Md. Zahirul Islam¹, Mst. Munira Akter Khanam², Md. Afzal Karim³, Md. Wahiduzzaman⁴

1. Dr. Md. Zahirul Islam, Assistant Professor (ENT), Patuakhali Medical College, Patuakhali, Bangladesh.

2. Dr. Mst. Munira Akter Khanam, Lecturer (Biochemistry),  Patuakhali Medical College, Patuakhali, Bangladesh.

3. Dr. Md. Afzal Karim, Assistant Professor (ENT), Patuakhali Medical College, Patuakhali, Bangladesh.

4. Dr. Md. Wahiduzzaman, Assistant Professor (Paediatrics), Patuakhali Medical College, Patuakhali, Bangladesh.

Correspondence:   Dr. Md. Zahirul Islam, Assistant Professor (ENT), Patuakhali Medical College, Patuakhali, Bangladesh, email: [email protected]

Received:  01 June 2023                                       Revised:  15 June 2023                              Accepted: 25 June 2023

ABSTRACT

Background: Hearing loss is the most frequent sequel of otitis media. Our aim is to assess the hearing thresholds in otitis media and to compare the hearing thresholds with non-diseased ears.

Methods: This is a cross sectional study. We performed pure tone audiometry in patients with otitis media and healthy individuals. Hearing loss was considered when the hearing thresholds were > 25 dB.

Results: Among our 110 patients diagnosed with otitis media (142 ears), 47.3% (52) were male and 52.7% (58) were female. The mean age was 45 years. Among them, 67 (61%) patients had mucosal COM; 04(3.6%) patients had cholesteatoma; 21 (19%) patients had OME and 18(16.3%) patients had AOM. Most patients (63%) had conductive hearing loss. About 35% of the patients had mixed hearing loss and 1.2% had pure sensorineural hearing loss.

Conclusion: Otitis media resulted in higher bone conduction threshold than non-diseased ears (p < 0.01).

Keywords: Otitis media, Hearing loss, Hearing threshold

INTRODUCTION

Inflammation in the middle ear cleft is known as otitis media. When inflammation persists more than three months, it known as chronic otitis media (COM). When discharge present, it is considered an active disease. The prevalence of COM was 4.1%, with 3.1% of individuals having unilateral disease and 1.0% having bilateral disease.¹When disease extends beyond the confines of the middle ear cleft, it is termed a complication of otitis media. These complications can be classified in different ways, such as by location in the intracranial spaces, chronicity, and degree of complexity. First-order complications result from direct or adjacent involvement of the infection, like mastoiditis, facial palsy in acute otitis media, labyrinthine fistula, and serous labyrinthitis. These complications typically have a clear presentation and diagnosis, can be treated with directed local measures within the temporal bone, and generally have a better prognosis. Second-order complications are the sequel of first order complications. And are more challenging to diagnose. Second-order complications may require a more urgent and specialized intervention.²

First-order complications have higher incidence and prevalence rates than second-order complications. Among these complications hearing loss requires special attention. A conductive type of hearing loss is common in otitis media due to effusion in tympanic cavity, perforation of the tympanic membrane or ossicular changes. Inflammatory processes in middle ear can also produce sensorineural hearing loss secondary to the inflammatory processes of the middle ear.³ Otitis media may result in some degree of hearing loss. The aim of our study to compare the hearing thresholds in different forms of otitis media. 

METHODS

This cross sectional study was performed in the outpatient deparment of Patuakhali Medical College Hospital and private consultation in Central Hospital Limited. We divided the patients into mucosal Chronic Otitis Media (mCOM), Cholesteatomatous, Otitis Media with Effusion (OME) and Acute Otitis Media (AOM). Ears with otitis media were compared with ears of healthy individuals.

We included all patients with otitis media and patients over 18 years of age. And we excluded patients having a history of ear surgery, cancer, receiving chemotherapy or radiotherapy. A control group was selected who have bone conduction threshold<25 dB and no bone-air gap.

After proper history taking and clinical examination we performed pure tonal audiometry.. We considered hearing loss when the auditory thresholds were > 25 dB.

Statistical analysis was performed with spss. ANOVA and Spearman's correlation was used to correlate numerical variables. Values of p < 0.05 determined the statistical significance. The study was approved by the Ethical Review Committee of Patuakhali medical college and consent was taken from all the participants.

RESULTS

Following inclusion and exclusion criteria, we have found 110 patients and 142 ears in otitis media group. Thirty two (29%) patients were bilateral disease and 78(71%) patients were unilateral disease. Our control group had 65 patients and 130 ears, which were normal with no history of otitis media, hearing loss, ear surgery, and brain trauma.

 In our 110 patients with otitis media, 58 (52.7%) were female and 52 (47.3%) were male. The control group consisted of 25 men (36.5%) and 40 women (63.5%). The ages of each group are described in Table 1.

Among our patients of otitis media, 67 (61%) had mucosal COM; 04(3.6%) patients had cholesteatoma; 21 (19%) patients had OME and 18(16.3%) patients had AOM. Regarding the number of ears, 80 ears had mucosal COM; 05 ears had cholesteatoma; 34 ears had OME and 23 ears had AOM. In addition to hearing loss most of the patients (69%) complained about tinnitus. Audiometric evaluation revealed that most patients (63%) had conductive hearing loss.

About 35% of the patients had mixed hearing loss and 1.2% had pure sensorineural hearing loss.

In the pure tone audiometry, we found worse bone thresholds in otitis media than the control in all frequencies (p < 0.01). (Table-3).

We also observed worse air thresholds in all ears with otitis media, when compared with the ears of the control group (p < 0.001), in all frequencies. (Table 4)

Table 1. Age of the patients