Management options for cochlear implantation in patients with chronic otitis media

ObjectivePatients with chronic otitis media with/without cholesteatoma present a significant challenge to safe cochlear implantation (CI). The aim of our study is to describe our experience and propose management options for CI in patients with chronic otitis media.Study designRetrospective case study.SettingTertiary academic center.Subject and methodsWe enrolled the 9 ears of 8 subjects who received CI in the ear with chronic otitis media from 2006 to 2013 by a single surgeon. CI was performed as a single-stage or staged operation with mastoid surgery according to the activity of ear infection.ResultsSix patients had bilateral chronic otitis media and 2 patients had long history of sensorineural hearing loss at contralateral ear. CI was performed with simultaneous radical mastoidectomy with closure of the EAC as a single-stage in 3 ears with a history of previous open cavity mastoidectomy and no active discharge. Staged CI was performed in 6 ears, after radical mastoidectomy with closure of the EAC in 3 ears and after intact canal wall mastoidectomy in 3 ears, due to active inflammation or complications related to otitis media. In one patient, wound infection had occurred, and implant was removed along with implantation at contralateral ear. Other subjects showed no evidence of recurrence.ConclusionDecision whether implantation as a single-stage or staged operation depends on the presence of active inflammation. Single-stage CI with proper mastoid surgery can be performed in patients without active inflammation. Staged procedure need to be done in ears with active inflammation. Proper application of mastoid surgery leads to safe CI for patients with chronic otitis media.     

Otitis media and mastoiditis in temporal bones of prehistoric Chilean populations. A paleopathological and paleoepidemiological study

Background: This study evaluates otitis media in prehistoric populations in northern Chile.

Aims/objectives: Determining prevalence of otitis media and diagnostic usefulness of temporal-bone X-rays in skulls.

Materials and methods: 444 skulls belonging to three groups: prehistoric-coastal (400–1000 AD), prehistoric-highland (400–1000 AD) and Pisagua-Regional Developments (1000–1450 AD). Skulls were evaluated visually and with Schuller’s view X-rays. Five skulls diagnosed as having had otitis media, five diagnosed as normal, and one with temporal bone fistula also had a computed tomography (CT).

Results: Changes suggestive of otitis media were present in Prehistoric-coastal 53.57%; Pisagua-Regional Developments 70.73%; prehistoric-highlands 47.90%. Diagnostic effectiveness of Schuller’s view X-rays for assesing middle ear disease was confirmed by CT studies. The case with temporal bone fistula had changes suggestive of mastoiditis and possible post auricular abscess.

Conclusions: There was a high prevalence of otitis media in prehistoric populations in Chile. The higher prevalence in one group was presumably due to racial factors. Temporal-bone X-rays are effective for massive evaluation of ear disease in skulls. A case of mastoiditis with temporal bone fistula and possible post-auricular abscess is documented.

Significance: Documenting racial factors in otitis media. Validating X-rays for massive evaluation of otitis media in skulls.     

Role of mastoid pneumatization in predicting tympanoplasty results: Will it have the same importance in different age groups?

IntroductionThere are several factors that seem to affect the surgical success rate of tympanoplasty, one of them being the pneumatization of the contralateral mastoid. In the current literature, several studies have been published with classification proposals for temporal bone pneumatization pattern.This study aims to evaluate the role of mastoid air cell extension in relation to the sigmoid sinus in predicting the surgical success of tympanoplasty.Material and methodsThis case-control study was performed on patients diagnosed with chronic otitis media (COM) who underwent type I tympanoplasty. The study group did not close the tympanic membrane, or there was a retraction or lateralization of the graft. The control group consisted of patients with surgical success.ResultsNo statistically significant difference was found between groups regrading age, gender, perforation side/type, previous nasal surgery, and the presence of chronic otitis media in contralateral ear.A statistically significant difference was found when groups were compared in relation to the degree of pneumatization of the contralateral ear (p = 0.046), and this relationship does not seem to be influenced by age.ConclusionTo predict surgical success in terms of tympanic membrane closure in tympanoplasty, classification of contralateral ear pneumatization degree using the sigmoid sinus as a reference seems to be a valid and easy to apply method, and makes it possible to restrict the evaluation of pneumatization to the mastoid, a cell complex that does not seem to change with age.     

