Ossicular Necrosis Research Articles

To Study the Pre Operative Indicators of Incudal Necrosis in Tubo-Tympanic Chronic Otitis Media.

To assess the pre-operative indicators of incudal necrosis in tubo-tympanic CSOM. A total of 80 patients with tubo-tympanic type of CSOM attending the SMGS Hospital ENT OPD/IPD of both genders were enrolled for the study. Pre-operative findings on oto-microscopic examination, pure-tone audiometry, x-ray mastoid and intra-operative microscopy was recorded. It was found that patients with age > 30years and more than 10years of CSOM had had higher incidence of ossicular necrosis as compared to patients age < 30years and less than 10years of CSOM (P < 0.05). Patients who had granulation tissue and moderate to moderately severe hearing loss had higher incidence of ossicular necrosis as compared to other patients. The difference was seen significant (P < 0.05). In this study, it was observed that the presence of granulations over the perforation margins, disease persisting for more than 10years, moderate to moderately severe hearing loss appear to be significant reliable indicators of incudal necrosis in tubo-tympanic type of CSOM. All patients of tubo-tympanic type of CSOM should be assessed in detail so as to reach early diagnosis of ossicular erosion that helps in surgical decision making and preparedness regarding ossiculoplasty and patient consent.

Pre-Operative Predictors of Ossicular Status in Chronic Supportive Otitis Media

Introduction: Chronic suppurative otitis media is associated with ossicular necrosis. Both safe and unsafe CSOM have incidence of ossicular necrosis. This study will provide the much-needed insight, into the factors which can act as significant predictors for the intra operative ossicular status, and help in better preparing the patient before the surgery and need for ossiculoplasty. Furthermore, narrowing down to the most significant ly related predictors, it may also be»possib1eto reduce the financial burden on the patient, something which is of prime importance in a resource limited country like ours. Objectives: pre-operative predictors of intra operative ossicular status in chronic suppurative otitis media and effect of duration of disease on hearing threshold and ossicular-status. Material and methods: A descriptive observational study was done in a Tertiary care referral center. A total number of 124 patients with the clinical diagnosis of CSOM were selected from outpatient department and admitted. All patients were subjected to otoendoscopy, X-raymastt), 1d (Schiller’s view) and pure tone audiometry. All patients underwent tympanomastoidectomy. Preoperative findings on the basis of history, examination and investigations were noted along with findings of intraoperative ossicular status. Findings were tabulated and statistical test were applied to determine significant preoperative predictors of iv intraoperative ossicular status. Results: Intraoperative ossicular necrosis was seen in a total number of 43 patients. On; univariate analysis, blood-stained discharge (P&lt;0.0001), purulent consistency of ear discharge (0&lt;0.0()01), associated symptoms of vertigo (p=0.0047), otalgia (p=0.0019), size(p=0.0042) and f site(p=0.004l), severity of hearing loss (p=0.004), sclerotic mastoid air cell (p=0.0001) had significant association with ossicular necrosis. The duration of disease and hearing threshold did not have statistically significant association (p=0.227). Conclusion: Ossicular necrosis is best indicated by the presence blood-stained and purulent discharge, vertigo, otalgia, total perforation, severe degree of hearing loss and sclerosed mastoid. Incus was the most common necrosed ossicle followed by malleus followed by stapes, Duration of disease did not have a significant connotation with hearing threshold.

Study of Mastoid Antral Changes in Tubotympanic Chronic Supportive Otitis Media

Background: Study of mastoid antrum findings in tubotympanic chronic suppurative otitis media Objectives: To study mastoid antrum findings in tubotympanic CSOM and to determine predictors for performing antrostomy. Methodology: 71 patients with tubotympanic CSQM were selected from OPD and IPD. All patients were subjected to investigations like X—ray mastoid (Schuller’s View), pure tone audiometry and Otoendoscopy. All patients were subjected to mastoid exploration (cortical mastoidectomy or antrostomy) with tympanoplasty. Pre-Operative findings on basis of history, examination and investigations were noted along with intra-operative findings of middle ear and mastoid antrum. Findings were tabulated and statistical tests were applied to determine significant predictors. Results: Mastoid antrum was found to be diseased in 21 patients with pathological findings like mucopus, granulations etc. Recurrent URTI, mastoid pneumatization pattern, pre operative middle ear mucosal status on otoendoscopy, degree of hearing loss and ossicular status were significantly associated with diseased antrum (P-value&lt;0.05). Conclusion: Disease can be found in mastoid antrum in tubotympanic CSOM. Mastoid exploration in form of antrostomy should be done in all cases where certain predictors are present. The predictors for performing antrostomy in tubotympanic disease are presence of recurrent URTI on history, sclerotic mastoid on x—ray mastoid (Schuller’s View), unhealthy middle ear mucosa on otoendoscopy, moderate and moderately severe hearing loss on pure tone audiometry and intra-operative ossicular necrosis and immobility.

