Clinico-epidemiological study of safe and unsafe chronic suppurative otitis media

Introduction: Chronic Suppurative Otitis Media (CSOM) remains one of the most commonest chronic infectious diseases worldwide particularly in children and adolescents. India has been classified as the high prevalence country with national prevalence of 4%. Knowledge of differential regional prevalence of risk factors is required for adequate health education of masses and for customised preventive and control measures in respective areas. Aims: To study the clinical and sociodemographic profile of patients with CSOM. Methods: The study was carried out in the department of Otorhinolaryngology, Jawaharlal Nehru Medical College, AMU, Aligarh from November, 2017 to December, 2019. Patients with CSOM attending the otorhinolaryngology OPD and those admitted in IPD were included in the study. Results: A total 200 cases of chronic suppurative otitis media including both safe (mucosal) and unsafe (squamous) type were studied. The mean age of participants was 22.8 ± 15.18 years. Of the total participants, 111 (55.5%, 95% CI 48.6 to 62.2) were males, 89 (44.5%, 95% CI 37.8 to 51.4) were females and the majority (60.5%, 95% CI 53.6 to 67) of them were from rural background. Around onefourth of the patients were illiterate (23%, 95% CI 17.7 to 29.3) and the patients mostly belonged to lower side (lower middle, upper lower and lower) of the spectrum of Kuppuswamy socioeconomic classification. The distribution of age-group, gender and laterality (side of involvement) was similar (P>0.05) in both safe and unsafe type. Overall, 151(75.5%, 95% CI 69.9 to 80.9) patients were found to have conductive hearing loss, 30 (15%, 95% CI 10.7 to 20.6) with mixed and 19 (9.5%, 95% CI 6.2 to 14.4) did not have any hearing loss at presentation. The distribution of patients with regards to hearing loss was found to be similar in both safe and unsafe groups (P = 0.311). Conclusion: CSOM particularly afflicts younger age populations from rural background with poor socioeconomic status. Appropriate timely interventions in the form of health promotion, education about the risk factors and improvement in the living conditions will result in decrease in incidence and prevalence of the disease. Moreover, knowledge of symptoms and signs of the disease is likely to result in early seeking of healthcare and hence better treatment outcomes and prevention of complications.

Otorrea por uso de audífonos en pacientes con otitis media crónica / Otorrhea due to hearing aids use in patients with chronic otitis media

Resumen Introducción: La presencia de otorrea es un indicador de actividad en otitis media crónica (OMC), además de influir en la calidad de vida. La oclusión del molde de un audífono generaría incremento de otorrea, por esto se acostumbra a evitarla en estos casos. La relación otorrea/audífono en OMC no ha sido adecuadamente estudiada. Objetivo: Comprobar si se produce incremento en frecuencia y/o gravedad de episodios de otorrea por el uso de audífono en OMC simple. Caracterización clínica-demográfica de la muestra. Material y Método: Estudio prospectivo antes/después en pacientes con diagnóstico de OMC simple que se implementen con audífono. Entrevista telefónica para caracterizar episodios de otorrea en relación con el audífono. Resultados: Fueron evaluados 35 oídos en 34 pacientes, edad promedio 66,6 años. Sin diferencias significativas en aparición de otorrea y consultas por otorrea antes y después de la implementación. El grupo diagnóstico OMC supurada correspondió al 28,6%, OMC supurada seca el 11,4% y OMC inactiva 60%. Diferencias significativas comparando otorrea posimplementación en subgrupo OMC supurada con resto de subgrupos (p < 0,0001). Análisis multivariado de regresión logística confirmó que sólo OMC supurada se asoció a otorrea posimplementación (p < 0,004). Conclusión: Tradicionalmente se correlaciona uso de audífono en OMC con incremento de otorrea. Nuestro estudio no evidenció diferencias después de la implementación: pacientes con otorrea previa al audífono siguieron presentándola de la misma manera y pacientes con oído seco se mantuvieron así. Otorrea al implementar es el único factor predictor de otorrea por audífono. Debe realizarse más investigación, con evaluación presencial e incorporando variables.