Tympanomastoidectomy versus parenteral antibiotic therapy for pediatric otorrhea

ObjectiveTo evaluate the efficacy of tympanomastoidectomy versus parenteral antibiotic therapy for otorrhea as a result of chronic suppurative otitis media (CSOM) without cholesteatoma in the pediatric population.MethodsA retrospective review of 221 patients treated for otorrhea at a tertiary academic pediatric hospital was performed to evaluate the impact of tympanomastoidectomy versus parenteral antibiotic therapy on resolution of otorrhea. Inclusion criteria were age 0–18 years, prior treatment with otic and/or oral antibiotic, prior history of tympanostomy tube placement for recurrent otitis media, history of otorrhea, treatment with tympanomastoidectomy or parenteral antibiotic therapy, and follow-up of at least 1 month after intervention. Time to resolution was compared between the two modalities adjusting for age, bilateral ear disease status, and comorbidities using a Cox proportional hazard model.ResultsEighty-three ears from 58 children met the inclusion criteria. Ears that initially underwent tympanomastoidectomy had a significantly shorter time to resolution of symptoms (median time to resolution) 9 months (95 % confidence interval CI: 6.2–14.8) vs. 48.5 months (95 % lower CI 9.4, p = 0.006). On multivariate analysis, however, only bilateral ear disease status was independently associated with time to resolution of symptoms (hazard ratio 0.4, 95 % CI 0.2–0.9, p = 0.03). There was no statistically significant difference in the rate of treatment-related complications when comparing tympanomastoidectomy to parenteral antibiotic therapy (p = 0.37).ConclusionWhen adjusting for age, bilateral ear disease status, and comorbidities, there does not appear to be a significant difference in time to resolution of symptoms when comparing parenteral antibiotic therapy to tympanomastoidectomy. An informed discussion regarding risks and benefits of each approach should be employed when deciding on the next step in management for patients with CSOM who have failed more conservative therapies.     

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.     

Evaluation of the vestibulo-ocular reflex in patients with chronic otitis media

IntroductionIn recent years, scientific evidence has shown that chronic otitis media may cause balance and vestibular dysfunction.ObjectiveTo compare the results of the video head impulse test (gain and symmetry of the vestibulo-ocular reflex and presence of covert and overt saccades) in patients with chronic otitis media and controls.MethodsCross-sectional study of patients with chronic otitis media (study group), aged between 18 and 60 years. The patients in the study group were further divided according to the chronic otitis media type as (1) non-suppurative, (2) suppurative, and (3) cholesteatomatous. For the comparative analysis, we selected volunteers with no history of ear and vestibular diseases (control group), who met the same inclusion and exclusion criteria as the study group. Patients in both groups underwent a video head impulse test.ResultsThe study group consisted of 96 volunteers, and the control group of 61 individuals. The prevalence of vestibular symptoms was 66% in the study group and 3.2% in the control group (p < 0.001). The results show a higher prevalence of changes in the vestibulo-ocular reflex gain (22.9%) and corrective saccades (12.6%) in the chronic otitis media group compared to the control group (p < 0.001). Despite the higher prevalence of changes in gain, the average vestibulo-ocular reflex gains in the chronic otitis media groups were within the pre-defined values ??of normality; however, the mean vestibulo-ocular reflex gain in the anterior semicircular canal was statistically worse in the cholesteatomatous chronic otitis media group compared to controls (p < 0.001). Regarding the corrective saccades, the prevalence of saccades was statistically higher in the suppurative and cholesteatomatous chronic otitis media subgroups compared to the non-suppurative and control groups (p = 0.004).ConclusionThe present study demonstrated that chronic otitis media is associated with a higher prevalence of vestibular symptoms and also a higher prevalence of changes in gain and corrective saccades when compared to controls.     

Prevalence of middle ear disease in Chilean natives and the impact of development over 14 years

IntroductionThe prevalence of middle ear disease and its risk factors have been the subject of multiple studies. High prevalence of middle ear disease has been described among North American natives, especially chronic otitis media. Such studies have not been carried out in South America.ObjectiveTo describe the prevalence of middle ear pathology and risk factors in native schoolchildren from southern Chile who belong to the Mapuche ethnic group, as well as the impact of socio-economic and demographic changes after 14 years of development.Material and methodsTwo otologic evaluations with an interval of 14 years were performed in schoolchildren with a percentage of indigenous population above 85%. Socioeconomic and demographic data were collected from national official statistical data.ResultsA total of 1067 schoolchildren were examined. Many described risk factors for ear pathology were found. An overall prevalence of 0.19% for tympanic membrane perforation, 5.6% for pars tensa retraction pockets, 1.5% for pars flaccida retraction pockets and 11.1% of otitis media with effusion was found. There were several socioeconomic improvements after 14 years. The difference between the prevalence of symptoms and the presence of otitis media with effusion was statistically significant (p < 0.001).ConclusionsDespite the presence of several risk factors for middle ear disease, this study population showed a low prevalence of middle ear disease. The ethnic-racial factor seems to be a protective factor.     

