Role of Acetic Acid Irrigation in Medical Management of Chronic Suppurative Otitis Media: A Comparative Study

Chronic otitis media is persistent and insidious disease. It is one of the most common bacterial infections in the field of otolaryngology having significant economic and individual repercussion. Medical management of chronic suppurative otitis media (CSOM) for dry ear is essential before surgical treatment. The objective is to consider the most appropriate medical treatment modalities for patients of CSOM. To assess results of acetic acid irrigation and topical and systemic antibiotic in CSOM and consider, the most appropriate medical management. This study was conducted prospectively from Nov 2011 to Sep 2013 in 100 patients of CSOM (tubotympanic type). Patient included in the present study were divided in two groups. In one group patients were treated with aural toilet and irrigation with acetic acid and in other group patients were treated with topical and systemic antibiotic. After a follow up period of 3 months duration results were assessed on the basis of absence of discharge, healing of perforation and status of middle ear. Otorrhoea resolution in group treated with acetic acid was 84 % and healing of perforation was noted in 26 % while failure rate of 16 % was noted. In group treated with topical and systemic antibiotic 58 % of patient shows otorrhoea resolution, 14 % achieve healing of perforation and 32 % had failure. Medical management of CSOM without Cholesteatoma by frequent aural cleaning and irrigation using dilute acetic acid can be more desirable choice as compared to the topical and oral antibiotics.     

Benign Paroxysmal Positional Vertigo: Our Experience

Benign paroxysmal positional vertigo (BPPV) is probably common cause of vertigo. A total of 205 cases reported to ENT OPD for vertigo. Of these 43 patients were found to suffer from BPPV and in our experience BPPV is common condition. BPPV was more common in age group of 4th and 7th decades. The youngest patient reported was 41 years and the oldest patient was 78 years with a mean of 56.5. In this group there were 16 females and 27 males. This is a retrospective case study of 205 cases presenting with vertigo. The modality of treatment was Epley’s manoeuvre in cases diagnosed with BPPV. The age of patients ranged from 41 to 78 years with mean of 56.5. The over all success rate was 96 %. All cases were instructed to report recurrence and were followed for 1 year.     

Chronic suppurative otitis media and sensorineural hearing loss: Is there a correlation?

Traditionally, it has been accepted that chronic suppurative Otitis media is associated with a breakdown in meekanical conduction of sound leading to conductive hearing loss, On;the contrary, there are two schools of thought when it come, to the issue of cpchlear involvement leading to sensorineural hearing loss (SNIIL) in chronic suppura the Otitis media. The present study was undertaken to find out whether a sensorineural component exists in hearing loss associated with chronic suppurative otitis media, A sample of 100 patients of unilateral chronic suppurative otitis media was selected for the Study and their bone conduction thresholds Mere analyzed in relation to the duration of disease using audiometric data. A 24 per cent incidence of sensoineural hearing loss was found in this series, garticularly involving the higher frequencies. Moreover, the incidence of sensorineural hearing loss progressively increased with the increase in duration of chonic suppurative Ouns meadia     

Epidemiology of chronic suppurative otitis media and deafness in a rural area and developing an intervention strategy

Of 613 children evaluated in a village in Haryana 94 (15.3%) were observed to have chronic suppurative otitis media (CSOM). Fifty eight (61.7%) children had hearing impairment. CSOM contributed to 71.6% of the hearing impaired (58/81). On analysis of association of CSOM with literacy and socio-economic status of mothers, and age, sex, and upper respiratory tract infections (URI) in children positive correlation was observed only with URIs (P<0.001). Literacy and socio-economic status of the mothers did not correlate significantly with knowledge about treatment seeking, and ear cleaning practices, probably due to the narrow range of incomes and literacy levels. An intervention program consisting of play, demonstrations, health charts and slogans, and aural cleaning and antibiotic drops was introduced.     