Abstract Introduction: Otorrhea is a chronic suppurative otitis media (CSOM) activity indicator, affecting quality of life. Hearing aid mold occlusion would increase otorrhea, so it is usual to avoid it. Otorrhea/hearing aid relationship in CSOM has not been properly studied. Aim: To check for an increase in frequency and/or severity of otorrhea episodes in CSOM due to hearing aid use. Clinical-demographic characterization of the sample. Material and Method: Prospective before/after study, in CSOM diagnosed patients using a hearing aid. Telephone interview to characterize otorrhea episodes due to hearing aid use. Results: 35 ears were evaluated in 34 patients, with a mean age of 66.6 years. There were no significant differences before and after hearing aid implementation in otorrhea episodes and medical consultations. 28.6% corresponded to active CSOM diagnosis group, 11.4% partially-active CSOM and 60% inactive CSOM. We found significant differences observed between active CSOM subgroup and the rest by comparing post-hearing aid implementation otorrhea (p < 0.0001). Only active CSOM diagnosis was associated to post-hearing aid implementation otorrhea by multivariate logistic regression analysis (p < 0.004). Conclusion: Traditionally, hearing aid use is correlated with increase in otorrhea in CSOM. In our study there were no differences before and after hearing aid implementation: patients with previous otorrhea continued presenting it in the same way after hearing aid use and patients with dry ear kept it that way. The only predicting factor of otorrhea due to hearing aid use is active otorrhea at implementation. Further investigation should be done, with face-to-face evaluation and incorporating variables.

A retrospective analysis of facial palsy in patients of squamosal chronic suppurative otitis media with diabetes mellitus

Background: Facial nerve palsy is a common intra-temporal complication of untreated chronic suppurative otitis media (CSOM) causing erosion of the fallopian canal and its pressure effects leading to facial weakness. There is a less favorable outcome in patients of CSOM with diabetes as they are more prone to neural degeneration. In such patients, early surgical decompression of the facial nerve helps in resolving facial palsy to some extent. In our study of 22 patients, we analyzed the prognosis and advantage of doing early surgical facial nerve decompression along with modified radical mastoidectomy in patients of unsafe CSOM with diabetes mellitus. Materials and Methods: We present a retrospective study of 22 patients with a squamosal type of CSOM with diabetes mellitus who came to the outpatient department, from June 2019 to March 2021, with complaints of ear discharge and facial palsy grades 3–5, in whom we did early surgical facial nerve decompression along with modified radical mastoidectomy. We observed the incidence of facial palsy and recovery after facial nerve decompression with limited use of steroids in patients with diabetes mellitus. Results: In our retrospective study of 22 patients with squamosal type of CSOM with diabetes mellitus with complaints of facial palsy, 10 were males and 12 were females. Patients were assessed clinically using House– Brackmann grading: 55% are of grade III, 31% are of grade IV, and 14% are of grade V. About 82% of the patients from our study had lesions at the tympanic segment, 9% patients had lesions at the vertical segment, 4.5% patients had lesion at the first genu, and 4.5% patients had lesion at the second genu. In our study, 95% of the patients from the study improved with early facial nerve decompression along with modified radical mastoidectomy, 55% of the patients improved to grade I, 36% of the patients improved to grade II, and 9% of the patients improved to grade III. Conclusion: In squamosal-type CSOM patients with facial palsy, early facial nerve decompression along with modified radical mastoidectomy within 12 weeks of development of facial palsy provides better results than just modified radical mastoidectomy as it increases recovery rate and reduces the need for post-operative steroids which is an advantage in diabetics.

Fatal otitic hydrocephalus due to sinus thrombosis: A case report

Objective@#To report a case of chronic suppurative otitis media with complications of lateral sinus thrombosis and otitic hydrocephalus and to discuss its clinical manifestations, clinical course, ancillary procedures and management.@*Methods@#Study Design: Case Report. Setting: Tertiary Government Training Hospital. Patient: One. @*Results@#A 35-year-old man was admitted due to intermittent right otorrhea for 20 years and headache for a month. The Glasgow Coma Scale (GCS) score was 12, and mastoidectomy performed on the second hospital day showed cholesteatoma with erosion of the bony covering of the sigmoid sinus with scanty purulent discharge. The GCS improved to 15 few hours post- operatively, however, 24 hours post-operatively, GCS decreased from 15 to 10 and a CT scan showed dilatation of cerebral ventricles and lateral sinus thrombosis which persisted on subsequent imaging studies. His condition deteriorated irreversibly despite a ventriculostomy, and he eventually expired after 3 weeks in the ward. @*Conclusion@#Otitic hydrocephalus due to lateral sinus thrombosis is a serious complication of chronic suppurative otitis media seldom encountered nowadays. In this case, otitic hydrocephalus developed and progressed despite broad spectrum antibiotics, mastoidectomy and a ventricular shunt. This case report underscores the importance of early recognition of warning signs of intracranial complications to institute prompt management.

