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     

慢性化脓性中耳炎与感音神经性聋

目的：观察慢性化脓性中耳炎（CSOM）对感音神经性聋（SNHL）的影响。方法：测量135例（168耳）CSOM患者的骨导听阈，并以66例单侧患者的健耳为对照，比较不同类型、不同病程的CSOM的骨导听阈。结果：CSOM各组骨导听阈均值明显高于对照组，且与中耳炎的类型和病程相关。结论：CSOM可引起SNHL，且中耳病变越重，病程越长，听力下降越明显     

Permanent t-tube insertion in two patients with Hurler's syndrome

Hearing loss in mucopolysaccharidosis is usually both conductive and sensorineural. The conductive component is attributable to serous otitis media secondary to dysfunction of the eustachian tube and chronic thickening of the mucosa of the middle ear. The conductive component may persist after myringotomy and insertion of short-term or long-term ventilation tubes. In Hurler's syndrome, death usually occurs in the first decade of life. In our study, we present two cases, a three-year-old girl and a four-year-old boy, who were diagnosed with Hurler's syndrome. Both children have a history of otitis media with effusion requiring repeated short-term ventilation tube insertions that were unsuccessful. Permanent t-tubes were inserted in both cases. Results showed an approximate 20 dB improvement in hearing sensitivity postoperatively for each patient.     

Serous Otitis Media Associated with Sensorineural Hearing Loss in Children

The effect of a conductive hearing loss secondary to serous otitis media in children with sensorineural hearing loss was seen to be an increase in threshold and in one case a decrease in speech discrimination. The diagnosis of the conductive component can be made by means of measurement of impedance, middle ear pressure, the recording of a tympanogram and otoscopy. It is likely that a conductive component can lead to delay in the diagnosis of an underlying sensorineural hearing loss in some children which could result in exacerbation of speech and language deficits. Correction of the conductive component can convert a profound hearing loss to a severe hearing loss, or a severe hearing loss to a moderate hearing loss, and it may also increase speech discrimination.     

Sensorineural hearing loss in patients with chronic otitis media

Chronic otitis media is generally associated with some degree of hearing loss, which is often the patient’s chief complaint. This hearing loss is usually conductive, resulting from tympanic membrane rupture and/or changes in the ossicular chain due to fixation or erosion caused by the chronic inflammatory process. When cholesteatoma or granulation tissue is present in the middle ear cleft, the degree of ossicular destruction is even greater. An issue that has recently gained attention is additional sensorineural hearing loss due to chronic otitis media. While the conductive loss can be minimized through surgery, sensorineural hearing loss constitutes a permanent after effect, attenuated only through the use of a hearing aid. However, a few groups have reported a decrease in sensorineural function in these patients as well. This survey study performed at a referral center evaluates the occurrence of sensorineural hearing loss in ambulatory patients with this disease. We reviewed the files of patients with unilateral chronic otitis media. One hundred and fifty patients met the inclusion criteria: normal otoscopy and normal hearing in the contralateral ear. Main outcome measure: bone-conduction threshold averages were calculated for frequencies of 500, 1,000, 2,000, 3,000 and 4,000 Hz, with comparison between the normal ear and the ear with chronic otitis media. Thresholds were examined separately for each frequency. The bone-conduction threshold averages for the normal side were lower than those for the ear with chronic otitis media. The threshold shift was statistically significant for each frequency (P < 0.0001, Student’s t test). There were differences between the groups when analyzed for age (500 and 1,000 Hz) or the presence of cholesteatoma (1,000 Hz). This study shows that chronic otitis media is associated with a decrease in cochlear function.     

