Middle Ear

Ototoxicity in Nigeria: Why it persists

July 13, 2014     Daniel D. Kokong, MBBS, FWACS; Aminu Bakari, MBBS, FWACS, FICS; Babagana M. Ahmad, MBBS, FWACS, FICS
article

Abstract

No therapy is currently available to reverse the serious damage that can be caused by ototoxic drugs, such as permanent hearing loss and balance disorders. Otolaryngologists in various regions of the world have developed strategies aimed at curtailing drug-induced ototoxicity, but similar efforts in most developing nations have yet to be well established. We conducted a study to document our experience in Nigeria. Our study population was made up of 156 patients-66 males and 90 females, aged 5 to 85 years (mean: 32.1 ± 30.7)-who were diagnosed with drug-induced ototoxicity over a 3-year period. Tinnitus was the first and the predominant symptom in 140 patients (89.7%). The most common cause of drug-induced ototoxicity among the 156 patients was injection of an unknown agent (n = 55 [35.3%]); among the known agents, the most common were chloramphenicol (n = 25 [16.0%]), chloroquine (n = 22 [14.1%]), and gentamicin (n = 20 [12.8%]). One pregnant woman experienced a miscarriage at 4 months after receiving intramuscular chloroquine, and another woman fell into a coma after receiving intramuscular streptomycin. Two agents that have not been linked to ototoxicity-oxytocin and thiopentone sodium-were found to be ototoxic in our study (1 case each). Of the 312 ears, 31 (9.9%) showed normal audiometric patterns; on the other end of the spectrum, 155 ears (49.7%) had profound sensorineural hearing loss (SNHL). Mixed hearing loss was seen in 90 ears (28.8%). Hearing loss was bilaterally symmetrical in 127 patients (81.4%), bilaterally asymmetrical in 15 patients (9.6%), and unilateral in 14 patients (9.0%). Treatment was primarily medical; hearing aids were fitted for 7 patients (4.5%). Only 41 patients (26.3%) kept as many as 3 scheduled follow-up appointments. Ototoxicity remains prevalent in the developing countries of Africa. Numerous drugs and other agents are responsible, and management outcomes are difficult to ascertain. Thus, our emphasis must be placed on prevention if we are to minimize the potentially devastating effects of ototoxicity.

Otologic manifestation of Samter triad

July 13, 2014     Danielle M. Blake, BA; Alejandro Vazquez, MD; Senja Tomovic, MD; Robert W. Jyung, MD
article

It is important for otolaryngologists to be aware of the mucoid quality of these middle ear effusions, as they tend to be persistent and they do not respond well to myringotomy and tube placement, which usually results in tube obstruction.

Tympanic paraganglioma

May 7, 2014     Danielle M. Blake, BA; Senja Tomovic, MD; Robert W. Jyung, MD
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Patients classically present with pulsatile tinnitus and a red mass medial to the tympanic membrane. Some patients may have findings of a red mass that blanches with pneumatic otoscopy, called Brown's sign.

Ceruminous adenocarcinoma of the ear

May 7, 2014     Jagdeep Singh Virk, MA (Cantab), MRCS, DOHNS; Gaurav Kumar, FRCS(ORL-HNS); Sherif Khalil, MS, FRCS(ORL-HNS), MD
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Ceruminous carcinomas are extremely rare and tend to present as a mass or with otalgia. They are difficult to diagnose histopathologically (in part due to varied and nonstandardized nomenclature).

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

Glial choristoma of the middle ear

December 20, 2013     Karen A. Shemanski, DO; Spencer E. Voth, DO; Lana B. Patitucci, DO; Yuxiang Ma, MD, PhD; Nikolay Popnikolov, MD, PhD; Christos D. Katsetos, MD, PhD; Robert T. Sataloff, MD, DMA, FACS
article

Abstract

Glial choristomas are isolated masses of mature brain tissue that are found outside the spinal cord or cranial cavity. These masses are rare, especially in the middle ear. We describe the case of an 81-year-old man who presented with left-sided chronic otitis media, mastoiditis, hearing loss, tinnitus, and aural fullness. He was found to have a glial choristoma of the middle ear on the left. Otologic surgeons should be aware of the possibility of finding such a mass in the middle ear and be familiar with the differences in treatment between glial choristomas and the more common encephaloceles.

Medial migration of a tympanostomy tube

December 20, 2013     Alejandro Vazquez, MD; Robert W. Jyung, MD
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Bilateral middle cranial fossa encephaloceles presenting as conductive hearing loss

December 20, 2013     Colleen T. Plein, MD; Alexander J. Langerman, MD; Miriam I. Redleaf, MD
article

Abstract

We report a case involving a patient with bilateral middle cranial fossa encephaloceles extending into the middle ear and causing conductive hearing loss. An obese, 47-year-old woman with a history of a seizure disorder presented with a slow-onset subjective hearing loss. Examination revealed opaque tympanic membranes, and audiometry showed a mixed hearing loss bilaterally. Myringotomy demonstrated soft tissue behind each tympanic membrane. Biopsy, computed tomography, magnetic resonance imaging, and mastoidectomy confirmed the diagnosis of bilateral middle cranial fossa encephaloceles. Bilateral encephaloceles are uncommon, and the resulting bilateral conductive hearing loss secondary to mechanical obstruction of ossicular vibration is even more rare. This patient's obesity and seizures perhaps contributed to her disease process.

Dehiscence of the high jugular bulb

October 23, 2013     Min-Tsan Shu, MD; Yu-Chun Chen, MD; Cheng-Chien Yang, MD; Kang-Chao Wu, MD
article

The conservative treatment for a high jugular bulb is regular follow-up with serial imaging studies to detect possible progression, even in asymptomatic cases.

Middle ear effusion in adult ICU patients: A cohort study

August 21, 2013     Bradley W. Kesser, MD; Charles Ryan Woodard, MD; Nicholas G. Stowell, MD; and Samuel S. Becker, MD
article

Abstract

We conducted a prospective study of 74 adults-34 men and 40 women, aged 18 to 90 (mean: 60.2)-to determine the prevalence of middle ear effusion (MEE) among patients in the setting of an intensive care unit (ICU) and to compare the findings with those of a control group of non-ICU hospitalized patients. Other goals were to identify risk factors associated with MEE in ICU patients and to evaluate any association with fever. Both groups included 37 patients. MEE was present in 19 patients (51.4%) in the ICU group, compared with only 2 patients (5.4%) in the control group (p < 0.01; odds ratio: 18.5; 95% confidence interval: 3.9 to 88.3). In the ICU group, there were statistically significant associations between MEE and both the use of mechanical ventilation (p = 0.03) and the use of sedation (p = 0.02). No significant relationships were seen in terms of length of stay, body position, the use of an endotracheal tube, the length of ventilation, and the use of a feeding tube. Fever was present in 8 ICU patients (21.6%) and 3 controls (8.1%), but none of the fevers was associated with MEE. We conclude that adult ICU patients have a high prevalence of MEE (51.4% in our sample) that is perhaps unrecognized. We believe that MEE in these patients is most likely related to altered consciousness, sedation, and mechanical ventilation. MEE was an unlikely cause of fever.

Degraded tympanostomy tube in the middle ear

July 21, 2013     Nitin J. Patel, MD; Joshua Bedwell, MD; Nancy Bauman, MD; Brian K. Reilly, MD
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Tympanostomy tubes can cause a foreign-body reaction that can lead to myringitis and the development of granulation tissue and polyps.

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