Clinicopathological Study of Salivary Gland Tumors in Tertiary Care Teaching Hospital

Background: The study “Preoperative predictors of ossicular status in chronic suppurative otitis media” was undertaken in Swami Rama Himalayan University, Dehradun. A total number of 124 patients who underwent “tympanomastoidcetomy” for CSOM were evaluated to correlate the preoperative predictors with intraoperative ossicular status. Materials and Methods: This study was carried out for 12 months period in the Department of Otorhinolaryngology at Himalayan Institute of Medical Sciences, SRHU, Swami Ram Nagar, Dehradun. Subjects were recruited from Inpatient Department planned for surgery. Each of the patients selected for the study was subjected to a detailed history and complete ear, nose and throat examination. Site and size of perforation, status of attic, middle ear mucosa status, presence of myringosclerosis, tympanosclerosis, granulations and cholesteatoma were noted in each patient. Degree and type of hearing loss was evaluated via pure tone audiometry. Results: Most of the patients belonged to the age group of less than 40 years, with maximum patients falling in the age group of 21-30 years i.e.,39 (31.45%) patients. The average age of patients was 29.39±10.79 years. Female predominance was seen with male to female ratio being 1:1.33. More cases were from rural areas comprising of 81 (65.3%) cases while 43 (34.6%) resided in urban areas. Ear discharge was the most common presenting complaint seen in 109 cases (87.90%) followed by hearing loss which was present in 100 cases (80.64%). Unilateral ear discharge present in 89 (81.65%) and 20 (18.34%) had bilateral ear discharge. Conclusion: Blood-stained discharge was present in 40 (36.66%) patients out of which 28 (70%) patients had ossicular necrosis. On assessing the amount of ear discharge, highest number of patients had scanty discharge i.e., in 75 (68.80%), out of which 30 (40%) patients had ossicular necrosis. Mucopurulent discharge was seen in highest number of patients i.e., in 68 (62.38%) out of which 30 (44.1%) had ossicular necrosis. Associated symptoms of vertigo were present in 28 patients (22.5%) out of which 16 patients (57.1%) had ossicles necrosed. On findings of otoscopy and otoendoscopy, perforation in pars tensa was seen in 82 patients (66.12%) out of which ossicular necrosis was present in 14 patients (17%). Highest incidence of ossicular necrosis was seen in 4 (4.83%) patients who had perforation involving both pars tensa and pars flaccida.

Comparison of Preop High Resolution CT Temporal Bone Findings with Intraoperative Findings in Cholesteatoma

