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 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 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>

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 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 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.

scholarly journals Retrospective study of fungal elements by potassium hydroxide mount in chronic otitis media

2020 ◽  
Vol 6 (8) ◽  
pp. 1439
Author(s):  
Santosh U. P. ◽  
Sanjay V. C.
Keyword(s):  
Retrospective Study ◽  
Otitis Media ◽  
Middle Ear ◽  
Potassium Hydroxide ◽  
Bacterial Infections ◽  
Bacterial Culture ◽  
Combined Therapy ◽  
Chronic Otitis Media ◽  
Antifungal Drugs ◽  
Medical College

<p class="abstract"><strong>Background:</strong> Chronic otitis media is defined as persistent disease of middle ear. Fungi can either be the primary pathogen or be superimposed on bacterial infections or can be secondary pathogen in previously perforated tympanic membrane. Keeping view of high prevalence of fungal infection of middle ear in hot, humid and dusty areas, retrospective study was done to detect the potassium hydroxide (KOH) mount positive in ear discharge of chronic otitis media and treat these patients.</p><p class="abstract"><strong>Methods:</strong> This was a retrospective study based on Bapuji Hospital records between 1 January 2018 to 26 July 2019 attached to the teaching college JJM Medical College, Davangere. Patients of either sex between age group 18 months to 87 years who diagnosed with chronic otitis media and given ear discharge sample for bacterial culture and KOH mount which is taken by a single surgeon. Collected bacterial culture reports and KOH mount reports and calculated all positive reports of KOH mount reports and treated accordingly and all reports were analysed statistically.  </p><p class="abstract"><strong>Results:</strong> We found that 15.8% KOH rate positive with 9.8-21.8% probable range for KOH positivity 95% CI which will impact in modification of treatment in chronic otitis media and were effectively treated with antibiotic and antifungal ear drops and 8 patients were required oral antibiotics as well.</p><p class="abstract"><strong>Conclusions:</strong> We conclude that in patients with COM, send ear discharge for both culture and sensitivity and KOH mount and it should be routine and always consider combined therapy i.e., antibiotic and antifungal drugs.</p>

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

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

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

Ossicular chain reconstruction improves bone conduction threshold in chronic otitis media

2008 ◽  
Vol 122 (4) ◽  
pp. 351-356 ◽  
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.

Comparison of the Aditus ad Antrum Diameter on CT between Patients with Chronic Otitis Media and Healthy Individuals

2019 ◽  
Vol 15 (10) ◽  
pp. 990-993 ◽  
Author(s):  
Elif Gündoğdu ◽  
Uğur Toprak
Keyword(s):  
Computed Tomography ◽  
Otitis Media ◽  
Middle Ear ◽  
Healthy Subjects ◽  
Normal Values ◽  
Chronic Otitis Media ◽  
Healthy Individuals ◽  
Inner Diameter ◽  
Male Patients ◽  
The Right

Background: The middle ear cavity is ventilated through the aditus ad antrum. Aditus blockage contributes to the pathology of otitis media. Objective: To determine the normal values of the aditus ad antrum diameter on computed tomography and to investigate its relationship with chronic otitis media and related pathologies (tympanosclerosis and myringosclerosis). Methods: The temporal CT images of 162 individuals were evaluated retrospectively. In the axial sections, the inner diameter of the aditus was measured at the narrowest point at the cortex. The differences in diameter were compared between diseased and healthy ears. Results: In healthy individuals, the diameter was narrower in women. There was no difference between the right and left ears in healthy subjects. No correlation was found between age and diameter. In male patients with myringosclerosis, the diameter was slightly narrower on both sides but more marked on the left. In female patients with myringosclerosis, the diameter in both ears was slightly narrower. In cases of otitis media and tympanosclerosis, the diameter was less than that of healthy individuals, despite the lack of statistically significant result in all cases. Conclusion: The aditus ad antrum was narrower in diseased ears, indicating that a blocked aditus may contribute to the development of otitis media, as well as mucosal diseases.

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