Long-term results of a hearing test in patients operated for chronic otitis media

Introduction: Chronic otitis media is characterized by tympanic membrane perforation and conductive hearing loss. In the active form of this disease, there will also be periodic or permanent otorrhea. With a number of surgical techniques available depending on intraoperative findings, otosurgery is the treatment of choice in such cases, the extent of which depends on the type and extent of the pathological changes. Material and Method: We carried out an analysis of 79 patients with chronic otitis media undergoing surgery at the Department of Otolaryngology, Jagiellonian University Medical College in Kraków between 2005 and 2014. Total audiometry was used as a part of hearing assessment, before the surgery, 6 months after the surgery and in the distant 10-year observation period. In addition, each patient completed the questionnaire and was examined by an otolaryngologist. Results: The analysis included 79 patients operated on due to chronic otitis media. The mean bone conduction (for frequencies 500,1000 and 2000 Hz) before surgery was 31.8 dB, it did not differ significantly (p = 0.355) after 6 months after surgery (32.8 dB), while it significantly increased (p < 0.001) in a distant 10-year control of 43.4 dB. The mean air conduction (for frequencies 500, 1000 and 2000 Hz) before the procedure was 57.6 dB, it significantly improved in the early control by 50.5 dB, at p < 0.001. In long-term follow-up it increased again to 61.3 dB and was significantly different from the early postoperative period (p < 0.001). The mean air-bone gap for frequencies 500, 1000 and 2000 Hz before surgery was on average 26.4 dB, it was significantly (p < 0.001) reduced in the postoperative period by 17.6 dB. The level of air-bone gap remained at a similar level in distant control. Conclusions: (1) A completely preserved ossicular chain in the absence of active chronic otitis media is the best prognosis for stable hearing improvement over the years with normal inner ear function; (2) Reoperation worsens the long-term results of a hearing test compared to the first operation

Auditory ossicles in Scanning Electron Microscopy

Introduction: Knowledge about the physiology of a healthy middle ear is essential for understanding the activity and mechanics of the ear as well as the basics of ossiculoplasty. Trauma of the epithelial lining of the tympanic cavity as well as the ossicular chain may be the result of chronic inflammation and surgery. Depending on the observed changes of the middle ear lining, there are several types of distinguished chronic inflammatory changes: simple, with cholesteatoma, with the formation of inflammatory granulation tissue, in course of specific diseases. Purpose: The aim of the article is presentation of the microstructure and vasculature of the ossicular chain in the Scanning Electron Microscope. Particular attention is drawn to the anatomical aspects of the structure and connections of auditory ossicles as vital elements for reconstruction of the conduction system of the middle ear. Material and method: The analysis covered auditory ossicles standardly removed in accordance with the methodology of the investigated surgical procedures. The preparations were evaluated in a scanning electron microscope. Results: The exposure of bone surface promotes deep erosion. The advanced process of destruction of bone surface in the case of chronic otitis media correlates with a significant degree of damage to both the lining covering the auditory ossicles and that surrounding articular surfaces. Conclusions: (1) The ossicles in the image of the Scanning Electron Microscope are covered with lining. It passes from the surface of the ossicles to the vascular bundles, forming vascular sheaths; (2) Damage to lining continuity on the surface of the auditory ossicles promotes the rapid destruction of bone tissue in the inflammatory process; (3) The dimensions of the individual ossicles are respectively: malleus – 8.36 +/- 0.01, incus – 8.14 +/- 0.0, stapes – 3.23 +/- 0.01 mm. Behavior of the anatomical length of ossicular chain during tympanoplasty appears to be essential to maintaining adequate vibration amplitude of the conductive system of the middle ear

Chronic suppurative otitis media with cholesteatoma and chronic otitis media with granulation investigated by scanning electron microscope based on an analysis of 140 patients

