Chronic suppurative otitis media.

Chronic suppurative otitis media (CSOM) is a leading global cause of potentially preventable hearing loss in children and adults, associated with socioeconomic deprivation. There is an absence of consensus on the definition of CSOM, which complicates efforts for prevention, treatment, and monitoring. CSOM occurs when perforation of the tympanic membrane is associated with severe or persistent inflammation in the middle ear, leading to hearing loss and recurrent or persistent ear discharge (otorrhoea). Cholesteatoma, caused by the inward growth of the squamous epithelium of the tympanic membrane into the middle ear, can also occur. The optimal treatment of discharge in CSOM is topical antibiotics. In resource-limited settings where topical antibiotics might not be available, topical antiseptics are an alternative. For persistent disease, surgery to repair the tympanic membrane or remove cholesteatoma might offer long-term resolution of otorrhoea and potential improvement to hearing. Recent developments in self-fitted air-conduction and bone-conduction hearing aids offer promise as new options for rehabilitation.

Tuberculosis of the middle ear: A systematic review.

OBJECTIVE: Tuberculous otitis media (TOM) is a rare extrapulmonary manifestation of tuberculosis (TB) and remains challenging to diagnose due to non-specific symptoms. This systematic review identifies clinical characteristics, diagnostic evaluation, and outcomes in cases of TOM. METHODS: A comprehensive literature search utilizing the PubMed, CINAHL, Scopus, and Cochrane Library databases was conducted for relevant articles published between 2000 and 2021. Cases involving adult patients with TOM were included. Non-English studies, animal studies, and reviews were excluded. RESULTS: 41 case reports and 7 case series were included, comprising data from 67 patients. The mean age was 40 years (range, 19-87 years) and the majority were female (n = 46, 68.7 %). The mean symptom duration was 12.8 months (range, 0.25-120 months). Common symptoms included otorrhea (n = 60, 89.6 %), HL (n = 58, 86.6 %), otalgia (n = 19, 28.4 %), and FP (n = 18, 26.9 %). Otoscopy revealed tympanic membrane (TM) perforation in 45 patients (67.2 %). Most patients were diagnosed with tissue biopsy (n = 53, 79.1 %). Surgical interventions were performed in 48 patients (71.6 %) and 63 patients (94.0 %) were prescribed anti-TB chemotherapy. Long-term sequelae (e.g., HL, FP, and TM perforation) were noted in 39 patients (58.2 %) at a mean follow-up of 18.8 months (range, 1-120 months). CONCLUSION: TOM should be included in the differential diagnosis of chronic suppurative otitis media. Histopathological examination is a reliable diagnostic method. Early detection and management are recommended for optimizing outcomes. LEVEL OF EVIDENCE: 3b.

Aural toilet (ear cleaning) for chronic suppurative otitis media.

