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El concepto de biopelículas ha surgido de forma paulatina durante un largo período; se presentan como estructuras tridimensionales compuestas por células sésiles de microorganismos que crecen y se adhieren irreversiblemente a superficies, tanto vivas como inertes. Su capacidad de desarrollarse, tanto en superficies bióticas como abióticas, es una característica que los relaciona directamente con la salud humana. Distintas infecciones óticas se han inculpado a la presencia de biopelículas en las mucosas como en la otitis media con efusión, de igual forma se manifiestan en la aparición y persistencia de la otitis media crónica. Las biopelículas afines con otitis media, generalmente, contienen uno o múltiples especies de bacterias otopatógenas primarias. La comprensión de la biopelicula auxiliará el progreso de nuevas terapias y estrategias de control, al evitar enfermedades infecciosas ya que las bacterias formadoras de biopelículas son una seria amenaza para la salud pública debido a su alta resistencia a los antimicrobianos.
The concept of biofilms has emerged gradually over a long period; they appear as three-dimensional structures composed of sessile cells of microorganisms that grow and adhere irreversibly to surfaces, both living and inert. Their ability to develop, both on biotic and abiotic surfaces, is a characteristic that directly relates them to human health. Different ear infections have been blamed on the presence of biofilms on the mucous membranes, such as otitis media with effusion, in the same way they manifest themselves in the appearance and persistence of chronic otitis media. Otitis media-related biofilms generally contain one or multiple species of primary otopathogenic bacteria. The understanding of the biofilm will help us refine new therapies and control strategies, by avoiding infectious diseases since biofilm-forming bacteria are a serious threat to public health due to their high resistance to antimicrobials.
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Biofilmes , Otite Média Supurativa , OrelhaRESUMO
Objective:Through analysis of the sound energy absorbance of wideband acoustic immittance to provide a basis for differential diagnosis of adult acquired secondary cholesteatoma of the middle ear and patients with chronic suppurative otitis mediaï¼CSOMï¼. Methods:38 cases of cholesteatoma and 40 cases of CSOM admitted to the Department of Otolaryngology, Affiliated Hospital of Xuzhou Medical University from September 2020 to December 2021 were selected as the research group, and 30 cases ï¼60 earsï¼ of normal adults were selected as the control group. A total of 16 frequency points were selected, and the energy absorbance of wideband acoustic immittance was taken as the research parameter. The characteristics of energy absorbance under ambient pressure among the three are compared. Then the ROC in the cholesteatoma group was drawn, and by calculating the AUC, the Cut-off values and the corresponding sensitivity and specificity were found. Results:The energy absorbance in CSOM group at 1100-5700 Hz and the cholesteatoma group at 560-5700 Hz was lower than that in the control group, and the difference in some frequency bands was statistically significant. The energy absorbance in the cholesteatoma group at 226-7100 Hz was lower than that in the CSOM group, and the difference between the two groups in many frequency points was statistically significant. The ROC in the research group was drawn and it was found that the AUC in the 560, 710, 890, and 4500 bands was > 0.5, and in the other bands was > 0.7ï¼P<0.05ï¼. The AUC in the 2800 Hz was the largest ï¼0.78ï¼, the Cut-off value was 0.31, the corresponding sensitivity was 78.38%, specificity was 73.33%. Conclusion:Wideband acoustic immittance can be used as an auxiliary method for the differential diagnosis of adult-acquired secondary cholesteatoma of the middle ear and chronic suppurative otitis media in adults.
