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Frequency of un-safe chronic suppurative otitis media in patients with discharging ear

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OBJECTIVE: To determine the frequency of un-safe chronic suppurative otitis media and its complications in patients with chronic discharging ear. METHODS: This study was carried out in the Department of Otorhinolaryngology, Civil Hospital Karachi, Sindh - Pakistan between January 2004 and June 2006. This study included 390 cases of chronic discharging ears attending out patient department. All were examined according to protocol, and relevant investigations were carried out. 107 cases underwent mastoid exploration and were observed for cholesteatoma, granulations, aural polyps and their complications. A structured questionnaire was designed to record all information which was later analyzed. RESULTS: Majority of patients was belonging to poor families. Female-male ratio was 1.2:1. Age range was between 6 months and 70 years. Most of the patients presented with discharging ears. Central perforation was seen in 89% cases. One hundred seven cases (27.5%) underwent mastoid exploration, in which cholesteatoma was found in 11.5% cases. Ossicular damage was the commonest complication in all cases having cholesteatoma, while 1% cases presented with mastoid abscess, 1.5% with exposed facial nerve, 1.2% with exposed sigmoid sinus and 0.25% with Bezold abscess. Intracranial complications were seen in nine patients. CONCLUSION: Cholesteatoma was found to be associated with most of the complications in cases of un-safe type of C.S.O.M. The complication rate in this study is lesser than that observed in our neighboring countries like Bangladesh, but still higher as compared to the developed countries. Cholesteatoma was also found in two cases having central perforation which is unusual presentation.

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... In our study, 56% patients were males and 44% were females with a male female ratio of 1 20 Islam et al, 21 Salman et al, 22 Sachdeva et al 23 27 In our study 72% patients were from rural area and 28% were from urban area. Socio-demographic distribution of our study correlates with study of Baig et al, 18 Islam et al, 21 Okafor, 24 Memon et al 25 and Berron 26 with majority of patients from rural background. ...
... Majority of patients (89%) in our study had central or total perforation and 11% had marginal or attic perforation. Our study coincides with study of Memon et al 25 with majority of central perforations. ...
... In 11% patients features of bone destruction were present. Our study coincides with study of Baig et al, 18 Memon et al. 25 In our study 4% patients had complications. Mastoid abscess was found in 2%, meningitis in 1% and facial nerve palsy in 1% patients. ...
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BACKGROUND: Chronic suppurative otitis media (CSOM) is the chronic inflammation of the middle ear cleft and mastoid cavity which presents with recurrent ear discharge. Mastoid exploration is required to remove the bone destroying cholesteatoma, to exenterate the infected mastoid air cells and to remove the infected and hypertrophied middle ear mucosa. Mastoid exploration is needed for unsafe CSOM with or without complications, safe CSOM with blocked aditus and not responding to conservative treatment. AIMS AND OBJECTIVES: To evaluate history, clinical features, clinical examination including otoscopic and microscope and radiological investigations to find out the need of mastoid exploration. MATERIAL AND METHODS: In this study 100 patients of CSOM were included without any due consideration for a particular type of CSOM, particular age or sex. Patients with history of traumatic perforation, hearing loss without ear discharge were excluded. Detailed history, clinical examination, routine and special investigations were done. Then by evaluating history, clinical features, clinical examination and investigations, we had find out the need of mastoid exploration. OBSERVATIONS: Majority of patients were males (56%) with a male female ratio of 1.27. Highest incidence of CSOM was found in 3rd decade (27%) and 63% patients were in 0- 30 years age group. Majority of patients (72%) were from rural background and were farmers. Otorrhoea was found in all patients and decreased hearing in 87% patients. Most of the tympanic membrane perforations were central or total (89%) and attic or marginal were only 11%. Clinically safe disease was found in 89% patients and unsafe in 11%. Lytic lesions on CT scan were found in 11%. Good response to conservative treatment was seen in 81% patients. Mastoid exploration was required in all unsafe cases and in 8 safe disease cases, so total 19% cases required mastoid exploration. CONCLUSION: It was concluded that all cases of unsafe disease and medically non responding cases of safe disease with blocked aditus and faulty ventilation required mastoid exploration. Improvement of socioeconomic status of people, early recognition and treatment of CSOM can reduce the number of cases and complications, thus decreasing the requirement of mastoid exploration.
... Similar presentation & duration have been reported from various studies. [12][13][14] Unilateral disease was more common in the present study and similar result was reported in various studies. [14,15] Majority of the patients in our study had central perforation (47.5%) followed by 15.6% cases with subtotal perforation. ...
... [12][13][14] Unilateral disease was more common in the present study and similar result was reported in various studies. [14,15] Majority of the patients in our study had central perforation (47.5%) followed by 15.6% cases with subtotal perforation. The result closely resembles to that of studies reported by Memon et al. [14] & Nagle SK et al. [16] It was also noted from our observation that central perforation commonly caused mild hearing loss (41.9% cases) whereas subtotal & postero-superior marginal perforation resulted in moderate hearing loss and attic perforation in squamous COM is associated with severe hearing loss. ...
