Topical Therapeutics for Otitis Media

1981 ◽  
Vol 89 (3) ◽  
pp. 381-385 ◽  
Author(s):  
David N.F. Fairbanks
Keyword(s):  
Bacterial Contamination ◽  
Topical Therapy ◽  
Tympanic Membrane Perforation ◽  
Definitive Treatment ◽  
Intracranial Extension ◽  
Membrane Perforation ◽  
Aerobic And Anaerobic ◽  
Ear Drops ◽  
Middle Ear Cleft ◽  
Antiseptic Solutions

In chronic draining ear associated with a tympanic membrane perforation, cholesteatoma, or both, the infection is that of bacterial contamination. Both aerobic and anaerobic organisms are found, notably Pseudomonas, staphylococcus, and enteric organisms, particularly bacteroides. The disease exists because of a structural defect in the middle ear cleft, which requires surgery as definitive treatment. Medical therapy is valuable as a temporary measure in preoperative preparation, and in prevention and management of intracranial extension. Topical therapy with antibiotic ear drops is often helpful, but also important is local care with cleansing, drying, and antiseptic solutions or powders. Therapy is usually directed toward the Pseudomonas organisms with aminoglycoside-polymyxin combination otic drops. However, Bacteroides fragilis now looms as an important pathogen in 13% of affected patients. Chloramphenicol otic drops are indicated when such an infection is suspected or identified.

Antimicrobial Therapy for Chronic Suppurative Otitis Media

1981 ◽  
Vol 90 (3_suppl2) ◽  
pp. 58-62 ◽  
Author(s):  
David N. F. Fairbanks
Keyword(s):  
Clinical Judgment ◽  
Topical Therapy ◽  
Tympanic Membrane Perforation ◽  
Definitive Treatment ◽  
Intracranial Extension ◽  
Suppurative Otitis Media ◽  
Membrane Perforation ◽  
Aerobic And Anaerobic ◽  
Middle Ear Cleft ◽  
Antiseptic Solutions

In chronic draining ear associated with a tympanic membrane perforation and/or cholesteatoma, the infection is that of bacterial contamination. Both aerobic and anaerobic organisms are found, notably Pseudomonas, Staphylococcus, and enteric organisms, particularly Bacteroides. The disease exists because of a structural defect in the middle ear cleft, which requires surgery as definitive treatment. Medical therapy is valuable as a temporary measure, in preoperative preparation, and in prevention and management of intracranial extension. Topical therapy with antibiotic ear drops is often helpful, but also important is local care with cleansing, drying, and antiseptic solutions or powders. Therapy is usually directed against the Pseudomonas organism with aminoglycosides and polymyxins, but Bacteroides fragilis now looms as an important pathogen in 13% of affected patients, requiring chloramphenicol. Since drugs directed against Bacteroides are ineffective against Pseudomonas, and vice versa, there is no one agent we can rely upon for treatment of both. What we are all looking for, of course, is that brand new antibiotic the FDA hasn't released yet: “panaceamycin.” It hasn't even been developed yet. None of the ones we have are a panacea; and until we get one, we will have to stick with what we have, exercise clinical judgment, and base our antibiotic selections on, if not proven culture results, then at least established microbial probabilities.

Ototoxicity after use of neomycin eardrops is unrelated to A1555G point mutation in mitochondrial DNA

2004 ◽  
Vol 118 (7) ◽  
pp. 546-550 ◽  
Author(s):  
Tatsuya Yamasoba ◽  
Katsunori Tsukuda
Keyword(s):  
Mitochondrial Dna ◽  
Tympanic Membrane ◽  
Point Mutation ◽  
Middle Ear ◽  
Dna Analysis ◽  
Tympanic Membrane Perforation ◽  
Mitochondrial Dna Analysis ◽  
Membrane Perforation ◽  
Inner Ear Damage ◽  
Ear Drops

Ear drops containing neomycin only rarely cause ototoxicity. The authors report on three patients with a tympanic membrane perforation who developed severe ototoxicity after use of eardrops containing 0.35 per cent neomycin. Mitochondrial DNA analysis revealed that there was no A1555G point mutation in these patients. This finding indicates that application of low concentration neomycin to the middle ear can cause severe inner ear damage even in humans who are not hyper-susceptible to aminoglycosides.