BACKGROUND: Chronic suppurative otitis media (CSOM), sometimes referred to as chronic otitis media (COM), is a chronic inflammation and often polymicrobial infection (involving more than one micro-organism) of the middle ear and mastoid cavity, characterised by ear discharge (otorrhoea) through a perforated tympanic membrane. The predominant symptoms of CSOM are ear discharge and hearing loss. Aural toileting is a term describing a number of processes for manually cleaning the ear. Techniques used may include dry mopping (with cotton wool or tissue paper), suction clearance (typically under a microscope) or irrigation (using manual or automated syringing). Dry mopping may be effective in removing mucopurulent discharge. Compared to irrigation or microsuction it is less effective in removing epithelial debris or thick pus. Aural toileting can be used alone or in addition to other treatments for CSOM, such as antibiotics or topical antiseptics. OBJECTIVES: To assess the effects of aural toilet procedures for people with CSOM. SEARCH METHODS: The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Central Register of Controlled Trials (CENTRAL via the Cochrane Register of Studies); Ovid MEDLINE; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 16 March 2020. SELECTION CRITERIA: We included randomised controlled trials (RCTs) with at least a one-week follow-up involving people (adults and children) who had chronic ear discharge of unknown cause or CSOM, where the ear discharge had continued for more than two weeks. We included any aural toileting method as the intervention, at any frequency and for any duration. The comparisons were aural toileting compared with a) placebo or no intervention, and b) any other aural toileting method. We analysed trials in which background treatments were used in both arms (e.g. topical antiseptics or topical antibiotics) separately. DATA COLLECTION AND ANALYSIS: We used the standard Cochrane methodological procedures. We used GRADE to assess the certainty of the evidence for each outcome. Our primary outcomes were: resolution of ear discharge or 'dry ear' (whether otoscopically confirmed or not), measured at between one week and up to two weeks, two weeks to up to four weeks, and after four weeks; health-related quality of life using a validated instrument; and ear pain (otalgia) or discomfort or local irritation. Secondary outcomes were hearing, serious complications, and the adverse events of ear bleeding and dizziness/vertigo/balance problems. MAIN RESULTS: We included three studies with a total of 431 participants (465 ears), reporting on two comparisons. Two studies included only children with CSOM in the community (351 participants) and the other study (80 participants) included children and adults with chronic ear discharge for at least six weeks. None of the included studies reported the outcomes of health-related quality of life, ear pain or the adverse event of ear bleeding. Daily aural toileting (dry mopping) versus no treatment Two studies (351 children; 370 ears) compared daily dry mopping with no treatment. Neither study presented results for resolution of ear discharge at between one and up to two weeks or between two to four weeks. For resolution of ear discharge after four weeks, one study reported the results per person. We are very uncertain whether there is a difference at 16 weeks (risk ratio (RR) 1.01, 95% confidence interval (CI) 0.60 to 1.72; 1 study; 217 participants) because the certainty of the evidence is very low. No results were reported for the adverse events of dizziness, vertigo or balance problems. Only one study reported serious complications, but it was not clear which group these patients were from, or whether the complications occurred pre- or post-treatment. One study reported hearing, but the results were presented by treatment outcome rather than by treatment group so it is not possible to determine whether there is a difference between the two groups. Daily aural toileting versus single aural toileting on top of topical ciprofloxacin One study (80 participants; 95 ears) compared daily aural toileting (suction) with administration of topical antibiotic (ciprofloxacin) ear drops in a clinic, to a single aural toileting (suction) episode followed by daily self-administered topical antibiotic drops, in participants of all ages. We are unsure whether there is a difference in resolution of ear discharge at between one and up to two weeks (RR 1.09, 95% CI 0.91 to 1.30; 1 study; 80 participants) because the certainty of the evidence is very low. There were no results reported for resolution of ear discharge at between two to four weeks. The results for resolution of ear discharge after four weeks were presented by ear, not person, and could not be adjusted to by person. One patient in the group with single aural toileting and self administration of topical antibiotic ear drops reported the adverse event of dizziness, which the authors attributed to the use of cold topical ciprofloxacin. It is very uncertain whether there is a difference between the groups (RR 0.33, 95% CI 0.01 to 7.95; 1 study; 80 participants, very low-certainty). No results were reported for the other adverse events of vertigo or balance problems, or for serious complications. The authors only reported qualitatively that there was no difference between the two groups in hearing results (very low-certainty). AUTHORS' CONCLUSIONS: We are very uncertain whether or not treatment with aural toileting is effective in resolving ear discharge in people with CSOM, due to a lack of data and the poor quality of the available evidence. We also remain uncertain about other outcomes, including adverse events, as these were not well reported. Similarly, we are very uncertain whether daily suction clearance, followed by antibiotic ear drops administered at a clinic, is better than a single episode of suction clearance followed by self-administration of topical antibiotic ear drops.

WITHDRAWN: Grommets (ventilation tubes) for recurrent acute otitis media in children.