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Colesteatoma da Orelha Média , Otite Média Supurativa , Testes de Impedância Acústica , Acústica , Adulto , Colesteatoma da Orelha Média/diagnóstico , Diagnóstico Diferencial , Humanos , Otite Média Supurativa/diagnóstico , Infecção PersistenteRESUMO
Objective:To explore the distribution of pathogenic bacteria and drug sensitivity among patients with chronic suppurative otitis media. Methods:Patients with chronic suppurative otitis media who were hospitalized in the Department of Otolaryngology, People's Hospital, Peking University for surgery from January 1, 2019 to May 1, 2021 were enrolled as the subjects, then take the deep secretions of the external auditory canal for bacterial culture. Finally, the distribution and drug sensitivity of the pathogenic bacteria are analyzed. Results:A total of 126 patients were enrolled, of which 53 were culture-positive, and 57 strains of bacteria were isolated, including 47 strains of Gram-positive cocci, 10 strains of Gram-negative bacilli. Among Gram-positive cocci, 24 methicillin-sensitive staphylococcus aureusï¼MSSAï¼ strains, 7 methicillin-resistant staphylococcus aureusï¼MRSAï¼ strains, 14 coagulase-negative staphylococcus strains, 1 strain enterococcus faecium, and 1 strain otitis Zurich. 4 strainsï¼4/10ï¼ of pseudomonas aeruginosa among Gram-negative bacilli. Among them, MSSA has a high resistance rate to levofloxacin, moxifloxacin, clindamycin, and gentamicin, and high sensitivity to oxacillin, vancomycin, linezolid, and rifampin. MRSA is highly resistant to common antibiotics except vancomycin, rifampicin, and linezolid. The Gram-negative bacilli have higher resistance rates to levofloxacin, aztreonam, ciprofloxacin, ceftazidime, and piperacillin/tazobactam, and to meropenem, imipenem, amika star, cefepoxime, cefoperazone/sulbactam, and tobramycin are more sensitive. The results of univariable and multivariable analysis showed that age and bacterial infection were independent factors related to dry ears, and the duration of the disease history was a non-independent factor. Conclusion:The main pathogenic bacteria infections in patients with chronic suppurative otitis media are MSSA, MRSA, and pseudomonas aeruginosa. Whether it is combined with bacterial infection and age are independent factors related to whether patients with chronic suppurative otitis media could have dry ears. Therefore, patients with chronic suppurative otitis media should be treated with specific antibiotics or surgical interventions as soon as possible in combination with drug sensitivity results to avoid prolonging disease course or causing serious infectious complications.
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Staphylococcus aureus Resistente à Meticilina , Otite Média Supurativa , Preparações Farmacêuticas , Infecções Estafilocócicas , Humanos , Testes de Sensibilidade MicrobianaRESUMO
Objective:To analyze the causes of infected mastoid cavity after mastoidectomy and explore the key techniques of revision mastoidectomy. Methods:Ninety-two patients, who underwent revision mastoidectomy due to mastoid cavity infection after mastoidectomy were retrospectively analyzed. There were 56 cases of canal wall up mastoidectomy plus tympanoplasty and 36 cases of canal wall down mastoidectomy plus tympanoplasty in previous surgery. The interval between the previous operation and this revision ranged from 7 months to 50 years, with a median of 9 years. By reviewing the general clinical data, preoperative HRCT scan of temporal bone and intraoperative findings, the defects of the previous operation and the region of the lesion were analyzed and counted. Results:Out of the 92 cases, 7 casesï¼7.6%ï¼ had sigmoid sinus antedisplacement and low-lying middle cranial fossa, and 45 casesï¼48.9%ï¼ with facial nerve canal loss. Among the 36 patients who underwent canal wall down mastoidectomy and tympanoplasty, mastoid cells were removed in completely; 26 patients had high facial ridge, accounting for 72.2%ï¼26/36ï¼. The defects of the previous operation included: stenosis of external auditory meatusï¼65/92, 70.7%ï¼, obstruction of Eustachian tubeï¼11/92, 12.0%ï¼, and tympanitisï¼2/92, 2.2%ï¼. Residual or recurrent lesions were most common in mastoid process and tympanic sinusï¼50/92, 54.3%ï¼, followed by attic cell and anterior cavityï¼44/92, 47.8%ï¼, posterior tympanic cavityï¼29/92, 31.5%ï¼, perilabyrinthine cellsï¼13/92, 14.1%ï¼, sinus meningeal angleï¼13/92, 14.1%ï¼, cells behind the facial nerveï¼12/92, 13.0%ï¼, Eustachian tubeï¼10/92, 10.9%ï¼, and hypotympanumï¼9/92, 9.8%ï¼. Conclusion:The main causes of mastoid cavity infecion after mastoidectomy include incomplete removal of the lesion and inadequate drainage conditions. The key techniques of revisional mastoidectomy include disc-shaped operative cavity, skeletonization of mastoid process, reduction of facial nerve ridge, management of Eustachian tube and conchaplasty. The above techniques are also key in the first operation in order to improve the success rate of operation and avoid revision operation.
Assuntos
Colesteatoma da Orelha Média , Mastoidectomia , Colesteatoma da Orelha Média/cirurgia , Meato Acústico Externo , Humanos , Processo Mastoide/cirurgia , Mastoidectomia/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento , TimpanoplastiaRESUMO
BACKGROUND AND OBJECTIVES: To assess whether the audiological and clinical outcomes of type 0 tympanoplasty (T0) performed using cartilage were comparable with those of ossiculoplasty in patients who underwent canal wall down mastoidectomy (CWDM). SUBJECTS AND METHODS: This study included patients who had chronic otitis media with cholesteatoma and underwent CWDM with ossiculoplasty involving partial ossicular replacement prosthesis (PORP), total ossicular replacement prosthesis (TORP), or T0. Anatomical success rates and hearing outcomes were analyzed. RESULTS: Seventy-two patients were included in this study; 29 of them underwent CWDM with T0, 27 underwent CWDM with PORP, while 16 underwent CWDM with TORP. The difference in mean improvement in the air-bone gap (ABG) between the groups was not significant. The differences in the rates of ABG closure to ≤10 dB HL (p=0.030) and ≤20 dB HL (p=0.029) were significant. There were significant differences in improvements in the ABG at 3 kHz among the PORP, TORP, and T0 groups. CONCLUSIONS: The audiological outcomes of CWDM with ossiculoplasty seemed to be better than those of CWDM with T0 with no significant difference in the incidence of complications following ossiculoplasty and T0.
