Ear microbiota and middle ear disease: a longitudinal pilot study of Aboriginal children in a remote south Australian setting

Background Otitis media (OM) is a major disease burden in Australian Aboriginal children, contributing to serious long-term health outcomes. We report a pilot analysis of OM in children attending an outreach ear and hearing clinic in a remote south Australian community over a two-year period. Our study focuses on longitudinal relationships between ear canal microbiota characteristics with nasopharyngeal microbiota, and clinical and treatment variables. Results Middle ear health status were assessed in 19 children (aged 3 months to 8 years) presenting in remote western South Australia and medical interventions were recorded. Over the two-year study period, chronic suppurative OM was diagnosed at least once in 7 children (37%), acute OM with perforation in 4 children (21%), OM with effusion in 11 children (58%), while only 1 child had no ear disease. Microbiota analysis of 19 children (51 sets of left and right ear canal swabs and nasopharyngeal swabs) revealed a core group of bacterial taxa that included Corynebacterium, Alloiococcus, Staphylococcus, Haemophilus, Turicella, Streptococcus, and Pseudomonas. Within-subject microbiota similarity (between ears) was significantly greater than inter-subject similarity, regardless of differences in ear disease (p = 0.0006). Longitudinal analysis revealed changes in diagnosis to be associated with more pronounced changes in microbiota characteristics, irrespective of time interval. Ear microbiota characteristics differed significantly according to diagnosis (P (perm) = 0.0001). Diagnoses featuring inflammation with tympanic membrane perforation clustering separately to those in which the tympanic membrane was intact, and characterised by increased Proteobacteria, particularly Haemophilus influenzae, Moraxella catarrhalis, and Oligella. While nasopharyngeal microbiota differed significantly in composition to ear microbiota (P (perm) = 0.0001), inter-site similarity was significantly greater in subjects with perforated tympanic membranes, a relationship that was associated with the relative abundance of H. influenzae in ear samples (rs = − 0.71, p = 0.0003). Longitudinal changes in ear microbiology reflected changes in clinical signs and treatment. Conclusions Children attending the ear and hearing clinic in a remote Aboriginal community present with a broad spectrum of OM conditions and severities, consistent with other remote Aboriginal communities. Ear microbiota characteristics align with OM diagnosis and change with disease course. Nasopharyngeal microbiota characteristics are consistent with the contribution of acute upper respiratory infection to OM aetiology.

ENDOSCOPIC CARTILAGE TYMPANOPLASTY. OUR TECHNIQUE AND EXPERIENCE OF 157 CASES

Objective: To assess the graft take rate and hearing gain in trans-canal endoscopic tympanoplasty Study Design: Descriptive study. Place and Duration of Study: Pakistan Naval Ship Hafeez, Islamabad Pakistan, form Dec 2015 to Jun 2018 Methodology: All patients with dry central perforations of >3 months history were included in the study. All Patients with perforations of pars tensa were booked for endoscopic cartilage tympanoplasty. All perforations were divided into four types small, medium, large and subtotal or total based on size of the tympanic membrane perforations. Small perforations involving <25% area of Pars Tensa. Medium perforation are Perforations involving 25-50% of Tympanic membrane. Large perforations include Perforations involving 50-75% of pars tensa. Subtotal or total perforations are defined as perforations with >75% perforation of the tympanic membranes. Wet Ears and perforations involving the Pars Flacida were excluded from the study. Preoperative Audiogram was carried out for all patients and A-B Gap were noted for all groups separately so as the demographic data including age and gender. Success was defined as complete closure of Tympanic membrane perforation at 3 months. All patients were operated with 0 Degree 3mm, 14cm rigid endoscope under general anesthesia. Results: Mean age of patients was. 37 years and standard deviation was 12.34 (range 12-58 years). Out of total 157 cases 81 patients male were males (51%) and 76 patients were females (49). Out of 157 ears operated 146 Perforations healed completely an overall success rate of 92%. Patients with small perforations had 100 percent success.....

EFFICACY OF PERMEATAL ENDOSCOPIC MYRINGOPLASTY IN INACTIVE (MUCOSAL) CHRONIC OTITIS MEDIA

Objective: To determine the efficacy of permeatal ednoscopic myringoplasty, in inactive (mucosal) COM regarding, graft take and hearing improvement. Study Design: Quasi-experimental study. Place and Duration of Study: ENT Department, Pak Emirates Military Hospital, Rawalpindi, from Aug 2019 to Feb 2020. Methodology: This was conducted on a sample size of n=100. Patients having inactive (mucosal) COM with dry central small, medium and large perforations were included. Patients were divided in to three groups on the basis of age, group A 15-30 years, group B 31-45 years and group C 46-60 years. All the patients underwent per-meatal endoscopic myringoplasty, without raising the tympano-meatal flap, under general anesthesia. Patients were followed up over a period of six months. Graft take was assessed by microscopy. Hearing was assessed by Pure Tone Audiometry (PTA) with improvement in air bone gap to 15db as primary end point. Data was collected on structured performa. Data was analyzed using SPSS version 17. Results: In this study, 33 (33%) were males and 67 (67%) were females. Age ranged 15-60 years. Out of 5 patients lost to follow up. A total of 95 completed their follow up. Based on age of the patients, in group A, successful graft take was 100%. In group B, it was 91% & in group C it dropped to 46%. On the basis of tympanic membrane perforation size, the graft success rate in small perforations was 94.8%; in medium sized perforations it was 86.8% and in large sized perforations of tympanic membrane it was........

