The evaluation of eustachian tube function in patients with chronic otitis media

In this study we evaluated eustachian tube function in patients with chronic otitis media and compared the results with normal subjects. Two different eustachian tube function tests were applied to 60 ears of the chronic otitis media group and 146 ears of the control group. While eustachian tube dysfunction was observed in 71.7% of the chronic suppurative otitis media group, it was only seen in 34.9% of the control group.     

咽鼓管功能障碍的慢性化脓性中耳炎治疗分析

目的 探讨合并咽鼓管功能障碍的慢性化脓性中耳炎病例的适宜手术方案。 方法 收集咽鼓管功能障碍的慢性化脓性中耳炎病例68耳,分为观察组(28耳),同期行中耳乳突手术及咽鼓管球囊扩张术,对照组(40耳),仅行中耳乳突手术。术前,术后3个月、6个月、12个月分别以ETDQ-7评分、听阈、气骨导差进行对比。 结果 观察组术后6~12个月随访气导平均听力改善率为89%(25/28),干耳率93%(26/28)。对照组听力改善率为75%(30/40),干耳率95%(38/40)。观察组术后3~6个月EDDQ-7评分及听阈达到较明显缓解,但术后6~12个月上述指标有加重趋势。观察组及对照组术后听力均比术前听力提高,有统计学差异,两组的术后听力相对比,观察组优于对照组,有统计学意义。 结论 在咽鼓管功能障碍的慢性化脓性中耳炎患者中,中耳手术同期咽鼓管球囊扩张术较单纯中耳手术的听力改善率高,改善程度高,重新内陷率低,重新粘连率低,干耳率无明显差别。术后3~6个月患者咽鼓管相应症状达到较明显缓解,6~12个月症状有反复。     

咽鼓管功能障碍的慢性化脓性中耳炎治疗分析

目的探究咽鼓管功能障碍的慢性化脓性中耳炎治疗效果。方法2016年12月~2020年2月,从本院收治的咽鼓管功能障碍的慢性化脓性中耳炎患者中选择50例进行研究,回顾患者病例,以不同的治疗方案作为分组标准,将50例患者分为对照组、实验组,各25例。对照组只开展中耳乳突手术,实验组同期开展中耳乳突手术与咽鼓管球囊扩张术,对比两组听力改善效果、治疗效果、并发症发生率。结果实验组听力改善效果明显高于对照组,P<0.05;术后3个月、6个月实验组患者的EDTQ-7评分、听阈值均低于对照组,P<0.05;实验组并发症发生率低于对照组,P<0.05。结论在咽鼓管功能障碍的慢性化脓性中耳炎患者行中耳乳突手术时,同期开展咽鼓管球囊扩张术,既能改善患者的听力状态,又能提升治疗效果,减少并发症,值得推荐。     

慢性化脓性中耳炎的咽鼓管功能对手术疗效的影响

目的探讨慢性化脓性中耳炎咽鼓管功能改变对手术疗效的影响.方法分析40耳行鼓室成形术的慢性化脓性中耳炎的咽鼓管功能与手术疗效的关系.咽鼓管功能检查用正-负压试验、TTAG法及音响法,咽鼓管鼓室口及咽口的观察分别用鼓室镜及鼻窦镜,对比分析咽鼓管功能改变与病变部位的关系,并比较鼓室成形术后咽鼓管功能正常耳与异常耳的鼓膜生长及听力变化情况.结果慢性化脓性中耳炎的咽鼓管功能与鼓室口病变程度相关,鼓室口病变轻者,咽鼓管功能良好;而鼓室口病变重者咽鼓管功能不良.40耳鼓室成形术后咽鼓管功能良好耳鼓膜生长良好,咽鼓管功能不良耳鼓膜生长欠佳;两者均有统计学意义.结论慢性化脓性中耳炎咽鼓管功能与鼓室成形术效果关系密切,咽鼓管功能障碍可能是导致手术失败的重要因素之一.     