BACKGROUND: This is an update of a Cochrane review first published in The Cochrane Library in Issue 4, 2008 and previously updated in 2011.Acute suppurative otitis media is one of the most common infectious diseases in childhood. Recurrent acute otitis media is defined for the purposes of this review as either three or more acute infections of the middle ear cleft in a six-month period, or at least four episodes in a year. Strategies for managing the condition include the assessment and modification of risk factors where possible, repeated courses of antibiotics for each new infection, antibiotic prophylaxis and the insertion of ventilation tubes (grommets). OBJECTIVES: To establish whether grommet insertion reduces the frequency of episodes of recurrent acute otitis media and the proportion of symptomatic children. SEARCH METHODS: The Cochrane Ear, Nose and Throat Disorders Group (CENTDG) Trials Search Co-ordinator searched the CENTDG Trials Register; Central Register of Controlled Trials (CENTRAL 2014, Issue 10); PubMed; EMBASE; CINAHL; Web of Science; Clinicaltrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 6 November 2014. SELECTION CRITERIA: Randomised controlled trials comparing grommet insertion versus control (antibiotics/other treatments/no treatment) for recurrent acute otitis media in children aged from 0 to 16 years. DATA COLLECTION AND ANALYSIS: Two authors independently selected studies. Three authors independently assessed study quality and extracted data. We synthesised data descriptively. MAIN RESULTS: Two randomised controlled trials with a total of 148 participants are included in this review. The overall risk of bias in the studies is unclear.The first study randomised 95 children to grommets or control (antibiotic treatment of acute otitis media episodes). For the primary outcome, this study showed that grommet insertion leads to a mean reduction of 1.5 episodes of acute otitis media in the first six months after treatment. In six months of follow-up significantly more children in the grommet group had no episodes of acute otitis media (P value < 0.001). Complications of surgery included grommet blockage with acute otitis media requiring re-operation within six months in 3/54 children who underwent grommet insertion. Adverse effects were not documented in the control group. The following pre-defined secondary outcomes were not reported: change in symptom scores for otalgia or otorrhoea, alteration in the frequency of otalgia or otorrhoea, and number of days at nursery or school lost secondary to acute otitis media.The second study reported on 53 of 68 children who were randomised to grommet insertion or six months of once a day sulfamethoxazole and trimethoprim antibiotic prophylaxis. There was no significant difference in the primary outcome, number of episodes of acute otitis media, during the six-month follow-up between grommet insertion and antibiotic treatment groups (64.5% in the surgical group versus 45.4% in the antibiotic group had no recurrence, P value = 0.4). Two participants underwent grommet re-insertion to replace extruded tubes during the follow-up period. The only other adverse effect reported was the development of a skin rash in two patients in the medical group. Other pre-defined secondary outcome measures were not reported. The study has a high risk of bias and the results should be interpreted cautiously. AUTHORS' CONCLUSIONS: Grommets significantly increase the number of acute otitis media-free children in the first six months after insertion compared to children who receive no treatment. Grommet insertion maybe of equivalent efficacy to once a day antibiotic prophylaxis. Further research is required to confirm the advantage of grommets over no treatment, investigate the effect beyond six months, compare grommet effectiveness against alternative active treatments and confirm the low risk of adverse effects compared to no treatment and all active treatments in recurrent acute otitis media. In the interim clinicians should consider the possible adverse effects of grommet insertion and alternative treatments before recommending surgery.

[The medical assistance seeking behaviour of the patients presenting with suppurative chronic otitis media and their treatment in Moscow]. / Obrashchaemost' i lechenie bol'nykh khronicheskim gnoinym srednim otitom v Moskve.

