Ossicular Status Research Articles

SITE AND RATE OF OSSICULAR CHAIN EROSION IN PATIENTS UNDERWENT TYMPANOMASTOID SURGERY

Background: Chronic suppurative otitis media (CSOM) is a common problem affecting middle ear and it’s commonly presented with chronic ear discharge and decreased hearing. Hearing problem in CSOM is primarily caused perforated tympanic membrane and in some cases by the presence of erosion of the ossicular chain. The study aimed to show the rate and site of ossicular chain erosion in patients with chronic suppurative otitis media underwent tympanomastoid surgery. Patient and methods: a cross sectional study conducted on 87 patients performed tympanomastoid surgery for chronic middle ear infection where their ossicular status has been assessed intraoperatively. Results: our study shows that 40% of the operated ears has at least a single bone erosion and the Incus bone was the most affected ossicle while the Malleus was the least one 54% and 14% respectively. No statistically significant difference was seen between bone erosion and gender as well as the side of operation. Conclusion: ossicular erosion is a common problem affecting patient with chronic suppurative otitis media and the surgeons should be aware about this pathology and they should have the proper skill to correct such problem.

Correlation between Clinical and Audiological Factors with Ossicular Chain Continuity in Chronic Otitis Media

Introduction: Chronic otitis media (COM) with the perforation of the tympanic membrane, myringoplasty is preferred treatment, but if ossicles are involved, myringoplasty is done with ossiculoplasty which is termed as tympanoplasty. Preoperative assessment of ossicular status is important to decide the type of tympanoplasty. Ossicular chain continuity is generally seen in the patient who has short duration of disease and smaller air–bone gap. Our study was conducted to support the relationship between preoperative clinical, audiological, and other factors in relation to the ossicular chain status. Materials and Methods: This was a prospective, cross-sectional study conducted at a tertiary care center, for 2-year duration (November 2019 to November 2021), on 100 patients who presented with COM (mucosal type). Preoperative diagnosis and assessment based on the clinical examination and investigations were compared with operative findings. Results: Thirty percent of the patients had ear discharge duration <1 year, 28% had 1–5 years, and 18% patients had 6–10-year duration. Hearing loss was present in 80% of the cases. Correlation of pure-tone average (PTA) with ossicular chain status was significant with P = 0.028. The majority of patients were in the moderate category 31% and 19.36% of patients had ossicular chain defect. The second common category was mild hearing loss (24%), of which 4.17% of patients showed ossicular chain defect. Conclusion: Maximum percentages of patients with severe hearing loss had ossicular chain discontinuity followed by profound hearing loss. Most of cases had moderate to moderately severe conductive hearing loss in PTA. As the air–bone gap increases, the possibility of ossicular discontinuity increases.

Diagnostic Accuracy of Plain Computed Tomography Temporal Bone in Detection of Pre-operative Ossicular Status versus Per-operative Findings in Chronic Otitis Media.

Ossicular destruction is a common phenomenon in chronic otitis media due to an imbalance between osteoblasts and osteoclasts. Computed tomography helps us in the assessment of ossicular status, extent of pneumatization, and early identification of complications. This study aims to check the diagnostic accuracy of computed tomography temporal bone for the detection of ossicular erosion in comparison with the surgical findings taken as a gold standard. The use of this investigation as an adjunct can prove to be helpful in planning mastoid exploration as well as a primary reconstruction surgery especially in mucosal and early squamosal diseases. It's a cross-sectional validation study done on 50 patients with chronic otitis media (both mucosal and squamous type) from July 2022 to November 2023. Patients underwent CT scanning of temporal bone and ossicular status was reported by the radiologist. Later on, mastoid surgery was carried out and per operative findings were documented. 2 × 2 tables were formed and diagnostic accuracy of CT temporal bone was checked in terms of sensitivity, specificity, negative predictive value, and positive predictive value. The results revealed that CT temporal bone has a high diagnostic accuracy with a sensitivity of 92.5% and specificity of 100% for malleus (p value < 0.001). For incus and stapes, sensitivity came out to be 93.5% and 76% respectively and specificity values were 94.7% and 100% (p value < 0.001 for all) giving a verdict that the pre-operative use of this radiological investigation should be encouraged by otologists.