Graft Uptake in Overlay and Underlay Technique Myringoplasty

The aim of this investigation was to compare the graft uptake in overlay and underlay system in myriongoplasty. The examination led among 50 patients in Sree Balaji Medical College and Hospital. Among 50 patients 25 patients underwent overlay and 25 patients experienced underlay strategy. This study concludes that underlay technique should be preferred compared to overlay method, but the ultimate decision about the technique to be employed depends on the surgeons preference and the site of perforation.

Study of Preoperative Indicators of Ossicular Defect in Mucosal Type of Chronic Suppurative Otitis Media.

Ossicular defect is although more common in squamosal type of chronic suppurative otitis media, it can also occur in mucosal type of the disease. Its preoperative knowledge not only helps surgeon to plan for ossicular reconstruction in a better way but also to counsel the patient accordingly. We wanted to determine the prevalence of ossicular chain defect and preoperative identification of clinical and audiological factors as indicators of ossicular defects in patients with Mucosal CSOM.METHODSThis is a hospital based cross sectional study of 2 years. Patients 15 to 60 years of age, having inactive mucosal type of Chronic Suppura­tive Otitis Media, posted for Tympanoplasty were included in the study. Findings on history, clinical, audiological and intraoperative otomicroscopic examination were recorded and analysed.RESULTSOssicular necrosis was noted in 21 (23.33%) of total 90 patients. On statistical analysis, patients of age >30 years (p=0.019, duration of ear discharge >10 years (p=0.003), those having large and subtotal perforation (p<0.001), adhesion of tympanic membrane edges to promontory (p=0.04), incudostapaedial joint area exposure (p=0.01) and air-one gap >40 dB (p <0.001) were found to be statistically significantly associated with ossicular erosion.CONCLUSIONSAll patients of mucosal type of chronic suppurative otitis media should be assessed in detail so as to get a clue of ossicular defects to be prepared for its repair and will not come as a surprise during surgery.

Sociodemographic Characteristics of Chronic Suppurative Otitis Media In Bangladesh

Objectives: To find out sociodemographic characteristics ofChronic Suppurative Otitis Media (CSOM) in Bangladesh.Methods: It was a prospective study conducted in thedepartment of otolaryngology & Head Neck Surgery,Bangabandhu Sheikh Mujib Medical University (BSMMU) andDhaka Medical College Hospital (DMCH), Dhaka, fromSeptember 2010 to February 2011. Fifty cases were selectedby random sampling. A descriptive analysis was performed forclinical features and results were presented as mean ±standard deviation for quantitative variables and numbers(percentages) for qualitative variables.Results: In tubotympanic group, 51.61% patients belong to 21-30 years age group, whereas for atticoantral, 63.15% patientsbelong to 11-20 years age group. People living in rural area(66%) were more sufferers. Bilateral involvement is morecommon in tubotympanic type of disease & unilateralinvolvement was more common in atticoantral type of CSOM.Conclusion: CSOM is the most common chronic ear diseasein Bangladesh. It is more common in rural peoples ofyounger age group in poor socioeconomic classes with malepredominance. Medical and surgical options are limited, withside effects and risks, and sometimes are not successful ineliminating disease. There is an urgent need to focus in thearea of CSOM and hence prevent hearing loss.