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Objective:To investigate the success rate, dry ear time and hearing improvement of myringoplasty on chronic suppurative otitis mediaï¼CSOMï¼ patients under dry and wet ear conditions. Method:Patients with CSOM who underwent endoscopic type â tympanoplasty between January 2018 and October 2019 in West China Hospital were prospectively enrolled. Before the operation, Ear HRCT, oto-endoscope and pure tone audiometry were completed. According to whether there was mucus and purulent secretion of middle ear accompanied with edema of tympanic mucosa, patients were divided into wet ear groupï¼32 casesï¼ and dry ear groupï¼69 casesï¼. All patients were followed up at half-month, 1 month and 3 months after surgery, with assessment of endoscopy and pure tone audiometry. SPSS 19.0 was used to compare the therapeutic effect of myringoplasty on different condition CSOM patients. Result:Compared with wet ear group, a higher level of perforation healing rate was found in dry ear group, but there was no significant difference between themï¼97.1% vs. 90.6%, P=0.367ï¼. The rate of dry ear was 98.6% and 93.7% in dry ear group and wet ear group respectively within three months after surgery, among which the rate of dry ear was 14.5%, 52.2% and 31.9% in dry ear group in half month, 1 month and 3 months after surgery, while that in wet ear group was 28.1%, 40.6% and 25.0% respectively. There was no significant difference in the time to dry ear after surgery between the two groupsï¼P=0.172ï¼. Meanwhile, changes of air bone gapï¼ABGï¼ between pre-operation and 3 months after operation in dry and wet ear groups was similar [ï¼9.87±1.08ï¼ dB vs. ï¼12.74±1.77ï¼ dB, P=0.154]. When included patients were analyzed as a whole, the ABG at 3 months was significantly lower than 1 month after operationï¼P<0.01ï¼, similar result was also found when compared the ABG at 1 month after operation with pre-operationï¼P<0.01ï¼. The air conduction threshold was improved from ï¼42.09±1.74ï¼ dB HL before operation to ï¼29.41±1.61ï¼ dB HL at 3 months after operationï¼P<0.01ï¼, however, there was no significant change in bone conduction thresholdï¼P=0.338ï¼. Conclusion:There is no significant difference in the therapeutic effect of myringoplasty on CSOM patients under dry and wet ear conditions. Direct type â tympanoplasty on wet ear patients has no adverse effect on the prognosis.
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Miringoplastia , Perfuração da Membrana Timpânica , China , Doença Crônica , Endoscopia , Humanos , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento , Perfuração da Membrana Timpânica/cirurgia , TimpanoplastiaRESUMO
Objective:To explore the application of simultaneous balloon Eustachian tuboplastyï¼BETï¼ in hearing reconstruction in patients with chronic suppurative otitis media. Method:Twenty-three patientsï¼23earsï¼ who diagnosesd as chronic suppurative otitis media and Eustachian tube dysfunction and underwent hearing reconstruction surgery were retrospectively enrolled, including 12 patientsï¼12 earsï¼ received BET + hearing reconstruction surgery as the case group, 11 patientsï¼11 earsï¼ received hearing reconstruction surgery as the control group. All patients underwent Eustachian tube function scoreï¼ETSï¼ and pure tone audiometry before the surgery and one year after the surgery. The subjective improvement degree of symptoms such as ear fullness, muffled hearing, tinnitus and hearing loss were investigated. The differences in test results between the two groups were analyzed. Result:There was no statistically significant difference in ETS and pure tone audiometry between the two groups before the surgeryï¼P>0.05ï¼. The preoperative ETS and postoperative ETS of the case group were 3.75±2.42 and 6.58±2.19, compared to 3.18±1.99 and 4.27±1.79 of the control group. ETS of two groups were improved after surgeryï¼P<0.01ï¼, and the improvement degree of the case group was better than that of the control groupï¼P<0.05ï¼. The preoperative air conduction hearing threshold, bone conduction hearing threshold and air bone gap of the case group wereï¼65.17±11.56ï¼ dB, ï¼24.25±12.96ï¼ dB, ï¼40.92±12.17ï¼ dB, and decreased toï¼30.58±6.40ï¼ dB, ï¼23.67±9.74ï¼ dB, andï¼6.92±12.00ï¼ dB after surgery. The preoperative air conduction hearing threshold, bone conduction hearing threshold and air bone gap of the control group wereï¼63.55±9.74ï¼ dB, ï¼22.64±8.61ï¼ dB, ï¼40.91±9.83ï¼ dB, and decreased to ï¼41.45±15.50ï¼ dB, ï¼25.73±8.52ï¼ dB, ï¼15.73±11.20ï¼ dB after surgery. The air conduction hearing threshold and air bone gap of the two groups were improved after surgeryï¼P<0.01ï¼, and the postoperative air conduction threshold of the case group was significantly lower than that of the control groupï¼P<0.05ï¼. In the follow-up questionnaire results, the subjective improvement degree of ear fullness, muffled hearing and hearing loss in the case group was higher than that of the control groupï¼P<0.05ï¼. Conclusion:In patients with chronic suppurative otitis media and Eustachian tube dysfunction, simultaneous BET and hearing reconstruction surgery can effectively increase the patients' hearing improvement degree, and can improve the Eustachian tube function and subjective symptoms.