Correlation Between Pure Tone Audiometry Values and Middle Ear Ossicular Chain Status in Chronic Otitis Media: Study in a Tertiary Health Care Centre.

In this study, we attempt to compare the pure tone audiometry findings with ossicular chain status intraoperatively in patients of chronic otitis media. 102 patients who presented with COM during a period of one year and met the inclusion criteria were included in the study. All patients underwent preoperative pure tone Audiometry and findings were tabulated. All patients were evaluated intraoperatively by the same surgeon and observations were made regarding ossicular chain integrity. Small central perforation was noted in 10%, medium central perforation in 38.57%, large central perforation in 27.14% and subtotal perforation in 24.28%. 71.56% patients had an intact ossicular chain, of which 94.5% was mucosal disease and 5.5% were squamous disease. 29 cases showed eroded/absent ossicles, out of which, 28 had squamous type and 1 case had central perforation. Ossicular status was classified based on Austin Classification. Conductive hearing loss was found to be maximum where all 3 ossicles were eroded/absent, with a mean AB gap of 45.33 and mean air conduction threshold of 60.33. There is a good correlation between the hearing threshold of the patient and the status of ossicular chain. Preoperative knowledge of the degree of hearing loss and status of ossicular chain would allow the surgeon to plan proper ossicular reconstruction and give the patient a better advice regarding prognosis of hearing improvement after surgery.

Determinant of chronic suppurative otitis media and its association with the sensorineural component of hearing loss

Abstract Background: Chronic suppurative otitis media (CSOM) is a leading disorder known for hearing loss. We aimed to investigate the associated determinant factors of CSOM with sensorineural hearing loss (SNHL). Materials and Methods: A prospective observational study of CSOM was conducted at a tertiary care university hospital from December 2020 to December 2022. The study included 149 patients of either gender and unilateral disease who presented to the otorhinolaryngology outpatient door. All subjects underwent clinical examinations and pure-tone audiometry. Bone conduction thresholds for both affected and nonaffected ears at audible frequencies were taken to determine sensorineural hearing loss. The intraoperative visibility of ossicular status was assessed through the operation recordings. Results: The mean age of the 79 males and 70 females was 26.54 ± 8.75 years. Sensorineural hearing loss was evidenced in 25.5% of cases; afterward, conductive and mixed hearing losses were found in 68.5% and 6% of individuals. It was found that females and the absence of cholesteatoma have a significant (P &lt; 0.05) association with SNHL, whereas hearing loss &gt;56 dB had a highly significant (P &lt; 0.001) association with SNHL. We investigated the relationship of SNHL with the status of ossicles. Similarly, incus was the most common ossicle erosion associated with SNHL (10.6%), which was statistically significant (P = 0.002). Conclusions: We found that ossicular status, cholesteatoma, and grade of hearing loss were statistically significant and were associated with sensorineural hearing loss in CSOM.

Intra-Operative Ossicular Chain Status in Patients with Chronic Otitis Media.

The Objective of the study was to assess the ossicular status in chronic otitis media (COM)-mucosal and squamosal type and statistically evaluate the extent of ossicular destruction intraoperatively in COM patients. The findings of this study could help us to predict preoperatively the probability of having ossicular chain destruction in COM ears and thus patients could therefore be properly consented about these potential issues before surgery. The study was carried out in ENT department of tertiary health care hospital, between January 2019 to January 2020. All patients of all age groups and both genders, diagnosed with COM Mucosal and Squamosal Type with complaints of ear discharge and hearing loss with good cochlear reserve and requiring surgery were included in the study, after taking informed written consent in vernacular language. All the patients included in the study were evaluated with detailed history, clinical examination including otomicroscopy, tuning fork tests and pure tone audiometry. The patients were then posted for ear surgery and the middle ear status and ossicular chain status were assessed using a microscope intraoperatively. Out of 98 patients, 45(45.9%) had mucosal and 53 (54.08%) had squamosal disease. Ossicular chain was eroded in 69 cases (70.5%). 23 out of 45 (51.1%) mucosal cases and 46 out of 53 squamosal cases (86.7%) reported ossicular erosion. Most frequently involved was long process of incus > stapes > malleus. From our study, we concluded that there is a significant relationship between type of disease pathology in middle ear and ossicular erosion being higher in Squamosal type of COM, with malleus being the most resistant and incus being the most susceptible ossicle.

