Dilemmas in Current Management of Complicated Chronic Otitis Media

Abstract

To evaluate the distribution of complications of chronic otitis media, dilemma of how soon to operate a seriously ill patient with CSOM and treatment outcomes. A retrospective study was done in a tertiary care centre. Clinical data from 2013 to 2015 was compiled, surgical management with outcome was analysed. A total of 425 patients with chronic otitis media were evaluated. Single/multiple complications were seen in 147 (34.5%) patients. Majority of the complications were seen in active squamosal type of chronic otitis media i.e. 137 (59.5%) cases out of the 147. Meningitis (3.3%) was the most common intracranial complication. Patients with intracranial complications were referred from other departments and did not primarily present to ENT, indicating a major fact that treatment was sort for the complication and not for chronic otitis media. Headache with or without ear discharge was the most common presenting complaint. Fever and pain were not prominent indicators of complications, posing a diagnostic dilemma as patients were already receiving antibiotics and analgesics before reaching tertiary care centre. The patients with severe intracranial complications were promptly taken up (within 3-5 days) for canal wall down mastoidectomy with intravenous broad spectrum antibiotic (vancomycin) and mannitol with high risk consent. However ill the patients were, especially children with very poor general conditions, there was dramatic recovery as soon as the mastoidectomy was done. There were no deaths due to the complications of chronic otitis media in our 3 years study period. Delay in resorting to surgical management of chronic otitis media was the main reason for patients going into complications. Timely mastoidectomy in patients with poor general condition with high risk of mortality, the surgery actually had a major role in reducing the morbidity and mortality. Lack of awareness that chronic otitis media is a condition that can lead to life threatening complications resulted in procrastination of surgery. Chronic otitis media requires speedy surgical management i.e. as soon as patient is fit to tolerate anaesthesia: Tympanoplasty and Canal wall up or down Mastoidectomy to prevent complications from arising or to resolve the present complication.

Perspectives From Working Parents of Children With Recurrent Acute Otitis Media During The COVID-19 Era: A Qualitative Study

“…In severe cases mastoiditis is a complication of recurrent AOM [16], and in instances of chronic or complicated otitis media procrastination of surgery increases the risk of intracranial complications. [17] Conversely, the "watchful waiting" approach for non-severe AOM results in satisfactory recovery without antibiotic use and therefore avoids patients unnecessarily developing multi-drug resistance. [18] Since outcomes of untreated AOM range from self-resolving to life threatening intracranial infections, this underscores the importance of clinician involvement to accurately monitor and document the course of AOM.…”

Postoperative Outcomes After Tympanoplasty for Active Versus Inactive Otitis Media Patients With Tympanic Membrane Perforation: A Systematic Review and Meta-Analysis

“…Over the years, it is still often advocated to operate dry ears to obtain a more favorable outcome, which requires ears with active discharge to be first treated with antibiotics or aural toilet. This is attributed to several common factors, including preoperative prediction of poorer prognosis due to higher Middle Ear Risk Index score from the increased risk value of otorrhea (2), difficulty in graft placement intraoperatively due to fibrosis as well as connective tissue build-up at the surrounding graft site (3) and postoperative concerns regarding increased chances requiring secondary closure because of wound dehiscence from friable tissue around perforation site of actively discharging ears (4).…”

Colesteatoma de oído con complicación intracraneana en contexto de pandemia COVID-19: Reporte de caso clínico y revisión de literatura

“…El tratamiento de la otitis media crónica colesteatomatosa (OMCC) complicada con infecciones intracraneales requiere el uso precoz de antibióticos endovenosos asociado a cirugía que permita la erradicación del foco y eventual drenaje de abscesos cerebrales o trombos sépticos 8 . De este modo, el advenimiento de la antibioticoterapia, el fortalecimiento de los sistemas de salud, los avances radiológicos y el tratamiento oportuno de las otitis medias y disfunción tubáricas en edad pediátrica han llevado a una disminución de la incidencia de OMCC y sus complicaciones asociadas en los países desarrollados 9,10 . La pandemia COVID-19 ha provocado que los pacientes con patologías con potenciales complicaciones consulten tardíamente en los servicios asistenciales por miedo al contagio.…”