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ENT AND Otitis media, chronic [keywords]
- Variation among pre-surgical CT assessments of chronic otitis media. [Journal Article]
- B-ENT 2013; 9(1):9-16.
To investigate the reliability of preoperative computed tomography (CT) in patients with chronic otitis media (COM) as assessed by otologist-ENT surgeons, compared with surgical findings and respective radiological assessments, and to identify areas of the middle ear that are difficult to evaluate reliably with preoperative CT.Fifty patients with COM underwent preoperative temporal bone CT reported by a qualified radiologist. Each operating surgeon completed a standardized questionnaire regarding the status of 10 middle-ear structures after the operation. Two otologists blindly reviewed the scans. AC1-statistics between the radiology/otology report and the intra-operative findings were calculated.In the attic, malleus-incus complex, tympanic cavity, and round window niche, the otologists' assessments of CT scans corresponded better to intra-operative findings than did the respective radiology report. In the lateral semicircular canal and sigmoid sinus, the otologists' assessments also outperformed those of the radiologists in cases of erosion. Radiological assessments outperformed those of otologists in only one of 10 studied areas: confirmation of an unexposed dura in the tegmen area. The scutum and oval window represent difficult areas for which to obtain a reliable preoperative CT scan report.Otologists' assessments regarding the pre-surgical status of the temporal bone in COM appear more reliable than those of radiologists. This finding has serious implications in current clinical practice, and should be considered when designing strategies for Radiology Head & Neck training. The inherent limitations of CT may necessitate modifications to imaging and operating strategies.
- Nanoporous Silica Coatings as a Drug Delivery System for Ciprofloxacin: Outcome of Variable Release Rates in the Infected Middle Ear of Rabbits. [JOURNAL ARTICLE]
- Otol Neurotol 2013 Apr 17.
HYPOTHESIS:The present study was performed to examine the impact of the release rate of ciprofloxacin from prostheses coated with nanoporous silica layers on the outcome of an acute bacterial infection of the middle ear of rabbits.
BACKGROUND:Middle ear prostheses are often implanted in an infectious environment because of chronic otitis media and cholesteatoma. Bacterial colonization leads to healing disorders after surgery and may lead to the extrusion of the implants. Nanoporous silica layers appear promising as a drug delivery system for antibiotics placed on implants. Before clinical applications can be envisioned, it is necessary to find an optimal release rate.
METHODS:White New Zealand rabbits were provided unilaterally with either a "slow release" or a "burst release" ciprofloxacin-containing middle ear Bioverit II prosthesis. After implantation, the middle ears were infected with a solution of Pseudomonas aeruginosa. Afterwards, animals were monitored clinically and, after 3 months, sacrificed to perform necropsy and microbiologic examinations.
RESULTS:In the "slow release" group, 7 of 12 animals had to be euthanized preterm because of their poor clinical condition compared with 2 of 12 animals of the "burst release" group (p < 0.05). Clinical and microbiologic examination also showed a better outcome for animals of the burst release group.
CONCLUSION:A burst release of ciprofloxacin from middle ear implants is important to combat a perioperative infection with Ps. aeruginosa in the middle ear model of the rabbit.
- Chondroperichondrial clip myringoplasty: a new technique for closure of tympanic membrane perforations. [JOURNAL ARTICLE]
- J Laryngol Otol 2013 Apr 15.:1-6.
Objective:This study aimed to evaluate the feasibility and efficacy of the recently described chondroperichondrial clip myringoplasty technique, and make comparisons with conventional myringoplasty techniques.
Methods:The study comprised a select group of patients with chronic otitis media (mucosal disease only), with central tympanic membrane perforations affecting less than 50 per cent of the pars tensa, and an air-bone gap below 35 dB. A modified custom-made cartilage perichondrial graft was placed using the recently described 'clip' technique.
Results:The graft success rate was 91.3 per cent. Post-operatively, the air-bone gap was within 10 dB in 52 per cent of cases and within 10-20 dB in 48 per cent of cases. There were few minor complications.
Conclusion:Chondroperichondrial clip myringoplasty can be considered as an alternative minimally invasive technique for the repair of select cases of tympanic membrane perforations. This technique, which showed impressive results, was associated with minimum morbidity and reduced operative time.
- National assessment of validity of coding of acute mastoiditis: a standardised reassessment of 1966 records. [Journal Article]
- Clin Otolaryngol 2013 Apr; 38(2):130-5.
