Chronic Otitis Media Mucosal Disease Research Articles

A study on Eustachian Tube Dysfunction after Tympanoplasty in Chronic Otitis Media mucosal disease

A study on Eustachian Tube Dysfunction after Tympanoplasty in Chronic Otitis Media mucosal disease

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.

Endoscopic Ear Surgery: Our Experience.

Endoscopes are presently used as an adjunct to microscopic surgery for better visualization of hidden areas of middle ear or they are used as a primary modality replacing the microscopes. We performed primary endoscopic ear surgery at a tertiary care center to evaluate the scope of endoscopic ear surgeries and to evaluate the anatomical, functional and quality of life outcomes. We evaluated 103 cases of which included patients with chronic otitis media mucosal disease (64), chronic otitis media squamous disease (29), otosclerosis (6), and benign ear tumors (4). In our study, the structural and functional outcomes of endoscopic ear surgeries were comparable to microscopic techniques however it conferred superior patient related outcomes of cosmesis, post-operative pain and early return to daily routine. Thus endoscopic ear surgery is a minimally invasive alternative option to microscopic techniques in the field of otology.

A Prospective Randomized Study to Compare Surgical Outcome Using Wet and Dry Temporalis Fascia Graft in Type I Tympanoplasty.

Temporalis fascia is being used as graft material for tympanic membrane repair for over six decades. Though cartilage with or without perichondrium is also being used for different situations, still temporalis fascia graft is being considered as an ideal graft for tympanoplasty. Earlier the dried temporalis fascia was used as a graft but now freshly taken wet temporalis fascia is increasingly being used as a more 'physiological/ live' graft. The present study was planned to compare the results of use of wet and dry temporalis fascia in chronic otitis media mucosal disease. The prospective study was conducted on 100 patients of chronic suppurative otitis media mucosal disease. Chronic ear survey questionnaire were filled to note the impact on quality of life. Otoscopic, oto-endoscopic and examination under microscope performed. Patients were allocated into two groups alternately. Freshly taken wet temporalis graft was used in group I whereas dry temporalis fascia was used in group II. Hearing evaluation by pure tone audiogram was done preoperatively and at 6th months post-operatively. Pre-operative and post-operative hearings in both the groups were compared. Air bone gap closures after surgery in between both the groups were compared to see for any statistical difference. We found similar graft uptake in both the groups after 6months of surgery. The air bone gap closure in group I was 10.80 ± 5.74 and group II was 9.28 ± 4.81, there was no significant difference. However senior authors noted that in some of the cases in group I with fresh wet graft placement neo-tympanum formation was noticed early showing good circumferential leash of blood vessels all around signifying early vascularisation.

A retrospective study comparing post-aural versus endaural approach for myringoplasty in cases of chronic otitis media

<p class="abstract"><strong>Background:</strong> Patients diagnosed with chronic otitis media mucosal disease with a mild degree of conductive hearing loss require myringoplasty as their treatment. Various approaches to myringoplasty are defined. The aim of the present study was to compare outcomes of the post-aural versus end aural approach for myringoplasty.</p><p class="abstract"><strong>Methods:</strong> A retrospective cohort study of 26 patients operated over a period of one year at tertiary otorhinolaryngology center. </p><p class="abstract"><strong>Results:</strong> Distribution of approaches among post-aural and end aural was 11 and 15 patients respectively.<strong> </strong>Otorrhea was the presenting complaint in 65% (n=17) of patients. Preoperative mean pure-tone average (PTA) of all patients was 34.8 dBHL (range 28 to 40 dBHL) while postoperatively 3 months mean PTA was 21.63 and 25.13 dBHL for patients undergoing end aural and post-aural approaches respectively (p=0.008). The success rate in terms of no re-perforation was 76.9% overall, 81.81% for the end aural approach and 73.33% for the post-aural approach with no statistically significant difference (p=0.612). Disease-free survival, as calculated with Kaplan-Meier analysis, was 9.7 and 13.9 months respectively (p=0.807). Cosmetic outcome was analyzed using the scar cosmesis assessment and rating (SCAR) scale. Mean SCAR scale score in our series was 5.36 and 6.20 for patients with end aural and post-aural approaches respectively with no statistically significant difference.</p><p class="abstract"><strong>Conclusions:</strong> Both approaches, end aural and post-aural, are good approaches for the purpose of myringoplasty with no statistically significant difference between the two in terms of re-perforation rates or cosmetic outcomes. However, based on our study, the end aural approach has better hearing outcomes in terms of hearing improvement.</p><p> </p>

A Comparative Study on Morphological and Audiological Outcome in Type Ι Tympanoplasty for Chronic Otitis Media Mucosal Disease Using Temporalis Fascia versus Cartilage Graft

A Comparative Study on Morphological and Audiological Outcome in Type Ι Tympanoplasty for Chronic Otitis Media Mucosal Disease Using Temporalis Fascia versus Cartilage Graft

