Middle Ear Risk Index Research Articles

Unveiling the Aggressiveness of Cholesteatoma: Associating MERI with miRNA-21 & IL-6 Expression.

Cholesteatoma, a destructive middle ear condition, poses challenges due to its variable clinical presentation and propensity for recurrence. Understanding its molecular underpinnings could enhance prognostication and guide therapeutic interventions. This study investigates the association between cholesteatoma aggressiveness, as assessed by the Middle Ear Risk Index (MERI), and the expression of miRNA-21 and IL-6 genes. A cross-sectional observational study involving 30 patients with cholesteatoma undergoing tympanomastoid exploration was conducted. MERI scores were calculated preoperatively, and cholesteatoma tissue was analyzed for miRNA-21 and IL-6 gene expression using RT-PCR. Statistical analysis was performed to correlate MERI scores with gene expression levels. The majority (80%) of patients exhibited severe MERI scores, correlating with extensive middle ear pathology and necessitating canal wall-down (CWD) mastoidectomy. Higher miRNA-21 and IL-6 gene expression levels were observed in cholesteatoma tissues, indicating local aggressiveness and inflammatory activity. Significant moderate correlations were found between MERI scores and miRNA-21 (Pearson correlation = 0.579, p = 0.001) and IL-6 gene expression (Pearson correlation = 0.388, p = 0.034). Patients with severe MERI scores had elevated miRNA-21 and IL-6 levels, suggesting a more aggressive disease phenotype. MERI scores demonstrated utility in predicting cholesteatoma aggressiveness, with higher scores correlating with elevated miRNA-21 and IL-6 expression. These findings suggest a potential role for MERI in guiding surgical decision-making and prognostication. Future research on targeted therapies based on molecular mechanisms holds promise for improving cholesteatoma management. 3 Laryngoscope, 2024.

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

Introduction: Middle ear risk index is one of the most reliable measuring tools to predict and evaluate the results of tympanoplasty. This study was done to analyse the predictive value of revised middle ear risk index on hearing improvement in patients undergoing surgery for chronic otitis media and to correlate the association between each index factor with hearing results. Materials and Methods: This prospective observational study was done over 2 years in a tertiary care Army Hospital with 88 patients in the age group of 10-65 years. Preoperative hearing thresholds and air-bone gaps were recorded. Patients were assigned to mild, moderate and severe groups with risk index scores. Hearing thresholds were assessed at 3 and 6 months following surgery for chronic otitis media. Data was statistically analysed. Results: 92.04% and 77.27% showed hearing improvements, 4.54% and 1.13% had deterioration and 3.40% and 21.59% had no change when compared to preoperative results in AC and BC thresholds respectively. 57.95% had post-operative closure of air bone gap of ≤ 12. Compared to cases with AB gap closure ≤ 12, those with AB gap closure > 12 showed statistically significant gain in BC by 0.2dB. Each unit increase in risk index score was associated with statistically significant increase of 0.64 dB in BC. Out of the seven individual factors, only perforation and previous surgery showed statistical significance in terms of hearing improvement. Conclusion: Middle ear risk index is not a good predictor of hearing improvement in ear surgery. Individually, risk index or air bone gap are not strong predictors but jointly, they show strong association with hearing improvement both in terms of AC and BC. Keywords: Middle ear risk index; Air conduction; Bone conduction; Air-bone gap; Hearing improvement.

The Role of the Middle Ear Risk Index in the Outcome of Tympanoplasty in Terms of Graft Uptake and Hearing Improvement

The Role of the Middle Ear Risk Index in the Outcome of Tympanoplasty in Terms of Graft Uptake and Hearing Improvement

Effectiveness of middle ear risk index (MERI) in outcome of tympanoplasty

Effectiveness of middle ear risk index (MERI) in outcome of tympanoplasty

Predictive Value of Middle Ear Risk Index Score in the Outcome of Tympanomastoidectomy and Tympanoplasty

Predictive Value of Middle Ear Risk Index Score in the Outcome of Tympanomastoidectomy and Tympanoplasty

TYMPANOPLASTY AND ITS OUTCOME IN VARIOUS AGE GROUPS USING THE MIDDLE EAR RISK INDEX SCALE AT A TERTIARY CARE CENTRE IN EASTERN NEPAL

