Challenges in managing complex chronic middle ear disease: MERF experience
Keywords:Chronic otitis media, Cholesteatoma, Tuberculous otitis media, Tympanosclerosis, Challenges
Background: Chronic otitis media is one of the commonest conditions managed in otolaryngology practice. In developing countries such as India, advanced disease presentation is often seen mostly owing to lack of awareness of the disease and its potential complications, long distance between the patient’s home and the treatment centre, causing delay in treatment. Surgical management is the mainstay of treatment of chronic otitis media.
Methods: The aim of this study was to retrospectively analyze the patients with complex chronic middle ear disease, who underwent tympanomastoid surgery. Forty-seven patients (4.9%) out of a total of 968 patients with chronic otitis media presented with complex advanced disease and challenging intra-operative situations at our tertiary referral centre between January 2016 to December 2020. The extent of disease, associated complications, challenges in surgical management, and the eventual outcomes were studied in detail.
Results: Among these forty-seven patients, there were 24 males and 23 females. Of the 47 patients, 8 were children (17%). Extensive cholesteatoma causing facial palsy, labyrinthine fistula, dural involvement, internal auditory meatus involvement, extensive granulations extending into the inner ear through the oval or round window, extensive tympanosclerosis was noted in these patients. All patients underwent surgical management, and achieved satisfactory outcomes.
Conclusions: Advanced chronic otitis media has the potential to pose various challenges during tympanomastoid surgery. Appropriate planning for surgery aiming at complete disease clearance, meticulous after-care and long-term surveillance result in favorable outcomes.
Benson J, Mwanri L. Chronic suppurative otitis media and cholesteatoma in Australia's refugee population. Aust Fam Physician. 2012;41(12):978-80.
Akinpelu OV, Amusa YB, Komolafe EO, Adeolu AA, Oladele AO, Ameye SA. Challenges in management of chronic suppurative otitis media in a developing country. J Laryngol Otol. 2008;122(1):16-20.
Kuo CL, Shiao AS, Yung M, Sakagami M, Sudhoff H, Wang CH et al. Updates and knowledge gaps in cholesteatoma research. Biomed Res Int. 2015;2015:854024.
Principi N, Esposito S. Unsolved problems and new medical approaches to otitis media. Expert Opin Biol Ther. 2020;20(7):741-9.
Ibekwe TS, Nwaorgu O. Classification and management challenges of otitis media in a resource-poor country. Niger J Clin Pract. 2011;14:262-9.
Penido NO, Chandrasekhar SS, Borin A, Maranhão ASA, Testa JRG. Complications of otitis media - a potentially lethal problem still present. Braz J Otorhinolaryngol. 2016;82:253-62.
Coleman A, Wood A, Bialasiewicz S, Ware RS, Marsh RL, Cervin A. The unsolved problem of otitis media in indigenous populations: a systematic review of upper respiratory and middle ear microbiology in indigenous children with otitis media. Microbiome. 2018;6(1):199.
Dochy F, Vanheule E, De Leenheer E, Van Hoecke H. Middle ear problems in children with cleft palate: A cross-sectional study. Arch Otolaryngol Rhinol. 2019;5(3):078-082.
Wahid FI, Khan A, Khan IA. Complications of chronic suppurative otitis media: challenge for a developing country. Kulak Burun Bogaz Ihtisas Dergisi: KBB J Ear, Nose, Throat. 2014;24(5):265-70.
Aljohani Z, Alghonaim A, Alhaddad R, AL Shaif W, Al Thomali R, Asiry A et al. Otitis media causes and management. Int J Community Med Public Health. 2018;5:3703-8.
Natarajan K, Kurkure R, Swathi, Anubhav S, Sowmya G, Kameswaran M. Management of advanced cholesteatoma: Madras ENT Research Foundation experience. Int J Otorhinolaryngol Head Neck Surg. 2020;6(6):1149-54.
Wallner LJ. Tuberculous otitis media. Laryngoscope. 1953;63(11):1058-77.
Kameswaran M, Natarajan K, Parthiban M, Krishnan PV, Raghunandhan S. Tuberculous otitis media: a resurgence? J Laryngol Otol. 2017;131(9):785-92.
De Corso E, Marchese MR, Sergi B, Rigante M, Paludetti G. Role of ossiculoplasty in canal wall down tympanoplasty for middle-ear cholesteatoma: hearing results. J Laryngol Otol. 2007;121(4):324-8.
Kelkar PA, Hirekerur JV. Study of hearing results of ossiculoplasty in patients with safe chronic suppurative otitis media. Int J Otorhinolaryngol Head Neck Surg. 2019;5:617-24.
Ahmad R, Beigh Z, Maqbool T. Revised grading system of tympanosclerosis. Egy J Ear, Nose, Throat Allied Sciences. 2017;18:23-5.
Gibb AG. Tympanosclerosis. Proc. roy. Soc. Med. Mar 1976; 69: 155-162.
Qureishi A, Lee Y, Belfield K, Birchall JP, Daniel M. Update on otitis media-prevention and treatment. Infect Drug Resist. 2014;7:15-24.