Assessment of chronic suppurative otitis media patients with cholesteatoma on the basis of gadolinium enhanced T1-T2 weighted images of MRI

Background: The propensity for ossicular destruction is much greater in case of unsafe CSOM due to presence of cholesteatoma and/or granulations. Partial or total destruction of ossicles is seen in approximately 80% of patients with cholesteatoma, whereas in chronic otitis media without cholesteatom, ossicular chain erosion can be seen in approximately 20% cases.The present study aims to evaluate the clinical profile of patients of unsafe chronic suppurative otitis media with cholesteatoma and assesses patients on the basis of gadolinium enhanced T1-T2 weighted images of MRI.Methods: The study was conducted among patients who were fulfilling the criteria for unsafe CSOM i.e., retraction pocket in pars tensa, marginal perforation, perforation in pars flaccida, presence of granulation tissue, presence of polyp, blood stained discharge etc. were selected for the study. MRI was performed in all cases by using gadolinium enhanced T1-T2 sequences for diagnosis of cholesteatoma. Mastoidectomy was done to confirm the findings of MRI. Results: In maximum number of cases perforation was found in attic region. Most common complication of disease is the ossicular chain erosion. In present study sensitivity was 84%, specificity was 100% and positive predictive value and negative predictive value were 100% and 66% respectively.Conclusions: It can be concluded that MRI can differentiate cholesteatoma from other inflammatory etiology. By using MRI with 1.5 or 3T unit a small cholesteatoma (even 2-3 mm) can be easily detected at its early stage and further complications can be prevented.

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Radio-surgical correlation of chronic suppurative otitis media

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20195700 ◽

2019 ◽

Vol 6 (1) ◽

pp. 118

Author(s):

Yogeesha B. S. ◽

Nagaraj Maradi ◽

Ravi Shekhar ◽

Rohini D. Urs

Keyword(s):

Otitis Media ◽

Middle Ear ◽

Predictive Value ◽

Ossicular Chain ◽

Chronic Suppurative Otitis Media ◽

High Resolution Computed Tomography ◽

Suppurative Otitis Media ◽

Fallopian Canal ◽

Ear Ossicles ◽

Kappa Value

Background: Chronic suppurative otitis media (CSOM) because of disease nature and location of vital structures like middle ear ossicles, facial nerve, and lateral semicircular canal poses clinical as well as radiological challenge in diagnosis, especially the squamosal variety. Hence this study to evaluate radio-surgical correlation in cases of CSOM.Methods: We retrospectively analysed 92 case records who met the inclusion criteria. Their pre-operative high-resolution computed tomography (HRCT) temporal bone imaging was evaluated for erosion of the ossicular chain and the fallopian canal. This was correlated with the surgical findings noted intra-operatively. The appropriate statistical analysis was carried out. The radio-surgical correlation was evaluated by Cohen’s kappa value. Results: The kappa value for status of ossicular chain was 0.805 and 0.384 for status of fallopian canal. HRCT imaging had a positive predictive value and negative predictive value of 94.3% and 85.3% respectively, in detecting ossicular chain erosion. In detecting fallopian canal erosion, HRCT showed a sensitivity of 33.3%. Analysing the individual ossicles, we found kappa to be 0.266 for malleus, 0.463 for incus and 0.827 for stapes.Conclusions: There was excellent radio-surgical correlation for ossicular chain erosion while it was poor for fallopian canal erosion. HRCT showed excellent radio-surgical correlation for stapes, moderate for incus and poor for malleus. In-spite of its shortcomings in differentiating cholesteatoma and non-cholesteatomatous pathologies of the middle ear cleft, HRCT imaging plays a key role in assessing the status of the ossicles and fallopian canal.

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Effect of Incudostapedial Reconstruction Using Conchal Cartilage Interposition Graft on Hearing Outcome

International Archives of Otorhinolaryngology ◽

10.1055/s-0038-1661398 ◽

2018 ◽

Vol 23 (03) ◽

pp. e262-e266

Author(s):

Nazrin Hameed ◽

Arun Alexander ◽

Sunil Kumar Saxena ◽

Sivaraman Ganesan ◽

Jyotirmay S. Hegde

Keyword(s):

