Mucosal Chronic Otitis Media Research Articles

Prospective study on technique of graft fishing with anterior tucking in type 1 tympanoplasty and its hearing outcome

<p class="abstract"><strong>Background: </strong>Chronic otitis media (COM) is a common health problem in developing world and has a major impact on patient in the form of hearing loss. Temporalis fascia is commonest graft material used for tympanoplasty as it is readily available through same post aural incision. The study was conducted with an aim to find out the effectiveness of fishing technique and anterior tucking in terms of graft stability, graft uptake, hearing improvement and complications.</p><p class="abstract"><strong>Methods: </strong>The present study is prospective study conducted on patients with complains of otorrhea and hearing loss, of age between 15 to 60 years, during the period January 2017 to June 2018. Patients with inactive mucosal COM and pure conductive hearing loss who underwent type-I tympanoplasty were included. Patients with cholesteatoma, ossicular pathology, trauma, mixed or sensorineural hearing loss, were excluded. Paired ‘t’ test was applied to compare preoperative and postoperative mean air-bone gap.</p><p class="abstract"><strong>Results:</strong> In our study total 123 patients were analysed for the follow-up period of 6 months and it was observed that graft was well accepted in 93.5% patients while in 4.8% patients residual anterior perforation was found and in 1.7% patients the graft was completely rejected, showing an overall success rate at the end of 6 months follow-up to be 93.5%. There was a statistically significant improvement in hearing gain at the end of 6 months follow-up (p<0.05).</p><p class="abstract"><strong>Conclusions: </strong>Tympanoplasty with temporalis fascia graft using fishing and anterior tucking technique gave good dimensional stability to graft, preventing lateralization / medialization of graft. The superiorly based circumferential flap allowed for 360 degree placement of graft and anterior tucking, with overall high success rate and lower rate of complications and graft rejection.</p>

A study of factors affecting the success rate of type-1 tympanoplasty

<p class="abstract"><strong>Background: </strong>Chronic otitis media (COM) (tubo-tympanic) is a common ear pathology for which tympanoplasty is done. Factors that affect the success rate of tympanoplasty can be patient related (age, gender, socio-economic status), disease related (duration and severity of symptoms) or technique related (equipment and surgical approaches). This study was undertaken to know the factors affecting success rate of type-1 tympanoplasty at our institute.</p><p class="abstract"><strong>Methods:</strong> This was a prospective observational study conducted at ENT Department of Gujarat Adani Institute of Medical Sciences, Bhuj, from October 2017 to July 2019. All patients between 20 and 60 years of age with inactive mucosal COM operated for type-1 tympanoplasty were included in the study. Pre-operative, intra-operative and post-operative details were recorded as per the pre validated proforma and evaluated using Chi-square and paired t-test.</p><p class="abstract"><strong>Results: </strong>100 patients were included in our study. Females were more commonly affected (61%) than males (39%). In 78% of patients one ear was affected (left 40%, right 38%). Ear discharge was the most common symptom (99%). Maximum patients (55%) had a moderate perforation. The perforation was central in all cases. Microscopic surgery was done in 79% of patients. Post aural approach (Wilde’s incision) was the most common approach used (70%). The most common graft material used was temporalis fascia (96%). In 61% of patients graft was kept by underlay technique.</p><p class="abstract"><strong>Conclusions: </strong>In our study, the success rate of tympanoplasty was significantly more when duration of discharge was less, microscope was used for surgery and post aural approach was used. Success rate was less when there was history of any previous nasal pathology. Other factors, like age, gender, socio-economic class, occupation, side of involvement of ear, size and site of perforation and grafting techniques, did not affect the success rate of tympanoplasty.</p>

Interlay Cartilage Rim Augmented Fascia Tympanoplasty: An Effective Graft Model in Mucosal Chronic Otitis Media.

