Otorrea por uso de audífonos en pacientes con otitis media crónica / Otorrhea due to hearing aids use in patients with chronic otitis media

Resumen Introducción: La presencia de otorrea es un indicador de actividad en otitis media crónica (OMC), además de influir en la calidad de vida. La oclusión del molde de un audífono generaría incremento de otorrea, por esto se acostumbra a evitarla en estos casos. La relación otorrea/audífono en OMC no ha sido adecuadamente estudiada. Objetivo: Comprobar si se produce incremento en frecuencia y/o gravedad de episodios de otorrea por el uso de audífono en OMC simple. Caracterización clínica-demográfica de la muestra. Material y Método: Estudio prospectivo antes/después en pacientes con diagnóstico de OMC simple que se implementen con audífono. Entrevista telefónica para caracterizar episodios de otorrea en relación con el audífono. Resultados: Fueron evaluados 35 oídos en 34 pacientes, edad promedio 66,6 años. Sin diferencias significativas en aparición de otorrea y consultas por otorrea antes y después de la implementación. El grupo diagnóstico OMC supurada correspondió al 28,6%, OMC supurada seca el 11,4% y OMC inactiva 60%. Diferencias significativas comparando otorrea posimplementación en subgrupo OMC supurada con resto de subgrupos (p < 0,0001). Análisis multivariado de regresión logística confirmó que sólo OMC supurada se asoció a otorrea posimplementación (p < 0,004). Conclusión: Tradicionalmente se correlaciona uso de audífono en OMC con incremento de otorrea. Nuestro estudio no evidenció diferencias después de la implementación: pacientes con otorrea previa al audífono siguieron presentándola de la misma manera y pacientes con oído seco se mantuvieron así. Otorrea al implementar es el único factor predictor de otorrea por audífono. Debe realizarse más investigación, con evaluación presencial e incorporando variables.

Abstract Introduction: Otorrhea is a chronic suppurative otitis media (CSOM) activity indicator, affecting quality of life. Hearing aid mold occlusion would increase otorrhea, so it is usual to avoid it. Otorrhea/hearing aid relationship in CSOM has not been properly studied. Aim: To check for an increase in frequency and/or severity of otorrhea episodes in CSOM due to hearing aid use. Clinical-demographic characterization of the sample. Material and Method: Prospective before/after study, in CSOM diagnosed patients using a hearing aid. Telephone interview to characterize otorrhea episodes due to hearing aid use. Results: 35 ears were evaluated in 34 patients, with a mean age of 66.6 years. There were no significant differences before and after hearing aid implementation in otorrhea episodes and medical consultations. 28.6% corresponded to active CSOM diagnosis group, 11.4% partially-active CSOM and 60% inactive CSOM. We found significant differences observed between active CSOM subgroup and the rest by comparing post-hearing aid implementation otorrhea (p < 0.0001). Only active CSOM diagnosis was associated to post-hearing aid implementation otorrhea by multivariate logistic regression analysis (p < 0.004). Conclusion: Traditionally, hearing aid use is correlated with increase in otorrhea in CSOM. In our study there were no differences before and after hearing aid implementation: patients with previous otorrhea continued presenting it in the same way after hearing aid use and patients with dry ear kept it that way. The only predicting factor of otorrhea due to hearing aid use is active otorrhea at implementation. Further investigation should be done, with face-to-face evaluation and incorporating variables.

Factors Related to Tympanic Membrane Perforation in Children with Acute Suppurative Otitis Media / 中国医学科学院学报

Objective To explore the factors related to tympanic membrane perforation in children with acute suppurative otitis media,and to provide reference for clinical practice. Methods We reviewed the clinical data of 1274 children with acute suppurative otitis media from February 2017 to May 2020,and analyzed the factors related to tympanic membrane perforation. Results Tympanic membrane perforation occurred in 67 out of the 1274 children with acute suppurative otitis media,with the incidence of 5.27%.The univariate analysis showed that 11 factors including the duration of onset(

Endoscopic cartilage tympanoplasty: full thickness and partial thickness tragal graft / Timpanoplastia endoscópica com enxerto de cartilagem tragal de espessura parcial ou total

