Hearing results following endoscopic type I tympanoplasty in medium and large perforations.

OBJECTIVES: To clarify the hearing outcomes after endoscopic type I tympanoplasty for medium and large perforations due to chronic otitis media. METHODS: We examined the clinical records of patients who underwent endoscopic type I tympanoplasty for medium and large perforations of the eardrum resulting from chronic otitis media between January 2019 and December 2021. We analyzed the changes in hearing pre- and post-operation in patients with healed eardrums and assessed the impact of tympanosclerosis on hearing. Patients with incomplete follow-up data, middle ear cholesteatoma, stapes fixation, severe lesions in the tympanic antrum and mastoid necessitating mastoidectomy and/or ossicular chain reconstruction were excluded. RESULTS: A total of 156 patients underwent analysis for audiological outcomes. Among them, 63 had medium tympanic membrane perforations, with 18 cases showing calcification of the tympanic membrane and 20 cases with calcification in the tympanic cavity. Additionally, 93 cases had large tympanic membrane perforations, with 25 cases showing tympanic membrane calcification and 32 cases with tympanic cavity calcification. Prior to surgery, the Air Conduction threshold (AC) in the large perforation group was higher than in the medium perforation group, particularly at low frequencies, measuring (47.4 ± 13.3 dB) and (41.2 ± 14.7 dB), respectively (p-value < 0.05). Following surgery, both groups experienced an improvement in AC, measuring (33.6 ± 13.9 dB) and (32.6 ± 12.8 dB), respectively, with no significant difference noted (p-value > 0.05). There was no significant change in Bone Conduction threshold (BC) before and after surgery in either the large or medium perforation groups (all p-values > 0.05). Except for 4000 Hz an increase, bone conduction did not increase post-surgery, instead showing further improved. Pre-surgery, the Air-Bone Gap (ABG) in the large and medium perforation groups was (27.7 ± 8.5 dB) and (21.8 ± 8.3 dB), respectively, mainly affecting low frequencies, with a statistically significant difference noted (p-value < 0.05). Following surgery, ABG in both groups improved to (16.3 ± 7.6 dB) and (15.7 ± 8.4 dB), respectively, with no significant difference observed (p-value > 0.05). There was no significant difference in hearing pre-surgery among the groups with No calcification (No), Tympanic Membrane Calcification (TM), and Tympanic Cavity Calcification (TC). However, TC significantly impacted low frequency (250-500 Hz) AC and ABG. The differences in AC and ABG pre-surgery between TC and No group, and TC and TM group (at 250-500 Hz) were statistically significant (all p-values < 0.05). Preoperative ABG in TM group was better than in No group and TC group, suggesting minimal impact of tympanic membrane calcification on hearing. No interaction was observed between tympanic membrane perforation size and tympanosclerosis on hearing. Post-surgery, both large and medium tympanic membrane perforation groups, regardless of tympanosclerosis presence, showed good AC and ABG, with no statistically significant difference in △ABG (all p-values > 0.05). CONCLUSION: Preoperative AC and ABG were increase in cases of large tympanic membrane perforations and medium tympanic membrane perforations with tympanic cavity calcification. Surgical intervention led to more significant hearing improvement in these patients. However, irrespective of tympanic membrane perforation size and the presence of tympanosclerosis, as long as the ossicular chain remains intact and functional, postoperative AC and ABG outcomes are satisfactory. Endoscopic type I tympanoplasty proves effective in achieving improved hearing outcomes for patients with medium to large tympanic membrane perforations and tympanosclerosis, provided there is no ossicle chain fixation. LEVEL OF EVIDENCE: Level 4.

Lactobacillus acidophilus VB1 co-aggregates and inhibits biofilm formation of chronic otitis media-associated pathogens.