... [14,15] Majority of the patients in our study had central perforation (47.5%) followed by 15.6% cases with subtotal perforation. The result closely resembles to that of studies reported by Memon et al. [14] & Nagle SK et al. [16] It was also noted from our observation that central perforation commonly caused mild hearing loss (41.9% cases) whereas subtotal & postero-superior marginal perforation resulted in moderate hearing loss and attic perforation in squamous COM is associated with severe hearing loss. Studies by various authors have reported that air bone gap is positively correlated with the size of the perforation. ...
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Background: Chronic otitis media (COM) is the commonest disorder in Otorhinolaryngology practice, characterized by chronic inflammation of the middle ear cleft and mastoid cavity which presents with recurrent ear discharge and deafness. It results in considerable morbidity and may even cause extra-cranial and intra-cranial complications. Infections of the middle ear and complications caused by COM, are still a major public health problem in the developing countries like India. It is one of the main causes for preventable hearing loss when treated appropriately.
... Mansoor et al [10] (2009) reported a female preponderance (52%) with male: female ratio of 1: 1.08. Memon et al [11] (2008) also showed a female preponderance (55.9%) with male: female ratio of 1: 1.2 ...
... Unilateral involvement was seen in 64% cases, while both the ear involved in 36% cases. Memon et al [11] (2008) reported bilateral involvement was seen in 35% patients, while most of the cases had unilateral presentation (65%). ...
... Yaor et al [13] (2006) reported 34.2% patients had cholesteatoma, while 65.8% had non-cholesteatomatous disease which was comparable to our study. Memon et al [11] (2008) found that safe disease without cholesteatoma was present in 88.5% cases and unsafe disease with cholesteatoma was present in 11.5% cases. In other study done by Baig et al [8] (2011), safe disease without cholesteatoma was found in 89.3% cases and unsafe disease with cholesteatoma was found in 10.6% cases. ...
... All cases of chronic suppurative otitis media including those described as safe can be associated with complications. Therefore, the term safe does not adequately categorize any case of chronic suppurative otitis media [6]. Understanding the pathology and pathogenesis of chronic suppurative otitis media is important in predicting the management, prognosis and sequelae of the disease. ...
... Retraction pockets were found in about 63% cases of unsafe ears by Grewal et al. [7]. Memon et al. [6] reported about 89% cases which had central perforation in CSOM which was similar to our observation. ...
Article
Chronic mucosal diseases of middle ear cleft or chronic suppurative otitis media has been traditionally defined as a chronic inflammation of the middle ear and mastoid usually associated with perforation of the tympanic membrane and otorrhoea. Understanding the pathology and pathogenesis of chronic suppurative otitis media is important in predicting the management, prognosis and sequelae of the disease. The present prospective study was conducted to evaluate the clinical, intraoperative and histopathological changes in middle ear cleft. 100 patients diagnosed with CSOM who underwent surgery were taken. The mucosa and granulation tissue was removed along with ossicles wherever indicated and sent for histopathological examination. On clinical examination, 72 cases were found to be of tubotympanic type and 28 cases of atticoantral variety. However, intraoperatively, of the tubotympanic cases 8 were found to be of unsafe type which was also proven histologically. Stratified squamous epithelium was revealed in most of the cases accompanied by changes in the submucosa. Ossicular chain was involved in 40 cases with incus being the commonest bone to be eroded.
... Males have high preponderance for both extracranial and intracranial complications. In our study, 60% patients were males and 40% were females with a male female ratio of 1 Varshney., et al. [10], Salman., et al. [7] and Memon., et al. [11] with almost all the cases present with ear discharge. ...
... In our study majority of patients had history of 2 -5 years duration of ear discharge (37%) and 0 -1 year (24%). So our study coincides with study of Varshney., et al. [10] and Memon., et al. [11] in terms of duration of discharge. Out of Extra-cranial complications, post auricular abscess is found to be most common complication and it was similar between our study and that of Osma., et al [12]. ...
... This result is consistent with other studies conducted in Pakistan. 12 This is also consistent with a study in The Republic of Congo, where otorrhea became the chief complaint along with hearing loss as the accompanying complaint. 13 Most CSOM patients developed unilateral complications. ...
Article
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Background: The prevalence of chronic suppurative otitis media (CSOM) is still high in developing countries. According to the World Health Organization (WHO), the prevalence of CSOM is 2-4%. In 1994-1996, the prevalence of CSOM in various provinces in Indonesia is diverse, with general prevalence of 3.9%. Chronic suppurative otitis media can also lead to various complications. The objective of this study was to determine the profiles of CSOM patients with complications in Dr Hasan Sadikin General Hospital Bandung. Methods: Secondary data was obtained from 117 medical records of the period January-December 2011 in Dr Hasan Sadikin General Hospital Bandung. Out of 117 medical records, 43 medical records consisted of CSOM patients who had complications. Data of patients’demography, risk factor, chief and accompanying complaints, infected ears, pathological findings, complications, and treatments were collected and were analyzed with frequency distribution. Results: There was 36.75% CSOM patients with complications, 55.8% are male, 30.3% were 30-39 years old, 62.8% level of education of patients was primary education. Ear discharge (otorrhea) was the most common chief complaints (95.3%) and hearing loss was the most dominated accompanying symptom (53.5%), Upper Respiratory Tract Infection (URTI) was the most common risk factors. Most of the cases had unilateral complication (93%) and intratemporal (72%). Both intratemporal and extratemporal was only 26% cases. Granulation tissue was the most common intratemporal complication (32.5%). The most common procedure given was Mastoidectomy without tympanoplasty (51.2%) followed by pharmacotherapy Conclusions: Percentage of CSOM with complication is still high in Dr. Hasan Sadikin General Hospital Bandung.