To study the efficacy of interlay cartilage rim augmented fascia tympanoplasty in mucosal chronic otitis media. A retrospective, observational study was conducted in a tertiary care hospital including charts of patients spanning a duration of one year, where 15 patients diagnosed with chronic otitis media-mucosal disease with large and subtotal perforations (with or without ossicular erosion), and had undergone interlay cartilage rim augmented fascia tympanoplasty, were analysed for morphological and functional improvement following surgery. Pre- and post-operative otomicroscopic examination and pure tone audiometry findings were the parameters considered. 86.6% had a well-healed, non-retracted, undisplaced mobile neotympanum, 6.7% who underwent a type III (minor columella) tympanoplasty had a medialised neotympanum and 1 subject (6.7%) who underwent a type I tympanoplasty had a residual pinpoint perforation which healed with conservative management. The overall morphological success rate was 93.3%. The mean hearing gain following surgery was 20.84dB with a minimum gain of 10dB and a maximum gain of 30dB. The mean air-bone gap closure gain achieved was 19.2dB with a minimum gain of 6.4dB and a maximum gain of 30dB. The interlay cartilage-fascia rim augmentation tympanoplasty is a novel, effective graft model suggested for large and sub-total central perforations. Future randomized studies with a larger sample size could be performed with longer follow-up to assess the outcome of this technique.

Hearing Outcome in Ossiculoplasty With Autologous Incus and Teflon Prosthesis in Chronic Otitis Media: a Comparative Study.

To observe and compare the functional outcome in term of hearing gain in ossiculoplasty with autologous incus and Teflon made TORP/PORP in cases of chronic otitis media (COM) with ossicular disruption. 60 patients of COM between age of 11-50years who had ossicular disruption were included in the study. They were divided into two groups of 30 patients/ group: group 1 included those patients who had mucosal COM and group 2 included those who had squamous COM. They were further subdivided into 3 subgroups each as per the ossiculoplasty material used. Pre-operative pure tone audiometry (PTA) was done. They all were followed-up at 3months after surgery and at that time PTA was done. Pre-and post-operative hearing was compared and hearing improvement was calculated in term of air-bone gap (ABG). Out of 60 cases, 16 cases marked as failure of ossicular reconstruction as post-operative A-B gap was > 30dB. Among these 16 cases, 7 were those patients whom ossiculoplasty was done using autologous incus and in rest 9 patients PORP/TORP was used. Success rate of ossiculoplasty using refashioned incus was 76.66% whereas Teflon TORP/PORP had success rate of 70.00%. We conclude that hearing improvement after ossiculoplasty with autologous incus is better as compare with that obtained by Teflon TORP/PORP. Also, it is a cost-effective method.

A comparative study of endoscopic cartilage myringoplasty used to treat wet and dry ears with mucosal-type chronic otitis media.

The outcomes of dry and wet ears were compared following endoscopic cartilage myringoplasty performed to treat chronic tympanic membrane perforations in patients with mucosal chronic otitis media. Patients with chronic perforations, and with mucosal chronic otitis media with or without discharge, were recruited; all underwent endoscopic cartilage myringoplasty. The graft success rate and hearing gain were evaluated at six months post-operatively. The graft success rates were 85.9 per cent (67 out of 78) in dry ears and 86.2 per cent (25 out of 29) in wet ears; the difference was not significant (p = 0.583). Among the 29 wet ears, the graft success rates were 100 per cent in 11 ears with mucoid discharge and 77.8 per cent in the 18 patients with mucopurulent otorrhoea. The wet or dry status of ears in patients with chronic perforations with mucosal chronic otitis media did not affect graft success rate or hearing gain after endoscopic cartilage myringoplasty. However, ears with mucopurulent discharge were associated with increased failure rates and graft collapse, whereas ears with mucoid discharge were associated with higher graft success rates.

Growing incidence of fungal flora in mucosal chronic otitis media

<p class="abstract"><strong>Background:</strong> Chronic otitis media (COM) is commonly encountered chronic inflammation of the middle ear cleft caused by dysfunction of Eustachian tube followed by microbial infection. Fungal infections superimposed over COM are suspected when the discharging ear does not respond to the local antibiotic ear drops. Many authors have focused their attention on the bacterial flora of COM but very little is known about the mycological aspects.</p><p class="abstract"><strong>Methods:</strong> Ear discharge or scrapings of debris were collected from one hundred patients of active mucosal COM in whom discharge persists after two weeks of medical management and sent to the microbiology laboratory for microscopic examination and fungal culture. </p><p class="abstract"><strong>Results:</strong> Fifty seven percent cases had positive fungal KOH mount whereas fungal culture demonstrated Aspergillus flavus in 15 cases, Aspergillus niger in 38 cases and Candida albicans in 4 cases. </p><p class="abstract"><strong>Conclusions:</strong> We conclude that the fungal isolation rate is very high among the patients who did not respond to antibiotic therapy and therefore, culture and sensitivity of discharge and removal of the focus of infection should be sought before using topical drops in cases of persistent otorrhoea.</p>

