Optimization of Tissue Reparative Histogenesis of the Dog’s Tympanic Membrane at Different Stages of Remission of Experimental Chronic Suppurative Otitis Media

AbstractThe aim of the study was to review the literature of tympanoscierosis especially its pathogenesis, to study the general incidence of tympanoscierosis among patients with chronic suppurative otitis media (CSOM), its association with cholesteatoma and also the type of hearing loss as well as its relation to the degree and site of tympanosclerosis.Seven hundred and seventy-five patients with CSOM were studied retrospectively. A full history was taken and thorough ENT examinations were carried out. Pure tone audiograms (PTA) of all patients were done and analysed. The operative finding of tympanosclerosis as well as middle-ear status were inspected.The incidence of tympanosclerosis was found to be 11.6 per cent (90 patients out of 775 CSOM cases). Most tympanosclerosis cases had dry ear, (85.6 per cent). Of the 57.8 per cent who had myringosclerosis, their PTA showed an AB gap 20–40 dB. When sclerosis affect both the tympanic membrane and middle ear, 61 per cent of patients had an AB gap >40 dB. The association of cholesteatoma and tympanosclerosis may be regarded as uncommon, 2.2 per cent.The exact aetiology and pathogenesis of tympanosclerosis is as yet not well known. Our study concentrated on the clinical picture of tympanosclerosis among patients with CSOM. The majority of hearing loss associated with tympanosclerosis was of the conductive type.

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A comparative study of superiorly based circumferential tympanomeatal flap tympanoplasty with anteriorly anchoring flap tympanoplasty in large, subtotal, and anterior tympanic membrane central perforations in chronic suppurative otitis media of mucosal type

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20180703 ◽

2018 ◽

Vol 4 (2) ◽

pp. 432

Author(s):

Amitkumar Rathi ◽

Vinod Gite ◽

Sameer Bhargava ◽

Neeraj Shetty

Keyword(s):

Comparative Study ◽

Tympanic Membrane ◽

Otitis Media ◽

Statistical Difference ◽

Chronic Suppurative Otitis Media ◽

Age Group ◽

Hearing Improvement ◽

Suppurative Otitis Media ◽

Gap Closure ◽

The Mean

Background: The main objective of the study was to assess and compare the graft uptake, hearing improvement, complications in large, subtotal, and anterior moderate perforations by each technique viz; superiorly based circumferential tympanomeatal flap tympanoplasty (STT)/full cuff and anterior anchoring flap tympanoplasty (AAT)/anterior tucking. Methods: In our study of 30 cases age group in the range of 10 years to 60 years. The mean air bone gap for the 8 patients with anterior moderate perforation was 31.75 db, for 17 patients with large central perforations was 38.75 db and for 5 patients with subtotal perforations was 41.4 db. Results: Mean air bone gap closure after 3 months of surgery in the STT group was 21.4 db while that after 6months of the surgery for the same group was 22.06 db. Mean air bone gap closure after 3 months of surgery in the AAT group was 18.2 db while that after 6months of the surgery for the same group was 18.73 db. Conclusions: Comparing the air bone gap closure in patients who underwent surgery by AAT and STT technique we found that there is no statistical difference. Both techniques (viz: superiorly based circumferential tympanomeatal flap tympanoplasty and anteriorly anchoring flap tympanoplasty) can be used for the repair of large, subtotal, and anterior tympanic membrane central perforations in chronic suppurative otitis media of mucosal type.

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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.

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Eustachian tube mucociuary transport in chronic suppurative otitis media

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0406148j ◽

2004 ◽

Vol 132 (5-6) ◽

pp. 148-151 ◽

Cited By ~ 2

Author(s):

Snezana Jesic ◽

Vladimir Nesic

Keyword(s):