Otitis Media ◽

Bone Conduction ◽

Chronic Otitis Media ◽

Ossicular Chain ◽

Chronic Suppurative Otitis Media ◽

P Value ◽

Suppurative Otitis Media ◽

Interposition Graft ◽

Conchal Cartilage ◽

Incudostapedial Joint

Introduction Chronic otitis media is a widely prevalent condition in developing countries and is a cause of correctable hearing loss. The most frequent ossicular chain defect found during surgery for chronic otitis media has been a discontinuity of the incudostapedial joint. This study observes the effect of incudostapedial reconstruction using conchal cartilage on the hearing of the patient. Objectives To evaluate improvement in hearing by incudostapedial reconstruction using conchal cartilage interposition graft in tympanoplasty and to identify the independent factors associated with erosion of the long process of incus among patients with chronic suppurative otitis media tubotympanic type. Methods This study was conducted in the department of ear, nose and throat (ENT) amongst 22 patients with tubotympanic-type chronic suppurative otitis media who were found to have erosion of the long process during tympanoplasty. These patients underwent incudostapedial reconstruction using conchal cartilage. Their hearing was again reassessed at 12 weeks postsurgery, and the changes were observed. Results A statistically significant improvement in air conduction by 15.14 dB was found after undergoing incudostapedial reconstruction using conchal cartilage (p < 0.001). There was no statistically significant change in bone conduction (p value > 0.05). A total of 59.1% of patients in the study had an improvement in hearing ranging from 11 to 20 dB. It was also found that 50% of the patients had a postoperative hearing of 10 to 20 dB. Conclusion Conchal cartilage interposition graft effectively improved hearing when used for the reconstruction of the incudostapedial joint during tympanoplasty in patients of chronic suppurative otitis media.

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Correlation of the Puretone Audiometry Findings with Intraoperative Findings in Patients with Chronic Suppurative Otitis Media

MVP Journal of Medical Sciences ◽

10.18311/mvpjms/2015/v2/i1/790 ◽

2015 ◽

Vol 2 (1) ◽

pp. 4

Author(s):

Devashri Uday Patil ◽

Kiran S. Burse ◽

Shreeya Kulkarni ◽

Vandana Sancheti ◽

Chaitanya Bharadwaj

Keyword(s):

Hearing Loss ◽

Otitis Media ◽

Pure Tone ◽

Pure Tone Audiometry ◽

Ossicular Chain ◽

Chronic Suppurative Otitis Media ◽

Suppurative Otitis Media ◽

Number Of Patients ◽

Operative Findings ◽

Air Conduction

Chronic suppurative otitis media is one of the common otological conditions in India for which patients seek advice from an otorhinolaryngologist. Chronic suppurative otitis media is recurrent and progressive disease which is characterized with tympanic membrane perforation and suppurative discharge. Pure tone audiometry is the most common test used to evaluate auditory sensitivity. Since hearing loss is a common complication of chronic suppurative otitis media, we designed this study to evaluate preoperative pure tone audiometry findings in patients with chronic suppurative otitis media and its correlation with the intra-operative findings. Aims and Objectives: 1] To assess the intra-operative findings in patients with chronic suppurative otitis media. 2] To evaluate the correlation between the preoperative pure tone audiometry findings and intra-operative findings in patients with chronic suppurative otitis media. 3] To assess the type of hearing loss and degree of hearing loss in patients with chronic suppurative otitis media. Materials and Methods: This is an Observational study carried over a period of 3 years from August 2011 to August 2013. Total number of patients included in this study was 100. Result: Out of 100 patients studied 69 % of patients had Tubo-Tympanic type of CSOM, 31 % of patients had Attico-antral type of CSOM. In patients of Safe CSOM; Central perforation was seen in maximum cases 46.4 %, anterior central perforations was seen in 8.7 % cases, posterior central perforations seen in 20.2 % cases, and subtotal perforations seen in 24.63 % cases. In patients of Unsafe CSOM posterosuperior cholesteatoma was seen in maximum cases 67.74 %, and attic cholesteatoma was seen in 32.2 % cases. In safe CSOM patients all ossicles were intact and mobile whereas in unsafe CSOM patients only 4 patients had intact ossicular chain, while maximum patients had ossicular defect. Conclusion: Hearing loss depends on size of perforation. Hearing loss increases as the size of perforation increases. Average air conduction threshold and air bone gap did not differ significantly between various groups of ossicular defect. This shows us that neither air conduction nor air bone gap are reliable parameters on basis of which we can predict ossicular status preoperatively.