Comparison of bilateral same-day and sequential endoscopic cartilage myringoplasty for bilateral chronic tympanic membrane perforation

Abstract

Background: There is debate over the applicability of bilateral same-day myringoplasty in patients with bilateral chronic tympanic membrane perforations (TMPs) requiring ear surgery on both sides.

Objectives: To evaluate the healing and hearing outcomes of bilateral endoscopic ‘push-through’ cartilage myringoplasty in patients with bilateral chronic TMPs with mucosal chronic otitis media (COM) on the same day.

Material and methods: The medical records of 60 patients (120 ears) with bilateral chronic TMPs who underwent bilateral same-day or sequential endoscopic push-through cartilage myringoplasty between January 2014 and March 2019 were evaluated.

Results: Of the 60 patients with 120 ears, 26 patients with 52 ears were in the bilateral same-day group and 34 patients with 68 ears in the sequential group. The overall graft success rate at 3?months was 92.3% (48/52) in the same-day group and 94.1% (64/68) in the sequential group. None of the sensorineural HL and retraction pockets occurred in two groups.

Conclusions and significance: Bilateral push-through cartilage myringoplasty can be performed safely for the patients with bilateral chronic TMPs in the same day, it significantly reduced the medical costs and shortened the operation time and length of stay compared to sequential myringoplasty.     

PERSISTENCE OF MIDDLE EAR DYSFUNCTION AFTER RECURRENT ACUTE OTITIS MEDIA

The presence of otitis media with effusion (OME) and high negative pressure (-200 to -400 mm H₂O)₃ were investigated in follow-up of a randomized double-blind placebo-blind placebo-controlled trial on the efficacyu of amoxicilin/clavulanic acid in the treatment of acute otitis media. All children in this study were recruited from a general practice population. Tympanometry results 1 month from the start of an episode of acute otitis media were taken as outcome criteria. Bilateral middle ear dysfunction was defined as bilateral OME, unilateral OME and contralateral or bilateral high negative pressure. Bilateral middle ear dyusfunction was present in 47.9% of the patients. Of all teh investigated factors of possible influence (age, sex, season, laterality of acute otitis media, therapy, and clinical course of acute otitis media), only season showed a statistically significant influence on the persistence of OME/high negative pressure (P = 0.001). Bilateral middle ear dysfunction was shown to be of prognostic value for the risk of a recurrence of acute otitis media (odds ratio 3.75). shown to be of prognostic value for the risk of a recurence of acute otitis media (odds ratio 3.75).     

Cochlear implantation in a patient with eosinophilic otitis media

Eosinophilic otitis media is an intractable middle ear disease with gelatinous mucoid fluid containing eosinophils associated with bronchial asthma and nasal allergy that sometimes induces deterioration of sensorineural hearing loss. Here, we report a case of eosinophilic otitis media in a 50-year-old woman who received a Nucleus 22 multi-channel cochlear implant in the right ear at the age of 42 years. She had received treatment for bronchial asthma, chronic sinusitis with nasal allergy and otitis media with effusion since the age of 30 years and had noted bilateral sudden deafness and vertigo at the age of 35 years. Preoperative CT and MRI showed cochlear ossification in the left ear, in which mastoidectomy was performed as treatment of eosinophilic otitis media. Long-term follow-up revealed that cochlear implant is indicated for deafness induced by eosinophilic otitis media, and an early decision for cochlear implant surgery is necessary. Steroid administration was remarkably useful in controlling eosinophilic otitis media in patients with bronchial asthma and chronic sinusitis with nasal allergy.     