This study aims to evaluate the antibacterial activity of Lactobacillus acidophilus, alone and in combination with ciprofloxacin, against otitis media-associated bacteria. L. acidophilus cells were isolated from Vitalactic B (VB), a commercially available probiotic product containing two lactobacilli species, L. acidophilus and Lactiplantibacillus (formerly Lactobacillus) plantarum. The pathogenic bacterial samples were provided by Al-Shams Medical Laboratory (Baqubah, Iraq). Bacterial identification and antibiotic susceptibility testing for 16 antibiotics were performed using the VITEK2 system. The minimum inhibitory concentration of ciprofloxacin was also determined. The antimicrobial activity of L. acidophilus VB1 cell-free supernatant (La-CFS) was evaluated alone and in combination with ciprofloxacin using a checkerboard assay. Our data showed significant differences in the synergistic activity when La-CFS was combined with ciprofloxacin, in comparison to the use of each compound alone, against Pseudomonas aeruginosa SM17 and Proteus mirabilis SM42. However, an antagonistic effect was observed for the combination against Staphylococcus aureus SM23 and Klebsiella pneumoniae SM9. L. acidophilus VB1 was shown to significantly co-aggregate with the pathogenic bacteria, and the highest co-aggregation percentage was observed after 24 h of incubation. The anti-biofilm activities of CFS and biosurfactant (BS) of L. acidophilus VB1 were evaluated, and we found that the minimum biofilm inhibitory concentration that inhibits 50% of bacterial biofilm (MBIC50) of La-CFS was significantly lower than MBIC50 of La-BS against the tested pathogenic bacterial species. Lactobacillus acidophilus, isolated from Vitane Vitalactic B capsules, demonstrated promising antibacterial and anti-biofilm activities against otitis media pathogens, highlighting its potential as an effective complementary/alternative therapeutic strategy to control bacterial ear infections.

Clinical diagnoses of patients showing caloric inversion.

OBJECTIVES: When air irrigation is used for caloric stimulation in patients with a perforated ear, warm irrigation may elicit a nystagmus that initially beats in the opposite direction of what is expected for warm irrigations, which is referred to as "caloric inversion". This study aimed to investigate the disease group in which caloric inversion appeared in patients who underwent caloric testing and to classify the patterns of caloric inversion. METHODS: We conducted a retrospective review of bithermal caloric test results that were collected in our dizziness clinic between 2005 and 2022. Caloric inversion was defined when nystagmus induced by caloric stimulation appeared in the opposite direction to that expected. The incidence of caloric inversion among all patients who underwent bithermal caloric tests was calculated. To confirm the clinical diagnoses of the patients with caloric inversion, their clinical records were reviewed. RESULTS: Out of 9923 patients who underwent bithermal caloric tests, 29 patients (0.29%) showed a caloric inversion. The most common clinical diagnosis was chronic otitis media (21 of 29, 72%). Of the 21 patients with chronic otitis media, 20 patients showed a caloric inversion by warm air irrigation and one patient showed caloric inversion by cold air stimulation. Patients with clinical diagnoses other than chronic otitis media such as sudden sensorineural hearing loss, benign paroxysmal vertigo of childhood and recurrent vestibulopathy showed caloric inversion by warm air irrigation. Caloric inversion by warm water irrigation was observed in patients with lateral semicircular canal cupulopathy and recurrent vestibulopathy. Two patients (one with Meniere's disease and one with age-related dizziness) showed caloric inversion by cold water irrigation. CONCLUSION: Caloric inversion can be observed in various diseases other than chronic otitis media with tympanic membrane perforation. Special care should be taken in the interpretation of caloric test results. LEVEL OF EVIDENCE: Level 4.

Clinical diagnoses of patients showing caloric inversion

Abstract Objectives When air irrigation is used for caloric stimulation in patients with a perforated ear, warm irrigation may elicit a nystagmus that initially beats in the opposite direction of what is expected for warm irrigations, which is referred to as "caloric inversion". This study aimed to investigate the disease group in which caloric inversion appeared in patients who underwent caloric testing and to classify the patterns of caloric inversion. Methods We conducted a retrospective review of bithermal caloric test results that were collected in our dizziness clinic between 2005 and 2022. Caloric inversion was defined when nystagmus induced by caloric stimulation appeared in the opposite direction to that expected. The incidence of caloric inversion among all patients who underwent bithermal caloric tests was calculated. To confirm the clinical diagnoses of the patients with caloric inversion, their clinical records were reviewed. Results Out of 9923 patients who underwent bithermal caloric tests, 29 patients (0.29%) showed a caloric inversion. The most common clinical diagnosis was chronic otitis media (21 of 29, 72%). Of the 21 patients with chronic otitis media, 20 patients showed a caloric inversion by warm air irrigation and one patient showed caloric inversion by cold air stimulation. Patients with clinical diagnoses other than chronic otitis media such as sudden sensorineural hearing loss, benign paroxysmal vertigo of childhood and recurrent vestibulopathy showed caloric inversion by warm air irrigation. Caloric inversion by warm water irrigation was observed in patients with lateral semicircular canal cupulopathy and recurrent vestibulopathy. Two patients (one with Meniere's disease and one with age-related dizziness) showed caloric inversion by cold water irrigation. Conclusion Caloric inversion can be observed in various diseases other than chronic otitis media with tympanic membrane perforation. Special care should be taken in the interpretation of caloric test results. Level of Evidence: Level 4.