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Development of an ear cap in chronic suppurative otitis media using additive manufacturing and TRIZ

Proceedings of the Institution of Mechanical Engineers Part H Journal of Engineering in Medicine ◽

10.1177/0954411918780126 ◽

2018 ◽

Vol 232 (7) ◽

pp. 733-738 ◽

Cited By ~ 1

Author(s):

Mahesh B Mawale ◽

Abhaykumar Kuthe ◽

Anupama M Mawale ◽

Sandeep W Dahake

Keyword(s):

Hearing Loss ◽

Additive Manufacturing ◽

Otitis Media ◽

Middle Ear ◽

Prevalence Rate ◽

Chronic Otitis Media ◽

Chronic Suppurative Otitis Media ◽

Suppurative Otitis Media ◽

Collaborative Tool ◽

Middle Ear Infection

The prevalence rate of chronic suppurative otitis media is high and its treatment continues to be a challenge for the otorhinolaryngologists. Due to middle ear infection, there may be pain, hearing loss and spontaneous rupture of the eardrum which results in perforation. Infections can cause a hole in the eardrum as a side effect of otitis media. The patients suffering from ear perforation or having a hole in eardrum require preventing entry of water in the ear. This article describes the development of ear cap using additive manufacturing and TRIZ (a collaborative tool) to prevent the entry of water in the ear during chronic otitis media.

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Scanning Electron Microscopy in the Evaluation of Defects to the Ossicular Chain in the Course of Chronic Otitis Media

Ear Nose & Throat Journal ◽

10.1177/0145561319873913 ◽

2019 ◽

pp. 014556131987391

Author(s):

Agnieszka Wiatr ◽

Katarzyna Swiezy ◽

Jacek Skladzien ◽

Maciej Wiatr

Keyword(s):

Electron Microscopy ◽

Scanning Electron Microscopy ◽

Chronic Inflammation ◽

Otitis Media ◽

Middle Ear ◽

Chronic Otitis Media ◽

Ossicular Chain ◽

Suppurative Otitis Media ◽

Ear Ossicles ◽

Scanning Electron

Objective: Chronic otitis media is a heterogeneous disorder. Chronic suppurative otitis media with cholesteatoma and, to a lesser extent, chronic otitis media with granulation lead to the destruction of bone structures within the middle ear. Bone loss may appear in the prominence of the horizontal semicircular canals and the bony canal of the facial nerve. The inflammatory process may spread to the bony labyrinth of the sigmoidal sinuses and the cranial cavities. Materials and Methods: The analysis comprised the examination of fragments of auditory ossicles removed during surgery in 21 patients with various types of chronic inflammation of the middle ear. The purpose of this study was to evaluate the usefulness of scanning electron microscopy in evaluating the erosion of middle ear ossicles in different types of chronic otitis media. Images captured at various magnifications were used for the best possible illustration of the observed lesions in bone tissue. Results: The observed lesions and the degree of bone surface damage were dependent on the type of chronic inflammation of the middle ear. The largest destructive changes in the ossicular chain were observed in chronic otitis media with cholesteatoma; smaller changes were observed in chronic otitis media with granulation. Conclusion: In the case of damage to the ossicles inflicted by inflammation, the use of a modeled bone block made of a temporal bone taken from outside the tympanic cavity or a biomaterial prosthesis is a good choice in ossiculoplasty.

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Silencing Nrf2 attenuates chronic suppurative otitis media by inhibiting pro-inflammatory cytokine secretion through up-regulating TLR4

Innate Immunity ◽

10.1177/1753425920933661 ◽

2020 ◽

Vol 27 (1) ◽

pp. 70-80

Author(s):

Abulajiang Tuoheti ◽

Xingzhi Gu ◽

Xiuqin Cheng ◽

Hua Zhang

Keyword(s):

Chronic Inflammation ◽

Otitis Media ◽

Inflammatory Cytokines ◽

Inflammatory Cytokine ◽

Acute Otitis Media ◽

Chronic Otitis Media ◽

Chronic Suppurative Otitis Media ◽

Related Factor ◽

Suppurative Otitis Media ◽

Knock Down

Compromised TLR-mediated chronic inflammation contributes to bacterial infection-caused chronic suppurative otitis media, but the mechanisms are unclear. The present study examined the expression status of nuclear erythroid 2-related factor 2 (Nrf2) and TLRs in human middle-ear mucosae tissues collected from patients with chronic suppurative otitis media, chronic otitis media and non-otitis media, and found that Nrf2 was high-expressed, whereas TLR4, instead of other TLRs, was low expressed in chronic suppurative otitis media compared to chronic otitis media and non-chronic otitis media groups. Consistently, inflammatory cytokines were significantly up-regulated in the chronic suppurative otitis media group, instead of the chronic otitis media and non-chronic otitis media groups. Next, LPS-induced acute otitis media and chronic suppurative otitis media models in mice were established, and high levels of inflammatory cytokines were sustained in the mucosae tissues of chronic suppurative otitis media mice compared to the non-otitis media and acute otitis media groups. Interestingly, continuous low-dose LPS stimulation promoted Nrf2 expression, but decreased TLR4 levels in chronic suppurative otitis media mice mucosae. In addition, knock-down of Nrf2 increased TLR4 expression levels in chronic suppurative otitis media mice, and both Nrf2 ablation and TLR4 overexpression inhibited the pro-inflammatory cytokine expression in chronic suppurative otitis media. Finally, we found that both Nrf2 overexpression and TLR4 deficiency promoted chronic inflammation in LPS-induced acute otitis media mice models. Taken together, knock-down of Nrf2 reversed chronic inflammation to attenuate chronic suppurative otitis media by up-regulating TLR4.

