scholarly journals Ossicular Involvement and Types of Pathology in Chronic Otitis Media Squamous Active Disease

2018 ◽  
Vol 1 (1) ◽  
pp. 45-48
Author(s):  
Swasti Sharma
Keyword(s):  
Otitis Media ◽  
Middle Ear ◽  
Granulation Tissue ◽  
Revision Surgery ◽  
Mixed Type ◽  
Chronic Otitis Media ◽  
Ossicular Chain ◽  
Pars Flaccida ◽  
The Status ◽  
Active Disease

Background: Chronic otitis media (COM) squamous type is commonly as­sociated with cholesteatoma. In COM squamous type with active disease, there is retraction of pars flaccida or pars tensa with retention of squamous epithelial debris and is associated with inflammation and production of pus. It is potentially dangerous because it can cause resorption of bone, leading to ossicular erosion and destruction of bony plates of middle ear. The objective of this study is to determine the effect of chronic otitis media squamous type on the ossicular chain as well as to observe the types of pathology in this disease. Methods and materials: Fifty cases of chronic otitis media squa­mous type who underwent surgical management were included. The status of ossicular chain was evaluated intraoperatively. The type of pathology in­volving middle ear was also studied. Cases admitted for revision surgery were excluded from the study. Results: Of the total fifty cases, ossicular changes were observed in forty eight cases and in two cases all ossicles were intact. Long process of incus is the most frequently involved ossicle. The most common pathology was found to be mixed type (52%). Conclusion: The conclusion of this study is that ossicular chain is commonly involved in chronic otitis media squamous type and mixed pathology consisting of cholesteatoma and granulation tissue is the most frequent pathology.

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

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

<p class="abstract"><strong>Background:</strong> 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. </p><p class="abstract"><strong>Methods:</strong> 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.  </p><p class="abstract"><strong>Results:</strong> 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).</p><p class="abstract"><strong>Conclusions:</strong> 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.</p>

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

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.

scholarly journals OSSICULAR STATUS IN CHOLESTEATOMA : A DEPARTMENTAL EXPERIENCE IN A STATE MEDICAL COLLEGE OF WESTBENGAL.

2015 ◽  
Vol 23 (3) ◽  
pp. 116-119
Author(s):  
Somesh Mozumder ◽  
Arunabha Sengupta ◽  
Alok Ranjan Mondal ◽  
Soumik Basu
Keyword(s):  
Otitis Media ◽  
Clinical Examination ◽  
Middle Ear ◽  
Chronic Otitis Media ◽  
Ossicular Chain ◽  
Radiological Evaluation ◽  
Super Structure ◽  
Medical College ◽  
Middle Ear Cleft ◽  
Age And Sex

Introduction: Chronic otitis media is a long standing infection of part or whole of middle ear cleft. Its active squamosal variant (cholesteatoma) is most dangerous due to its bone eroding property. Aims & Objective: Background knowledge of ossicular status in cholesteatoma  will help us in determining the type  of reconstruction needed during the surgery. Material & methods: 60 cases of cholesteama, irrespective of age and sex [diagnosed on the basis of clinical examination , audiological and radiological evaluation] were selected during the study period of two years and their ossicular status were recorded intra-operatively. Results &  analysis: Ossicles and their parts getting involved in cholesteatoma cases , in decreasing order are : Lenticular process (in total 50 cases)>Long process of incus (in total 49 cases) > stapes super-structure(in total 29 cases) > body of incus(in total 26 cases)> head of malleus(in total 23 cases)> handle of malleus(in total 10 cases). Ossicular chain  defeact in decreasing order are : M-I-S- > M+I-S- > M-I-S+ > M+I-S+. Conclusion: In our study it was found that incus is the most vulnerable ossicle to get involved in cases of active squamosal variety of chronic otitis media where as malleus appeared to be the least susceptible one.