... 14 Tingkat kebersihan yang buruk, malnutrisi dan penduduk yang padat menjadi dasar utama penyebaran penyakit ini. 17 Penelitian ini menemukan penderita yang mengeluhkan telinga berair (61,34%), sesuai dengan penelitian di rumah sakit dr. Moewardi Surakarta sekitar 37,42% pasien mengeluhkan keluar cairan kental berbau. ...
Article
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Otitis media supuratif kronis merupakan penyakit telinga umum di negaranegara berkembang. Komplikasi otitis media supuratif kronis tipe bahaya mempunyai tanda dan gejala klinis yang khas.Tujuan penelitian ini adalah mengetahui profil penderita otitis media supuratif kronis (OMSK) tipe bahaya di RSUP H. Adam Malik. Penelitian deskriptif terhadap 119 penderita dari tahun 2006-2010. Sekitar 28,57% penderita dijumpai pada tahun 2010, sekitar 31,93% terjadi pada usia 11-20 tahun, sekitar 53,78% laki-laki, dan sekitar 38,66% pada telinga kanan. Sebanyak 68,91% terjadi akibat riwayat otitis media berulang dan 61,34% dengan keluhan utama telinga berair. Gejala dan tanda klinis yang sering terjadi adalah telinga berair (76,47%) dan perforasi membran timpani (74,79%), baik perforasi atik (0,84%), marginal (1,68%), subtotal (23,53%), dan total (48,74%). Gangguan pendengaran terbanyak adalah tuli konduktif (58,82%). Pada foto proyeksi Schuller, 62,18% dijumpai gambaran mastoiditis kronis dengan kolesteatoma. Dari hasil kultur dijumpai 21,01% Pseudomonas aeruginosa. 86,55% terjadi komplikasi mastoiditis.Profil penderita OMSK tipe bahaya di RSUP H. Adam Malik Medan sesuai dengan profil penderita OMSK tipe bahaya pada umumnya. Chronic suppurative otitis media (CSOM) is a common ear disease in developing countries. The complications of CSOM have a unique set of clinical signs and symptoms. This study aimed to identify the profile of dangerous type CSOM patients at H. Adam Malik General Hospital Medan in 2006-2010. A descriptive study of 119 patients in 2006-2010. From 119 patients, 28.57% were found in 2010, 31.93% were at age between 11-20 years old, 53.78% men and 38.66% were at right ear. 68.91% due to a history of recurrent otitis media and 61.34% with a main complaint of draining ears. The most clinical symptoms and signs were aqueous ears (76.47%) and tympanic membrane perforations (74.79%), as attic perforation (0.84%), marginal (1.68%), subtotal (23.53%), and total (48.74%). The most hearing impairments were conductive deafness (58.82%). In Schuller projections, 62.18% were found the imaging of chronic mastoiditis with cholesteatoma. From the culture results, 21.01% were Pseudomonas aeruginosa. 86.55% were mastoiditis complications.The profile of dangerous type CSOM patients at H. Adam Malik General Hospital Medan is similar with the other profile of dangerous type CSOM commonly.
... Conservative therapy alone is recommended in selected cases, such as in the early stages of an abscess. However, surgical treatment along with antibiotics is the preferred regimen nowadays, which helps in reducing mortality and was adopted in this case (13). The patient was put on a quadruple regimen of antibiotics, and when the acute stage of the disease was overcome the primary source of the disease was treated properly by performing radical masoidectomy on the right side. ...
Article
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Introduction: An otogenic brain abscess is a common ENT problem but an otogenic trapezius abscess can also be experienced in otolaryngological practice, particularly in patients with chronic suppurative otitis media.
... CSOM, one of the common diseases presenting in ENT clinics in developing countries still poses a great challenge due to inherent morbidity and mortality associated with its complications. 1,2 Cholesteatoma an expanding lesion of temporal bone composed of outer bone eroding stratified squamous epithilial lining and desquamated keratin centre is found to be associated with most of the complications of unsafe type of CSOM 3 . The surgical treatment in management of middle ear cholesteatoma has been a matter of debate for years. ...
Article
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Introduction: Oto-endoscopy is a new and latest introduction in the middle ear and mastoid surgery. Its application has not yet gained popularity in Pakistan and our study is first of its kind in Pakistan to evaluate the utility of oto-endoscope in canal wall down procedures. Objectives: To see whether the use of oto-endoscope helps in decision making to modify the procedure pre-operatively or decrease the incidence of residual disease better than microscope in radical and modified radical mastoidectomy. Study design: Case series Patients and methods: ENT Unit, Madina Teaching Hospital, Faisalabad (A tertiary care hospital). Non-probability convenience sampling. Twenty patients in total. Results: Oto-endoscopy detected five cases of residual disease after modified radical mastoidectomy and one case after radical mastoidectomy. Conclusions: 1. Oto-endoscopy does influence the detection of residual cholesteatoma in sinus tympani, anterior epitympanum and protympanum. 2. It can also modify the decision to convert modified radical to radical mastoidectomy if required.