[Actinomyces europaeus (Gleimia europaea) associated with brain abscess: A report of three cases]. / Actinomyces europaeus (Gleimia europaea) asociado con absceso cerebral: comunicación de tres casos.

A brain abscess is a focal infection characterized by a collection of pus in the brain parenchyma. It is a life-threatening condition that should be diagnosed and treated as soon as possible. We report here three cases of patients with otogenic brain abscesses of polymicrobial origin that had in common the isolation of Actinomyces europaeus, which has not been previously described in this location. A. europaeus was identified by the conventional methodology, matrix-associated laser deionization-time of flight mass spectrometry (MALDI-TOF MS) and 16S rRNA gene sequencing. Antibiotic susceptibility was evaluated by the epsilometric method, and all isolates showed sensitivity to penicillin, vancomycin and linezolid, whereas susceptibility to clindamycin and erythromycin was variable. MALDI-TOF MS identification allowed a quick and reliable species level identification in order to provide a rapid and effective response to avoid treatment delay that could lead to increased morbidity and even mortality.

Mongolian Gerbils as a Model for the Study of Cholesteatoma: Otoendoscopic as a Diagnostic Tool

Abstract Introduction Cholesteatoma is a disease with significant clinical impact but is incompletely understood. The challenge of performing studies with long-term follow-up in humans is a factor that has restricted the advance of knowledge in this field. Thus, the use of animal models is highly pertinent, and the Mongolian gerbil model has emerged as one of the most useful. Objective The present study aims to evaluate, through serial otoendoscopies, the development and characteristics of pars flaccida retraction pocket and cholesteatoma in Mongolian gerbils after obliteration of the eustachian tube and compare it with the control group. Methods Forty Mongolian gerbils were divided into two groups of 20 animals each. In the intervention group, the animals were followed with serial otoendoscopies after eustachian tube obliteration. In the control group, the animals were only followed through serial otoendoscopies. Results At the end of the 16-week follow-up, cholesteatoma was present in 13 of 38 (34.2%) ears in the intervention group, and in 7 of 34 (20.6%) in the control group (p = 0.197). When we considered cholesteatoma and its potential precursor, pars flaccida retraction pocket, in a combined way, we verified it in 23 of 38 (60.8%) in the intervention group and in 11 of 34 (32.3%) in the control group (p = 0.016). Conclusions Over the 16 weeks of follow-up, serial otoendoscopies enabled us to evaluate the formation and development of pars flaccida retraction pockets and cholesteatomas in Mongolian gerbils and proved to be an excellent diagnostic tool.

Concordancia entre hallazgos radiológicos y quirúrgicos en pacientes sometidos a mastoidectomía / Concordance between radiological and surgical findings in patients undergoing mastoidectomy

Introducción: Existe gran controversia acerca de los signos radiológicos de la patología de oído medio y su relación con la extensión real de la patología que nos sugiera decidir un comportamiento determinado. Objetivo: establecer la concordancia entre los hallazgos radiológicos y quirúrgicos encontrados en pacientes sometidos a mastoidectomía. Material y Método: Diseño observacional descriptivo de corte transversal de prueba diagnóstica. Se revisó fichas clínicas y se especificó el tipo de cirugía junto con los hallazgos intra-quirúrgicos. Resultados: se observó erosión de la cadena osicular intraoperatoria en 75 pacientes, 63 predichos correctamente por tomografía computada (TC), con sensibilidad del 84% y especificidad del 94% (k = 0,625). Se detectó erosión del tegmen tympani en nueve pacientes por TC de los 10, con un VPP = 90% y un VPN = 95% (k = 0,809). Hubo sospecha de erosión del canal semicircular lateral en cinco pacientes y se encontró dehiscencias intraoperatorias en 12, sin falsos positivos (k = 0,554). La TC detectó dehiscencia del canal del nervio facial con sensibilidad del 55% y especificidad del 98% (k = 0,636). Conclusión: Los resultados sugieren que la TC preoperatoria con evidencia radiológica de erosión osicular tiene una buena a muy buena concordancia con los hallazgos intraoperatorios.