scholarly journals Epitympanic Diaphragm: Endoscopic Functional Tympanoplasty

2018 ◽  
Vol 01 (01) ◽  
pp. 023-028
Author(s):  
Sreerama Boddepalli ◽  
Rajesh Boddepalli
Keyword(s):  
Gas Exchange ◽  
Tympanic Membrane ◽  
Eustachian Tube ◽  
Middle Ear ◽  
Normal Mucosa ◽  
Tympanic Membrane Perforation ◽  
Middle Ear Mucosa ◽  
Tympanic Membrane Perforations ◽  
Membrane Perforation ◽  
Middle Ear Cleft

Abstract Background Simple closure of tympanic membrane perforation is not a successful myringoplasty. It has to obey a lot of functional aspects of the middle ear cleft. Certain factors play a role in failure cases. The endoscopic functional myringoplasty or tympanoplasty is a clear visualization of all the parts of the middle ear; examination and removal of the disease from the hidden parts of the middle ear, examination of inter-attico-tympanic diaphragm; and removal of blocks, if any, in isthmus, to reestablish the gas exchange pathways and finally preserve the middle ear mucosa at maximum to further restore the ventilation. Methods Endoscopic tympanoplasty was performed in 100 patients with large tympanic membrane perforations and patent eustachian tube, using 4-mm “0” and “45” degree endoscopes by proper visualization of the tympanic diaphragm and isthmus in every patient and clearing its blockage if present. Results Among the 100 patients, 78 had epitympanic diaphragm blockage at the level of isthmus, 5 patients were found with closed tensor tympani folds, both vertical and horizontal without any ventilatory routes in them. Although in all the patients the eustachian tube was patent, we found majority of them had a dysventilation at the level of the epitympanic diaphragm. Thus, by performing endoscopic ventilatory pathway clearance and tympanoplasty, we achieved 94% positive results. Conclusion Epitympanic diaphragm is a functional barrier between upper and lower compartments of the middle ear cleft, which play important role in the ventilation and partial pressure regulation, blockage of its isthmus may lead to tympanic membrane retractions and perforations. With the aid of endoscopes of various degrees, removing any pathological blocks, recreating proper ventilation, reestablishing gas exchange mechanism, and maximum preservation of normal mucosa for the gas exchange are the aims of an endoscopic functional tympanoplasty procedure.

scholarly journals COMPARATIVE STUDY BETWEEN UNDERLAY AND OVERRLAY TECHNIQUE IN TYPE 1 TYMPANOPLASTY IN CSOM MUCOSAL INACTIVE TYPE

2020 ◽  
pp. 1-3
Author(s):  
Chandpreet Kour ◽  
Saima Tabassum ◽  
Madeha Drabu
Keyword(s):  
Surgical Techniques ◽  
Tympanic Membrane Perforation ◽  
Surgical Closure ◽  
Type 1 Tympanoplasty ◽  
Grafting Technique ◽  
Membrane Perforation ◽  
Air Cells ◽  
Middle Ear Cleft ◽  
Mastoid Air Cells

Otitis Media (OM) is an inflammatory condition which usually involves muco-periosteal covering of middle ear cleft (partial or full) comprising of eustachain tube (ET), hypo-tympanum, meso-tympanum, epi-tympanum,additus and the mastoid air cells. Myringoplasty was introduced by Berthold5 long back in 1878 and included the surgical closure of tympanic membrane perforation including removal of epithelium and grafting with skin. This period witnessed an improvement in surgical techniques with improved optics and emergence of microsurgery, thus making the Myringoplasty safer and lowered the rate of graft rejection. In this study we have compared the the grafting technique in type-1 tympanoplasty of in CSOM mucosal inactive type.

scholarly journals Otomycosis in Immunocompetent and Immunocompromised Patients: Comparative Study and Literature Review

2012 ◽  
Vol 91 (3) ◽  
pp. 114-121 ◽  
Author(s):  
Borlingegowda Viswanatha ◽  
Dadarao Sumatha ◽  
Maliyappanahalli Siddappa Vijayashree
Keyword(s):  
Candida Albicans ◽  
Clinical Study ◽  
Clinical Presentation ◽  
Tympanic Membrane Perforation ◽  
Immunocompromised Patients ◽  
Bilateral Involvement ◽  
Membrane Perforation ◽  
Comparative Clinical Study ◽  
Ear Drops ◽  
Immunocompetent Patients