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Tuba Auditiva , Otite Média Supurativa , Otite Média , Tuba Auditiva/cirurgia , Audição , Humanos , Otite Média Supurativa/cirurgia , Estudos Retrospectivos , TimpanoplastiaRESUMO
Endoscopic ear surgery has been applied in therapy of chronic suppurative otitis media and middle ear cholesteatoma these years. Offering a minimally invasive approach, it requires more experience and skills. The comparative outcomes of endoscopic and microscopic tympanoplasty remains unclear. Therefore, this article summarizes clinical research results of two surgical approaches, hoping to provide references for choice of endoscopy on treatment of chronic suppurative otitis media and middle ear cholesteatoma.
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Colesteatoma da Orelha Média , Otite Média Supurativa , Colesteatoma da Orelha Média/cirurgia , Endoscopia , Humanos , Otite Média Supurativa/cirurgia , Procedimentos Cirúrgicos Otológicos , TimpanoplastiaRESUMO
Objective:To evaluate hearing outcome and complications of one-stage tympanoplasty in patients with stapes fixation due to tympanosclerosis. Method:59 patientsï¼sixty-one earsï¼ underwent one-stage tympanoplasty for stapes fixation due to tympanosclerosis were retrospectively analyzed. Stapes fixation due to tympanosclerosis were proved during the surgery in these patients diagnosed with chronic otitis media. For all the patients, tympanosclerotic plaques around stapes were removed for stapes mobilization. Then the ossicular chain was rebuilt by autogenous incus or PORP. The pre-and post-operative audiometric resultsï¼500 Hz, 1 kHz, 2 kHz and 4 kHzï¼ were evaluated for each patient. Improvement of pure-tone average more than 10 dB postoperatively were accepted as success criteria. Result:Complications included temporary facial paralysisï¼1/61ï¼, temporary vertigoï¼2/61ï¼, mild elevation in bone conduction thresholdsï¼2/61ï¼ and delayed healing of tympanic membraneï¼1/61ï¼. Postoperativeï¼1 and 3 monthsï¼ bone conduction thresholds improved at frequencies of 1 and 2 kHzï¼P<0.01ï¼. Postoperativeï¼1 and 2 yearsï¼ air conduction thresholds improved at all frequenciesï¼P<0.01 or P<0.05ï¼. A gain ≥10 dB in pure-tone average was found in 44ï¼72.13%ï¼ patients at 1 year after surgery. The air conduction levels were significantly improved in both autogenous incus and PORP groupsï¼P<0.01ï¼. There was no difference about success rate between these two groupsï¼P>0.05ï¼. Conclusion:For patients with stapes fixation due to tympanosclerosis, one-stage tympanoplasty can improve hearing threshold though ossicular chain reconstruction and stapes release. The major complications such as facial paralysis and sensorineural hearing loss should be avoided by delicate surgical operation.
