The Role of Vitamins A and E Level in Chronic Suppurative Otitis Media with and without Cholesteatoma.

Aim: High expression of lytic enzymes and cytokines is related to cell proliferation in Otitis Media Chronic Suppurative (CSOM) with cholesteatoma. In addition, the process of inflammation healing and maintenance of homeostatic conditions requires Reactive Oxygen Species (ROS), which can cause significant damage to cells. To address this issue, secondary antioxidants such as Vitamins A and E are used to inhibit and neutralize the occurrence of oxidation reactions. These vitamins complement each other, with vitamin A working effectively at low concentrations of oxygen, while vitamin E functions in the opposite manner. Purpose: This study aims to investigate the roles of vitamin A and E levels in CSOM patients with Cholesteatoma. Patients and Methods: The study was conducted between July and December 2020, and the method used was an analytical observational approach with a case-control design. The sample population comprised 60 CSOM patients divided into 2 groups. These included those with and without cholesteatoma. Results: The results showed that there was no significant difference between these two groups in terms of the impact of vitamin A and E levels (respectively, p = 0.626, p = 0.864). Conclusion: Considering these results, it was discovered that vitamins A and E levels do not influence the occurrence of CSOM with or without cholesteatoma.

Diagnostic challenges of an atypical presentation of ear and mastoiditis tuberculosis in a-5-year-old child in a developing country: A case report and review of literature.

We report a case of a 5-year-old girl who came to Otolaryngology Outpatient Clinic of our hospital with the chief complaint of recurrent ear discharge which had started to appear since 3 years ago and had recurred every month despite repeated antibiotics and antifungals ear drops treatments, given by general practitioners and otolaryngologists. Gram staining, acid-fast staining and Mycobacterium tuberculosis culture examination from the discharge had never been conducted. There was a history of inadequate weight increment since she was 2 years old. Her uncle who often met her died about 6 months ago due to TB disease. She was initially diagnosed with otitis media from the previous clinicians before finally referred to our hospital due to the perforated tympanic membrane. Otoscope examination showed perforated tympanic membrane. CT scan showed right osteomastoiditis with cholesteatoma with destruction of right mastoid antrum and right ear bone. We did not find pale-looking granulomatous tissue or multiple perforated tympanic membrane. The patient was diagnosed with chronic suppurative otitis media (CSOM) of the right ear with right mastoiditis and right posterior auricle fistulae. Afterwards, canal wall up, canaloplasty, mastoid obliteration, tympanoplasty, and rotational flap right ear were performed. Histopathology examination revealed the presence of caseous necrosis and datia langhans cells. Based on her chronic illness supported by the histopathological findings, anti-tuberculosis therapy was commenced. No more ear discharge complained and her body weight started to increase after oral anti tuberculosis treatment.

Factors associated with time of diagnosis and habilitation of congenital hearing loss in Indonesia: A multicenter study.

OBJECTIVES: To investigate factors associated with time of diagnosis and habilitation of congenital hearing loss in Indonesia. METHOD: A retrospective cohort study was conducted from January to December 2020 by collecting data on patients with congenital hearing loss using validated questionnaires. RESULT: Among 535 children with congenital hearing loss, 2.7% had a family history of congenital hearing loss, 11.2% and 37.4% had a maternal history of ototoxic drugs and herbal medicine use during pregnancy, respectively, and 17.8% had prenatal exposure to TORCH infection. Lower maternal education level was shown to be associated with older age at diagnosis (p = 0.045), while older maternal age (p < 0.001), non-housewife mothers (p = 0.029), and out-of-pocket payment scheme (p = 0.027) were associated with a higher rate of habilitation. CONCLUSION: The present study showed that the presence of family history, the use of certain medications during pregnancy, and prenatal TORCH infection are prevalent in children with congenital hearing loss in Indonesia. Several factors such as maternal education level, age, occupation, and habilitation payment scheme may be associated with time of diagnosis and habilitation of congenital hearing loss.

Impact of social activity restriction and routine patient screening as a preventive measurement for tertiary referral hospital staff in a country with high COVID-19 incidence.

Background: Measuring COVID-19 incidence among hospital staff and the influencing factors and preventative measures affecting outcomes is important given their high risk of exposure and potential impacts on health service provision. Method: Study participants included all hospital staff with COVID-19 confirmed by real-time reverse transcription-polymerase chain reaction (RT-PCR) from March 2020 to July 2021. Data were collected on age, gender, occupation, working area, symptoms and vaccination status. We also collected data on pediatric oncology patients and their caregivers to review the hospital screening policy. Results: Approximately 59% of positive cases among hospital staff occurred in the green zone; 75% were fully vaccinated. Whole-genome sequencing indicated that staff infections in June 2021 were Delta variant. A decrease in cases coincided with government implementation of social activity restriction. When RT-PCR was performed in suspected cases, 3 of 36 pediatric oncology patients and 10 staff tested positive. After routine screening, 8 of 121 patients, 3 patient caregivers, and 5 staff tested positive, all were asymptomatic, and all were infected in the community. Conclusions: Routine testing for staff, patients and caregivers, vaccination booster programs, continuing education of health care workers, and government policy, such as social activity restriction, are needed to protect frontline workers.

Impact of the COVID-19 pandemic on the volume of chronic suppurative otitis media surgeries.