Pro or contra drainage of the tympanum

Ventilation tubes ("grommets") appear to be the logical treatment of chronic secretory otitis media, based on the theory of its pathogenesis. Usually they have an impressive immediate effect, and enjoy great popularity. However, there are critics who restrict the indications, for two reasons: it has been observed repeatedly that the spontaneous healing rate in secretory otitis media is about 80%, and follow up studies over several years suggest that persistent lesions of the middle ear (scars and defects of the tympanic membrane, conductive hearing loss, cholesteatoma etc.) occur somewhat more often in grommet-treated ears than in ears without ventilation tubes. A therapeutic advantage of ventilation tubes in the resolution of chronic secretory otitis media has not been proved. Therefore, according to our present knowledge the only treatment effect of ventilation tubes is the immediate elimination of conductive hearing loss. As development studies in children suggest that a conductive hearing loss does not become a handicap for speech and mental development unless it has persisted for several months, ventilation tubes seem to be indicated only when a bilateral middle ear effusion of greater than 25 dB persists for more than 3 months. However, in children with delayed speech development one should not wait such a long time, because they particularly depend upon normal hearing ability.     

Prevalence of middle ear pathologies in children with bilateral sensorineural hearing loss

OBJECTIVES: In poor countries, hearing aids are too expensive for sensorineural hearing loss (SNHL) children's parents to offer for their children. These children may have middle ear problem, this will aggravate the level of hearing loss which may lead to delay in their ability to speak. This study is to highlight the prevalence of middle ear pathology in SNHL children. METHODS: Two hundred children with bilateral sensorineural hearing loss (SNHL) were selected in our study from the outpatient clinic of ENT department of Sohag University Hospital, Egypt. Children were classified into three categories according to their middle ear status. They were normal middle ear, middle ear with unhealthy tympanic membrane or otitis media with intact drum and chronic suppurative otitis media with perforation. RESULTS: Seventy percent of cases were normal, 25% had middle ear problem with intact tympanic membrane and 5% had chronic suppurative otitis media with perforation. CONCLUSION: Thirty percent of SNHL children have middle ear pathology which aggravate the degree of hearing loss. Regular evaluation of SNHL children to treat those having middle ear pathology medically and/or surgically and this may help those having no ability to have hearing aids to learn language early.     

Prevalence of otitis media,hearing impairment and cerumen impaction among school children in rural and urban Dar es Salaam,Tanzania

Eight hundred and two (802) primary school children in rural and urban Dar es Salaam, Tanzania, were examined to determine the prevalence of otitis media, hearing impairment and cerumen impaction by otoscopy and pure tone audiometry. Ear disease was found in 222 (27.7%) of the children. One hundred and twenty six (15.7%) had cerumen impaction, 70 (8.7%) had sensorineural hearing loss and 21 (2.6%) had chronic suppurative otitis media. Cerumen impaction was found in 20.45% of the rural school children and in 14.8% of the urban school children. This difference in prevalence between the two groups was not statistically significant. The prevalence of chronic suppurative otitis media (COM) was 9.44% among the rural school children and 1.3% among the urban school children, the difference being statistically significant (P < 0.001). Sensorineural hearing impairment was found in 14.1% of the rural school children and in 7.7% of the urban children, this also being statistically significant (P < 0.05). The low prevalence of chronic suppurative otitis media among the urban school children is ascribed to better medical services which facilitate early diagnosis and treatment of acute otitis media. This emphasizes the need to improve the health services in the rural areas so that acute otitis media is diagnosed and treated at the primary level of health care. This will in turn prevent hearing impairment due to chronic suppurative otitis media.     

C3H/HeJ mouse model for spontaneous chronic otitis media

OBJECTIVES/HYPOTHESIS: Chronic otitis media is a significant clinical problem. Understanding the mechanisms of chronic otitis media is critical for its control. However, little is known of these processes as a result of lack of animal models of spontaneous otitis media. The C3H/HeJ mouse has a single amino acid substitution in its toll-like receptor 4 (TLR4), making it insensitive to endotoxin. As a result, these mice cannot clear Gram-negative bacteria. The chronically inflamed middle ear in this animal provides us the opportunity to study spontaneous chronic otitis media. STUDY DESIGN AND METHODS: Otoscopy and auditory brain response (ABR) evaluation of C3H/HeJ mice at 3, 5, 7, 9, and 11 months were carried out under sedation. At 12 months of age, mice were killed and histologic analysis of the middle ear, inner ear, and eustachian tube was carried out. RESULTS: Tympanic membrane visualization and ABR thresholds in 7- to 8-month-old C3H/HeJ mice showed that approximately half developed middle and inner ear disease spontaneously. The significant elevation of thresholds suggested a sensorineural component in addition to the conductive loss. Middle and inner ear histology showed some degree of middle and inner ear inflammation in half the mice, paralleling the ABR data. CONCLUSIONS: The histopathologic changes reported here in the C3H/HeJ mouse model of chronic otitis media have been reported in human chronic otitis media. This spontaneous model of chronic otitis media will be valuable for the characterization of middle and inner ear inflammatory disease processes that are induced by middle ear infections.     

