Objective:The objective of this study is to analyze the detection rate, the pathogenic fungus distribution, risk factors and drug sensitivity of fungal infection of external auditory canal in patients diagnosed with chronic otitis media. Methods:The data of a total of 419 patients with chronic suppurative otitis media or middle ear cholesteatoma who were admitted from January 2019 to February 2023 were retrospectively analyzed. Results:A total of 419 patients were included, and 71 patients（16.9%） were positive for fungal culture. The disease mostly occurred in subjects aged 51-60 years old, and patients over 60 years old（47 cases, 66.2%）. From the fungal culture of external auditory canal secretions, 48 cases（11.4%） of Aspergillus and 14 cases（3.3%） of Candida were identified. The prevalence of fungal cultures in patients with chronic suppurative otitis media（20.8%） was significantly higher than that in patients with middle ear cholectestoma（4.9%）. The detection rate of Fungal was significantly increased after topical treatment with antibiotic ear drops（47.0% vs 13.6%）. Most of the isolated fungal strains are wild-type, and they are the sensitivity to voriconazole and fluconazole was the highest（97.2%）. For patients with positive fungal culture, iodoform gauze with triamcinolone acetonide and econazole cream was used to fill the external auditory canal during surgery. There was no significant difference in the tympanic membrane healing rate between patients with positive fungal culture and patients with negative fungal culture at 3 weeks after surgery（98.6% vs 97.7%）. Conclusion:Fungal infections of external auditory canal in patients with chronic otitis media tend to occur in older patients, which is more common in patients with chronic suppurative otitis media. Long-term topical treatment with antibiotic ear drops is an independent risk factor for fungal infection of external auditory canal in patients with chronic otitis media. The isolated fungal strains were highly sensitive to antifungal drugs. Therefore, it is advisable to refrain from employing topical antibiotic treatment for elderly patients with chronic suppurative otitis media/middle ear cholesteatoma, abuse of local antibiotic therapy should be avoided, and Fungal-related pathogenic examinations should be actively performed and anti-fungal drugs should be added if necessary.
Humans ; Middle Aged ; Female ; Male ; Risk Factors ; Retrospective Studies ; Chronic Disease ; Otitis Media, Suppurative/microbiology* ; Ear Canal/microbiology* ; Antifungal Agents/therapeutic use* ; Adult ; Mycoses/epidemiology* ; Aspergillus/isolation & purification* ; Candida/isolation & purification* ; Otitis Media/complications* ; Aged ; Cholesteatoma, Middle Ear/microbiology*

Objective:To investigate the distribution of pathogenic bacteria in the ear canal secretions of patients with chronic suppurative otitis media（CSOM）, the changes in the levels of interleukin-8（IL-8） and Toll like receptor 4（TLR4） in the ear canal secretions, and their clinical significance. Methods:This study selected 128 CSOM patients who visited our hospital from January 2022 to February 2024 as the study subjects and recorded them as the CSOM group. Additionally, 135 volunteers who underwent physical examinations at our hospital during the same period were regarded as the control group. Video otoscopy was used to collect and cultivate ear canal secretions, and a fully automated microbial identification instrument was used to identify the bacterial species. ELISA was applied to detect levels of IL-8, TLR4. Multivariate logistic regression was employed to examine the factors that affect the occurrence of CSOM. Pearson correlation was applied to analyze the correlation between IL-8, TLR4 levels and various influencing factors. ROC curve was applied to analyze the diagnostic value of IL-8 and TLR4 levels for the occurrence of CSOM. Z-test was applied to compare the differences in AUC. Results:Among 128 patients, the detection rate was 89.06%, and a total of 181 strains of pathogenic bacteria were cultured, among them, Gram positive bacteria accounted for the highest proportion of 54.14%, followed by Gram negative bacteria, accounting for 34.25%, and finally fungi, accounting for 11.60%. The common bacteria were Staphylococcus aureus （20.44%）, Pseudomonas aeruginosa （13.26%）, and Staphylococcus epidermidis （8.29%）. The resistance of Gram-positive bacteria to penicillin, clindamycin, erythromycin, and amoxicillin is high. Gram-negative bacteria are highly resistant to penicillin, ampicillin and erythromycin. Fungi are resistant to ketoconazole and fluconazole. The levels of IL-8 and TLR4 in CSOM group were higher than those in the control group, and gradually increased with the increase of hearing impairment. （P<0.05）. Elevated levels of IL-8, TLR4 were independent risk factors for the occurrence of CSOM（P<0.05）. The AUC of CSOM diagnosed by IL-8 and TLR4 alone was 0.790 and 0.777, respectively, while the AUC of combined diagnosis was 0.898, which was better than their respective individual diagnoses（both P<0.05）. Conclusion:The distribution of pathogenic bacteria in the ear canal secretions of CSOM patients is mainly Gram positive, with common ones being Staphylococcus aureus and Pseudomonas aeruginosa. The levels of IL-8 and TLR4 in CSOM patients are higher than those in the control group. The higher the levels, the higher the degree of hearing loss, which can be used for clinical diagnosis.
Humans ; Toll-Like Receptor 4/metabolism* ; Interleukin-8/metabolism* ; Otitis Media, Suppurative/metabolism* ; Ear Canal/metabolism* ; Chronic Disease ; Male ; Female ; Adult ; Middle Aged ; Clinical Relevance