The objective of the present study was the analysis of the medical assistance seeking behaviour of the patients presenting with suppurative chronic otitis media (CSOM) and their treatment in Moscow during the period from 2009 till 2016. The incidence of suppurative chronic otitis media in the city of Moscow in 2016 was estimated to be 0.14 per 1000 population, its prevalence 1.23 per 1000 population. The materials of the statistical reports of Moscow ENT clinics give evidence of the considerable growth in the number of the admitted patients suffering from ear diseases including suppurative chronic otitis media (mean 5.5). The surgical activity of the ENT clinics with respect to CSOM amounted to 46%. The overall increase in the number of surgical interventions is attributable to a rise in the frequency of reconstructive operations. These data give evidence of excellent continuity in the work of outpatient facilities and ENT clinics, intensification of their activities, and a change of the people's attitude toward the care for their health. Suppurative chronic otitis media is the commonest pathology encountered in the specialized ENT hospitals where it accounts for 59.8% of the total number of ENT diseases. The frequency of the surgical interventions performed for the treatment of CSOM amounts to 98.9%. The enhanced attention given to the patients with this pathology resulted in the two-fold increase of the specialized medical assistance provided to the patients presenting with suppurative chronic otitis media. The most frequently practiced form of the surgical treatment employed for the management of CSOM is tympanoplasty (in 72% of the patients on the average). The 'closed' variants of sanitizing operations are performed in 59.8% of the patients presenting with chronic suppurative otitis media and concomitant cholesteatoma whereas the 'open' interventions are used to treat 45.1% of the patients in need of tympano- and mastoidoplasty. On the whole, the priority surgical treatment of the patients with chronic suppurative otitis media in specialized medical facilities is reconstructive operations intended to simultaneously reach the beneficial sanative and functional effects without deterioration of the quality of life of the patients suffering from chronic suppurative otitis media.

Recurrent otorrhea in chronic suppurative otitis media: is biofilm the missing link?

Dispersal of bacteria from a biofilm in the middle ear, serving as a bacterial reservoir, could explain the recurrent and chronic nature of chronic suppurative otitis media (CSOM). The objective of this study is to investigate if the same strains of bacteria could be detected in repeated episodes of otorrhea in CSOM. In a prospective case series at a primary healthcare clinic in Nuuk, Greenland, patients with more than 14 days of otorrhea were included consecutively. Samples for culturing and biofilm analysis were taken at enrollment and at any subsequent episode with otorrhea. Participants were treated with daily saline irrigation and Ciprofloxacin eardrops for 7-14 days. Biofilm was identified in otorrhea in 81% (17/21) of participants at enrollment. Multispecies infections dominated with Non-typeable Haemophilus Influenzae (NTHI), Staphyloccocus aureus, and anaerobes being the most frequent pathogens. After the initial treatment, 19 (90%) had dry ears. Median observation period was 140 days (range 14-280) where 13 participants had one or more recurrences. Median time to first recurrence was 60 days (range 14-197). Among the 13 with recurrence, three individuals had the same genotype of bacteria at a subsequent episode. Another two had the same phenotype (NTHI). The remaining eight had new multispecies infections. We confirmed a high rate of biofilm in CSOM. However, the clinical implication might be of minor importance when treating with irrigation and antibiotic eardrops, as recurrent episodes of otorrhea were dominated by new pathogens in each episode.

Luc abscess: an extraordinary complication of acute otitis media.

Luc abscess is an uncommon suppurative complication of otitis media. Unfamiliarity of this complication leads to delayed diagnosis and treatment. This abscess is usually benign. Infection in the middle ear spreads via anatomic preexisting pathways, and this process results with subperiosteal pus collection. Conservative treatment with drainage under empirical wide spectrum antibiotic is efficient. Here,we present a 9-year-old boy who had left facial swelling after a period of otalgia, diagnosed as Luc abscess without mastoiditis.

Childhood otitis media is associated with dizziness in adulthood: the HUNT cohort study.

The objective of the study was to examine the association between otitis media in childhood and dizziness in adulthood. Longitudinal, population-based cohort study of 21,962 adults (aged 20-59 years, mean 40) who completed a health questionnaire in the Nord-Trøndelag Hearing Loss Study was conducted. At 7, 10 and 13 years of age, the same individuals underwent screening audiometry in a longitudinal school hearing investigation. Children found with hearing loss underwent an ear, nose and throat specialist examination. Adults diagnosed with childhood chronic suppurative otitis media (n = 102) and childhood hearing loss after recurrent acute otitis media (n = 590) were significantly more likely to have increased risk of reported dizziness when compared to adults with normal hearing as children at the school investigation and also a negative history of recurrent otitis media (n = 21,270), p < 0.05. After adjusting for adult age, sex and socio-economic status, the odds ratios were 2.1 [95 % confidence interval (CI): 1.4-3.3] and 1.3 (95 % CI: 1.0-1.5), respectively. This longitudinal cohort study suggests that childhood chronic suppurative otitis media and childhood hearing loss after recurrent acute otitis media are associated with increased risk of dizziness in adulthood. This might reflect a permanent effect of inflammatory mediators or toxins on the vestibular system. The new finding stresses the importance of treatment and prevention of these otitis media conditions.

