearing loss development in the region. Prevention of noise-induced hearing loss or delay in the manifestation of presbycusis can reduce the risk of having hearing loss by as much as 75% [OR 0.253, 95% CI (0.180 to 0.355), p < .001]. All pure tone audiometry measurements were obtained with surrounding median ambient noise of 55dB (IQR 46 to 60dB).</p><p><strong>Conclusion:</strong> The prevalence of hearing loss among surveyed residents of the Southern Tagalog Region IV-A provinces was high compared to the previous nationwide study but low compared to other low- and middle-income countries. The top otologic conditions of this population (ear occlusion with ear wax, chronic suppurative otitis media, chronic otitis media, presbycusis, noise-induced hearing loss) were associated with hearing loss and their absence decreased the risks for hearing impairment.</p>
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Humans , Male , Female , Adult , Prevalence , Hearing Loss , Pediatrics , Presbycusis , Otoscopy , OtolaryngologyABSTRACT
Background: The AAA (Anterior epitympanic, Attic, and Antrum) space is the space between the mastoid and middle ear which functions to balance the pressure in both organs (buffer). Pathological tissue in the AAA cavity due to chronic infection would disrupt the buffer function and could change the morphology of the mucosa in the tympanic membrane and middle ear. Obstruction in the AAA space measured subjectively by observing the smoothness of the flow using saline solution has been shown to be associated with a plaque in the tympanic membrane (myringosclerosis) in Chronic Otitis Media (COM) patients. This study aims to determine the relationship between AAA space obstructions with myringosclerosis using CT-Scan for an objective result.Methods: Retrospective study with case-control approach used in this study. Case criterias are Chronic Suppurative Otitis Media (CSOM) patients with myringosclerosis, both men and women and age 15-50 years, while the control group are benign CSOM patients without myringosclerosis. Data were analyzed with the chi-square test to prove the association between the AAA space status and length of symptom onset with myringosclerosis.Results: During January 2017-December 2019 there were 33 respondents, 19 cases and 14 controls, 21 men and 12 women with an average age of 35 years (cases) and 23.5 years (control). The length of symptom onset more than 5 years (p <0.05, OR 6.94 with CI 0.5-1.5) and AAA space obstruction (p <0.05 OR 34.25 with CI 0.8-1.8) has been shown to be associated with myringosclerosis in people with benign CSOM.Conclusions: AAA space obstruction and symptom onset more than 5 years significantly associated with myringosclerosis.
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Hyper IgM syndrome are group to disorders characterized by elevated serum level of IgM and low or absent serum levels of IgG, IgA and IgE the mechanism of HIGM is immunoglobulin Class-Switch Recombination (CSR) failure and Somatic Hyper Mutation (SHM). This diagnosis should be considered in any patient presenting with hypogammaglobulinemia, with low or absent IgG and IgA and normal or elevated IgM level. In the present case report, this was a 6-year-old male child who had history of recurrent respiratory tract infections who presented with otitis media and persistent fever spikes. Immunoglobulin studies revealed a pattern consistent with hyper IgM.
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Background: Chronic suppurative otitis media (CSOM) is one of the most frequently observed diseases in Otolaryngology practice. The primary objective of the study was to assess the bacteriological and mycological profile in chronic suppurative otitis media among patients visiting a tertiary care hospital in Tamil Nadu. Materials and methods: A total of 268 samples from 200 patients fulfilling the criteria were included. All patients underwent otoscopic examination; Tuning fork test and pure tone audiometry (PTA) were performed. Microbial identification was performed by collecting Aural discharge from the middle ear of each patient by using two sterile swabs. Results: More than half of the patients belonged to 21 to 40 year age group. Only 5.5% of them were aged 20 years and below. Unilateral involvement of CSOM was observed in 66% of the patients with 34% of them affecting both the ears. Microbial assay showed 78% of cases with gram-negative microbial infection while 22% were with gram-positive microbes. Staphylococcus aureus was the commonest gram positive bacteria (90.9%) while Pseudomonas aeruginosa was the most frequent gram-negative microbe. Among fungi, Candida albicans was found in 71.42 patients. V.C. Suresh Chander, A. Kavinkumar. Microbiological profile of chronic suppurative otitis media presenting to a tertiary care teaching hospital - A cross-sectional study. IAIM, 2019; 6(5): 5-11. Page 6 Conclusion: The findings of the study revealed that Staphylococcus aureus and Streptococcus pyogenes were the most prevalent gram-positive bacteria while Pseudomonas aeruginosa and Klebsiella pneumoniae were the commonest CSOM-causing gram-negative microorganisms.