Introduction: There is a great controversy about the radiological signs of middle ear pathology and its relation with the real extension of the pathology that suggests us to decide a certain medical choice. Aim: To establish concordance between radiological and surgical findings in patients submitted to mastoidectomy. Material and Method: An observational and descriptive design of retrospective cross-sectional diagnostic test. Clinical records were reviewed to specify the type of surgery and intraoperative findings. Results: Intraoperative ossicular chain erosion was observed in 75 patients, 63 were correctly predicted by computed tomography (CT), with a sensitivity of 84% and specificity of 94% (k = 0.625). Tegmen tympani erosion was detected by CT in 9 patients out of 10, with a PPV = 90% and NPV = 95% (k = 0.809). There was suspected lateral semicircular canal erosion in 5 patients and intraoperative dehiscence was found in 12, with no false positives (k = 0.554). CT detected facial nerve canal dehiscence with sensitivity of 55% and specificity of 98% (k = 0.636). Conclusion: The results suggest that preoperative CT with radiological evidence of ossicular erosion has good to very good agreement with intraoperative findings.

Mongolian Gerbils as a Model for the Study of Cholesteatoma: Otoendoscopic as a Diagnostic Tool.

Introduction Cholesteatoma is a disease with significant clinical impact but is incompletely understood. The challenge of performing studies with long-term follow-up in humans is a factor that has restricted the advance of knowledge in this field. Thus, the use of animal models is highly pertinent, and the Mongolian gerbil model has emerged as one of the most useful. Objective The present study aims to evaluate, through serial otoendoscopies, the development and characteristics of pars flaccida retraction pocket and cholesteatoma in Mongolian gerbils after obliteration of the eustachian tube and compare it with the control group. Methods Forty Mongolian gerbils were divided into two groups of 20 animals each. In the intervention group, the animals were followed with serial otoendoscopies after eustachian tube obliteration. In the control group, the animals were only followed through serial otoendoscopies. Results At the end of the 16-week follow-up, cholesteatoma was present in 13 of 38 (34.2%) ears in the intervention group, and in 7 of 34 (20.6%) in the control group ( p = 0.197). When we considered cholesteatoma and its potential precursor, pars flaccida retraction pocket, in a combined way, we verified it in 23 of 38 (60.8%) in the intervention group and in 11 of 34 (32.3%) in the control group ( p = 0.016). Conclusions Over the 16 weeks of follow-up, serial otoendoscopies enabled us to evaluate the formation and development of pars flaccida retraction pockets and cholesteatomas in Mongolian gerbils and proved to be an excellent diagnostic tool.

Timpanoplastías en el Hospital San Vicente de Arauco: Revisión de 3 años / Tympanoplasties in San Vicente de Arauco Hospital: 3 years review

Resumen Introducción: La timpanoplastía es el tratamiento de elección en la otitis media crónica simple. En Chile se han realizado diversos estudios para evaluar el éxito de la timpanoplastía. En nuestro centro evaluamos el resultado anatómico y funcional, correlacionando los resultados con la demografía de nuestra población. Objetivo: Realizar una descripción epidemiológica de los pacientes con diagnóstico de otitis media crónica simple, sometidos a timpanoplastía en el Hospital San Vicente de Arauco entre los años 2017 y 2019. Material y Método: Estudio retrospectivo y descriptivo. Se revisaron las fichas clínicas de pacientes con cirugía realizada entre enero de 2017 y noviembre de 2019. Este estudio cuenta con la aprobación del comité de ética del servicio de salud Arauco. Resultados: Se realizaron 77 timpanoplastías. 56 oídos cumplieron los criterios de inclusión. 71,43% fueron de sexo femenino. El rango de edad es de 8 a 64 años. 92,86% corresponde a timpanoplastía tipo I. Se utilizó un abordaje endoauricular en el 58,93%. El injerto utilizado fue predominantemente compuesto (cartílago-pericondrio) en un 75%. Se usó una técnica medial en un 94,94%. Se obtuvo un éxito anatómico 85,71% de los pacientes. Se obtuvo una ganancia sobre 10 dB en un 60,71% de los pacientes. Conclusión: No se encontraron diferencias significativas importantes que relacionan las elecciones quirúrgicas con los resultados anatómicos y auditivos del procedimiento a mediano plazo.