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.

Study of ossicular chain status in chronic otitis media patients at a tertiary care hospital in southern Bihar

Background: The objective is to assess the ossicular status and statistically evaluate the extent of ossicular destruction intraoperatively in chronic otitis media (COM) patients. Knowledge of pattern of involvement of ossicular chain in COM cases may help us to determine the type of reconstruction needed during surgery. The findings of this study could be exploited to predict preoperatively the probability of having ossicular chain destruction in COM ears and thus patients could therefore be properly consented about these potential issues before surgery. Methods: Prospective observational study conducted over 2 years in diagnosed patients posted for surgical management and fulfilling the inclusion criteria. Intraoperative status of ossicles was noted for various types of COM and outcome was evaluated. Results: Out of 92 patients, 59 (64.1%) had mucosal and 33 (35.9%) had squamosal disease. Ossicular chain was eroded in 41 cases (44.6%). 9 out of 59 (15.3%) mucosal cases and 32 out of 33 squamosal cases (97%) reported ossicular erosion. Most frequently involved was long process of incus (44.6%) &gt;stapes (9.8%) &gt;malleus (8.7%). Order of involvement (Austin-Kartush classification) was found as: type A (26.1%)&gt;B (9.8%)&gt;C (8.7%). 67.4% belonged in the group 15-30 years. Male: female ratio=1:1.5. Conclusions: Degree of ossicular destruction is much greater in squamosal COM, owing to overproduction of cytokines and inflammatory mediators and due to presence of cholesteatoma and/or granulations. The long process of incus was found to be most vulnerable. Malleus was found to be the most resilient among all ossicles.

Endoscopic classification system of pars tensa retractions.

Previous classification systems of pars tensa retractions have not consistently incorporated ossicular erosion or the presence of cholesteatoma. This study aimed to illustrate our classification of pars tensa retractions, which is more precise than previous systems, with aided use of the endoscope. A retrospective study was carried out on 200 ears of 170 patients whose pars tensa retractions had been documented at a tertiary otological referral centre. A classification system was developed. Pars tensa retractions were divided into the following subcategories: grade 0, grade 1, grade 2a, grade 2b, grade 3a, grade 3b, grade 3c, grade 4a, grade 4b, grade 4c, grade 5a, grade 5b and grade 5c. This classification system was able to accommodate all pars tensa retractions. The distribution of grades of pars tensa retractions was based on ossicular status and the presence or absence of cholesteatoma. It is therefore a more applicable, and functionally based system than previous alternatives.

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.

Correlation of Mastoid Pneumatization with Middle Ear Pathology in Unilateral Squamous Type of Chronic Otitis Media