Background: Since many years, CT-scan of the temporal bone is a widely accepted investigation in preoperative evaluation of patients with cholesteatoma in the middle ear. Aim: To compare the preoperative HRCT findings with intraoperative findings in the patients with atticoantral CSOM Study design: Comparative cross-sectional study Setting: Department of ENT Sir Ganga Ram Hospital Lahore Duration: February 1st 2022 to January 31st 2023 Methods: After taking approval from board of studies, IRB &amp; ASRB of FJMU, 50 patients fulfilling inclusion criteria were admitted in Department of ENT, Sir Ganga Ram Hospital Lahore. Firstly patients were seen in outdoor, history and otoscopy followed by examination under microscope was done, then the diagnosis of atticoantral CSOM was established. HRCT temporal bone of the cases diagnosed as atticoantral type CSOM was done. The patients were then admitted for mastoid exploration. Informed consent was obtained. Demographic information was recorded. HRCT temporal bone was reported by consultant radiologist from Department of Radiology, Sir Ganga Ram Hospital in all cases. Intraoperative findings like soft tissue mass, dural&amp; sinus plate, ossicular status, status of semicircular canal, facial canal and scutum was noted and compared with the preoperative HRCT findings. Then the data was collected in accordance to patients Proforma. Results: The mean age of patients was 22.32±10.42 years. Among patients 56% were male and 44% were female. HRCT was closely in agreement with intraoperative findings for detection of soft tissues mass in middle ear [HRCT:92% &amp; IOF: 100%], dural plates [HRCT:98% &amp; IOF: 98%], Sigmoid sinus plates [HRCT:92% &amp; IOF: 92%], erosion of malleus [HRCT:56% &amp; IOF: 62%], Incus [HRCT:56% &amp; IOF: 26%], stapes [HRCT:60% &amp; IOF: 66%], ;lateral semicircular canal [HRCT:96% &amp; IOF:96%], facial canal nerve [HRCT:96% &amp; IOF: 94%] and scutum [HRCT:70% &amp; IOF: 74%] respectively. This would be of great help to the otologists in anticipating the possible complications, developing treatment strategy, counseling the patient regarding the procedure and in taking consent about expected complications. Conclusion: In patients of atticoantral CSOM HRCT effectively helps in preoperative assessment of the site &amp; extent of the disease process, Ossicular erosion and status of various important anatomical structure. Keywords: Preoperative, HRCT, Intraoperative, Atticoantral, CSOM, Mastoidectomy, Ossicular necrosis.

Association of Preoperative Audiological and Radiological Ossicular Findings with Peroperative Findings in Patients with Chronic Otitis Media- A Prospective Clinical Study

Introduction: Chronic Otitis Media (COM) refers to a chronic infection of mucosa lining the middle ear cleft and is the leading cause of conductive hearing loss in adults. The erosion or disruption of ossicular chain is determined while during the surgery. Complete disruption of ossicular chain can lead up to 60 dB hearing loss. Preoperative High-Resolution Computed Tomography (HRCT) scan of temporal bone can give a clue of ossicular integrity. Aim: To determine the association of preoperative audiological and radiological findings with the peroperative findings in cases of chronic otitis media. Material and Methods: This prospective clinical study was conducted in the Department of Otorhinolaryngology at Subharti Medical College and associated Chhatrapati Shivaji Subharti Hospital, Meerut, Uttar Pradesh, India, from October 2019 to August 2021. Seventy five patients of unilateral uncomplicated chronic otitis media (mucosal or squamosal), with conductive hearing loss, aged between 10 to 50 years were included in the study. Audiological assessment was done in form of pure tone audiometry using Alps 2100 instrument to measure hearing loss in decibels (dB). Radiological assessment was done using bilateral X-ray mastoid Schuller’s view, and HRCT temporal bone. Association of audiological and radiological findings was determined with intraoperative findings using Statistical Package for Social Sciences (SPSS) version 24.0. Results: The mean age of the study population was found to be 26.34±9.14 years. Females 42 (56%) were found to be affected more than males 33 (44%). Significant association was found between severity of hearing loss and necrosed ossicles seen peroperatively as p-value &lt;0.05 in mucosal type of CSOM. Chances of peroperative ossicular necrosis (mucosal) were more in sclerosed (76.47%) and diploic (84.61%) mastoid as compared to pneumatized mastoid (7.69%) with statistically significant difference as p-value&lt;0.01. Maximum accuracy of reporting for HRCT was found for the involvement of part of Incus. Conclusion: There was a significant association of audiological findings and number of ossicles necrosed peroperatively. hence, it can be concluded that greater the degree of hearing loss, more the chances of ossicular necrosis peroperatively.