Abstract Introduction: Tympanoplasty is the treatment of choice for chronic otitis media. In Chile, several studies have been carried out to evaluate the success of tympanoplasty. Here, we assesed the anatomical and functional outcomes, correlating the results with the demographics of our population. Aim: To carry out an epidemiological description of patients with a diagnosis of chronic otitis media who underwent tympanoplasty at our hospital between 2017 and 2019. Material and Method: Retrospective, descriptive study. We reviewed clinical records of patients who underwent surgery between January 2017 and November 2019. This study has been approved by the ethics committee of Arauco health service. Results: 77 tympanoplasties were performed, of which 56 ears met the inclusion criteria. 71.43% were female. The age range is 8 to 64 years. 41% had chronic pathologies. 51.79% were left ear surgeries. 92.86% were type I tympanoplasty. An endoauricular approach was performed in 58.93%. A cartilage - perichondrium composite graft was used in 75% of the surgeries. A medial technique was performed in 94.94%. Anatomical success was achieved in 85.71% of patients. An average gain over 10 dB was obtained in 60.71% of the patients. Conclusion: There were no significant differences regarding the surgical choices with the anatomical and auditory results.

Tympanic Membrane Retractions in patients with Williams Syndrome: A Controlled Study

Abstract Introduction The role of elastin in tympanic retractions and chronic otitis media is not well established. Williams Syndrome (WS), a pathology related to a mutation in the elastin gene, could generate tympanic retractions. Objective To compare the prevalence of tympanic retractions among patients with WS and controls. Methods WS patients (n= 43 ears) and controls (n= 130 ears) were evaluated by digital otoscopic examination and the degree of tympanic membrane retraction was classified by 2 blinded experienced otolaryngologists. Results The agreement rate between the evaluators was 71.1% for pars tensa and 65% for pars flaccida retraction (p< 0.001). The pars tensa and pars flaccida retractions are present in patients with WS after an adjusted residue of respectively - 2.8 and - 2.6 (p= 0.011 and p= 0.022) compared with controls. Conclusions Tympanic membrane retractions are not more common in the WS group when compared with controls.

Tympanic Membrane Retractions in patients with Williams Syndrome: A Controlled Study.

Introduction The role of elastin in tympanic retractions and chronic otitis media is not well established. Williams Syndrome (WS), a pathology related to a mutation in the elastin gene, could generate tympanic retractions. Objective To compare the prevalence of tympanic retractions among patients with WS and controls. Methods WS patients ( n = 43 ears) and controls ( n = 130 ears) were evaluated by digital otoscopic examination and the degree of tympanic membrane retraction was classified by 2 blinded experienced otolaryngologists. Results The agreement rate between the evaluators was 71.1% for pars tensa and 65% for pars flaccida retraction ( p < 0.001). The pars tensa and pars flaccida retractions are present in patients with WS after an adjusted residue of respectively - 2.8 and - 2.6 ( p = 0.011 and p = 0.022) compared with controls. Conclusions Tympanic membrane retractions are not more common in the WS group when compared with controls.

Mastoid obliteration and reconstruction techniques: A review of the literature.

OBJECTIVE: To review the published literature related to the different obliteration and reconstruction techniques in the management of the canal wall down mastoidectomy. METHODS: A PubMed (Medline) and LILACS databases as well as crossed references search was performed with the following Mesh terms: "cholesteatoma", "cholesteatoma-middle ear", "otitis media", "otitis media, suppurative", "mastoiditis", "mastoidectomy", "canal wall down mastoidectomy", "radical mastoidectomy", "mastoid obliteration" and crossed references. Inclusion criteria were adult patients subject to mastoid cavity obliteration and posterior canal wall reconstruction. The technique and materials used, anatomic and functional results, complications, recurrence rates, and changes in quality of life, were analyzed. A total of 94 articles were screened, 38 were included for full-text detailed review. RESULTS: Twenty-one articles fulfilled the inclusion criteria. Techniques and materials used for canal wall reconstruction, tympanoplasty, and ossiculoplasty were varied and included autologous, biosynthetic, or both. Auditory results were reported in 16 studies and were inconsistent. Three studies reported improvement in the quality of life using the GBI scale. Follow-up time ranged from 1 to 83 months. Eleven articles used imaging studies to evaluate postoperative disease recurrence. The highest recurrence rate reported for cholesteatoma after obliteration was 19%. The most frequently reported complications were retraction pockets and transient otorrhea. CONCLUSION: Plenty of techniques combining grafts and other materials have been used to overcome mastoidectomy cavity problems. So far, it is still not possible to standardize an ideal procedure. The available level of evidence for this topic is low and limited.

