Otitis

Evidence-based update on tympanostomy tube placement for otitis media in children

July 13, 2014     Jeffrey Cheng, MD; Lisa Elden, MD
article

Controversy has grown over the indications, timing, and efficacy of tympanostomy tube placement compared with watchful waiting.

Modified radical mastoidectomy and its complications-12 years' experience

May 7, 2014     Sardar U. Khan, DLO, FCPS, FRCS(Ire); Rajesh K. Tewary, MS, FRCS(Ed); Timothy J. O'Sullivan, FRCS(Canada)
article

Abstract

To find the incidence of complications of modified radical mastoidectomy and to evaluate different parameters that play a role in their causation, we conducted a retrospective study spanning a period of 12 years. Included were 210 patients who underwent primary modified radical mastoidectomies performed by one senior surgeon; of these patients, 163 fulfilled the inclusion criteria. The charts were evaluated for patients' age and sex, laterality, intraoperative pathology, and complications. The complications were grouped into nine categories for analysis of their etiology. The results in this study were compared with those from other published reports. Complications were documented in 46 of 163 (28.2%) operated ears; 21 (45.7%) of them were noted in children <15 years of age, and 25 (54.3%) were found in adults. Sex and laterality were of no significance. The most common complication recorded was residual/recurrent cholesteatoma (20 [12.3%]), followed by meatal stenosis (11 [6.7%]). A moist cavity with discharging ear was noted in only 4 (2.5%) patients. No facial nerve palsies or dead ears were observed. Eleven (6.7%) patients had more than one complication. The parameters evaluated were size of the meatus, tympanic membrane appearance, status of the mastoid cavity, height of the facial ridge, and extent of the disease process. Complications can be caused by a number of factors, such as congenital anomalies, disease process, and the surgeon's skill. Each complication must be thoroughly evaluated for immediate management and to learn how to avoid it in the future.

Eosinophilic otitis media

February 12, 2014     Alejandro Vazquez, MD; Danielle M. Blake, BA; and Robert W. Jyung, MD
article

Eosinophilic otitis media is refractory to conventional therapy for otitis media and may lead to severe hearing impairment if not recognized promptly.

A case of direct intracranial extension of tuberculous otitis media

February 12, 2014     Dong-Kee Kim, MD; Shi-Nae Park, MD, PhD; Kyung-Ho Park, MD, PhD; and Sang Won Yeo, MD, PhD
article

Abstract

We describe a very rare case of tuberculous otitis media (TOM) with direct intracranial extension. The patient was a 55-year-old man who presented to our ENT clinic for evaluation of severe headaches and right-sided otorrhea. A biopsy of granulation tissue obtained from the right external auditory canal demonstrated chronic inflammation that was suggestive of mycobacterial infection. Magnetic resonance imaging of the brain indicated intracranial extension of TOM through a destroyed tegmen mastoideum. After 2 months of antituberculous medication, the headaches and otorrhea were controlled, and the swelling in the external ear canal subsided greatly. Rarely does TOM spread intracranially. In most such cases, intracranial extension of tuberculosis occurs as the result of hematogenous or lymphogenous spread. In rare cases, direct spread through destroyed bone can occur, as it did in our patient.

Cicatricial external auditory canal stenosis caused by ectodermal dysplasia: Rapp-Hodgkin syndrome

June 11, 2013     Amanda B. Sosulski, MD and James D. Hayes, MD
article

Abstract

We present a case of recurrent cicatricial stenosis of the external ear canals caused by ectodermal dysplasia, specifically Rapp-Hodgkin syndrome, in a 45-year-old woman. No form of medical or surgical management has produced durable patency of the patient's ear canals, and her hearing loss is being managed with hearing aids. Topical management of the recurring external otitis slows the process but has been unsuccessful in preventing restenosis of both external auditory canals.

Evolution of acute otitis media

April 17, 2013     Joseph A. Ursick, MD; Jose N. Fayad, MD
article

Treatment for acute otitis media (AOM) ranges from watchful waiting to myringotomy with or without tube placement.

Complicated coexisting pyogenic and tuberculous otitis media affecting the temporozygomatic, infratemporal, and parotid areas: Report of a rare entity

January 24, 2013     Tripti Brar, MBBS, MS, DNB; Sumit Mrig, MBBS, MS, DNB; J.C. Passey, MS; A.K. Agarwal, MS; Shayma Jain, MD
article

Abstract

We report an unusual case in which a 28-year-old woman presented with a long-standing history of ear discharge, hearing loss, facial weakness with ipsilateral facial swelling and cellulitis, a postauricular fistula, and an abscess of the temporozygomatic, infratemporal, and parotid areas. The pus stained positive for bacteria and acid-fast bacilli, and culture was positive for Proteus vulgaris and mycobacteria. Based on these findings, a diagnosis of tuberculous otitis media with complications was made. Computed tomography showed extensive destruction of the tympanic and mastoid part of the temporal bone, as well as lytic lesions in the skull. The patient was placed on antituberculosis drug therapy. Although her facial nerve palsy and hearing loss persisted, she otherwise responded well and did not require surgery.