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

2019 ◽  
Vol 6 (1) ◽  
pp. 78
Author(s):  
Bharat G. Deshmukh ◽  
Deepak Bhisegaonkar ◽  
Akanksha Bakre
Keyword(s):  
Tympanic Membrane ◽  
Otitis Media ◽  
Middle Ear ◽  
Chronic Otitis Media ◽  
Ossicular Chain ◽  
Suppurative Otitis Media ◽  
High Incidence ◽  
Ossicular Chain Reconstruction ◽  
Small Bones ◽  
Set Up

<p class="abstract"><strong>Background:</strong> 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.</p><p class="abstract"><strong>Methods:</strong> 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.</p><p class="abstract"><strong>Results:</strong> 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.</p><p class="abstract"><strong>Conclusions:</strong> After conducting this study we concluded that incus and tragal cartilage both are excellent materials for ossiculoplasty.</p>

Experimental Pneumococcal Otitis Media: A Histopathologic Study

1980 ◽  
Vol 88 (5) ◽  
pp. 606-612 ◽  
Author(s):  
William L. Meyerhoff ◽  
Donald A. Shea ◽  
G. Scott Giebink
Keyword(s):  
Otitis Media ◽  
Middle Ear ◽  
Granulation Tissue ◽  
Endolymphatic Hydrops ◽  
Chronic Otitis Media ◽  
Tympanic Membrane Perforation ◽  
Middle Ear Mucosa ◽  
Diffuse Infiltration ◽  
Membrane Perforation ◽  
Histologic Changes

An animal model for pneumococcal otitis media was studied histologically at varying intervals postinoculation. Histologic changes generally associated with acute inflammation (edema, diffuse infiltration with polymorphonuclear leukocytes, and hemorrhage) occurred early in the disease while the ears were culture positive. Changes generally associated with chronic otitis media (lymphocyte infiltration and osteoneogenesis) occurred later in the course of the disease when the ears were culture negative. Metaplasia of middle ear mucosa and middle ear granulation tissue were observed as early as five days following inoculation. Middle ear granulation tissue was identified in 82% of all cases; cholesteatoma was seen in only one ear. Tympanic membrane perforation did not occur. Labyrinthitis and endolymphatic hydrops were fairly common findings. The former was identified in 56% of ears examined, and the latter, in 45%. These two conditions coexisted in 34% of ears studied, while endolymphatic hydrops alone occurred in 11%.

Middle-ear or mastoid granulation pathology associated with retraction of the pars flaccida and low-pitched tinnitus

2021 ◽  
pp. 1-4
Author(s):  
Z Lou
Keyword(s):  
Computed Tomography ◽  
Middle Ear ◽  
Granulation Tissue ◽  
Ossicular Chain ◽  
Endoscopic Examination ◽  
Canal Wall ◽  
Pars Flaccida ◽  
Surgical Exploration ◽  
Clinical Records ◽  
Canal Wall Up

Abstract Objective This study aimed to evaluate the clinical features and outcomes of patients with middle-ear granulation pathologies associated with attic retractions. Method The clinical records of adult patients with middle-ear granulation pathologies and attic retractions confirmed via computed tomography and surgical exploration between January 2012 and January 2019 were retrospectively reviewed. Results A total of 59 patients were included. Endoscopic examination showed a normal pars tensa but retraction of the pars flaccida in all patients. No granulation tissue or debris were observed. Low-pitched tinnitus was the principal complaint of 55 patients (100 per cent), followed by ear fullness (14 patients, 23.7 per cent). Of the 59 patients, 52 patients (88.1 per cent) underwent canal wall up mastoidectomy and 7 patients (11.9 per cent) underwent endoscopic endaural atticoantrotomy. No ossicular chain destruction was evident. All patients were followed up for 12 months. Tinnitus disappeared completely in 48 patients (81.4 per cent), improved significantly in 9 patients (15.3 per cent) and improved mildly in 2 patients (3.3 per cent). Conclusion A granulation tissue pathology should be considered when a patient complains of low-pitched tinnitus and exhibits retraction of the pars flaccida. Computed tomography and surgical exploration should be scheduled.