... In an Irish study on 58 patients, bilateral involvement was seen in 35% patients while most of the cases had unilateral presentation (65%). [11] In a study, of the 510 patients, studied left ear was involved 50.2% while right ear was involved in 49.8% patients. [12] In our study all the patients gave history of ear discharge and decreased hearing. ...
... Similar reports are made from other developing countries including Pakistan and Bangladesh. [11,12] Other study by Fakir et al., and Hossain et al., shows that younger age group suffer more as because of cellular mastoid, the horizontal position of E.T. and enlarge adenoid. [13,14] However, in other studies by Gupta et al., and Loy et al., it was stated that age has not much relation to CSOM, but it is common in people with poor socioeconomic status. ...
Article
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Background: Chronic suppurative otitis media is one of the common causes of deafness in India and occupies a considerable amount of clinic and operating time of otolaryngologists. Materials and Methods: This was a prospective study containing 50 patients, which was further divided into two groups of 25 patient each. One group was cartilage palisade technique group and other was temporalis fascia technique group (TFT group). Detailed history and examination along with pure tone audiometry was performed. Pre-and postoperative hearing results and graft uptake were compared. All surgeries were performed through the post aural approach. Cartilage was harvested from cymba concha and fascia from temporalis muscle. Results: Hearing improved significantly when either of the technique was used. Though this was slightly better, but stastically insignificant in TFT. there was no significant difference in the graft uptake rates, but it was better in cases of Eustachian tube dysfunction when cartilage palisades were used. Conclusion: There was no statistically significant difference in results in terms of success and auditory function but cartilage palisade technique gave better results in specific conditions like Eustachian tube dysfunction.
... Conservative therapy alone is recommended in selected cases, such as in the early stages of an abscess. However, surgical treatment along with antibiotics is the preferred regimen nowadays, which helps in reducing mortality and was adopted in this case (13). The patient was put on a quadruple regimen of antibiotics, and when the acute stage of the disease was overcome the primary source of the disease was treated properly by performing radical masoidectomy on the right side. ...
Article
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An otogenic brain abscess is a common ENT problem but an otogenic trapezius abscess can also be experienced in otolaryngological practice, particularly in patients with chronic suppurative otitis media. We report a rare case of a trapezius abscess in an eight-year-old girl who presented at the ENT, Head and Neck Surgery Postgraduate Medical Institute, Lady Reading Hospital, Peshawar, Pakistan on 15th December, 2010, with a presenting complaint of discharge from her right ear that had been occurring for the last five years. An exploration of the patient's right ear was performed, which showed that there was extensive cholesteatoma and tissue granulation tissues the antrum, attic and middle ear. The trapezius abscess had spread down to her back and was repeatedly drained. The patient was discharged on the 14th day following admission after making a complete recovery. After a regular follow-up period the child has remained disease free. The rare nature of this case prompted us to write this report. Chronic suppurative otitis media is a common clinical problem in developing countries. It can result in a number of complications if not treated properly. Although an otogenic trapezius abscess is a rare complication of chronic suppurative otitis media, it must be kept in mind.
... 9 According to the observations of Memon, COM is a disease of young adults and about 50% of patients were between the ages of 11-30 years. 10 Pre-dominant presence of COM in younger decades of life observed by other investigators matches with findings of our study. ...
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p class="abstract"> Background: Chronic otitis media (COM) affects 0.5-30% of individuals in any community and over 20 million people are estimated to suffer from this condition worldwide. COM often evolves in a continuum. Squamosal disease is more commonly found in poorly pneumatized bones, but whether the sclerosis is relevant to the etiology of the disease or is caused by it, has not been fully resolved. Our study aimed at comparing the mastoid pneumatization patterns obtained using X-ray mastoid and high-resolution computed tomography (HRCT) temporal bone. It was an interventional study. Methods: Sixty patients of unilateral squamosal COM, aged more than 8 years, underwent X-ray mastoid Schuller’s view and HRCT temporal bone, using Philips extended brilliance 48 slice CT. Results: Upon analysis, in diseased and healthy ears, the coincidence of X-ray and HRCT findings was 63.33% and 80% respectively. Conclusions: HRCT temporal bone should be done in all cases of squamosal COM to know the extent of the disease, pneumatization patterns and the presence of anatomical variations. </p
... That study stated that the peak incidence of the disease was in the age group between 21 to 30 years. 25,26 In this study 85% cases showed the incus erosion while 15% cases showed intact incus. The long process of incus was the commonest portion involved (Table 4). ...