A Randomized Prospective Study on Interlay Vs Underlay of Type I Tympanoplasty in Remote Tertiary Center

Background: Type I tympanoplasty is a surgical technique used to restore the integrity of tympanic membrane as well as improve the hearing in inactive mucosal chronic otitis media. There are two main methods that are underlay and overlay in between both is interlay. The aim of the present study is to analyse and compare the results of the two most commonly used type I tympanoplasty techniques, underlay and the interlay technique in chronic otitis media with mucosal disease in large central perforation, in terms of graft uptake and hearing improvement. Subjects and Methods: This is a randomized prospective study of 100 cases of inactive mucosal chronic otitis media with total or large anterior central perforation between October2017 to September 2019 in Anugarah Narayan Magadh Medical College & Hospital, Gaya. Half had gone through Interlay and half by Underlay technique of Type I Tympanoplasy surgery. Results: The graft uptake rate in this study was 96% and 90% for Interlay and Underlay technique respectively. Postoperatively mean air bone gap maximally reduced in the Interlay technique. Conclusion: The present study showed that Interlay method had better graft uptake rate as well as hearing improvement in total and large anterior central perforation of inactive mucosal chronic otitis media than the Underlay technique.

Comparison of bilateral same-day and sequential endoscopic cartilage myringoplasty for bilateral chronic tympanic membrane perforation

Background: There is debate over the applicability of bilateral same-day myringoplasty in patients with bilateral chronic tympanic membrane perforations (TMPs) requiring ear surgery on both sides.Objectives: To evaluate the healing and hearing outcomes of bilateral endoscopic ‘push-through’ cartilage myringoplasty in patients with bilateral chronic TMPs with mucosal chronic otitis media (COM) on the same day.Material and methods: The medical records of 60 patients (120 ears) with bilateral chronic TMPs who underwent bilateral same-day or sequential endoscopic push-through cartilage myringoplasty between January 2014 and March 2019 were evaluated.Results: Of the 60 patients with 120 ears, 26 patients with 52 ears were in the bilateral same-day group and 34 patients with 68 ears in the sequential group. The overall graft success rate at 3 months was 92.3% (48/52) in the same-day group and 94.1% (64/68) in the sequential group. None of the sensorineural HL and retraction pockets occurred in two groups.Conclusions and significance: Bilateral push-through cartilage myringoplasty can be performed safely for the patients with bilateral chronic TMPs in the same day, it significantly reduced the medical costs and shortened the operation time and length of stay compared to sequential myringoplasty.

Comparative study of different approaches of myringoplasty in chronic otitis media

Objectives: To determine the best surgical approach of myringoplasty regarding healing of tympanic membrane and improvement of hearing.
 Methods: This was a cross sectional comparative study carried out in the departments of Otolaryngology and Head-Neck Surgery of Bangabandhu Sheikh Mujib Medical University, Dhaka Medical College Hospital, Sir Salimullah Medical college Mitford Hospital and Shaheed Suhrawardy Medical College Hospital during the period of July’2009 to March 2011. A total number of 75 patients of age 15-45years having inactive mucosal chronic otitis media with central perforation were included in this study. All patients has undergone myringoplasty and patients were divided into three groups according to surgical approach such as postaural, transcanal and endaural. All patients were followed up postoperatively and all postoperative findings were recorded. The three groups were compared with regard to healing of tympanic membrane and improvement of hearing.
 Results: The success rate in this study was 80% . graft take rate in postaural, transcanal and endaural approaches were 92.5%, 66.67% and 63.64% respectively. Improvement of mean airbone gap in postaural, transcanal and endaural approaches were 19.04dB, 10.02dB and 11.36dB
 Conclusion: Graft take rate and hearing improvement is significantly higher in postaural approach than other approaches.
 Bangladesh J Otorhinolaryngol; April 2016; 22(1): 21-25