To investigate the internal validity of the diagnosis code used at discharge after treatment of acute mastoiditis.Retrospective national re-evaluation study of patient records 1993-2007 and make comparison with the original ICD codes.All ENT departments at university hospitals and one large county hospital department in Sweden.A total of 1966 records were reviewed for patients with ICD codes for in-patient treatment of acute (529), chronic (44) and unspecified mastoiditis (21) and acute otitis media (1372).ICD codes were reviewed by the authors with a defined protocol for the clinical diagnosis of acute mastoiditis. Those not satisfying the diagnosis were given an alternative diagnosis.Of 529 records with ICD coding for acute mastoiditis, 397 (75%) were found to meet the definition of acute mastoiditis used in this study, while 18% were not diagnosed as having any type of mastoiditis after review. Review of the in-patients treated for acute media otitis identified an additional 60 cases fulfilling the definition of acute mastoiditis. Overdiagnosis was common, and many patients with a diagnostic code indicating acute mastoiditis had been treated for external otitis or otorrhoea with transmyringeal drainage.The internal validity of the diagnosis acute mastoiditis is dependent on the use of standardised, well-defined criteria. Reliability of diagnosis is fundamental for the comparison of results from different studies. Inadequate reliability in the diagnosis of acute mastoiditis also affects calculations of incidence rates and statistical power and may also affect the conclusions drawn from the results.
- Retention cyst in chronic otitis media. [Journal Article]
- Ear Nose Throat J 2013 Mar; 92(3):101.
- Gastroesophageal reflux disease in children with chronic otitis media with effusion. [Journal Article]
- J Craniofac Surg 2013 Mar; 24(2):380-3.
We aimed to evaluate a possible relation between gastroesophageal reflux disease and middle ear effusion in children.Children who came to ear, nose, and throat (ENT) department with the symptoms of hearing loss or aural fullness and diagnosed as OME by examination and tympanometry were included into the study. Children were reviewed gastroesophageal reflux disease symptoms including the following: (a) airway symptoms: stridor, frequent cough, recurrent croup, wheezing, nasal congestion, obstructive apnea, hoarseness, and throat clearing; (b) feeding symptoms: frequent emesis, dysphagia, choking: gagging, sore throat, halitosis, food refusal, regurgitation, pyrosis, irritability, failure to thrive, and anemia. Diagnosis is made with at least one positive test of radionuclide gastroesophageal scintigraphy or 24 h pH probe in the patients with reflux. ENT findings were also examined between gastroesophageal reflux disease positive and gastroesophageal reflux disease negative groups.Approximately 39 (54.9%) of 71 children had at least 1 positive test for gastroesophageal reflux disease. Between the gastroesophageal reflux disease-positive and gastroesophageal reflux disease-negative groups, symptoms of reflux were not significantly different. Two pooled variables were created: airway complex (stridor, frequent cough, throat clearing), and feeding complex (irritability, pyrosis, failure to thrive). Percentage of positive symptom complexes were no statistically different between gastroesophageal reflux disease-positive and gastroesophageal reflux disease-negative groups (>0.05). Ear, nose, and throat disorders (including rhinitis/sinusitis, adenoid hypertrophy, tonsillitis/pharyngitis, and laryngitis) were more frequent in gastroesophageal reflux disease-positive group. Tonsillitis/pharyngitis was significantly different between the gastroesophageal reflux disease positive and gastroesophageal reflux disease-negative groups.Upper respiratory tract infections were seen more frequently in gastroesophageal reflux disease positive group. Children who present with gastroesophageal reflux disease symptoms are more likely to have a positive gastroesophageal reflux disease test. However, no concordance may be found between the complaints and gastroesophageal reflux disease findings. For this reason, a decision about gastroesophageal reflux disease should not only be made by looking to complaints; diagnostic tests must also be performed.
- Detection of human bocavirus in children with upper respiratory tract infection by polymerase chain reaction. [Journal Article]
- Clin Lab 2013; 59(1-2):139-42.
The aim of this study was to investigate whether in children with middle ear effusions (MEE), adenoid and tonsil tissues are associated with human bocavirus (HBoV).A total of 124 patients (56 females (45.2%) and 68 males (54.8%)) with chronic adenotonsillitis and serous otitis media under the age of 15 were recruited. Two hundered four samples (113 adenoid (55.4%), 68 tonsil (33.3%), and 23 middle ear effusion (11.3%)) were analyzed for the presence of HBoV using polymerase chain reaction (PCR).HBoV was detected in only 6 (4.8%) adenoid tissue samples each belonging to a different patient.Our findings are consistent with the results of other studies, reporting approximately 5 - 10% of the samples being positive for HBoV. To understand the detailed role of HBoV in the etiology of RTI in children, further studies would be needed.
