A case of tympanogenic labyrinthitis complicated by acute otitis media

Post-operative vestibular and equilibrium evaluation in patients with cholesteatoma-induced labyrinthine fistulas

OBJECTIVE

This study aimed to compare the pre- and post-operative vestibular and equilibrium functions of patients with cholesteatoma-induced labyrinthine fistulas who underwent different management methods.

METHODS

Data from 49 patients with cholesteatoma-induced labyrinthine fistulas who underwent one of three surgical procedures were retrospectively analysed. The three management options were fistula repair, obliteration and canal occlusion.

RESULTS

Patients underwent fistula repair (n = 8), canal occlusion (n = 18) or obliteration procedures (n = 23). Patients in the fistula repair and canal occlusion groups suffered from post-operative vertigo and imbalance, which persisted for longer than in those in the obliteration group. Despite receiving different management strategies, all patients achieved complete recovery of equilibrium functions through persistent efforts in rehabilitation exercises.

CONCLUSION

Complete removal of the cholesteatoma matrix overlying the fistula is reliable for preventing iatrogenic hearing deterioration due to unremitting labyrinthitis. Thus, among the three fistula treatments, obliteration is the optimal method for preserving post-operative vestibular functions.

Imaging of Pathologies of the Temporal Bone and Middle Ear: Inflammatory Diseases, Their Mimics and Potential Complications-Pictorial Review

Imaging of the temporal bone and middle ear is challenging for radiologists due to the abundance of distinct anatomical structures and the plethora of possible pathologies. The basis for a precise diagnosis is knowledge of the underlying anatomy as well as the clinical presentation and the individual patient's otological status. In this article, we aimed to summarize the most common inflammatory lesions of the temporal bone and middle ear, describe their specific imaging characteristics, and highlight their differential diagnoses. First, we introduce anatomical and imaging fundamentals. Additionally, a point-to-point comparison of the radiological and histological features of the wide spectrum of inflammatory diseases of the temporal bone and middle ear in context with a review of the current literature and current trends is given.

Cranial nerve palsy prevalence and associated factors in patients with malignant otitis externa

Objective

To identify the prevalence of cranial nerve (CN) palsy and its associated factors in malignant otitis externa (MOE).

Methods

In a retrospective study, records of MOE patients from 2011 to 2014 were reviewed. MOE and CN involvement were evaluated based on patient demographics, clinical, and paraclinical data.

Results

Overall, 119 MOE patients with a mean age of 65.9 ± 11.3 were included. 69.7% were male, and 63.0% had a history of diabetes. The most common symptoms and signs were otalgia (97.5%), otorrhea (44.5%), and ear canal erythema/edema (24.4%). Thirty-three patients (27.7%) had CN involvement. The facial nerve was mostly involved (26.1%). Skull base osteomyelitis (SBO) was present in 59 patients. When excluding patients younger than 30 and older than 80, age decade was correlated with CN palsy. 66.9% of patients with CN palsy and 65.6% without CN palsy were male, which was significantly different. The following factors were not significantly different between patients with and without CN palsy: Comorbidities, signs and symptoms, diagnostic delay, erythrocyte sedimentation rate level, fasting blood sugar, hemoglobin A1c level, antifungal therapy, hospitalization duration, and SBO on imaging. Tinnitus was correlated with SBO evidence on imaging (specificity: 96.7%).

Conclusion

CN involvement occurs in about three out of 10 MOE patients. Male gender and advanced age may be related to a higher incidence rate of CN palsy. Tinnitus can be a specific indicator of SBO. These findings could help in better decision-making for early interventions.

Level of Evidence

4.

The Relation of Sudden Sensorineural Hearing Loss in Pediatric Patients With Recurrent Otitis Media: A Nested Case-control Study Using a National Sample Cohort

OBJECTIVE

The risk of sudden sensorineural hearing loss (SSNHL) was suggested to be increased in chronic otitis media patients. This study expanded previous findings by using pediatric patients with recurrent otitis media.

STUDY DESIGN

A nested case-control study.

SETTING

Participants in the Korean National Health Insurance Service-National Sample Cohort that were less than 15 years old from 2002 to 2004 were included.

PATIENTS

Overall, 24,226 patients with ≥ 5 instances of otitis media were 1:1 matched with a group controlled for age, sex, income, and region of residence.

MAIN OUTCOME MEASURE

The occurrence of SSNHL was followed until 2013. The hazard ratio (HR) for SSNHL was analyzed in the otitis media patients using a stratified Cox proportional hazard regression model. Matching variables were stratified. The histories of sinusitis and atopic dermatitis were adjusted. Subgroup analysis was performed according to age and sex.

RESULTS

Overall, 0.14% (33/24,226) of the otitis media group and 0.06% (14/24,226) of the control group had SSNHL (p = 0.006). The otitis media group had a higher adjusted HR for SSNHL than the control group (adjusted HR = 2.13, 95% CI = 1.13-4.02). According to age, the 10- to 14-year-old group showed a 9.07-fold higher HR for SSNHL than the control group (95% CI = 1.14-72.54). According to sex, the female group showed a 3.74-fold higher HR for SSNHL than the control group (95% CI = 1.24-11.29).

CONCLUSION

Recurrent otitis media in children was related to the onset of SSNHL.

Acute otitis media associated bilateral sudden hearing loss: case report and literature review

Background:

Sudden sensorineural hearing loss is a rare otological condition with potential for dire outcomes including permanent hearing loss. Although the majority of cases are deemed idiopathic, bilateral sudden sensorineural hearing loss represents a rare subset typically related to systemic conditions, with higher morbidity and mortality. A controversial association with acute otitis media has been reported, with few bilateral cases published in the literature.

Case report:

A very rare case of bilateral sudden sensorineural hearing loss associated with acute otitis media is described, with a review of the literature.

Conclusion:

The limited evidence available suggests that acute otitis media with tinnitus and/or bacterial pathology may have an increased risk of sudden sensorineural hearing loss, which is consistent with the case described. Although there is no sufficiently powered published evidence to provide definitive treatment guidelines, the literature reviewed suggests that early myringotomy and antibiotics may greatly improve treatment outcomes.

Indications and radiological findings of acute otitis media and its complications

Most cases of acute otitis media resolve with antibiotics and imaging is not required. When treatment fails or a complication is suspected, imaging plays a crucial role. Since the introduction of antibiotic treatment, the complication rate has decreased dramatically. Nevertheless, given the critical clinical relevance of complications, the importance of early diagnosis is vital. Our objective was to review the clinical and radiological features of acute otitis media and its complications. They were classified based on their location, as intratemporal or intracranial. Imaging makes it possible to diagnose the complications of acute otitis media and to institute appropriate treatment. Computed tomography is the initial technique of choice and, in most cases, the ultimate. Magnetic resonance is useful for evaluating the inner ear and when accurate evaluation of disease extent or better characterization of intracranial complications is required.