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.

Water protection in patients with tympanostomy tubes in tympanic membrane: a randomized clinical trial / Proteção auricular da água em pacientes com tubo de ventilação em membrana timpânica: ensaio clínico randomizado

ABSTRACT Objective To analyze the incidence of otorrhea in the postoperative period of patients submitted to tympanotomy to place ventilation tube, and who did not protect the ear when exposed to water. Methods Open, randomized-controlled trial. Eighty patients submitted to unilateral or bilateral ear grommet tympanostomy were included and divided into two groups: Auricular Protection and Non-Protection to water during bathing and activities in water. Results In the first postoperative month, the Non-Protection Group presented a significant increase in the number of patients with otorrhea and in the incidence. Four patients of the Protection Group (11%) presented at least one episode of otorrhea in this period, representing an incidence of 0.11 (standard deviation ±0.32) episode/month, whereas in the Non-Protection Group there were 12 episodes (33%; p=0.045) and incidence of 0.33 (±0.48; p=0.02). Between the 2nd and the 13th postoperative months, there was no difference between groups. Seven patients in the Protection Group (20%) had at least one episode of otorrhea, representing an incidence of 0.04 (±0.09) episodes/month, while in the Non-Protection Group there were seven episodes (22%; p=0.8) and incidence of 0.05 (±0.1; p=0.8). Conclusion Patients who underwent ear protection when exposed to water had a lower incidence of otorrhea in the first postoperative month than those who did not undergo protection. From the second month, there was no difference between groups.

RESUMO Objetivo Avaliar a incidência de otorreia no período pós-operatório em pacientes submetidos à timpanotomia para colocação de tubo de ventilação e que não realizaram proteção auricular quando expostos à água. Métodos Ensaio clínico controlado, aberto e randomizado. Foram incluídos 80 pacientes submetidos à timpanotomia para colocação de tubo de ventilação unilateral ou bilateral, divididos em dois grupos: Grupo Proteção e Grupo Não Proteção auricular da água durante o banho e as atividades aquáticas. Resultados No primeiro mês pós-operatório, o Grupo Não Proteção apresentou aumento significativo tanto no número de pacientes com otorreia quanto na incidência. Quatro pacientes do Grupo Proteção (11%) apresentaram ao menos um episódio de otorreia neste período, representando incidência de 0,11 (desvio padrão ±0,32) episódio/mês, enquanto no Grupo Não Proteção ocorreram 12 episódios (33%; p=0,045) e incidência de 0,33 (±0,48; p=0,02). Entre o 2º e o 13º meses pós-operatórios, não houve diferença entre os grupos. Sete pacientes do Grupo Proteção (20%) apresentaram ao menos um episódio de otorreia, representando incidência de 0,04 (±0,09) episódios/mês, enquanto no Grupo Não Proteção foram registrados sete episódios (22%; p=0,8) e incidência de 0,05 (±0,1; p=0,8). Conclusão Pacientes que realizaram a proteção auricular quando expostos à água apresentaram menor incidência de otorreia no primeiro mês pós-operatório do que aqueles que não a realizaram. A partir do segundo mês, não houve diferença entre os grupos.

Water protection after tympanostomy (Shepard) tubes does not decrease otorrhea incidence - retrospective cohort study / Proteção contra a água após colocação de tubos de ventilação (Shepard) não diminui a incidência de otorreia - estudo retrospectivo de coorte

Abstract Introduction Myringotomy for tube insertion is the most common otologic surgery. Otorrhea is a frequent complication of this procedure and, to prevent it, most surgeons strongly recommend avoiding contact with water as this is thought to adversely impact on post-operative quality of life. Objective To understand the benefit of this recommendation. Methods Observational study - retrospective cohort study comparing the incidence of post-operative otorrhea and its impact on patients' quality of life, in two groups of patients comprising children under 10 years of age who underwent bilateral myringotomy and tube placement for chronic otitis media with effusion between May 2011 and May 2012. One group received water protection care after surgery, the other did not. Data was collected through telephonic interview, after one year of follow up (one year after the procedure). Water exposure without protection was considered the exposure event. Incidence of otorrhea and perceived impact on quality of life were the outcome measures. Results were compared after logistic regression. Results We included 143 children: 116 were not exposed to water without protection and 27 were exposed. In the not exposed group 36.2% had at least one episode of otorrhea, compared to 40.0% of the exposed group. Odds ratio for otorrhea on exposed was 1.21 (95% CI 0.51-2.85, p = 0.6). Negative impact on quality of life was reported by parents of 48.2% on the not exposed children, compared to 40.7% on the exposed group. This difference was not significant (p = 0.5). Conclusion We found that recommending water protection did not have beneficial effect on the incidence of otorrhea after myringotomy with tubes on chronic otitis media with effusion. However, such measures did not appear to have a negative impact on quality of life. This is a populational observational study with few cases (143 cases); these final statements would be better stated by a very large populational study with another large control group.