OBJECTIVETo analyze factors relevant to revisional tympanomastoid surgery for chronic otitis media(COM).

METHODSThe clinical data of 159 patients (159 ears), who exhibited either wet ear or relapsed after the initial operation, and were subjected to revisional tympanomastoid surgery, were retrospectively analyzed in this study. Of those 159 consecutive patients, 85 were males and 74 were females, aged 11-64 years, with a median age of 36 years old. The situations in terms of intra-operative findings, surgical procedures, change dressing post-operation, dry ear time, and the improvement of aural ability during the second operation, were recorded and analyzed.

RESULTSThe second surgery found that, of those 159 patients underwent the re-operation, 67 presented with cholesteatoma and 92 had no cholesteatoma. In addition, the inadequate skeletonization and insufficient opening for mastoid cavity accounted for 70.4% (112/159) of all previous operations, the external auditory canal stenosis for 98.7% (157/159), the high facial ridge leading to insufficient drainage for 61.0% (97/159), the lesion in tympanic ostium of Eustachian tube for 34.6% (55/159), the insufficient drainage due to inappropriate post-operating dressing for 5.0% (8/159), the postauricular incision for 30.8% (49/159), and the endaural incision for 69.2% (110/159). As for the re-operation of the canal wall down mastoidectomy, tympanoplasty plus plastic repairing of cavity of concha were performed in 94 cases, the modified Bondy plus plastic repairing of cavity of concha in four cases, the radical mastoidectomy plus plastic repairing of cavity of concha in 59 cases, and the simple cleaning for mastoid cavity in two cases. Since one to two weeks after the revisional operations, the post-operating dressing was performed with aid of microscopy once a week on average. The average dry ear time ranged from 2 to 6 weeks (median=3 weeks). During a period of 6-93 months for the follow-up, all patients presented with dry ears. The epithelialization of the operating cavity was well and the tympanic membranes were integrity. Neither granulation tissue nor cholesteatoma was found to reoccur. Both pure tone hearing thresholds and air-bone gap decreased in 87 cases after the revisional operation, with statistically significant different in comparison to those two parameters before the operation (P<0.05).

CONCLUSIONThe primary causes responsible for the wet ear or reoccurrent cholesteatoma after tympanomastoid surgery may be related to the improper operation procedures and selection of incision, the non-standard operation, inexhaustive removal of pathological tissues, as well as the irregular postoperation change dressing, and other factors.