Article
Background: Cholesteotoma is a benign but destructive lesion leading to ossicular necrosis. Objective: To see the frequency of incus bone erosion on mastoid exploration in chronic suppurative otitis media with middle ear cholesteotoma. Study Design: Cross-sectional descriptive study. Setting: This study was carried out in the Department of ENT Unit-2, Sir Ganga Ram Hospital, Lahore. Duration of Study: Fifteen months months (10th April, 2019 to 9th July, 2020) Sample technique: Non- probability purposive sampling Methods: One hundred and twenty patients were admitted through outpatient department of ENT Unit-2, Sir Ganga Ram Hospital Lahore. Patients were included after fulfilling the inclusion criteria and information was collected on a prescribed proforma. Finally during surgery under general anesthesia, the operative findings were noted to know the incus bone erosion after middle ear cholesteatoma formation in chronic suppurative otitis media. Results: A total number of one hundred and twenty patients of chronic suppurative otitis media with middle ear cholesteatoma were included. Out of which 80 (66.7%) were males and 40 (33.3%) were females(Table 1).The patients shown in table 2 were divided in six age groups (Table 2).Table 3 shows that the procedure of mastoidectomy was performed in 112 patients (93.3%) and modified radial mastoidectomy was performed in 8 patients (6.7%).Incus bone erosion in chronic suppurative otitis media with middle ear cholesteatoma in 102 patients (85%) and 18 patients (15%) have no incus bone erosion (Table 4). Conclusion: Ear discharge was the most common presenting characteristic of chronic suppurative otitis media with cholesteatoma. The majority of the cases had ossicular erosion, with the incus being the most common site of involvement. Males are more likely than females to develop cholesteatoma. Keywords: erosion of incus bone, Mastoid exploration, Chronic suppurative otitis media, Cholesteatoma
... Ginni et al. [8] noted that patients of squamousal COM are mostly affected in 3rd decade. According to the observations of Memon [9], chronic suppurative otitis media is a disease of young adults and about 50 % of patients were between the ages of 11-30 years. Observation that the squamousal COM is most common in third decade has also been made by Gomaa et al. [10]. ...
Article
To study the pneumatization pattern of mastoid bone in cases of squamousal type of chronic otits media and analyze pneumatization pattern of opposite normal ear in cases of unilateral chronic otitis media (COM). A total of 94 patients (104 ears) between the age group of 7–84 years attending the E.N.T outpatients, inpatients and casualty of Acharya Vinoba Bhave Rural Hospital, Sawangi (Maghe), Wardha, after applying inclusion and exclusion criteria were found suitable and hence selected for the present study and were subjected to bilateral X-ray mastoid (Schuller’s view). HRCT temporal bone done in selected 55 patients. On analyzing patients radiologically (X-ray mastoid), it was found that out 104 ears, mastoid was pneumatized in 2 (1.92 %) diploic in 20 (19.23 %) and sclerotic in 82 (78.85 %) ears. Contralateral mastoid of 70 normal ears, mastoid was pneumatized in 30 (42.86 %) diploic in 22 (31.43 %) and sclerotic in 18 (25.71 %) ears. Most of the diseased ear demonstrated non pneumatized mastoid (98.08 %) whereas contra lateral mastoid of 70 normal ear, showed significantly more pneumatization This difference is statistically significant (P value < 0.0001). Significantly more sclerosis and non pneumatization in the ear with COM of squamousal type than the healthy contralateral ear supports the environmental theory.
Article
Introduction: Chronic Suppurative Otitis Media (CSOM) is frequently associated with symptoms of inflammation like discharge from the ear or pain. In many cases, patients suffer from hearing loss causing communication problems and social withdrawal. Tubotympanic type of chronic suppurative otitis media is characterized by a perforation of pars tensa, while marginal & attic perforations are pathognomonic of attico–antral variety. The latter category is usually associated with the presence of cholesteatoma. In cases of cholesteatoma, complications like facial nerve paralysis, meningitis, cerebellar abscess, sigmoid sinus thrombosis may develop and potentially threaten the patient’s life. The aim of this study was to retrospectively perform analysis of patients suffering from Chronic Suppurative Otitis Media, visiting our Tertiary Health Centre, Nashik. Materials and Methods: This was a retrospective study, conducted in a tertiary care medical college hospital over a period of 5 years. The study group comprised 528 patients in and around Nashik District and were subjected to Tympanoplasty or Mastoid surgery. Results: Complete data records from 528 patients were available for statistical analysis. Maximum numbers of patients were in age group 21–40. High prevalence of CSOM was found in females. 408 patients had CSOM of Safe type. 97 patients had CSOM of unsafe type, whereas 23 patients had unsafe CSOM with complications. 381 patients underwent Type 1 Tympanoplasty, while 31 patients underwent Modified Radical Mastoid Surgery. 61 patients were operated for MRM with Tympanoplasty and 28 patients were operated for MRM with Myringostapediopexy. 27 patients were operated for revision tympanoplasty. Different methods of tympanoplasty were performed. Simple underlay was done in 123 patients. Maximum patients about 245 were operated by cartilage support method of tympanoplasty. Anterior tucking was done in 40 patients. Myringostapediopexy was done in 28 patients. Ossiculoplasty with tragal or conchal cartilage was done in 61 patients. Graft was not placed in 31 patients. Temporalis fascia was used in maximum patients. In 90.9% of patients temporalis fascia was used. Fascia Lata was used in 3.2% of patients. Conclusion: Retrospective study of patients with CSOM shows: females were affected more than males. Majority of patients were in age group of 21 to 40 years. The reason could be that this age group is socially active and health conscious. 77.3% of patients had safe CSOM while 22.7% of patients had unsafe CSOM. 2.27% of patients had extra–cranial complication, and 2.08% of patients had intracranial complications. 5.1% of patients underwent revision tympanoplasty surgery. Temporal is fascia as a graft material was used for tympanoplasty in maximum patients, and cartilage support method of tympanoplasty was used in majority of patients. Maximum patients were operated in year 2012. This was due to conduction of camps in peripheral areas around Nashik City which shows that CSOM is more common in patients of lower socioeconomic group, overcrowding, sub–standard hygiene and under resourced health care.