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Miringoesclerose/cirurgia , Prótese Ossicular , Cirurgia do Estribo , Humanos , Estudos Retrospectivos , Estribo , Resultado do Tratamento , TimpanoplastiaRESUMO
Objective:A retrospective analysis of audiologic outcome and graft take rate on post-tympanoplasty with different middle ear mucosal conditions in wet ear. Method:According to the characteristics of middle ear mucosal condition and residual eardrum, 80 cases with wet ear of chronic suppurative otitis media were divided into the hydrocele group, the swelling group and the granulation group. The factors in different groups, including gender, age, disease course, sides, size and location of perforations, destruction of ossicular chain and reconstruction methods were analyzed. Moreover, postoperative hearing improvement and graft take rate were compared among the three groups. Result:There was no significant difference in gender, age, disease course, sides, size and location of perforations among the hydrocele group, the swelling group and the granulation group ï¼P>0.05ï¼. Overall, the postoperative average Air-Bone Gapsï¼ABGï¼ were reduced in all wet ear patients after surgery ï¼P<0.01ï¼. The ABG was decreased from ï¼25.5 ± 10.8ï¼ dB toï¼15.4 ± 9.4ï¼ dB in the hydrocele group, and decreased from ï¼27.6 ± 8.7ï¼ dB to ï¼15.2 ± 9.6ï¼ dB in the swelling group, and from ï¼29.5 ± 7.7ï¼ dB to ï¼17.2 ± 17.2ï¼ dB in the granulation group. The graft take rates were 90.0% in totally. There were no significant difference in graft take rates among the three groups, and 84.6% in the hydrocele group, 93.3% in the swelling group and 100.0% in the swelling groupï¼P>0.05ï¼. Conclusion:Wet ear is not an absolute contraindication of tympanoplasty for chronic suppurative otitis media. Whether there was effusion, swelling or granulomatous hyperplasia in the tympanoplasty, the patients'hearing improved significantly after tympanoplasty, and the healing rate of the tympanoplasty did not decrease. Further basic and clinical studies are needed to standardize the timing of wet ear surgery, clarify the operative contraindication and elucidate the pathophysiological mechanism of eardrum healing.
Assuntos
Otite Média com Derrame/cirurgia , Timpanoplastia , Doença Crônica , Orelha Média/patologia , Humanos , Estudos Retrospectivos , Resultado do Tratamento , Membrana TimpânicaRESUMO
OBJECTIVE: To correlate pre-operative computed tomography findings, intra-operative details and surgical outcomes with cholesteatoma recurrence in revision tympanomastoidectomy. METHODS: This retrospective, non-randomised, single-institution cohort study included 42 patients who underwent pre-operative computed tomography imaging and revision surgery for recurrent chronic otitis media. Twelve disease localisations noted during revision surgery were correlated with pre-operative temporal bone computed tomography scans. A matched pair analysis was performed on patients with similar intra-operative findings, but without pre-operative computed tomography scans. RESULTS: Pre-operative computed tomography identified 25 out of 31 cholesteatoma recurrences. Computed tomography findings correlated with: recurrent cholesteatoma when attic opacification and ossicular chain involvement were present; and revision surgery type. Sinodural angle disease, posterior canal wall erosion and dehiscent dura were identified as predictors of canal wall down tympanomastoidectomy. Patients with pre-operative computed tomography scans had a higher rate of cholesteatoma recurrence, younger age at diagnosis of recurrent disease, more revision surgical procedures and less time between previous and revision surgical procedures (all p < 0.05). CONCLUSION: Pre-operative imaging and intra-operative findings have important clinical implications in revision surgery for chronic otitis media. Performing pre-operative computed tomography increases diagnosis accuracy and reduces the time required to diagnose recurrent disease.
Assuntos
Colesteatoma/diagnóstico por imagem , Colesteatoma/cirurgia , Mastoidectomia/métodos , Ventilação da Orelha Média/métodos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Colesteatoma/patologia , Doença Crônica , Terapia Combinada/métodos , Feminino , Humanos , Cuidados Intraoperatórios , Masculino , Mastoidectomia/estatística & dados numéricos , Pessoa de Meia-Idade , Ventilação da Orelha Média/estatística & dados numéricos , Otite Média/diagnóstico por imagem , Otite Média/cirurgia , Período Pré-Operatório , Recidiva , Reoperação/métodos , Estudos Retrospectivos , Osso Temporal/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
Objective@#A retrospective analysis of audiologic outcome and graft take rate on post-tympanoplasty with different middle ear mucosal conditions in wet ear. @*Method@#According to the characteristics of middle ear mucosal condition and residual eardrum, 80 cases with wet ear of chronic suppurative otitis media were divided into the hydrocele group, the swelling group and the granulation group. The factors in different groups, including gender, age, disease course, sides, size and location of perforations, destruction of ossicular chain and reconstruction methods were analyzed. Moreover, postoperative hearing improvement and graft take rate were compared among the three groups. @*Result@#There was no significant difference in gender, age, disease course, sides, size and location of perforations among the hydrocele group, the swelling group and the granulation group (P>0.05). Overall, the postoperative average Air-Bone Gaps(ABG) were reduced in all wet ear patients after surgery (P<0.01). The ABG was decreased from (25.5 ± 10.8) dB to(15.4 ± 9.4) dB in the hydrocele group, and decreased from (27.6 ± 8.7) dB to (15.2 ± 9.6) dB in the swelling group, and from (29.5 ± 7.7) dB to (17.2 ± 17.2) dB in the granulation group. The graft take rates were 90.0% in totally. There were no significant difference in graft take rates among the three groups, and 84.6% in the hydrocele group, 93.3% in the swelling group and 100.0% in the swelling group(P>0.05). @*Conclusion@#Wet ear is not an absolute contraindication of tympanoplasty for chronic suppurative otitis media. Whether there was effusion, swelling or granulomatous hyperplasia in the tympanoplasty, the patients'hearing improved significantly after tympanoplasty, and the healing rate of the tympanoplasty did not decrease. Further basic and clinical studies are needed to standardize the timing of wet ear surgery, clarify the operative contraindication and elucidate the pathophysiological mechanism of eardrum healing.