Risk Factors for Postoperative Recurrence of Chronic Suppurative Otitis Media / 中国医学科学院学报

To analyze the risk factors for postoperative recurrence of chronic suppurative otitis media(CSOM) and explore the intervention measures to prevent postoperative recurrence of CSOM. A total of 1066 patients with CSOM who underwent concurrent surgical treatment and achieved clinical cure in our hospital from January 2012 to December 2018 were enrolled.The clinical data and laboratory findings were reviewed by using an electronic medical record system and the patients were followed up for 1 year.The patients were divided into the non-recurrent group and the recurrent group.Chi-square test and multivariate logistic regression were used to compare the factors may contribute to the postoperative recurrence. The recurrence rate of CSOM was 6.38%.Multi-drug-resistant(MDR) infection before surgery(=16.338,=0.000),aged ≥60 years(=5.182,=0.023),frequency of occurrence ≥3 times/year(=4.388,=0.036),duration of active period>7 d(=4.729,=0.030),repeated upper respiratory tract infection>3 times/year(=11.913,=0.001),accompanied by chronic sinusitis(=11.077,=0.001),blood glucose>6.11 mmol/L(=15.327,=0.000),postoperative serum procalcitonin(PCT)>0.5 μg/L(=8.337,=0.004) were the risk factors for postoperative recurrence.The use of snorkel was a protective factor for postoperative recurrence(=5.308,=0.021).Multivariate analysis showed that MDR infection(=3.373,95%:1.825-6.234,=0.000),repeated upper respiratory tract infection>3 times/year(=2.727,95%:1.479-5.030,=0.001),accompanied by chronic sinusitis(=2.980,95%:1.654-5.369,=0.000),blood glucose>6.11 mmol/L(=3.219,95%:1.741-5.953,=0.000),and postoperative serum PCT>0.5 μg/L(=2.085,95%:1.106-3.931,=0.023) were independent risk factors for postoperative recurrence in CSOM patients. Effective prevention and control of MDR infection,control of blood sugar,prevention of upper respiratory tract infection,and lowering the recurrence of chronic sinusitis are the main measures to reduce postoperative recurrence of CSOM.Monitoring of the infection marker PCT can help to achieve early intervention.

LC-MS/MS analysis of pazufloxacin in human plasma and otorrhea: application to a pharmacokinetic study of ear drops / 药学学报

Pazufloxacin eardrops are a topical quinolone agent for the treatment of outer ear infection. The present study evaluated the pharmacokinetics and topical distribution of pazufloxacin eardrops by a sensitive LC-MS/MS method for determining pazufloxacin in plasma and otorrhea. Plasma and otorrhea samples were extracted by acetonitrile-induced protein precipitation and were subjected to liquid chromatography-tandem mass spectrometric analysis with an electrospray ionization interface. The samples were separated on an HSS T3 column (50 mm×2.1 mm, 1.8 μm). To avoid the matrix effect, gradient elution was performed with the mobile phase consisting of methanol and 1 mmol·L-1 ammonium acetate aqueous solution (0.1% formic acid). The ion transitions for pazufloxacin and pazufloxacin-d4 were m/z 319.1→281.2 and m/z 323.1→285.2, respectively, under the multiple reaction monitoring (MRM) mode. The method was linear in the range of 0.010 0 - 8.00 ng·mL-1 for pazufloxacin in plasma and 0.500 - 1 000 ng·mg-1 in otorrhea. The intra- and inter-day accuracy and precision for pazufloxacin in plasma and in otorrhea met acceptable criteria. The clinical trial was approved by the Society of Ethics and conducted in Nanjing First Hospital and Jiangsu Province Hospital. The validated methods were used in a systemic and topical pharmacokinetic study of 0.1% pazufloxacin eardrops in 3 patients with chronic suppurative otitis media.

Study to Determine the Incus Bone Erosion Ratio on Mastoid Exploration in Cases of Chronic Suppurative Otitis Media with Middle Ear Cholesteatoma

Aim: To evaluate the frequency of incus bone erosion during mastoid exploration in chronic suppurative otitis media with cholesteatoma of the middle ear. Study design: A cross-sectional descriptive study. Place and duration: In the ENT Department of Services Hospital Lahore for the one-year duration from January 2018 to January 2019. Methods: 70 chronic suppurative otitis media patients with the middle ear cholesteatoma were prospectively evaluated and selected with a non-probability purposive sampling technique. The operation was performed on 70 patients under general anaesthesia in the operating room. A standard questionnaire was prepared and history, examination, laboratory data, and treatment were recorded for each patient. Results: One of the usual common diseases of the ear, nose and throat is chronic suppurative otitis media. Previously this disease was called atticoantral type was considered usually unsafe, is mostly caused by marginal perforation with cholesteatoma, the distinguishing feature of this condition and is taken as a complicating element. A total of 70 patients with chronic suppurative otitis media with middle ear cholesteatoma were included in the study. Forty-five (64.28%) are men and 25 (35.71%) are women. 2: 1 was the M: F ratio. There were 10 patients in the first age group from 1 to 10 years 10 (14.28%), in the second age group patients from 11 to 20 years 35 (50%), in the third age group 21-30 years 12 (17.14%), in the fourth age group, 31 to 40 years of age 5 (7.14%), in the fifth age group, 41 to 50 years age 5 (7.14%), and in the sixth age group, 3 patients were >50 years (4.28%). The mean ± standard deviation in the age group was 21.2 ± 11.9 years. The mastoidectomy was performed in 64 patients (91.42%) and a modified radical mastoidectomy was performed in 6 patients (8.57%). Bone erosion due to suppurative otitis media with middle ear cholesteatoma was absent in 59 patients (84.28%) and 11 patients (15.71%) without bone erosion.