Article
Aim: To evaluate the commonest presentation and intraoperative findings and significant post operative challenges in patients who underwent modified radical mastoidectomy in Melmaruvathur adhiparasakthi Institute of medical sciences and research. Design: Retrospective study. Materials and Methods: Fifty six patients who underwent modified radical mastoidectomy for unsafe ear disease were included in this study. The study period was from 2009 to 2012.The commonest presentation was evaluated with the history taken from the patient's records. The intraoperative evaluation of primary pathology and its anatomic extension and ossicular status were identified. Common problems we faced postoperatively were documented. Results: Of the 56 patients,thirty eight(68%) were male and eighteen(32%) were female. The age ranged from nine years -fifty years of age. The commonest presentation in this study was foul smelling scanty discharge (75%) and the primary pathology was isolated cholesteatoma (54%). The involvement of mesotympanum, attic, aditus & antrum with primary disease was more than the isolated involvement of attic,aditus and antrum. Stapes erosion was more common than incus erosion in our study. We faced a very rare postoperative complication of delayed facial palsy in one patient who had no facial nerve dehiscence. Conclusion: Good attention given to patients with infrequent, minimal ear discharge helps to identify unsafe ear. In unsafe ear, otologists should be well prepared to face the stapes erosion during surgery. Even though rare, otologists should be aware of delayed facial palsy and be cautious about the past history of herpes simplex and varizella infection and consider antiviral prophylaxis before surgery.
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Objective: To determine the clinical and operative findings of the patients sustaining chronic suppurative otitis media. Patients and Methods: This descriptive cross sectional study of six months duration was conducted at the department of ENT, Head and Neck Surgery, Hayat Medical Complex (HMC), Peshawar-Pakistan from June 2012 to December 2012. All the patients of any age and either gender having discharging ears for more than three months were included. Those patients having aural discharge due to otitis externa or trauma were excluded from study. All patients having otogenic intracranial complications were first treated by neurosurgeon before treating the primary focus in ears. Mastoid surgery was performed according to the nature and type of disease. Results: A total of 93 patients were enrolled who were 67 male and 26 females with male to female ratio of 2.5:1. These patients were in age range from 5 years to 67 years with mean age of 37+13 years. Most of the patients were from lower socioeconomic group (56%). In this study 90 patients (96.78%) had atticoantral type tympanic perforation while 3 patients (3.22%) presented with tubotympanic type tympanic perforation with commonest presentation of ear discharge (100%).In majority of patients (54.71%) there was mild to moderate hearing loss. In 36 patients (38.7%) total perforation was common among atticoantral type while cholesteatoma was the commonest (47.31%) finding in this disease. Conclusion: Otorrhoea is the common presentation of atticoantral type diseased ear that is best treated with mastoidectomy operation to minimize its complications.
Article
Aim: To assess the frequency of ossicles erosion on mastoid exploration in chronic suppurative otitis media with middle ear cholesteatoma. Study Design: Cross-sectional descriptive study. Place and Duration of Study: This study was carried out in the ENT Department, Mayo Hospital, Lahore affiliated with King Edward Medical University Lahore. One year study (10th February 2013 to 10th February, 2014). Methods: 120 patients were admitted through non-probability purposive sampling technique via outpatient and emergency at the Department of ENT, Mayo Hospital, Lahore. Patients were selected after fulfilling the inclusion criteria. All the data was analysed by SPSS version 18. Quantitative data like age was analysed using mean and standard deviation. Qualitative data including gender and presence or absence of ossicular erosion was analysed using percentages and frequencies. Result: A total of 120 patients of chronic suppurative otitis media with middle ear cholesteatoma were included in this study. Out of these 120 patients 80(66.7%) were males and 40(33.3%) were females. Male to female ratio was 2:1. Mean±standard deviation of age group was 21.2±11.9 years. Radical mastoidectomy was performed in 112 patients (93.3%) and modified radical mastoidectomy was performed in 8 patients (6.7%). Ossicles erosion in chronic suppurative otitis media with middle ear cholesteatoma observed in 102 patients (85%) and 18 patients (15%) had no ossicles erosion. Conclusion: Cholesteatoma a non-malignant destructive lesion is the commonest finding in operated cases of chronic suppurative otitis media. Most of the studied cases showed ossicles erosion specially incus. Early diagnosis and treatment can prevent intracranial and extra cranial complications. Treatment of cholesteatoma is surgery with the primary goal to eradicate disease and provide a safe and dry ear with hearing improvement. Radical mastoidectomy is a procedure of choice for the treatment of extensive cholesteatoma. It was also observed that cholesteatoma is more common in low socio-economic groups.
