Study of Predictive Value of Middle Ear Risk Index on Hearing Improvement in Patients Undergoing Surgery for Chronic Suppurative Otitis Media

Chronic otitis media (COM) continues to be a major cause of preventable hearing loss in developing countries. The Middle Ear Risk Index (MERI) has been proposed as an objective method for stratifying disease severity and predicting surgical outcomes. However, regional data correlating MERI with surgical success remain limited. Aims: To assess graft uptake and audiological gain in relation to MERI scores in patients of COM undergoing ear surgery. Materials and Methods: A prospective longitudinal study was conducted in the Department of Otorhinolaryngology, Regional Institute of Medical Sciences, Imphal, from April 2023 to October 2024. A total of 108 patients aged 12–65 years with COM and conductive hearing loss underwent tympanoplasty (with or without mastoidectomy). Patients were categorized as mild (MERI 1–3), moderate (MERI 4–6), and severe (MERI 7–12). Postoperative graft uptake and hearing gain were evaluated by otoscopy and pure tone audiometry at 1 and 3 months. Data were analysed using SPSS v23 with p value < 0.05 considered significant. Results: Graft uptake rates were 95.3% in mild, 82.8% in moderate, and 46.7% in severe MERI groups (p < 0.001). Mean postoperative air–bone gap (ABG) improved across all groups, with percentage closure of 54.7%, 41.9%, and 28.3% respectively with respect to preoperative hearing thresholds. A significant negative correlation was observed between MERI score and both percentage audiological gain (r = –0.407, p < 0.001) and ABG closure (r = –0.543, p < 0.001). Conclusion: MERI scoring effectively predicts anatomical and functional outcomes following ear surgery for COM. Higher MERI scores are associated with lower graft success and poorer hearing improvement. MERI should be incorporated into preoperative evaluation for better prognostication and surgical planning.

<p><strong>Background: </strong>Chronic otitis media (COM) is a highly prevalent disease of the middle ear and constitutes a serious health problem worldwide, especially in developing countries. This study was done to evaluate the role of the middle ear risk index (MERI) on the outcome of surgeries for COM in the form of successful graft uptake and improvement in hearing.</p><p><strong>Methods:</strong> A total of 68 patients of COM were included in this study. Detailed ENT examination and preoperative pure tone audiometry were done in all patients. MERI score was calculated and patients were stratified based on the MERI score. All patients were evaluated at the end of 3 months postoperatively, for the status of graft uptake and improvement in hearing.</p><p><strong>Results:</strong> The MERI was found to be a remarkable predictor of the outcome of surgeries for COM. The patients with mild MERI scores had a significantly better prognosis than patients with severe MERI scores.</p><p><strong>Conclusions:</strong> MERI is a very useful and honest predictor of the graft uptake and hearing benefit in patients undergoing surgeries for COM. It has an inverse relation with graft uptake and hearing benefit. Based on the MERI score, the likelihood of surgical success and hearing benefit could be explained to the patient of COM to give them realistic expectations.</p>

To establish a link between the MERI score and post-operative anatomical and audiological gain in COM. This prospective observational study was conducted at a tertiary care centre in North India from April 2023 to March 2024. It involved 63 patients aged between 10 and 60years diagnosed with chronic otitis media (COM) who were scheduled for surgery and provided informed consent. The Middle Ear Risk Index (MERI) score was calculated based on patient's pre-operative and intra-operative findings. At 3months post-surgery, pure tone audiogram was conducted and graft uptake status was assessed using otoendoscopy. In our study, 41 (65.1%) had mild (1-3) MERI score, 17 (26.9%) had moderate (4-6) MERI score, and 5 (7.93%) had severe (7-12) MERI score. Post-operative audiograms showed statistically significant improvement in hearing threshold in patients with mild MERI scores than in patients with moderate and severe MERI score. Graft uptake rates were highest in mild cases (78%), compared to moderate (76%) and severe (60%) MERI scores, with a statistically significant difference observed (p < 0.05). We could conclude from our study that patients with lower MERI scores had better outcome in terms of graft acceptance and hearing improvement. Thus, MERI score can be a simple and effective tool to predict the outcome of surgery in patients of COM.

