A comparative study of tragal cartilage and autologous incus for ossicular chain reconstruction in type IIB tympanoplasty at Dr. Hedgewar Hospital, Aurangabad

Background: Tympanoplasty is the surgical operation performed for the reconstruction of the eardrum (tympanic membrane) and/or the small bones of the middle ear. Chronic otitis media is a very common condition of middle ear which not only has a high incidence in the world but also in our set up. So, in view of this, we decided to conduct a study on the surgical management of CSOM-tubotympanic type.Methods: We conducted this study at ENT department of Dr. Hedgewar Rugnalaya, Aurangabad to compare air bone gap closure by using tragal cartilage and autologous incus in type IIB tympanoplasty in patients with chronic suppurative otitis media, (tubotympanic). 66 patients with central perforation of tympanic membrane, necrosed incus and mobile stapes requiring type IIB tympanoplasty, were included as a part of the study.Results: We performed type IIB tympanoplasty with a routine post-aural incision in 66 patients. According to our observation, both incus and cartilage are good materials for ossiculoplasty, tragal cartilage being better.Conclusions: After conducting this study we concluded that incus and tragal cartilage both are excellent materials for ossiculoplasty.

Download Full-text

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.

Download Full-text

Anterior epitympanic attic antrum space obstruction and symptom onset associated with myringosclerosis in benign chronic suppurative otitis media

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20202235 ◽

2020 ◽

Vol 8 (6) ◽

pp. 2013

Author(s):

Zulfikar Naftali ◽

Suprihati . ◽

Dharmana E. ◽

Setyawan H.

Keyword(s):

Tympanic Membrane ◽

Otitis Media ◽

Middle Ear ◽

Symptom Onset ◽

Chronic Otitis Media ◽

Chronic Suppurative Otitis Media ◽

Control Group ◽

Chi Square ◽

Suppurative Otitis Media ◽

Control Approach

Background: The AAA (Anterior epitympanic, Attic, and Antrum) space is the space between the mastoid and middle ear which functions to balance the pressure in both organs (buffer). Pathological tissue in the AAA cavity due to chronic infection would disrupt the buffer function and could change the morphology of the mucosa in the tympanic membrane and middle ear. Obstruction in the AAA space measured subjectively by observing the smoothness of the flow using saline solution has been shown to be associated with a plaque in the tympanic membrane (myringosclerosis) in Chronic Otitis Media (COM) patients. This study aims to determine the relationship between AAA space obstructions with myringosclerosis using CT-Scan for an objective result.Methods: Retrospective study with case-control approach used in this study. Case criterias are Chronic Suppurative Otitis Media (CSOM) patients with myringosclerosis, both men and women and age 15-50 years, while the control group are benign CSOM patients without myringosclerosis. Data were analyzed with the chi-square test to prove the association between the AAA space status and length of symptom onset with myringosclerosis.Results: During January 2017-December 2019 there were 33 respondents, 19 cases and 14 controls, 21 men and 12 women with an average age of 35 years (cases) and 23.5 years (control). The length of symptom onset more than 5 years (p <0.05, OR 6.94 with CI 0.5-1.5) and AAA space obstruction (p <0.05 OR 34.25 with CI 0.8-1.8) has been shown to be associated with myringosclerosis in people with benign CSOM.Conclusions: AAA space obstruction and symptom onset more than 5 years significantly associated with myringosclerosis.

Download Full-text

Pre-operative predictors of ossicular necrosis in chronic otitis media-mucosal type

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20190769 ◽

2019 ◽

Vol 5 (2) ◽

pp. 396

Author(s):

Razim Abdul Rasheed ◽

Mubeena . ◽

K. S. Gangadhara Somayaji

Keyword(s):