Adolescent ; Adult ; Child ; Cholesteatoma, Middle Ear ; surgery ; Chronic Disease ; Ear Auricle ; surgery ; Eustachian Tube ; pathology ; Female ; Humans ; Male ; Mastoid ; surgery ; Middle Aged ; Otitis Media ; surgery ; Postoperative Period ; Reconstructive Surgical Procedures ; Reoperation ; Retrospective Studies ; Treatment Outcome ; Tympanic Membrane ; pathology ; surgery ; Tympanoplasty ; Young Adult

PURPOSE: The aim of this study was to determine an appropriate energy level of breakfast with less risk of chronic disease for Korean adults. METHODS: Using data from the 2007~2009 Korean National Health & Nutrition Examination Survey, from a total of 12,238 adults aged 19~64, the final 7,769 subjects were analyzed except subjects who were undergoing treatment for cancer or metabolic disorder. According to the percent of breakfast energy intake versus their estimated energy requirement (EER), the subjects were divided into four groups: < 10% (very low, VL), 10~20% (low, L), 20~30% (moderate, M), > or = 30% (sufficient, S). All data were analyzed on the metabolic risk and nutritional state after application of weighted value and adjustment of sex, age, residential area, income, education, job or jobless, and energy intake using a general linear model or logistic regression. RESULTS: The subjects of group S were 16.9% of total subjects, group M 39.2%, group L 37.6%, and group VL 6.3%. The VL group included more male subjects, younger-aged (19 to 40 years), urban residents, higher income, higher education, and fewer breakfasts eaters together with family members. Among the 4 groups, the VL group showed the highest waist circumference, while the S group showed the lowest waist circumference, body mass index, and serum total cholesterol. The groups of VL and L with lower intake of breakfast energy showed high percent of energy from protein and fat, and low percent of energy from carbohydrate. With the increase of breakfast energy level, intake of energy, most nutrients and food groups increased, and the percentage of subjects consuming nutrients below EAR decreased. The VL group showed relatively higher intake of snacks, sugar, meat and eggs, oil, and seasonings, and the lowest intake of vegetable. Risk of obesity by waist circumference was highest in the VL group by 1.90 times of the S group and the same trend was shown in obesity by BMI. Risk of dyslipidemia by serum total cholesterol was 1.84 times higher in the VL group compared to the S group. Risk of diabetes by Glu-FBS (fasting blood sugar) was 1.57 times higher in the VL group compared to the S group. CONCLUSION: The results indicate that higher breakfast energy level is positively related to lower metabolic risk and more desirable nutritional state in Korean adults. Therefore, breakfast energy intake more than 30% of their own EER would be highly recommended for Korean adults.
Adult* ; Body Mass Index ; Breakfast* ; Cholesterol ; Chronic Disease ; Dyslipidemias ; Ear ; Education ; Eggs ; Energy Intake ; Humans ; Korea ; Linear Models ; Logistic Models ; Male ; Meat ; Nutrition Surveys* ; Obesity ; Ovum ; Seasons ; Snacks ; Vegetables ; Waist Circumference

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

BACKGROUND AND OBJECTIVES: Tinnitus is the perception of sound in the absence of any outside acoustic stimulus with high prevalence. Multiple risk factors for tinnitus have been identified. So far, most of studies have concentrated on prevalence and associated chronic disease of tinnitus in adults. In the present study, we focused on tinnitus in adolescents which has not been adequately evaluated. The main goal of this study was to assess the prevalence and associated risk factors of tinnitus in adolescents. SUBJECTS AND METHOD: This study was a retrospectively designed analysis of data from the 5th Korea National Health and Nutrition Examination Survey conducted in 2011-2012. We used tinnitus related interview data, the results of physical and audiological evaluation by ENT specialists, the results of daily intake of vitamin using a 24-hour dietary recall method, and blood samples in 1370 subjects. RESULTS: The prevalence of tinnitus was 22.2% in the age range of 12 and 19 years old. Logistic regression is a statistical method used to assess the association between tinnitus and independent variables. The following factors were independently and positively associated with tinnitus; sex (adjusted OR=1.531, CI=1.097-2.137), excessive earphone use (adjusted OR=1.422, CI=1.026-1.970), Non-occupational noise (adjusted OR=4.096, CI=1.702-9.859), explosive noise (adjusted OR=4.100, CI=1.703-9.872), niacin intake (adjusted OR=0.966, CI=0.940-0.993), vitamin (vit.). D serum concentration (adjusted OR=0.959, CI=0.925-0.994). CONCLUSION: This study showed an association between tinnitus prevalence in adolescents and gender, noise exposure, and vit. D supplement. Tinnitic patients are recommended to reduce excessive noise and use hearing protection devices such as earplugs or earmuffs; they are also recommended to obtain a supply vit. D from adequate sun exposure and outside activities.
Acoustics ; Adolescent* ; Adult ; Chronic Disease ; Ear Protective Devices ; Hearing ; Humans ; Korea ; Logistic Models ; Niacin ; Noise ; Nutrition Surveys ; Prevalence* ; Retrospective Studies ; Risk Factors* ; Solar System ; Specialization ; Tinnitus* ; Vitamins