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Investigation of the Presence of Biofilms in Chronic Suppurative Otitis Media, Nonsuppurative Otitis Media, and Chronic Otitis Media with Cholesteatoma by Scanning Electron Microscopy

The Scientific World JOURNAL ◽

10.1155/2013/638715 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 17

Author(s):

Ercan Kaya ◽

Ilknur Dag ◽

Armagan Incesulu ◽

Melek Kezban Gurbuz ◽

Mustafa Acar ◽

...

Keyword(s):

Electron Microscopy ◽

Scanning Electron Microscopy ◽

Otitis Media ◽

Middle Ear ◽

Chronic Otitis Media ◽

Chronic Suppurative Otitis Media ◽

Middle Ear Mucosa ◽

Suppurative Otitis Media ◽

Tissue Samples ◽

Scanning Electron

Objective. Biofilms have been shown to play a major role in the pathogenesis of otolaryngologic infections. However, very limited studies have been undertaken to demonstrate the presence of biofilms in tissues from patients with chronic otitis media (COM) with or without cholesteatoma. Our objective is to study the presence of biofilms in humans with chronic suppurative and nonsuppurative otitis media and cholesteatoma.Study Design. In all, 102 tissue specimens (middle ear, mastoid tissue, and ossicle samples) were collected during surgery from 34 patients.Methods. The samples were processed for the investigation of biofilms by scanning electron microscopy (SEM).Results. Our research supports the hypothesis in which biofilms are involved in chronic suppurative otitis media, cholesteatoma, and, to a lesser degree, chronic nonsuppurative otitis media. There were higher rates in hypertrophic and granulated tissue samples than in normal mucosa. In addition, the presence of biofilms was significantly higher in the middle ear mucosa compared with the mastoid and ossicle samples.Conclusion. In the clinic, the careful use of topical or systemic antimicrobials is essential, and, during surgery, hypertrophic tissue must be carefully removed from normal tissue.

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Development and Administration of Chronic Suppurative Otitis Media Questionnaire-12 (COMQ-12) and Chronic Otitis Media Outcome Test-15 (COMOT-15) in Kannada

International Archives of Otorhinolaryngology ◽

10.1055/s-0037-1603644 ◽

2017 ◽

Vol 22 (02) ◽

pp. 108-112 ◽

Cited By ~ 6

Author(s):

Prashanth Prabhu ◽

Anusha Chandrashekar ◽

Anita Jose ◽

Aishwarya Ganeshan ◽

Lavanya Kiruthika

Keyword(s):

Quality Of Life ◽

Otitis Media ◽

Chronic Otitis Media ◽

Chronic Suppurative Otitis Media ◽

Health Related Quality ◽

Suppurative Otitis Media ◽

Related Quality ◽

Health Related ◽

Significant Impairment

Introduction It is essential to determine the quality of life among individuals with chronic suppurative otitis media (CSOM). However, there is limited literature on health-related quality of life measurements in Kannada-speaking individuals with CSOM. Objectives The present study attempted to translate and validate Chronic Suppurative Otitis Media Questionnaire-12 (COMQ-12) and Chronic Otitis Media Outcome Test-15 (COMOT-15) in Kannada. Method The English questionnaires were translated and back-translated, and they were later verified for content validity. The developed questionnaires were then administered to 100 individuals with CSOM for further validation. Results The results of the study showed that the translated questionnaires have good internal consistency for measuring quality of life among individuals with CSOM. The study also showed that Kannada-speaking individuals with CSOM show significant impairment in their health-related quality of life measures. Conclusions The impairments were more related to ear symptoms and psychological issues. However, test-retest reliability of the developed questionnaire and its further validation are essential. Thus, these questionnaires attempt to understand the problems of the individuals with CSOM from the patients' perspective and help clinicians provide the appropriate management.

