Intracranial abscess is a serious, life-threatening condition with a dire prognosis. Although the advent of the antibiotic era has drastically reduced the incidence of the disease, predisposing factors such as untreated ear infections, poor personal hygiene, significant trauma with violation of the sterile cranial environment as well as existing co-morbidities such as an immunocompromised state make intracranial abscess a horrifying reality. Ear infections, in particular, are notorious for being the origin of roughly 50% of cerebellar abscesses.1 Chronic suppurative otitis media (CSOM) is one of the leading causes of brain abscess. Shaw and Russell2 reviewed 47 cases of cerebellar abscess and showed that 93% were caused by CSOM; the most common mechanism of entry into the brain parenchyma being direct extension. Chronic infection in the middle ear space could erode through the tegmen tympani and into the temporal lobe or through the tegmen mastoidei into the cerebellum. Neurological symptoms may be delayed as the abscess ‘grows’ in areas around the cerebellum that are regarded as ‘silent’, until vital areas such as those responsible for coordination and balance are violated. We describe a case of cerebellar abscess secondary to CSOM and discuss the possibility of performing ear surgery with simultaneous drainage of a contiguous abscess through a transmastoid approach in cases of chronic suppurative otitis media with intracranial complications.
Human ; Male ; Young Adult ; EAR DISEASES ; OTITIS ; Otitis Media, Suppurative ; OTITIS MEDIA-COMPLICATIONS, suppuration, SURGERY ; CHRONIC EAR DISEASE ; pain ; Headache

Actinomycosis is a chronic granulomatous disease caused by the species of Actinomyces. Although it has become a rare disease in the present antibiotics era, it still needs long term antibiotic treatment and often mis- or delayed- diagnosed due to no typical sign and symptoms. Most often, it occurs in the cervicofacial region. Middle ear is not a common site for Actinomycosis, and the inner ear involvement is extremely rare. Here, we report a case of middle ear Actinomycosis involving facial nerve and lateral semicircular canal.
Actinomyces ; Actinomycosis* ; Anti-Bacterial Agents ; Ear, Inner ; Ear, Middle* ; Facial Nerve* ; Granulomatous Disease, Chronic ; Rare Diseases ; Semicircular Canals* ; Temporal Bone

OBJECTIVETo study the therapeutic effect of ventilation tube insertion in the middle ear and the external auditory canal on chronic secretory otitis media in children.

METHODSA retrospective study on 30 patients (40 ears) with chronic secretory otitis media and who underwent the operation of middle ear exploration and ventilation tube insertion in the middle ear and the external auditory canal was performed. Poor tympanic membrane, even with adhesion, was seen in 23 ears. Ten patients had evidence of bilateral secretory otitis media. From this group one ear was first injected with drugs (dexamethasone, mucosolvin, etc) and then tube insertion into the auditory tube was performed; the other ear only received drug injections into the auditory tube. The remaining 20 patients who had evidence of unilateral secretory otitis media only received drug injections into the auditory tube.

RESULTSThe tubes inserting into the auditory tube all dropped out 5-8 days after operation. None of the ventilation tubes into the middle ear dropped out and the patients' tympanum recovered after the ventilation tubes were removed (6-8 months after operation). The total cure rate was 87.5% (35/40) and the improvement rate was 12.5% (5/40). The operation of inserting tubes into the auditorytube did not improve the therapeutic effects. In the 0.5-2 years postoperative follow-up, middle ear effusions recurred in one ear, and three ears were transferred from type C to type A.

CONCLUSIONSThe surgery of ventilation tube insertion in the middle ear and the external auditory canal for chronic secretory otitis media can prevent the tympanic membrane from damage and dropping out of the ventilation tube and reduce recurrence in children. It is a preferred selection for the patients with poor tympanic membrane or adhesive tympanic membrane. It is no use to insert the tube into the auditory tube for the improvement of therapeutic effects.