Background: Chronic suppurative otitis media (CSOM) is a case of ear infection which prevalence is still relatively high, especially in developing countries. Surgery is the definitive management for CSOM that aims to eradicate the infection and improve the hearing conduction system. The COVID-19 pandemic has put enormous pressure on the global health care system, including limitations on elective surgical procedure at most hospital at the beginning of the pandemic. Objective: This study aimed to assess the impact of the Covid-19 pandemic on the volume of chronic suppurative otitis media surgeries. Methods: A retrospective study on 236 chronic suppurative otitis media patients. The number of surgeries collected from April to December 2019 and 2020 was compared. Statistical analysis used the t-independence and linear regression test with p < 0.05. Results: The otologic surgeries decreased by 83.7% between 2019 and 2020. There were 203 surgeries (2019) vs 33 (2020). The average number of surgeries per month in 2019 and 2020 was 23 ± 6 patients and 4 ± 2 patients, respectively (t = 2.365; p < 0.001). All cases that underwent surgery in 2020 were cases with complications. Special consent and preparation must be completed before surgery. Conclusion: The number of otitis media surgeries significantly decreases during the COVID-19 pandemic.

The association of iron deficiency anemia on chronic suppurative otitis media in children: A case-control study.

BACKGROUND: Chronic suppurative otitis media (CSOM) is the most common infectious disease in the world and the leading cause of hearing loss in children in developing countries. Iron deficiency anemia (IDA) is often found in children with CSOM. OBJECTIVE: This study was conducted to determine the association between IDA and the incidence of CSOM in children. METHOD: This research is a case-control study using consecutive sampling. Participants were divided into case group which are children diagnosed with CSOM (n = 42) and control group which are children with normal ear (n = 42). All participants were examined for serum iron (FE), hemoglobin (Hb), total iron-binding capacity (TIBC), and ferritin levels. The analysis used in this study includes the chi-square test or fisher extract test and independence t-test or Man Whitney test with p < 0.05. RESULT: The measurement results obtained values of Hb (13.00 ± 1.34 g/dL; p < 0.001), FE (95.13 ± 40.84 g/dL; p < 0.001), TIBC (354.18 ± 62.44 g/dL; p = 0.016), and ferritin levels (17.57 ± 8.55 g/dL; p < 0.001). Participants who experienced IDA were 21.43% which in the case group was 31.0% and control group was 11.9% (OR = 3.32; p = 0.033). CONCLUSION: IDA can increase the incidence of CSOM in children.

Surgical treatment of external auditory canal cholesteatoma in congenital malformation of the ear: A case series.

BACKGROUND: External auditory canal (EAC) cholesteatoma is a lesion lined with stratified squamous epithelium containing proliferative keratin with bony erosion in EAC which can spread to the tympanic cavity, mastoid, and surrounding organ. External cholesteatoma can occur in patients with congenital abnormalities such as congenital aural atresia (CAA). METHOD: This case series was reported using the 2020 PROCESS Guideline. The design of this study used a retrospective study during the 2015-2020 period. RESULT: 3 participants aged 10.67 ± 2.31 years with CAA had other complaints of ear infections. All participants experienced sensorineural hearing loss with an average threshold of 59.33 ± 36.68 dB and suspicious cholesteatoma from a CT scan. Canal wall down, meatoplasty, and/or canaloplasty were performed based on the findings. CONCLUSION: Surgical procedure in CAA with cholesteatoma aimed on preventing further complications and recurrence.

Management evaluation of patients with chronic suppurative otitis media: A retrospective study.

BACKGROUND: Chronic suppurative otitis media (CSOM) is a chronic infection of the middle ear with perforation of the tympanic membrane and secrete from the ear more for than two months, either continuously or intermittently. Chronic suppurative otitis media has a high prevalence and impact on the physical, social, and psychological of the patients. This disease may be fatal and even cause death. OBJECTIVE: Analyzing management evaluation of CSOM patients. METHODS: A retrospective study was conducted based on medical records of CSOM patients from January 2017-December 2019. The study used total sampling Chi-squared test with p < 0.05. RESULTS: There were 600 patients with CSOM in January 2017-December 2019. Most of them were male, aged 36-45 years old with normal body mass index. There were 431 patients on the follow-up post-treatment by either medical or surgical management. The recovery rate could be assessed from the evaluation of CSOM complaints 6 months after treatment, and the results were significant (p < 0.001). Conclusions: CSOM managements are in the form of operative and non-operative that shows improvement within 6-month evaluation.

Canal wall down in tuberculosis matoiditis: 4 case series.

BACKGROUND: Tuberculosis of the ear and temporal bone is an extremely rare case. METHODS: This case series was reported using the 2020 PROCESS Guideline. The design of this study used a retrospective study during the 2017-2019 period. RESULTS: Four cases of tuberculosis mastoiditis with age range between 16 and 66 years from 2016 to 2019. All patients presented with chronic ear discharge from chronic ear with signs of mastoiditis with intra- and extra-temporal complications. All patients underwent radical mastoidectomy, and histopathologic examination showed tuberculosis. All patients received anti-tuberculosis drug first and second category. CONCLUSION: Clinical features of tuberculosis mastoiditis may vary. The diagnosis of tuberculosis mastoiditis can be examined through histopathologic examination and geneXpert tuberculosis. Surgical treatment and anti-tuberculosis administration are the primary choices in the management of tuberculosis mastoiditis.