Sensorineural hearing loss in chronic suppurative otitis media with and without cholesteatoma

Revista Brasileira de Otorrinolaringologia

Azevedo, Alexandre Fernandes de¹  Santa Casa de Misericórdia de Belo Horizonte¹  Greco, Dirceu Bartolomeu¹  Gonçalves, Denise Utsch¹  Souza, Nicodemos José Alves de¹  UFMG¹  Pinto, Daniele Cristine Gomes¹ 

关键词: colesteatoma middle ear;    otitis media suppurative;    hearing loss.;   

DOI  :  10.1590/S0034-72992007000500013

学科分类：医学（综合）

来源: Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervicofacial

【 摘 要 】

Chronic otitis media may be considered a public health problem. In the United States, it is estimated that over two billion dollars are spent yearly to treat both acute and chronic ear infections1. In developing countries, the prevalence of middle ear infections reaches 72 cases per 1,000 inhabitants and chronic otitis media is the main cause of hearing loss in children2. In Brazil, epidemiological studies show an association between chronic otitis media and hearing loss in school age children3.Now, considering suppurative chronic otitis media (SCOM), this may or may not be associated with the development of a cholesteatoma, and conductive hearing loss is the characteristic audiologic alteration4.The association between chronic otitis media and sensorineural hearing loss (SNHL) has been broadly studied and remains a controversial topic. Studies present a frequency that varies from no clinical significance5-9 to 10%10. A variation in sample selection could justify this difference. Some studies do not differentiate between SCOM with and without cholesteatoma5,11. Others assessed SCOM without considering the presence or absence of cholesteatomas separately6,7,12. There is much controversy about the correlation between SNHL with the patientÂ’s age and chronic otitis media duration time5-12. The socio-economic environment could also be a possible factor influencing SNHL evolution2,3.The goal of the present investigation was to correlate SCOM associated with SNHL with cholesteatoma with patientÂ’s age and disease duration. METHODS The present study was carried out through the analysis of charts from those patients submitted to otologic surgery because of SCOM with or without cholesteatomas. As for inclusion criterion we considered chronic unilateral otorrhea with a normal contralateral ear in patients with less than 60 years of age. As exclusion criteria, we considered the family history of congenital or acquired SNHL, history of noise exposure, head injury, prior ear surgery, or the possibility of a perilymphatic fistula. The socio-economic statuses of the patients were controlled: having a private health insurance and having been submitted to ear surgery in a hospital that does not belong to the public health care system.All patients were assessed, treated and followed up by the same professional, with vast experience in otology. In the month prior to the otologic surgery, audiometry exams were carried out in double by two independent professionals and who did not know about the patientÂ’s clinical history or about the presence or absence of cholesteatoma. The exams were carried out in the same equipment and in a sound treated booth. In the audiometry analysis, the air-bone gap considered was of 10 dB to define a conductive hearing loss13. In order to define SNHL, we considered a 30dB hearing loss or above for the bone hearing threshold. This cutting point was used in order to rule out the inclusion of those cases that did not represent significant damage to the inner ear10. In order to increase the analysis specificity, we assessed the bone hearing loss alone in 4 KHz and the frequency averages of 0.5, 1 and 2 KHz10.We assessed the correlation between SNHL with the following variables: age, ear disease duration and the presence or absence of cholesteatoma. The criterion to define the presence of cholesteatoma was the pathology description of the surgical specimen. In the

【 授权许可】

Unknown