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Introduction: A brain abscess is a fatal infection if it is not diagnosed and treated promptly. It is more common in children and has high mortality rates compared to adults. Respiratory infections, such as otitis and sinusitis, generally precede brain abscesses. In most cases, a double treatment, antibiotics, and surgery should be necessary. Complications can be fatal even with proper treatment. Clinical case: This is a 3-year-old girl patient with a history of respiratory infection. His parents took him to the emergency room due to a severe headache and a seizure episode. The clinical examination revealed left ear otalgia associated with pain and sensitivity to palpation of the mastoid region. Laboratory tests revealed leukocytosis of 18,770/MMC with neutrophilia, thrombocytosis of 628,000/MMC, elevated C-reactive protein of 8.35 mg/dl (average value 0.10-0.30 mg/dl) and elevated ferritin of 250.20 ng/dl (average value 7-140 ng/dl). Due to the history and clinical findings, a computed tomography of the skull was performed, revealing an image of evident hypodensity of the left hemisphere. An MRI was also performed, which revealed the lesion previously associated with thrombosis of the left breast. He received antibiotics and low molecular weight heparin with neurosurgery therapy, with good results. Evolution: Despite the extent of the injury, he had two episodes of seizures. He promptly received adequate antibiotic therapy and surgical treatment with good results. Three months later, for follow-up, he looks normal and has no long-term complications. Conclusions: Complications of brain abscess, even with adequate treatment, can be severe, such as epilepsy or death.

Introduction The surgical treatment of Chronic Otitis Media by modified radical mastoidectomy usually results in an open cavity, with chronic discharge, hearing loss of 30 to 40 dB, frequent visits to OPD for debris removal and none the less dizziness on cold air exposure. One way to deal with these issues effectively is to obliterate the mastoid cavity. In our study we used vascularised periosteo-temporofascial swing flap with medicated bone dust to obliterate the mastoid cavity. Material and Methods In this prospective study, 50 patients who suffered from chronic otitis media, active squamous (cholesteatoma) disease, and underwent modified radical mastoidectomy with tympanoplasty procedure were and split between two equally sized groups. Group 1 had patients with open mastoid cavity and Group 2 had obliteration of mastoid cavity using vascularised periosteo-temporofascial swing flap with medicated bone dust. Patients were followed at 3rd week, 6th week, 3rd month and 6th month. Results Patients with cavity obliteration had better and statistically significant outcomes in term of discharge status of cavity and epithelization at 3 weeks. Patients with obliteration also had positive and statistically significant results in hearing levels and hearing gain at 6 months follow up. Conclusion Mastoid cavity obliteration with vascularised periosteo-temporofascial swing flap with medicated bone dust is a good and effective method for better post-operative outcomes and curtailing dependency on doctors for cavity care.

The activation of the NLRP3 inflammasome has been linked to several inflammatory and autoinflammatory diseases. Despite cases of potential hearing improvement in immune-mediated diseases, direct evidence of the efficacy of targeting this mechanism in the inner ear is still lacking. Previously, we discovered that macrophages are associated with Sensorineural Hearing loss (SNHL) in Chronic Suppurative Otitis Media (CSOM), the leading cause of this permanent hearing loss in the developing world and incurring costs of $4 to $11 billion dollars in the United States. However, the underlying mechanism remained unknown. Here, we investigate how macrophages drive permanent hearing loss in CSOM. We first confirmed the occurrence of NLRP3 inflammasome activation in cochlear macrophages in CSOM. We then revealed that Outer Hair Cells (OHCs) were protected in CSOM by macrophage depletion and subsequently confirmed the same protection in the NLRP3 knockout condition. Furthermore, we showed that therapeutic inhibition of NLRP3 inflammasome activation and downstream inhibition of IL-1β protects OHCs in CSOM. Collectively, our data demonstrates that the main driver for hearing loss in CSOM is NLRP3 inflammasome activation in cochlear macrophages and this is therapeutically targetable, leading the way for the development of interventions to prevent the leading cause of permanent hearing loss and a costly disease in the developed world., (© 2024. The Author(s).)

