Intra-operative findings of attico-antral type of chronic suppurative otitis media: A study of 85 patients.

Objectives: Chronic suppurative otitis media is the most common ear disease in Otolaryngology OPD and Head & Neck surgery in tertiary care hospitals worldwide. Due to its life threatening complications and management difficulties, attico-antral disease, a type of CSOM poses a huge challenge to otolaryngologists. Study Design: Descriptive study. Setting: Department of Otolaryngology and Head & Neck Surgery Allied Hospital (FMU) Faisalabad. Period: From January 2016 to December 2018. Material & Methods: Eighty five patients with CSOM of attico-antral type were included. Results: Forty six patients (54.1%) were male and thirty nine patients (45.9%) were female, aged 07 to 58 years with an average age of 23.7 years. 42 patients (49.4%) had a right ear disease and 43 patients (50.6%) had a left ear disease. Granulation tissue was observed in 50 patients (58.8%), cholesteatoma in 27 patients (31.7%) and both granulation tissue and cholesteatoma in 08 patients (09.5%). The main pathology was observed to involve the attic area only of 04 patients (04.7%), attic and middle ear of 44 patients (51.7%), attic and antrum of 16 patients (18.9%) and attic, middle ear, antrum and other mastoid air cells in 21 cases (24.7%). The malleus handle was found eroded in 10 patients (11.8%), head & handle in only 02 patients (02.4%). In 23 patients (27%) long process of incus was damaged while incus was completely eroded in 03 patients (03.5%). The suprastructure of stapes was found eroded in 03 patients (03.5%). Conclusion: Granulation tissue is the most common primary lesion along with cholesteatoma associated with attico-antral type of CSOM. Due to this pathology, the incus is the most frequently eroded small bone of the middle ear. In addition the management of granulation tissue and cholesteatoma poses a huge challenge to the otolaryngologists. Therefore, the general practitioners are needed to be educated for early referral to otolaryngologist for early and rapid management to prevent complications due to attico-antral type of CSOM.

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Frequency of Incus Bone Erosion on Mastoid Exploration in Chronic Suppurative Otitis Media with Middle Ear Cholesteotoma

10.53350/pjmhs211561426 ◽

2021 ◽

Vol 15 (6) ◽

pp. 1426-1428

Author(s):

W. Javaid ◽

A. Rashid ◽

M. U. K. Amin ◽

T. Khan ◽

M. Fatima

Keyword(s):

Otitis Media ◽

Middle Ear ◽

Bone Erosion ◽

Age Groups ◽

Chronic Suppurative Otitis Media ◽

Cross Sectional ◽

Suppurative Otitis Media ◽

Middle Ear Cholesteatoma ◽

Sample Technique ◽

Operative Findings

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

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A study of complications of chronic suppurative otitis media at tertiary care hospital

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20200146 ◽

2020 ◽

Vol 6 (2) ◽

pp. 330

Author(s):

Bhagirathsinh D. Parmar ◽

Sushil Jha ◽

Vikas Sinha ◽

Nirav Chaudhury ◽

Gavendra Dave

Keyword(s):

Otitis Media ◽

Tertiary Care ◽

Acute Otitis Media ◽

Neck Surgery ◽

Study Data ◽

Chronic Suppurative Otitis Media ◽

Common Disease ◽

Care Hospital ◽

Suppurative Otitis Media ◽

Intracranial Complications

Background: Chronic suppurative otitis media (CSOM) is a still common disease in developing country and is found sometimes difficult to treat. Different complications can develop inspite of availability of higher antibiotics. In pre-antibiotic era, complications of acute otitis media and CSOM were very common and lead to high mortality. Inspite of initial decline in the complication of CSOM due to higher antibiotics, the incidences are still on rise. CSOM remains a serious disease, particularly in developing countries and CSOM-related complications are still found life-threatening. The aim and objective was to study various clinical presentations and management of CSOM related complications.Methods: All patients of chronic supurrative otitis media with intra or extracranial complication who were admitted in Department of Otorhinolaryngology Head and Neck surgery, Sir. T. General Hospital, Government Medical College, Bhavnagar from July 2015 to December 2018 was included in this study. Data of clinical presentation, associated complication, management, and follow-up were analysed. Results: Out of 250 patients of CSOM admitted during these 3 years in ENT Department, 36 patients presented with CSOM related complications. 15 patients presented with intracranial complications and 21 patients presented with extracranial complications.Conclusions: Inspite of availability of higher antibiotics, CSOM related complications are still common. In all the patients require higher intravenous antibiotics (which crosses blood brain barrier) followed by mastoid surgeries.