Perilymphatic fistulas in children: rationale for therapy

We report 26 consecutive patients (32 ears) who were identified in a 2 year period (July 1, 1985-June 30, 1987) with unexplained sudden, fluctuating, or progressive sensorineural hearing loss (SNHL). All patients underwent an exploratory tympanotomy and a perilymphatic fistula was identified in 13 patients (14 ears). The mean change of 14 +/- 27 dB in speech reception threshold before and after surgery was significant at p = 0.08 among children with fistula and ranged from -30 to 80 dB. In children with sudden, progressive or fluctuating SNHL and multiple sensory deficits, including blindness or contralateral SNHL, or prior head trauma, prompt surgical exploration is mandatory. Additionally, the aggressive management of otitis media with effusion is essential in such patients to minimize fluctuations in hearing caused by superimposed conductive hearing loss. Caution must be exercised to separate fluctuating hearing loss from fluctuations in audiologic testing.     

The influence of chronic otitis media on the sensorineural component of hearing

The objective of the present study was to estimate the influence of chronic suppurative otitis media (CSOM) on the sensorineural component of deafness in the patients presenting with unilateral otitis media. A total of 49 patients with this pathology were included in the study. The bone conduction thresholds at the affected side were measured at a frequency of 500, 1000, 2000, and 4000 Hz and compared with those in the unaffected ear. The loss of hearing was especially well-apparent in the examination at higher frequencies and significantly deteriorated with age. The study did not reveal a marked influence of duration of the disease on the development of the sensorineural component of deafness.     

慢性化脓性中耳炎与感音神经性聋的相关性分析

目的：探讨慢性化脓性中耳炎与感音神经性聋之间的相关性。方法：回顾分析174例单侧慢性化脓性中耳炎患者的骨导阈值改变。采用配对t检验分析0．5kHz，1．0kHz，2．0kHz，4．0kHz患耳与健耳骨导阈值的差异，单因素方差分析法分析胆脂瘤存在及听骨链破坏对语频(0．5kHz，1．0kHz，2．0kHz)和4．0kHz骨导阈值的影响，直线回归法讨论了语频和4．0kHz骨导阈值改变与年龄和病程之间的相关性。结果：患耳与健耳各频率骨导阈值之间差异有统计学意义。语频骨导听力损失程度随着患者年龄的增加而逐渐加重。胆脂瘤的存在以及听骨链破坏亦未增加感音神经性聋的发生概率。结论：慢性化脓性中耳炎可引起感音神经性聋。高频骨导听阈较低频更易受到影响。     

Clinicostatical study on the sensorineural hearing loss accompanying otitis media with effusion

It is pointed out that sensorineural hearing loss sometimes accompanies otitis media with effusion. In order to clarify the incidence and clinical features of sensorineural hearing loss associated with otitis media with effusion, the cases over the past ten years were reviewed. During the period from January 1979 through December 1988, 1338 patients were diagnosed to have otitis media with effusion and showed reliable audiograms in our clinic. Among these patients, 237 patients (17.7%) showed sensorineural hearing loss, defined as a bone conduction loss of 25 dB or more at any one of the frequencies of 500 through 4 kHz. The incidence of sensorineural hearing loss increased as the age of the patients increased. By analyzing their clinical course, these 237 patients were classified into 3 groups according to the etiological relationship of sensorineural hearing loss and otitis media with effusion. In Group A which comprises 14 patients (1.0%), a strong causal relationship was suspected. This group was further divided into 2 subgroups. In one subgroup of 4 patients, sensorineural hearing loss developed rather rapidly during the course of otitis media with effusion and recovered gradually. In the other subgroup of 10 patients, sensorineural hearing loss progressed and did not recover. The clinical features of these 2 subgroups were quite different. In Group B which comprises 50 patients (3.7%), causal relationship was suspected but was not confirmed. Many of the patients in this group showed unilateral otitis media with effusion and the sensorineural hearing loss in the same ear, which was characteristically demonstrated as bone conduction loss at 2 and 4 kHz.(ABSTRACT TRUNCATED AT 250 WORDS)     