Abstract Introduction: Cartilage is the grafting material of choice for certain disorders of the middle ear. The indications for its routine use remain controversial due to the possible detrimental effect on post-operative hearing. Objective: The present study was carried out to report a personal experience with "tragal cartilage shield" tympanoplasty to compare the results, in terms of graft uptake and hearing improvement, of endoscopic cartilage shield technique using either partial thickness or full thickness tragal cartilage for type 1 tympanoplasty and to highlight the tips for single-handed endoscopic ear surgery. Methods: Fifty patients with safe chronic suppurative otitis media, assisted at out-patient department from February 2014 to September 2015 were selected. They were randomly allocated into two groups, 25 patients were included in group A where a full thickness tragal cartilage was used and 25 patients included in group B where a partial thickness tragal cartilage was used. Audiometry was performed 2 months after the surgery in all cases and the patients were followed for one year. Results: Out of the total of 50 patients 39 (78%) had a successful graft take up, amongst these 22 belonged to group A and 17 belonged to the group B. The hearing improvement was similar in both groups. Conclusion: This study reveals that endoscopic tragal cartilage shield tympanoplasty is a reliable technique; with a high degree of graft take and good hearing results, irrespective of the thickness. Furthermore, the tragal cartilage is easily accessible, adaptable, resistant to resorption and single-handed endoscopic ear surgery is minimally invasive, sutureless and provides a panoramic view of the middle ear.

Resumo Introdução: A cartilagem é o material de enxerto de escolha no tratamento cirúrgico de certas condições clínicas da orelha média. Devido ao possível efeito prejudicial na audição pós-operatória, as indicações para seu uso rotineiro ainda são controversas. Objetivo: Relatar a experiência dos autores com a timpanoplastia tipo 1 endoscópica usando cartilagem tragal e comparar os resultados entre a cartilagem tragal com espessura parcial e espessura total, em termos de integração do enxerto e melhoria da audição. O estudo também buscou apresentar sugestões para cirurgia endoscópica de orelha média com uma única mão (single-handed endoscopic ear surgery). Método: Foram selecionados 50 pacientes com otite média crônica supurativa, atendidos neste ambulatório entre fevereiro de 2014 e setembro de 2015, alocados aleatoriamente em dois grupos: 25 pacientes foram incluídos no grupo A, no qual uma cartilagem tragal de espessura total foi usada e outros 25 pacientes foram incluídos no grupo B, no qual foi usada uma cartilagem tragal de espessura parcial. Em todos os casos, uma audiometria foi feita dois meses após a cirurgia; os pacientes foram acompanhados por um ano. Resultados: Dos 50 pacientes, o enxerto foi bem-sucedido em 39 (78%), entre os quais 22 pertenciam ao grupo A e 17 pertenciam ao grupo B. A melhoria da audição em ambos os grupos foi muito semelhante. Conclusão: O estudo indicou que a timpanoplastia endoscópica com cartilagem tragal é uma técnica confiável, com alto grau de integração do enxerto e bons resultados de audição, independentemente da espessura usada. Além disso, a cartilagem tragal é facilmente acessível, adaptável e resistente à reabsorção; a cirurgia endoscópica é minimamente invasiva, sem sutura e proporciona uma visão panorâmica da orelha média.

Suppurative labyrinthitis associated with otitis media: 26 years' experience / Labirintite associada à otite média: experiência de 26 anos

ABSTRACT INTRODUCTION: Suppurative labyrinthitis continues to result in significant hearing impairment, despite scientific efforts to improve not only its diagnosis but also its treatment. The definitive diagnosis depends on imaging of the inner ear, but it is usually clinically presumed. OBJECTIVE: To analyze the clinical factors and hearing outcomes in patients with labyrinthitis secondary to middle ear infections and to discuss findings based on imaging test results. METHODS: Retrospective cohort study, based on the charts of patients admitted with middle ear infection-associated labyrinthitis. RESULTS: We identified 14 patients, eight (57%) of whom were females and six (43%) males. Mean age was 40 years. Cholesteatomatous chronic otitis media was diagnosed in six patients (43%), acute suppurative otitis media in six (43%), and chronic otitis media without cholesteatoma was diagnosed in two patients (14%). Besides labyrinthitis, 24 concomitant complications were identified: six cases (25%) of labyrinthine fistula, five cases (21%) of meningitis, five cases (21%) of facial paralysis, five cases (21%) of mastoiditis, two cases (8%) of cerebellar abscess, and one case (4%) of temporal abscess. There was one death. Eight (57%) individuals became deaf, while six (43%) acquired mixed hearing loss. CONCLUSION: Suppurative labyrinthitis was often associated with other complications; MRI played a role in the definitive diagnosis in the acute phase; the hearing sequel of labyrinthitis was significant.

