Classification and management challenges of otitis media in a resource-poor country

The clinical features and sequelae of otitis media (OM) vary depending on the duration, severity and progression of the disease. As a result, opinions on the modes of classification and management protocols have differed over the years. The need to critically appraise these opinions according to the peculiarities of each region is imperative. This work was aimed at reviewing the world literature on the subject and also highlights the limitations in management in our region. A wide literature search was conducted using the following search engines: PubMed, AJOL and University of Toronto Library. Also incorporated were essential materials obtained from the authors’ clinical practices. The search engines returned 22,903 related articles on OM. Further filtration yielded 88 articles on “classification and management” and these were obtained in full and thoroughly read. Extracted materials for review spanned between 1980 and 2008. OM is prevalent the world over with potentially severe complications if inadequately managed, especially in the developing countries. It is of note that in the developing countries, poverty, ignorance, dearth of specialists and limited access to medical care amongst others conspire to worsen the course and complications of OM

Complications of chronic otitis media and their management: a study at tertiary care centre

Background: Chronic otitis media is a disease associated with complications. Due to ignorance, poor literacy and late presentation the management becomes challenging and difficult. The aim is to find the incidence of complications of COM and their management. Methods: This is a hospital based observational study carried out on 50 patients with COM admitted in the Department of Otorhinolaryngology of a tertiary care centre during a period of 1 year. Results: Out of 50 patients, 19 cases of safe COM and 31 of unsafe COM. 31% of safe COM patients had complications with 100% extracranial complication (mastoiditis). 45% of unsafe COM had complications, where most common extracranial complication was mastoiditis and intracranial complication was brain abscess. Complications were more common in the age group of 21-30 years. In all the patients, multiple intravenous antibiotics were given covering gram positive, gram negative and anaerobic organisms. The intracranial complications were initially managed by neurosurgery or neurology followed by disease eradication at source. 2 mortalities were seen in cases with intracranial complication due to late presentation. Conclusions: The complications of COM still pose a great challenge. Late presentation leads to difficulty in management and consequently higher mortality. This study mainly emphasizes the importance of early diagnosis and prompt treatment to avoid complications

Review of patients with chronic suppurative otitis media in the National Ear care centre, Kaduna Nigeria.

Chronic suppurative otitis media (CSOM) is the most common condition presenting to Otolaryngological clinics, often patients present late with consequent complications that require surgical intervention. This study aimed to review the mode of clinical presentation, modality and outcome of treatment of CSOM seen at NECC Kaduna. Methodology:This was a retrospective study carried out in the National Ear Care Centre, Kaduna for a period of 3 years; from January 2016 - December 2018. Results: Two hundred and thirty-four patients with CSOM were studied. There were 127 males and 107 females making M: F =1.2:1. The age range was from 8-60years with a mean age of 26.5±12.6years. The age group 11-20 (31.2%) had the highest number. Majority presented with hearing loss and ear discharge 228(97.4%) and 182(77.8%) respectively. Other symptoms were otalgia, tinnitus, vertigo and nasal symptoms. Eleven (4.7%) had complications at presentation. Ninety-two (39.3%) had surgery, 64 had only aural toileting and dressing with topical antibiotic with recorded success as majority achieved dry ear, while 38 patients were lost to follow up. Postoperative complications include; loss of taste sensation, facial nerve palsy, recurrent/persistent ear discharge, persistent dizziness, and infection of the donor site and no mortality was recorded. Conclusion: One-third of the patients who benefitted from surgery had a good outcome and for those with conservative treatment, the majority achieved dry ear. Early presentation is advised to avoid complications