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Relationship of Pure Tone Audiometry and Ossicular Discontinuity in Chronic Suppurative Otitis Media

Philippine Journal of Otolaryngology Head and Neck Surgery ◽

10.32412/pjohns.v21i1-2.819 ◽

2006 ◽

Vol 21 (1-2) ◽

pp. 5-10

Author(s):

Ryner Jose C. Carrillo ◽

Nathaniel W. Yang ◽

Generoso T. Abes

Keyword(s):

Logistic Regression ◽

Otitis Media ◽

Pure Tone ◽

Operative Procedure ◽

Multiple Logistic Regression Analysis ◽

Chronic Otitis Media ◽

Pure Tone Audiometry ◽

Chronic Suppurative Otitis Media ◽

Likelihood Ratios ◽

Suppurative Otitis Media

Background: Pure tone audiometry is routinely used to determine conductive and sensorineural hearing status. Ossicular discontinuity is usually assessed intra-operatively. If ossicular discontinuity can be predicted by pure tone audiometry, perhaps the operative procedure of choice and prognosis for hearing can also be anticipated. Objective: To determine the predictive value of preoperative pure tone audiometry on the presence of gross ossicular discontinuity in chronic otitis media. Methods: Records of 205 patients, 7 to 75 years of age undergoing their first operation for chronic otitis media were reviewed. Preoperative audiograms and operative records for tympanomastoidectomy were evaluated. A total of 162 patients meeting inclusion criteria were included in the study. Likelihood ratios for positive and negative ossicular discontinuity for frequency-specific air-bone gap cut-offs were determined. Multiple logistic regression analysis for pure tone audiometry and operative findings to predict ossicular discontinuity was performed and a model for predicting ossicular discontinuity using logistic regression obtained. Results and Conclusion: Frequency-specific air bone gap (ABG) cut-off values can predict ossicular discontinuity in chronic suppurative otitis media namely: < 20 dB ABG at 500 Hz predicts absence of ossicular discontinuity while > 50 dB ABG at 500 Hz, >30 dB ABG at 2 KHz, and > 50 dB ABG at 4 KHz best predict the presence of ossicular discontinuity in general. In the absence of cholesteatoma, the air bone gaps of <30 dB at 500 Hz and <20 dB at 1 KHz decrease probability of ossicular discontinuity from 32.97% to 2.54%. Combination of air bone gaps of >50 dB at 500 Hz, >20 dB at 2 KHz and >40 dB at 4 KHz increase the probability of ossicular discontinuity from 32.97% to 85.9%. These findings suggest that ossicular exploration may not be necessary for the former while an evaluation of the ossicular chain may be mandatory for the latter in the setting where cholesteatoma is not present or suspected. Presence of cholesteatoma, granulation tissue and size of tympanic membrane perforation are important factors to consider in predicting ossicular discontinuity. Keywords: air bone gap; audiometry, pure tone; ossicular discontinuity; otitis media, suppurative; logistic reg

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A clinical study of evaluation of tympanoplasty with mastoidectomy in mucosal chronic otitis media

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20195709 ◽

2019 ◽

Vol 6 (1) ◽

pp. 163

Author(s):

Ritesh Mahajan ◽

Nidhi Abraham ◽

Nagaraj T. M.

Keyword(s):

Otitis Media ◽

Disease Process ◽

Chronic Otitis Media ◽

Chronic Suppurative Otitis Media ◽

Suppurative Otitis Media ◽

Medical College ◽

Cortical Mastoidectomy ◽

A Prospective Study

Background: Chronic suppurative otitis media (CSOM) is one of the most common ear diseases in developing countries with a varying incidence of 3% to 57%. It the disease process is further divided into mucosal type and squamosal type depending on clinical presentation. The mainstay of therapy in CSOM remains surgery which aims at eradication of disease and restoring the hearing mechanism. The main objective of our study was to evaluate the changes and impact of tympanoplasty with mastoidectomy as a surgical treatment modality in mucosal type of CSOM.Methods: A prospective study was conducted in Rajarajeshwari Medical College and Hospital between November 2015 and June 2017, involving 50 patients with mucosal type of chronic otitis media. These patients, after complete clinical examination and hearing analysis, underwent tympanoplasty with cortical mastoidectomy. Follow-up of the patients was done at one month and three months after the surgery where the parameters recorded preoperatively were assessed. Results: The graft uptake three months after the surgery was 94%. Patients reported a subjective improvement in symptoms of ear discharge, decreased hearing, earache and tinnitus to 94%, 70%, 86% and 78% respectively. There was hearing improvement in ears that had discharge preoperatively and those ears that did not.Conclusions: Chronic suppurative otitis media is a very common problem and it can lead to recurrent ear discharge and hearing problems. Timely intervention is necessary as early diagnosis results in good surgical outcomes and can make an impact on patient’s quality of life.

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