RESUMO INTRODUÇÃO: Labirintite permanece resultando em deficiência auditiva significativa, apesar dos esforços científicos para melhorar não só o diagnóstico, como também o tratamento. O diagnóstico definitivo é dependente de imagens da orelha interna, mas geralmente é presumido clinicamente. OBJETIVO: Analisar os fatores clínicos e os resultados auditivos em pacientes com labirintite secundária à otite média e discutir os achados dos exames de imagem. MÉTODO: Estudo de coorte retrospectivo, com base nos prontuários de pacientes diagnosticados com labirintite associada à infecção da orelha média. RESULTADOS: Foram identificados 14 pacientes, oito (57%) do sexo feminino e seis (43%) masculino. Média etária de 40 anos. Otite média crônica colesteatomatosa foi diagnosticada em seis pacientes (43%), otite média aguda em seis pacientes (43%) e otite média crônica sem colesteatoma em dois pacientes (14%). Foram identificadas 24 complicações concomitantes: seis casos (25%) de fístula labiríntica, cinco casos (21%) de meningite, cinco (21%) de paralisia facial, cinco (21%) de mastoidite, dois casos (8%) de abscesso cerebelar e um caso (4%) de abcesso temporal. Houve uma morte. Oito (57%) indivíduos tornaram-se anacústicos, enquanto seis (43%) evoluíram para perda auditiva mista. CONCLUSÃO: Labirintite foi frequentemente associada a outras complicações; RNM auxiliou no diagnóstico definitivo da labirintite na sua fase aguda; a sequela auditiva da labirintite foi significativa.

The historic data series on AIDS in the state of Ceará, Brazil / Série histórica da AIDS no Estado do Ceará, Brasil

This study describes the historic records on AIDS in the Brazilian state of Ceará, with analysis by gender, age group and race. It is a descriptive, retrospective, ecological study, analyzing 7,896 notifications of cases of AIDS, of people aged 13 and above, resident in the Ceará, over the period 2001 through 2011. Percentage occurrences and other data were calculated based on the variables gender, age group and race. Average and comparison tests were made, considering p < 0.05 and the trend line. There is a progressive increase in the number of cases. The majority of cases are in men. The ratio between the sexes falls from 2003 through 2007, but the number of women is still lower overall in the period. Higher rates of occurrence were found between the ages of 30 and 39, and of those with black-white mixed-race skin color (80%). Based on the variables studied in the series that was analyzed, the results indicate a need for differentiated strategies in prevention and control of the disease in the state.

Objetivou-se descrever a série histórica da AIDS, no Ceará, relacionada a sexo, faixa etária e raça. Estudo ecológico, descritivo e retrospectivo, analisou 7.896 notificações de casos de AIDS, de pessoas ≥ 13 anos, residentes no Ceará, entre 2001 e 2011. Calculou-se a incidência dos casos, das variáveis sexo, faixa etária e raça. Realizaram-se testes de médias e comparações, considerando p < 0,05 e a linha de tendência. A taxa de AIDS revela o aumento progressivo do número de casos. Os homens detêm a maioria dos casos. De 2003 a 2007, verificou-se queda na razão entre os sexos, porém o número de mulheres mantém-se inferior no período. Maiores incidências foram verificadas nas idades entre 30 e 39 anos, e entre os de cor parda (80%). Mediante as variáveis estudadas na série analisada, aponta-se a necessidade de estratégias diferenciadas em prevenção e controle da doença no Estado.

correlation of radiographic and surgical findings in complicated cases of chronic suppurative otitis media

This study aimed to examine the correlation between preoperative high resolution computed tomography scan [HRCT] with surgical findings in twelve patients with complicated chronic suppurative otitis media. Seven points were studied, including, mastoid air cell development, extension of pathology, erosion of ossicles, integrity of facial canal, tegmen, sinus plate and presence of labyrinthine fistula. Excellent correlation is obtained in five of these points, with good correlation in remaining two

Epidemiological and Genetic Characterization of Methicillin-Resistant Staphylococcus aureus Isolates from the Ear Discharge of Outpatients with Chronic Otitis Media

The origin of methicillin-resistant Staphylococcus aureus (MRSA) strains from otolaryngology outpatients has not been evaluated yet in Korea. We analyzed epidemiologic and genetic characteristics of MRSA isolates from the ear discharge of 64 outpatients with chronic otitis media in a Korean University Hospital during 2004. MRSA strains were grouped as either from the initial visit (n=33) or the follow-up visit (n=31) based on the timing of isolation. Healthcare-associated risk factors were frequently present among patients of the initial visit group, especially prior visit to primary clinic (79%) and antibiotic use (73%). SCCmec typing and multilocus sequence typing results showed that two genotypes, ST5-MRSA-II and ST239-MRSAIII, were prevalent in both the initial visit (73% vs. 24%) and the follow-up visit (55% vs. 42%). Pulsed-field gel electrophoresis identified eight types, including two major types shared by both groups. We conclude that majority of MRSA strains from ear discharge of chronic otitis media belonged to nosocomial clones that might be circulating in the community. This is the first report of the genetic analysis of MRSA strains from otolaryngology practices in Korea.

