Tuberculous otitis media presenting as complications: report of 18 cases.

Tuberculous otitis media is a rare but treatable disease; delay in its diagnosis usually leads to complications. In the last 15 years we have come across 18 cases of tuberculous otitis media, which presented various intra- and extracranial complications. In the past, tuberculous otitis media had always been considered a discrete disease, but it is possible that tuberculosis may coexist or secondarily affect an already discharging ear. The following discussion illustrates the complications and clinical problems encountered in tuberculous otitis media.     

Otologic disease in the acquired immunodeficiency syndrome

It appears that true otologic manifestations of AIDS are rare and that incidental otologic disease associated with AIDS is more common. A review of the literature revealed that otitis externa, acute otitis media, recurrent acute otitis media, otitis media with effusion, chronic suppurative otitis media with cholesteatoma, and herpes zoster oticus may all represent incidental otologic disease occurring in patients with AIDS. Chronic otitis media without cholesteatoma (P carinii-infected aural polyps), sensorineural hearing loss, acceleration of otosyphilis from the latent stage, and development of Kaposi's sarcoma of the external auricle or nasopharynx may represent true otologic manifestations of AIDS.     

SURGICAL TREATMENT OF OTITIS MEDIA

Otitis Media is a common disease in the practice of otolaryngology and one of the famous "three inflammations and one deafness".Otitis media has been with humans from the very beginning. Treatment for otitis media started in the west in 1774 and much later in China.     

A case of pneumocephalus and meningitis as a complication of silent otitis media

Silent otitis media is a progressive otogenic disease. Intracranial manifestations of this complication are limited; the most common is meningitis. We report a case of meningitis and pneumocephalus as a complication of silent otitis media. To the best of our knowledge, this is the first reported case of pneumocephalus as a complication of silent otitis media.     

中耳胆脂瘤研究进展

中耳胆脂瘤是耳鼻咽喉科较为常见的一种慢性中耳疾病,长期外耳道流脓、鼓膜穿孔、听力下降为其主要特点,它对周围组织具有侵袭性,易引起中耳传音结构的破坏和骨质吸收,进而引起面瘫、迷路炎、耳后骨膜下脓肿及各种颅内外并发症。中耳胆脂瘤的病因及发病机制复杂,治疗方法的疗效争议较多。本文主要将近年来关于中耳胆脂瘤的病因、发病机制及治疗进展进行综述。     

The reliability of self-reported childhood otitis media by adults

OBJECTIVE: To estimate reliability of retrospective questionnaire data on childhood recurrent otitis media, and to identify factors influencing inconsistency in self-report. METHODS: Retrospective questionnaire data from a population-based sample of 4430 Norwegian twins who participated in two questionnaire surveys, 6 years apart, containing identical questions on otitis media. Main outcome measure was individual consistency in reporting of otitis media. The tetrachoric correlation and Cohen's Kappa were used to measure reliability. Inconsistent and consistent responders were compared on medical history and mental distress. The use of twin data made it possible to test whether inconsistent responders represent a group with intermediate levels of otitis media severity. RESULTS: The test-retest tetrachoric correlation was 0.82 and Kappa was 0.53. Inconsistency in response was not associated with mental distress, but related to reported number of otitis media episodes per year, use of medical services and history of ear surgery. CONCLUSION: Retrospective self-reported otitis media is a relatively reliable measure. The study suggests that reporting inconsistency is likely to be associated with less severe disease. The finding that reporting pattern is related to disease severity is in accordance with the proposed need for a uniform agreement on the definition of the term "recurrent otitis media" for research purposes.     

Experimental pneumococcal otitis media: longitudinal studies in the gerbil model

In order to ascertain that the Mongolian gerbil, Meriones unguiculatus, is an acceptable model for studying the development of chronic from acute otitis media, we used previously published methods for experimental otitis media in a longitudinal study of the acute disease and sequellae. The gerbil was found to be susceptible to as few as 30 viable Streptococcus pneumoniae type 3 cells, indicating that only a few viable pathogens are able to cause the disease. Untreated experimental infections with S. pneumoniae type 23 resulted in a mild, self-limiting disease with little permanent sequellae, while S. pneumoniae type 3 produced severe disease characterized by an acute phase of from 2 to 3 weeks, followed by the development of new bone formation and a vascularized granulation tissue which persisted throughout the 13-week study. Viable pneumococci could be recovered from the middle ears for only two weeks. We conclude that the gerbil is a useful model for otitis media.     