BACKGROUND: Noise-induced hearing loss (NIHL) is a major preventable occupational health problem with 250 million people worldwide known to have disabling impairment of moderate to greater severity. The aims of the study are to estimate the prevalence of NIHL in the police force; and study its association with age, sex, duration of service (years), smoking and alcohol habits, use of hearing protective devices, as well as preexisting chronic diseases. METHODS: A cross-sectional study was conducted on 543 police personnel who had undergone periodic medical examination over a 12-month period. The diagnostic criteria for NIHL were (1) history of occupational noise exposure, (2) bilateral hearing loss, (3) hearing loss of > or = 25 dBA at 4,000 Hz in two consecutive audiograms, and (4) no significant medical history affecting hearing. Severity of NIHL was based on the World Health Organization grading. RESULTS: Males (74.8%) made up the majority of the police force. The mean age for police personnel was 35.55 +/- 9.57 years, and the mean duration of service was 14.75 +/- 9.39 years. Compliance with the usage of hearing protective devices was seen in 64.4%. The prevalence of NIHL in this study population was 34.2%, with a higher prevalence in males (37.7%) than in females (23.9%). The study also showed strong associations between NIHL and male sex (odds ratio, 1.9; P < 0.05), and hypertension (odds ratio, 3.3; P < 0.001). Overall, 93% were found to have mild NIHL, 3.5% had moderate NIHL, and 3.5% had severe NIHL. No police personnel were found to have profound hearing loss. CONCLUSION: The prevalence of NIHL in this study is high compared to other similar studies among police personnel. This study shows that increasing age, male, presence of hypertension, diabetes, and longer duration of service are significant associated factors for NIHL. Preventative strategies include health surveillance, implementation of a hearing conservation program, and legislation.
Chronic Disease ; Compliance ; Cross-Sectional Studies ; Ear Protective Devices ; Female ; Hearing ; Hearing Loss ; Hearing Loss, Bilateral ; Hearing Loss, Noise-Induced* ; Humans ; Hypertension ; Male ; Noise, Occupational ; Occupational Health ; Police* ; Prevalence ; Smoke ; Smoking ; World Health Organization

This study compared long-term speech performance after cochlear implantation (CI) between surgical strategies in patients with chronic otitis media (COM). Thirty patients with available open-set sentence scores measured more than 2 yr postoperatively were included: 17 who received one-stage surgeries (One-stage group), and the other 13 underwent two-stage surgeries (Two-stage group). Preoperative inflammatory status, intraoperative procedures, postoperative outcomes were compared. Among 17 patients in One-stage group, 12 underwent CI accompanied with the eradication of inflammation; CI without eradicating inflammation was performed on 3 patients; 2 underwent CIs via the transcanal approach. Thirteen patients in Two-stage group received the complete eradication of inflammation as first-stage surgery, and CI was performed as second-stage surgery after a mean interval of 8.2 months. Additional control of inflammation was performed in 2 patients at second-stage surgery for cavity problem and cholesteatoma, respectively. There were 2 cases of electrode exposure as postoperative complication in the two-stage group; new electrode arrays were inserted and covered by local flaps. The open-set sentence scores of Two-stage group were not significantly higher than those of One-stage group at 1, 2, 3, and 5 yr postoperatively. Postoperative long-term speech performance is equivalent when either of two surgical strategies is used to treat appropriately selected candidates.
Adult ; Aged ; Cholesteatoma, Middle Ear/epidemiology ; Chronic Disease/therapy ; Cochlear Implantation/*adverse effects ; Cochlear Implants/*adverse effects ; Female ; Hearing Loss, Sensorineural/*surgery ; Humans ; Inflammation/epidemiology ; Male ; Middle Aged ; Otitis Media/*surgery ; Retrospective Studies ; *Speech Articulation Tests ; Treatment Outcome ; Young Adult