To Compare the Graft Uptake in Permeatal versus Postaural Approaches in Myringoplasty

Objective: To compare the graft uptake in permeatal versus postaural approaches in myringoplasty. Study design: Cross sectional comparative Place and Duration of Study: Department of ENT, Head and Neck Surgery, Pakistan Institute of Medical Sciences/Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad Pakistan from 1st March 2018 to 31st December 2018. Methodology: Seventy two patients were classified into two equal groups. Thirty six patients underwent myringoplasty by permeatal approach and thirty six patients underwent postaural approach. Those patients were included who had mucosal type moderate central perforation with inactive disease with age 15-42 years and those patients were excluded who had small, subtotal, total, squamosal type atticoantral tympanic membrane perforation, with comorbidities and pregnancy. Results: Thirty seven were (51.4 %) males and 35 (48.6%) were females. In both the groups the success of graft uptake was 52 (72.2%) patients and graft rejection in 20 (27.8%) patients. In each group there were 36 patients. The graft uptake in permeatal approach was 30 patients (83.3%), while the graft uptake in postaural approach was 22 (61.1%) patients. The overall graft uptake in permeatal approach is more as compared to postaural approach (p=0.035). Conclusion: The permeatal approach is better than the postaural approach in terms of graft uptake in medium sized central perforations in myringoplasty. Key words: Myringoplasty, Tympanoplasty, Permeatal, Postauricular

Surgical results and factors affecting outcome in patients with fat-graft myringoplasty

Objectives: We evaluated the closure rate after fat-graft myringoplasty (FGM) of perforations differing in size and location. We explored whether patient’s factors and the FGM surgical technique influenced surgical outcomes. Methods: We retrospectively studied patients with tympanic membrane perforations who underwent FGM from March 2015 to March 2019. All procedures were performed by a single senior surgeon at our tertiary hospital. The patients who followed-up for at least 6 months after surgery were enrolled. We recorded hypertension and diabetes status, age, any prior ear surgery, any calcific plaques adjacent to the perforation, and perforation size and location. Results: A total of 150 patients were enrolled. Our success rate of FGM was 90%. Hypertension, diabetes, prior ear surgery history, and eardrum calcific plaques did not affect the surgical outcomes. There was no statistical difference in the surgical success rate according to the size (< 50%) or location of perforation. The closure rate was 97.2% in patients aged 1660 and 87.5% in patients aged > 60, respectively. However, FGM was successful in only two of six children (33.3%) aged ≤ 15 years, thus significantly less than in the other groups. Conclusion: FGM is a fast, safe, and efficient method for repairing tympanic membrane perforation. The surgical outcome is not significantly affected by underlying disease, perforation size or location, or by the condition of the tympanic membrane or older age. However, it may be poor in children with dysfunctional Eustachian tube.

A clinical study of traumatic tympanic membrane perforation

<p><strong>Background:</strong> Tympanic membrane (TM) which forms the partition between external auditory canal and middle ear may be ruptured by trauma. Traumatic TM perforation is a commonly observed condition. Though, several therapeutic interventions have been described, conservative follow-up until spontaneous complete recovery is the most common choice.</p><p><strong>Methods:</strong> It was a prospective cohort study conducted during a period of 10 months from July 2020 to April 2021, carried out in 30 patients who presented to outpatient department of ENT and casualty of Hassan institute of medical sciences hospital with traumatic TM perforation. After taking informed consent, detailed history was taken, thorough examination of ear was performed and characteristics of perforation were noted. Pure tone audiometry (PTA) was conducted, data was statistically analysed.</p><p><strong>Results:</strong> Mean age group was 33.1 years and 73.3% were males. Ear pain was the commonest symptom with accidental trauma being the most common cause. 70% of them had left TM perforation and posteroinferior quadrant was mostly involved.</p><p><strong>Conclusions:</strong> Traumatic TM perforation is commonly seen in young adults following accidental trauma and assault. Earache, sudden hearing loss and tinnitus are the common symptoms. Most of the cases heal spontaneously with conservative management.</p>

Eardrum perforation treatment blood plasma enriched with platelet growth factors

Introduction. The problem of the development of acute post-traumatic otitis media has not lost its relevance. Long-term preservation of the defect of the tympanic membrane contributes to the development of chronic inflammation in the middle ear and a deterioration in the quality of life of patients.Objective. To study the effect of blood plasma enriched with platelet growth factors on the regeneration of the tympanic membrane tissues in patients with acute post-traumatic perforation.Materials and methods. Patients with acute post-traumatic perforation of the tympanic membrane were divided into the main (24 people) and control (19 people) groups. Patients of the main group in the area of perforation of the tympanic membrane were injected once by application with a clot of autoplasma, enriched with platelet growth factors. The control group patients underwent dynamic observation of the processes of natural regeneration of the tympanic membrane tissues. On the 5, 10 and 15th days, the tissue regeneration of the tympanic membranes was assessed subjectively (patient complaints, audiometry) and objectively (otoscopy with the calculation of the dynamics of the relative perforation area, otoacoustic emission).Results. A single application of blood plasma enriched with platelet growth factors to the perforation area was significantly more often accompanied by closure of the tympanic membrane perforation (p ≤ 0.01) and a decrease in the average relative area of the tympanic membrane perforation on days 10 and 15 of the study (p ≤ 0.01). The dynamics of the average relative area of the tympanic membrane perforation reflected a high rate of closure of the tympanic membrane defect in the main group. Better healing of the tympanic membrane in patients of the main group was accompanied by an improvement in the auditory function of the affected ear. The quality of hearing was, on average, significantly better in the patients of the main group than in the patients of the control group, both on the 10th and 15th days of observation (p ≤ 0.01).Conclusion. Clinical use of blood plasma enriched with platelet growth factors has a beneficial effect on the rate, intensity of closure of the tympanic membrane perforation and hearing.