Nontuberculous mycobacterial otomastoiditis: A case report

January 24, 2013     Li-Tai Tsai, MD; Ching-Yuan Wang, MD; Chia-Der Lin, MD; Ming-Hsui Tsai, MD
article

Abstract

Nontuberculous mycobacterial otomastoiditis is rare and can be easily confused with various different forms of otitis media. We describe the case of a 50-year-old woman who presented with left-sided chronic otitis media that had persisted for more than 1 year. It was not eradicated by standard antimicrobial therapy and surgical debridement. After appropriate antibiotic therapy for nontuberculous mycobacteria was added to the therapeutic regimen, the patient improved significantly and the lesion had healed by 6 months. Based on our experience with this case, we conclude that early bacterial culture and staining for acid-fast bacilli in ear drainage material or granulation tissue should be performed when standard antimicrobial therapy fails to eradicate chronic otitis media of an undetermined origin that is accompanied by granulation tissue over the external auditory canal or middle ear. Polymerase chain reaction testing is also effective for rapid diagnosis. Surgical debridement and removal of the foreign body can successfully treat nontuberculous mycobacterial otomastoiditis only when effective antimicrobial therapy is also administered.

Complications of chronic suppurative otitis media: A left otogenic brain abscess and a right mastoid fistula

October 4, 2012     Yok Kuan Chew, MS; Jack Pein Cheong, MBBS; Abdullah Khir, MS; Sushil Brito-Mutunayagam, MS; Narayanan Prepageran, FRCS
article

Abstract

Otogenic brain abscess and postauricular fistula are complications of chronic suppurative otitis media. We describe a rare case of bilateral chronic suppurative otitis media that caused a left temporal lobe abscess and a right mastoid fistula.

Juvenile xanthogranuloma of the tympanic membrane: A case report

September 7, 2012     Michael W. Chu, MD; Alice Werner, MD; Stephanie A. Moody-Antonio, MD
article

Abstract

Juvenile xanthogranuloma (JXG) is a benign, non-Langerhans cell histiocytic lesion that generally affects infants and children. These lesions characteristically appear as a solitary, yellow, cutaneous nodule of the head, neck, or trunk. Subcutaneous and extracutaneous forms can involve the gastrointestinal tract, kidney, lung, gonads, pericardium, central nervous system, temporal bone, larynx, and eye. We describe the clinical presentation, imaging, histochemical findings, and management of a solitary JXG of the tympanic membrane in a 17-month-old girl. The patient underwent surgical resection and was without disease several months following surgery and reconstruction of the defect. To the best of our knowledge, this is the first reported case of a JXG of the tympanic membrane.

Interhemispheric subdural abscess: A rare complication of atticoantral ear disease

August 10, 2012     Borlingegowda Viswanatha, MS, DLO
article

Abstract

A 14-year-old girl who had been experiencing ear discharge for the previous 3 years was referred to a tertiary care center for management of a 3-day history of severe headache and vomiting. Otolaryngologic examination revealed the presence of an atticoantral type of ear disease on the left side. Computed tomography detected an interhemispheric subdural abscess that had originated on the left side. The patient was initially treated with antibiotics, and she later underwent a mastoidectomy to clear the ear disease. She recovered without complications. Subdural empyema is the rarest complication of otitis media, and it is very rarely seen in an interhemispheric setting.

Is there an ototoxicity risk from Cortisporin and comparable otic suspensions? Distortion-product otoacoustic emission findings

March 1, 2012     Leonard P. Berenholz, MD, Dyana L. Rossi, MA, William H. Lippy, MD, and John M. Burkey, MA
article

Abstract

The purpose of this investigation was to use distortion-product otoacoustic emission (DPOAE) testing to address the issue of possible ototoxicity from the use of neomycin/polymyxin B/hydrocortisone otic suspension following tympanostomy tube placement. We retrospectively reviewed our clinical records and identified 36 children (52 ears) who had met our three study criteria: (1) unilateral or bilateral placement of transtympanic ventilation tubes, (2) treatment for 3 to 5 days with neomycin/polymyxin B/hydrocortisone drops, and (3) postoperative evaluation by DPOAE testing. We identified another set of 36 children (52 ears) who had not received these drops and who had not undergone tube placement but who had been evaluated by DPOAE testing to serve as a control group. We found no significant differences in DPOAE amplitudes between the treatment and control groups. These findings are consistent with decades of clinical experience indicating that neomycin/polymyxin B/hydrocortisone otic suspension is safe when used responsibly.

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