The morphology of central tympanic membrane perforations.

The objective of this study was to assess the extent of conductive hearing loss in relation to different sizes and sites of simple central tympanic membrane perforations. Total 100 cases attending ENT OPD, BPKIHS during period of April 2003 to Mar 2004 without any discrimination of sex, race and religion were taken for the cross sectional prospective study. Dry, clean central tympanic membrane perforations due to various causes like chronic suppurative otitis media-tubotympanic, post acute suppurative otitis media residual perforations or simple traumatic perforations with conductive hearing loss and without preexisting hearing loss were clinicoaudiologically evaluated and analyzed. Hearing loss was found to be directly proportional to the size of perforation irrespective of their cause, which was statistically significant. Hearing loss in the study was found to range from negligible to 53dB. Overall, perforations involving posterioinferior quadrant were found to have maximum hearing loss.

Perda auditiva sensório-neural na otite média crônica supurativa em pacientes com e sem colesteatoma / Sensorineural hearing loss in chronic suppurative otitis media with and without cholesteatoma

Perda auditiva sensório-neural (PASN) relacionada a otite média crônica supurativa (OMCS) foi estudada para esclarecer a participação do colesteatoma nesse contexto. OBJETIVO: Avaliar ocorrência de PASN na OMCS, correlacionando com colesteatoma, duração da doença e idade. CASUÍSTICA E MÉTODOS: Estudo retrospectivo de 115 pacientes com OMCS com e sem colesteatoma submetidos à cirurgia. Incluíram-se pacientes com doença unilateral, orelha contralateral normal e idade inferior a 60 anos. RESULTADOS: Idade média foi de 26 anos, sendo 58 homens e 57 mulheres. Tempo médio de duração da doença otológica de 12,4 anos. Limiar auditivo médio foi de 40 dB na orelha com OMCS e 22dB na orelha normal (P=0,002). Observou-se colesteatoma em 78 dos 115 casos. Na orelha com OMCS, ocorreram 15 (13 por cento) casos de PASN, sendo 7 associadas à colesteatoma e 8 não associadas. Seis casos de PASN foram severa/profunda, correlacionando-se com idade ajustada (P=0,003), ausência de colesteatoma (P=0,01), mas não com duração da doença (P=0,458). CONCLUSÃO: PASN ocorreu em 13 por cento dos pacientes com OMCS, correlacionando-se com o aumento da idade, mas não com a presença de colesteatoma ou com maior duração da doença otológica.

Sensorineural hearing loss (SNHL) related to chronic suppurative otitis media (CSOM) was studied to clarify the involvement of cholesteatomas in this context. AIM: to evaluate SNHL related to CSOM and its association with cholesteatomas, disease duration and patients’ ages. METHODS: Retrospective analysis of 115 patients with CSOM with and without cholesteatoma submitted to surgical treatment. Inclusion criteria were active unilateral disease, normal contralateral ear and age below 60 years. RESULTS: The average age was 26.3 years, 58 males and 57 females. The duration of ear disease was, in average, 12.4 years. The average threshold of hearing was 40 dB in CSOM ear and 22 dB in the normal contralateral ear (P=0.002). CSOM with cholesteatoma occurred in 78 of 115 cases. In the abnormal ear, SNHL was seen in 15 cases, being 6 cases of profound loss, that correlated with adjusted-age (P=0.003) and absence of cholesteatoma (P=0.01), but not with disease duration (P=0.458). CONCLUSION: SNHL occurred in 13 percent of the patients with CSOM, and was correlated with older age, but not with the presence of cholesteatoma or longer duration of ear disease.

Size of typmanic membrane perforation and hearing loss.