Aims: To evaluate a group of patients undergoing surgery for chronic otitis media with reference to theprognostic value of middle ear risk index and other factors in predicting the anatomical and functionaloutcome of tympanomastoidectomy with tympanoplasty.Subjects: The study comprised of 90 patients suffering from chronic otitis media with or withoutcholesteatoma. Patients attending the Otorhinolaryngology out patients department were considered for thisstudy.Methods: The patients underwent tympanomastoidectomy with tympanoplasty in which mastoidectomyperformed was of either canal wall up or canal wall down technique. In cholesteatoma surgery, wheneverpossible a canal wall up procedure was performed. Myringoplasty was done using autologous temporalisfascia graft by underlay technique. Middle ear risk index [MERI] and other factors were evaluated for theiroutcome predictive role in patients undergoing tympanomastoidectomy with tympanoplasty.Results: Outcomes were evaluated in terms of tympanic membrane graft uptake and post operative meanaudiological gain. The Middle ear risk index was also found to be significant predictor ofthe outcome ofsurgery. The patients with mild MERI scores had significantly better prognosis than the patients with severMERI scores.Conclusion: The Anatomical and Functional outcome of tympanomastoidectomy with tympanoplasty isdiversely affected by the pathological and technical factors associated with disease and its management. Abetter understanding of these factors is helpful for better prognostication of the factors affecting the diseaseand in planning the surgical procedure.

Mastoid obliteration during chronic otitis media (COM) surgery could improve hearing results by enhancing the acoustic properties of the external auditory canal. The obj ective of this study was to compare postoperative hearing results by type of tympanoplasty with mastoid obliterat ion during COM surgery. Twenty-five COM patients (25 ears) underwent tympanoplasty type III during canal wall down (CWD) mastoidectomy and mastoid obliteration: 10 patients underwent classic tympanoplas ty type III (group I), and 15 patients underwent columellarization between the tympanic membrane and the stapes head with a partial ossicular replacement prosthesis or cartilage (group II). Hearing results and complic ations were compared between the 2 groups. Postoperative air-bone gap (ABG) levels within 20 dB were 30% a nd 60% in group I and group II, respectively. Closure of the ABG was significantly better in group II than in group I (p＜0.05). No serious complications were observed in either group. In CWD tympanomastoidectomy with mastoid obliteration, tympanoplasty using strut results in greater hearing improvement than does classic tympanoplasty type III.Key Words: Otitis media; Obliteration; Tympanoplasty

Introduction Chronic otitis media is a widely prevalent condition in developing countries and is a cause of correctable hearing loss. The most frequent ossicular chain defect found during surgery for chronic otitis media has been a discontinuity of the incudostapedial joint. This study observes the effect of incudostapedial reconstruction using conchal cartilage on the hearing of the patient.Objectives To evaluate improvement in hearing by incudostapedial reconstruction using conchal cartilage interposition graft in tympanoplasty and to identify the independent factors associated with erosion of the long process of incus among patients with chronic suppurative otitis media tubotympanic type.Methods This study was conducted in the department of ear, nose and throat (ENT) amongst 22 patients with tubotympanic-type chronic suppurative otitis media who were found to have erosion of the long process during tympanoplasty. These patients underwent incudostapedial reconstruction using conchal cartilage. Their hearing was again reassessed at 12 weeks postsurgery, and the changes were observed.Results A statistically significant improvement in air conduction by 15.14 dB was found after undergoing incudostapedial reconstruction using conchal cartilage (p < 0.001). There was no statistically significant change in bone conduction (pvalue > 0.05). A total of 59.1% of patients in the study had an improvement in hearing ranging from 11 to 20 dB. It was also found that 50% of the patients had a postoperative hearing of 10 to 20 dB.Conclusion Conchal cartilage interposition graft effectively improved hearing when used for the reconstruction of the incudostapedial joint during tympanoplasty in patients of chronic suppurative otitis media.