Intratemporal complications of otitis media

Otitis media (OM) is considered a potentially severe disease due to the risk of complications. OBJECTIVE: To establish the annual incidence of intratemporal complications (ITC) resulting from OM and to prospectively assess patients for epidemiological and clinical factors. METHOD: This prospective cohort study included patients admitted during one year at a university hospital diagnosed with intratemporal complications of OM. Patients were analyzed for age, gender, type of intratemporal complication, treatment, and clinical outcome. The overall incidence of complications and the specific incidence rates of each type of complication were determined. RESULTS: 1,816 patients were diagnosed with OM; 592 (33%) had chronic OM; 1224 (67%) had acute OM. Fifteen patients were diagnosed with OM ITC, adding up to an annual incidence of 0.8%. Nineteen diagnoses of ITC were made in 15 patients. Seven (36.8%) patients were diagnosed with labyrinthine fistula, five (26.3%) with mastoiditis, four (21.1%) with peripheral facial palsy, and three (15.8%) with labyrinthitis. CONCLUSION: The incidence of intratemporal complications remains significant when compared to the rates seen in developed countries. Chronic cholesteatomatous otitis media is the most frequent etiology of intratemporal complications. Labyrinthine fistula is the most common intratemporal complication.Otite média (OM) é considerada doença potencialmente grave em razão dos riscos de complicações que podem ocorrer em sua evolução. OBJETIVO: Estabelecer a incidência anual de complicações intratemporais de OM e avaliar prospectivamente os pacientes por meio da análise dos aspectos epidemiológicos e clínicos. MÉTODO: Estudo de coorte contemporânea. Durante o período de um ano, os pacientes admitidos em um Hospital Universitário, com diagnóstico de OM e de complicação intratemporal (CIT) de OM foram incluídos no estudo. Os dados avaliados foram: idade, sexo, tipo de complicação intratemporal, tratamento e desfecho clínico. A incidência geral das complicações e de cada complicação foi determinada. RESULTADOS: 1.816 pacientes foram diagnosticados com OM. Em 592 (33%) indivíduos, o diagnóstico foi de otite média crônica; em 1224 (67%) o diagnóstico foi de otite média aguda. CIT de OM foi diagnosticada em 15 pacientes, perfazendo uma incidência anual de CIT 0,8%. Foram identificados 19 diagnósticos de CIT em 15 pacientes. Fístula labiríntica foi diagnosticada em sete (36,8%) indivíduos, mastoidite em cinco (26,3%), paralisia facial periférica em quatro (21,1%) e labirintite em três (15,8%). CONCLUSÃO: A incidência das complicações intratemporais permanece significativa quando comparada à de países desenvolvidos. A otite média crônica colesteatomatosa é a etiologia mais frequente das complicações intratemporais. A fístula labiríntica é a complicação intratemporal mais comum.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)UNIFESP-EPM Departamento de OtorrinolaringologiaUNIFESP-EPMUNIFESP, EPM, Depto. de OtorrinolaringologiaUNIFESP, EPMSciEL

Correlation between HRCT Temporal Bone Findings and Surgical Findings in Patients with Chronic Suppurative Otitis Media

INTRODUCTION: Chronic otitis media [COM] is an inflammation of the middle ear cleft of long duration. It involves inflammation of the mastoid air cell system also due to its anatomical connection to the middle ear. Due to the location of the tympanomastoid compartment, separated from the middle and posterior cranial fossae by thin bony partitions, otitis media has the potential for intracranial extension. So it is very important to know the location and extent of the disease before planning surgical management. Radiological examination of the temporal bone helps us to achieve this objective. The various modalities of temporal bone imaging are conventional radiography, CT scan and MRI. The petrous temporal bone is a complex structure containing the middle and inner ear and various contained structures like the ossicles. This challenges the limits of resolution by imaging techniques. Good spatial resolution by imaging to allow adequate demonstration of these bony structures in the middle and inner ears has made management of otitis media much simpler these days. AIMS AND OBJECTIVES OF THE STUDY: 1. To study the findings of HRCT temporal bone in patients with chronic otitis media with and without cholesteatoma. 2. To evaluate the extent of pathological process and sites of involvement of the middle ear and the mastoid air cell system in these patients. 3. To study the relationship of the tympanomastoid compartment to the adjacent , critical neurovascular structures. 4. To evaluate the results of our study and compare with similarly published studies. MATERIALS AND METHODS: The present work was undertaken to study the radiological findings of temporal bone in patients diagnosed as having chronic otitis media at Government Rajaji Hospital attached to the department of ENT, Madurai Medical College, Madurai between December 2011 and November 2012. Methods of collection of data: Sample size: A minimum of 50 patients were enrolled for the study. 50 patients with Chronic otitis media presenting to ENT outpatient department at Government Rajaji Hospital attached to Madurai Medical College were taken up for study. As soon as the patient presented to the hospital, detailed clinical history and examination were carried out as per the proforma prepared. Laboratory investigations were done. All patients were subjected to HRCT temporal bones, 1mm axial and coronal slices. Once the radiological findings were noted and extent of disease established, management was done accordingly. Inclusion Criteria: 50 patients of both sexes and all age groups presenting with chronic otitis media. Exclusion criteria: 1. Patients with previous surgery for chronic otitis media were excluded. 2. Chronic otitis media requiring MRI and, 3. Patients with a history of prior temporal bone trauma were excluded. All patients entering the present study underwent certain investigations. CONCLUSION: Chronic suppurative otitis media is a disease entity that an otorhinolaryngologist encounters frequently in his day to day practice. HRCT temporal bones is emerging as an imaging tool that would guide the surgeon regarding the extent and location of the pathology in these patients such that the appropriate line of management can be chalked out in the mind of the treating surgeon. The study conducted at our centre regarding the role of CT temporal bones in patients with CSOM with respect to the variables like ossicular erosion- malleus handle, malleus head, incus; facial canal dehiscence, LSCC erosion, mastoid cortex dehiscence, cholesteatoma, and anatomical variants like Korner‟s septum, high jugular bulb and forward lying sigmoid sinus were as follows. It showed excellent correlation for anatomical variantions like Korner‟s septum, anteriorly placed sigmoid sinus; good correlation for ossicular destruction – incus being the most commonly eroded ossicle. A moderate correlation was seen in cases of diagnosis of cholesteatoma on CT and on table. CT was found to be more accurate in detection of atticoantral pathology when there were associated changes of bony destruction. CT temporal bones was not found to be so reliable for predicting facial canal dehiscence and lateral semicircular canal dehiscence due to the partial averaging effects of the imaging modality. HRCT temporal bones is a useful preoperative tool in patients who present with chronic suppurative otitis media due to - Its ability to demonstrate fine bony details, - delineation of important adjacent anatomical structures and avoid inadvertent injury, - plan the surgical approach, - detect complications, - aids in good and effective surgical clearance