Success Rate of Revision Myringoplasty Using Temporalis Fascia Graft

Background and Aim: To evaluate the success rate of revision myringoplasty using temporalis fascia graft and to assess the effect of potential influencing factors on closure of tympanic membrane (TM) and hearing outcome such as size and site of perforation, whether the patient is smoking or not and condition of contralateral ear. Methods: Thirty patients were included in this prospective study, who underwent revision myringoplasty for chronic otitis media without cholesteatoma in the period between 2017- 2019 in the Department of Ear, Nose, and Throat-Head and Neck Surgery in Almowasat University Hospital. Data of all patients: perforation size and site, middle ear status, surgical approach, graft material, pre and postoperative morphological and functional results were assessed. The temporal fascia was used for the reconstruction of TM. The interrelation between multiple preoperative parameters and postoperative morphological (closure of the perforation) and functional (hearing level) outcomes were assessed. Results: Successful closure rate of the TM perforation was 86.66% and failure rate was 13.34% in revision myringoplasty. The improvement of the air bone gap between 10-20 dB was 76.66% while the air bone gap between 20-30 dB was unchanged 23.33%. Conclusion: Revision myringoplasty can offer reasonably good chances for postoperative graft healing and hearing improvement with a high success rate. This gives the patient a good benefit in protecting the ear from developing complications that may have poor structural changes in the middle ear (ossicular necrosis and tympanosclerosis) which in turn leads to hearing loss. Keywords: Revision myringoplasty; temporalis fascia; tympanic membrane perforation

The Role of Biofilms in Chronic Otitis Media-Active Squamosal Disease: An Evaluative Study.

To study the presence of biofilms in patients of chronic otitis media (COM)-active squamosal disease and to evaluate the microflora and clinical impact of biofilms. A total of 35 patients suffering from COM - active squamosal disease was studied. Cholesteatoma sample was collected at the time of mastoid surgery and the same was used to image for biofilms by scanning electron microscope. The said sample was also analyzed microbiologically. Biofilms were present in 25 (72%) patients including 6 cases of fungal biofilms (24%). Biofilms were detected irrespective of the micro-organism growth. No statistically significant relationship was observed between biofilms and discharging ear and complications of COM. Though univariate analysis of our data found some correlation between duration of disease, the extent of cholesteatoma and ossicular necrosis but multivariate analysis revealed no such associations, thereby implying a doubtful association between these factors and biofilm. Biofilms are an integral part of cholesteatoma ear disease and sometimes harbors fungal isolates.

English

BACKGROUND We wanted to study the preoperative clinical, audiological, radiological findings &amp; compare them with the perioperative findings of ossicular necrosis. METHODS 100 patients were clinically diagnosed as mucosal chronic otitis media (COM). They underwent a thorough clinical, audiological &amp; radiological examination. X-ray mastoid Schuller's view on both sides was done in all patients &amp; HRCT temporal bone was done in 51 patients. They were then posted for surgery &amp; findings were compared with the perioperative ossicular necrosis. RESULTS 42 patients had ossicular defects perioperatively. Incus was found to be the most commonly necrosed ossicle &amp; malleus was the most resistant ossicle. There was a positive association found between duration of disease, posterior perforations, large central &amp; subtotal perforations, polypoidal middle ear mucosa, granulations over margins of perforations &amp; audiological findings with the perioperative ossicular defects. HRCT was the most reliable investigation to predict ossicular necrosis. CONCLUSIONS From the study, it was concluded that all patients with mucosal COM can be assessed preoperatively for ossicular erosion. HRCT gives us a preoperative picture of the extent of ossicular necrosis &amp; helps the surgeon in planning the surgical intervention. KEY WORDS COM, HRCT, Ossicular Necrosis, Mucosal, PTA

Frequency of Incus Bone Erosion on Mastoid Exploration in Chronic Suppurative Otitis Media with Middle Ear Cholesteotoma