Introduction: Chronic purulent cholesteatoma of the middle ear, as well as to a lesser extent chronic granulomatous otitis media, lead to destruction of bone structures within the middle ear space. The above process is controlled by the OPG/RANKL/RANK system. Aim: The aim of the study is a comparative analysis of surgical material obtained from patients with diagnosed chronić cholesteatoma and chronic otitis media with inflammatory granulation in the assessment of the Scanning Electron Microscope (SEM). Material and methods: An analysis of 140 patients operated on due to chronic otitis media was performed. Forty patients who had been diagnosed with chronic cholesteatoma of the middle ear and chronic granulomatous otitis media were selected for a detailed analysis in the SEM. The final study under SEM included 20 patients. Results: The regular structure of cholesteatoma depicted in the SEM concerned 5 patients. In the remaining 7 patients, the system was irregular and even chaotic. The lack of regularity can also be observed in the case of granulation tissue, which in the SEM image presented itself as an irregular tissue mass without detectable regularities. Conclusions: (1) The regular pattern of the cholesteatoma matrix cells observed in some patients with chronic cholesteatoma of the middle ear reduces the molecular permeability of inflammatory cytokines, concurrently limiting the destructive activity on bone structures; (2) the presence of inflammatory granulation tissue in the middle ear is accompanied by an influx of leukocytes: neutrophils and lymphocytes, which are the source of pro-inflammatory cytokines, the growth of which activates the processes leading to the damage of bone tissue and the development of inflammation; (3) no specimen of acquired cholesteatoma revealed the presence of commensal organisms from Demodex species on the surface of the exfoliated human epithelium

The effect of preserved stapedial superstructure on hearing improvement

Introduction: Ossiculoplasty can be carried out in a number of ways, depending on the anatomical and functional conditions encountered during otosurgery and the experience of a given centre. The extent of damage to the ossicular chain determines the reconstruction method. Aim: The objective of the study was to analyse treatment effects in terms of postoperative hearing improvement in patients with chronic otitis media, with a particular emphasis on stapedial superstructure preservation. Material and method: The records of 294 consecutive patients undergoing their first ENT surgery due to chronic otitis media at the Department of Otolaryngology of Collegium Medicum, Jagiellonian University of Kraków in 2009–2013 were analysed. In order to assess the role of preserved stapedial superstructure, 96 patients were eligible for further analysis. Results: The analysis points to a significant hearing improvement after ossiculoplasty with the preserved stapedial superstructure as compared with the patients after footplate mobilisation. On the other hand, the research results point to significantly smaller hearing improvement in those patients, in whom only stapes was preserved, as compared with those, in whom a more extensive reconstruction of the ossicular chain was possible. Conclusions: The air-bone gap measured before otosurgery often fails to reflect the extent of abnormalities and cannot, therefore, be considered as the only prognostic factor for postoperative hearing improvement. Stapes preservation is crucial for hearing improvement after middle ear surgery

Laryngopharyngeal reflux in children with chronic otitis media with effusion

BACKGROUND/AIMS: To evaluate the characteristic properties of laryngopharyngeal reflux (LPR) and gastroesophageal reflux (GER) in children with otitis media with effusion (OME) using 24-hour multichannel intraluminal impedance combined with dual-probe (pharyngeal and esophageal) pH-metry. METHODS: Children aged 7–10 years of age with OME underwent 24-hour multichannel intraluminal impedance pH-metry. The upper pH sensor was situated 1 cm above the upper esophageal sphincter, and the lower pH sensor was placed 3–5 cm above the lower esophageal sphincter. Parents were asked to complete the gastroesophageal reflux assessment of symptoms in a pediatrics questionnaire. RESULTS: Twenty-eight children were enrolled; LPR was detected in 19 (67.9%) children. The criteria of the LPR diagnosis was the presence of at least one supraesophageal episode with a pH < 5.0 and a change in the pH value measured from the initial level at the upper sensor of > 0.2. In total, 64 episodes were observed. Assessment of all LPR episodes showed the presence of 246 episodes in the entire study. A considerable predominance of weakly acidic episodes (87.8%) was noted; there were 6.5% acidic episodes, and weakly alkaline episodes reached 5.7%. Pathological GER was noted in 10 (35.7%) subjects. Acid GER was detected in 8 children, 2 of whom demonstrated non-acidic reflux. In the LPR-negative patients, no pathological GER was confirmed with the exception of a single case of non-acidic reflux. CONCLUSIONS: LPR was frequently noted in the group of children with OME, and it might be an important risk factor in this common disease