Introduction. Intracranial complications of otitis media still occur, despite great progress in the treatment of all forms of inflammation. These are serious conditions which are still life-threatening and require a fast and accurate diagnosis and an adequate treatment. We present an illustrative case of an acute, foudroyant, pneumococcal, suppurative otitis media with infection spreading into endocranium and development of meningoencephalitis and otic hydrocephalus. Case report. A 6-year-old girl was admitted to the University Children's Clinic because of fever, headache, vomiting and disorder of consciousness. Computed tomography scan of the endocranium and temporal bone has revealed brain edema and hypodense content in the left mastoid and timpanic cavity. The diagnosis of acute otitis media with meningoencephalitis was made and we started with intensive antibiotic treatment. Lumbar puncture and haemoculture were confirmed a pneumococcal infection. Otosurgical treatment was conducted too due to an inadequate reaction to conservative treatment. Firstly, left mastoidectomy with the implantation of ventilation tube has been performed, followed by radical tympanomastoidectomy because there was no improvement. Three weeks after the second operation, a magnetic resonance imaging of the endocranium was performed and an otic hydrocephalus was diagnosed. A neurosurgical operation was performed on the same day with the setting of the ventriculo-peritoneal shunt. Conclusion. Intracranial complications of acute otitis media in children are extremely rare and they require multidisciplinary treatment. Surgical treatment of the ear shouldn't be postponed and the choice of the type of otosurgical intervention should be individually adapted. Audiological and neurological complications of the disease are frequent and they further prolong and impair the treatment.

Abstract Background To validate and evaluate the reliability of the Dutch version of the Chronic Ear Survey (CES) in patients suffering from Chronic Suppurative Otitis Media (CSOM) and to evaluate clinical outcomes of surgery using this questionnaire. Methods We developed the Dutch version of the CES (D-CES) using forward-backward translation of the original CES into the Dutch language. Next, patients with CSOM and controls completed the D-CES pre- and postoperatively. Internal consistency, test-retest reliability, known-group validity and convergent validity were evaluated. In addition to the D-CES, the Short Form 36 (SF-36) was administered to all participants to correlate D-CES data to quality of life. Results A total of 29 patients with CSOM scheduled for ear surgery were included. Our control group consisted of 26 patients scheduled for eye surgery, all without signs and symptoms of CSOM. Cronbachs’ α of the complete questionnaire was 0.69. The Intraclass Correlation Coefficients (ICCs), reflecting test-retest reliability, ranged between 0.69 and 0.82. Scores differed significantly between CSOM patients and controls with substantial lower (more impaired) D-CES scores in the CSOM group. Duration of complaints preoperatively and the presence of a dry ear and/or improvement of hearing postoperatively all had a significant impact on D-CES improvement scores. Small to moderate correlations were found between D-CES subscales and matching subscales of the SF-36. Conclusion The D-CES is an appropriate disease specific questionnaire to assess a patient’s perceived functional health in CSOM.

Introduction: Chronic otitis media (COM) is amongst the most common diseases treated by ENT surgeons in India. It has been advocated in lot of research articles that there is no significant difference in tympanoplasty done in active and inactive COM. The objective was to see if cortical mastoidectomy in cases of active mucosal COM, improves the success rate of tympanoplasty measured as per the following parameters: improvement in the hearing threshold by 15 dB, increased graft uptake and reduction in retraction of tympanic membrane in post operative period. Materials and Methods: This study comprises of 120 patients coming to the ENT OPD from October 2016 to October 2017 with active mucosal COM with central perforation requiring tympanoplasty. These patients were randomly assigned to two groups: Group 1 of 60 subjects in which tympanoplasty without mastoidectomy was done, Group 2 of 60 subjects in which tympanoplasty with mastoidectomy was done. Patients were evaluated after a post operative period of 3 months. Results: The Results were the hearing improvement was 73.33% in group 1 while 83.33% in group 2, graft uptake was 63.33% in group 1 and 80% in group 2, graft retraction was 33.33% and 23.33% in group 1 and group 2 respectively. Conclusion: There was statistically significant difference in results in group with and without mastoidectomy in active mucosal chronic otitis media with respect to graft uptake and improved hearing.