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A retrospective analysis of audiologic outcome and graft take rate on post-tympanoplasty with different middle ear mucosal conditions in wet ear. According to the characteristics of middle ear mucosal condition and residual eardrum, 80 cases with wet ear of chronic suppurative otitis media were divided into the hydrocele group, the swelling group and the granulation group. The factors in different groups, including gender, age, disease course, sides, size and location of perforations, destruction of ossicular chain and reconstruction methods were analyzed. Moreover, postoperative hearing improvement and graft take rate were compared among the three groups. There was no significant difference in gender, age, disease course, sides, size and location of perforations among the hydrocele group, the swelling group and the granulation group (>0.05). Overall, the postoperative average Air-Bone Gaps(ABG) were reduced in all wet ear patients after surgery (0.05). Wet ear is not an absolute contraindication of tympanoplasty for chronic suppurative otitis media. Whether there was effusion, swelling or granulomatous hyperplasia in the tympanoplasty, the patients'hearing improved significantly after tympanoplasty, and the healing rate of the tympanoplasty did not decrease. Further basic and clinical studies are needed to standardize the timing of wet ear surgery, clarify the operative contraindication and elucidate the pathophysiological mechanism of eardrum healing.
RESUMO
RESUMEN Fundamento: la otitis media crónica es causa importante de morbilidad, deterioro auditivo e ingresos hospitalarios debido a recurrencias y complicaciones, donde la mastoidectomía radical modificada la técnica adecuada para lograr resultados anatómicos y funcionales. Objetivo: describir los resultados de la mastoidectomía radical modificada en pacientes con otitis media crónica supurada. Métodos: se realizó un estudio descriptivo retrospectivo, longitudinal en 54 pacientes con otitis media crónica, a los que se les realizó mastoidectomía radical modificada. Las variables objeto de estudio fueron de caracterización clínica y epidemiológica y los resultados se evaluaron en excelente, bueno, regular y malo. Los datos fueron procesados utilizando la estadística descriptiva para distribución de frecuencias absolutas y relativas, y se reflejaron en tablas. Resultados: el mayor número de operados fue del sexo masculino, entre la tercera y cuarta década de la vida; la hipoacusia, otorrea y perforación timpánica fueron las manifestaciones más frecuentes. La imagen tumoral e hipoacusia conductiva y la Pseudomona aeruginosa, se hallaron con mayor frecuencia. La mastoidectomía con timpanoplastia tipo III por lisis de los huesecillos, cavidades limpias, amplias, muros bajos e injerto íntegro, permitió que la mayoría de los pacientes tuvieran buenos resultados anatómicos y funcionales, y las complicaciones fueron escasas. Conclusiones: la técnica utilizada fue la mastoidectomía radical modificada, asociada a timpanoplastia tipo III y predominaron los resultados excelentes, buenos y regulares en los enfermos operados.
ABSTRACT Background: chronic media otitis is an important cause of morbidity, hearing impairment and hospital admissions due to recurrences and complications, with modified radical mastoidectomy being the appropriate technique to achieve anatomical and functional results. Objective: to describe the results of the modified radical mastoidectomy in patients with suppurative chronic media otitis. Methods: a retrospective, longitudinal descriptive study in 54 patients with chronic media otitis, who underwent modified radical mastoidectomy. The variables under study were of clinical and epidemiological characterization and the results were evaluated as excellent, good, fair and bad. The data were processed using descriptive statistics for distribution of absolute and relative frequencies, and were reflected in tables. Results: the largest number of patients was male, between the third and fourth decade of life; hearing loss, otorrhea and tympanic perforation were the most frequent manifestations. The tumor image and conductive hearing loss and Pseudomonas aeruginosa were found more frequently. The mastoidectomy with tympanoplasty type III by lysis of the ossicles, clean, wide cavities, low walls and intact graft, allowed the majority of patients to have good anatomical and functional results, and complications were scarce. Conclusions: the technique used was modified radical mastoidectomy, associated with tympanoplasty type III and excellent, good and regular results prevailed in the operated patients.