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Correlation between histomorphometric changes and the type of aerobic bacteria isolated in chronic suppurative otitis media

Vojnosanitetski pregled ◽

10.2298/vsp1101046z ◽

2011 ◽

Vol 68 (1) ◽

pp. 46-50

Author(s):

Emilija Zivkovic-Marinkov ◽

Milan Stankovic ◽

Dragan Mihailovic ◽

Mila Bojanovic

Keyword(s):

Staphylococcus Aureus ◽

Otitis Media ◽

Middle Ear ◽

Granulation Tissue ◽

Bacterial Flora ◽

Inflammatory Cells ◽

Chronic Suppurative Otitis Media ◽

Aerobic Bacteria ◽

Middle Ear Mucosa ◽

Suppurative Otitis Media

Background/Aim. Bacterial flora is a very important factor in pathogenesis of chronic suppurative otitis media (CSOM) and significantly influences the type and intensity of osteolytic process. There are few histomorphometric investigations of middle ear mucosa in chronic otitis. The aim of this study was to identify aerobic bacteria responsible for chronic suppurative otitis media as well as their association with histomorphometric changes of middle ear mucosa. Methods. A prospective study that comprised 153 patients treated in the Clinc for Ear, Thorat and Nose Diseases, Nis, was conducted. Bacteriologic analysis of diseased ear secretion was carried out in all patients. Intraoperatively removed granulation tissue was used for histomorphometry. The analysed parameters were: the number of inflammatory cells, as well as vascularization and vasodilatation. Results. The most frequently isolated aerobic bacteria from chronic suppurative otitis media were Staphylococcus aureus (29.02%), Pseudomonas aeruginosa (29.02%) and Proteus spp. (21.76%). There was no correlation between the type of pathologic process and the type of bacteria.The number of inflammatory cells in the granulation tissue in pure cultures of Staphylococcus aureus was 1,597.33 ? 549.45 and in Pseudomonas auriginosa cultures was 2,639 ? 648. Conclusion. This study showed that there is a statistically significant correlation between the number of inflammatory cells in the granulation tissue and the type of aerobic bacteria we isolated. The intensity of the infection in chronic suppurative otitis media depends on the type of the isolated bacteria, which emphasizes the importance of adequate preoperative antimicrobial therapy.

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The intraoperative pathological findings in cases of chronic suppurative otitis media with central perforation of tympanic membrane at a tertiary care centre in Eastern Nepal

Asian Journal of Medical Sciences ◽

10.3126/ajms.v8i1.15944 ◽

2017 ◽

Vol 8 (1) ◽

pp. 42-47 ◽

Cited By ~ 1

Author(s):

Sanjeev Kumar Thakur ◽

Nisha Ghimire ◽

Rabin Acharya ◽

Sanjay Kumar Singh ◽

Anwar Afaque

Keyword(s):

Otitis Media ◽

Middle Ear ◽

Tertiary Care ◽

Pure Tone Audiometry ◽

Chronic Suppurative Otitis Media ◽

Pathological Findings ◽

Tertiary Care Centre ◽

Middle Ear Mucosa ◽

Suppurative Otitis Media ◽

Central Perforation

Background: Chronic suppurative otitis media (CSOM) is the chronic inflammation of the middle ear cleft. The atticoantral type is called unsafe type because of the associated complications due to granulations and cholesteatoma which may be life-threatening. CSOM with central perforation (tubotympanic type) is usually not associated with major complications such as cholesteatoma formation.Aims and Objectives: To find out the intraoperative pathological findings in cases of CSOM with central perforation (tubotympanic type)Materials and Methods: This descriptive, cross sectional study has been conducted in the Department of Ear, Biratnagar Eye Hospital in Nepal over 2 years. Study group includes 172 patients having CSOM with central perforations in the tympanic membranes who underwent different types of procedures. Preoperatively, all the patients were evaluated with otoscopy, microscopy, pure-tone audiometry, and some patients with computed tomography scan. The pathological findings were confirmed with biopsy. The findings were tabulated and analysed.Results: 21(12.2%) patients were having dry central perforation with normal Eustachian tube function. 95 patients, i.e., 55.23% were having granulations in attic, aditus, antrum. 25 (14.53%) cases were having ossicular erosion.5 (2.9%) cases had tympanosclerosis in middle ear. 1 (0.58%) case had facial nerve dehiscence. 16 (9.3%) cases had oedema of middle ear mucosa/aural polyp from middle ear. Surprisingly 9 patients, i.e., 5.23% were having cholesteatoma which was confirmed by histopathological study.Conclusion: This study shows that cholesteatoma can be found in tubotympanic type of CSOM, along with other pathological findings. Hence it is on the part of the surgeon to be careful while planning surgery on their patients with CSOM (tubotympanic type), remembering that all safe CSOM might not always be safe. Asian Journal of Medical Sciences Vol.8(1) 2017 42-47