Objective: To correlate pre-operative computed tomography findings, intra-operative details and surgical outcomes with cholesteatoma recurrence in revision tympanomastoidectomy. Methods: This retrospective, non-randomised, single-institution cohort study included 42 patients who underwent pre-operative computed tomography imaging and revision surgery for recurrent chronic otitis media. Twelve disease localisations noted during revision surgery were correlated with pre-operative temporal bone computed tomography scans. A matched pair analysis was performed on patients with similar intra-operative findings, but without pre-operative computed tomography scans. Results: Pre-operative computed tomography identified 25 out of 31 cholesteatoma recurrences. Computed tomography findings correlated with: recurrent cholesteatoma when attic opacification and ossicular chain involvement were present; and revision surgery type. Sinodural angle disease, posterior canal wall erosion and dehiscent dura were identified as predictors of canal wall down tympanomastoidectomy. Patients with pre-operative computed tomography scans had a higher rate of cholesteatoma recurrence, younger age at diagnosis of recurrent disease, more revision surgical procedures and less time between previous and revision surgical procedures (all p < 0.05). Conclusion: Pre-operative imaging and intra-operative findings have important clinical implications in revision surgery for chronic otitis media. Performing pre-operative computed tomography increases diagnosis accuracy and reduces the time required to diagnose recurrent disease. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the frequency of common microorganisms involved in chronic suppurative otitis media (CSOM) and their antibiotic sensitivity. METHODS: This cross sectional study of 776 patients suffering with CSOM was conducted at Otolaryngology Department, Ayub Teaching Hospital, Abbottabad from 5th May 2017 to 5th November 2018. Patients fulfilling the inclusion criteria were enrolled for otoscopic examination. Sterile cotton swabs were used to collect pus samples and were sent to microbiological analysis and antibiotics sensitivity. RESULTS: The age ranges of the patients were from 13-73 years, with a mean age of 28.98±13.40 years. The incidence of CSOM was highest in 21-30 years age group (294~37.9%). In a total 776 CSOM patients, only 501 (64.56%) of the samples showed microbial growth. In aerobic isolates, the most common bacterium was Pseudomonas aeruginosa (30.7%) followed by Staphylococcus aureus (11.1%) including 6.7% MRSA. Anaerobes were isolated in 1.2% of the samples in which bacteriodes were being the most common. Samples (1.8%) showed fungal growth and yielded only Candida spp while 0.5% samples were positive for acid fact bacilli. In antimicrobial sensitivity investigation Pseudomonas aeruginosa showed highest sensitivity to piperacillin/tazobactum (84%), to levofloxacin (25.21%), to ciprofloxacin (20.59%). The highest sensitivity of S. aureus was investigated for piperacillin/tazobactum and ceftazidime with 91.18%, and showed no sensitivity to ciprofloxacin and levofloxacin. CONCLUSION: Pseudomonas aeruginosa and Staphylococcus aureus were the most common bacteria. Both show increasingly high resistance to quinolones and amino glycosides, but both isolates are sensitive to piperacillin/tazobactum, imipenam, cefoperazone/salbactum and ceftazidime.