OBJECTIVE: To evaluate the efficiency of autologous conchal cartlage in ossicular chain reconstruction in patients with chronic suppurative otitis media. METHOD: Seventy-three cases of chronic suppurative otitis media (COM) with or without cholesteatoma who had undergone mastoidectomy with tympanoplasty and ossicular chain reconstruction(OCR) using autologous conchal cartilage as prosthesis were studied retrospectively. Sixty-six cases of COM who had undergone mastoidectomy with tympanoplasty and without OCR were studied as control. The examination of pure tone hearing level of air conduction(AC) and bone conduction(BC) was done before operation, 2 months and 6 months after operation respectively. The pure tone average (PTA) of 0.5, 1.0, 2.0 kHz was observed. RESULT: The average air conduction gain was more than 15dB or the PTA (AC) was less than 25 dB 2 months after operation in 35 out of 73 cases who had undergone OCR. Nevertheless, the data became 56 out of 73 cases 6 months after operation. In the control group, The average air conduction gain was more than 15dB or the PTA(AC) was less than 25 dB 2 months after operation in 10 out of 66 cases who had not undergone OCR. The data became 14 out of 66 cases 6 months after operation. In OCR group, air bone gap(ABG) was less than 20 dB in 39 cases 2 months after operation and in 57 cases 6 months after operation. In the control group without OCR, ABG was less than 20 dB only in 11 cases 2 months after operation and in 16 cases 6 months after operation. By statistically analysis, there was significant difference of postoperative hearing improvement between the two groups. CONCLUSION The autologous conchal cartilage can be used as the material of prosthesis for ossicular chain reconstruction in the operation of chronic otitis media. It has many advantages, such as easily--obtained, good histocompatibility, easy to shape and so on.
Audiometry, Pure-Tone ; Bone Conduction ; Cartilage ; transplantation ; Cholesteatoma ; surgery ; Chronic Disease ; Ear Auricle ; Hearing ; Humans ; Mastoid ; surgery ; Ossicular Prosthesis ; Ossicular Replacement ; Otitis Media, Suppurative ; surgery ; Postoperative Period ; Reconstructive Surgical Procedures ; Retrospective Studies ; Treatment Outcome ; Tympanoplasty

OBJECTIVE: To study the correlation between the bacterial biofilm formation and bacterial culture in chronic otitis media. METHOD: As a prospective reserch, we used scanning electron microscopy to examinate patients samples which collected from 32 cases of patients with chronic suppurative otitis media and middle ear cholesteatoma in the operations, and performed the middle ear secretions bacterial culture. According to the different types of chronic otitis media group, we analysised the relationship between chronic otitis media bacterial biofilm formation and the bacterial culture results. RESULT: Chronic suppurative otitis media (activity) and middle ear cholesteatoma bacterial biofilm formation rate were 87.5%, 81.3%, chi-square (P > 0.05). Compared bacterial biofilm results with the results of bacterial cultured in chronic otitis media, sensitivity was 70.37%, specificity was 60.00%, the misdiagnosis rate was 40.00%, the missed diagnosis was 29.63%, positive predictive value was 90. 46%, negative predictive value was 27.27%, accuracy was 68.75%. Youden index was 30. 37%, and Pearson correlation coefficient was 0.232 (P > 0.05). CONCLUSION Chronic suppurative otitis media (activity) and middle ear cholesteatoma bacteria had a higher biofilm formation rate. The routine bacterial culture results can't reflecte bacterial biofilm formation in chronic otitis media. We need to explore more reliable experimental methods to accurately reveal the infection status of chronic otitis media.
Adolescent ; Adult ; Bacteria ; growth & development ; Biofilms ; Cholesteatoma, Middle Ear ; microbiology ; Chronic Disease ; Female ; Humans ; Male ; Middle Aged ; Otitis Media, Suppurative ; microbiology ; Sensitivity and Specificity ; Young Adult