Adolescent ; Child ; Chronic Disease ; Ear Canal ; surgery ; Ear, Middle ; surgery ; Female ; Humans ; Male ; Middle Ear Ventilation ; methods ; Otitis Media with Effusion ; surgery ; Retrospective Studies

Acupuncture Points ; Acupuncture, Ear ; Adolescent ; Adult ; Aged ; Child ; Chronic Disease ; therapy ; Female ; Humans ; Male ; Middle Aged ; Urticaria ; therapy ; Young Adult

OBJECTIVERetrospectively analyzed the influences of preoperative acoustic immittance pressure balance tests and intraoperative wet ear findings in myringoplasty surgery results.

METHODSOne hundred and twenty-one chronic suppurative otitis media patients underwent myringoplasty surgeries were included and divided into functional group and non-functional group according to preoperative acoustic immittance pressure balance tests. Meanwhile, cases were divided into dry ear group and wet ear group according to intraoperative findings. Postoperative hearing improvement and perforation rate were compared between the two groups.

RESULTSFunctional group had 72 cases, including 58 dry ears and 14 wet ears. Non-functional group had 46 cases, including 19 dry ears and 27 wet ears. Postoperative hearing improvement rate in functional group was 85.5% (59/69), and 72.1% (31/43) in non-functional group (χ(2) = 2.230, P = 0.093). Perforation rate in functional group was 16.7% (12/72), significant higher when compared with 2.2% (1/46) in non-functional group (χ(2) = 4.626, P = 0.015). Postoperative hearing improvement rate in dry ear group was 85.3% (64/75), and 71.8% (28/39) in wet ear group (χ(2) = 2.213, P = 0.085) . Perforation rate in dry ear group was 12.8% (10/78), and 7.0% (3/43) in wet ear group (χ(2) = 0.472, P = 0.377).

CONCLUSIONSNon-functional result of preoperative acoustic immittance pressure balance test had significant relationship with the intraoperative wet ear findings. It may result in lower postoperative hearing level, and lower perforation rate. Large sample studies should be carried out in future.

Chronic Disease ; Ear ; Hearing ; Humans ; Myringoplasty ; methods ; Otitis Media, Suppurative ; Postoperative Period ; Retrospective Studies ; Treatment Outcome ; Tympanic Membrane Perforation ; epidemiology

Tympanosclerosis is the middle ear tissue hyalinization and calcification caused by chronic middle ear inflammation, which mainly results in conductive deafness with unobvious clinical symptom. Etiology is unclear. The treatment is given priority to surgical treatment at present, while long-term effect reported mostly poor. This article analyzed etiology and treatment of the tympanic cavity sclerosis.
Calcinosis ; Chronic Disease ; Ear, Middle ; Hearing Loss, Conductive ; etiology ; Humans ; Myringosclerosis ; complications ; etiology ; therapy ; Otitis Media ; Sclerosis

OBJECTIVE: Analyse the effect of the treatment of infection in posterior tympani cavity in 168 cases with chronic otitis media. METHOD: Infection was eliminated in posterior tympani cavity of all 168 cases after surgical procedures of otitis media, and 102 tympanoplasty with autoplastic bone were operated in all cases. 22 tympanoplasty were operated without mastoidectomy, 53 with transmastoid approach, 27 with mastoidectomy and tympanoplasty. RESULT: All cases were followed up for more than one year. 160 cases were cured, the effective rate was 95% and no recurrence appeared except for 8 cases. The average threshold of hearing improvement of 87 cases > 15 dB, the effective rate was 85%. CONCLUSION To eliminate infection, the exploratory surgery of posterior tympani cavity should be done during surgical procedures of otitis media, for improving the effect of the treatment of otitis media.
Adolescent ; Adult ; Chronic Disease ; Ear, Middle ; surgery ; Female ; Humans ; Male ; Middle Aged ; Otitis Media ; surgery ; Tympanoplasty ; methods ; Young Adult