Introduction Ossicular chain reconstruction is the surgical procedure used to correct the hearing problems in patients with chronic otitis media (COM). In this era, where a large variety of innovative artificial prosthetic materials are being used to replace and reconstruct the ossicular chain, autografts still play a significant role. Materials and Methods The present study included 40 patients. Study population was selected based on inclusion and exclusion criteria. The ossicular reconstructive procedure was done under anesthesia and according to the status of the ossicular chain. Temporalis fascia was used to close the perforation. Mainly two procedures were performed: one is intact canal wall and the other is canal wall down. Results Most of the study population was middle aged and males were more compared to females. Thirty five patients had air bone gap above 30dB. In 38 patients, the incus had undergone necrosis. Most of the patients underwent short columella reconstruction. A closure of air bone gap with in 20 dB was achieved in 72.2% in patients with malleus stapes assembly. In short columella 22.2% of patients had closure of air bone gap within 20 dB. Incus remnant grafts gave better hearing gain. Discussion The published literature on the result of use of sculptured ossicle and cartilage in tympanoplasty have been reviewed Conclusion In the present study, cases with COM showed good hearing results patients implanted with autogenous cartilage and bone.

Background: This study was conducted to determine whether tympanic membrane perforation or chronic otitis media affects the results of an infrared tympanic membrane thermometer in adults., Methods: A literature search was performed using PubMed, Embase, Cochrane Library, Web of Science, and Google Scholar., Results: Four nonrandomized studies were included in the analysis. The temperatures of the bilateral eardrums (one eardrum with normal condition [control group] and the other eardrum with perforation or chronic otitis media [experimental group]) were measured for the same subject in the studies. The mean and standard deviation of the bilateral tympanic membrane temperatures were used to calculate the mean difference (MD) with a corresponding 95% confidence interval (CI). The fixed-effect model was utilized based on the results of the heterogeneity measurement using the Chi2 test and I2 statistic. The results of a meta-analysis in the normal eardrum (control group) and perforated eardrum, chronic suppurative otitis media with tympanic membrane perforation, or chronic otitis media with cholesteatoma (experimental group) were 343 subjects (MD = 0.05; 95% CI = -0.00 to 0.11; P = .06). A meta-analysis of the normal eardrum (control group) and perforated eardrum or chronic suppurative otitis media with tympanic membrane perforation except for cholesteatoma (experimental group) found 296 subjects (MD = 0.05; 95% CI = -0.01 to 0.11; P = .10)., Conclusion: When the temperatures of the bilateral eardrums were measured using an infrared tympanic membrane thermometer, no difference was observed between the eardrum with perforation or chronic otitis media and the normal eardrum., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Surgery for chronic suppurative otitis media performed in low- and middle-income countries creates specific challenges. This paper describes the equipment and a variety of techniques that we find best suited to these conditions. These have been used over many years in remote areas of Nepal. Results and conclusion: Extensive chronic suppurative otitis media is frequently encountered, with limited pre-operative investigation or treatment possible. Techniques learnt in better-resourced settings with good follow up need to be modified. The paper describes surgical methods suitable for resource-poor conditions, with rationales. These include methods of tympanoplasty for subtotal wet perforations, hearing reconstruction in wet ears and open cavities, large aural polyps, and canal wall down mastoidectomy with cavity obliteration. Various types of autologous ossiculoplasty are described in detail for use in the absence of prostheses. The following topics are discussed: decision-making for surgery on wet or best hearing ears, children, bilateral surgery, working with local anaesthesia, and obtaining adequate consent in this environment. [ABSTRACT FROM AUTHOR]

Objective: Perforations of the tympanic membrane are treated with various surgical techniques and materials. This study aimed to determine the efficacy of platelet-rich plasma during underlay myringoplasty. Methods: The study included 40 patients. Autologous platelet-rich plasma was applied in-between temporalis fascia graft and tympanic membrane remnant during underlay myringoplasty in group 1 (n = 20). The outcome was evaluated after three months and compared with group 2 (n = 20), a control group that underwent routine underlay tympanoplasty. Results: After three months' follow up, graft uptake was 95 per cent in group 1 and 85 per cent in group 2 (p < 0.03). Mean hearing threshold gain was 18.62 dB in group 1 and 13.15 dB in group 2. This difference was statistically significant (p < 0.01). Conclusion: Platelet-rich plasma, with its ease of preparation technique, availability, low cost, autologous nature and good graft uptake rate, justifies its use in tympanoplasty type I procedures. [ABSTRACT FROM AUTHOR]