A case of primary immunodeficiency: hyper IgM syndrome

Hyper IgM syndrome are group to disorders characterized by elevated serum level of IgM and low or absent serum levels of IgG, IgA and IgE the mechanism of HIGM is immunoglobulin Class-Switch Recombination (CSR) failure and Somatic Hyper Mutation (SHM). This diagnosis should be considered in any patient presenting with hypogammaglobulinemia, with low or absent IgG and IgA and normal or elevated IgM level. In the present case report, this was a 6-year-old male child who had history of recurrent respiratory tract infections who presented with otitis media and persistent fever spikes. Immunoglobulin studies revealed a pattern consistent with hyper IgM.

A Cross Sectional Study on Quality of Life Measurements for Patients with Chronic Suppurative Otitis Media in a Tertiary Care Centre - A Chronic Ear Survey.

Introduction: Chronic suppurative otitis media (CSOM) is achronic suppurative inflammation of mucoperiosteal layer ofthe middle ear cleft appreciated by perforation of the tympanicmembrane. CSOM can severely impact quality of life (QoL)of patients. QoL is the latest indicator of health care. The aimwas to assess the quality of life in CSOM (Chronic suppurativeotitis media) patients in a tertiary care centre.Materials and methods: It was a descriptive epidemiologicalstudy and sample size is approximately 60 using aQuestionnaire by interview method - the CES questionnaire(Activity Restriction, Symptom and Medical Resource).Results: In the end we came to know QoL is not affected inCSOM patients (p<.05) in terms of age, gender with activityrestriction, symptom and medical resource.Conclusion: Hence concluded that quality of life is notaffected in csom patients and though the health seekingbehavior has increased, the knowledge about the disease isminimum. We have to promote health education about thedisease. Further studies with larger sample size necessary toget significant correlation in QoL of csom patients.

Incidence of Tympanosclerosis in Chronic Suppurative Otitis Media Patients in a Tertiary Care Hospital

introduction: Tympanosclerosis is an anatomoclinical entity which causes thickening and fusion of collagenous fibers intoa homogenous mass with final deposition of scattered intracellular and extracellular calcium and phosphate crystals in thesubepithelial tissue of tympanic membrane and middle ear structure.Aim: This study aims to study the incidence of tympanosclerosis in chronic suppurative otitis media (CSOM) patients.Materials and Methods: Patients with CSOM admitted for surgery were subjected to detailed ENT examination and investigationwhich included otoscopy, tuning fork tests with 256, 512, and 1024 Hz, free-field hearing, pure tone audiometry, X-ray mastoids,and computed tomography (CT) temporal bone. CT temporal bone can be used to determine the extent of disease in the middleear and ossicles fixation.Results: In 62 patients with CSOM, the incidence of tympanosclerosis was found to be 17.7% (11 cases). In patients withtympanosclerosis, the lesions were confined to tympanic membrane alone in 72% (8 cases) while the involvement of bothtympanic membrane and middle ear was found in 18% (2 cases). In tympanosclerosis, 9% (1 case) had an AB gap of <20 dB,63.6% (7 cases).Conclusion: Tympanosclerosis is long-term sequelae of CSOM. The hearing loss associated with tympanosclerosis was ofthe conductive type in the majority of cases.