Pediatric approach to the diagnosis and management of otitis media

The diagnosis of otitis media is complicated by confusing terminology and a disease continuum with overlap between clinical entities. The patient's history often reveals determinants of otitis media chronicity and recurrence. Certain laboratory tests, including tympanocentesis for middle ear fluid culture, may be useful in treatment decisions. Although seven antimicrobial drugs are useful in treating acute otitis media, certain drugs are more useful in specific cases. There are several medical treatment options for chronic otitis media with effusion and for preventing recurrent acute otitis media.     

Tomographic evaluation of the contralateral ear in patients with severe chronic otitis media

Some studies indicate a bilateral tendency of chronic otitis media. It is believed that the contralateral ear can provide evidences of the route of formation of ear disease in the most affected, be a parameter of Eustachian tube function and predict successful treatment. The CT scan is an excellent test to evaluate the structures of the temporal bone and the changes resulting from otitis media.ObjectiveTo evaluate Temporal Bone Computed Tomography of patients with chronic otitis media and describe abnormalities in the contralateral ear.MethodCross-sectional study. Evaluation of CT scans of 75 patients with chronic otitis media from a tertiary referral hospital in Brazil by a neuroradiologist.ResultsPopulation was consisted of 50.6% males with a mean age of 36 years. We found 54.7% of changes in contralateral ear clearly associated with chronic otitis media.ConclusionThe prevalence of radiographic changes in the contralateral ears of patients with chronic otitis media corroborates with clinical, histopathological and functional resources developed by the same group that this disease has a bilateral feature.     

Classification of otitis media and surgical principles.

Otitis media is an important disease of children and adults and is caused by multiple interrelated factors, including infection, eustachian tube dysfunction, allergy, and barotrauma. This article includes a pertinent review of the literature regarding otitis media. The pathogenesis, classification, and treatment of otitis media in children and adults are also reviewed in this article. Additionally, therapy is discussed with emphasis on the surgical options appropriate at each stage.     

Management of chronic otitis media in the only hearing ear

OBJECTIVE: Chronic ear surgery is difficult. The management of such a disease either with or without cholesteatoma and in an only hearing ear is particularly challenging. Consequences of disease or unintended outcomes of therapy can both result in patient lifestyle alterations of major proportion. This report offers a diagnostic and treatment plan for chronic otitis media with and without cholesteatoma in the only hearing ear. METHODS: More than 10,000 charts of patients with chronic otitis media were retrospectively reviewed. Twenty-seven charts of patients with chronic otitis media in an only hearing ear who underwent surgical treatment were identified. The patients were followed for an average time of 43 months. RESULTS: Overall, the chronic otitis media was well controlled, and there was no change in the average discrimination or hearing thresholds when comparing preoperative and postoperative results. CONCLUSIONS: Chronic otitis media with and without cholesteatoma in an only hearing ear can be treated successfully with hearing preservation. Canal wall down tympanomastoidectomy is performed in most cases. Manipulation of the ossicular chain is avoided, and cholesteatoma that lies over a potential fistula is exteriorized.     

Patulous eustachian tube following otitis media

Loss of weight, dehydration, pregnancy, fatigue, and otitis media are among the factors proposed as causes of a patulous eustachian tube, but true details remain obscure. We studied patients who developed a patulous eustachian tube following otitis media and discuss the relationship between these 2 conditions. Subjects were 12 patients diagnosed with otitis media at our department who later developed a patulous eustachian tube. The initial middle ear disease progressed from acute otitis media to otitis media with effusion in 2, acute otitis media in or acute mastoiditis in 1 each, and otitis media with effusion in the remaining 8 patients. Seven patients evidenced a low body mass index (BMI), weight loss, and underlying disease, but 5 with a patulous eustachian tube following otitis media did not. We retrospectively analyzed 119 patients diagnosed with a patulous eustachian tube in our department for whether they had been diagnosed by an ENT physician as having otitis media, i.e., acute otitis media or otitis media with effusion. Some 42 (35.3%) had a history of otitis media. At acute otitis media or otitis media with effusion, the tympanic cavity becomes inflamed, accompanied by inflammation of the eustachian tube mucosa and a stenotic tendency. Healing from otitis media is accompanied by decreased eustachian tube mucosa inflammation. We surmise that, depending on how inflammation disappears, fibrosis of the eustachian tube mucosa occurs, leading to a pathologically patulous eustachian tube. Many aspects of the causation of this condition remain unclear, but we surmised that in patients with earlier otitis media, a pathological patulous eustachian tube develops during resolution of inflammation. Our findings indicate the involvement of otitis media as a causative factors in a patulous eustacian tube.     