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Mycology of Chronic Suppurative Otitis Media at Tertiary Care Centre of Nepal

10.21203/rs.3.rs-286123/v1 ◽

2021 ◽

Author(s):

Ajay Kumar Chaurasiya ◽

Rabindra Bhakta Pradhananga ◽

Dipendra Kumar Mandal ◽

Manoj Mahato ◽

Niranjan Prasad Sah ◽

...

Keyword(s):

Otitis Media ◽

Potassium Hydroxide ◽

Tertiary Care ◽

Neck Surgery ◽

Chronic Suppurative Otitis Media ◽

Fungal Culture ◽

Care Centre ◽

Tertiary Care Centre ◽

Suppurative Otitis Media ◽

Positive Growth

Abstract ObjectiveThis study was designed to find out the fungal aetiological agents in chronic suppurative otitis media (CSOM) patients attending tertiary care centre of Nepal. ResultTotal 123 samples of 117 patients, outdoor as well as indoor from Department of ENT and Head and Neck Surgery (HNS) TUTH, Maharajgunj, Kathmandu those specimens were processed and among them, 23(18.7%) was found potassium hydroxide (KOH) mount positive whereas positive growth was in 27 specimens. The prevalence rate of fungus was 21.95 percent in which the main pathogen was Aspergillus species (51.8%), followed by Candida species (14.8 %). Keywords: CSOM, KOH, Fungal culture, Aspergillus

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Spectrum of clinical characteristics of chronic suppurative otitis media unsafe type: a retrospective study from a tertiary care teaching hospital in Central India

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20212444 ◽

2021 ◽

Vol 7 (7) ◽

pp. 1105

Author(s):

Rashmi Hansdah ◽

Kavita Sachdeva

Keyword(s):

Hearing Loss ◽

Otitis Media ◽

Tertiary Care ◽

Disease Process ◽

Chronic Otitis Media ◽

Central India ◽

Neck Surgery ◽

Chronic Suppurative Otitis Media ◽

Retropharyngeal Abscess ◽

Suppurative Otitis Media

Background: Chronic suppurative otitis media (CSOM)-unsafe type or atticoantral disease or chronic otitis media-squamosal type is a commonly encountered bone eroding disease of the middle ear whose complications can be potentially fatal.Methods: Retrospective analysis of 80 patients who underwent mastoid exploration in the department of otolaryngology and head and neck surgery, NSCBMCH, Jabalpur between June 2016 and May 2017.Results: Unsafe CSOM is commoner in young males of 16-30-year age group. Foul smelling, scanty, purulent ear discharge was the commonest symptom (97.5%). Attic perforation was the most consistent otoscopic finding (47.5% cases). 15% of our patients had central perforations. Conductive hearing loss was most common (62%) followed by mixed hearing loss (23%) and sensorineural hearing loss (11%). Commonest complication encountered was mastoiditis (27 cases). Mastoidectomy with tympanoplasty was done in almost all cases (97.5%). Attic (96.2%), additus (90%), and antrum (86.2%) were commonly involved by disease process. Incus was found to be most susceptible to erosion (88.5%) while stapes was most resistant (36.25%).Conclusions: Unsafe CSOM presenting late warrant prompt diagnosis and surgical intervention. Unusual presentation like retropharyngeal abscess and trismus should raise suspicion of complicated unsafe CSOM in patients with history of otorrhoea. Canal wall down mastoidectomy with rehabilitation of hearing is the surgery of choice in patients who are unlikely to follow up regularly.