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Objectives 1. Selection of patients of CSOM with conductive deafness to undergo various types of Tympanoplasty surgeries. 2. To document hearing improvement after various types of Tympanoplasty surgeries in cases of CSOM by means of PTA. Methods Atotal of 50 cases of CSOM presented with hearing loss were compiled after applying the inclusion and exclusion criterias. All the cases underwent detailed otoscopic and audiometric examination. All the patients were treated surgically and were followed up after 3 months. Descriptive and inferential statistical analysis has been carried out in this study. Results Comparing the preop and 3 months postop PTA, significant AB gap closure was seen in 30(60%) patients, remained same in 18(36%) patients and worsened in 2(4%) patients. Maximum improvement (75%) was seen in pre op 21-30 dB group. The mean preop AB gap calculated was 37.2±6.875 dB and mean postop AB gap calculated was 27.08±9.9 dB.
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Background: The battle against micro-organisms, in their role as primary cause of the disease and infective complications of medical and surgical techniques, has not decreased in spite of modern antimicrobial therapy. Chronic suppurative otitis media (CSOM) is a disease with worldwide prevalence having potentially serious long term effects. The disease remains an important global public health problem leading to hearing impairment, and due to wide spread irrational use microbial resistance is very common to these antibiotics, thereby leading to treatment failure. Hence it is important to know the type of bacteria and their sensitivity pattern so that appropriate antibiotics may be given for treatment and prevention of complications.Methods: 428 patients of otitis media were enrolled from ENT OPD of Tertiary Care Hospital. Ear swab was taken from diagnosed cases of CSOM and culture and sensitivity were done.Results: The microbiology of the swab showed no growth in (25.4%) of samples. Staphylococcus aureus (26%) and Pseudomonas (25%) were the main organisms isolated. Staphylococcus aureus isolated was sensitive to vancomycin, clindamycin, cefixime, gentamicin and cefipime in descending order. Pseudomonas aeruginosa was sensitive to ceftazidime, imipenem, piperacillin, gentamicin, cefipime. In the present study Staph. aureus and Pseudomonas were the predominant bacteria, it is suggested to undertake a gram staining in all patients. If gram positive organisms are isolated it is suggested that presumptive treatment should be directed against Staphylococcus aureus and if gram negative then against Pseudomonas aeruginosa. Such a treatment is not only likely to be effective but will also go a long way in preventing emergence of drug resistance.Conclusions: The antimicrobial therapy should be based on locally determined microbiological isolates and local sensitivity patterns to a particular antimicrobial agent. The presumptive antimicrobial therapy should therefore be directed against these organisms.
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Background: Chronic suppurative otitis media (CSOM) is a commonly encountered infection of the middle ear. It cancause extra cranial and intracranial complications and involves considerable morbidity. Although it is a global disease, its incidence has remained relatively higher in resource-constrained countries. Due to its recurrent nature and the development of resistant pathogenic organisms, control of infection poses a greatest therapeutic challenge. Knowledge of the local microbial flora in CSOM is essential for initiating empirical therapy. The objective of our study was to examine the current bacteriological profile and antibiotic sensitivity pattern to locally available antibiotics in CSOM. Methods: A total of 157 patients clinically diagnosed of CSOM were enrolled in the study and the samples were obtained from each patient using sterile cotton swabs and were processed as per standard microbiological techniques. Antibiotic sensitivity to ten locally available antibiotics was analyzed. Antibiotic susceptibility testing for bacterial isolates was conducted using Kirby-Bauer disc diffusion method. Results: Out of total 157 swabs bacterial growth was seen in 144 (91.72%) with Pseudomonas aeruginosa (28.5%) and Staphylococcus aureus (22.9%) being the most common bacterial isolates. Among the antibiotics tested amikacin (88.3%), ciprofloxacin (78.9%) and cotrimoxazole (78.2%) were found to be most active against all the isolates, whereas maximum resistance was seen for ampicillin (45.8%). Poor hygiene 79 (50.3%) and pond/river bath 51 (32.5%) were the two most common predisposing factors associated with CSOM. Conclusion: In the era of continuously increasing drug resistance among bacteria, periodic monitoring of the bacterial isolates causing CSOM and their antibiogram with clinical correlation is very important. Local antimicrobial susceptibility data should be utilized for formulating antibiotic policy for every institution. Our results will surely help in the modification of hospital’s current antibiotic policy and also will optimize the therapy to patients.