- A comparison of three MDCT post-processing protocols: preoperative assessment of the ossicular chain in otitis media. [JOURNAL ARTICLE]
- Eur Arch Otorhinolaryngol 2013 Mar 10.
The aim of this study was to examine and assess comparative values of HRCT-based multiplanar reformation (MPR), volume rendering (VR) and virtual endoscope built on three-dimensional (3D) shaded-surface display (SSD-based CTVE) for detections of ossicular chain's damage in patients with otitis media. 70 human ears from 70 patients suffering by chronic otitis media or cholesteatoma, who were examined with a preoperative multi-slice computer tomography (MSCT) examination and tympanoplasty in our hospital were collected. The patients ossicular chains were reconstructed with the aforementioned three protocols and assessed via a three-point scoring system by three radiologists. Then, all the patients ossicular chains were reviewed by a surgeon and a radiologist via the same three-point scoring system used during surgeries at same time. By calculation, the Youden's index and coincidence rate were acquired without a significant difference for display of malleus. With regard to the incus, the Youden's index and coincidence rate of VR and MPR did not show any difference, however, both were higher than CTVE. For representation of the stapes, the accuracy of these three modalities is very low; especially, for the CTVE. In conclusion, both MPR and VR are relative robust, and CTVE is not effective for evaluation of small ossicular structures, particularly the stapes. Furthermore, the VR images are real 3D ones. Therefore, it could be the more valuable protocols for detection of the damage of ossicular chain in the patients with otitis media, and should be further applied in the future work.
- Idiopathic incus necrosis: Analysis of 4 cases. [Journal Article]
- Ear Nose Throat J 2013 Feb; 92(2):E10-3.
We evaluated ossicular chain reconstruction in patients with idiopathic incus necrosis who have conductive hearing loss and an intact ear drum. The study included four patients (3 women and 1 man; the ages of the patients were 22, 31, 35, and 56 years, respectively) with unilateral conductive hearing loss, no history of chronic serous otitis media, an intact ear drum, normal middle ear mucosa, and necrosis of the long processes of the incus. On preoperative pure tone audiometry, air-bone gaps were 24, 25, 38, and 33 dB. Bilateral tympanometry and temporal bone computed tomography results were normal. All 4 patients underwent an exploratory tympanotomy. During the operation, the mucosa of the middle ear was normal, with a mobile stapes foot plate and malleus. No evidence of any granulation tissue was found; however, necrosis of the incus long processes was seen. For ossicular reconstruction, we used tragal cartilage between the incus and the stapes in 1 patient; in the other 3 patients, glass ionomer bone cement was used (an interposition cartilage graft also was used in the patients who received the glass ionomer bone cement). In all patients, air-bone gaps under 20 dB were established in the first year after surgery. In the ossicular disorders within the middle ear, the incus is the most commonly affected ossicle. While, the most common cause of these disorders is chronic otitis media, it may be idiopathic rarely. Several ossicular reconstruction techniques have been used to repair incudostapedial discontinuity.
- Chronic suppurative otitis media and its association with socio-econonic factors among rural primary school children of bangladesh. [Journal Article]
- Indian J Otolaryngol Head Neck Surg 2012 Mar; 64(1):36-41.
Chronic Suppurative Otitis Media (CSOM) is a common community health disorder of children in all developing countries like Bangladesh which causes significant impact in speech, cognitive, educational and psychological development. The aim of the study was to determine the prevalence of CSOM and its association with certain socio-economic factors and health related practice and believes among rural primary school children of Bangladesh. The study was done among 1468 rural school going children (Boys:Girls, 1:1.23) aged between 4 and 12 years (mean 8.8 ± 1.66) in five randomly selected rural primary school of Palash Upazilla of Narsingdi district, Bangladesh. They had underwent ENT check up by the doctors trained in ENT and their guardians were interviewed regarding their socioeconomic status, health related practices and beliefs and other related issues using a pre tested protocol. Total 77 (5.2%) cases of CSOM were detected with girl's predominance (5.7 vs. 4.7%). Our study revealed statistically significant association of CSOM with yearly income of guardian ( < 0.005), maternal education ( < 0.001), bathing habit ( < 0.001), ear cleaning habit ( < 0.05), pattern of primary medical consultation ( < 0.05). Disease prevalence was also found higher among the dwellers of kachha house. So, this preventable burning problem of CSOM can be resolved by collective effort by incorporating primary ear care program with primary health care system among the vulnerable children of rural area along with their socio-economic development. Thus, future citizens can be safeguarded from developing CSOM, hearing impairment and its resultant complications.