Volume (9) No.1

January 2007

The O�cial Publication of theSaudi Oto-Rino-Laryngology Society

Intracranial haemorrhage pp 28

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This is the official publication of the Saudi Oto-Rhino-Laryngology Society

ISSN:1319-8491 (Legal Deposit No.0857//20)

JANUARY 2007 Volume 9 Number 1

Editor-in-Chief

Kamal J. Daghistani

Editorial Board:

Khalid Al Noury

Seraj M. Zakzouk Mohammad A. Zuwayed

International Advisory Board

Accredited as a refereed journal by the Academic Council of

King Saud Universty, Riyadh, Saudi Arabia

Hussain Abdul Rahman ( UAE ) Sigurd Hellmich ( Germany )

David Adams ( Northern Ireland ) Mazen J. Khabori ( Oman )

Peter Alberti ( Canada ) David W. Kennedy ( USA )

Mohammed Baraka ( UK) Valerie J. Lund ( UK )

Jaafar Bareeq ( Bahrain ) A. Hameed Al Muhana (

Kuwait )

Robin Cotton ( USA ) D. Passãli ( Italy )

W. Draf ( Germany ) Salah Soliman ( Egypt )

Patrick Gullane ( Canada ) Mirko Tos ( Denmark )

C. Herberhold ( Germany ) Sadek Zaher ( Egypt )

Jun-Ichi Suzuki ( Japan )

Volume 9 No.1, January 2007Saudi Journal of Oto-Rhino-Laryngology Head and Neck Surgery

Table of Contents

Original Articles

Audiological Evaluation of Cerebral Palsy Children. ......................................................................... 1

Wahab O. Owolawi.

Sarcomatoid carcinoma of the head and neck: a twenty years experience. ...................................... 7

Abdulrahman Hagr, Khalid Alabdulhadi.

Effect of tonsillectomy, adenoidectomy or adenotonsillectomy ........................................................... 11

on Eustachian tube function.

Kamal-Eldin Ahmed Abou-Elhamd.

Prevalence of Chronic Suppurative Otitis Media and Cholesteatoma ............................................. 15

Among Saudi Adult Population.

Fatma H. Al Anazi.

The impact of smoking on recurrent Laryngeal carcinoma. .............................................................. 18

Lubna Janahi.

The other ear in unilateral chronic suppurative otitis media. ............................................................ 24

Kamal-Eldin Ahmed Abou-Elhamd, Ramadan Hashem Sayed,

Abd- Elmateen Moussa.

Case Report

Intracranial hemorrhage: a rare complication of cochlear implant. ................................................. 27

Abdulrahman Hagr, Manohar Bance.

Blindness: A curable complication of acute sinusitis. .......................................................................... 30

Abdulrahman Hagr.

Selected Abstracts. ................................................................................................................................... 35

Volume 9 No.1, January 2007Saudi Journal of Oto-Rhino-Laryngology Head and Neck Surgery

Introduction:

Chronic Suppurative Otitis Media (CSOM) is the

chronic inflammation of part or all of the muco-

periosteal lining of the middle ear cleft resulting

in chronic discharge from the middle ear through a

perforation in the tympanic membrane.

There are 2 types of chronic suppurative otitis me-

dia; tubotympanic and atticoantral. In tubotympanic

type, the ear presents with a long standing infection

characterized by profuse odourless mucoid or mu-

copurulent discharge and is associated with a large

or small central defect of the tympanic membrane.

In atticoantral type, the ear presents with a long

standing infection characterized by scanty foetid

discharge and is associated with bone erosion giv-

ing rise to granulations, polypi or whitish debris (

cholesteatoma ).

There are many predisposing factors for chronic

suppuratve otitis media to develop. Unhealthy ton-

sils and adenoids are thought to constitute a focus of

sepsis from which infection spreads along the eusta-

chian tube to cause bacterial otitis media.(1) Nasal

and sinus diseases may cause otitis media. Watson

reported that the septum was deviated (2) toward

the affected side in most of his patients of unilateral

chronic otitis media (4 ).

Allergic rhinitis has been implicated as a factor

causing eustachian tube dysfunction

and chronic otitis media ( 5 ).

Chronic otitis media is common among people of

low social standards ( 6 ).

The size of mastoid air cells and infection of the

middle ear was considered to be genetically deter-

mined ( 7 ).

The aim of this study was to find out the presence

of abnormalities in the other ear in patients with

CSOM.

Materials and Methods:

This study was conducted on 46 patients with uni-

lateral chronic suppurative otitis media who were

admitted to ear, nose and throat ( ENT ) department,

Sohag University Hospital for ear surgery, in the

period from April 2002 to August 2002. A care-

ful history was taken with particular attention to

the other ear. Thise included: aural pain, discharge,

decrease of hearing, tinnitus,1990(1) nasal obstruc-

The other ear in unilateral chronic suppurative otitis mediaKamal-Eldin Ahmed Abou-Elhamd, MD*, Ramadan Hashem Sayed, MD**

Abd- Elmateen Moussa, MD***

Abstract:

Objectives: This is a study of patients presented with unilateral chronic suppurative otitis media to know how

often there is an abnormality in the other ear in these patients.

Material & Methods: This study was conducted on 46 patients with unilateral chronic suppurative otitis me-

dia who were admitted to ear, nose and throat ( ENT ) department, Sohag university hospital for ear surgery.

The contralateral ear was assessed by otoscopy.Investigations included pure tone audiometry, tympanometry

and plain x-ray of both mastoids media.