A clinical study of evaluation of tympanoplasty with mastoidectomy in mucosal chronic otitis media

<p class="abstract"><strong>Background:</strong> Chronic suppurative otitis media (CSOM) is one of the most common ear diseases in developing countries with a varying incidence of 3% to 57%. It the disease process is further divided into mucosal type and squamosal type depending on clinical presentation. The mainstay of therapy in CSOM remains surgery which aims at eradication of disease and restoring the hearing mechanism. The main objective of our study was to evaluate the changes and impact of tympanoplasty with mastoidectomy as a surgical treatment modality in mucosal type of CSOM.</p><p class="abstract"><strong>Methods:</strong> A prospective study was conducted in Rajarajeshwari Medical College and Hospital between November 2015 and June 2017, involving 50 patients with mucosal type of chronic otitis media. These patients, after complete clinical examination and hearing analysis, underwent tympanoplasty with cortical mastoidectomy. Follow-up of the patients was done at one month and three months after the surgery where the parameters recorded preoperatively were assessed. </p><p class="abstract"><strong>Results:</strong> The graft uptake three months after the surgery was 94%. Patients reported a subjective improvement in symptoms of ear discharge, decreased hearing, earache and tinnitus to 94%, 70%, 86% and 78% respectively. There was hearing improvement in ears that had discharge preoperatively and those ears that did not.</p><p class="abstract"><strong>Conclusions:</strong> Chronic suppurative otitis media is a very common problem and it can lead to recurrent ear discharge and hearing problems. Timely intervention is necessary as early diagnosis results in good surgical outcomes and can make an impact on patient’s quality of life.</p>

Endoscopic Tympanoplasty without Mastoidectomy for Active Mucosal Chronic Otitis Media with Mastoid and Tympanic Antrum Lesions: A Prospective Clinical Study

Objective: This study aims to assess the effectiveness of endoscopic tympanoplasty without mastoidectomy in the management of active mucosal chronic otitis media (COM) patients with mastoid and tympanic antrum lesions. Methods: It is a prospective controlled study where 42 patients with active mucosal COM with mastoid and tympanic antrum lesions or normal aeration were recruited from the outpatient clinic of the otology department, Eye Ear Nose and Throat Hospital of Fudan University. All patients underwent endoscopic tympanoplasty without mastoidectomy by using the underlay technique with tragal cartilage graft with one side-perichondrium. The follow-up period was at least 3 months and results were evaluated in terms of graft uptake, ear dryness and hearing improvement. Results: Statistics showed no significant difference in graft uptake between the mastoid and tympanic antrum lesions group (90.5%) and the normal aeration group (95.2%). There was no significant difference in ear dryness between the mastoid and tympanic antrum lesions group (95.2%) and the normal aeration group (100%). Hearing improvement was comparable in the 2 groups. Conclusion: Regardless of the occurrence of soft density shadows in temporal bone showed by high-resolution computerized tomography in the mastoid and tympanic antrum, mastoidectomy is an unnecessary procedure for dealing with active mucosal COM without cholesteatoma. Therefore, this study shows that endoscopic tympanoplasty without mastoidectomy may be applied to active mucosal COM without cholesteatoma.