Análisis de tratamiento de la otitis media crónica simple con miringoplastía en el Hospital Barros Luco Trudeau

Resumen Introducción: La otitis media crónica simple (OMC) es una patología común en nuestra población y hasta la fecha no queda bien claro cuál técnica y material de injerto da mejores resultados. Objetivo: Determinar si existen diferencias en los resultados anatómicos y funcionales al utilizar fascia de músculo temporal (FMT) versus injerto de cartílago de trago (CT) en los pacientes con OMC en que se les realizó miringoplastía en el Hospital Barros Luco Trudeau. Material y Método: Estudio de cohorte no concurrente de datos obtenidos de la revisión de fichas clínicas. Resultados: De 227 fichas, 154 cumplieron criterios de inclusión. En 102 pacientes (66%) se utilizó FMT y en 52 pacientes (34%) CT. Con FMT 38 presentaron reperforación (37%) y 41 presentaron un éxito funcional (40%). Con CT 18 presentaron reperforación (35%) y 22 presentaron un éxito funcional (42%). 38 pacientes presentaban antecedente de tabaquismo activo y de ellos 53% presentaron reperforación, mientras que de los sin antecedentes de tabaquismo solo un 31%, siendo esta diferencia estadísticamente significativa (p < 0,05). Conclusión: No se obtuvieron diferencias estadísticamente significativas entre los resultados anatómicos y funcionales comparando el uso de injerto FMT y CT para el tratamiento quirúrgico de la OMC simple con miringoplastía.

Abstract Introduction: Simple chronic otitis media (COM) is a common pathology in our population, and it is currently unclear, which grafts technique and material gives the best results. Aim: To determine if there are differences in the anatomical and functional results, when using temporal muscle fascia (FMT) or tragus cartilage graft (CT) in patients with COM who underwent myringoplasty at the Barros Luco Trudeau Hospital. Material and Method: Retrospective analytical cohort study of data obtained from clinical records. Results: Of 227 medical records, 154 met inclusion criteria. FMT was used in 102 patients (66%) and CT in 52 patients (34%). With FMT, 38 had reperforation (37%) and 41 had functional success (40%). With CT 18 had reperforation (35%) and 22 had functional success (42%). 38 patients had a history of active smoking and 53% of them presented reperforation, while of those without a history of smoking only 31%, this difference being statistically significant (p < 0,05). Conclusion: No statistically significant differences were obtained when analyzing the anatomical and functional results comparing the use of FMT and CT graft, for the simple surgical treatment of COM with myringoplasty.

Audiological Outcome in Myringoplasties with an Intact Ossicular Chain: Is there a Difference between Chronic Otitis with or without Cholesteatoma?

Introduction Chronic otitis media (COM) with a central perforation or a concomitant cholesteatoma are both inflammatory lesions, however, with different etiologies. Both entities may present with an intact chain, and the final reconstruction is quite similar. Does it also apply for the hearing outcome? Objectives In a retrospective analysis, we investigated the preoperative hearing and the final hearing outcome of two groups of patients: those with COM and those with cholesteatoma, and compared various factors. Methods Patients operated between 2010 and 2019 were entered prospectively into a research database, and the integrity of the ossicular chain, the extent of the cholesteatoma, and the findings on computed tomography (CT) scans were retrospectively analyzed and correlated to the final hearing outcome. Results Out of 210 tympanoplasties for COM, 162 (80%) presented with an intact chain, and 85 (40%) ears could be analyzed. Out of 283 cholesteatoma surgeries, 53 (19%) ears presented with an intact chain. The preoperative air-bone gap (ABG) was worse in the COM group, but the postoperative ABG over the frequencies of 0.5 kHz and 4 kHz was the same (10 dB to 12 dB) in both groups, and remained within 20 dB in 90% (40 and 78 patients, respectively). The extension of the disease was rather limited in the cholesteatoma group (stages Ch1a and 1b), and better pneumatization and ventilation were beneficial for a good result. Postoperatively, the frequency of 4 kHz had the largest ABG (14 dB and 18 dB). Conclusion Overall, 80% of the patients with COM and less than 20% of those with cholesteatoma had an intact and mobile chain at surgery. Using equivalent surgical techniques for the tympanoplasty, the final outcome was almost the same for both groups, with a mean ABG of 10 dB to 12 dB.

Prevalence of middle ear disease in Chilean natives and the impact of development over 14 years / Prevalência de doenças da orelha média em nativos chilenos e o impacto do desenvolvimento ao longo de 14 anos

Abstract Introduction The 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. Objective To 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 methods Two 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. Results A 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). Conclusions Despite 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.