Background and Objectives Surgery for bilateral chronic otitis media (COM) is usually performed sequentially, not simultaneously. The main reason is to prevent iatrogenic bilateral conductive hearing loss during recovery period. However, with asymmetric hearing loss, the difference in patient inconvenience between sequential and simultaneous surgery may be the same. This study evaluates the efficacy of simultaneous COM surgery in patients with asymmetric hearing.Subjects Materials and Method From 2012 to 2018, 9 patients underwent simultaneous bilateral COM surgery. The period of patients’ hospital stay, the success rate of tympanoplasty, tolerability for operation, and hearing thresholds were analyzed statistically.Results For the 8 same-day surgery patients, the mean hospital period was 4.4±0.7 days, which was much shorter than that of sequential surgery (8 days). Tympanoplasty was successful in all patients without complications. In the better side, the preoperative/postoperative mean air conduction thresholds (AC) were 62.97±12.89 dB/47.81±19.07 dB (p=0.017), the bone conduction thresholds (BC) were 46.72±10.31 dB/37.66±16.99 dB (p=0.161) and the air-bone gaps (ABG) were 16.25±8.81 dB/10.16±7.78 dB (p=0.176). In the worse side, the preoperative/ postoperative mean AC were 86.56±18.22 dB/72.18±29.43 dB (p=0.035), BC were 53.28± 11.10 dB/48.13±18.41 dB (p=0.173), and ABG were 33.28±11.22 dB/24.06±14.80 dB (p=0.500). In both ear, the postoperative AC and BC were better than or equivocal to those of the preoperative value, and the result was similar with each of the unilateral ear audiological results.Conclusion Despite the fact that there is no complete consensus to date, simultaneous bilateral COM surgery can be an option when patients have asymmetric hearing loss. Simultaneous bilateral COM surgery could save time, cost, and lead to similar results with sequential surgery, so it could be a considerable surgical option for patients with bilateral COM.

A review of the literature to determine the fate of the inner ear when the footplate has been removed during surgery for chronic otitis media revealed 48 cases of stapes extraction that were reported during the 19th century and in no patient did total cochlear loss develop in a one-year follow-up. In four clinical cases of chronic otitis media, there was visibly definite exposure of the vestibule during surgery, but no significant cochlear loss developed postoperatively. The prompt recognition of exposure and coverage of the oval window, with immediate parenteral administration of antibiotics would appear to be indicated when the vestibule is opened during surgery for cholesteatoma or chronic otitis media.

Introduction Chronic otitis media (COM) is an otological challenge in the developing countries as it is a persistent disease causing severe destruction of middle ear with irreversible sequalae. To assess Middle Ear Risk Index (MERI) score and study its prognostic effect in postoperative outcome following mastoidectomy with tympanoplasty. To evaluate MERI score with respect to graft uptake and A-B gap closure. Materials and Methods This prospective study comprised 25 patients suffering from COM who presented to the Department of ENT, HSK Hospital, Bagalkot, over a period of 1 year from November 2020 to November 2021. The patients underwent tympanoplasty with mastoidectomy. MERI 2001 was used in the current study, and risk factors were assessed based on pre- and intra-operative findings to obtain the MERI score. Patients were segregated into those with mild (1–3), moderate (4–7), and severe (8–15) MERI. They were evaluated at 1 month follow-up visit. Results and Conclusion The study reveals the degree to which MERI score can predict the extent of disease and indicate outcome of surgery. In the present study, patients with lower MERI score benefitted more favorably in terms of graft uptake and hearing improvement as compared with success rate of severe MERI score. MERI index is in fact a very reliable predictor of graft uptake and audiological alteration in patients undergoing tympanoplasty with mastoidectomy surgeries for COM.

Cholesterol granuloma in the middle fossa presenting 30 years after surgery for chronic otitis media: a case report

To correlate pre-operative computed tomography findings, intra-operative details and surgical outcomes with cholesteatoma recurrence in revision tympanomastoidectomy. This retrospective, non-randomised, single-institution cohort study included 42 patients who underwent pre-operative computed tomography imaging and revision surgery for recurrent chronic otitis media. Twelve disease localisations noted during revision surgery were correlated with pre-operative temporal bone computed tomography scans. A matched pair analysis was performed on patients with similar intra-operative findings, but without pre-operative computed tomography scans. Pre-operative computed tomography identified 25 out of 31 cholesteatoma recurrences. Computed tomography findings correlated with: recurrent cholesteatoma when attic opacification and ossicular chain involvement were present; and revision surgery type. Sinodural angle disease, posterior canal wall erosion and dehiscent dura were identified as predictors of canal wall down tympanomastoidectomy. Patients with pre-operative computed tomography scans had a higher rate of cholesteatoma recurrence, younger age at diagnosis of recurrent disease, more revision surgical procedures and less time between previous and revision surgical procedures (all p < 0.05). Pre-operative imaging and intra-operative findings have important clinical implications in revision surgery for chronic otitis media. Performing pre-operative computed tomography increases diagnosis accuracy and reduces the time required to diagnose recurrent disease.