COMPARATIVE STUDY OF ENDOSCOPIC AND MICROSCOPIC ASSISTED MYRINGOPLASTY IN TIRUMALA HOSPITALS, KADAPA

Objective: The main aim of the study is to assess the operative time, graft uptake and audiological gain and post-operative scar in the group of the patients undergoing the endoscope assisted and the microscope assisted myringoplasty in Tirumala Hospital, Kadapa.
 Material and Methods: Myringoplasty or type-1 tympanoplasty was performed by either the endoscope or the microscope assistance. Postaural approach was undertaken for microscope assisted myringoplasty. Underlay technique of myringoplasty was performed using temporalis fascia graft in all the patients suffering from the inactive mucosal chronic otitis media. Post operative evaluation was done in terms of operative time, graft uptake and audiological gain. The patients were followed up for a period of 6 months. The study was longitudinal in nature and comprised of 100 patients suffering from the chronic otitis media inactive mucosal disease. The patients are divided into two groups consisting of 50 in each group. One group of patients have undergone microscopic assisted myringoplasty one group undergone endoscopic assisted myringoplasty and were followed up regularly. Study period is one year from January 2016 to December 2016 attending outpatient otolaryngology department were included in the study.
 Results: The operative time in the patients undergoing the endoscope assisted myringoplasty(EAM) was 45minutes whereas it was 60 minutes in the patients undergoing the microscope assisted myringoplasty(MAM). The tympanic membrane graft uptake and audiological gain was assessed at 1 month, 3months and 6 months post operatively. The successful closure of the tympanic membrane perforation was higher with the endoscope assisted myringoplasty as compared to the microscope assisted myringoplasty at 1 month, 3 months and 6 months of follow up. The mean audiological gain following myringoplasty with both the techniques used was noted. The mean audiological gain was found to be marginally better with the endoscope assisted myringoplasty at follow up of 1, 3 and 6 months as compared to the microscope assisted myringoplasty.
 Conclusion: The operative time was less in the endoscope assisted technique as compared to the microscope assisted technique. The post operative morbidity (evaluated in terms of post operative scar) was less in the group of patients undergoing the Transcanal endoscope assisted as compared to microscope assisted myringoplasty. There was no significant difference in either graft uptake or post-operative audiological gain in the patients undergoing myringoplasty by endoscope assisted and microscope assisted technique. The endoscope assisted myringoplasty has advantages of better assessment of ossicular chain and in the patients with canal overhang it improves the visualisation of the margins of the perforation thus obviating the need for canalplasty. Thus the endoscope assisted myringoplasty can be used as a preferred alternative to the conventional microscope assisted myringoplasty, with better post operative results and reduced operating time and morbidity of the surgical procedure.
 Keywords: Chronic otitis media (COM); Myringoplasty; Endoscope assisted myringoplasty; Microscope assisted myringoplasty.

Benefit of Tympanoplasty with or without Cortical Mastoidectomy in Active Mucosal Otitis Media – A Comparative Study

Introduction: 
 Chronic otitis media (COM) is amongst the most common diseases treated by ENT surgeons in India. It has been advocated in lot of research articles that there is no significant difference in tympanoplasty done in active and inactive COM. The objective was to see if cortical mastoidectomy in cases of active mucosal COM, improves the success rate of tympanoplasty measured as per the following parameters: improvement in the hearing threshold by 15 dB, increased graft uptake and reduction in retraction of tympanic membrane in post operative period.
 Materials and Methods: 
 This study comprises of 120 patients coming to the ENT OPD from October 2016 to October 2017 with active mucosal COM with central perforation requiring tympanoplasty. These patients were randomly assigned to two groups: Group 1 of 60 subjects in which tympanoplasty without mastoidectomy was done, Group 2 of 60 subjects in which tympanoplasty with mastoidectomy was done. Patients were evaluated after a post operative period of 3 months.
 Results: 
 The Results were the hearing improvement was 73.33% in group 1 while 83.33% in group 2, graft uptake was 63.33% in group 1 and 80% in group 2, graft retraction was 33.33% and 23.33% in group 1 and group 2 respectively.
 Conclusion:
 There was statistically significant difference in results in group with and without mastoidectomy in active mucosal chronic otitis media with respect to graft uptake and improved hearing.

Analysis of hearing improvement in patients with chronic mucosal otitis media after type-1 tympanoplasty