Silent otitis media

There is a traditional view that chronic otitis media and chronic mastoiditis must exist in the presence of a tympanic membrane perforation. Based on a human histopathological study of 123 temporal bones with chronic otitis media out of 333 temporal bones with all forms of otitis media pathology, only 24 patients (36 ears) had symptoms of otological disease recorded on their charts and only 19.5% of these had an associated tympanic membrane perforation. Unsuspected findings of chronic otitis media (active or inactive) are occasionally confirmed at exploratory tympanotomy. Such quiet chronic pathological findings in the middle ear have occurred in association with endolymphatic hydrops and cochlear end organ lesions suggesting the possibility that silent chronic otitis media may help explain sensorineural hearing loss, vertigo, and tinnitus for certain patients. We put forth the hypothesis that clinically undetectable silent otitis media in neonates and infants might help explain why certain children are otitis media prone. Our otopathology laboratory includes 111 ears harvested from neonates and infants (average age 8 months). Histological analysis revealed normal findings in some, whereas significant numbers of others show all forms of otitis media, including purulent otitis media, chronic otitis media, serous otitis media, and mucoid otitis media, with occasional overlap of types. Clinical implications will be discussed wth emphasis on silent otitis media and its relationship to the pathogenesis of otitis media and silent chronic otitis media and its possible role in causing insidious labyrinthine changes. A significant outcome of this study was the marked degree of unresolved mesenchyme in the clinically manifest otitis media group or silent otitis media group as compared to a control group. This association and role of mesenchyme is discussed relative to the pathogenesis of infantile otitis media.     

Otologic findings in an Inuit population of cleft palate children

Otitis media with effusion is almost universal in infants with cleft palate. Inuit children have a very high incidence of otitis media. The otologic problems of Inuit infants and children with cleft palate have not previously been reported. The current study presents 14 Inuit children with cleft palate. All show significant otitis media with effusion or chronic otitis media with tympanic membrane perforation. The management of otitis media in this special population of cleft palate children is discussed.     

Is it necessary to screen for hearing loss in the paediatric population with osteogenesis imperfecta?

Is it necessary to screen for hearing loss in the paediatric population with osteogenesis imperfecta? The aim of the study was to assess the necessity of a screening service to detect early hearing loss in the paediatric population with osteogenesis imperfecta. Twenty‐two children were assessed over a 5‐year period. Five children (22.7%) had normal hearing. Fourteen (63.6%) had conductive hearing loss, with 12 children in this group having otitis media with effusion (OME); all had resolution of hearing loss with appropriate therapy. Two children had persistent conductive losses unrelated to OME. Three children (13.6%) had sensorineural hearing loss, with one being detected at the age of 1 year. Existing evidence suggests that hearing loss associated with osteogenesis imperfecta has its onset in the second to third decade of life. Contrary to this, hearing loss was detected in 77.3% (17) of this population with a median and mean age of 9 years. This study would suggest that routine screening is worthwhile in children with osteogenesis imperfecta.     

感音神经性聋患儿伴分泌性中耳炎同期人工耳蜗植入效果分析

目的探讨伴分泌性中耳炎的感音神经性聋患儿同期植入人工耳蜗术后的听觉言语康复效果。方法回顾性分析安徽医科大学第一附属医院2015年1月到2017年12月期间伴分泌性中耳炎同期植入人工耳蜗的感音神经性聋患儿30例(A组)的临床资料,并与同期不伴分泌性中耳炎的感音神经性聋患儿30例(B组)比较。所有患儿均采用面隐窝入路植入人工耳蜗,术后随访24个月,采用听觉行为分级(categories of auditory performauce-Ⅱ,CAP-Ⅱ)和言语可懂度分级(speech intelligibility rating,SIR)评估并比较两组患儿的听觉言语康复效果。结果 A组患儿同期植入人工耳蜗后均未出现术后并发症,术前A组CAP-II评分为0.87±1.07分,SIR评分为1.07±0.37分,术后分别为5.07±0.91和3.73±0.87分,术后较术前明显提高(P<0.01)。B组术前CAP-II评分为0.93±1.17分,SIR评分为1.10±0.40分,术后分别为5.23±0.77和3.77±0.73分,术后较术前明显提高(P<0.01)。A组与B组之间术前、术后CAP-II和SIR评分差异均无统计学意义(P>0.05)。结论感音神经聋患儿伴分泌性中耳炎患儿同期人工耳蜗植入安全可行,且分泌性中耳炎对术后听觉言语康复效果无明显影响。     