Background: Tympanoplasty is done in cases of chronic otitis media. Middle Ear Risk Index (MERI) Scale is used to predict the outcome of tympanoplasty, based on various risk factors like otorrhoea, perforation, ossicular chain status, cholesteatoma, smoking and middle ear granuation/effusion. The objective of the study was to report the success rate of graft uptake, postoperative gain in hearing threshold and to find out the association of success to the different categories of MERI scale. Methods: A prospective study of 75 cases of chronic otitis media who underwent tympanoplasty, was done over one year. Convenience sampling method was done. Clinical and audiological evaluation was done pre- and post- operatively. Risk categorization based on MERI scale was done. Data were recorded and analyzed using SPSS 16. Results: Out of 75 cases, 39 (52%) cases were male and 36 (48%) were female. The mean age was 24.55 years±11.545. Overall, 53 (70.66%) cases had successful graft uptake. MERI 1-3 group had 82.6 % (38/46), MERI 4-7 group had 64.7 % (11/17) and MERI 8-12 group had only 33.33% (4/12) graft uptake, (p-value 0.003). Above-10-year age group had higher graft uptake rate and hearing gain. Graft acceptance was seen equal in dry or wet ear, and in unilateral or bilateral perforation. Conclusions: Tympanoplasty done in cases with lower MERI scale and more than 10 years age group was associated with higher graft acceptance. More than 10 years age group had better hearing gain. The status of middle ear, dry or wet and laterality of perforation had no association for graft acceptance.

Role of Middle Ear Risk Index in the Selection of Middle Ear Surgery and Factors Determining Outcome: A Cross-sectional Study

Introduction: Chronic Otitis Media (COM) is a major cause of preventable hearing loss. Tympanoplasty is a crucial surgical step in managing COM and restoring hearing loss. Various prognostic factors are believed to influence the success of graft take-up. The Middle Ear Risk Index (MERI) is a numerical grading system used to assess the severity of the disease and predict the outcome of tympanoplasty for individual patients. Aim: To investigate the role of preoperative MERI in the selection of middle ear surgery. Materials and Methods: This cross-sectional study was conducted on a sample size of 40 patients (40 ears) who were treated at the Department of ENT, Acharya Vinobha Bhave Rural Hospital, Sawangi (Meghe), Wardha, Maharashtra, India, from December 2020 to December 2022. Only patients free from comorbidities and COM-related complications who underwent surgical intervention were included. The patients were evaluated for their MERI score, and the outcome of the surgical intervention was then correlated. Statistical analysis was performed with SPSS version 25.0 at a significance level of p<0.05. Results: The MERI was utilised as a tool for assessing surgical outcomes. A lower MERI score indicated a less invasive choice of middle ear surgical procedure and was associated with a better outcome in terms of graft uptake, which was statistically significant. Patients requiring tympanoplasty alone had mild MERI scores (1-3), while more extensive surgeries such as canal wall up or canal wall down were associated with moderate or severe MERI scores (4-6 or 7-12), and this association was found to be significant (p=0.001). Interestingly, out of the total 40 patients, five with Eustachian Tube (ET) dysfunction had severe MERI scores (7-12) and experienced graft rejection. Patients with lower grades of ET dysfunction had higher chances of graft uptake, and this association was statistically significant (p=0.001). Conclusion: This study demonstrated that lower MERI scores were associated with better postoperative outcomes. In a country like India, where the cost of surgery and time away from work are major considerations, it is important to establish a standardised approach to predict the surgical outcome, whether it involves tympanoplasty alone or in combination with other middle ear surgeries like cortical mastoidectomy or canal wall down mastoidectomy, and counsel the patient accordingly. This plays a crucial role in informed decision-making.

A Prospective Study on Correlation of MERI (Middle Ear Risk Index) Score with Surgical Outcome of Tympano-mastoid Surgery in Patients of CSOM.

Chronic otits media (COM) is surgically treatable disease which includes complete removal of disease and improving hearing via ossicular reconstruction. Therefore, thorough assessment of the disease, ossicles and various factors causing it plays a major role in surgical outcome prediction. MERI (Middle ear risk index) is one such tool being used worldwide. Our aim was to evaluate the surgical outcome of tympanomastoid surgery using MERI and find out correlation between them as well as categorize cases into their severity score in a developing country. Observational prospective study conducted in a tertiary care center. 200 patients were included. After complete history and examination, they were given MERI scores and prediction of surgical outcome was done. Postoperatively it was compared with the real outcome of the surgery. Out of 200 patients, 71.5% had mild, 15.5% had moderate and 13% had severe MERI scores preoperatively. There was a success rate of 88.5% in graft uptake and the mean score of hearing benefit (A-B gain) among patients was 8.75 ± 8.82 dB postoperatively. MERI may be used as a prognostic indicator for predicting surgical outcome. Based on the MERI score, chances of surgical success and hearing benefit can be explained to the patient with certain limitations.