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Background: Intracranial complications of otogenic origin is now a rarity. Advent of antibiotics are both blessings if used intelligently and curse if used indiscriminately especially by quacks. Antibiotic resistance and cross resistance have given adverse results. Methods: A total of twenty cases were studied in the Department of ENT at Jawaharlal Nehru Medical College, AMU, Aligarh, Uttar Pradesh Results: Maximum number of cases belonged to 10 to 20 years age group, i.e eight cases (40%) followed by six cases (30%) in the age group greater than 30 years, four cases (20%) in 20 to 30 years age group, and 2 cases (10%) below 10 years. Males were affected more than females in the ratio of 4:1. The commonest presenting symptom was otorrhea, headache, fever and hearing loss. About half of the patients had vomiting, some had vertigo, otalgia and one patient had facial weakness. Conclusions: Almost all the intracranial complications encountered were intensively and meticulously treated by medical and surgical exercise which gave excellent results with collective team approach.
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Background: Transcanal endoscopic ear surgery has many advantages over conventional microscopic ear surgery and is used as adjunct to microscope or is used independently. Precise large visual field and angular vision has edge over the clumsy, expensive, peeping tubular vision of microscopes. Moreover, it is a better teaching methodology for the undergraduates and postgraduates. Our study comprised of twenty-five patients who had safe ear and underwent transcanal endoscopic ear surgery (TEES). Methods: This prospective study was carried out between October 2014 to December 2015 at Hayaat hospital, Allahabad, Uttar Pradesh, India and Hind Institute of Medical Sciences, Safedabad, Barabanki. Twenty-five patients of age group more than fifteen years were selected. All the patients selected had dry and safe type of chronic suppurative otitis media (CSOM). Results: Of the twenty five people ten were females and fifteen males in the ratio of 2:3. All the patients selected had dry ear and safe type of chronic suppurative otitis media (CSOM). All had conductive hearing loss of variable decibels but not greater than fifty-five decibels. Conclusions: Further research is needed in the field of operative TEES. We all need to discuss and more research work is needed to prove its genuinity and practicality.
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Background: The purpose of this study was to evaluate the clinical and epidemiological profile of patients diagnosed with tubotympanic type of CSOM. Methods: A prospective study was conducted on 110 patients at Teerthankar Mahaveer Medical College and Research Centre Teerthankar Mahaveer University, Moradabad, Uttar Pradesh over a period of 12 months. Patients clinically diagnosed as tubotympanic type of CSOM were included in this study. Each of these patients was subjected to complete history and thorough ENT examination after taking proper written informed consent. Clinical and laboratory data from the study was recorded as per the pro forma. Results: Analysis of collected data revealed that maximum cases were found to be in the second or third decade. There was a male preponderance with a male to female ratio of 1.3:1.0. Rural patients were more as compared to those from urban background. Of the total 112 ears examined 29 (25.9%) ears had normal hearing while, 71 (63.4%) ears had pure conductive hearing loss, and remaining 12(10.7%) with mixed loss. Medium sized central perforation with anteroinferior and posteroinferior quadrant involvement was most common and was seen in 37.5% ears. Conclusion: The result of the present study and its similarities with a number of published articles state that CSOM is a main source of tremendous health predicament.