A Comperative Study Between Tympanoplasty With Cortical Mastoidectomy Versus Tympanoplasty In The Management Of Mucosal Variety Of Chronic Otitis Media

Introduction:Chronic suppurative otitis media (COM), mucosal variety is defined as a chronic inflammation of the middle ear and mastoid cavity, which presents with recurrent ear discharges or otorrhoea through a tympanic perforation. Aims:To find out the incidence of chronic otitis media with respect to age and sex in the study population and to compare the graft up-take rate, the graft failure rate, the rate of residual perforation and the degree of hearing improvement between the two modalities of treatment of type 1 tympanoplasty with cortical mastoidectomy and type 1 tympanoplasty aloone. Methods:The 80 patients were randomly divided into two equal groups with 40 patients undergoing type 1 tympanoplasty with cortical mastoidectomy (group A) and 40 patients undergoing type 1 tympanoplasty (Group B). Post operatively all the patients were followed up for a total of 6 months with weakly intervals on 1st month; bi weekly on 2nd month; monthly on 3rd and 6th month. Post operatively all the study patients were assessed for the status of the graft; mobility, rejection or residual perforation of the graft and the hearing improvement.ConclusionIn successful graft take up, results of hearing improvement is better in Tympanoplasty with cortical mastoidectomy than with Tympanoplasty alone. Possibility of finding mastoid antral pathology is more in patients having Chronic otitis media (mucosal) with sub total perforation as observed in this study

Study of Bacterial Pathogens and Antibiotic Sensitivity Pattern of Ear Infections in Patients with Chronic Suppurative Otitis Media Attending a Tertiary Care Hospital in Panipat, India

Background: Chronic suppurative otitis media (CSOM) is an inflammation of the middle ear irrespective of the etiology or pathogenesis. CSOM is a disease of multiple etiologies and is well known for its persistence and recurrence in spite of treatment. It is renowned for its arrival suffering disease. Aim: This study aims to study the bacterial pathogens and their antibiotic sensitivity pattern of ear infections in patients with chronic otitis media.Materials and Methods:This prospective study was conducted at the Department of ENT and Department of Microbiology, Medical College and Hospital, India, over a period of 1 year from January 2018 to December 2018. A total of 100 patients were included in this study. The ear discharge which is collected with sterile swabs is subjected to Gram’s staining and culture of the causative organism. Antibiotic sensitivity test of cultured bacterial growth is undertaken to know the susceptibility of the causative organism.Results: Of 100 samples, 72 were positive for microbial growth and 28 showed no growth. The most common bacteria causing CSOM was Pseudomonas aeruginosa in 43 (54.43%) of samples followed by Staphylococcus aureus 12 (15.19%), coagulase-negative staphylococci 9 (11.39%), Klebsiella pneumoniae 7 (8.86%), Escherichia coli 4 (5.06%), Proteus vulgaris 2 (2.53%), and Proteus mirabilis and Streptococcus pneumoniae 1 (1.27%) each. Susceptibility test was done for known the best antibiotic agents which can be used as a proper treatment to CSOM infection.Conclusions: In the present study, the most effective antibiotics agents for most of bacterial isolates were gentamicin, ciprofloxacin, amikacin, and chloramphenicol.

A Study on Correlation of External Auditory Canal Dimensions and Endoscopic Tympanoplasty in a Tertiary Health Care Centre

Introduction: Endoscopic tympanoplasty is a minimalinvasive surgery, causing minimal trauma to healthy tissue.The other advantages are speculum which narrows canal canbe avoided, there is no frequent tilting of head, no seepageof blood into graft bed and no fear of perichondritis. Currentresearch aimed to study the advantages and disadvantagesof endoscopic tympanoplasty and to study the limits andlimitations of endoscopic tympanoplasty in relation to theanatomy and disease.Material and Methods: This study includes evaluating 35cases of endoscopic tympanoplasty with follow up period of 4months study was prospective study performed. Patient of age(18-50years) and both sexes with CSOM inactive stage withconductive deafness who require surgical intervention wereincluded in our study and patients with the External auditorycanal width is less than 6 mm were excluded in this study.Results: In our Study out of 35 patients, 8 (23%) patientsshowed Small Central Perforation, 4 cases showing perforationin antero-inferior quadrant and 4 cases showing perforationin postero-inferior quadrant), 19 (54%) patients showed largecentral perforation and the remaining 8 (23%) showed SubTotal Perforation.Conclusion: The Trans-canal endoscopic tympanoplasty isthe procedure of choice for chronic suppurative otitis mediaof tubo-tympanic type in inactive stage (Inactive mucosalchronic otitis media) with Grade 2 and Grade 3 canals.