Background: One hundred years ago, millions of British and Allied troops were fighting in the trenches of the Great War. With a tenth of soldiers losing their lives, hearing loss seemed a low priority; however, vast numbers of troops sustained significant hearing loss. Method: A review was conducted of literature published between 1914 and 1925. Results: Soldiers were exposed to up to 185 dB of sustained noise from new, high-energy weapons, which caused 'labyrinthine concussion'. Traumatic injuries, non-organic hearing loss and malingering were also common. One source estimated that 2.4 per cent of the army was disabled by hearing loss. However, many British doctors viewed this 'soldier's deafness' as a temporary affliction, resulting in soldiers being labelled as malingerers or 'hysterical'. Conclusion: Today, one can recognise that a scant evidence base and misconceptions influenced the mismanagement of hearing loss by otolaryngologists in World War I. However, noise-induced hearing loss is still very much a feature of armed conflict. [ABSTRACT FROM AUTHOR]

Introduction Diseases of the nose and paranasal sinuses are known to influence the middle ear conditions. In the evaluation of the patients with chronic otitis media, radiological, endoscopic, and other auxiliary diagnostic tools may have their roles in the objective assessment of the patients, and to rule out lesions of the nasal cavity and the nasopharynx as potential aetiological factors. Materials and method This cross sectional observational study was conducted for a period of two years to establish the role of sinusitis as focus of sepsis in patients with tubotympanic type of CSOM. All patients in the age group of 20-40 years with more than 2 months of ear discharge and with a hearing loss of 25- 40 db and diagnosed as tubotympanic type of CSOM were included in our study. Patients who had features of mastoiditis on X-ray and also with persistent ear discharge even after treatment with oral and topical antibiotics were subjected (n=70) to diagnostic nasal endoscopy and computed tomography of paranasal sinuses. Result Among the 100 patients of CSOM, 70% had features suggestive of sinusitis. Deviated nasal septum (40%) was the most common pathology among the study population. Majority (54%) of them had mucopurulent type of ear discharge. The CT findings of the paranasal sinuses revealed that 48.5% of the study population had grade I type of involvement of the PNS. 54.2% of the patients had a large central perforation and the middle ear mucosa was found to be edematous for 65.7% of the patients. Discussion Coexistence of deviated nasal septum and chronic rhinosinusitis with discharging CSOM is at par with several other studies conducted in other parts of the world. Conclusion Deviated nasal septum, enlarged middle turbinate, medialised uncinate associated with sinusitis are the predisposing factors in the development of CSOM. So assessment for sinusitis in the treatment of CSOM should become a routine practice.

Introduction: Persistent otorrhoea and granulation tissue in the mastoid cavity are common post-operative complications of Canal Wall Down Mastoidectomy. In order to avoid the same and to achieve a dry cavity instillation of acetic acid into the mastoid cavity during the post operative period is common practice. Materials and Methods In this study we assessed the results of 4% acetic acid instillation in varying quantity and frequency, in the ears after modified radical mastoidectomy. 40 Patients of chronic suppurative otitis media (atticoantral) / cholesteatoma, who underwent modified radical mastoidectomy during one and a half year period, were included in the study. The patients were divided into two groups; Group A with 30 patients and Group B with 10 patients, by simple randomization method. Group A patients were asked to instill 4% acetic acid approximately 10 to 12 drops (generously) into the mastoid cavity thrice a day for 8 weeks and were followed up every week. 10 patients of Group B were asked to instill the same preparation only once weekly and followed up for the next 12 weeks. Results: In Group A, dry mastoid cavity was achieved remarkably faster within six to eight weeks and in all the 30 patients. In Group B the results were delayed by up to 4 to 6 weeks in comparison to the Group A patients. Conclusion: Though acetic acid instillation is known to help in achieving a dry cavity but a slightly higher concentration (4% acetic acid) used more frequently is highly effective in rendering dry cavity much earlier without proliferation of granulation tissue.