Introduction: Chronic otitis media is chronic inflammation of middle ear cleft followed by permanent abnormality of tympanic membrane. As mastoid a part of temporal bone is in close relation to middle ear; its pneumatization plays an important role in pathogenesis and prognosis of chronic otitis media.&#x0D; Aims: To study the pneumatization pattern of mastoid in unilateral chronic otitis media and its relationship with contralateral mastoid, diseased side tympanic membrane and ossicular status.&#x0D; Methods: Forty patients of 10-65 year of age diagnosed as unilateral chronic otitis media squamous type were selected. They were otoscopically evaluated for retraction and perforation of tympanic membrane and were subjected to high-resolution computed tomography of temporal bone. High resolution computed tomographies were analyzed for mastoid status of bilateral ear and ossicular involvement. During mastoidectomy ossicular status was noted and correlated with high resolution computed tomography.&#x0D; Results: Forty cases were enrolled in the study. Age ranged from10-65 years. On radiological analysis of temporal bones, 21(52.5%) mastoids were sclerotic, 15(37.5 %) mastoid diploic and 4(10%) were pneumatized in the diseased sides. Contralateral side showed pneumatization in 23(57.5%), diploic in 11(27.5%) and sclerotic in 6(15%) Amongst 21 sclerotic mastoid, 11(52.3%) patient had retraction in pars tensa and 9(42.8 %) had retraction of pars flaccida. In total 15 diploic mastoids retraction of pars tensa was in 8(53.3%) and pars flaccid retraction in 8(53.3%) All three ossicles were involved in 8(38%), Malleus and incus were eroded in 3(14%), incus were eroded in 7(33.3%), malleus were eroded in 3(14%) and ossicles were intact in 3(14%)of 21 sclerosed mastoids on high resolution computed tomography. In remaining 19 non sclerotic mastoids all 3 ossicles were eroded in 4 (21%), malleus plus incus eroded in 8 (16%), incus were eroded in 5(26.3%) andossicular chain was intact in 2(10%).&#x0D; Conclusion: Mastoid pneumatization pattern not only effect to the pressure of middle ear leading to chronic otitis media but also alter the pathogenesis and outcome of chronicotitismedia. Contralateral mastoid pneumatization is not altered in unilateral Chronic otitis media.

Chronic Otitis Media (Squamous Disease): Clinical Predictors for Hearing Outcome

Introduction Postoperative hearing outcome after tympanomastoid surgery may sometimes be disappointing. This study aims to identify the factors influencing hearing outcome in squamous type of chronic otitis media (COM). Materials and Methods Prospective descriptive study on consecutive patients undergoing tympano-mastoidectomy for squamous COM. Results Analysis of 40 ears revealed that 10% had discharge less than one year with majority (75%) having more than three years. Pars flaccida and postero-superior pars tensa retraction pockets were most common findings with frank cholesteatoma only in 10%. Though mean preoperative pure tone average was significantly better (p=0.004) in those with ear discharge less than one year, 50% required type IV tympanoplasty, irrespective of duration of discharge. Type IV tympanoplasty revealed significant worsening of hearing (p=0.05), unlike type I-III where intact stapes suprastructure showed a significant postoperative improvement (p = 0.036). Successful graft uptake with discharge free ear was noted in 97.5% by 12 weeks. Conclusion Majority of our patients availed otolaryngologist opinion after more than three years of onset of discharge. Significant ossicular erosion occurs early in the disease. Preoperative better audiogram is not a predictor of ossicular status. Lack of significant symptoms and subtle clinical finding in the tympanic membrane, overlooked by the patient as well as the primary health care provider are confounding factors for early referral and surgical intervention by otolaryngologist. There appears to be a considerable delay for the common person in reaching the services of otolaryngologist; a relevant issue which need to be addressed at a national level to reduce the burden of the disease.

Evaluation of Recurrence and Hearing Outcome for Inactive Squamosal Disease after Cartilage Strengthening Tympanoplasty

Introduction Inactive squamosal disease is unique for having a conflicting treatment protocol, with an age-old debate between early surgical intervention or keeping patients in a long-term follow-up. The shifting paradigm is early intervention to prevent further progress into active disease and improve hearing outcome in its nascent stage. Objective To evaluate recurrence and hearing outcome in cases of inactive squamosal disease after cartilage strengthening tympanoplasty. Methods The study was conducted on 50 patients with inactive squamosal disease. Detailed examination was done to grade the retraction. All patients underwent autologous conchal cartilage tympanomastoidectomy with temporalis fascia grafting. Recurrence and hearing evaluations were done by pure tone audiogram at regular intervals for one year. Results Hearing loss was the most common presenting symptom. Isolated pars tensa retractions were more common (54%) than pars flaccida (12%), or those involving both (34%). Ossicular status was normal in only 14% of the cases, and the most common ossicular damage was to the lenticular process of the incus (52%). Three of the patients (6%) had residual perforation at the 3 rd month of follow-up. Subjective improvement in hearing was reported by 42% patients. Hearing improvement greater than 10 dB was found in 24 patients (48%). Air-bone gap reduced from 25.16 ± 8.15 dB preoperatively to 12.90 ± 6.20 at 1 year of follow-up. Recurrence was seen in three patients (6%). Conclusion Early intervention by cartilage strengthening of weakened tympanic membrane and ossicular reconstruction not only offers better hearing results, but also prevents progress to active disease.