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Complications of Chronic Suppurative Otitis Media AA Type-3 Years Experience at TUTH

Journal of Nepal Medical Association ◽

10.31729/jnma.842 ◽

2003 ◽

Vol 40 (138) ◽

pp. 77-82 ◽

Cited By ~ 1

Author(s):

Naramaya Thapa ◽

R P Shrivastava ◽

RC M Amatya ◽

B K Sinha ◽

H Bhattarai ◽

...

Keyword(s):

Retrospective Study ◽

Otitis Media ◽

Teaching Hospital ◽

Granulation Tissue ◽

Neck Surgery ◽

University Teaching ◽

Chronic Suppurative Otitis Media ◽

Suppurative Otitis Media ◽

Intracranial Complications ◽

Type 3

This retrospective study was carried out in the Department of ORL and Head &Neck Surgery, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu.Three hundred patients having atticoantral type of chronic suppurative otitis mediaunderwent emergency or routine mastoid exploration from 14 April 1997 to 12April 2000. Of the 300 patients, 64 (21.33%) had complications. Age of the patientswith complications ranged from 5-38 years. Thirty eight (59.38%) patients were malewhile 26 (40.62%) were female. Forty eight (75%) had extracranial and 15 (23.44%)had intracranial complications while 1 (2.08%) had both extra and intracranialcomplications. Cholesteatoma was present in 233 (77.66%) patients and of these 48(20.60%) had complications. Sixty seven (22.33%) patients had granulation tissue, ofthese 16 (23.88%) had complications.In cholesteatomatous cases 34 (70.83%) hadextracranial complications. Intracranial complications were present in 14(29.17%)cholesteatomatous cases. In patients with granulation tissue extracranial complicationwas present in 14 (87.50%) patients and only one patient had intracranialcomplication.Combination of extra and intracranial complications were found in 1patient with granulation tissue. When compared with types of pathology extracranialcomplications were higher in patients with granulation tissue (87.50% vs 70.83%)and intracranial complications were found more in cholesteatomatous cases (29.17%vs 6.26%). Both these findings were , however, statistically not significant. Reasonsbehind these findings may be presence of granulation tissue beneath the epitheliumof choleateatoma, and association of both types of pathology with infection andinflammatory process.Key Words: Chronic Suppurative Otitis Media, Atticoantral Type, Mastoid Exploration, Complications.

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Clinico-epidemiological study of complicated and uncomplicated chronic suppurative otitis media

The Journal of Laryngology & Otology ◽

10.1017/s0022215107000278 ◽

2007 ◽

Vol 122 (5) ◽

pp. 442-446 ◽

Cited By ~ 23

Author(s):

B K Vikram ◽

N Khaja ◽

S G Udayashankar ◽

B K Venkatesha ◽

D Manjunath

Keyword(s):

Hearing Loss ◽

Otitis Media ◽

Granulation Tissue ◽

Tertiary Care ◽

Age Distribution ◽

Chronic Suppurative Otitis Media ◽

Prognostic Indicators ◽

Suppurative Otitis Media ◽

Disease Focus ◽

Media Group

AbstractIntroduction:This study aimed to compare the clinical and epidemiological profiles of cases of complicated and uncomplicated chronic suppurative otitis media, based on their prognostic factors.Materials and methods:This was a prospective, cross-sectional study conducted in a tertiary care medical college hospital over a period of two and a half years. The study group comprised 187 ears, out of which 62 had complications while 125 did not. The two groups were compared with respect to nine prognostic variables: age distribution, sex, patient's domicile, literacy status, duration of ear discharge at presentation, ear pathology, predisposing disease focus in the nose or throat, ear swab microbiology, and hearing loss.Results:Patients in the complicated chronic suppurative otitis media group had a higher male predominance and were younger. Rural and illiterate patients had a higher risk of developing complications. Cholesteatoma and granulation tissue were potential risk factors in the complicated chronic suppurative otitis media group. Ears with complications were more prone to develop sensorineural hearing loss. Age, sex, duration of ear discharge, predisposing disease focus in nose or throat, and ear swab microbiology were all less useful prognostic indicators of complications.Conclusion:Early detection and timely treatment of chronic suppurative otitis media in rural and illiterate patients may prevent life-threatening complications and reduce their incidence. Ears that harbour relatively large quantities of both cholesteatoma and granulation tissue together require more urgent surgical intervention and more extensive disease clearance in order to prevent complications.