分泌性中耳炎研究现状

分泌性中耳炎是临床上常见的一种耳科疾病,可以造成患者听力丧失,严重影响人类的生命健康质量,也给患者的家庭带来严重的经济负担。目前,引起分泌性中耳炎的病因机制复杂,并未形成统一的认识,对分泌性中耳炎的早期准确诊断,进行及时的治疗,对于改善患者预后,提高生命质量至关重要。本文将对近年来分泌性中耳炎有关的机制、诊断以及治疗等方面的研究进行综述,为临床治疗分泌性中耳炎提供一定的指导意义。     

Tympanoplasty: prudent considerations of silent otitis media and interactions of middle ear and inner ear.

Otitis media is a common problem, often with simple, minimally invasive solutions; however, a small subset of patients progress to chronic disease despite provision of standard therapies. The flexible approach to tympanoplasty is a prudent consideration for patients with chronic otitis media, especially children. This article discusses the findings and implications of silent otitis media, interactions of the middle ear and inner ear, and obstructive sites in the middle ear cleft. Tympanoplasty by the flexible approach is described in the context of these findings.     

Chronic silent otitis media

Otitis media occurs along a continuum. For example, otitis media with effusion characterized by fluid pathology can lead to chronic otitis media plus chronic mastoiditis, characterized by the presence of intractable tissue pathology such as cholesteatoma, cholesterol granuloma or granulation tissue. The literature defines chronic otitis media as having a tympanic membrane perforation and otorrhea. Amongst many other sequelae, which can result from the continuum, an important common one is chronic silent otitis media. This overlooked entity which includes pathology beneath an intact tympanic membrane is commonly seen in our human temporal bone laboratory and in patients. The clinical pathological correlates of this important disease are discussed herein.     

Allergic airway disease and otitis media in children

The occurrence of allergic rhinitis, asthma and otitis media was examined in 395 Indian children living on two separate reservations in Arizona. The children were followed from birth to age 5 years in a study of otitis media. On retrospective review of medical records, 45% of the children at Parker had a clinical diagnosis of allergic airway disease, in contrast to only 6% at San Carlos. At each site, about 55% had recurring otitis media in infancy; of these otitis-prone infants, 40% at Parker and 36% at San Carlos persisted to have 3 or more episodes of otitis media after age 2 years. The only allergic airway disease correlate with otitis media was allergic rhinitis in children age 2-4 years.     

Otitis media with effusion and early sequelae: flexible approach.

Patients suffering from chronic otitis media often have a variety of associated disease processes and pathologic conditions. The identification and recognition of these factors are critical to the effective treatment of the condition. This article provides an overview of the conditions associated with chronic otitis media, a detailed review of the disease process, and guidelines for surgical therapy.     

微波治疗对儿童分泌性中耳炎转归的影响

目的：探讨微波治疗对儿童分泌性中耳炎转归的影响。方法:将2003年10月～2005 年10月收治的152例分泌性中耳炎患儿按治疗方法分为微波组78例（86耳），对照组74例（84耳），对其结果进行分析；并对微波组78例（86耳）患儿按病程、年龄分组比较。结果:微波组有效率 75.6%，对照组51.2%，两组疗效有统计学差异（P＜0.01）；微波组疗效与病程、年龄有关。结论:微波治疗对儿童分泌性中耳炎的转归有积极作用，病程越短，疗效越好，12岁以下儿童疗效优于12岁以上儿童。     

Blastomycotic cranial osteomyelitis.

This is the second case report of a temporal bone osteomyelitis caused by Blastomyces dermatitidis, which presented as a chronic serous otitis media. The presenting serous otitis media was refractory to conventional medical and surgical management and progressed to a temporal bone osteomyelitis prior to diagnosis. B. dermatitidis is a rare fungal pathogen that causes a systemic pyogranulomatous disease that primarily manifests itself in the skin, bones, pulmonary, and genitourinary systems. If left untreated it is associated with a high rate of mortality. The otologic presentation of this rare disease is emphasized, while the clinical and therapeutic features are reviewed.