Otitis Media ◽

Middle Ear ◽

Granulation Tissue ◽

Chronic Otitis Media ◽

Ossicular Chain ◽

Bivariate Analysis ◽

Middle Ear Mucosa ◽

Cross Sectional ◽

Suppurative Otitis Media ◽

Wide Range

Background: Chronic suppurative otitis media can cause a wide range of pathologies in the middle ear that include irreversible mucosal changes, granulation tissue formation, cholesteatoma, tympanosclerosis, and destruction of ossicles. Knowledge regarding ossicular discontinuity before surgery enables the surgeon to be prepared for ossiculoplasty. Objective was to study the pre-operative clinical, audiological and microscopic findings in chronic otitis media mucosal type and correlate preoperative findings with intra-operative ossicular necrosis. Methods: Study design was observational, descriptive and cross sectional study. All patients were subjected to detailed clinical, otoscopic and microscopic examination to assess the size and site of perforation, presence or absence of ear discharge, granulation tissue, tympanosclerosis in the middle ear, exposure of incudostapedeal joint and condition of middle ear mucosa. Pure tone audiogram was also done. All patients underwent tympanoplasty±cortical mastoidectomy and the intraoperative findings of ossicular necrosis were noted. Results: Of the 105 patients, 18(17.1%) had ossicular necrosis. Bivariate analysis showed positive correlation for long standing disease (p=0.004), presence of discharging ear (p=0.014), polypoidal middle ear mucosa (p=0.000) granulations in middle ear (p=0.000) and also when incudostapedeal joint was exposed (p=0.005). Mean Air bone gap was higher with 35 dB in ossicular necrosis and 22.7 dB in intact ossicular chain was also statistically significant (p=0.0001).Conclusions: Ossicular necrosis was best indicated by the presence of polypoidal mucosa, granulation in the middle ear and higher air-bone gap on audiometry. However longer duration of disease, persistent active stage of disease and exposure of incudostapedeal joint were also found to be significant.

Download Full-text

Study of hearing results of ossiculoplasty in patients with safe chronic suppurative otitis media

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20191465 ◽

2019 ◽

Vol 5 (3) ◽

pp. 617

Author(s):

Prasad A. Kelkar ◽

Jyoti V. Hirekerur

Keyword(s):

Otitis Media ◽

Middle Ear ◽

Chronic Otitis Media ◽

Cost Effective ◽

Ossicular Chain ◽

Suppurative Otitis Media ◽

Hearing Results ◽

Cost Effective Method ◽

History Of ◽

Local Examination

Background: Ossicular discontinuity can occur as a result of erosion by chronic otitis media or due to trauma. Reconstruction of the ossicular chain aims to surgically optimize the middle ear transformer mechanism. The goal of this study was to devise a protocol to manage the ossicular discontinuity, provide good hearing to the patients and to demonstrate that use of ossicle for ossicular reconstruction is a safe, physiological, practical, successful and cost effective method.Methods: The present study is retrospective study of 50 patients who underwent ossiculoplasty in our institute over the period of 2 years. Most patients presented to us with a history of chronic intermittent ear discharge and decreased hearing. Detailed clinical examination included general examination and local examination of ear, nose and throat. Examination of ear included otoscopy, tuning fork tests, and examination under microscope. Results: The average pre-operative air-bone gap in patients with ossicular disruption was 34.95 dB and after ossiculoplasty was 12.93 dB. The mean air-bone closure after surgery was 27.88 dB. In most cases the post-operative air bone closure was within the range of 20 dB. The hearing results in ossiculoplasty are dependent on various factors but middle ear status in one of the most important factor in deciding the final outcome.Conclusions: The ossiculoplasty using autograft has stood the test of time and the results are superior to that of prosthesis. They have less rate of complications, are economic and easily available. The expertise to sculpt the ossicle can be easily developed with practice.

Download Full-text

Ossicular chain reconstruction improves bone conduction threshold in chronic otitis media

The Journal of Laryngology & Otology ◽

10.1017/s0022215107009474 ◽

2008 ◽

Vol 122 (4) ◽

pp. 351-356 ◽

Cited By ~ 7

Author(s):

H-S Lee ◽

S-D Hong ◽

S H Hong ◽

Y-S Cho ◽

W-H Chung

Keyword(s):

Otitis Media ◽

Middle Ear ◽

Bone Conduction ◽

Chronic Otitis Media ◽

Ossicular Chain ◽

Bone Conduction Threshold ◽

Ossicular Chain Reconstruction ◽

Duration Of Disease ◽

The Mean ◽

Conductive Mechanism

AbstractThis study aimed to assess the elevation of bone conduction threshold in patients with chronic otitis media and to investigate the mechanism of this phenomenon. One hundred and six patients with unilateral chronic otitis media who had undergone a tympanomastoidectomy were reviewed retrospectively. The differences in the bone conduction thresholds between the diseased and normal sides were assessed and compared according to the duration of the disease and the presence of cholesteatoma. Post-operative changes in the bone conduction threshold were also assessed. The mean bone conduction thresholds were significantly elevated on the diseased side, ranging from 3.4 to 11.6 dB across frequencies, with a maximal elevation at 2000 Hz. The duration of disease and the presence of cholesteatoma did not affect the degree of the bone conduction elevation. After ossicular reconstruction, bone conduction thresholds improved significantly at all frequencies, with the greatest improvement being observed at 2000 Hz. These results suggest that the elevation in the bone conduction threshold in chronic otitis media is mainly caused by a change in the conductive mechanism in the middle ear.