声导抗测试对慢性化脓性中耳炎咽鼓管功能的评价

目的:运用声导抗测试探讨不同类型、病程和病情的慢性化脓性中耳炎的咽鼓管功能。方法:采用声导抗仪手动ETF-P咽鼓管功能(鼓膜穿孔)记录模式,对368例402耳慢性化脓性中耳炎进行测试,并根据患者的病程、鼓膜穿孔部位和中耳炎类型进行测试结果的统计学分析。结果:慢性化脓性中耳炎咽鼓管平均正压开放压在通畅时为(23.5±8.3)daPa、轻度阻塞时为(79.8±16.2)daPa、严重阻塞时为(154.1±28.7)daPa、如>200 daPa仍不开放则为咽鼓管完全阻塞。咽鼓管通畅者为50.5%、轻度阻塞为26.9%、严重阻塞为11.9%、完全阻塞为10.7%,咽鼓管通畅者明显多于各类阻塞者。在3个月~1年病程的患者中咽鼓管通畅所占的比例明显低于其他病程组。紧张部大穿孔的咽鼓管开放压显著低于紧张部小穿孔和松弛部穿孔,而咽鼓管阻塞发生的比例却显著低于紧张部小穿孔和松弛部穿孔。结论:慢性化脓性中耳炎约1/2患者的咽鼓管是通畅的,轻度阻塞约占1/4,严重阻塞和完全阻塞各约占1/10。咽鼓管的功能与中耳炎的病程、类型和鼓膜的穿孔部位有关。运用声导抗测试对慢性化脓性中耳炎的咽鼓管功能进行评价是一种简便易行、无创快速、易于判别、较为准确的检测方法。     

慢性化脓性中耳炎的微生物学研究进展

慢性化脓性中耳炎(CSOM)是一种常见病多发病,CSOM是一种多因素疾病,由环境、细菌、宿主和遗传危险因素等一系列因素相互作用引起,细菌感染是CSOM重要的原因之一。由于地区、民族、饮食习惯等差异,CSOM在世界各地的发病率及细菌种类也有所差异。既往基于培养技术获得CSOM部分优势菌群,但不能获得CSOM细菌群落的全貌,限制了CSOM的病原学研究。随着各项检测技术的提高,特别是16S rRNA测序及宏基因组测序等分子技术的发展,CSOM病原学研究也逐步完善,这不仅对抗生素的选择提供依据,同时也能进一步研究细菌在CSOM中的致病机制。     

Analysis on the correlation between Eustachian tube function and outcomes of type I tympanoplasty for chronic suppurative otitis media

Abstract

Background: The potential influence of Eustachian tube dysfunction (ETD) on the efficacy of tympanoplasty is controversial.

Objective: This study aims to investigate the correlation between Eustachian tube function (ETF) and outcomes of type I tympanoplasty for chronic suppurative otitis media (CSOM).

Materials and Methods: 53 patients with CSOM and receiving type I tympanoplasty were divided into a dysfunction group (Eustachian tube score; ETS ≤ 5points) and a normal group (ETS > 5 points) according to their preoperative ETS. During the one-year follow-up, the ETS, hearing results, and eardrum condition of the patients were recorded and analyzed.

Results: The ETS improved significantly from 2.57 (±1.73SD) to 4.68 (±2.00SD), while the mean air–bone gap (ABG) decreased significantly from 20.94 (±9.04SD) dB to 16.43 (±9.06SD) dB in the dysfunction group (p?<?.05). The postoperative ABG showed no significant difference in the two groups. The healing rate of the tympanic membrane was 96.43% in the dysfunction group, and 100% in the normal group.

Conclusions and significance: The ETF was significantly improved after type I tympanoplasty for CSOM combined with ETD, and the postoperative efficacy was not adversely affected. The ETD may not influence the outcomes of type I tympanoplasty for CSOM.     

慢性化脓性中耳炎并发迷路瘘管20例

目的 :探讨慢性化脓性中耳炎并发迷路瘘管的临床特征及治疗方法。方法 :回顾性分析 1992～ 1999年收治的慢性化脓性中耳炎患者 45 0例的临床资料 ,全部病例均行乳突根治术。结果 :45 0例中并发迷路瘘管 2 0例 (4 .4% ) ,18例 (90 % )有主观听力下降 ,13例 (6 5 % )有眩晕史。 9例 (4 5 % )瘘管试验阳性。患耳全聋 2例 ,患耳纯音测听骨导平均听阈≤ 30 d B 11例 ,31～ 5 0 d B 3例 ,≥ 5 1d B 4例。瘘管试验阳性患者患耳听力较瘘管试验阴性者差 (P <0 .0 1)。 CT检查的 9例中 ,2例发现迷路瘘管。术中发现 18例 (90 % )为胆脂瘤性中耳炎 ,2例 (10 % )为骨疡型中耳炎 ,瘘管均发生在外半规管。结论 :迷路瘘管术前尚无可靠的诊断方法 ,最可靠的方法是在手术中探查。对迷路瘘管区的处理应视瘘管的大小、部位、病变性质及患者的具体情况而定。     