Otologic evaluation of patients with primary antibody deficiency.

Common variable immunodeficiency (CVID) represents the most frequent primary immunodeficiency, often encountered in the ENT clinical practice. The clinical spectrum of CVID is quite broad, but otitis media are certainly among the most common clinical manifestations. This prospective study enrolled 60 patients (34 males, 26 females) with a previous diagnosis of CVID with the aim of performing an otologic evaluation and a more precision characterization of incidence, diagnosis, and treatment of otitis media in this group of patients. In consideration that Eustachian tube dysfunction (ETD) could be the 'primum movens' of otitis media, we wanted to assess whether a Eustachian tube dysfunction was present in these patients. Besides, we propose a possible diagnostic algorithm of middle ear pathologies to use in all cases of primary antibody deficiency patients. Results of our otologic examination showed that: 5 % of patients had chronic suppurative otitis media, 25 % bilateral otitis media with effusion and 10 % reported unilateral OME with associated contralateral ETD. There was bilateral isolated ETD and unilateral isolated ETD in 5 and 15 % of patients, respectively. All patients with unilateral OME had associated contralateral ETD. Finally, 40 % of patients were bilaterally negative at otoscopic examination and all otologic tests.

Malignant otitis externa in a healthy non-diabetic patient.

A healthy 60-year-old male was initially treated for external otitis, and subsequently received multiple surgeries including abscess drainage, temporal bone debridement, canaloplasty of the external auditory meatus, and fistula excision and was treated with numerous antibiotics at another hospital over a 1-year period. He was seen at our hospital on February 14, 2014 with a complaint of a non-healing wound behind the left ear and drainage of purulent fluid. He had no history of diabetes mellitus or compromised immune function. Computed tomography (CT) and magnetic resonance imaging (MRI) studies at our hospital showed osteomyelitis involving the left temporal, occipital, and sphenoid bones, the mandible, and an epidural abscess. Routine blood testing and tests of immune function were normal, and no evidence of other infectious processes was found. He was diagnosed with malignant otitis externa (MOE). Bone debridement and incision and drainage of the epidural abscess were performed, and vancomycin was administered because culture results revealed Corynebacterium jeikeium, Corynebacterium xerosis, and Enterococcus faecalis. MOE should be considered in healthy patients with external otitis who fail initial treatment.

[Efficacy of Dioxidine antimicrobial preparation for the treatment of inflammatory diseases of the external and middle ear].

In this article, the comparative analysis of the clinical efficacy of drugs for local therapy in patients with acute external otitis, acute purulent otitis media and exacerbation of chronic suppurative otitis media is presented. The results of the clinical study, dynamic bacteriological investigation confirmed the high efficacy, safety and good tolerance of dioxidine in treatment of external and middle ear infections.

[Exacerbation of chronic suppurative otitis media in the childhood].

Chronic suppurative otitis media has for many years remained one of the most serious forms otorhinolaryngological pathology in the children since its exacerbation may lead to the life-threatening extra- and intracranial complications. This disease is a most frequent cause of the loss of hearing in the childhood. The present paper is designed to present the analytical review of the relevant literature publications and compare its results with the original observations of the authors. Special attention is given to the etiopathogentic, therapeutic, and diagnostic aspects of exacerbation of chronic inflammatory pathology of the middle ear in the children. The most challenging problems of prophylaxis of this disease are discussed along with the available approached to their solution with the use of moderm methods for its diagnostics, conservative and surgical treatment.

[The clinical manifestations and diagnostics of otitis media caused by tuberculosis].