The changing pattern of otitis media in Korea

From a nationwide survey of otitis media in Korea, 44.52% of the population were found to have some type of otitis media or its sequelae. A high prevalence rate was seen in the age group over 41 years. This finding suggests a strong relationship between socioeconomic status and incidence of otitis media. From a clinical study of surgical cases of otitis media seen in the past 10 years, we have found that the prevalence of chronic otitis media is decreasing every year. However, severity and pathological findings of otitis media were reflected remarkably in a decreased incidence of acute purulent otitis media and an increased incidence of middle ear effusion in children. In recent years our efforts to control chronic otitis media in children have focused on the treatment of chronic middle ear effusion. To prevent the latter condition, it is strongly emphasized that pediatricians and primary care physicians should be competent in diagnosing otitis media as early as possible, and that they should refer appropriate patients to otolaryngologists for further evaluation and management.     

Ototoxicity of ear drops in patients suffering from chronic otitis media

The sensorineural hearing loss in 150 patients with chronic otitis media who were treated in the Haifa Medical Center (Rothschild) during a ten year period was studied. There were 124 patients treated with a mixture containing neomycin, polymyxin B and dexamethasone and a control group of 26 patients with dexamethasone only. All patients were followed up for a period of 1-2 years. Patients with hearing loss due to factors such as previous ear surgery, family history, exposure to noise etc., have been excluded. The conclusions reached were that there is a relationship between the period of disease and the sensorineural hearing loss and that the local treatment with a mixture containing neomycin + polymyxin B appears to contribute to the worsening of the sensorineural hearing loss in patients with chronic otitis media. Our numbers are small and further studies must be done, but the fact that currently used ear drops may produce a sensorineural hearing loss should not be ignored.     

Otological and audiological outcomes five years after tympanostomy in early childhood

OBJECTIVE: Ventilation tubes in the treatment of otitis media in young children remain controversial. Despite abundant research, few prospective long-term follow-up studies have included even a minority of patients under 1 year old. We investigated long-term otological and audiological outcomes in children with recurrent acute otitis media and otitis media with effusion, who were treated early with ventilation tubes. STUDY DESIGN: Prospective follow-up. METHODS: Three hundred five children under 17 months of age received a primary tympanostomy in the Central Hospital of Central Finland (Jyv?skyl?, Finland), and those 281 (92.1%) who were monitored prospectively for 5 years made up the study group. At the final examination, pneumatic otoscope and otomicroscope were used and pure-tone audiometric thresholds of air and bone conduction were measured to define the hearing levels (mean of 0.5, 1.0, and 2.0 KHz thresholds). RESULTS: Of ears, 67.3% were healed, 7.1% had a retraction of tympanic membrane in pars flaccida and 9.6% in pars tensa, 7.5% had an ongoing otitis media with effusion, 3.9% had a ventilation tube in place, and 4.6% had a tympanic membrane perforation with mean hearing levels of 7.6, 9.0, 16.0, 18.5, 10.5, and 17.7 dB, respectively. CONCLUSIONS: Hearing in general was well preserved, and no ear presented with adhesive otitis media or cholesteatoma. Adverse otological and audiological outcomes of these young children did not exceed those presented by others for older counterparts. Tympanic membrane perforations, ongoing otitis media with effusion, and pars tensa retractions were causes of mild conductive hearing loss. Because one third of ears continued to have middle ear disease or sequelae, we emphasize the proper follow-up and restoration of middle ear ventilation with repeat ventilation tubes if not otherwise achieved.