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Summary To analyze the clinical features of IgG4-related diseases mainly with otologic manifestations and investigate diagnosis and treatment of IgG4-related diseases. We report the clinical course and diagnosis and treatment process of a case of IgG4-related disease misdiagnosed as chronic suppurative otitis media. After looking through relevant literatures, we review 22 cases of IgG4-related diseases mainly with otologic manifestations, and summarize their epidemiological characteristics, clinical manifestations, histopathologic features, radiologic features, and diagnostic and therapeutic criteria. IgG4-related diseases mainly with otologic manifestations are usually clinically characterized by atypical symptoms such as otalgia, tinnitus, aural fullness, otorrhea and progressive or fluctuating hearing loss, together with nausea, vomiting, and dizziness. The three central histopathologic features are dense lymphoplasmacytic infiltration, storiform fibrosis and obliterative phlebitis. The exact diagnosis of IgG4-related diseases requires a combination of clinical manifestations, serology, histopathology and radiologic results. Glucocorticoids are currently the first-line approach for IgG4-related diseases. Otologic manifestations involved in IgG4-related diseases are poorly specific, which is likely to result in more misdiagnosis and treatment delay. Current golden standard for diagnosing IgG4-related diseases is the identification of characteristic histopathology. In addition, immunohistochemistry can help clinicians diagnose IgG4-related diseases as early as possible. Otologists should strengthen their understanding of otologic manifestations of IgG4-related diseases. Early diagnosis and treatments are the key factors in prognosis.
Assuntos
Pavilhão Auricular/fisiopatologia , Perda Auditiva/etiologia , Doença Relacionada a Imunoglobulina G4/complicações , Doença Relacionada a Imunoglobulina G4/diagnóstico , Fibrose , Glucocorticoides/uso terapêutico , Humanos , Imuno-Histoquímica , PrognósticoRESUMO
Summary To study the clinical features, diagnosis and treatments of tuberculous otomastoiditis. One case is reported and literatures are reviewed. In this report, the specimen of the middle ear revealed the presence of acid fast bacilliï¼AFBï¼, grew mycobacterium tuberculosis on a culture. Lung CT scans demonstrated tuberculosis. After anti-tuberculosis therapy, the symptoms disappeared and did not recur in 3 years. Hydrotympanum can be the early symptom of tuberculous otomastoiditis. When persistent otorrhea can not be improved by conventional therapy, tuberculous otomastoiditis should be considered as one of the differential diagnosis.
Assuntos
Mastoidite/diagnóstico , Otite Média com Derrame/etiologia , Tuberculose/diagnóstico , Orelha Média/microbiologia , Orelha Média/patologia , Humanos , Mycobacterium tuberculosis/isolamento & purificação , Tomografia Computadorizada por Raios XRESUMO
Objective: To investigate the influences of preoperative secretions of the patients with chronic suppurative otitis media and/or middle ear cholesteatoma on the time to have dry ears after the operations. Method: The study enrolled 228 patients with chronic suppurative otitis media and/or middle ear cholesteatoma who received modified radical mastoidectomies and tympanoplasty. The patients were divided into two groups based on whether there were secreions in the surgical ear before the operations. The time to have dry ears after surgeries were compared between the two groups. Result: The time to have dry-ear postoperatively was significantly different between patients with different preoperative microbial types of surgical ear secretions(P<0.05). The dry ear time was(2.24±1.83) months in the secretion-free group, (2.22±1.96) months in the normal bacteria group of oral cavity and skin,(3.00±2.51) months in the single non-resistant bacteria group, (3.82±2.78) months in the fungal group and (6.82±1.83) months in the compound or multi-drug resistant bacteria group. The dry ear time of compound bacteria group or multi-drug resistant bacteria group was significantly longer than that of the other groups(P<0.05). The time to have dry ears of the fungus group was longer than that of the non-drug resistant bacteria, the normal oral and skin flora and the secretion free group(P<0.05). Chi-square test results showed that there was a significant difference in postoperative dry ear rate among patients with different preoperative secretions classification(P<0.05). Conclusion: The presence of secretion and microorganism type in ear before operation is an important influencing factor of postoperative time to have dry ears. Microbiological culture and appropriate medication based on the drug sensitivity tests are beneficial for the postoperative recovery of patients with chronic suppurative otitis media and/or middle ear cholesteatoma.