Article
Objective: To determine the relative frequency of various parts of temporal bone eroded by cholesteatoma. Place and duration of study: This was a combined study conducted in the ENT Departments of Postgraduate Medical Institute, Hayatabad Medical Complex, Peshawar, and Lady Reading Hospital Peshawar. The study took place over a period of 5 years from January1, 2007 to December 31, 2011. Sample size: The study included 70 cases of chronic suppurative otitis media with cholesteatoma. Study design: It was a descriptive study using the non probability convenience sampling technique. Methodology: This was a combined study conducted in the ENT Departments of Postgraduate Medical Institute, Hayatabad Medical Complex, Peshawar and Lady Reading Hospital Peshawar from January1, 2007 to December 31, 2011. Informed consent was obtained before including patients in the study. The various parts of temporal bone eroded by cholesteatoma were studied in patients who underwent radical and / or modified radical mastoidectomy for chronic suppurative otitis media with cholesteatoma. The frequency of damage to the ossicular chain and other bones was determined. Results: A total of 70 cases were included in the study. The ages of the patients ranged from 8 to 48 years. The male to female ratio was 3:1. All the patients had chronic suppurative otitis media with cholesteatoma and underwent radical and / or modified radical mastoidectomy. The commonest type of bony erosion was damage to the ossicular chain (92.85%) followed by erosion of the lateral attic wall (54.28%). Conclusion Cholesteatoma has the ability to erode bony structures which may lead to deafness, disability and potentially life threatening intracranial complications. Therefore it is important that the examiner is aware of its possibility in patients presenting with otorrhea, the types of bone damage it may cause and it's potential for producing serious consequences.
Article
Objective: The objective of the study was to analyse the frequency of occurrence of chronic suppurative otitis media with cholesteatoma regarding age, sex and socioeconomic status of the patient Study design: Analytical study Materials and methods: A total of 75 cases of chronic suppurative otitis media with cholesteatoma with different age groups and from different areas of pakistan were admitted at E.N.T. Unit-1, Mayo Hospital, Lahore from July 2002 to July 2005. Each patient had essentially the work up according to the specific Performa. Results: Cholesteatoma was more common in the males (52%) than in the females (48%). Majority of patients i.e. 52% were in the age group of 16-30 years. It is also revealed that majority of patients (76%) belonged to poor communities living in rural or slum areas of the Pakistan. (72%) Conclusion: Cholesteatoma is more common in males than in females. Majority of patients were in the age group of 16-30 years. Cholesteatoma is more common in low socioeconomic groups.
Article
p> Abstrak Tujuan penelitian ini adalah mengisolasi bakteri pattogen pada infeksi telinga Chronic suppurative otitis media yang nantinya sebagai tahap awal dari pengembangan analisa antimikroba Bakteri Asam Laktat (BAL) pada proses fermentasi santan kelapa menjadi Virgin Coconut Oil (VCO), yang diharapkan mampu berfungsi sebagai antimikroba/antibakteri dari bakteri pattogen. Menurut Suryani dkk (2014), isolat BAL dari fermentasi santan mampu berfungsi sebagai antibakteri terhadap 5 bakteri uji ( E.coli NBRC14237, Staphylococcus aereus NBRC 13276, Bacillus substilis BTCCB, Salmonella thypii, dan Listeria monocytogenes ). Untuk mendapatkan informasi tersebut maka di isolasi bakteri yang ada di cairan telinga pasien penderita infeksi telinga Chronic suppurative otitis media dengan menggunakan media umum Blood Agar dengan metoda Pengenceran. Dari penelitian ini didapatkan 42 isolat dengan 4 jenis bakteri pattogen yaitu Pseudomonas aureginosa, Staphilococus aureus, Staphilococus epidermidis, Proteus mirabilis. Pasien OMSK yang diambil sekret nya 60 % berumur diatas 20 tahun dan 40% berumur dibawah 20 tahun yang sama banyak antara perempuan dan Laki-laki . Kata Kunci: Isolasi bakteri pattogen sekret pasien OMSK, Chronic suppurative otitis media, BAL( Bakteri Asam Laktat), Virgin Coconut Oil (VCO), The Isolation of Pathogen Bacteria on The Sufferer of Ear Infection Chronic Supparative Otitis Media <sup>1</sup>Suryani, <sup>1</sup>Zulmardi,<sup>2</sup> Abdi Dharma, <sup>2</sup>Yunazar Manjang <sup>1</sup>Universitas Muhammadiyah Sumatera Barat <sup>2</sup>Universitas Andalas E-mail suryanimdiah@yahoo.com Absract This research is aimed to isolate pathogen bacteria in ear infection Chronic Supparative Otitis Media. This is the first phase in developing analysis Antimicroba Lactic Acid. Bacteria in the process of coconut milk fermentation into Virgin Coconut Oil (VCO). It is expected can be fanctioned as antibacteria of pathogen. According to Suryani et.al (2014), isolate of Antimicroba Lactic Acid of coconut milk fermentation can act as antibacteria against 5 examined bacteria ( E.coli NBRC14237, Staphylococcus aereus NBRC 13276, Bacillus substilis BTCCB, Salmonella thypii, dan Listeria monocytogenes ). To achieve it, the ear liquid of sufferer containing bacteria is isolated with Blood Agar media and Dilution method. The result is that there 42 isolate in accordance with 3 kinds pathogen bacteria such as Pseudomonas aureginosa, Staphilococus aureus, Staphilococus epidermidis, Proteus mirabilis . The sufferer who has choosen as participant are 72% coming from the age of above 20 and the rest are under 20 years old. The ratio of sexes are similar between male and female. Key Word: Isolation pattogen bacteria sckret OMSK, Chronic suppurative otitis media, LAB(Lactat Acid Bacteria), Virgin Coconut Oil (VCO), </p
Article