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

2019 ◽  
Vol 5 (4) ◽  
pp. 1020
Author(s):  
Sumeer Verma ◽  
Anshu Arora ◽  
Ajay Kumar Jain
Keyword(s):  
Otitis Media ◽  
Predictive Value ◽  
Early Stage ◽  
Chronic Otitis Media ◽  
Ossicular Chain ◽  
Chronic Suppurative Otitis Media ◽  
Pars Flaccida ◽  
Retraction Pocket ◽  
Suppurative Otitis Media ◽  
Total Destruction

<p class="abstract"><strong>Background:</strong> 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 T<sub>1</sub>-T<sub>2</sub> weighted images of MRI.</p><p class="abstract"><strong>Methods:</strong> 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 T<sub>1</sub>-T<sub>2</sub> sequences for diagnosis of cholesteatoma. Mastoidectomy was done to confirm the findings of MRI.  </p><p class="abstract"><strong>Results:</strong> 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.</p><p class="abstract"><strong>Conclusions:</strong> 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.</p>

Detection of endotoxin in ear specimens from patients with chronic otitis media by means of the limulus amebocyte lysate test

1980 ◽  
Vol 26 (4) ◽  
pp. 546-548 ◽  
Author(s):  
Joel M. Bernstein ◽  
Martin D. Praino ◽  
Erwin Neter
Keyword(s):  
Otitis Media ◽  
Middle Ear ◽  
Granulation Tissue ◽  
Chronic Otitis Media ◽  
Limulus Amebocyte Lysate ◽  
In Vitro Multiplication ◽  
Tissue Specimens ◽  
Limulus Amebocyte Lysate Test

The limulus amebocyte lysate (LAL) test is the most sensitive procedure for the detection of endotoxic lipopolysaccharides. The test was applied to middle ear fluids, cholesteatomas, and granulation tissue specimens from 31 patients in parallel with bactériologic examination. The LAL test and bacteriologic examination yielded concordant results with 26 out of 28 specimens. A positive LAL test was obtained with 11 specimens containing endotoxin-producing organisms. The test became positive within 60 min of incubation in 10 out of 11 specimens and in 1 specimen between 1 and 24 h, suggesting that, in the majority of specimens, endotoxin was present in the specimen itself and that the result was not due to the in vitro multiplication of the microorganisms. All negative tests remained negative for 24 h. It is conceivable that endotoxin present in ear fluids may contribute to the pathologic changes in chronic otitis media.

Ossicular chain erosion in chronic otitis media patients with cholesteatoma or granulation tissue or without those: analysis of 915 cases

2019 ◽  
Vol 276 (5) ◽  
pp. 1301-1305 ◽  
Author(s):  
Mustafa Akarcay ◽  
M. Tayyar Kalcioglu ◽  
Ozan Tuysuz ◽  
Emine Timurlenk ◽  
Hasan Guclu
Keyword(s):  
Otitis Media ◽  
Granulation Tissue ◽  
Chronic Otitis Media ◽  
Ossicular Chain

scholarly journals Patterns of Bone Damage in Patients With Chronic Middle Ear Inflammation

2020 ◽  
pp. 014556132092414
Author(s):  
Agnieszka Wiatr ◽  
Pawel Strek ◽  
Maciej Wiatr
Keyword(s):  
Otitis Media ◽  
Middle Ear ◽  
Inflammatory Process ◽  
Chronic Otitis Media ◽  
Ossicular Chain ◽  
Bone Lesions ◽  
Scanning Microscope ◽  
Inflammatory Lesions ◽  
Bone Damage ◽  
Intracranial Complications

Background: Despite different etiologies, chronic otitis media involves the damaging and restructuring of bone tissue. The inflammatory process destroys elements of the ossicular chain, and bone lesions may appear that allow the development of otogenous complications. Aims/Objectives: A correlation between the degree of damage to the ossicular chain as well as the bony walls of the middle ear and the type of chronic inflammatory lesions was sought. Destructive changes to bones were observed using scanning microscopy. Material and Methods: The removed damaged fragments of the ossicles were prepared for evaluation with a scanning microscope. Preparations were sputter-coated with a thin layer of gold and subsequently evaluated. Results: Of 220 surgeries carried out in the discussed period, destruction of the middle ear bone walls, opening the way for the development of intracranial complications, was found in 27 patients. Most of them had ongoing chronic otitis media with granulation. Conclusions: (1) Bone loss of the skull base was observed more frequently in patients with chronic otitis media with granulation than with cholesteatoma. (2) In chronic otitis media with cholesteatoma, damage to the ossicular chain was observed significantly more frequently than in the case of otitis media with granulation.

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