The objective of the present study was to clarify the characteristic pathognomonic features of middle ear lesions associated with tuberculosis and the approaches to their diagnostics under the present-day conditions. The study included 11 cases (18 ears) of tuberculosis otitis media and the related lesions of the mastoid process diagnosed with the use of clinical, roentgenological, cytological, bacteriological, pathomorphological, and molecular-genetic methods (including PCR diagnostics). The primary localization of tuberculosis in the middle ear was documented in 6 patients; in 5 patients, it was associated with pulmonary involvement. Five patients presented with smoldering exudative otitis media and the remaining six ones with suppurative perforating otitis media. The tuberculous process was diagnosed with the use of various methods including clinical examination, bacteriological (9%), cytological (27.3%), pathomorphological (18%) studies, and PCR diagnostics (55%). Diagnosis was made within a period from 1 month to 1.5 years after the application of the patients for medical assistance which suggests the difficulty of verification of tuberculous etiology of the disease of the middle ear. It is concluded that the high index of suspicion in the case of smoldering middle ear pathology facilitates its early diagnostics and successful treatment.

To study the role of antibiotic+steroid irrigation of the middle ear in active chronic otitis media with small perforation and pulsatile discharge.

OBJECTIVE: To evaluate the usefulness of antibiotic+steroid irrigation of the middle ear in patients with otitis media with small perforation and pulsatile discharge. METHOD: A prospective, randomised, evaluator-blinded study was carried at a single tertiary care centre over eight years, looking at 100 patients with chronic suppurative otitis media involving small tympanic membrane perforations and pulsatile mucopurulent discharge. The patients were randomised and divided into two groups. In group A, the examination under microscope, with suction cleaning of the external canal, was followed by irrigation of the middle ear with antibiotic+steroid solution for up to one week, while group B was prescribed self-administration of the same drops with systemic antibiotics. The patients were followed up daily for 10 days to monitor otorrhoea relief and on a weekly basis subsequently to monitor the healing of the tympanic membrane. RESULTS: Forty-nine patients in group A had a dry ear after 3-7 days of daily suction and the irrigation of middle ear with the antibiotic+steroid solution and 44 had a healed tympanic membrane after an average three months of follow-up. Five patients with dry ear but persistent perforation underwent tympanoplasty, while only one patient with a persistent ear discharge underwent mastoid exploration. In group B, eight patients on oral antibiotics and self-administration of the same drops had dry ear while 34 had dry ear after receiving intravenous antibiotics. Thirty perforations healed spontaneously and 12 required tympanoplasty. In 8 patients, the tympano-mastoid was explored and these patients had dry, hearing ears only after surgery. CONCLUSION: Patients with chronic suppurative otitis media involving small perforations and pulsatile discharge can be managed conservatively with simple suction cleaning + middle ear irrigation with antibiotics + steroid drops.

Complications of chronic suppurative otitis media: a retrospective review.

The purpose of this study was to review our patients with complications of chronic suppurative otitis media (CSOM) and compare with literature. This retrospective study was performed over 10 years in our tertiary referral university hospital. During this period 4,630 patients with CSOM were admitted to the department and 906 patients underwent a surgery. From the records of the 4,630 patients, 121 patients (2.6%) with complications were identified. Of the 906 CSOM patients that underwent a surgery, 511 had cholesteatoma, and 395 had granulation and/or polyp tissue. Ninety-four of 511 (18.4%) patients with cholesteatoma and 27 of 395 (6.8%) patients with granulation and/or polyp tissue had a complication. Of the 121 complicated CSOM patients, 57 extracranial (47.1%) and 37 intracranial (30.6%). Multiple combined complications were occurred in 27 (22.3%) patients. The mastoid abscess was the commonest extracranial complication (28.3%); it was followed by labyrinthitis (9%), facial nerve paralysis (8.4%), and Bezold's abscess (1.3%). The most common intracranial complication was lateral sinus thrombophlebitis (19.5%), followed by perisigmoid sinus abscess (13.5%), meningitis (9%), brain abscess (6.5%), and extradural abscess (4.5%). Most frequent intraoperative finding of complicated CSOM patients was cholesteatoma, with the exception of patients with facial nerve paralysis. There was no mortality in any of our patients. The additional morbidities were recorded in 25 patients (20.6%). In this study, we emphasize the importance of an accurate and early diagnosis, followed by adequate surgical therapy and a multidisciplinary approach.

