Study of Antibiotic Sensitivity of Aural Swab and Aetiological Factors of Chronic Otitis Media-Active Mucosal Type

Background: Chronic otitis media (COM) refers to chronic inflammation of mucoperiosteal lining of middle ear cleft resulting in aural discharge and deafness. The objective of this study is to evaluate the antibiotic sensitivity and aetiological factors of COM. Methods: This cross-sectional study was conducted from July 2017 to June 2018 for duration of one year among the patients who attended with COM- active mucosal disease at Department of ENT & Head Neck Surgry, Combined Military Hospital (CMH) Chattogram. Total 50 cases were isolated and among them 5 cases had been suffering from bilateral COM. Aural swab was taken from 55 ears and a predesigned data collection sheet was duly filled up with the information of socioeconomic status of the patient. The laboratory records of every case was systematically organized. The data were analyzed with simple manual analysis using percentage and frequency. Results: About 24% patients were in 31-40 years age group. Out of 50 patients 62% were male. 44% patient lived in barrack. Ear cleaning habit shows, 32% has got the cleaning habit with cloth and stick. Out of 50 patients 5 had bilateral COM. So out of 55 ears, Culture & sensitivity test viewed that Pseudomonas aeruginosa was the most predominant organism - 41.8% followed by S. aureus- 30.9% Antibiotic sensitivity profile shows, 80% cases showing sensitivity to Amikacin then gentamycin-73.3% Resistant 5 cases showed 100% sensitivity to Tazobactum. Again out of 19 cases of Gram positive organism 78.9% were sensitive to Amoxyclav. 3 resistant cases showed 100% sensitivity to Meropenem. Conclusion: By studying this topic we hope to able to make an idea about the aetiological and predisposing factors and antibiotic sensitivity of COM-active mucosal variety. Bangladesh J Otorhinolaryngol 2021; 27(2): 111-116

Cholesteatoma extending into the sternocleidomastoid muscle presenting as a Bezold abscess

Cholesteatoma is a non-neoplastic cystic lesion arising in the middle ear cleft with the propensity to spread and recur after surgery, but it is unusual to find cholesteatoma invading sternocleidomastoid muscle after 15 years of modified radical mastoidectomy and presenting as Bezold abscess. In this report, the authors highlight the fact that cholesteatoma recurrence if neglected can present as a Bezold abscess with the invasion of cholesteatoma from the mastoid tip into the sternocleidomastoid muscle. This requires complete excision of the cholesteatoma sac along with the surrounding soft tissue.

Tubotympanic cholesteatoma

Chronic suppurative otitis media is defined as a chronic inflammation of the mucoperiosteal lining of the middle ear cleft. It is described as a persistent disease that is insidious in onset, often capable of causing severe destruction with irreversible sequelae, and clinically present with hearing loss and discharge. It has been classified into tubotympanic (safe) and atticoantral (unsafe) perforation. Cholesteatoma always occur in the atticoantral type and in marginal perforation. We report a case of cholesteatoma that occurred as a tubotympanic type of perforation.

TO ASSESS THE OUTCOME OF ENDOSCOPIC INTERLAY TYMPANOPLASTY IN TERTIARY CARE CENTER

Background: Chronic otitis media is an inammatory process in middle ear cleft which is treated by a common otological procedure tympanoplasty to reconstruct the tympanic membrane and to restore sound-conducting mechanism. Rigid endoscope in transcanal interlay tympanoplasty has signicant advantage as it provides magnied, and wide angle view, with better success rate and postoperative hearing gain. The Aims and objectives were to assess the outcome of endoscopic interlay tympanoplasty, in terms of graft uptake, hearing improvement and rate of complications in cases of inactive mucosal chronic suppurative otitis media. Methods: This prospective study was conducted for 1 year at our institution in 50 patients having conductive hearing loss with dry, central perforation. All patients underwent transcanal endoscopic interlay tympanoplasty and were followed up for 3months to determine the graft uptake, hearing improvement and rate of complications. Results: Graft uptake rate in the present study was found to be 98% with residual perforation as a complication in 2% patients and no other complications were encountered. Post operatively air bone gap (ABG) after 12 weeks found to be < 20 dB ABG in 84% patients. Conclusion: Endoscopic interlay tympanoplasty is a effective method with high success rate both in terms of graft uptake as well as post operative hearing improvement and can be implemented in all cases of inactive mucosal COM.