This prospective study was done to assess the level of preoperative hearing impairment in different sizes of pars tensa perforation in patients with chronic suppurative otitis media (CSOM) tubo-tympanic type undergoing myringoplasty. A total of 50 patients were recruited from the outpatient Department of Otorhinolaryngology - Head and Neck Surgery from June 2003 to May 2004. Cases of CSOM tubo-tympanic type with dry central perforation, conductive type of hearing loss were subjected to myringoplasty. Preoperative audiometric evaluations were done. While operating under microscope diameter of perforations were measured and perforations were grouped according to the size. It was observed that greater hearing loss was reported in group D perforation (44 dB), where as in group A, it was 31 dBHL. The average hearing loss at 500 Hz was 46.40 dB, at 1000 Hz was 30.90 dB and at 2000 Hz it was 31.9 dB. This shows that the hearing loss is more at lower frequencies and less as the frequencies increase. This study shows that as the size of perforation is increased, the hearing loss also increases. The hearing loss is more marked at lower frequencies as compared to higher frequencies.

Extracranial complications of chronic suppurative otitis media.

The aim of this study was to find out the pattern of extracranial complications of CSOM cases who attended to the department of ENTD, Mymensingh Medical College Hospital during the period from July'1999 to June' 2001. Different types of extracranial complications of CSOM were presented here. A total of 100 cases, diagnosed clinically and radiologically were included in the study of which 66 were male and 34 were female giving a male to female ratio of 1.94 : 1 (p < 0.05). Majority cases (53) were in the age group of 11- 20 years followed by the age group of below 10 years where there were 30 cases. Majority (64) cases came from low socio-economic class. The number of different types of extracranial complications of CSOM were as follows: mastoid abscess 57, discharging sinuses 28, purulent labyrinthitis 07, Bezold's abscess 04, fascial nerve paralysis 03 and zygomatic abscess 01. In all cases of CSOM Cholesteatoma were detected. In 14 cases, Cholesteatoma were associated with granulation tissue/polyp. Modified radical mastoidectomy were performed in all cases. On analyzing the findings of the present study it was observed that mastoid abscess were the predominant extracranial complications of CSOM, affecting mostly the male population of 11 - 20 years age group coming from low socio-economic class.

Complicações intracranianas das otites médias crônicas supurativas em crianças / Intracranial complications of chronic suppurative otitis media in children

Apesar de sua significativa diminuição após o advento dos antibióticos, as complicações intracranianas das otites médias ainda representam uma situação de risco, uma vez que a taxa de mortalidade permanece alta, chegando a 36 por cento. Entre as formas mais comuns estão meningite, abscesso cerebral, abscesso extradural e tromboflebite do seio lateral. Um alto índice de suspeição é fundamental para seu diagnóstico e manejo precoces. É importante a identificação de casos atípicos que podem estar mascarados pelo uso de antimicrobianos. OBJETIVO: Apresentamos seis casos de complicações intracranianas por otite média em crianças e adolescentes ocorridos no período de dois anos no Serviço de Otorrinolaringologia do Complexo Hospitalar Santa Casa (CHSC). FORMA DE ESTUDO: relato de série.

A Case of Tympanogenic Labyrinthitis Complicated by Acute Otitis Media

Widespread use of antimicrobial drugs in the management of otitis media has significantly reduced the incidence of labyrinthitis nowadays. Cases of tympanogenic labyrinthitis following acute otitis media have rarely been reported in recent literature on otolaryngology. We report an unusual case of tympanogenic labyrinthitis that presented with sudden sensorineural hearing loss (SNHL) following acute otitis media in an adult who had no previous otological complaints. An audiogram revealed SNHL with pure tone threshold of 43.7 dB in the left ear. MRI was helpful to identify the inflammatory change of the membranous labyrinth. The patient's hearing returned to normal after treatment. The definite diagnosis of serous labyrinthitis was established retrospectively.

Otitis media crónica superada en niños / Chronic suppurative otitis media in children