Resumo Introdução A miringotomia para inserção de tubo de ventilação é a cirurgia otológica mais comum. Otorreia é uma complicação frequente deste procedimento e, para evita-la, a maioria dos cirurgiões recomenda evitar o contato com a água, pois acredita-se que isso possa afetar negativamente a qualidade de vida pós-operatória. Objetivo Verificar o benefício dessa recomendação. Método Estudo observacional - estudo de coorte retrospectivo, comparando a incidência de otorreia pós-operatória e seu impacto na qualidade de vida dos pacientes, em dois grupos de pacientes com crianças menores de 10 anos submetidas à miringotomia bilateral e colocação de tubo de ventilação para o tratamento de otite média crônica com efusão, entre maio de 2011 e maio de 2012. Um grupo recebeu cuidados de proteção contra a água após a cirurgia, o outro não. Os dados foram coletados através de entrevista telefônica, após um ano de seguimento (um ano após o procedimento). A exposição à água sem proteção foi considerada o evento de exposição. A incidência de otorreia e o impacto percebido na qualidade de vida foram as medidas de resultado. Os resultados foram comparados após a regressão logística. Resultados Incluímos 143 crianças: 116 não foram expostas à água sem proteção e 27 foram expostas. No grupo não exposto, 36,2% apresentaram pelo menos um episódio de otorreia, em comparação com 40,0% do grupo exposto. A razão de chances (odds ratio) para otorreia no grupo exposto foi de 1,21 (IC 95%: 0,51-2,85, p = 0,6). O impacto negativo na qualidade de vida foi relatado pelos pais de 48,2% nas crianças não expostas, em comparação com 40,7% no grupo exposto. Essa diferença não foi significante (p = 0,5). Conclusão Não verificamos um efeito benéfico sobre a incidência de otorreia ao recomendar a proteção contra a água após colocação de tubos de ventilação para otite média com efusão. Entretanto, tais medidas não parecem ter tido um impacto negativo na qualidade de vida.

Chronic Suppurative Otitis Media in urban private school children of Nepal / Otite Média Crônica Supurativa em crianças de uma escola particular urbana do Nepal

Chronic suppurative otitis media is one of the common ear diseases of the ear, particularly in childhood. It is the commonest cause of persistent mild to moderate hearing impairment in children and young adults. AIM: To find out the prevalence of chronic suppurative otitis media among school children studying in urban private schools of Nepal. MATERIAL AND METHODS: This study was carried out among 500 school children aged between 5 -15 years. Students were selected from urban private schools of four districts of Nepal. In all students, history was taken and otoscopic examination done from May 2006 to October 2006. Data were described using frequency and percentage. Study design: Prospective cross sectional study. RESULTS: Results showed that the prevalence of chronic suppurative otitis media in children studying in urban private schools of Nepal is 5.0 percent. Unilateral disease was seen in 72.0 percent, 76.0 percent had a tubotympanic disease and 24.0 percent had atticoantral disease. CONCLUSION: The prevalence of chronic suppurative otitis media in urban private school children in Nepal is higher than other studies done in private school children. Health education, improvement of socioeconomic status and health facilities will be helpful in reducing the prevalence of chronic suppurative otitis media.

Otite média crônica supurativa é uma das mais comuns doenças do ouvido, principalmente em crianças. É a causa mais comum de perda auditiva persistente leve a moderada em crianças e adultos. OBJETIVO: encontrar a prevalência de otite média crônica supurativa em crianças de escolas particulares urbanas do Nepal. MATERIAIS E MÉTODOS: este estudo envolveu 500 crianças escolares com idades entre 5 e 15 anos. Os estudantes foram selecionados de escolas particulares urbanas de quatro distritos do Nepal. Todas as crianças passaram por anamnese e exame otoscópico entre Maio e Outubro de 2006. Os dados foram descritos por meio de freqüência e porcentagem. Formato do estudo: transversal e prospectivo. RESULTADOS: os resultados mostraram que a otite média crônica supurativa em crianças de escolas particulares do Nepal é de 5,0 por cento. Doença unilateral esteve presente em 72,0 por cento; 76,0 por cento tiveram doença tubo-timpânica e 24,0 por cento tiveram doença ático-coanal. CONCLUSÃO: a prevalência de otite média crônica supurativa em crianças de escolas particulares urbanas do Nepal é maior do que aquele encontrado em outros estudos envolvendo crianças de escolas particulares. Educação em saúde, estado sócio-econômico e instalações de atenção à saúde serão úteis na redução da prevalência de otite média crônica supurativa.

Prevalence of CSOM among rural school going children.