高龄及合并全身疾病慢性化脓性中耳炎患者围手术期管理

摘要：目的手术治疗高龄或伴全身疾病的慢性化脓性中耳炎患者时,手术风险及手术相关并发症的发生率相对较高。本文分析了此类患者的基础疾病特点及管理原则,以期更好地维护围手术期安全,为存在相对手术禁忌的患者提供治愈机会。方法2009年1月~2015年1月我科收治拟行手术治疗的高龄或伴全身疾病慢性化脓性中耳炎患者268例,根据基础疾病的类型、严重程度、治疗用药对手术的影响等进行围手术期管理,排除手术禁忌并决定是否建议手术。根据手术实施率、基础疾病恶化率、干耳率等评估围手术期管理的合理性。结果268例患者中,6例因无法控制基础疾病而放弃手术,余262例接受手术,手术实施率为97.8%。所有手术患者中,术前91例（34.7%）需要调整基础疾病治疗方案;术后14例（5.3%）出现基础疾病恶化,包括7例血糖紊乱、4例血压紊乱、1例诱发谵妄、1例哮喘复发、1例再发脑梗,余248例（94.7%）术后平稳。所有手术患者均实现干耳,未出现面瘫、感音神经性耳聋等手术相关并发症。结论针对各不同类型基础疾病,采用相应的干预措施,有望为存在相对手术禁忌的慢性化脓性中耳炎患者获得治愈机会,降低围手术期严重并发症的发生几率。     

The role of retinol in the etiology and outcome of suppurative otitis media

Vitamin A deficiency is still a serious public health problem affecting an estimated 127 million preschool children. The resulting immunological dysfunctions lead to increased risks of respiratory tract infections, diarrhoeal diseases and blindness, among others. The aim of this study is to determine the significance of the role of serum retinol in the etiology of acute suppurative otitis media (ASOM) and its chronicity (CSOM). In a prospective follow-up of patients with ASOM for 6–9 months, serum retinol determination was done using the high performance liquid chromatography. Participants comprised 358 ASOM and 52 control subjects. Six-month follow-up was achieved in 264 subjects (74%); of these, there was persistence of otorrhoea (CSOM) in 116, while 148 had resolved ASOM. Of the 264 subjects, 146 were males and 118 were females, between the ages of 6 months and 9 years and a mean of 7 years (SD = 2.32), whereas the control subjects comprised 29 males and 22 females, between the ages of 6 months and 11 years and a mean of 7.8 years (SD = 3.6). The range of serum retinol in the ASOM subjects was 1.63–2.64 μg/L, mean of 1.53 μg/L, median value of 2.61 μg/L and (SD = 0.16). Among control subjects, the range was 2.5–2.8 μg/L, mean of 2.58 μg/L and median value of 2.61 μg/L (SD = 0.14) (Table 1). The range of serum retinol in the resolved ASOM subjects was 1.61–2.63 μg/L, mean of 2.07 μg/L and median value of 2.09 μg/L (SD = 0.16) while the CSOM subjects ranged between 0.8–2.86 μg/L, mean of 1.58 μg/L and median value of 1.28 μg/L, (SD = 0.48) (Table 2). Univariate analysis using unpaired t test to compare the mean serum retinol revealed significant difference between ASOM and control (P = 0.0000) and between resolved ASOM and CSOM (P = 0.0000). In conclusion, hyporetinolaemia was a significant etiological factor in the etiology ASOM and CSOM, suggesting retinol supplementation as one strategy in control of SOM.     