p class="abstract"> Background: Chronic otitis media (COM) is a serious healthcare concern worldwide, because of the distress and economic burden to the patient and their family. Temporal bone pneumatization plays an important role in etiology, behaviour, course and outcome of COM. Pneumatisation gets poorer with growing chronicity of the disease . Methods: A retrospective study was conducted between March 2015-March 2017 on female patients visiting with COM, at ENT department Kasturba Gandhi Hospital, Madras Medical College. The records were analysed of the age, duration of symptoms, associated complaints, pure tone audiogram, computerised tomography of temporal bone, mastoid surgery done according to the disease process affecting the ear . Results: 35 female COM patients were analysed, most common age group is between 31-40 years in 14 patients. There hearing loss was mild category in 27. There were 27 cases of mucosal type of chronic otitis media and 8 cases of squamous type. The CT scan with sclerosis of mastoid was the common finding . Conclusions: In exclusive study on female patients with COM, the mucosal type of COM is common with mild hearing loss and sclerosed mastoid indicating the chronicity . </p
Article
strong>Introduction: Chronic Suppurative Otitis Media (CSOM) is frequently associated with symptoms of inflammation like discharge from the ear or pain. In many cases, patients suffer from hearing loss causing communication problems and social withdrawal. Tubotympanic type of chronic suppurative otitis media is characterized by a perforation of pars tensa, while marginal & attic perforations are pathognomonic of attico-antral variety. The latter category is usually associated with the presence of cholesteatoma. In cases of cholesteatoma, complications like facial nerve paralysis, meningitis, cerebellar abscess, sigmoid sinus thrombosis may develop and potentially threaten the patient's life. The aim of this study was to retrospectively perform analysis of patients suffering from Chronic Suppurative Otitis Media, visiting our Tertiary Health Centre, Nashik. Materials and Methods: This was a retrospective study, conducted in a tertiary care medical college hospital over a period of 5 years. The study group comprised 528 patients in and around Nashik District and were subjected to Tympanoplasty or Mastoid surgery. Results: Complete data records from 528 patients were available for statistical analysis. Maximum numbers of patients were in age group 21-40. High prevalence of CSOM was found in females. 408 patients had CSOM of Safe type. 97 patients had CSOM of unsafe type, whereas 23 patients had unsafe CSOM with complications. 381 patients underwent Type 1 Tympanoplasty, while 31 patients underwent Modified Radical Mastoid Surgery. 61 patients were operated for MRM with Tympanoplasty and 28 patients were operated for MRM with Myringostapediopexy. 27 patients were operated for revision tympanoplasty. Different methods of tympanoplasty were performed. Simple underlay was done in 123 patients. Maximum patients about 245 were operated by cartilage support method of tympanoplasty. Anterior tucking was done in 40 patients. Myringostapediopexy was done in 28 patients. Ossiculoplasty with tragal or conchal cartilage was done in 61 patients. Graft was not placed in 31 patients. Temporalis fascia was used in maximum patients. In 90.9% of patients temporalis fascia was used. Fascia Lata was used in 3.2% of patients. Conclusion: Retrospective study of patients with CSOM shows: females were affected more than males. Majority of patients were in age group of 21 to 40 years. The reason could be that this age group is socially active and health conscious. 77.3% of patients had safe CSOM while 22.7% of patients had unsafe CSOM. 2.27% of patients had extra-cranial complication, and 2.08% of patients had intracranial complications. 5.1% of patients underwent revision tympanoplasty surgery. Temporal is fascia as a graft material was used for tympanoplasty in maximum patients, and cartilage support method of tympanoplasty was used in majority of patients. Maximum patients were operated in year 2012. This was due to conduction of camps in peripheral areas around Nashik City which shows that CSOM is more common in patients of lower socioeconomic group, overcrowding, sub-standard hygiene and under resourced health care.
Article
The clinical features of 58 consecutive patients presenting with a new case of chronic otitis media were prospectively collected over a 15-month period. Twenty-three ears had a keratin filled marginal or attic defect (14 with cholesteatoma), 20 had a self-clearing marginal or attic defect, and 21 had a central tympanic membrane perforation (including one cholesteatoma). Twenty patients (35 per cent) had an abnormal finding in the opposite ear. The patients' ages were dispersed over a wide range of age groups with a mean age of 34 years. Hearing loss was the most common presenting symptom (78 per cent), followed by otorrhoea (64 per cent). A significant proportion of patients denied any history of otorrhoea. Our findings should alert the clinician to suspecting a new case of COM in patients with hearing loss of any age, with, or without, a history of otorrhoea, regardless of their background ear history or the duration of their symptoms.
Article
The aim of this study was to determine the effect of surgical approach, intact canal wall (ICW) or canal wall down (CWD), upon the success of revision surgery for chronicotitis media (COM). A retrospective analysis of 367 patients (including 65 children aged <15years) who underwent revision tympanoplasty because of persistent disease was performed. Single-staged tympanoplasty was performed, preserving the canal wall when present. Hearing was reconstructed with allograft incus. Follow-up ranged from one to 15 years. Hearing was determined by pre- and post-operative air-bone gaps. Post-operative re-perforation, aural discharge and/or cholesteatoma rates were similar for CWD and ICW. Cholesteatoma could present following the revision, even though it was not apparentat surgery. Following tympanoplasty, the final hearing was not significantly affected by the surgical approach or presence of cholesteatoma. Improvement in hearing was adversely affected by cholesteatoma or an absent stapes suprastructure. Revision ICW and CWD operations were both successful in controlling signs of COM. Cholesteatoma is a peripheral risk in COM and may become apparent after revision surgery.
Article
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.