ANNEXURE-II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION1 / nAME OF THE CANDIDATE AND ADDRESS (IN BLOCK LETTERS) / DR. AROOSH. T. P,
POST GRADUATE STUDENT,
DEPT OF OTORHINOLARYNGOLOGY,
KIMS, HUBLI – 580 022.
2 / nAME OF THE INSTITUTION / KARNATAKA INSTITUTE OF
MEDICAL SCIENCES,
HUBLI-580 022.
3 / cOURSE OF STUDY AND SUBJECT / M. S. OTORHINOLARYNGOLOGY
4 / DATE OF ADMISSION TO COURSE / 17th JUNE 2010
5 / tITLE OF THE TOPIC / PREDISPOSING DISEASE FOCI OF NOSE AND THROAT IN ACUTE AND CHRONIC SUPPURATIVE OTITIS MEDIA
6 / BRIEF RESUME OF THE INTENDED WORK:
6.1 NEED FOR THE STUDY:
Suppurative otitis media is a widespread disease of the developing countries like india especially in rural areas. The etiology and pathogenesis of suppurative otitis media is multifactorial. The more relevant factor in the evolution of this disorder is the Eustachian tube dysfunction.
The major cause of abnormal tubal function appears to be obstruction which is either mechanical or functional. Mechanical obstruction can be extrinsic or intrinsic . Extrinsic obstuction can be the result of a small nasopharyngeal tumour hidden in the fossa of Rosenmuller or a persistent adenoid mass. The most common cause of intrinsic mechanical obstruction is inflammation of Eustachian tube due to allergy or infection.
Many cases of surgical failure in tympanoplasty have a reactivated, predisposing focus in the nose and throat. Such predisposing foci include persistent adenoid, sinusitis, nasal polyp, allergic rhinitis and atrophic rhinitis. In failed cases, dormant foci in the nose and throat can become clinically significant after surgery and lead to recurrence of ear disease.
Nasal colonisation with otitis media organisms like Streptococcus pneumonia, Haemophilus influenzae, Moraxella catarrhalis is a precursor to the onset of otitis media. In few studies, correlation between organism present in nasopharynx or throat are strong in ASOM while weak in CSOM. A significant association between nasal bacterial load and suppurative otitis media has been demonstrated in few studies.
Preoperative evaluation of the predisposing focus in nose and throat in suppurative otitis media will be helpful in determining the potential results of tympanoplasty and mastoid surgery and hence the need for study
6.2. REVIEW OF LITERATURE :
In 1977 Ajith singh, M.M.L.Arora studied 100 patients, divided into 3 groups , 25 normal subjects without any adenoid hypertrophy or ear discharge, 25 patients with adenoid hypertrophy and 50 patients with CSOM .They found significant relationship between adenoid and CSOM.
In 1991 Ahmed El-Guindy, studied 80 adult cases with a dry central perforation of the ear drum investigated both monometricaly and endoscopically. He found out that nasal endoscopy was indispensable in diagnosing , localizing and even treating hidden leisions in the key areas, with probable normalization of the tubal function. The correction of the mechanical tubal obstruction must thus precede ear surgery.
In 2003 to 2005 K V Bhat, K Naseeruddin, U S Nagalotimath, P R Kumar, J S Hegde studied 68 patients with CSOM, found out most of surgical failures in tympanoplasty had a reactivated, predisposing focus in the nose and throat, include persistent adenoid, sinusitis, nasal polyp, allergic rhinitis and atrophic rhinitis.
In 2004 Merab Adamia studied 76 patients with middle ear disorders and found a significant pathology in nasal cavity and paranasal sinus in different forms of CSOM.
In 1972 P C Baruah, S C Agarwal, M M L Arora , Y N Mehra studied 100 patients with suppurative otitis media and found that 36 had URI, 25 had nasal allergy, 11 had septal deformity and one had cleft palate. They also found that bacteria isolated from chronic ears had no appreciable relationship with that isolated from throat and nasopharynx , whereas in acute ears there was a strong relationship between bacteria isolated from throat or nasopharynx.
In 1982 D S Grewal, N L Hiranandani, A G Pusalkar studied 50 cases of CSOM. The bacteriological study of nasopharynx and ear was done and compared. No appreciable relationship between the organism isolated from the nasopharynx and the ear could be demonstrated.