A prospective study was carried out from January 2001 to December 2002 to find the prevalence of CSOM among rural school going children. Altogether 225 students aged 4-13 years from five primary schools and junior high schools of Magura district were interviewed and examined. 28 (12.44%) children were found to have CSOM. Out of these 28 cases, 25 came from lower and 3 from middle income group families. No case of CSOM was found in higher income group family. In this study 73.33% mothers were not aware of CSOM. 60% mothers had no knowledge about treatment and sequelae of CSOM. Only (5.78%) people use cotton bud to clean ear while majority use unhygienic materials like matchstick, cloth with stick and chicken feathers. Treatment seeking pattern was observed in our study. 10.71% cases did not receive any treatment and remaining 89.29% received treatment of which 25% from MBBS doctor or Hospital and 7.14%, 35.71%, 10.71%, 10.71% received it from Kabiraj, Quack, Homeopathy doctor, and salesman of pharmacy respectively.

Prevalence of chronic suppurative otitis media among the children living in two selected slums of Dhaka City.

Chronic Suppurative Otitis Media (CSOM) is one of the important health problems in our country. Serious complications may arise from it. As such the study was aimed to find out the prevalence of CSOM among the children of two-selected slum dwellers in Dhaka City. This was a descriptive type of cross-sectional study. A total of 203 samples were interviewed and examined. Altogether 7.39% of children were observed to have CSOM. Among CSOM cases, 60% had hearing impairment. Ear discharge and perforation were observed in 26.7% in right ear, 46.7% in left ear and 26.7% in both ears. Central perforation was present in 93% cases. Cholesteatoma was present in 6.7% cases. Among CSOM cases, 53.3% children were in 2-5 years age group, 80% were dependent, 53.3% cleaned ear by cotton buds, 93.3% lived in Kutcha house, 73.3% had a monthly income of TK. 1001-2000 and 46.7% belonged to families having 6 members. Out of 15 CSOM, 11 cases were seen among children of 141 illiterate mothers. Four cases of CSOM were found among children of 62 literate mothers. Among the 203 mothers, 65.52% were found aware, and 34.48% were not aware about the disease and sequel of CSOM. Here 39.9% mothers had knowledge and 60.01% had no knowledge about the treatment of CSOM. Among the CSOM cases 46.67% cases did not receive any treatment. In treatment receiving group, only 3(20%) children received it from MBBS doctor or Hospital.

Bacteriology in the chronic discharging ears in aligarh, India

Six hundred and ten cases of Chronic Suppurative Otitis media comprising of 380 males and 230 females were studies. The patients attended the out-patient department of ENT on bi-weekly basis during a period of two years at the Jowaharlal Nehru Medical College, Aligarh Muslim University, Aligarh. A total of 530 [86.88%] strains of different bacterial species were isolated as a single infecting micro-organism. The remaining eighty cases showed two bacterial species. Out of the total 610 bacterial isolates, Pseudomonas species accounted the highest 200 [32.78%] among isolates, followed by Staphylococcus aureus 130 [21.31%], Proteus mirabilis 80 [13.11%], Proteus vulgaris 20 [3.28%], Escherichia coli 80 [13.11%], Coagulase negative Staphylococcus 50 [8.19%], Klebsiella 30 [4.91%] and 10 each isolates of Streptococcus pyogenes and Alkaligenes faecalis. Antibiotic susceptibility patterns varied according to the isolates and Pseudonomas was found to be the most resistant of all the species

Atualizaçäo em otite média crônica supurada em crianças / Uptade in chronic suppurative otitis media in children

A otite média crônica supurada (OMCS) é uma doença bastante freqüente no nosso meio, necessitando muitas vezes intervençäo cirúrgica. Complicaçöes também podem ocorrer, às vezes fatais. Os autores apresentam Revisäo da Literatura dos últimos cinco anos da otite média crônica supurada, com enfoque para a doença na infância. Definem a otite média crônica supurada como otorréia persistente há mais de três meses, apresentando a incidência. Relatam os fatores de risco, a fisiopatologia para cronificaçäo do processo inflamatório, os agentes mais freqüentes, o diagnóstico clínico e a importância do estudo audiológico e de imagem, o tratamento clínico e cirúrgico, e as complicaçöes que podem decorrer da otite média crônica supurada, principalmente da colesteatomatosa.

predisposing factors of otitis in children

Our research was done on infants and children with acute or recurrent acute suppurative otitis media to study the significance of the different predisposing factors. The youngest infant subjected to this study was 2 months old, while the oldest child was 12 years old

Otitis medias crónicas en el infancia: formas de presentación / Otitis media chronic in the infancy: presentation forms

Se analizaron historias clínicas de niños con otitis medias crónicas, observando que este tipo de proceso en nuestro medio, hace su debut al 1er. año de vida con picos de máxima frecuencia, variables según la forma de presentación. Las otitis medias crónicas tipo II y III con grave compromiso de la estructura y función y con mayor índice de complicaciones fueron los más frecuentes (64%) y de aparición más temprana. Las imágenes radiológicas oscilaron entre lesiones mínimas en las otitis medias crónicas tipo I a trastornos morfológicos severos en las tipo II y III