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Evaluation of single stage tympanomastoid surgery in unsafe chronic suppurative otitis media in Kashmiri population: a cross sectional study

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20201691 ◽

2020 ◽

Vol 6 (5) ◽

pp. 939

Author(s):

Parvez Ahmed Mir ◽

Owais Makhdoomi ◽

Syed Waseem Abbas

Keyword(s):

Otitis Media ◽

Ossicular Chain ◽

Neck Surgery ◽

Cross Sectional Study ◽

Single Stage ◽

Chronic Suppurative Otitis Media ◽

Cross Sectional ◽

Suppurative Otitis Media ◽

Ossicular Chain Reconstruction ◽

Operative Findings

Background: Chronic suppurative otitis media (CSOM) is typically a persistent disease insidious in ONSET, affecting the mucoperiosteal lining of middle ear cleft, often capable of causing severe destruction and irreversible sequelae and manifests clinically with hearing impairment and discharge. Successful management of unsafe CSOM has posed challenge before otolaryngologists for ages.Methods: The prospective study is based on 40 patients of unsafe CSOM who were managed and followed up in the post graduate department of otorhinolaryngology and head and neck surgery of Government medical college Srinagar with relevant data was recorded on the proforma. Results: All the patients who underwent single stage tympanomastoid surgery with or without ossicular chain reconstruction had no evidence of recurrent disease at follow up with 82.5% were below the age of 40, of which 40% were between 21 to 30 years. Males were more involved than females (1.2:1), also CT scan findings were co related with intra operative findings during our study.Conclusions: In conclusion a perfectly performed canal wall down mastoidectomy with tympanoplasty with us without ossiculoplasty in same sitting give good and acceptable post-operative results as far as the hearing improvement and dry and safe ear is concerned.

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Bacteriological Profile of Chronic Suppurative Otitis Media and Antibiotic Susceptibility in a Tertiary Care Hospital in Shanghai, China

Ear Nose & Throat Journal ◽

10.1177/0145561320923823 ◽

2020 ◽

pp. 014556132092382

Author(s):

Jianghong Xu ◽

Qiang Du ◽

Yilai Shu ◽

Jian Ji ◽

Chunfu Dai

Keyword(s):

Staphylococcus Aureus ◽

Otitis Media ◽

Middle Ear ◽

Antibiotic Susceptibility ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Chronic Suppurative Otitis Media ◽

Care Hospital ◽

Suppurative Otitis Media ◽

Bacteriological Profile

Objective: Chronic suppurative otitis media (CSOM) is mostly caused by bacterial infection of the middle ear and antibiotics are generally used empirically, which may lead to the emergence of resistant bacterial strains. The objective of the study is to assess the bacteriological profile of and evaluate the antibiotic susceptibility of strains isolated in a tertiary care hospital in Shanghai, China. Methods: This study included 289 individuals with clinical diagnosis of CSOM. Middle ear purulent discharge was obtained with sterile swabs and cultured for bacterial pathogens. The susceptibility of the isolated microorganisms to antibiotics was assessed by a microdilution method. Results: Bacterial pathogens were found in 223 (77.2%) of the 289 cases. A total of 236 strains were isolated. Staphylococcus aureus was the commonest bacteria (44.9%) followed by Pseudomonas aeruginosa (16.9%) and coagulase-negative Staphylococcus (8.5%). There were 18.9% methicillin-resistant S aureus (MRSA) among the obtained S aureus organisms. Multidrug-resistant P aeruginosa was found in 4 patients, making up 10% of all detected P aeruginosa. Staphylococcus aureus showed highest susceptibility to vancomycin (100%), then gentamicin (98.1%) and rifampicin (97.2%) and was most resistant to penicillin (61.3%) and erythromycin (50%). All isolated P aeruginosa showed susceptibility to piperacillin, piperacillin/tazobactam, and meropenem. High degree of resistance in P aeruginosa was observed toward levofloxacin (42.5%), ciprofloxacin (40%), and ceftriaxone (30%). Conclusion: The high prevalence of MRSA and fluoroquinolone-resistant P aeruginosa indicated cephalosporins and fluoroquinolone as primary empirical antibiotic drugs in CSOM to be cautiously used. In order to reduce the incidence of resistant strains and promote effective usage of antibiotics, all aural discharges should be cultured to determine antibacterial susceptibility patterns before treatment.

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