<p class="abstract"><strong>Background:</strong> Chronic mucosal otitis media implies a permanent abnormality of the pars tensa. It can be active, where there is pus formation and inflammation or it can be inactive, where there is no inflammation and pus formation. It may occur due to many etiological factors like recurrent Upper respiratory tract infection leading to Eustachian tube blockage, sequelae to unresolved acute otitis media etc. Patient is most commonly presented with pus discharge from ears and decreased hearing.</p><p class="abstract"><strong>Methods:</strong> This prospective study was carried out in 44 patients, above the age of 18 years, with unilateral chronic mucosal otitis media. All patients underwent type 1 tympanoplasty. Pre and post treatment hearing was measured by pure tone audiometry. </p><p class="abstract"><strong>Results:</strong> The result shows that most patients were in the age group of 20-30 years of age. Most common symptom patients presented with was hearing loss and pus discharge. The pre treatment mean air bone gap was 34 db and the post treatment mean air bone gap was 14 db.</p><p class="abstract"><strong>Conclusions:</strong> Most common age group was between 20-30 years. Patients presented with mostly hearing loss and discharge from the ear which was chronic in nature and mostly mucoid. All patients benefitted in hearing postoperatively after type 1 tympanoplasty was done. It shows that type 1 tympanoplasty is still one of the most used methods and produces effective results in patients with chronic mucosal otitis media.</p>

Endoscopic myringoplasty: outcome and hearing gain in inactive mucosal chronic otitis media

<p class="abstract"><strong>Background:</strong> Chronic otitis media is an inflammatory process in the middle ear cleft that poses serious health problem in developing countries. Myringoplasty is a common otological procedure to reconstruct the tympanic membrane to prevent recurrent otorrhea, and restore sound-conducting mechanism. The use of rigid endoscope in transcanal myringoplasty has significant advantage as it provides magnified, close up as well as wide angle view, less morbidity and early postoperative wound healing with better cosmetic results without compromising success rate and postoperative hearing gain. The aims and objectives of the study were to analyze the results of endoscopic transcanal interlay myringoplasty, in terms of graft uptake and hearing improvement in cases of chronic suppurative otitis media with inactive mucosal disease with central perforation.</p><p class="abstract"><strong>Methods:</strong> This is a prospective study conducted from January 2016 to August 2018 in 30 patients of inactive mucosal chronic otitis media (COM). All patients underwent transcanal endoscopic interlay myringoplasty and patients were called for regular follow up for 12 weeks and results were statistically analysed. </p><p class="abstract"><strong>Results:</strong> The graft uptake rate in the present study was found to be 93.33%. Pre operatively mean air bone gap (ABG) was 27.33 dB and post operatively after 12 weeks mean air bone gap improved to 10.5 dB. Mean ABG gain was 16.33%.</p><p class="abstract"><strong>Conclusions:</strong> Endoscopic transcanal interlay myringoplasty with superiorly based TM flap is an effective technique over conventional microscopic technique in terms of graft uptake, hearing improvement, better postoperative scar and less morbidity in cases of inactive mucosal COM.</p>

Study of Correlation of Pre-Operative Findings with Intra-Operative Ossicular Status in Patients with Chronic Otitis Media

Chronic otitis media (COM) has been broadly classified into mucosal and squamous subtypes. COM types are associated with erosion of the ossicular chain. The aim of the present study was to correlate the type of COM, the site of perforation/retraction, and the type of disease pathology with the pattern and degree of ossicular chain necrosis. A prospective cross-sectional study was performed in 76 cases of COM, who were subjected to tympanomastoidectomy. Pre-operative findings were compared with per-operative ossicular chain status and pathology. Incus was found to be the most vulnerable ossicle for erosion, followed by malleus and suprastructure of stapes. The pattern of multiple ossicle involvement was more common. Ossicular chain erosion was more common in squamous COM than mucosal COM (X2=66.25; P=0.0001) and in the presence of cholesteatoma and granulations. Ossicular necrosis was most common in squamous disease with cholesteatoma, followed by squamous disease with granulations, mucosal disease with granulations, and inactive mucosal disease in that order. The degree of ossicular necrosis has a positive correlation with the type of disease pathology, being higher in squamous disease than in mucosal disease. The pattern of ossicular necrosis varies with the site of origin of the disease and the pattern of spread of cholesteatoma, being variable for pars tensa and pars flaccida squamous disease.