Tympanic Membrane ◽

Otitis Media ◽

Eustachian Tube ◽

Middle Ear ◽

Chronic Suppurative Otitis Media ◽

Traumatic Rupture ◽

Mucociliary Transport ◽

Tympanic Cavity ◽

Suppurative Otitis Media ◽

Mean Time

Eustachian tube dysfunction is one of the well-known factors leading to development of chronic suppurative otitis media. Tube mucociliary transport is important for elimination of the inflammation products from the middle ear enabling recovery of the affected mucosa of the middle ear, local circulation and restoration of normal air pressure in the middle ear. The study was aimed at determining: 1. whether perforation site on the tympanic membrane influences tube mucociliary transport time in individuals with traumatic rupture of the eardrum; 2. possible time difference of tube mucociliary transport between group of patients with chronic suppurative otitis media and group of patients with traumatic rupture of the tympanic membrane; 3. possible time difference of tube mucociliary transport between chronic tubotympanic type of suppurative otitis media, so called tubotympanic otitis media and atticoantral type of chronic suppurative otitis media, the so called atticoantral otitis; 4. the association between the degree of defect of the tympanic membrane mucosa and time of tube mucociliary transport in each individual type of chronic suppurative inflammation of the middle ear. Eustachian tube mucociliary transport was studied in 16 patients with tubotympanic otitis, in 13 patients with atticoantral otitis and in 9 patients with traumatic rupture of the eardrum (control group of patients). All patients were treated at the Institute of Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia in Belgrade during 2002. Tube mucociliary transport was studied upon instillation of 10 ?l 5% sterile saccharine solution through the existing eardrum perforation in the course of preoperative preparation of the patient for surgical intervention. The time interval from the moment of sterile saccharine solution application till perception of the sweet taste in the mouth and pharynx was measured in studied patients. The obtained results were analyzed using the methods of descriptive and analytical statistics (t-test for small independent samples). The mean time of tube mucociliary transport in patients with traumatic rupture of the tympanic membrane was 7.6 minutes. The mean time of tube mucociliary transport in tubotympanic otitis with normal mucosa of the tympanic cavity promontorium was 15 minutes, while mean time of tube mucociliary transport in tubotympanic otitis with polypoid changes of the promontory mucosa was 24 minutes (t=5.218; p<0.01). Mean time of tube mucociliary transport in atticoantral otitis with normal promontory mucosa of the tympanic cavity was 35.5 minutes, while mean time of mucociliary tube transport in atticoantral otitis with polypoid changes of promontory mucosa was 48 minutes (t=6.99; p<0.01). In the irreversibly changed tympanic cavity mucosa, tube clearance saccharine test was negative even after one hour. The results of our study indicate the possibility that prolonged mucociliary tube transport has greater influence to development of atticoantral otitis rather than to development of tubotympanic otitis. The association between the degree of mucosal defect and time of mucociliary transport was evidenced in both types of chronic suppurative inflammation of the middle ear.

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Correlation between degree of hearing loss and intraoperative findings in tubotympanic type of chronic suppurative otitis media

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20180717 ◽

2018 ◽

Vol 4 (2) ◽

pp. 537 ◽

Cited By ~ 1

Author(s):

Ravi Dudda ◽

Sowmya Tumkur Rangaiah ◽

M. Hanumantha Prasad ◽

Nagavara Kalegowda Balaji

Keyword(s):

Hearing Loss ◽

Tympanic Membrane ◽

Otitis Media ◽

Pure Tone ◽

Pure Tone Audiometry ◽

Ossicular Chain ◽

Chronic Suppurative Otitis Media ◽

Hearing Improvement ◽

Suppurative Otitis Media ◽

Significant Difference

Background: The aim of tympanoplasty done for tubotympanic type of chronic suppurative otitis media (CSOM) should not only be to achieve a dry ear, but also to give hearing improvement to the patient. Aim of this study was to determine the correlation between size and site of tympanic membrane perforation with degree of hearing loss and correlation between ossicular chain status and degree of hearing loss on pure tone audiometry.Methods: Patients with tubotympanic CSOM with hearing loss upto 60 dBHL undergoing tympanoplasty were examined to know the site and size of tympanic membrane(TM) perforation. Intraoperative findings pertaining to middle ear and ossicles were noted. Results: Out of 52 patients of tubotympanic type of CSOM, hearing loss was least (31.18±7.46 dBHL) in small perforations of the TM and highest in subtotal perforations (48.74±7.83 dBHL) which was statistically significant. Hearing loss was significantly more in posterior perforation (46.61±7.02 dBHL) than in anterior perforation of TM (32.65±8.77 dBHL). There was a statistically significant difference in pure tone average hearing loss between intact ossicle group (32.87±9.77 dBHL) and eroded ossicle group (43.39±9.60dBHL). Difference in air bone gap was also significant between intact ossicle group (24.09±9.56 dB) and eroded ossicle group (31.02±9.83 dB). Multiple ossicles were eroded in nineteen patients with incus being the most commonly eroded ossicle.Conclusions: In this study, hearing loss increased with increased size of TM perforation and also with posterior perforation. Incus was found to be the most commonly eroded ossicle. Multiple ossicles were seen eroded most commonly when hearing loss was moderate. The surgeon will be better equipped to do ossiculoplasty in view of these preoperative findings and also to counsel the patient better about their expectation of hearing improvement following surgery.