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Background: The paring of tympanic membrane is usually done by doing myringoplasty with temporal is fascia graft. Methods: A newer technique of butterfly cartilage underlay grafting has been used in 50 patients with small to moderate size safe perforation. Results: The result of the study would be analysed for hearing improvement and graft uptake. Hearing gain of 0-5 dB was observed in 4 patients, 6-10 dB in 3 patients, 11-15 dB in 14 patients, 16-20 dB in 22 patients and 21-25 dB in 7 patients. Conclusion: Butterfly cartilage myringoplasty is a very good technique for closure of small to moderate size central perforations.
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Background and Aim: CSOM causing deafness is seen in more than one third of the population in developing countries and is responsible for more than two thirds of deafness in children thereby causing intellectual and educational problems which have a profound impact on the society. Knowledge of the pathogens responsible for CSOM and their antibiotic sensitivity can assist in the selection of the appropriate treatment regimen in these cases. Objective: To identify the bacteria causing CSOM in our hospital area and to determine their antibiotic sensitivity. Methodology: Prospective study of 20 samples from clinically suspected cases of CSOM was performed over a period of two months. Samples were subjected to culture and the isolates were identified by standard biochemical tests. Antibiotic sensitivity testing was performed by modified Kirby-bauer disc diffusion technique as per CLSI guidelines. Results: The predominant organism isolated was Staphylococcus aureus. No other organism was isolated in our study. The antimicrobial sensitivity of the isolates in our study showed 100% sensitivity to ciprofloxacin,ofloxacin and netilmycin followed by 75% sensitivity to cefotaxime and ceftriaxone. Conclusion: The bacterial pathogens causing CSOM are unique to each geographical area. There is a high carriage of Staphylococcus aureus strains in the external auditory canal and upper respiratory tract prevalent in our hospital area. Quinolones and third generation cephalosporins are the most effective drugs for CSOM in our hospital area and can be considered for empiric therapy of these cases.
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Background: Tympanoplasty is one of the commonest operations performed on the middle ear. Endoscopes are increasingly used for various middle ear surgeries. The objective was to determine merits and demerits of the endoscope as compared to the microscope in myringoplasty surgery and to compare the results of both group. Methods: Between the time period of January 2014 to September 2014, 44 patients underwent myringoplasty, 22 were endoscope assisted and 22 were microscope assisted. Results of surgery were compared at the end of 3 months post surgery. Results: In both groups, equal number of patients i.e. 15 (68.18%) had a successful outcome. Conclusion: Panoramic, wide angle, and magnified view provided by endoscope as well as ability to easily negotiate through EAC and provide uninterrupted image overcomes most of the disadvantage of microscope. In our study success rate was equal between endoscopic and microscopic technique. In terms of morbidity and postoperative recovery endoscope produced better results. Loss of depth perception and one handed technique are some of the disadvantage of endoscope that can be overcome with practice. Thus, Endoscopic tympanoplasty can be a good alternative of microscopic tympanoplasty.
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Introduction: CSOM is a massive public health problem with incidence higher in developing countries like India, especially among low socio-economic society because of malnutrition, overcrowding, poor hygiene, inadequate health care, and recurrent upper respiratory tract infections. It is associated with various complications like persistent otorrhoea, hearing impairment, mastoiditis, labyrinthitis, facial nerve paralysis to more serious intracranial abscesses etc. The knowledge of microbiological profile is essential to enable efficacious treatment of this disease & thereby reducing the potential risk of complications. Methodology: This study was aimed to determine the microbial profile & their antimicrobial resistance pattern using Kirby Bauer disc diffusion method among the patients suffering from CSOM between April 2013 to March 2014. Results: Out of 216 samples processed, isolates were seen in 145 (67.1%) cases with male to female ratio of 1.5: 1 and age group affected was 10-20 years. Most common organism isolated was Pseudomonas spp. (49%) followed by S. aureus (35.9%). Pseudomonas spp. showed high degree of resistance to gentamicin (57.7%) and ciprofloxacin (53.5%). Also, S. aureus was found resistant to ciprofloxacin (61.5%) and cotrimoxazole (40.4%). Conclusion: Management of CSOM consists mainly of eradicating infection and closure of tympanic membrane. Periodical monitoring of bacterial isolates and their antibiotic susceptibility pattern is necessary for administering appropriate antibiotics for empirical treatment and also helps in reducing the potentially disabling and fatal complications of CSOM.