A Review of the Middle Ear Risk Index as a Prognostic Tool for Outcome in Middle Ear Surgery.

This review article aims to scrutinize the studies conducted to determine a relationship between preoperative Middle Ear Risk Index (MERI) factors and postoperative graft acceptance and audiological gain in patients undergoing tympanoplasty procedures in middle ear surgeries. Critical analysis is done on numerous research and types of studies that were done in this area during the past years. The clinical and technical aspects connected to disease and its care have a variety of effects on the morphological and functional outcome of tympanoplasty. A better comprehension of these characteristics aids in better disease prognostication, surgical planning, and patient counseling. At the end of this review, we can conclude that the MERI score is inversely proportional to the post-operative graft acceptanceand audiological gain. The accumulated MERI is hence a good prognostic factor for the hearing outcome ofsurgery.

The role of middle ear risk index on the outcome of surgery for chronic otitis media

<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>

ROLE OF MIDDLE EAR RISK INDEX SCORE, DIAGNOSTIC NASAL ENDOSCOPY AND EUSTACHIAN TUBE FUNCTION IN PREDICTING OUTCOME OF TYMPANOPLASTY

AIM To study the role of middle ear risk index (MERI) score, nasal pathology and Eustachian tube f u n c t i o n i n p r e d i c t i n g t h e o u t c o m e o f tympanoplasty. METHODOLOGY Patients of age group 5-60 years both male and female with diagnosis of CSOM, planned for tympanoplasty with or without mastoidectomy were taken in the study. Detailed history and examination of all patients fulfilling the inclusion criteria was done. Preop findings were observed and recorded. MERI scoring was obtained. The data collected pre operatively was assessed with surgical outcome based on graft uptake status and PTA. Post op follow up was done at 1.5 and 3 months. This data was evaluated and compared with pre op finding. RESULTS The overall success rate of tympanoplasty in the study was 86% based on graft uptake and 85% according to hearing benefit. The number of patients with graft up[take was higher among those with mild MERI score (87.5%) compared to those with moderate and severe MERI scores (83%). The graft uptake is lesser in patients with gross DNS & Eustachian tube dysfunction. Thus MERI is a helpful tool to ascertain the prognosis of tympanoplasty. CONCLUSION The study concludes that MERI score, DNE and ET function evaluation in patients with chronic otitis media are very useful methods in predicting the outcome of tympanoplasty. KEYWORDS Chronic otitis media, Middle ear risk index, Eustachian tube function, diagnostic nasal endoscopy, tympanoplasty outcome

Predictive Value of Middle Ear Risk Index Score in the Outcome of Tympan mastoidectomy and Tympanoplasty

Predictive Value of Middle Ear Risk Index Score in the Outcome of Tympan mastoidectomy and Tympanoplasty

A Prospective Study to Evaluate Role of Middle Ear Risk Index in Tympanoplasty with Mastoidectomy as a Prognostic Parameter

Abstract 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.

Hearing outcome after tympanoplasty type III

PurposeWe assessed overall hearing outcome after tympanoplasty type III in chronically infected ears with cholesteatoma (CH) and without cholesteatoma: otitis media chronica mesotympanalis, tympanosclerosis, and adhesive process (COM_T_AP).Methods303 surgeries were evaluated: 229 CH-group and 74 COM_T_AP-group. Air-bone gaps (PTA-ABG) with pure-tone averages (PTA-4) at four frequencies (0.5, 1, 2 and 4 kHz) were compared preoperatively, early postoperatively (< 40 days) and late postoperatively (40–400 days). Hearing outcome was compared in various types of middle-ear reconstruction and in smokers and non-smokers. Correlations between hearing outcome and predictive staging indices were evaluated: Middle Ear Risk-Index (MER-I) and Ossiculoplasty Outcome Parameter Staging-Index (OOPS-I).ResultsMean PTA-ABG in the CH-group increased from 20.9 ± 11.3 dB to 22.3 ± 10.4 dB early postoperatively and decreased significantly to 19.2 ± 10.1 dB late postoperatively. Mean PTA-ABG in the COM_T_AP-group decreased significantly from 27.3 ± 10.9 dB to 20.6 ± 10.9 dB early postoperatively and decreased to 20.0 ± 12.2 dB late postoperatively. No significant difference was seen between PTA-ABG-closures of partial or total ossicular replacement prosthesis (PORP/TORP) and cartilage ossiculoplasty in the CH-group. Patients receiving TORP showed a significantly higher preoperative PTA-ABG. All reconstruction types exhibited postoperative PTA-ABG around 20 dB. In the COM_T_AP-group, smokers had a significantly higher mean PTA-ABG early postoperatively; this equalized with that of non-smokers late postoperatively. PTA-ABG-closures and MER-I or OOPS-I were not significantly correlated.ConclusionTympanoplasty type III maintains hearing in patients with cholesteatoma and significantly improves hearing in chronically inflamed ears without cholesteatoma. All investigated ossicular replacement prostheses are equally beneficial. Healing postoperatively takes longer in smokers, but they eventually catch up with non-smokers.