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Outcome of Type 1 Tympanoplasty with and without the use of Topical Nasal Steroid: A Comparative Study from Eastern Nepal

Birat Journal of Health Sciences ◽

10.3126/bjhs.v3i1.19765 ◽

2018 ◽

Vol 3 (1) ◽

pp. 377-380

Author(s):

Rajeev Kumar Shah ◽

Karuna Shrestha ◽

Shrijana Sapkota ◽

Sandarva Giri

Keyword(s):

Tympanic Membrane ◽

Otitis Media ◽

Chronic Suppurative Otitis Media ◽

Suppurative Otitis Media ◽

Type 1 Tympanoplasty ◽

Post Surgery ◽

Hearing Assessment ◽

Nasal Steroid ◽

Intact Tympanic Membrane

Introduction: Chronic suppurative otitis media (CSOM) is the infection of the middle ear cleft. It is an important cause of preventable hearing loss.Objectives: The primary objective of this study is to compare the surgery outcome in terms of graft uptake described as intact tympanic membrane or residual perforation of tympanic membrane in patients with use of levocetirizine tablet 5 milligram only and levocetirizine tablet 5 milligram with topical fluticasone 100 microgram nasal steroid spray. This study is also aimed to determine the hearing status before and after the surgery and to find out its association with graft intake.Methodology: This prospective cross sectional study was conducted on patients diagnosed with chronic suppurative otitis media with medium to large central perforation of tympanic membrane in Birat Medical College Teaching Hospital during the period from 14 April 2015 to 13 April 2017. All the patients underwent type 1 tympanoplasty with placement of temporalis fascia under general anesthesia. After surgery, two equal groups were created with 40 patients in each group. One group received antibiotics, levocetirizine tablet and another group received antibiotics, levocetirizine tablets along with topical intranasal steroid spray from 1 post operative day till 6 wks. All the patients were followed up on the 5th day, 7th day and 42nd day. On 42nd day, status of tympanic membrane graft, post operative hearing assessment was done and compared between the two groups. Data were entered and analysed using Statistical Package For Social Sciences (SPSS) v21.Result: There were 40 patients who received levocetirizine only starting from the first post operative day and 39 patients received levocetirizine and topical nasal steroid spray. Patients with intact tympanic membrane following surgery were 88.6% and remaining had residual perforation of tympanic membrane. Of the study participants 87.3 % had improvement during post operative hearing assessment. 92.3% of the patients receiving levocetirizine and topical nasal steroid post surgery had intact tympanic membrane on otoscopic examination and there was a significant association with p value of 0.04Conclusion: Combination therapy with topical intranasal steroid spray, antihistaminics and antibiotics is beneficial compared to antibiotics and antihistaminics in type 1 tympanoplasty in terms of graft intake and improvement in hearing. BJHS 2018;3(1)5 : 377-380

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Observation of hearing loss in patients with chronic suppurative otitis media tubotympanic type

Kathmandu University Medical Journal ◽

10.3126/kumj.v7i4.2761 ◽

1970 ◽

Vol 7 (4) ◽

pp. 397-401 ◽

Cited By ~ 8

Author(s):

M Maharjan ◽

P Kafle ◽

M Bista ◽

S Shrestha ◽

KC Toran

Keyword(s):

Hearing Loss ◽

Tympanic Membrane ◽

Otitis Media ◽

Tympanic Membrane Perforation ◽

Chronic Suppurative Otitis Media ◽

Common Finding ◽

Hearing Level ◽

Suppurative Otitis Media ◽

Low Frequencies ◽

Membrane Perforation

Background: It is acknowledged that size and site of tympanic membrane perforation is proportional to degree of hearing loss but there are many studies which suggests otherwise. Persistent ear discharge is also supposed to deteriorate hearing level with passage of time. This study is carried out to find out the relation between size and site of tympanic membrane perforation and duration of ear discharge on hearing loss. Objectives: The objective of this study is to study the effect of size and site of tympanic membrane perforation and duration of ear discharge on hearing loss. Materials and methods: This is a cross-sectional prospective study conducted at Kathmandu Medical College, department of ear nose and throat from January till July 2009. One hundred patients aged between 8 to 60 years with pars-tensa perforations were included in the study. Detail clinical examination and history was carried out followed by hearing evaluation by audiometry was done in all cases. All the data is collected, statistical analysis is done using SPSS program and documented for study. Results: One hundred patients with 119 perforated tympanic membrane, age ranged between 8 to 60 years, 44 males and 56 females were studied. Bilateral tympanic membrane perforation were seen in 19 patients, right sided perforation in 39 and left sided in 42 patients respectively. Large central perforation involving all four quadrants was the most common otologic findings seen in 72 ears (60.50%) whereas perforation in posterosuperior quadrant was the least common finding seen in 3 patients (2.52%). Significant relation is observed between site of perforation and degree of hearing loss; posterior placed perforations seem to have larger hearing loss. Ninety-five perforations (79.83%) showed more loss in low frequencies with larger air bone gap at low frequencies. The longer the duration of ear discharge, the more the hearing loss. Conclusion: The larger the perforation, the greater the decibel loss in sound perception. The location of perforation on the tympanic membrane and the duration of ear discharge have significant effect on the magnitude of hearing loss. Key words: chronic suppurative otitis media; tympanic membrane perforation; hearing loss DOI: 10.3126/kumj.v7i4.2761 Kathmandu University Medical Journal (2009) Vol.7, No.4 Issue 28, 397-401

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