La otitis media crónica supurada es una enfermedad del oído medio caracterizada por inflamación crónica de la mucosa del oído medio y mastoides, perforación de la membrana timpánica y otorrea. Para determinar las características clínicas de la OMC en niños se realizó un estudio prospectivo, longitudinal y descriptivo durante 3 meses en el Servicio de Otorrinolaringología del Hospital Nacional de Pediatría “Prof. Dr. J. P. Garrahan”. Población, material y métodos. De los pacientes asistidos en el Servicio de ORL se seleccionaron los que cumplían con los criterios diagnósticos de otitis media crónica: otorrea (permanente o intermitente) de más de tres meses de evolución, a través de perforación timpánica documentada por otomicroscopia. Se excluyeron aquellos con sospecha de colesteatoma, enfermedades tumorales, inmunodeficiencias primarias y secundarias, anomalías craneofaciales, síndromes genéticos y los que no concurrieron a controles posteriores. A todos se les realizó otomicroscopia, toma de material para cultivo y tratamiento local inicial con alcohol 70 boricado a saturación. Resultados. De 115 niños con otitis media crónica se incluyeron 96 en el estudio (51 por ciento [n igual 49] masc menos 49 por ciento [n igual 47] fem). Edad media: 77 más o menos 43,78 meses. El tiempo medio de otorrea fue de 12 meses (rango 1 menos 175 m). Presentaban sinusopatía maxilar 48 (50 por ciento) pacientes. La otitis crónica era bilateral en 33,3 por ciento (32) y unilateral en 66,7 por ciento (64). Microbiología: se aislaron 153 gérmenes del material aspirado de oído medio, 50 por ciento (48) de los cultivos fueron polimicrobianos. Las bacterias más comunes fueron Pseudomonas aeruginosa (53/153) y Proteus (33/153). Desarrollaron gérmenes anaerobios 18/153 cultivos. El tratamiento inicial con alcohol 70 boricado a saturación resolvió la otorrea en el 77 por ciento de los casos

Tympanoplasty for anterior perforation

This study included 25 patients having chronic mucosal suppurative otitis media with anterior perforation. The surgical closure of the anteriorly located tympanic membrane perforation can present a problem. Anterior canaloplasty together with a good support of the graft which is placed medial to the tympanic membrane remnant, lateral to the malleus and deep to the tympanomeatal flap anteriorly and posteriorly can increase the success rate. The success rate [determined by an intact tympanic membrane at the end of the follow up period, which was one year] was 96% with only one case presented with graft failure identified at two months postoperatively. The postoperative mean air-bone gap gain was 9.5 dB at the four frequencies tested. The use of this method was recommended on the repair of the anteriorly located tympanic membrane perforation

Screening of chronic suppurative otitis media in primary school children

This study was carried among schoolchildren aged 5-12 years of both sexes in the period from May 2001 to May 2002. One group [2080 children including 1244 males and 836 females] was selected from a rural area [El-Warrak and El-Monib] and the other group [1863 children including 944 males and 892 females] from an urban area [Roxi]. The incidence was found to be 0.11% in the urban area and 1.15% in the rural area. These figures reflected the urgent need for upgrading the public health services and medical care in the rural area

Gradenigo's syndrome--a rare complication of otitis media.

Petrous apicitis is a rare intracranial complication of otitis media. A 4-year-old female child was presented with persistent ear discharge, retro-orbital pain and lateral rectus palsy (triad of Gradenigo's syndrome). A right temporal burr-hole was placed and tapping was done under antibiotic coverage. Turbid cerebrospinal fluid could be drained. Follow-up could not be done as the patient refused treatment and was discharged against medical advice.

Comparative study between tubotympanic and atticoantral types of chronic suppurative otitis media.

This prospective study was done to compare the different aspects of tubotympanic (group I) and atticoantral types (group II) of chronic suppurative otitis media. The study included 200 patients of chronic suppurative otitis media, of them 100 were of tubotympanic type and 100 were with atticoantral disease. The age (mean +/- SD) of group I and II were 17 +/- 2.7 years and 12 +/- 2.3 years respectively (P < 0.05). The majority of the patients having poor socio-economic condition 69% in group I and 87% in-group II. In both groups, slum dwellers with bathing habit in pond or river and illiterate were more sufferer (P < 0.05). There was central perforation in all patients in-group I, and in-group II, 67% were with attic and 33% were with marginal perforations. In group I, aural discharge was mucoid or mucopurulent in majority of cases 80% and in-group II foul smelling scanty ear discharge was from 88% of subjects. In atticoantral type, hearing impairment was more than tubotympanic disease. Complications were more in atticoantral type of disease. In-group II, post auricular sinus 25% was the commonest extracranial complication followed by subperiosteal abscess 18%, and meningitis 10% was the commonest intracranial complication followed by brain abscess 8%. In tubotympanic type conservative treatment with reconstructive surgery were the treatment of choice, whereas radical or some modifications of radical surgery (with or without reconstruction) were the treatment plan for atticoantral disease. Among the groups the mortality rate was only 4% in-group II and was due to intracranial complications. The study recommends early detection and effective surgical treatment of the disease to improve the situation.