Role of High Resolution Computed Tomography of Mastoids in Planning Surgery for Chronic Suppurative Otitis Media

Chronic suppurative otitis media (CSOM) presents with a typical history of recurrent otorrhoea with tympanic membrane perforation. The diagnosis of cholesteatoma is usually made on otologic examination. High resolution computed tomography (HRCT) is indicated to evaluate the extension and the complications of cholesteatoma. The aim of the work was to study the role of HRCT in detecting, evaluating diagnosing and managing CSOM. All patients presenting with CSOM who were planned for mastoid exploration surgery in department of ENT, Gauhati Medical College and Hospital within a period of 2 years—from 1st January, 2013 to 31th December, 2014, were taken up for the study. HRCT mastoids done routinely before cholesteatoma surgery, but with improved resolution, to characterize all middle ear structures and complications of the disease prior to surgery, might guide as road map during mastoid explorations for unsafe CSOM. The important role of HRCT lies on the early detection of cholesteatoma, and more conservative surgical procedures can be used to eradicate the disease.     

A comparative study of different graft materials used in myringoplasty

Two hundred twenty cases of unilateral chronic suppurative otitis media (CSOM) with dry central perforation were chosen for this study and myringoplasty were done. Age group ranged from 13 to 48 years. Four types of autogenous tissues were used as graft material. Grafting was done by underlay technique when temporalis fascia, tragal perichondrium, areolar tissue were used as graft material and when fat graft was used the ear lobule fat was placed directly into perforation through transcanal route. Postoperative follow-up was carried out up to 6 months. In this study, it was found that the younger age group has less impairment of hearing and better chance of tympanic membrane perforation closure than the older age group in CSOM with central perforation. Anterior perforations has less impairment of hearing and better result in successful closure of tympanic membrane than posterior perforation group. It was also observed that larger the size of perforation greater is the hearing impairment preoperatively and postoperative hearing gain is also less compared to small perforation. Best hearing improvement occurred using temporalis fascia. Failure occurred may be due to postoperative infection, respiratory tract infection, neglected post-operative advice etc.     

Ossicular Chain Status in Chronic Suppurative Otitis Media in Adults

This study was conducted to find out the status of the ossicles in cases of chronic suppurative otitis media (CSOM). One hundred and fifty cases of CSOM, who underwent surgery, were included and their intra-operative ossicular chain findings noted. Ossicular erosion was found to be much more common in unsafe CSOM than in safe CSOM. Malleus was found to be the most resistant ossicle to erosion whereas incus was found to be the most susceptible.     

Does preoperative bacterial culture have bearing on healing of mastoid cavity: A prospective study

Objective

To study the bacteriological profile in a healing mastoid cavity.

Otitis media as a cause of significant hearing loss among Nigerians

Mild or worse hearing loss, defined as pure tone average >25 decibel, is seen commonly with preventable etiologies.

Settings

A tertiary care, urban referral hospital.

Methods

Retrospective analysis of prospectively collected data of individuals attending the hearing loss clinic of National Hospital, Abuja, between May 2005 and April 2007. Data matching the diagnosis of acute otitis media (AOM), otitis media with effusion (OME) and chronic suppurative otitis media (CSOM) were extracted from the database and analyzed.

Result

A total of 298 cases with primary presenting complaints of hard of hearing were seen. A total of 77 cases had hearing loss due to otitis media. 44 (57.1%) had OME, 26 (33.8%) had CSOM, while 7 (9.1%) had AOM. The observed distribution of the OME was left OME (18.1%, n = 14), right OME (9.1%, n = 7) and bilateral OME (29.9%, n = 23), while the CSOM is distributed into left CSOM (15.5%, n = 12), bilateral CSOM (11.7%, n = 9) and right CSOM (6.4%, n = 5), and AOM is distributed into right AOM (2.6%, n = 2), left AOM (3.9%, n = 3), and bilateral AOM (2.6%, n = 2). The mean pure tone averages for the three groups are AOM (30.5 dB), OME (41.5 dB) and CSOM (56.9 dB).

Conclusion

Otitis media is an important cause of preventable hearing loss in developing countries, and the predominance of unilateral otitis media in the left ear observed in this study deserves further studies.