Resumo Introdução A prevalência de doenças da orelha média e seus fatores de risco já foram objeto de múltiplos estudos. A alta prevalência dessas doenças foi descrita entre os nativos da América do Norte, principalmente a otite média crônica. Tais estudos não foram feitos na América do Sul. Objetivo Descrever a prevalência de doenças da orelha média e fatores de risco em crianças de idade escolar, nativos do sul do Chile pertencentes à etnia Mapuche, bem como o impacto de mudanças socioeconômicas e demográficas após 14 anos de desenvolvimento. Método Foram feitas duas avaliações otológicas com intervalo de 14 anos em escolares com percentual da população indígena acima de 85%. Dados socioeconômicos e demográficos foram coletados a partir de dados estatísticos oficiais nacionais. Resultados Foram examinados 1.067 escolares. Foram encontrados diversos fatores de risco descritos para doença otológica. Foi encontrada uma prevalência geral de 0,19% para perfuração da membrana timpânica, 5,6% para retrações da pars tensa, 1,5% para retração da pars flácida e 11,1% de otite média com efusão. Houve várias melhorias socioeconômicas após 14 anos. A diferença entre a prevalência de sintomas e a presença de otite média com efusão foi estatisticamente significante (p < 0,001). Conclusões Apesar da presença de vários fatores de risco para doença da orelha média, a população estudada apresentou baixa prevalência da doença. O fator étnico parece ser protetor.

Audiological Outcome in Myringoplasties with an Intact Ossicular Chain: Is there a Difference between Chronic Otitis with or without Cholesteatoma?

Abstract Introduction Chronic otitis media (COM) with a central perforation or a concomitant cholesteatoma are both inflammatory lesions, however, with different etiologies. Both entities may present with an intact chain, and the final reconstruction is quite similar. Does it also apply for the hearing outcome? Objectives In a retrospective analysis, we investigated the preoperative hearing and the final hearing outcome of two groups of patients: those with COM and those with cholesteatoma, and compared various factors. Methods Patients operated between 2010 and 2019 were entered prospectively into a research database, and the integrity of the ossicular chain, the extent of the cholesteatoma, and the findings on computed tomography (CT) scans were retrospectively analyzed and correlated to the final hearing outcome. Results Out of 210 tympanoplasties for COM, 162 (80%) presented with an intact chain, and 85 (40%) ears could be analyzed. Out of 283 cholesteatoma surgeries, 53 (19%) ears presented with an intact chain. The preoperative air-bone gap (ABG) was worse in the COM group, but the postoperative ABG over the frequencies of 0.5 kHz and 4 kHz was the same (10 dB to 12 dB) in both groups, and remained within 20 dB in 90% (40 and 78 patients, respectively). The extension of the disease was rather limited in the cholesteatoma group (stages Ch1a and 1b), and better pneumatization and ventilation were beneficial for a good result. Postoperatively, the frequency of 4 kHz had the largest ABG (14 dB and 18 dB). Conclusion Overall, 80% of the patients with COM and less than 20% of those with cholesteatoma had an intact and mobile chain at surgery. Using equivalent surgical techniques for the tympanoplasty, the final outcome was almost the same for both groups, with a mean ABG of 10 dB to 12 dB.

Actinomicosis en el hueso temporal. Reporte de un caso pediátrico / Actinomycosis in temporal bone. A pediatric case report

La actinomicosis es una infección causada por un bacilo anaerobio Gram-positivo, filamentoso, ramificado, no esporulado. Integra la flora habitual de la orofaringe y coloniza transitoriamente el tracto gastrointestinal, genital femenino y el árbol bronquial. Es poco frecuente en el hueso temporal. Por su semejanza a un hongo, es difícil su reconocimiento, lo que hace necesaria la sospecha clínica para obtener los cultivos apropiados en condiciones anaeróbicas en forma prolongada. Los hallazgos microscópicos típicos incluyen necrosis con gránulos de azufre amarillento y la presencia de filamentos que se asemejan a infecciones fúngicas. El tratamiento requiere de elevadas y prolongadas dosis de antibiótico con penicilina o amoxicilina, entre 6 y 12 meses. La duración de la terapia antimicrobiana podría ser reducida en pacientes que han sido operados quirúrgicamente. Se presenta, a continuación, un caso clínico de actinomicosis en el hueso temporal en un paciente pediátrico que requirió tratamiento quirúrgico para su resolución.