Nasopharynx as a microbiologic reservoir in chronic suppurative otitis media: preliminary study

ObjectivesThe present study was designed to identify the correlations of bacterial strains of the middle ear and the nasopharynx in chronic suppurative otitis media (CSOM) patients who were scheduled for operations.MethodsSixty-three patients with CSOM were enrolled in the study. Culture specimens were collected from the middle ear and nasopharynx of patients who were admitted for operation. Samples collections were performed 3 times; from the middle ear and nasophaynx at the admission day, from the middle ear during the operation, and from the external auditory canal post-operatively. Bacteria were identified by gram staining and biochemical tests. The correspondence rate of organisms which simultaneously exist in the middle ear and the nasopharynx was measured.ResultsSixty-eight organisms were isolated from the middle ear and 57 organisms from the nasopharynx among 63 patients. Of 68 bacteria identified in middle ear, 26.52% (18 bacteria) corresponded with those of nasopharynx. MRSA had the high correspondence rate, and of 18 methicillin-resistant Staphylococcus aureus (MRSA) isolated from middle ear, 33.3% (6 bacteria) corresponded with nasophaynx. Meanwhile, 3 organisms of MRSA were detected from the external auditory canal post-operatively, although they were only found in nasopharynx pre-operatively.ConclusionThe current trend of middle ear swab alone for bacterial detection would be insufficient to identify the potent MRSA and impede early antibiotic intervention for the effective middle ear surgery. Therefore, it is necessary to perform nasopharynx cultures together with conventional middle ear culture to control potent risk for infection pre-operatively.     

Susceptibility of microorganisms isolated from chronic suppurative otitis media to ciprofloxacin

In order to evaluate the susceptibility of the microorganisms isolated from chronic suppurative otitis media to ciprofloxacin, cultures of specimens from 127 patients with chronic suppurative otitis media and their antibiotic sensitivity results were examined. The most common aerobic isolates were Pseudomonas sp., Proteus sp. and Staphylococcus aureus with recovery rates of 40.7%, 21.6% and 19.1% respectively. Sensitivity results showed that 6.2% of Pseudomonas isolates, 2.9% of Proteus isolates, 10% of Staphylococcus aureus isolates and 8.3% of Escherichia coli isolates were resistant to ciprofloxacin.     

分泌性中耳炎和慢性鼻-鼻窦炎患儿咽鼓管咽口形态及功能的观察与分析

目的：观察分泌性中耳炎及慢性鼻-鼻窦炎患儿咽鼓管咽口及其周围形态的改变并检测其功能,为临床治疗提供客观依据。方法：将150例患儿分为分泌性中耳炎组（50例）、慢性鼻-鼻窦炎组（50例）及对照组（50例,无分泌性中耳炎及慢性鼻-鼻窦炎的声嘶患儿）,在电子鼻咽喉镜直视下观察各组咽鼓管咽口及其周围形态的改变,用声导纳仪检测各组患儿的咽鼓管功能状态,并进行统计学分析。结果：①分泌性中耳炎组咽鼓管咽口的形态学改变高达94%,慢性鼻-鼻窦炎组则为80%,2组差异无统计学意义（P〉0.05）,但与对照组比较均差异有统计学意义（均P〈0.05）。②分泌性中耳炎组70%存在咽鼓管功能障碍,慢性鼻-鼻窦炎组26%存在咽鼓管功能障碍,2组比较差异有统计学意义（P〈0.05）,且2组与对照组（2%）比较均差异有统计学意义（均P〈0.05）。结论：分泌性中耳炎及慢性鼻-鼻窦炎患儿存在咽鼓管功能障碍、咽鼓管咽口及其周围形态的改变;咽鼓管功能障碍在分泌性中耳炎的发病中占主导作用,与慢性鼻-鼻窦炎比较,咽鼓管功能障碍较咽鼓管咽口的形态改变更有差异性。     

Clinical and demographic risk factors associated with chronic suppurative otitis media