Objective: To compare measured and perceived taste function before and after surgery of patients with chronic otitis media with cholesteatoma (OMCC) to patients without cholesteatoma (patients with chronic suppurative otitis media [CSOM] and patients with lateral skull base lesions [LSB])., Methods: This prospective cohort study included 29 patients undergoing surgery for unilateral OMCC. The chorda tympani nerve (CTN) was resected in 8 of these patients. Fourteen patients undergoing surgery for unilateral CSOM and 5 patients undergoing surgery for unilateral LSB (with CTN resection) served as the comparison group. Taste function was measured using taste strips on both sides of the tongue before surgery, 2 weeks postoperatively and 3 months postoperatively. The affected side of the tongue was compared to the unaffected side. A questionnaire on taste perception was completed at each visit., Results: Preoperatively, cholesteatoma patients showed higher taste strip scores than non-cholesteatoma patients, indicating a larger difference between the healthy and affected sides of the tongue. Despite this difference in measured taste function few cholesteatoma patients reported taste alteration before surgery (3/29 [10.3%]). Postoperatively, patients with CTN resection (OMCC patients with CTN resection and LSB patients) showed a decreased measured taste function. Subjectively, only approximately 20% of these patients reported taste alteration 3 months postoperatively., Conclusions: Before surgery, cholesteatoma patients displayed an impaired measured taste function compared to patients without cholesteatoma (CSOM, LSB). Subjectively this was often unnoticed. After surgery, despite removal of the CTN and consequent reduction of measured taste function, few patients reported taste alteration and subjective taste perception was seen to be improving. In regards to middle ear surgery, perceived taste function does not seem to reflect measured gustatory function.

Objective: To determine whether patients with simple chronic otitis media and incomplete ossicular discontinuity should undergo ossicular reconstruction. Design: Prospective, randomised surgical trial comparing no intervention with incus interposition over a 5‐year period. Setting: Tertiary referral hospital. Participants: Seventy‐six participants with simple chronic otitis media and erosion of the long process of the incus but apparent good transmission throughout the ossicular chain as tested intra‐operatively. Forty‐four patients had partial erosion of the incus but still bony contact with the stapes head (Group A—Type I), and 32 had mainly connective tissue binding the incus and stapes (Group B—Type II). Each of these groups was randomised to either leaving the ossicular chain as it was (A1 and B1) or performing an incus interposition (A2 and B2). Main outcome measures: Average postoperative air‐bone gap and the degree of ABG closure. A postoperative air‐bone gap under 20 dB was considered a successful result. Results: In group A, there was no significant difference between no intervention and incus interposition. In group B, patients in the no reconstruction subgroup had a significantly worse hearing result than the incus interposition subgroup (postoperative air‐bone gap of 27.5 dB and 31% closure within 20 dB vs 15 dB and 75% closure). Conclusions: For Type I patients, the postoperative hearing results were similar for the reconstruction and no reconstruction groups. For Type II patients, the results clearly favour reconstruction. [ABSTRACT FROM AUTHOR]

Objective: To present an unusual cause of pulsatile tinnitus, presenting in a young adult suffering from chronic recurrent foul-smelling discharge from the same ear. Methods: Study Design: Case report Setting: Tertiary National University Hospital Patient: One Results: A 24-year old woman presented with pulsatile tinnitus on a background of chronic recurrent foul-smelling discharge. Clinico-radiologic findings seemed consistent with a glomus tympanicum coexisting with chronic suppurative otitis media with cholesteatoma. She underwent tympanomastoidectomy with excision of the mass. Histopathologic evaluation revealed the mass to be granulation tissue. Conclusion: Pulsatile tinnitus is rarely associated with chronic middle ear infection. Granulation tissue arising at the promontory may mimic glomus tumors when accompanied with this symptom. Despite this revelation, it would still be prudent to prepare for a possible glomus tumor intraoperatively, so that profuse bleeding and complications may be avoided. Keywords: tinnitus, pulsatile; otitis media, suppurative; glomus tympanicum