Evaluation of Eustachian Tube Function in Mucosal Chronic Otitis Media: A Cost-Effective Method for Developing Countries

Abstract Background In the developing nations, the sinonasal region is routinely screened in chronic otitis media, but Eustachian tube is not as it is not cost-effective. Hence, we innovated an inexpensive device named Eustachian barotubometer. Materials and Methods A prospective case–control study was performed on ­mucosal type of chronic otitis media and traumatic tympanic perforation (100 cases each). Eustachian tube function was assessed by the Eustachian barotubometer (forced and physiological opening) and nasopharyngoscopy. Results Eustachian tube dysfunction was found to be five times higher in cases than controls. Both forced opening function and physiological opening function were ­poorer in cases than controls. However, the difference was statistically significant only in physiological opening function (p = 0.003). Among the cases with dysfunctional tubes, 86.7% were hypofunctional, whereas 13.3% were totally blocked. Conclusion Eustachian tube function was affected in 15% of cases of mucosal ­chronic otitis media as compared with controls in this study. This novel device could be ­conveniently used to help decide the right time to undertake middle ear surgery.

Clinical and Radiological Predictability of Aditus Patency in Mucosal COM with Sclerosed Mastoid: An Analytical Study

ABSTRACT Objectives To evaluate the predictability of aditus patency in mucosal chronic otitis media (COM) with sclerosed mastoid using clinical and radiological tests. Study design Prospective study. Materials and methods Thirty-five cases of mucosal COM with sclerosed mastoid were taken for antrotomy with tympanoplasty. The preoperative evaluation of aditus patency was done using clinical examination, inflation deflation test for Eustachian tube function and high-resolution computed tomography (HRCT) temporal bone. The intraoperative patency was tested by water test. Results This study shows that there is statistically insignificant correlation between duration of discharge, tympanosclerosis and Eustachian tube function with aditus patency. There is statistically significant relationship between HRCT temporal bone and aditus patency (p < 0.0001). Conclusion High-resolution computed tomography temporal bone is a reliable predictor for aditus patency and we recommend routine use in sclerosed mastoid before all tympanoplasties for best results. How to cite this article Varma A, Maithani T, Agrahari AK, Pandey AK, Singh VP. Clinical and Radiological Predictability of Aditus Patency in Mucosal COM with Sclerosed Mastoid: An Analytical Study. Int J Otorhinolaryngol Clin 2015;7(3):121-124.

Endoscopic vs microscopic myringoplasty: a different perspective

The objectives of this study were to ascertain the feasibility of transcanal endoscopic underlay myringoplasty using temporalis fascia and compare the results with microscopic myringoplasty. This prospective randomized trial included 60 patients with mucosal chronic otitis media with tympanic membrane perforations of all sizes and locations apart from posteriorly based small or moderate sized perforations. In the endoscopy group, 30 patients underwent exclusive transcanal myringoplasty using tympanomeatal flap elevation with underlay graft placement. In the microscopy group, 30 patients underwent myringoplasty using the postaural approach. Intra-operative variables compared were canalplasty and canal wall curettage for assessment of ossicular status. Graft uptake, hearing outcomes using pure tone audiometry and subjective cosmetic outcomes were assessed 24 weeks post-operatively and compared in the two groups. Resident feedback on the feasibility of endoscopic myringoplasty was obtained using a questionnaire. In the microscopy group, 5/30 patients required canalplasty due to canal overhangs and 4/30 required canal wall curettage for ossicular assessment, whereas none of the patients in the endoscopy group required these procedures. A graft uptake rate of 83.3% was observed in both groups post-operatively after 24 weeks. Mean air-bone gap pre- and post-operatively in the endoscopy group was 28.5 and 18.13 dB, respectively, whereas these values were 32.4 and 16.9 dB, respectively, in the microscopy group. Subjective cosmetic outcomes were better in the endoscopy group. Resident feedback on endoscopic myringoplasty was positive. Endoscopic myringoplasty appears to be an effective alternative to microscopic myringoplasty and results in excellent hearing with good cosmetic outcomes.

Mastoid Cholesteatoma: A Result of Metaplasia

Presence of cholesteatoma in the middle ear of the patients with chronic mucosal otitis media has been reported in the literature. But presence of cholesteatoma only in the mastoid, in the absence of cholesteatoma in the middle ear of a patient with chronic mucosal otitis media, is not reported in the literature. In this article three cases of mastoid cholesteatoma, in patients with a clinical picture of chronic mucosal otitis media is reported along with the literature review.