Bilateral chronic otitis media

Summary We have compared the clinical presentations and results of operative treatment in 86 patients with bilateral chronic otitis media with findings in 641 patients with unilateral disease. Concomitant conditions such as cleft palate, rhinitis and chronic adenotonsillitis were found significantly more frequently in those patients with bilateral chronic otitis media than in the patients with unilateral disease. Additionally, cholesteatomas in the cases in which both ears were involved were larger than in those cases which only one ear was involved. The overall results of surgery were similar in the bilateral and unilateral cases. The timing of operation in cases of bilateral chronic otitis media and the special problems of operation on an only hearing ear are discussed.     

Bilateral chronic otitis media

We have compared the clinical presentations and results of operative treatment in 86 patients with bilateral chronic otitis media with findings in 641 patients with unilateral disease. Concomitant conditions such as cleft palate, rhinitis and chronic adenotonsillitis were found significantly more frequently in those patients with bilateral chronic otitis media than in the patients with unilateral disease. Additionally, cholesteatomas in the cases in which both ears were involved were larger than in those cases which only one ear was involved. The overall results of surgery were similar in the bilateral and unilateral cases. The timing of operation in cases of bilateral chronic otitis media and the special problems of operation on an only hearing ear are discussed.     

Central auditory processing in teenagers with non-cholesteatomatous chronic otitis media

IntroductionEvidences of possible effects of early age otitis media with effusion in the central auditory processing, emphasize the need to consider such effects also in subjects with chronic otitis media.AimTo investigate and analyze the impact of non-cholesteatomatous chronic otitis media on central auditory processing in teenagers.MethodsThis is a study in which 68 teenagers were recruited, 34 with a diagnosis of non-cholesteatomatous chronic otitis media (study group) and 34 without otological disease history (control group). The evaluation of the subjects consisted of: anamnesis, pure-tone threshold audiometry, speech audiometry and a behavioral test battery for assessment of central auditory processing.ResultsA statistically significant difference was found between the means observed in the study and control groups in all tests performed. An association was found between the control group and subgroups of the study group with unilateral alterations in all tests. An association was shown between the results for the control group and study group for family income, with a greater impact on subjects with a lower income.ConclusionsNon-cholesteatomatous chronic otitis media affects the central auditory processing in teenagers suffering from the disorder, and monaural low-redundancy hearing is the most affected auditory mechanism. Unilateral conductive changes cause more damage than bilateral ones, and lower family income seems to lead to more changes to the central auditory processing of subjects with non-cholesteatomatous chronic otitis media.     

Tuberculous otitis media –series of 10 cases

BackgroundTuberculosis (TB) of the middle ear cleft (MEC) is a rare extra-pulmonary manifestation. Signs and symptoms of tuberculous otitis media are indistinguishable from that of non-tuberculous otitis media making early diagnosis difficult.ObjectivesTo study the clinical presentations, complications and effective diagnostic modalities in tuberculosis of middle ear cleft.MethodsWe retrospectively studied 10 patients diagnosed with chronic otitis media, unresponsive to 2 months conventional treatment. Pure tone audiogram, High resolution computed tomography (HRCT) of temporal bone, and AFB staining of ear discharge were done. All patients underwent mastoid surgery. AFB staining and histopathological examination of granulation tissue removed from the middle ear and mastoid were also done.ResultsClinical findings were mastoid swelling, facial palsy and post-aural fistula 3,4 & 2 patients respectively. All patients had persistent ear discharge and three had vertigo. Hearing loss was of moderate conductive type in five, sensorineural type in three and mixed type in two. HRCT of temporal bone revealed soft tissue density in MEC in 9 and evidence of bone destruction in 6 cases. Diagnosis of TB was confirmed either by (a) demonstration of AFB in ear discharge (4 patients)/tissue removed during surgery (4 patients) or (b) by demonstration of tuberculous granulomas with necrosis on histopathological examination of tissue from MEC (8 patients).ConclusionTuberculosis should be suspected in all cases of chronic otitis media unresponsive to conventional treatment particularly in endemic areas. Histopathological examination and AFB staining of tissue removed during mastoid surgery are reliable diagnostic methods.     

Clinical features of 22q11.2 deletion syndrome related to hearing and communication

Abstract

Background: Individuals with 22q11.2 deletion syndrome (22q11.2DS) exhibit various phenotypes.

Objective: To compare the clinical and otorhinolaryngological features of Japanese patients with 22q11.2DS with those of patients reported in Western literature.