Correlation of the Neutrophil-to-Lymphocyte Ratio with the Middle Ear Risk Index in Patients with Chronic Otitis Media.

This study aimed to investigate the neutrophil-to-lymphocyte ratio (NLR) and severity of the chronic otitis media according to middle ear risk index (MERI) scores. The NLR and middle ear risk index were calculated for 210 chronic otitis media (COM) patients retrospectively. NLR compared between COM patients and 159 participants in control group. Pearson correlation analysis was performed for NLR and MERI. In addition, The cut-off value, sensitivity, and specificity for NLR were determined in COM according to the severity of the disease with ROC analysis. The average of NLR in all patients was 1.94 ± 0.89. NLR was calculated as 2.05 ± 1.03 in the patients with COM and 1.79 ± 0.64 in the control group (p = 0.006, 95% CI 0.07-0.44, t test). According to the ROC analysis, the cut-off point was determined as 1.95 for moderate and severe disease in MERI. For the cut of a NLR = 1.95, sensitivity was calculated as 48.5% and the specificity 57.1% for moderate and severe COM. MERI score was found significantly higher in patients with postoperative graft perforation (p < 0.001, 95% CI 0.7-1.8). NLR has not related significantly with the MERI score according to linear regression analysis (p = 0.927). NLR was found to be significantly higher in chronic otitis media patients compared to the control group. But NLR was not related to the severity of the disease classified with MERI. The cut-off value, sensitivity and sensitivity rates of NLR obtained was not available for clinically use.

A retrospective study on middle ear risk indices in analysing the post-operative outcome following tympanoplasty

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Chronic otitis media is a highly prevalent disease of middle ear. As tympanoplasty plays an important role in management of otitis media it is important to predict the outcome of surgery and give proper counselling to the patient. The objective of this study was to evaluate the effectiveness of Middle ear risk index (MERI) in determining postoperative graft uptake and postoperative air bone gap closure following tympanoplasty.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was a retrospective study conducted to find the correlation between MERI and the result of tympanoplasty outcome and post-operative hearing gain. Ninety-six subjects who underwent tympanoplasty for chronic otitis media were included in the study. MERI score was calculated and was compared with postoperative graft uptake and audiogram. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In this study there was no statistical difference in graft uptake between the MERI categories. There was statistically significant decrease in postoperative air bone gap closure in both mild and moderate categories. Other prognostic factors associated with a favourable outcome were healthy middle ear mucosa and absence of smoking.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; MERI did not have a direct impact on the outcome of surgery in terms of graft uptake and hearing results. However certain factors like Belluci’s criteria and smoking had an impact on the outcome. Hence MERI can be used for pre-operative counselling of the patients.&lt;/p&gt;

Prediction of hearing outcomes in chronic otitis media patients underwent tympanoplasty using ossiculoplasty outcome parameter staging or middle ear risk indices.

PurposeOssiculoplasty outcome parameter staging (OOPS) and middle ear risk index (MERI) are the most commonly used indices for predicting prognosis of patients with chronic otitis media (COM). This study aimed to verify the efficiency of OOPS and MERI scores in predicting outcomes of patients with COM who underwent tympanoplasty.MethodsWe retrospectively reviewed the data of patients who underwent tympanoplasty (n = 526). OOPS, and MERI scores were collected. Hearing data were measured 1 day preoperatively, and 3 and 12 months postoperatively. Operation success was defined according to the Korean Society of Otology guidelines.ResultsFor calculation of success, the ROC values of MERI were 0.551 at 12 months. ROC values of OOPS were 0.637 at 12 months. There were no significant differences in hearing variables among the three groups according to MERI. There were significantly favorable outcomes in hearing variables in the low-risk group in OOPS. The mean OOPS score was greater in patients with success than those with non-success. Otorrhea, ossicle status, and status of mucosa as variables in both indices were associated with success. The type of mastoidectomy as a variable in OOPS alone was associated with success. Absence of hypertension, presence of ossiculoplasty, and use of incus as ossiculoplasty material were associated with poor success rate.ConclusionCompared with MERI, the OOPS index was more closely associated with the hearing outcomes, which may be due to the extent of inflammation in the OOPS index.