​Post-operative Auditory Gain in Patients Undergoing Intact Canal Wall Mastoidectomy and Ossiculoplasty with Primary Malleus Transposition (Rotation) Ossiculoplasty

Background: The absence of the long process of the incus with or without the absence of the stapes superstructure accountsfor >80% of the ossicular deformities encountered during surgery for chronic suppurative otitis media. Instead of using variousinterposing prosthesis in vogue to simplify ossicular reconstruction, to reduce time and cost, and to improve functional outcomesby retaining the catenary lever function of the handle of malleus, malleus is used by repositioning it. The present study evaluatesauditory gain after 1-year post-operative follow-up.Aim of the Study: This study aims to conduct audiological evaluation of patients who underwent malleus repositioningossiculoplasty over a period of 36 months.Materials and Methods: A total of 56 patients undergoing cortical mastoidectomy and ossiculoplasty in a tertiary care hospital inKerala over a period of 3 years were included in the study. Pure tone audiometry done, pure tone average (PTA) was calculatedfor the speech frequencies (500 HZ, 1000 HZ, and 2000 HZ). Air-bone gap was calculated and tabulated. Ossicular statusduring surgery was typed according to Austin[17] and Kartush[18] classification.Procedure: Malleus transposition and assembly with stapes were done. All the data were tabulated and analyzed usingstandard statistical methods.Observations and Results: Among 56 patients, 29 (51.78%) were males and 27 (48.21%) were females. The mean auditorygain in PTA among all the operated patients was 24.65 ± 1.20 dB. Mean air-bone gap closure was 26.30 ± 3.10 dB.Conclusions: Malleus relocation is a safe and efficient technique for ossicular reconstruction. The ideal position of the relocatedmalleus allows easier and more stable placement of middle ear ossicular grafts or prostheses. It helps to reduce operative timeand cost and to improve functional outcomes by retaining the catenary lever function of the handle of malleus.

Microbiological profile of chronic suppurative otitis media presenting to a tertiary care teaching hospital – A cross-sectional study

Background: Chronic suppurative otitis media (CSOM) is one of the most frequently observed diseases in Otolaryngology practice. The primary objective of the study was to assess the bacteriological and mycological profile in chronic suppurative otitis media among patients visiting a tertiary care hospital in Tamil Nadu. Materials and methods: A total of 268 samples from 200 patients fulfilling the criteria were included. All patients underwent otoscopic examination; Tuning fork test and pure tone audiometry (PTA) were performed. Microbial identification was performed by collecting Aural discharge from the middle ear of each patient by using two sterile swabs. Results: More than half of the patients belonged to 21 to 40 year age group. Only 5.5% of them were aged 20 years and below. Unilateral involvement of CSOM was observed in 66% of the patients with 34% of them affecting both the ears. Microbial assay showed 78% of cases with gram-negative microbial infection while 22% were with gram-positive microbes. Staphylococcus aureus was the commonest gram positive bacteria (90.9%) while Pseudomonas aeruginosa was the most frequent gram-negative microbe. Among fungi, Candida albicans was found in 71.42 patients. V.C. Suresh Chander, A. Kavinkumar. Microbiological profile of chronic suppurative otitis media presenting to a tertiary care teaching hospital - A cross-sectional study. IAIM, 2019; 6(5): 5-11. Page 6 Conclusion: The findings of the study revealed that Staphylococcus aureus and Streptococcus pyogenes were the most prevalent gram-positive bacteria while Pseudomonas aeruginosa and Klebsiella pneumoniae were the commonest CSOM-causing gram-negative microorganisms.