Materials and methods: We retrospectively assessed the medical records of 17 Japanese patients with 22q11.2DS and compared our findings with previously reported findings in Western literature.

Results: Hearing loss was the most frequent complaint (n?=?8, 47%), followed by articulation disorders and/or nasopharyngeal closure failure (n?=?4, 24%) and language development delay (n?=?2, 12%). Ten patients (59%) had hearing loss regardless of the chief complaint (total 15 ears – mild, 9; moderate, 6). Four patients had bilateral hearing loss. One patient (6%) underwent tympanostomy tube placement for refractory exudative otitis media, another (6%) underwent myringoplasty, and three patients (18%) underwent tympanoplasties for chronic otitis media or middle ear malformation. Previous studies in Western countries reported similar results in terms of frequency of hearing loss, severity of hearing loss, and the percentage of middle ear malformations.

Conclusions: The otorhinolaryngological characteristics of Japanese patients with 22q11.2DS were similar to those in Western countries. Hearing loss was primarily caused by disorders like otitis media and middle ear malformation.

Significance: Our findings may aid treatment planning for Asian patients with 22q11.2DS.     

Association of asymptomatic otitis media with effusion in patients with adenoid hypertrophy

ObjectiveClinical symptoms of otitis media with effusion are rarely brought forward to the guardians of young children who the disease is most prevalent in. This often leads to poor scholastic performances and difficult social interactions. The objective of this study was to identify asymptomatic cases of otitis media with effusion present in individuals with adenoid hypertrophy.Material and MethodsIn a cross sectional study advocated in Justice K.S.Hegde Hospital, Karnataka India we evaluated one hundred patients above the age of three from August 2016 to December 2017. Candidates who presented with an adenoid nasopharyngeal ratio of more than 0.5 were selected for the study. Individuals who complained of otological symptoms were not considered for the study. Patients cleared of other pathological otological conditions were underwent audiological evaluation with pure tone audiometry and tympanometry for evaluating the middle ear status and hearing loss.ResultsThe study showed a total of 36% of patients evaluated presented with asymptomatic otitis media with effusion. In candidates who presented with a bilateral B tympanogram, 40% had significant conductive hearing loss of more than 25dB.ConclusionAn objective test such as impedance audiometry in all patients with adenoid hypertrophy would aid in the diagnosis of fluid in the middle ear, so that timely intervention can be done and possible complications be averted.     

Reevaluation of bilateral same-day surgery for bilateral perforated chronic otitis media.

OBJECTIVE: To evaluate the results of bilateral same-day surgery for bilateral perforated chronic otitis media in comparison with our previous report. STUDY DESIGN: Prospective study. PATIENTS: Seventeen patients ranging in age from 5 to 70 years (mean, 52.5 yr), with bilateral perforated chronic otitis media. METHODS: Two hundred cases of chronic otitis media were operated on at the Department of Otolaryngology, Hyogo College of Medicine from December 1998 to November 2002. Fifty-nine patients (29.5%) had bilateral disease and 17 patients (8.5%) underwent bilateral same-day surgery. RESULTS: The postoperative air-bone gap was less than 10 dB on both sides in 5 of 17 (29%) and less than 20 dB in 15 of 17 (88%). The postoperative hearing level was less than 20 dB in both ears in 4 of 17 (24%), less than 30 dB in 7 of 17 (41%), and less than 40 dB in 10 of 17 (59%). The rate of closure of the ear drum was 20 of 22 (91%) in the simple underlay myringoplasty series and 9 of 12 (75%) in the conventional myringoplasty/tympanoplasty series. The rate of closure of the ear drum on both sides was successful in 4 of 5 (80%) that underwent simple underlay myringoplasty/simple underlay myringoplasty and 8 of 12 (67%) that underwent simple underlay myringoplasty/conventional myringoplasty/tympanoplasty, whereas that on at least one side was successful in 100%. CONCLUSION: Bilateral same-day surgery for bilateral perforated chronic otitis media is possible if operative indications are considered. Furthermore, it will help patients save time and money.     

Is it useful to use computerized tomography image-based artificial intelligence modelling in the differential diagnosis of chronic otitis media with and without cholesteatoma?