A comparative clinical study was carried out that included 50 cases of otomycosis in immunocompetent patients and 50 cases of otomycosis in immunocompromised patients. Clinical presentation, predisposing factors, mycologic profile, and treatment outcomes were compared. Aspergillus spp were the most commonly isolated fungi in the immunocompetent group, and Candida albicans in the immunocompromised group. Bilateral involvement was more common in the immunocompromised group. All the patients were treated with topical clotrimazole ear drops. Four patients in the immunocompromised group did not respond to treatment with clotrimazole but were treated successfully with fluconazole ear drops. Three patients had a small tympanic membrane perforation due to otomycosis.

scholarly journals Myringoplasty using temporalis fascia and its clinical outcome

2019 ◽  
Vol 5 (6) ◽  
pp. 1539 ◽  
Author(s):  
Akbar Zaman ◽  
Saif Omar
Keyword(s):  
Hearing Loss ◽  
Success Rate ◽  
Otitis Media ◽  
Tympanic Membrane Perforation ◽  
Chronic Suppurative Otitis Media ◽  
Temporalis Fascia ◽  
Suppurative Otitis Media ◽  
Before And After ◽  
Membrane Perforation ◽  
Middle Ear Cleft

<p class="abstract"><strong>Background:</strong> Chronic suppurative otitis media is one of the common otological conditions in India for which patients seek advice from an otorhinolaryngologist. Various surgical modalities of treatment have been tried since ages, to eliminate the disease from middle ear cleft, with varying degrees of success rate. One such modality of treatment is myringoplasty. The aim of the present study was to assess the success rate of myringoplasty using temporalis fascia and to evaluate preoperative and postoperative hearing loss in patients with chronic suppurative otitis media.</p><p class="abstract"><strong>Methods:</strong> Sixty adult cases of tympanic membrane perforation were included in the study. Myringoplasty was performed in all cases and hearing loss was compared both before and after surgery.  </p><p class="abstract"><strong>Results:</strong> Preoperatively 20 cases showed hearing loss at 16-25 dB, 26 cases at 26-40 dB, and 14 cases showed hearing loss at &gt;40 dB. Graft uptake was successful in 50 patients (83.33%). Postoperatively definitive improvement of hearing was observed in 46 patients. The success rate of surgery in cases of dry ear with more than 6 months was 100%.</p><p class="abstract"><strong>Conclusions:</strong> Outcome of myringoplasty does not depend on sex and site of perforation. Dry ear of duration greater than 6 months is a favourable prerequisite. Graft take up was impaired in cases of sclerotic mastoid and postoperative infection.</p>

scholarly journals Effectiveness of oral itraconazole in the management of otomycosis with tympanic membrane perforation

2017 ◽  
Vol 5 (4) ◽  
pp. 1373 ◽  
Author(s):  
Aju Ravindran ◽  
Sagesh M.
Keyword(s):  
Tympanic Membrane ◽  
Treatment Response ◽  
Difficult Problem ◽  
Tympanic Membrane Perforation ◽  
Prolonged Treatment ◽  
Membrane Perforation ◽  
Oral Itraconazole ◽  
Methods Of Treatment ◽  
Perforated Tympanic Membrane ◽  
Ear Drops

Background: Otomycosis can be a difficult problem to treat in a patient who already has a perforation of the tympanic membrane. This study highlights the effectiveness of oral Itraconazole in treating such cases.Methods: Thirty-four patients with otomycosis and a perforated tympanic membrane were included in the study and were treated with oral itraconazole and antibiotic ear drops. They were followed up for six weeks to look for treatment response and any recurrence.Results: Of the 34 patients in the study, 25 patients were fully cured with one week of oral Itraconazole therapy. Six out of the remaining 9 patients were cured of the disease with two weeks’ therapy. Three patients needed prolonged treatment and one patient had a recurrence at six weeks.Conclusions: Oral itraconazole therapy is an effective alternative to the traditional methods of treatment for otomycosis with tympanic membrane perforation.

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