Validation of a Portuguese version of the health-related quality of life measure for active chronic otitis media (COMQ-12) / Validation of a Portuguese version of the health-related quality of life measure for active chronic otitis media (COMQ-12)

Abstract Introduction: Measuring the impact on quality of life, especially after the beginning of the treatment, is becoming increasingly important in healthcare. Objective: The aim of this study was to translate the Chronic Otitis Media Questionnaire-12 (COMQ-12) into Portuguese language and validate this version in a group of patients with chronic otitis media. Methods: The Portuguese version of COMQ-12 was obtained by translation and back translation. Portuguese speaking patients with a history of active chronic otitis media were asked to complete the COMQ-12 Portuguese version. Cronbach's α coefficient was calculated for an estimation of the internal consistency of the questionnaire. Results: A total of 100 patients were included in the study; 49 women and 51 men, with a mean age of 39 years (range 12-77 years, median 40 years). The average COMQ-12 score was 29, out of a maximum score of 60. Cronbach's α result for the Portuguese version of the COMQ-12 was 0.85, indicating a high internal consistency. The participants presented with different forms of chronic otitis media, and almost all domains of the COMQ-12 questionnaire were able to differentiate between patients with healed chronic otitis media and patients with cholesteatoma or wet tympanic membrane perforation. Showing that patients with healed chronic otitis media have a better quality of life, measured by the COMQ-12, is a first step to guarantee the questionnaire's validity. The next step will consist on routinely using the questionnaire in patients undergoing surgery for chronic otitis media in order to evaluate their quality of life after treatment. Conclusion: The COMQ-12 Portuguese version showed high reliability, and may be used as an assessment of quality of life in patients with chronic otitis media

Resumo: Introdução: Medir o impacto na qualidade de vida, especialmente após o início do tratamento dos pacientes, está se tornando cada vez mais importante nos cuidados da saúde. Objetivo: O objetivo deste estudo foi traduzir o Questionário de Otite Média Crônica-12 (COMQ-12) para a língua portuguesa e validar essa versão em um grupo de pacientes com Otite Média Crônica. Método: A versão em Língua Portuguesa do COMQ-12 foi obtida através de tradução e posterior retrotradução. Pacientes nativos da língua portuguesa com histórico de OMC ativa foram convidados a completar o COMQ-12 em Português. O coeficiente α de Cronbach foi calculado para estimar a consistência interna do questionário. Resultados: Um total de 100 pacientes foram incluídos no estudo; 49 eram mulheres e 51 eram homens, com média de idade de 39 anos (variação: 12 a 77 anos, mediana de 40 anos). O escore médio do COMQ-12 foi 29, de um escore máximo de 60. O resultado do coeficiente α de Cronbach para a versão em português do COMQ-12 foi de 0,85, indicando que sua consistência interna era alta. Os participantes apresentavam diferentes formas de otite média crônica e quase todos os domínios do questionário COMQ-12 foram capazes de diferenciar entre pacientes com otite média crônica curada e pacientes com colesteatoma ou perfuração úmida de membrana timpânica. Demonstrar que pacientes com otite média crônica curada apresentam uma melhor qualidade de vida, medida pelo COMQ-12 é o primeiro passo para garantir a validade do questionário. O próximo passo será utilizá-lo rotineiramente em pacientes submetidos à cirurgia para otite média crônica e avaliar a qualidade de vida após o tratamento. Conclusão: A versão em português do questionário COMQ-12 mostrou alta confiabilidade e pode ser utilizada como questionário de medida de qualidade de vida em pacientes com otite média crônica.

Development and Administration of Chronic Suppurative Otitis Media Questionnaire-12 (COMQ-12) and Chronic Otitis Media Outcome Test-15 (COMOT-15) in Kannada

Abstract Introduction It is essential to determine the quality of life among individuals with chronic suppurative otitis media (CSOM). However, there is limited literature on healthrelated quality of life measurements in Kannada-speaking individuals with CSOM. Objectives The present study attempted to translate and validate Chronic Suppurative Otitis Media Questionnaire-12 (COMQ-12) and Chronic Otitis Media Outcome Test- 15 (COMOT-15) in Kannada. Method The English questionnaires were translated and back-translated, and they were later verified for content validity. The developed questionnaires were then administered to 100 individuals with CSOM for further validation. Results The results of the study showed that the translated questionnaires have good internal consistency for measuring quality of life among individuals with CSOM. The study also showed that Kannada-speaking individuals with CSOM show significant impairment in their health-related quality of life measures. Conclusions The impairments weremore related to ear symptoms and psychological issues. However, test-retest reliability of the developed questionnaire and its further validation are essential. Thus, these questionnaires attempt to understand the problems of the individuals with CSOM from the patients' perspective and help clinicians provide the appropriate management.