ObjectiveCholesteatoma is an aggressive form of chronic otitis media (COM). For this reason, it is important to distinguish between COM with and without cholesteatoma. In this study, the role of artificial intelligence modelling in differentiating COM with and without cholesteatoma on computed tomography images was evaluated.MethodsThe files of 200 patients who underwent mastoidectomy and/or tympanoplasty for COM in our clinic between January 2016 and January 2021 were retrospectively reviewed. According to the presence of cholesteatoma, the patients were divided into two groups as chronic otitis with cholesteatoma (n = 100) and chronic otitis without cholesteatoma (n = 100). The control group (n = 100) consisted of patients who did not have any previous ear disease and did not have any active complaints about the ear. Temporal bone computed tomography (CT) images of all patients were analyzed. The distinction between cholesteatoma and COM was evaluated by using 80% of the CT images obtained for the training of artificial intelligence modelling and the remaining 20% for testing purposes.ResultsThe accuracy rate obtained in the hybrid model we used in our study was 95.4%. The proposed model correctly predicted 2952 out of 3093 CT images, while it predicted 141 incorrectly. It correctly predicted 936 (93.78%) of 998 images in the COM group with cholesteatoma, 835 (92.77%) of 900 images in the COM group without cholesteatoma, and 1181 (98.82%) of 1195 images in the normal group.ConclusionIn our study, it has been shown that the differentiation of COM with and without cholesteatoma with artificial intelligence modelling can be made with highly accurate diagnosis rates by using CT images. With the deep learning modelling we proposed, the highest correct diagnosis rate in the literature was obtained. According to the results of our study, we think that with the use of artificial intelligence in practice, the diagnosis of cholesteatoma can be made earlier, it will help in the selection of the most appropriate treatment approach, and the complications can be reduced.     

Antibiogram guided optimized medical treatment in chronic otitis media: A useful interventional strategy before surgery?

BackgroundChronic otitis media is a middle ear cleft disease presenting with tympanic membrane perforation and discharge. Wet ear after tympanoplasty and discharging mastoid cavity are problematic in clinical practice.Material and methods1050 patients of age 10 to 50 years presenting with active ear discharge and clinically diagnosed with unilateral chronic suppurative otitis media were included in the study. The patients were equally divided into two equal groups, Group ET, and AT. All patients were prescribed topical ciprofloxacin, oral levocetirizine 5 mg and n-acetyl cysteine 600 mg BD for one week. Swabs of ear discharge were collected in ET groups for antibiogram. Both groups were evaluated on next visit and treatment changed in AT groups and result observed in next visit. Surgical outcome was evaluated at end of 2 yrs.ResultA total of 1158 organisms were isolated in culture out of which, 69.94 % were aerobes, 13.47 % anaerobes and 16.58 % were fungi. On the second visit in group AT, treatment of 85.14 % patients was changed in accordance with culture sensitivity report. In patients with mucosal disease, only 46.87 % patients of group ET had a favorable outcome in comparison to 90.28 % patients of group AT while in patients with squamosal disease, 17.56 % patients of group ET and 28.99 % patients in group AT had a dry ear. Surgeries in AT group were found to have statistically significant higher success rate as compared to ET group.     

Chronic otitis media and subsequent hearing loss in children from the Himalayan region residing in Buddhist Monastic schools of Nepal

ObjectivesThe main objective of the study was to ascertain the prevalence of chronic otitis media and determine the corresponding hearing loss in children from Nepal’s Himalayan region now residing in Buddhist Monastic schools of Nepal.MethodsThe study was conducted among children at Buddhist monastic school in different parts of Nepal. A total of 3174 children aged between 5 and 15 years, who were originally from the Himalayan region of Nepal and were currently residing in monastic schools, were screened for ear problems and hearing loss. They were examined by otoscope to diagnose chronic otitis media. Hearing was evaluated by pure tone audiometer, and 0.5–4 kHz air conduction hearing threshold was measured and documented.ResultsOf the total of 3174 children who were screened for ear diseases and hearing loss, monks constituted 76.21% (n = 2419) and Nuns 23.78% (n = 755). Chronic otitis media was the most common otoscopic finding during the screening, and it affected a total of 344 (10.83%) children. Out of these 344, hearing loss of varying degrees was observed in 5.42% (n = 172) children.ConclusionThere is high prevalence of chronic otitis media in children belonging to the Himalayan region of Nepal, and it is the main cause of avoidable hearing loss. Timely diagnosis and treatment of chronic otitis media could prevent unnecessary hearing loss in these children.