Background: Cholesteotoma is a benign but destructive lesion leading to ossicular necrosis. Objective: To see the frequency of incus bone erosion on mastoid exploration in chronic suppurative otitis media with middle ear cholesteotoma. Study Design: Cross-sectional descriptive study. Setting: This study was carried out in the Department of ENT Unit-2, Sir Ganga Ram Hospital, Lahore. Duration of Study: Fifteen months months (10th April, 2019 to 9th July, 2020) Sample technique: Non- probability purposive sampling Methods: One hundred and twenty patients were admitted through outpatient department of ENT Unit-2, Sir Ganga Ram Hospital Lahore. Patients were included after fulfilling the inclusion criteria and information was collected on a prescribed proforma. Finally during surgery under general anesthesia, the operative findings were noted to know the incus bone erosion after middle ear cholesteatoma formation in chronic suppurative otitis media. Results: A total number of one hundred and twenty patients of chronic suppurative otitis media with middle ear cholesteatoma were included. Out of which 80 (66.7%) were males and 40 (33.3%) were females(Table 1).The patients shown in table 2 were divided in six age groups (Table 2).Table 3 shows that the procedure of mastoidectomy was performed in 112 patients (93.3%) and modified radial mastoidectomy was performed in 8 patients (6.7%).Incus bone erosion in chronic suppurative otitis media with middle ear cholesteatoma in 102 patients (85%) and 18 patients (15%) have no incus bone erosion (Table 4). Conclusion: Ear discharge was the most common presenting characteristic of chronic suppurative otitis media with cholesteatoma. The majority of the cases had ossicular erosion, with the incus being the most common site of involvement. Males are more likely than females to develop cholesteatoma. Keywords: erosion of incus bone, Mastoid exploration, Chronic suppurative otitis media, Cholesteatoma

Single centre experience of ossiculoplasty using different materials: a subjective and objective evaluation

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Chronic otitis media has serious impact over the ossicular integrity in middle ear resulting in ossicular necrosis and various grades of hearing loss along with other associated symptoms. Tympanomastoidectomy with ossicular reconstruction using various materials can improve the symptoms.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A retrospective study of 50 patients underwent tympanomastoidectomy with ossiculoplasty in Department of ENT and Head and Neck Surgery at AIIMS Patna from April 2017 to 2018. Patients with chronic otitis media having ossicular necrosis with ABG (air bone gap) more than 25 dB were included in this study. PORP (partial ossicular reconstruction prosthesis) and TORP (total ossicular reconstruction prosthesis) were used as ossicular reconstruction after clearance of disease. This study was expressed as subjective and objective evaluation following ossiculoplasty. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Fifty patients having chronic otitis media with decreased hearing and other associating symptoms were included in this study. Preoperative air conduction threshold was 55.32 dB with preoperative ABG was 44.24 dB. Postoperative result was summarised as postoperative AC threshold was 32.72 dB with gain of 22.60 dB with ABG 25.45 dB.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Chronic otitis media may lead to ossicular necrosis and various grade of hearing loss. A proper technique and skilled tympanomastoidectomy with ossiculoplasty can improve the symptoms of chronic otitis media.&lt;/p&gt;

A Prospective Longitudinal Study to Evaluate the Patency of the Aditus ad Antrum in Chronic Otitis Media Mucosal Type.

Chronic otitis media is defined as the chronic inflammation of the mucoperiosteal lining lining of the middle ear cleft which presents with recurrent ear discharge through tympanic membrane perforation. The study was planned to evaluate the patency of the aditus ad antrum in cases of chronic otitis media mucosal type, and its correlation with various direct and indirect indicators of blocked aditus. The prospective longitudinal study was conducted on 100 patients with chronic otitis media mucosal type. The commonest complaint of patients was ear discharge (100%) followed by hearing impairment in 72% patients.Tympanoplasty with antrotomy was performed. The patency and dimensions of the aditus ad antrum were assessed by saline water test. In 41% cases saline test showed blockade, on further drilling patency achieved in 27 cases with minimal drilling and dissection of mucosa with or without fibrotic mucosal bands. In rest 14 cases widening of aditus and atticotomy was required to achieve patency. Out of these nine were having associated tympanosclerosis and five were having edematous mucosa. Ossicular necrosis was seen on 18 cases. Presence of myringosclerosis and polypoidal edematous mucosa increases the probability of an obstructed aditus ad antrum. Mastoid antrostomy and water test for patency can be performed without additional cost and risk to the patient in minimal time and can be considered as the surest indicator of patency of aditus ad antrum.