Results: The other ear was normal in 63% of cases, had eustachian obstruction in 24% of cases & with adhe-

sive otitis media in 9% of cases.

Recommendation: This high incidence of contralateral ear disease ( 37% ) makes it our policy to follow up

the contralateral ear in patients with unilateral chronic suppurative otitis media for two years.

Key words: Chronic otitis media; the contralateral ear; hearing loss

* Assistant Professor in ENT, Sohag Faculty of Medicine, Sohag, Egypt.

** Assistant Professor in ENT, Sohag Faculty of Medicine, Sohag, Egypt.

*** Professor in ENT, Sohag Faculty of Medicine, Sohag, Egypt.

Saudi Journal of Oto-Rhino-Laryngology Head and Neck Surgery Volume 9 No.1, January 2007

24

Type of HL CHL Mixed HL SNHL

Atticoantral other ear 3 3 1

Tubotympanic other ear 5 1 1

tion and headache. Any patient who had unilateral

CSOM was included in this study. Complete ENT

examination was done.

The contralateral ear was assessed by otoscopy with

particular note being made of :

1- Normal tympanic membrane

2- Eustachian tube obstruction

3- Otitis media with effusion

4- Adhesive otitis media

5- Tympanosclerosis

Investigations included pure tone audiometry, tym-

panometry and plain x-ray of both mastoids were

performed.

Results:

Forty-six patients with unilateral chronic suppuratve

otitis media were admitted to our ENT department

of Sohag University hospital between April 2002

and August 2002 and were the core of our study.

They were 31 males and 15 females. Their age

ranged from 7 to 57 years. They were 25 patients

with atticoantral type and 21 patients with tubotym-

panic type.

Most of cases ( 56.5%) presented with aural dis-

charge and 17% presented with diminution of hear-

ing ( Table I). The other ear was normal in 63% of

cases ( Table II). The other ear had eustachian ob-

struction in 24% of cases & adhesive otitis media in

9% of cases. There was hearing loss in the other ear

otitis media in 30.5% of cases ( Table III ).

Sixty five percent of tympanometric findings of oth-

er ear were type A ( 13 other ear in atticoantral cases

and 17 other ear in tubotympanic cases ). Twenty

three percent were type C ( 11 cases) and 6.5% were

type B (3 cases).

Thirty- seven percent of x-rays of other ear showed

partial sclerosis (10 other ear in atticoantral cases

and 7 other ear in tubotympanic cases ). Twenty two

percent showed complete sclerosis (10 cases).

Discussion:

The aetiology of chronic suppurative otitis media is

complex. Factors such as enviroment, race, genet-

ics, mucociliary dysfunction, immunodeficiency or

Symptom No. Symptom No.

Discharge 26 Mastoiditis 2

Decrease of hearing 8 Mastoid abscess 1

Discharge & decrease 4 Mastoid fistula 1

of hearing

Discharge & headache 1 Aural polyp 1

Tinnitus 2

Table I - Mode of presentation

Presentation Normal Eust. Obs. Adhesive OME

Atticoantral other ear 13 8 3 1

Tubotympanic other ear 16 3 1 1

Table II - The other ear presentation

Table III - Hearing level (HL) of other ear

Abou-Elhamd,Sayed, Moussa. The other ear in CSOM

25

allergy may be the cause of bilateral chronic suppu-

rative otitis media. While in unilateral suppurative

cases, localized factors may be the cause. Upper

respiratory tract pathology may play a role in the

aetiology of middle ear pathology via eustachian

tube dysfunction.

The most common presentation was aural discharge

which is similar to that mentioned by Williams et

al. 1989 ( 8 ).

The other ear hearing was normal in 69.5% of cas-

es. Conductive hearing loss was found in 8 cases.

SNHL was found in 2 cases and mixed hearing loss

in 4 cases.

In a study done by Chalton and Stearns 1984 (6),

they found that more than half of their patients

(53.5%), had an abnormality in the contralateral

ear. The majority of the abnormalities found in the

contralateral ears were those associated with unsafe

ear disease (33 out of 73 patients 45% ).

It is difficult to obtain accurate figures for the in-

cidence of unilateral chronic otitis media from the

literature because I (the first outher) searched on the

net and I did not find in the English literature except

the previous one.

Conclusion:

The other ear in unilateral chronic suppurative otitis

media cases is normal in 63% and has ear pathology

in 37% of cases.

References:

1 Lee JAH, Webb JW: Discussion on national service medical examinations and epidemiological research. Proc

Roy Soc Med 1955;48:653-666.

2 Diamant M Mastoid pneumatization and cholesteatoma: the genetic question in cholesteatoma and mastoid sur-

gey. Proceeding of the 11 th international conference edited by Sade J; Amsterdam Kugler, pp.: 105 - 110. 1982

3 Williams SR, Robinson PJ, Brightwell AP : Management of the inflammatory aural polyp. J Laryngol Otol

1989;103:1040-1042.

4 Chaltoh RA, Steaivs MP. MP Stearns: The incidence of bilateral chronic otitis media. J Laryngol

Otol1984;98:337–340.

Address of correspondence:

Dr. Kamal-Eldin A. Abou-Elhamd M.D

ENT Consultant

Ghassan Najeeb Pharaon Hospital

P. O. Box 761 Khamis Mushayt 61961,

Saudi Arabia

Mobile: 00966 508580065

Fax.: 00966 7 222 2739

Kamal375@yahoo.com

Saudi Journal of Oto-Rhino-Laryngology Head and Neck Surgery Volume 9 No.1, January 2007

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