Chronically discharging ears : evalution with high resolution computed tomography

Chronic suppurative otitis media (CSOM) refers to the middle ear inflammation which is clinically characterized by the discharging ear, hearing deficit, fever and otalgia. Although a clinical diagnosis, imaging is imperative to rule out associated complications which apart from causing hearing deficit, may prove fatal at times. Both high resolution computed tomography (HRCT) and MRI are helpful in evaluating middle ear pathologies, usage being indication specific. Due to its excellent spatial resolution, HRCT is invaluable in assessment of chronically discharging ears, especially to look for bone erosion and the integrity of the ossicles. Due to its better spatial resolution, HRCT is preferred in suspected intra temporal complications whereas MRI is more useful in evaluating intracranial extension

Lateral Sinus Thrombosis in Otology: a Review

Lateral sinus thrombosis (LST) is usually occurs as a complication of middle ear infection. The involvement of lateral sinus during the course of ear infection was a well known complication in preantibiotic days. The decrease in the incidence of LST is due to the introduction of broad-spectrum antibiotics, early diagnosis and surgical treatment. Now, it is a rare complication of otitis media and poses a serious threat that warrants immediate medical and surgical treatment. The classical clinical picture is often changed by previous antibiotic therapy. An awareness of this rare potentially devastating condition and its varied presentations is necessary for early diagnosis and treatment. LST can also occur after head injury

Otogenic Meningitis: A Comparison of Diagnostic Performance of Surgery and Radiology

Development of intracranial complications from middle ear infections might be difficult to diagnose. We compared radiological and surgical findings of 26 patients affected by otogenic meningitis. Results of our analysis showed that surgery is more reliable than imaging in revealing bone defects. Therefore, suggest that surgery be performed for diagnosis and eventual management of all cases of suspected otogenic meningitis

Clinical and operative study of otogenic intracranial complications

Background: Chronic otitis media is chronic inflammation of the mucoperiostial lining of the middle ear cleft. The prevalence of chronic otitis media and its intracranial complications poses a major public health problem in developing countries like India. By this study; we authors have attempted to highlight the significance of various etiological factors in the occurrence of intracranial complications due to chronic otitis media.Methods: The study was done prospectively in the department of otorhinolaryngology, J.A. group of hospitals, G. R. medical college, Gwalior during the period October 2007-2008. Thirty patients presenting to ear, nose and throat unit, diagnosed as having intracranial complications due to chronic otitis media were included in this study.Results: Most intracranial complications cases were that of meningitis. One third of the cases had past surgical history like mastoid exploration and incision & drainage of post aural abscess, and one fourth of the cases had associated extracranial complications like post aural abscess, lower motor neuron palsy, labrynthitis.Conclusion: The present study and the reference studies, both reveal that the intracranial complications of chronic otitis media are still common till date, and their signs and symptoms are often subtle until late in the course of the disease. Hence, clinicians need to maintain high index of suspicion to avoid delay in diagnosis as morbidity and mortality rates are still high, even with the advent of modern antimicrobials and aggressive surgical intervention.

Clinical and intraoperative findings for dangerous chronic suppurative otitis media in paediatric cases

The number of complications in dangerous Chronic Suppurative Otitis Media (CSOM) remain high, especially in late presentation. Extensive disease with intratemporal and intracranial complications, especially in children, was commonly found in Cipto Mangunkusumo General Hospital (CMGH), a tertiary referral hospital. This was a retrospective study that used secondary data from 2017 to 2019 in CMGH. All paediatric patients with diagnoses of dangerous CSOM and who underwent surgery from January 2017 to June 2019 were included. Clinical and intraoperative findings were described in this study. Twenty paediatric patients underwent surgery in CMGH from 2017 to 2019; of that number, 17 had unilateral dangerous CSOM, and three had bilateral dangerous CSOM. All patients aged 2 to 18 years old underwent canal wall down technique surgery. Profound hearing loss was found in nine ears; severe loss, in four ears; moderately severe loss, in four ears; and moderate loss, in seven ears. The most common intraoperative finding were total ossicular destruction in 17/23 ears. Erosion of sigmoid sinus plate was found in 5/23 ears, with perisinus abscess occurring in one case. Tegmen erosion was found in 4/23 ears. Facial nerve dehiscence was found in seven ears (5 vertical segments, 2 horizontal segments) and two patients had facial nerve paralysis before surgery. Lateral semicircular canal (SCC) fistula was found in 6/23 ears. Late presentation in dangerous CSOM can lead to extensive disease and complication, especially in paediatric patients