Pre-operative predictors of ossicular necrosis in chronic otitis media-mucosal type

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Chronic suppurative otitis media can cause a wide range of pathologies in the middle ear that include irreversible mucosal changes, granulation tissue formation, cholesteatoma, tympanosclerosis, and destruction of ossicles. Knowledge regarding ossicular discontinuity before surgery enables the surgeon to be prepared for ossiculoplasty. Objective was to study the pre-operative clinical, audiological and microscopic findings in chronic otitis media mucosal type and correlate preoperative findings with intra-operative ossicular necrosis. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Study design was observational, descriptive and cross sectional study. All patients were subjected to detailed clinical, otoscopic and microscopic examination to assess the size and site of perforation, presence or absence of ear discharge, granulation tissue, tympanosclerosis in the middle ear, exposure of incudostapedeal joint and condition of middle ear mucosa. Pure tone audiogram was also done. All patients underwent tympanoplasty±cortical mastoidectomy and the intraoperative findings of ossicular necrosis were noted. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Of the 105 patients, 18(17.1%) had ossicular necrosis. Bivariate analysis showed positive correlation for long standing disease (p=0.004), presence of discharging ear (p=0.014), polypoidal middle ear mucosa (p=0.000) granulations in middle ear (p=0.000) and also when incudostapedeal joint was exposed (p=0.005). Mean Air bone gap was higher with 35 dB in ossicular necrosis and 22.7 dB in intact ossicular chain was also statistically significant (p=0.0001).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Ossicular necrosis was best indicated by the presence of polypoidal mucosa, granulation in the middle ear and higher air-bone gap on audiometry. However longer duration of disease, persistent active stage of disease and exposure of incudostapedeal joint were also found to be significant.&lt;/p&gt;

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.

Assessment of short term hearing improvement in patients of cartilage interposition ossiculoplasty for lenticular process of incus necrosis in cases of chronic suppurative otitis media: mucosal disease

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Chronic suppurative otitis media is a highly prevalent disease in developing countries. Hearing loss associated with this disease is significantly more in cases associated with ossicular necrosis along with tympanic membrane perforation. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;We would like to present a study of such cases of mucosal chronic suppurative otitis media associated with lenticular process necrosis treated by cartilage interposition ossiculoplasty. The patients were followed up for a minimum period of 6 months and their pre op and post op hearing was documented and analyzed. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;An average air bone gap of 39.07 decibels in pre op was reduced to 18.13 decibels in post-operative period and these improvements persisted over 6 months of follow-up. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;We have hereby concluded that the hearing improvement is comparable to other methods of ossiculoplasty with minimum disruption of natural hearing assembly in lenticular process of incus necrosis.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

Doing Mastoidectomy Along with Tympanic Membrane Repair Reduces the Need for Revision Procedures: A Prospective Study.

To determine the role of cortical mastoidectomy on the results of tympanoplsty in tubotympanic type of chronic suppurative otitis media. A prospective, observational, interventional study was conducted from a period of October 2006-October 2008. This included 40 patients of either sex in the age group of 15-45years having tubotympanic type of CSOM. Tympanoplasty with mastoidectomy was done in all the patients and they were followed up for graft acceptance and hearing impairment for 5years to see the long term results. Per-operatively, the antrum was involved in 17, aditus in 11 and middle ear in 8 patients. Incus was necrosed in 10 cases and malleus and incus were absent in a single case. Mucoid discharge was found in the middle ear in 12 out of 40 patients. Mucoid discharge ears had antral mucosal hypertrophy in 100%, blocked aditus in 75% and middle ear mucosal hypertrophy in 58% cases; ossicular necrosis in 75% cases. 90% of the cases had graft accepted. In dry ears, graft take up rate was 89% and in ears with mucoid discharge it was 92%. Average air-bone-gap reduced to 13.90dB as compared to average air-bone-gap (Av. AB Gap1) preoperatively of 38.62dB. After 5years, 83.5% patients had >10dB improvement in hearing. We recommend opening of the mastoid if on inspection of middle ear one finds mucoid type of discharge.

Ossicular status in patients operated for chronic suppurative otitis media

Introduction: Chronic suppurative otitis media (CSOM) is a chronic inflammation of the middle ear and mastoid cavity, which presents with recurrent ear discharge through a tympanic perforation. The WHO has classified India as a country with highest prevalence ( &gt; 4%) requiring urgent attention to deal with a massive public health problem. CSOM is often associated with a bone eroding process which occurs due to the presence of cholesteotoma, granulation tissue or both. Methods: This study was conducted in a department of E.N.T, Yenepoya Medical College Hospital, Deralakatte, Mangalore for a period of 2 years. This study was conducted to evaluate the ossicular involvement in chronic suppurative otitis media (CSOM). A retrospective-prospective study was conducted over a 2-year period on 86 patients who underwent surgery for the disease. Demography, ossicular status and hearing loss were studied and analyzed using SPSS programme. Results: The study revealed Tubotympanic disease was the more common type of disease. Ossicular necrosis was present in 35% of population. The most common ossicles involved were the whole of incus, followed by lenticular process and long process of incus. There was a higher incidence of ossicular disruption in atticoantral disease than in tubotympanic disease.