Assuntos
Colesteatoma da Orelha Média/cirurgia , Otite Média Supurativa/cirurgia , Doença Crônica , Humanos , Mastoidectomia , Fatores de Tempo , TimpanoplastiaRESUMO
BACKGROUND: To validate and evaluate the reliability of the Dutch version of the Chronic Ear Survey (CES) in patients suffering from Chronic Suppurative Otitis Media (CSOM) and to evaluate clinical outcomes of surgery using this questionnaire. METHODS: We developed the Dutch version of the CES (D-CES) using forward-backward translation of the original CES into the Dutch language. Next, patients with CSOM and controls completed the D-CES pre- and postoperatively. Internal consistency, test-retest reliability, known-group validity and convergent validity were evaluated. In addition to the D-CES, the Short Form 36 (SF-36) was administered to all participants to correlate D-CES data to quality of life. RESULTS: A total of 29 patients with CSOM scheduled for ear surgery were included. Our control group consisted of 26 patients scheduled for eye surgery, all without signs and symptoms of CSOM. Cronbachs' α of the complete questionnaire was 0.69. The Intraclass Correlation Coefficients (ICCs), reflecting test-retest reliability, ranged between 0.69 and 0.82. Scores differed significantly between CSOM patients and controls with substantial lower (more impaired) D-CES scores in the CSOM group. Duration of complaints preoperatively and the presence of a dry ear and/or improvement of hearing postoperatively all had a significant impact on D-CES improvement scores. Small to moderate correlations were found between D-CES subscales and matching subscales of the SF-36. CONCLUSION: The D-CES is an appropriate disease specific questionnaire to assess a patient's perceived functional health in CSOM.
Assuntos
Otite Média Supurativa/psicologia , Qualidade de Vida , Inquéritos e Questionários/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Otite Média Supurativa/cirurgia , Reprodutibilidade dos Testes , Traduções , Adulto JovemRESUMO
BACKGROUND: Surgery for chronic suppurative otitis media performed in low- and middle-income countries creates specific challenges. This paper describes the equipment and a variety of techniques that we find best suited to these conditions. These have been used over many years in remote areas of Nepal. RESULTS AND CONCLUSION: Extensive chronic suppurative otitis media is frequently encountered, with limited pre-operative investigation or treatment possible. Techniques learnt in better-resourced settings with good follow up need to be modified. The paper describes surgical methods suitable for resource-poor conditions, with rationales. These include methods of tympanoplasty for subtotal wet perforations, hearing reconstruction in wet ears and open cavities, large aural polyps, and canal wall down mastoidectomy with cavity obliteration. Various types of autologous ossiculoplasty are described in detail for use in the absence of prostheses. The following topics are discussed: decision-making for surgery on wet or best hearing ears, children, bilateral surgery, working with local anaesthesia, and obtaining adequate consent in this environment.
RESUMO
Objective@#To investigate the effect of endoscopic tympanic membrane repair in the clinical treatment of patients with chronic suppurative otitis media with tympanic membrane perforation.@*Methods@#From November 2014 to September 2018, 72 patients with chronic suppurative otitis media with tympanic membrane perforation in Taizhou Central Hospital were divided into control group and observation group according to different treatment methods, with 36 cases in each group.The control group underwent microsurgical tympanic membrane repair, the observation group underwent endoscopic tympanic membrane repair.The bleeding volume and operation time of the two groups were compared.The pain degrees of the two groups were evaluated by numerical simulation scale (VAS). The postoperative hospital stay and complications were recorded.The postoperative follow-up of 6 months was used to evaluate the aesthetics of the two groups.The hearing improvement status and treatment effect of the two groups were evaluated.@*Results@#The average surgical bleeding volume of the observation group was (6.14±1.25)mL, which was significantly less than that of the control group [(19.87±2.65)mL], and the operation time was (75.69±2.54)min, which was significantly shorter than that of the control group [(102.34±3.69)min](t=28.116, 35.694, all P<0.05). The VAS score of the observation group was (2.34±0.62)points, which was significantly lower than that of the control group [(3.59±0.85)points](t=7.128, P<0.05). The average length of hospital stay in the observation group was (4.89±1.25)d, which was significantly shorter than that in the control group [(9.18±1.36)d](t=13.935, P<0.05). The incision satisfaction of the observation group was significantly higher than that of the control group(P<0.05). The improvement in hearing of the observation group was (22.058±10.129)dB, which of the control group was (21.695±9.764)dB, the difference was not statistically significant (P=0.487). The effective rate of the observation group was 94.44%(34/36), which of the control group was 91.67%(33/36) (χ2=3.598, P=0.165). The incidence rate of complications in the observation group was 2.78%(1/36), which was significantly lower than 16.67%(6/36) in the control group(χ2=3.956, P=0.046).@*Conclusion@#Chronic suppurative otitis media tympanic membrane perforation patients treatment with endoscopic tympanic membrane repair is more effective, and the surgical method is better after surgery, so it is more acceptable to patients, it is worthy of promoting.