Evaluation of Prognostic Factors and Middle Ear Risk Index in Type 1 Tympanoplasty

Background: Chronic suppurative otitis media (CSOM) is a long-standing infection of middle ear cleft, characterized by ear discharge and permanent perforation of tympanic membrane. Surgical treatment of CSOM is still controversial. Recently many studies have been undertaken to evaluate the prognostic impact of various factors on the outcomes of tympanoplasty. Nonetheless, only few studies have assessed the clinical preoperative assessment method that allows for tympanoplasty outcome to be predicted. Objective: To examine the role of the prognostic factors and middle ear risk index on the success of tympanoplasty. Patients and methods: The medical records of 100 patients who underwent type 1 tympanoplasty between 2018 and 2020 were prospectively reviewed. Prognostic factors such as age, sex, presence of systemic diseases, location and size of perforation, duration of dry period, presence of myringosclerosis, presence of septal and conchal pathology, operation type, and status of the opposite ear were evaluated. Middle ear risk index (MERI) was calculated and its correlation with the rate of success of surgery was evaluated. Results: It was noticed that experience of surgeon more than 5 years, absence of comorbidities and low middle ear risk score were significant predictors for success of tympanoplasty type 1 (P < 0.001, P < 0.001, P < 0.001 respectively). Conclusion: We found that younger age, female gender, no comorbidities, and higher surgeon experience were associated with better outcome. In addition, patients with mild MERI score showed higher rate of success for tympanoplasty. The surgeon experience and MERI were independent predictors of successful procedure.

Middle ear risk index (MERI) as a prognostic factor for tympanoplasty success in children

Tympanoplasty performed in childhood has been controversial over the years because there is no clarity in determining what prognostic factors lead to surgical success. The objective of this study was to evaluate the effect of the Middle Ear Risk Index (MERI) score on the success of pediatric tympanoplasty. A retrospective case-control study was performed at a tertiary pediatric referral center. A database was created with surgical and clinical records of pediatric patients (<18 years of age) with tympanic membrane perforation, assessed and surgically managed by the same surgical team from January 2012 through March 2018. Mild MERI before tympanoplasty was found to be a protective factor against surgical failure, with an odds ratio of 0.24 (p: 0.002). The odds ratio for severe MERI in unsuccessful tympanoplasty was 5.87, with a p: 0.003, standing out as a risk factor for surgical failure. Presurgical MERI in children may be a useful tool to determine if patients are candidates for tympanoplasty, more aggressive interventions, or if medical treatment before tympanoplasty is necessary to improve prognosis. When facing a high MERI score, parents and family should be advised before surgery about the possibility of tympanoplasty failure.

Evaluation of the role of middle ear risk index as a prognostic tool in cases of tympanoplasty in chronic suppurative otitis media

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; In chronic suppurative otitis media (CSOM), the success rate of tympanoplasty, can range from 35% to 92% and is influenced by a number of factors such as age of patient, size and site of perforation, status of ear, ossicular status and surgical technique. The middle ear risk index (MERI) of a CSOM patient is an effective numerical grading system helpful in predicting the outcome of surgery. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A prospective observational study was conducted in 50 patients over a period of 1 year including all cases of CSOM in age group of 18-55 years with conductive hearing loss that underwent tympanoplasty with or without cortical mastoidectomy and role of MERI was analysed for the outcome of the surgery. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Successful graft uptake was seen in 92% cases while in 8% cases graft was rejected. Of these 46 cases, 32 cases had mild MERI score, 10 had moderate MERI score and 4 had severe MERI score. It was observed that higher the MERI score, lower the graft uptake. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Our study comprised of 50 patients of CSOM which were categorized into mild, moderate and severe on the basis of MERI score preoperatively. All the patients underwent tympanoplasty with or without cortical mastoidectomy and surgical outcome in terms of graft uptake was found to be significant. Higher the MERI score, lower was the graft uptake while lower the MERI score, higher was the graft uptake. Hence, MERI is a useful tool to ascertain the prognosis of tympanoplasty.&lt;/p&gt;