Study of bacteriological profile in chronic suppurative otitis media and their pattern of antibiotic sensitivity

<p class="abstract"><strong>Background: </strong>Chronic suppurative otitis media is a long-standing infection of the middle ear cleft which is characterized by recurrent and persistent ear discharge and persistent non healing perforation of tympanic membrane. It can lead to severe complications if not treated appropriately. Due to emerging antibiotic resistance, it is necessary to understand the antimicrobial pattern and their sensitivity to antibiotics which will help clinicians to select antibiotic which is sensitive to their corresponding microorganism. The aim of the study is to isolate the prevalent microorganism and study their antibiotic sensitivity pattern in patients of chronic suppurative otitis media (CSOM).</p><p class="abstract"> <strong>Methods:</strong> Total 100 patients were examined, ear swab were collected by sterile ear swab and sent for microscopy and culture sensitivity examination to microbiology department. Results were documented and analyzed.</p><p class="abstract"><strong>Results: </strong>Pseudomonas aeruginosa was the most common isolate (41%) followed by Staphylococci (28.2%). Gram negative cocci showed high degree of sensitivity to Cotrimoxazole (100%), Amikacin (79%) and Piperacillin - tazobactum (75%). Gram positive cocci showed high degree of sensitivity to Linezolid.</p><p class="abstract"><strong>Conclusions: </strong>Study of bacteriological profile and their sensitivity pattern helps in empirical therapy and reduces the risk of complications.</p>

HIGH RESOLUTION COMPUTED TOMOGRAPHY FINDINGS OF TEMPORAL BONE IN PATIENTS WITH UNSAFE CHRONIC SUPPURATIVE OTITIS MEDIA.

CSOM is defined as chronic inflammation of mucoperiosteal lining of middle ear cleft, i.e. eustachian tube, middle ear and mastoid. Unsafe CSOM is associated with marginal/ attic perforations and cholesteatoma, which may produce multiple complications. It is a potentially serious condition as it can progressively enlarge and cause erosion into neighbouring structures, giving rise to serious complications. HRCT provides information regarding the extent of disease and depicts anatomical variations, which may lead to complications during surgery. The aim of this study was to assess the usefulness of HRCT imaging of temporal bone in cases of unsafe CSOM. In an IRB approved cross-sectional observational study of consecutive 50 patients with clinically diagnosed unsafe CSOM, HRCT of temporal bone was performed. Patients not fit for CT scan e.g., pregnant patients were excluded. HRCT was performed on Philips Brilliance 40 slice CT. Collimation was set at 190mm with scan time of 4.79 seconds with kVp of 140 and mAs of 350. HRCT findings of these patients were compared with the intraoperative findings of those patients who underwent surgery. Standardised statistical methods were used. It was found to be male predominant disease with a mean age of 25.5 years. The most common finding on HRCT was soft tissue density involving the middle ear cleft. Cholesteatoma caused ossicular erosion with the incus being most commonly affected. This study concludes that HRCT should be done in all patients of unsafe CSOM to know the extent of disease which guide in surgical approach and treatment plan.

A STUDY OF RADIOLOGICAL CHANGES IN CSOM AND THEIR CO-RELATION WITH INTRA-OPERATIVE SURGICAL FINDING

Introduction: HRCT temporal bone is the currently widely used investigation for the chronic otitis media patient especially in unsafe disease. Aim: This study was conducted to assess the condition of the middle ear in CSOM by HRCT temporal bone and compare them with intraoperative finding of the middle ear cleft . Method: Study group includes patients of Attico-antral variety of CSOM presenting in ENT OPD in our institution over a period of 18 months who undergone Computed Tomography Temporal bone followed by Surgical Procedure. Results: After study it was observed that CT scan can reliably detect bony & soft tissue changes in middle ear and intracranial complication. It can detect soft tissue in the middle ear but can not differentiate between soft tissue and cholesteatoma. Conclusion: CT scan provides excellent anatomical details and pathological changes of the ear and mastoid. Scanning all the patients is not feasible and justified, so we need to select patients in whom diagnosis and extend of the diseases is in doubt.