We present a case of subarachnoid hemorrhage induced by chronic suppurative otitis media and discuss the possible mechanism here. Chronic suppurative otitis media is a common suppurative inflammation of middle ear, which can cause sorts of extracranial and intracranial complications in the situation of lower resistance or higher virulence. However, the condition of subarachnoid haemorrhage caused by chronic suppurative otitis media is quite rare. According to this case and previously published articles, we consider that meningitis may be the main reason of subarachnoid hemorrhage induced by chronic suppurative otitis media.
Chronic Disease ; Ear, Middle ; Female ; Humans ; Meningitis ; complications ; Middle Aged ; Otitis Media, Suppurative ; complications ; Subarachnoid Hemorrhage ; complications

OBJECTIVETo discuss the etiological factors of facial nerve paralysis due to chronic inflammation of middle ear.

METHODSThis retrospective research included 41 patients operated for facial nerve paralysis due to chronic inflammation of middle ear. Careful exploration was made in facial canal in order to identify pathological tissue involvement. Pathological examination was performed in all operative specimens.

RESULTSFour intact fallopian canals were observed. There was a defect on the fallopian canal in 37 patients (90%) and it was most commonly located on the tympanic segment of the canal (89%). Pathological report was cholesteatoma, granulation and tuberculosis, which was found in 24 cases (59%) 14 cases (34%) and 3 cases (7%), respectively.

CONCLUSIONSFacial nerve paralysis due to chronic inflammation of middle ear was frequently relevant with cholesteatoma,the tympanic segment of the fallopian canal was most location to be involved in. Its major factor was the infection spreading along the nerve tissue, but not atrophy due to compression. The defect on the fallopian canal was not necessary for infection diffusion.

Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Cholesteatoma, Middle Ear ; complications ; Chronic Disease ; Facial Paralysis ; etiology ; Female ; Humans ; Male ; Middle Aged ; Otitis Media ; complications ; Retrospective Studies ; Young Adult

OBJECTIVETo investigate the differential expression of toll-like receptor 2 (TLR2), toll-like receptor 4 (TLR4) and their potential role in the pathogenesis of chronic suppurative otitis media and cholesteatoma.

METHODSNormal canal skin of 30 patients with tympanosclerosis were enrolled as control, 30 cases with chronic suppurative otitis media and 30 patients with cholesteatoma were studied. Real-time PCR, Western blot and Immunohistochemistry were preformed to detect the expression of TLR2/TLR4 in normal canal skin, mucosa and granulation tissue of chronic suppurative otitis media, mucosa, granulation tissue, cholesteatoma epithelium of cholesteatoma, and the differential expression were analyzed.

RESULTS(1) the mRNA and protein expression of TLR2 and TLR4 were detected in all normal canal skin, mucosa and granulation tissue of chronic suppurative otitis media, mucosa, granulation tissue, cholesteatoma epithelium of cholesteatoma. (2) Both mRNA and protein level of TLR2/TLR4 in mucosa of chronic suppurative otitis media and cholesteatoma were higher than those in normal canal skin, but lower in cholesteatoma epithelium, there was no significant difference in mucosa of the two otitis media groups. (3) The mRNA and protein expression of TLR2/TLR4 in granulation tissue of chronic suppurative otitis media and cholesteatoma were significant increased when compared with normal canal skin, and TLR2 expression level was higher in granulation tissue of cholesteatoma than in chronic suppurative otitis media. (4) TLR2/TLR4 positive cells mainly infiltrated in granulations, significantly more than in normal skin, while fewer in the epithelium of cholesteatoma.

CONCLUSIONSDifferential expression of TLR2 and TLR4 in mucosa suggests middle ear is a TLR2/TLR4 participated functional modulation of the innate immune system and also suggests that they may play a different role in the pathophysiology of chronic otitis media and cholesteatoma.

Case-Control Studies ; Cholesteatoma, Middle Ear ; metabolism ; Chronic Disease ; Humans ; Otitis Media, Suppurative ; metabolism ; Toll-Like Receptor 2 ; metabolism ; Toll-Like Receptor 4 ; metabolism