BACKGROUND: The incidence of chronic suppurative otitis media (CSOM) is high worldwide but increasing occurrence of complications appear peculiar to West Africa. However, knowledge of associated risk factors is sparse, we report the sociodemographic risk factors of CSOM with the aim of control of the disease and complications; and possible preventive strategies. METHOD: This is a survey of children with CSOM in five sites spread in two suburban cities in two states in Nigeria. Questionnaire was administered on the informants followed by examination of the children. RESULT: Of the 189 children, 114 (60%) had developed ear suppuration before 6 months of age, the number of attacks within the previous 18 months ranged between 2-12 with average of 7. Sociodemographic risk factors included low socioeconomic class in 153 (81%), 136 (72%) live in congested houses with more than 10 people and 79 (42%) belonged to families with more than 5 children. Indoor-cooking and infant daycare attendance were 117 (62%) while supine bottlefeeding was 115 (61%) and 34 (18%) of subjects had smoking father. The clinical risk factors were upper respiratory tract infection (URI) 85 (45%), allergy 53 (28%), adenoid 54 (28%) and malnutrition 65 (34%). The univariate analysis revealed that low social class (OR=7.33, CI=4.18-12.83, P=0.0001), malnutrition (OR=3.57, CI=1.88-6.76, P=0.00001), bottlefeeding (OR=2.93, CI=1.63-5.28, P=0.0001), indoor-cooking (OR=1.35, CI=0.88-2.10, P=0.161) and high number of people in a household (OR=0.59, CI=0.34-0.98, P=0.04) are significant in development of OM; while multivariate logistic regression analysis showed malnutrition (OR=3.48, CI=1.633-7.425, P=0.001), low social status (OR=7.74, CI=4.15-14.43, P=0.0001) and indoor-cooking (OR=2.34, CI=1.18-4.66, P=0.014), second table. Parental smoking, daycare attendance, allergy, adenoiditis/adenoidal hypertrophy and upper respiratory tract infection were not found significant. CONCLUSION: Low socioeconomic class, malnutrition, congestion from high number of children in the household and bottlefeeding constitute significant risk factor. The early onset of disease (<6 months) may suggest a prenatal predisposition. We need further research for the understanding of the biologic effect of these factors while this remains a database for prevention and control of disease.     

我国慢性化脓性中耳炎患者的病原学及其动态变化分析

摘要：目的了解我国近年来慢性化脓性中耳炎（chronic suppurative otitis media,CSOM）患者的病原菌谱分布及动态变化趋势,为临床合理用药提供指导。方法通过检索中国期刊全文数据库（CNKI）、万方数据库、维普数据库（VIP）及中国生物医学文献数据库（CBM）从1991年1月~2015年5月发表的所有有关CSOM细菌培养的描述性临床研究中文献,共筛选出50篇文献纳入本次研究,累积研究CSOM患者7462例（7521耳）。根据文献资料的中位年限平均分为4组：1990-1995年组、1996-2001年组、2002-2007年组及2008-2013年组。对各组细菌培养病原菌检出率、真菌检出率、前4种细菌所占比例及革兰阳性（G+）菌与革兰阴性（G-）菌比例进行动态分析。结果细菌培养病原菌总检出率86.21%,真菌检出率5.25%。细菌以金黄色葡萄球菌、凝固酶阴性葡萄球菌、铜绿假单胞菌及变形杆菌4种细菌为主;真菌以念珠菌及曲霉菌为主。随着时间推移,细菌培养病原菌检出率逐渐降低;真菌检出率逐渐增高;前4种细菌中以金黄色葡萄球菌排名首位,凝固酶阴性葡萄球菌的比例有逐渐增加的趋势;G+菌与G-菌比例分别逐渐增加和下降。结论我国CSOM患者病原菌谱中以金黄色葡萄球菌、凝固酶阴性葡萄球菌、铜绿假单胞菌及变形杆菌为主要病原菌;随着时间推移,细菌培养病原菌检出率逐渐降低,真菌检出率、G+菌检出比例及凝固酶阴性葡萄球菌的检出率有增高趋势。     

慢性化脓性中耳炎手术前后患者生活质量的调查分析

目的采用问卷调查方式评价手术对慢性化脓性中耳炎(chronic suppurative otitis media,CSOM)患者生活质量的影响。方法对2009年9月至2010年5月符合纳入标准的78例CSOM患者术前、术后分别接受中文版《慢性耳病调查量表》(The Chinese version of the Chronic Ear Survey,CCES)问卷调查,分析手术对患者生活质量的影响。结果 57名患者在术后2～6月完成术后随访及调查,结果如下:(1)手术前后生活质量CCES总评分无显著变化;(2)术后症状评分较术前有明显改善;(3)术后生活限制及心理影响评分较术前无明显变化;(4)听骨链重建手术患者术后生活限制较术前增加。11名患者完成术后10～12月随访调查。术后各项评分均较术前明显改善。结论中耳炎手术患者术后恢复是长期过程,术前谈话应充分解释术后半年内的症状、生活限制及心理影响,使其对手术预后有正确的认知,减轻术后心理困扰。     