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Background: Chronic suppurative otitis media (CSOM) remains one of the most common childhood chronic infectious diseases worldwide, affecting diverse racial and cultural groups both in developing and industrialized countries. It involves considerable morbidity and can cause extra- and intra-cranial complications. The aim of this study was to determine the microbial diversity and the antibiogram of aerobic bacterial isolates among patients suffering from CSOM who attended the ENT Department of SMHS hospital, a tertiary care centre located in the heart of the Kashmir valley. Methods: A total of 154 patients clinically diagnosed with CSOM were enrolled in the study and the samples were obtained from each patient using sterile cotton swabs and cultured for microbial flora. Drug susceptibility testing for aerobic isolates was conducted using Kirby-Bauer disc diffusion method. Results: Out of total 154 ear swabs processed, microbial growth was seen in 138 (89.61%) while 16 (10.38%) samples showed no growth. In 102 (66.23%) samples mono-microbial growth was seen whereas 26 (16.88%) samples showed poly-microbial growth. The most frequent organism isolated was Pseudomonas aeroginsa followed by Staphylococcus aureus and Proteus sp. The most effective antibiotic against Pseudomonas aeroginsa was amikacin followed by imipenem and piperacillin plus tazobactam, while as Staphylococcus aureus showed maximum sensitivity to vancomycin. Conclusion: Otitis media linked with high levels of multiple antibiotic resistant bacteria is a major health concern in all age groups of the study population. An appropriate knowledge of the etiology and antibacterial susceptibility of microorganisms would contribute to a rational antibiotic use and the success of treatment for chronic supportive otitis media.
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Introduction: Ear diseases are common in children mainly due to altered anatomy of Eustachian tube which is straighter in children as compared to that in adults. However, the cause of hearing loss in children is more varied, including the etiologies. This study was done to find out the pattern of ear diseases in paediatric age group attending ear, nose and throat OPD in a tertiary care centre in Pokhara, Nepal. Materials and Methods: This is a prospective study done in paediatric patients attending ENT OPD over a period of one year from January 2010 to January 2011. The diagnoses were made on the basis of history and clinical examination. Results were expressed in numbers and percentages. Results: Out of 1632 Pediatric ENT patients, 944 had ear diseases, 59.2% were males and 40.8% females. Wax (33.4%) was the commonest diagnosis followed by Chronic suppurative otitis media (24.3%) and Acute ottitis media (13%). Conclusion: Ear diseases are most common condition in ENT OPD among paediatric age group. Wax, CSOM and ASOM were the three most common ear diseases.
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Objective: The main objective of this study is to assess the intraoperative finding during canal wall down mastoidectomy in paediatric patients undergoing surgery for unsafe type of chronic suppurative otitis media (CSOM) attending ENT OPD of Kathmandu Medical College. Materials and Methods: Fifty patients of age group 4 to 13 years who were suffering from unsafe type of CSOM with or without cholesteatoma were taken for the study. The study period was two years from April 2007 to March 2009. The operative findings like extent of cholesteatoma in different location of middle ear cleft, mastoid bony landmarks, and ossicular chain condition and otogenic complication were identified during canal wall down mastoidectomy. Result: Of the 50 patients 32 (64%) were boys and 18(36%) were girls. The age ranged from 4 years to 13 years. Majority of patients had cholesteatoma with granulation diseases (72%) followed by granulation diseases (16%). Involvement of disease in attic, aditus, antrum and mesotympanum were found to be high in majority of cases (82%) with high percentage of necrosis of incus (56%). Conclusion: The primary disease found in patients undergoing canal wall down mastoidectomy (CWDM) was cholesteatoma combined with granulation in72%, granulation in 16% and cholesteatoma in 12%.