Download Full-text

Ossicular Chain Reconstruction in a Developing Country

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489418760054 ◽

2018 ◽

Vol 127 (5) ◽

pp. 306-311 ◽

Cited By ~ 3

Author(s):

Es-Hak Bedri ◽

Miriam Redleaf

Keyword(s):

Tympanic Membrane ◽

Developing Country ◽

Middle Ear ◽

Granulation Tissue ◽

Ossicular Chain ◽

Single Stage ◽

Limited Resources ◽

Closure Rate ◽

Average Improvement ◽

Ossicular Chain Reconstruction

Objectives: In Ethiopia, 2-stage operations with middle ear prostheses are economically unfavorable. We hypothesized that single-stage autologous ossiculoplasty results in acceptable tympanic membrane (TM) and hearing improvements in a setting of limited resources. Methods: One hundred eighty-eight patients (197 ears) who underwent 1-stage autologous ossiculoplasty for ossicular dysfunction are presented. All but 14 of these ears also had perforations of the TM. Conditions of the middle ear were granulation tissue, ossicular disruption only, tympanosclerosis, and cholesteatoma. Reconstructions of the ossicular chain were performed with autologous ossicles only. Results: The closure rate of TM perforations was 95%. Preoperative air bone gaps were 27 to 60 dB (mean [SD] = 44 [7] dB); postoperative air bone gaps were 0 to 50 dB (average [SD] = 23 [10] dB), for an average improvement of 21 dB across all reconstruction types ( P < .001). The largest favorable changes in air bone gaps were with incus and malleus columellas from the footplate to the TM (33 and 23 dB, respectively) ( P < .001). No patient had worsening of sensorineural hearing levels or extrusion of the reconstructed ossicles. Conclusion: Autologous ossiculoplasty performed well in this setting. Acceptable TM closure rates and improvement of air bone gaps were seen in 1-stage operations without the use of prostheses.

Download Full-text

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.

Download Full-text

High Human Papillomavirus DNA loads in Inflammatory Middle Ear Diseases

Pathogens ◽

10.3390/pathogens9030224 ◽

2020 ◽

Vol 9 (3) ◽

pp. 224 ◽

Cited By ~ 4

Author(s):

Nicola Malagutti ◽

John Charles Rotondo ◽

Luca Cerritelli ◽

Claudio Melchiorri ◽

Monica De Mattei ◽

...

Keyword(s):

Otitis Media ◽

Middle Ear ◽

Dna Sequences ◽

Direct Sequencing ◽

Chronic Otitis Media ◽

Human Papillomaviruses ◽

Middle Ear Mucosa ◽

Suppurative Otitis Media ◽

Ear Diseases ◽

Hpv Dna

Background. Previous studies reported human papillomaviruses (HPVs) in middle ear tumors, whereas these viruses have been poorly investigated in chronic inflammatory middle ear diseases. We investigated HPVs in non-tumor middle ear diseases, including chronic otitis media (COM). Methods. COM specimens (n = 52), including chronic suppurative otitis media (CSOM) (n =38) and cholesteatoma (COMC) (n = 14), as well as normal middle ear (NME) specimens (n = 56) were analyzed. HPV sequences and DNA loads were analyzed by quantitative-PCR. HPV genotyping was performed by direct sequencing. Results. HPV DNA was detected in 23% (12/52) of COM and in 30.4% (17/56) of NME (p > 0.05). Specifically, HPV DNA sequences were found in 26.3% (10/38) of CSOM and in 14.3% (2/14) of COMC (p > 0.05). Interestingly, the HPV DNA load was higher in COMC (mean 7.47 copy/cell) than in CSOM (mean 1.02 copy/cell) and NME (mean 1.18 copy/cell) (P = 0.03 and P = 0.017 versus CSOM and NME, respectively). HPV16 and HPV18 were the main genotypes detected in COMC, CSOM and NME. Conclusions. These data suggest that HPV may infect the middle ear mucosa, whereas HPV-positive COMCs are associated with higher viral DNA loads as compared to NME.

Download Full-text

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.

Download Full-text