122例慢性化脓性中耳炎患者术前骨导听力分析

 目的探讨慢性化脓性中耳炎对骨导听力的影响。方法回顾性分析122例单侧慢性化脓性中耳炎患者,同期选取对侧正常耳作为对照耳,通过对患耳与健耳、不同年龄组、单纯型与胆脂瘤型中耳炎、听骨链完好与听骨链破坏、细菌培养阳性者与阴性者,不同病理患者的术前骨导听力进行研究。所有患者进行纯音测听检查, 并对各频率骨导听阈进行统计学处理, 对影响骨导听力的因素做相关分析。结果0.5、2、4 kHz处,患耳骨导听阈值高于健耳,而低频0.25 kHz及1 kHz处患耳与健耳骨导听阈值差异不显著;随年龄增长,患耳与健耳骨导听阈值差异有逐渐缩小趋势;中耳胆脂瘤及听骨链破坏者对各频率骨导有明显影响;病程及细菌培养阳性与否对骨导听力损害差异不显著。结论①慢性化脓性中耳炎对骨导听力有明显影响,但在不同频率,损害程度有差异;②慢性化脓性中耳炎可能会影响对侧正常耳的骨导听力;③中耳胆脂瘤及听骨链破坏对骨导听力影响较大。     

Microbiological profile with antibiotic sensitivity pattern of cholesteatomatous chronic suppurative otitis media among children

Introduction

Chronic suppurative otitis media (CSOM) is the most common cause of childhood hearing impairment in the developing countries and atticoantral type is associated with increased incidence of intracranial and extracranial complications. This study was undertaken to define the microbiology of atticoantral type of chronic otitis media and the antibiotic sensitivity pattern, thereby reducing the potential risks of complications.

Materials and methods

A retrospective study was done in the Department of Otolaryngology, JIPMER, Puducherry from the year August 2003 to October 2009 using the medical record department database to retrieve the patient details. During this study period, 223 children with atticoantral type CSOM consisting of 126 males and 97 females with an age range of 1-14 years were assessed. Patients with persistent otorrhea for more than 3 months with atticoantral type of chronic otitis media were selected. The exudates were collected under sterile conditions and inoculated onto culture media; bacterial growth and antibiotic sensitivity pattern were studied.

Results

Nine species of micro organisms were isolated from the middle ear aspirate, Pseudomonas aeruginosa being the most predominant isolate constituting about 32% (72 discharging ears) of the total isolates followed by Proteus mirabilis (20% of isolates) and Staphylococcus aureus (19% of isolates). Gram negative organisms accounted 58% of total isolates and gram positive organisms constituted 22% isolates. Candida albicans and methicillin resistant S. aureus were identified in 4% and 2% of isolates, respectively.100% of Pseudomonas isolates showed susceptibility to ceftazidime and a high sensitivity (92% of isolates) to ciprofloxacin and 88% isolates were sensitive to amikacin. 100% of P. mirabilis isolated from inoculates showed sensitivity to ceftazidime and ciprofloxacin. It also showed 87-97% sensitivity to ceftriaxone, amikacin and ampicillin. All (100%) of the Staphylococcus isolates were sensitive to vancomycin and 84-86% were sensitive to ciprofloxacin and erythromycin. In general, gram negative organisms showed increased sensitivity to ceftazidime, ciprofloxacin and amikacin, while gram positive organisms to vancomycin, erythromycin and ciprofoxacin.

Conclusion

Continuous and periodic evaluation of microbiological pattern and antibiotic sensitivity of cholesteatomatous CSOM is necessary to decrease the potential risks of complications by early institution of appropriate systemic and topical antibiotic alongside mastoid exploration. We believe that our data may contribute to an effective medical management of chronic suppurative otitis media with cholesteatoma. Since the most common organisms in our clinical set up being P. aeruginosa, P. mirabilis and S. aureus, which showed a percentage susceptibility of 100% to ceftazidime and vancomycin, thus making it an empirical antibiotic combination therapy of choice in the recent times.