Impact of otorrhoea and ossicular status on the effect of tympanoplasty

<p><strong>Background: </strong>The objective of the study<strong> </strong>was to assess the effect of otorrhoea, osscicular and middle ear status on anatomical and functional results in patients undergoing tympanoplasty with or without mastoidectomy for chronic otitis media mucosal disease</p><p><strong>Methods: </strong>This was a prospective study conducted on 100 patients<strong> </strong>with otological complaints (otorrhoea, hearing loss) attending the out-patient Department of ENT, at Mamata Medical College and Research Hospital, Khammam Telangana state during the period from December 2015 to July 2017. All the patients underwent a detailed general physical, otoneurological evaluation, hearing assessment by pure-tone audiometry prior to surgery. As per MERI the patients were evaluated for factors preoperatively and intraoperatively. Postoperatively the patients were followed up at 3 and 6 months to ascertain the structural (graft take up) and functional (hearing improvement) success.<strong></strong></p><p><strong>Results: </strong>Otorrhoea was the most common complaint observed (48%). As per Belluci's classification of otorrhoea, maximum number of patients (52%) had a dry ear, wet ears (48%) and persistently wet ears (8%). According to Austin-Kartush classification 50 patients had an intact ossicular chain, defects of the incus in 36 patients, defects in both malleus and incus, stapes and incus was seen in 7 patients each. Majority of the patients 79% had normal middle ear status while 21% of them had middle ear effusion present. Majority of the patients belonged to the group of mild risk MERI (l-3) (n=69) patients, moderate risk category MERI (4-6) (n=26) severe risk (7-12) (n=5). Graft uptake was successful in 78 patients and failure in 22 patients. Hearing Improvement was noticed in 78 patients.</p><p><strong>Conclusion: </strong>Otorrhoea and middle ear cleft status have an impact on the success of the tympanoplasty, while ossicular status did not have a significant effect on the outcome.</p>

A comparative study on type I tympanoplasty with or without mastoidectomy in chronic otitis media-mucosal disease

Introduction: This comparative study evaluates the outcomes of type 1 tympanoplasty with or without mastoidectomy in chronic otitis media, mucosal disease in a tertiary care institute. Materials and methods: The study included 84 patients with mucosal type of ear disease in quiescent stage .42 of these patients underwent type 1 tympanoplasty alone [Group A] and 42 underwent type 1 tympanoplasty with mastoidectomy [Group B]. Patients were followed up in the outpatient clinic at one week, third week, three months, and six months after the surgery. At third and sixth month the patients underwent otoscopic evaluation and hearing assessment. Results: 19% of the patients who underwent Type I tympanoplasty had residual perforation at 6 months when compared with 14% of the patients of cortical mastoidectomy with Type I tympanoplasty which was statistically insignificant in this study. In group B out of 7 patients who had diseased mastoid status per operatively 4 had residual perforation which was significant [p<0.05]. Conclusion: In this study the comparison of results between groups A & B is statistically insignificant. Disease status of mastoid proved to be a significant factor for success of surgery. Belfast rule of thumb proved to be a better method to assess the post-operative hearing improvement subjectively.

Predisposing Sinonasal Disease Foci: Do They Really Affect Mucosal Chronic Otitis Media?

Abstract Background This study aimed to find the relationship between sinonasal predisposing foci in chronic otitis media mucosal disease (COMMD) and risk from these predisposing disease foci, and to identify the correlation of bacterial flora of the ear and nose in chronic otitis media. Materials and Methods This was a prospective case–control study with 100 cases and 100 controls. All patients underwent a detailed clinical ear-nose-throat (ENT) examination and diagnostic nasal endoscopy to look for sinonasal and pharyngeal pathology. In all patients, ear and nasal swabs were taken at the first visit. The relationship between these factors and COMMD was studied by appropriate statistical tests. Observations and Results Extremely significant association between tubal tonsil hypertrophy and COMMD, very significant association between adenoid hypertrophy and COMMD, and just significant association between deviated nasal septum, inferior turbinate hypertrophy, concha bullosa, and COMMD were found. No significant association was found between sinusitis and COMMD. In this study Staphylococcus aureus (51%) was the predominant organism isolated from ear swab, followed by Pseudomonas (27%). The same organism in nasal and ear swabs was demonstrated only in eight (13%) cases. Conclusion Sinonasal predisposing foci play a substantial role in the development of COMMD and observed in 97% of the cases with bilateral disease and 91% with unilateral disease in this study. Hence, every case of COMMD must undergo investigations such as diagnostic nasal endoscopy to discover these foci. Because sinonasal disease is one of the important factors contributing to otitis media, timely detection and management of symptomatic sinonasal disease must precede surgical management of COMMD.

Effect of Canalplasty on Outcome of Results in Type I Tympanoplasty

Background: The aim of the surgical procedure of tympanoplasty is to strive to achieve an intact neo tympanum with normal hearing acuity. Widening of the external auditory canal, called canalplasty, helps in better visualization and hence better placement of the tympanic membrane graft. Aim of this study was to compare effect of canalplasty on the outcome of results of type I tympanoplasty. 
 Methods: 50 cases of patients diagnosed with chronic otitis media mucosal disease with a central dry perforation involving two or more quadrants of the tympanic membrane were included in the study. One group of 25 cases underwent tympanoplasty with canalplasty and was grouped under Group I while the other group of 25 cases underwent tympanoplasty without canalplasty and was called group II. 
 Results: Analysis was done for graft uptake, hearing improvement and time taken for the surgery. Group I achieved a success rate of 92% graft uptake as compared to group II, which achieved 84%. There was statistically significant improvement in post-operative hearing in cases with canalplasty. Time taken was between the two groups were not statistically significant.
 Conclusion: Anatomical and technical factors diversely affect the functional outcome of tympanoplasties. Canalplasty helps in better visualization and placement of the graft. Time spent on drilling in canalplasty is compensated by the time gained in grafting of the neo tympanum. The procedure prevents lateralization of the graft due to the accurate exposure of the annulus. Post operative care is also easier in cases of tympanoplasty with canalplasty.