6.3. Objectives of Study:
1. To study the relationship between predisposing factors in nose and throat and suppurative otitis media.
2. To study the risk from the predisposing disease foci to the development and sustenance of suppurative otitis media.
3. To compare the bacterial flora from ear and upper respiratory tract in patients with suppurative otitis media.
7. / MATERIALS AND METHOD
7.1 SOURCE OF DATA :
Patients attending ENT OPD in KIMS Hubli, in the study period from January 2011 to December 2011 who have acute and chronic suppurative otitis media
7.2 METHODS OF COLLECTION OF DATA :
a) Period of study: January 2011 to December 2011
b) Design of study: A prospective correlative study
Every consecutive eligible patient will be recruited into the study and divided into three groups 1)Acute suppurative otitis media, 2)Chronic suppurative otitis media- tubo tympanic disease, 3)Chronic suppurative otitis media- attico antral disease. In all three groups, diagnostic nasal endoscopy will be performed to look for adenoids, tubal tonsil, lateral pharyngeal band, movement of eustachian tube, turbinate hypertrophy, deviated nasal septum, nasal polyp, atrophic rhinitis, sinusitis and tumors. In all the three groups ear swab and nasal swab will be taken at the first visit.
Inclusion criteria:
1) All subjects having suppurative otitis media with or without complication
2) Age more than 15 years
Exclusion criteria:
1) Otitis media with effusion
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION TO BE CONDUCTED ON PATIENTS (OR) ANIMALS SPECIFY.
Yes,
Diagnostic nasal endoscopy
Ear swab and nasal swab for culture and sensitivity
CT scan, Otoendoscopy and Biopsy if necessary
7.4 HAS ETHICAL CLEARANCES BEEN OBTAINED FROM ETHICAL COMMITTEE OF YOUR INSTITUTION IN CASE OF 7.3 ?
‘Yes’, ethical clearance has been obtained from Ethical Committee of KIMS , HUBLI.
8. / LIST OF REFERENCES :
1. Singh A, Arora MML. Relationship between Adenoids and Chronic Suppurative Otitis media. Indian Journal of Otolaryngology and Head & Neck Surgery 1977; 29( 2): 69-71
2. El-Guindy A. A correlative manometric and endoscopic study of tubal function in dry central perforation of the tympanic membrane. J Laryngol Otol 1991; 105(9): 716-20
3. Bhat KV, Naseeruddin K, Nagalotimath US, Kumar PR, Hegde JS. Cortical mastoidectomy in quiescent, tubotympanic, chronic otitis media: is it routinely necessary?. J Laryngol Otol 2009; 123(4): 383-390
4. Adamia M . The Treatment of Nasal Obstruction with Tubal Disorders in patients with chronic suppurative otitis media. Tbilisi State Medical University 2004; 4(2):60-62
5. Baruah PC, Agarwal SC, Arora MML, Mehra YN. Clinical and microbiological studies in suppurative otitis media in Chandigarh. Indian Journal of Otolaryngology and Head & Neck Surgery 1972; 24(4): 157-160
6. Grewal DS, Hiranandani NL, Pusalkar AG. The middle ear mucosa in chronic suppurative otitis media. Indian Journal of Otolaryngology and Head & Neck Surgery 1982; 34(2): 1-5
7. Kvaerner KJ, Tambs K, Harris JR, Mair IW, Magnus P. Otitis media: relationship to tonsillitis, sinusitis and atopic diseases. Int J Pediatr Otorhinolaryngol 1996; 35(2): 127-41
8. Vikram BK, Khaja N, Udayashankar SG, Venkatesha BK, Manjunath D. Clinico-epidemiological study of complicated and uncomplicated chronic suppurative otitis media. J Laryngol Otol 2008; 122(5): 442-446
9. Smith-Vaughan H, Byun R, Nadkarni M, Jacques NA, Hunter N, Halpin S, Morris PS, Leach AJ . Measuring nasal bacterial load and its association with otitis media. BMC Ear Nose Throat Disord 2006; 6: 10
10. Maqbool M, Pampori RA. Telescopic rhinoscopy in chronic secretory otitis media. Indian Journal of Otolaryngology and Head & Neck Surgery 1987; 39(4): 157-158
11. Mion O, de Mello JF Jr, Lessa MM, Goto EY, Miniti A. The role of rhinitis in chronic otitis media. Otolaryngol Head Neck Surg 2003; 128(1): 27-31
12. Mathew GA, Kuruvilla G, Job A.
13. Bottom of Form
14. Dynamic slow motion video endoscopy in eustachian tube assessment. Am J Otolaryngol 2007; 28(2): 91-97Bottom of Form
9 / SIGNATURE OF THE CANDIDATE
10 / REMARKS OF THE GUIDE
11 /
11.1 NAME AND DESIGNATION OF
GUIDE
/ DR.VIKRAM BHAT, MS, DNB, PhD,associate professor,
DEPARTMENT OF otorhinolaryngology,
KIMS, HUBLI.
11.2 SIGNATURE
11.3 HEAD OF THE DEPARTMENT /
DR.umesh nagalotimath, ms, DNB
PROFESSOR & HEAD,DEPARTMENT OF otorhinolaryngology,
KIMS, HUBLI.
11.4 SIGNATURE12 / 12.1 REMARKS OF THE CHAIRMAN AND PRINCIPAL
12.2 SIGNATURE
2