Revision surgery for chronic otitis media: Characteristics and outcomes in comparison with primary surgery

Introduction: Otitis media is a prevalent global medical condition. Tubo-tympanic chronic otitis media often requires tympanoplasty, highlighting the need to assess severity and predict outcomes. The Middle Ear Risk Index (MERI) score predicts tympanoplasty results and correlates inversely with graft success and hearing improvement. This study aimed to evaluate the MERI score for mild middle ear pathologies and analyse surgical outcomes in tubotympanic chronic otitis media cases to the MERI score. Methods: This prospective study was conducted at the Department of ENT, Aarupadai Veedu Medical College and Hospital, involving 50 patients with chronic suppurative otitis media and conductive hearing impairment. The study lasted 8 months, only including patients with a MERI score of 1-3, indicating mild conditions. Pure tone audiometry was performed preoperatively, and all patients underwent tympanoplasty using the underlay technique with temporalis fascia as the graft. Post-operative evaluations occurred in the second week, with follow-up audiometry at one and three months. Results: The study included 50 patients with a mild MERI score. Males represented 56% of the participants. The predominant age group was 30 to 35 years, constituting 40% of the population. Patients with a mild MERI score demonstrated a statistically significant improvement in hearing post-surgery. Conclusion: The MERI score is a valuable tool for assessing tympanoplasty effectiveness. Keywords: Tympanoplasty, meri score, chronic otitis media.

Introduction: Chronic otitis media (COM), affecting millions globally, remains a significant health concern despite antibiotic advancements. Evolving otological approaches focus on both dry ear attainment and hearing restoration. Grading systems such as middle ear risk index (MERI) can aid in stratifying disease severity and predicting surgical outcomes for effective patient management. Aims and Objectives: The study aimed to assess MERI scores in tympanomastoid surgery patients to categorize disease severity and evaluate its correlation with postoperative hearing improvement. Materials and Methods: A prospective study was conducted over 2 years on 50 patients of COM. Patients were categorized into three groups based on MERI scores developed by Becvarovski and Kartush. A preoperative audiometry was obtained. The type of middle ear surgery required for each patient was decided intraoperatively as per the findings. Patients were followed up for a 6-month period, and hearing improvement was assessed in terms of closure of air-bone gap in the postoperative audiogram. Statistical analysis was performed using SPSS v23 software for Windows, and P &lt; 0.05 was considered statistically significant. Results: In our study, significant associations (P &lt; 0.05) were observed between the “MERI category” and variables such as otorrhea, cholesteatoma, ossicular status, previous surgery, middle ear granulation/effusion, smoker, total MERI score, and surgery performed. MERI was found to be negatively associated with hearing improvement, the higher the score lesser the improvement in hearing, and vice versa. Conclusion: The incorporation of MERI scoring into the surgical evaluation of COM cases holds promise for improving patient care and treatment strategies.

The ossicles may be affected through the mass effect of the pathological tissue in chronic otitis media. Ossicular reconstruction may be accomplished using the patients' own ossicles or with alloplastic materials. Glass ionomer ossiculoplasty is a fast, efficient, safe and cost-effective method and it has been used more frequently in recent years. Forty-six patients who had surgery for chronic otitis media were included in this study. All patients had an incus long process defect and a normal stapes superstructure. Ossicular reconstruction was performed using glass ionomer cement (GIC) (Ketac-Cem, Espe Dental AG, Seefeld, Germany) in 23 patients (group 1), while incus interposition was performed in other 23 patients (group 2). Preoperative and postoperative air pure tone averages of the group 1 patients were 42.8 and 35.2 dB, respectively (p < 0.01). These values were 42.9 and 34.5 dB in group 2 (p < 0.01). Two groups were similar with respect to postoperative hearing gain (p > 0.05). The air bone gap of group 1 was 27 dB preoperatively and 20.7 dB postoperatively. These values were 28.7 and 20.2 dB, respectively, in group 2. The closure of air bone gap was statistically significant in both the groups (p < 0.01, p < 0.01). The comparison of the mean gains of the air bone gap revealed no difference between the groups (p > 0.05). In conclusion, the use of both GIC ossiculoplasty and incus interposition are efficient methods for reconstruction of incus long process and one is not superior to the other. A larger study population may be useful for comparison of these methods.