Actinomycosis is an infection caused by a Gram-positive, filamentous anaerobic bacillus. Mainly belonging to the human commensal flora of the oropharynx, it normally colonizes the human digestive and genital tracts and the bronchial tree. It is slightly frequent in the temporal bone. Bacterial cultures and pathology are the cornerstone of diagnosis, but particular conditions are required in order to get the correct diagnosis. Prolonged bacterial cultures in anaerobic conditions are necessary to identify the bacterium and typical microscopic findings include necrosis with yellowish sulfur granules and filamentous Gram-positive fungal-like pathogens. Patients with actinomycosis require prolonged (6- to 12-month) high doses of penicillin G or amoxicillin, but the duration of antimicrobial therapy could probably be shortened in patients in whom optimal surgical resection of infected tissues has been performed. A pediatric patient with actinomycosis in temporal bone who needed surgery resolution is reported.

[Actinomycosis in temporal bone. A pediatric case report]. / Actinomicosis en el hueso temporal. Reporte de un caso pediátrico.

Actinomycosis is an infection caused by a Gram-positive, filamentous anaerobic bacillus. Mainly belonging to the human commensal flora of the oropharynx, it normally colonizes the human digestive and genital tracts and the bronchial tree. It is slightly frequent in the temporal bone. Bacterial cultures and pathology are the cornerstone of diagnosis, but particular conditions are required in order to get the correct diagnosis. Prolonged bacterial cultures in anaerobic conditions are necessary to identify the bacterium and typical microscopic findings include necrosis with yellowish sulfur granules and filamentous Gram-positive fungal-like pathogens. Patients with actinomycosis require prolonged (6- to 12-month) high doses of penicillin G or amoxicillin, but the duration of antimicrobial therapy could probably be shortened in patients in whom optimal surgical resection of infected tissues has been performed. A pediatric patient with actinomycosis in temporal bone who needed surgery resolution is reported.

La actinomicosis es una infección causada por un bacilo anaerobio Gram-positivo, filamentoso, ramificado, no esporulado. Integra la flora habitual de la orofaringe y coloniza transitoriamente el tracto gastrointestinal, genital femenino y el árbol bronquial. Es poco frecuente en el hueso temporal. Por su semejanza a un hongo, es difícil su reconocimiento, lo que hace necesaria la sospecha clínica para obtener los cultivos apropiados en condiciones anaeróbicas en forma prolongada. Los hallazgos microscópicos típicos incluyen necrosis con gránulos de azufre amarillento y la presencia de filamentos que se asemejan a infecciones fúngicas. El tratamiento requiere de elevadas y prolongadas dosis de antibiótico con penicilina o amoxicilina, entre 6 y 12 meses. La duración de la terapia antimicrobiana podría ser reducida en pacientes que han sido operados quirúrgicamente. Se presenta, a continuación, un caso clínico de actinomicosis en el hueso temporal en un paciente pediátrico que requirió tratamiento quirúrgico para su resolución.

Colesteatoma de oído con complicación intracraneana en contexto de pandemia COVID-19: Reporte de caso clínico y revisión de literatura

Resumen La otitis media crónica colesteatomatosa (OMCC) complicada es una condición inusual en la época actual. Clásicamente las complicaciones se han clasificado en extracraneales e intracraneales. Estas últimas suponen un alto riesgo para los pacientes debido a la alta morbimortalidad y las secuelas neurológicas asociadas. La atención médica oportuna y derivación a otorrinolaringología junto con las medidas preventivas en edad pediátrica han disminuido la incidencia de los colesteatomas y sus complicaciones. Se presenta a continuación el caso de una paciente de 50 años, atendida en el Hospital Guillermo Grant Benavente de Concepción (Chile) por cuadro de OMCC complicada con meningoencefalitis y vasculitis infecciosa sin consulta precoz por contexto de pandemia COVID-19. Se expone metodología diagnóstica y manejo terapéutico.

Abstract Complicated chronic cholesteatomatous media otitis (CCMO) is an unusual condition nowadays. Complications have traditionally been classified as extracranial and intracranial. The last one entails a higher risk for patients due to high morbi-mortality and neurological consequences associated. Suitable medical care and otorhinolaryngological attention among with preventive measures in pediatric age have decreased the incidence of cholesteatomas and their complications. The following, is the case of a 50-year-old patient treated for CCMO at Guillermo Grant Benavente Hospital in Concepcion (Chile) complicated due to meningoencephalitis and infectious vasculitis without early diagnose due to COVID-19 pandemic. Diagnostic methodology and therapeutic management are exposed.

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

INTRODUCTION: The 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. OBJECTIVE: To 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 METHODS: Two 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. RESULTS: A 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). CONCLUSIONS: Despite 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.