Wegener granulomatosis presenting as refractory otitis media: a case report.

Wegener's granulomatosis (WG) is a granulomatous widespread necrotizing vasculitis, sometimes progressing rapidly, characterized by a tendency to involve the upper and lower respiratory tracts, and in most cases, the kidneys. Otologic manifestations may be seen during the course of the disease, however, they are not frequently seen as the first and only presenting feature. The presence of anticytoplasmic antibodies versus neutrophil polymorphonucleate granules (c-ANCA) is highly specific for the diagnosis of WG, being positive in 97% of the cases. The early diagnosis and the timely medical treatment result in high rates of remission of this potentially lethal disease. In this article, we report a case of WG presenting with acute serous otitis media, progressing to suppurative otitis media and granulomas as the first and only symptom, which was refractory to medical therapy during follow-up and which was diagnosed with further examination.

[The treatment of the patients presenting with chronic inflammation of the trepanation cavity with a preparation containing silver nanoparticles following sanitation surgery of the open type].

The objective of the present study was to estimate the efficacy of argovit used for the treatment of relapses of chronic suppurative otitis medium (CSOM) developing in the patients who underwent the sanitation surgical procedure. The study carried out between January 2011 and November 2011 included 35 patients aged from 12 to 69 years presenting with CSOM after surgical intervention on the tympanic cavity of the middle ear. The treatment resulted in the rapid elimination of clinical symptoms and positive dynamics of the objective signs of the disease, such as reduction or termination of pathological exudation and stimulation of the epidermization processes. The majority of the treated patients had stable remission within 6 months after the termination of the treatment.

[Our experience with the application of collagen-based preparations in reconstructive surgery of the middle ear].

This paper summarizes our experience with the application of collagen-based preparations for reconstructive surgery of the middle ear. The best morphological results (88.46%) were obtained by the closure of extensive defects with the Oblecolum membrane as a temporary supporting structure and the outer atraumatic dressing for the tympanic transplant (in 30 patients) or by the use of the compact-porous explants from the "Sanguicol" preparation as an overlay on the transplant (in 22 patients). Twenty seven patients presenting with the so-called "operated ear disease" underwent mastoidoplasty with the use of the compact-porous preparation "Stimul-oss" as a supporting structure to induce the ingrowth of the bone tissue and the subsequent substitution of the defect. This treatment ensured the reduction of the volume of the bony trepanation cavity. In addition, we have obtained preliminary encouraging results of the application of collagene preparations for the surgical intervention on the stirrup in the patients suffering otosclerosis.

[Local antibacterial therapy for the inflammatory diseases of the external and middle ear].

The objective of the present study was to estimate the efficacy and safety of candibioic designed for the treatment of the patients presenting with diffuse otitis externa and chronic otitis media. The open randomized trial included 40 patients with diffuse otitis externa and 40 ones with chronic otitis media who had undergone a surgical sanitation procedure. Their standard clinical and otorhinolaryngological examination was supplemented by the characteristic of clinical symptoms and personal complaints using the 10-score scale. The composite preparation candibiotic was found to be equally effective for the treatment of both diffuse otitis externa and chronic otitis media. The results of the study give reason to recommend the use of candibiotic as an efficacious and safe drug for the treatment of these conditions.

[The acceleration of remission after exacerbation of chronic suppurative otitis media following functional-reconstructive operations on the middle ear].

This study had the objective to enhance the efficacy of the surgical treatment of the patients presenting with chronic suppurative otitis media by means of reduction of the time needed to achieve persistent remission of the disease in the framework of a complex of therapeutic and rehabilitative measures making possible the surgical intervention on the middle ear regardless of the activity of the inflammatory process and its severity. Sixty five patients with chronic suppurative otitis media were examined and treated to estimate the clinical efficiency of the proposed complex of therapeutic and rehabilitative measures. It is maintained that this complex allows to achieve the positive results of reconstructive and restorative surgery without waiting for the development of long-term remission.