Pre-operative Indicators of Ossicular Necrosis in Tubotympanic CSOM.

Ossicular necrosis and erosion is commonly seen in CSOM with cholesteatoma but can also occur in tubotympanic CSOM. This usually comes as a surprise during surgery. Preoperative knowledge of ossicular necrosis helps the surgeon to be better prepared for the surgery and ossicular construction if required. Hence, this study is intended to identify the pre-operative indicators of ossicular necrosis. This cross sectional study was conducted in Father Muller Medical College in Mangalore. Sixty nine consecutive patients with tubotympanic CSOM underwent a detailed clinical examination with pure tone audiometry and subsequently tympanoplasty with or without cortical mastoidectomy. All clinical findings, pure-tone audiometry, and intraoperative otomicroscopic observations were recorded. Incidence of ossicular necrosis was 23%. The incus was most frequently eroded followed by malleus and then stapes. On bivariate analysis patients age above 30years (p=0.05), duration of CSOM more than 10years (p=0.02), presence of granulation (p<0.05), absence of tympanosclerosis (p=0.01), moderately severe (45-60dB) hearing loss (p=0.01) and an air bone gap of more than 55.7dB in the right ear and 63.95dB in the left ear was found to be statistically significant (p<0.05). On multivariate analysis only presence of middle ear granulation tissue was found to be the significant predicator [(p=0.005), OR 14.37, 95% CI 2.26-90.0]. The presence of granulation tissue and a wide air bone gap on pure tone audiometry were the best indicators of ossicular necrosis. Preoperative identification of these indicators can help the surgeon to be better prepared for the surgery.

Migrated aural foreign body in parapharyngeal space

Foreign bodies in ear are very frequently encountered by an otorhinolaryngologist. They should be diagnosed and removed immediately. Otherwise it may cause complications like tympanic membrane perforation, chondritis, ossicular necrosis, facial palsy, inner ear injury or it may migrate to adjacent structures. It may migrate to subcutaneous tissue or middle ear. Migration of aural foreign body to parapharyngeal space is very rare and never been reported in literature. We are reporting this type of very unusual migrated foreign body which was recovered from the parapharyngeal space by a small incision endoscopic assisted approach after 8 years if insertion.

Ossicular chain defects in safe type of chronic suppurative otitis media

Introduction: Chronic suppurative otitis media (CSOM) is a long standing infection of middle ear cleft having a permanent perforation in the tympanic membrane with or without discharge. This is of two types; tubotympanic and atticoantral disease. Tubotympanic type of CSOM is called safe type, because the rate of complication is very low and usually not associated with cholesteatoma. Ossicular chain involvement is found in both safe and unsafe type of disease. In safe type though the involvement of ossicular chain is less common, still significant numbers of patients are having hearing deterioration due to it. Materials and Methods: Present study has been conducted in the Department of Ear, Nose, and Throat (ENT), Alluri Sitarama Raju Academy of Medical Science, Eluru, AP (India). Study group includes 200 patients having safe type of CSOM selected from ENT outpatient department (OPD). Preoperatively, all patients were evaluated to identify ossicular involvement. Then they were evaluated per operatively for confirmation of preoperative findings under microscope. Results: It was found that 74 patients out of 200 are having some amount of ossicular involvement in the form of ossicular necrosis, ossicular tympanosclerosis, or ossicular fibrosis, that is, 37% cases. Thirty-eight patients are having ossicular necrosis, that is, 19% cases. Conclusion: So our study shows that in safe type of CSOM, approximately one-third patients are having some amount of ossicular involvement and one-fifth patients are having ossicular necrosis. So as an ENT surgeon, we should be competent enough to do the ossicular chain reconstruction during surgery to give the best hearing results to our patients.