Correlation between Intraoperative Ossicular Status and Conductive Hearing Loss Degree among Chronic Suppurative Otitis Media Patients in Dr Mohammad Hoesin General Hospital Palembang

Background: Chronic suppurative otitis media (CSOM) is a chronic inflammation of the mucosa and periosteum of the middle ear and mastoid cavity that defined as a perforated tympanic membrane with persistent drainage for more than 2 months. Preoperative hearing threshold and air bone gap (ABG) assessment are expected to predict the ossicular status which can only be ascertained intraoperatively. This study aimed to determine the correlation between intra-operative ossicular status and the degree of conductive hearing loss assessed based on the hearing threshold and average ABG among CSOM patients in RSUP Dr. Mohammad Hoesin Palembang.&#x0D; Methods: Observational research using a cross sectional design. The data were collected using medical record on 64 subjects with a diagnosis of CSOM who underwent mastoidectomy surgery at Dr. Mohammad Hoesin Hospital Palembang for the period of March 2019 to June 2021.&#x0D; Results: From 64 samples conducted in the study, the average ossicular status score in CSOM patients was 1.84 ± 1.48, with the highest group scoring 0 being the malleus incus and intact stapes as many as 21 patients (31.3%). There was a strong positive correlation between hearing threshold scores and intra-operative ossicular status scores (p&lt;0.005, R=0.5) and there was a strong positive correlation between ABG scores and intra-operative ossicular status scores (p &lt;0.005, R=0.6). From the linear regression test, the most influential in predicting intra-operative ossicular status scores were gender, hearing threshold value, ABG value, and the presence of cholesteatoma&#x0D; Conclusions: There is a significant relationship between intra-operative ossicular status and the degree of conductive hearing loss in CSOM patients.

English

BACKGROUND Chronic otitis media (COM) of squamosal type is associated with cholestatoma with potential complications. Clinical examination and high resolution computed tomography (HRCT) scans are necessary to assess the disease site and extension. The purpose of the study was to compare the preoperative HRCT findings with the intraoperative surgical findings in squamosal type of chronic otitis media as well as various parameters in HRCT temporal bone and intraoperative findings. METHODS A prospective study was conducted on 30 patients aged between 18 and 60 years of both the genders who presented with chronic otitis media squamosal type, for a period of 22 months who attended the outpatient department of ENT. RESULTS HRCT findings and intraoperative findings were compared and results were analysed. Facial canal erosion (P - 0.0031), tegmen plate erosion (P - 0.0001), sigmoid sinus plate erosion (P - 0.002) were found to be statistically significant. Lateral semicircular canal fistula (P - 0.36) and ossicular status malleus (P - 1.000), incus (P - 0.949), stapes suprastructure (P - 0.984), and stapes footplate erosion (P - 0.977) were found to be statistically insignificant. CONCLUSIONS In our study, HRCT imaging for COM squamosal type, accurately depicted the soft tissue mass, erosion of tegmen plate, sigmoid sinus plate, scutum, lateral semicircular canal fistula, incus and suprastructure of stapes erosion and the same were found intraoperatively as well. Our study showed good comparison between the preoperative HRCT scans and the surgical findings in cholesteatoma cases. HRCT is confirmed to be valuable in the diagnosis and in guiding the surgical management of cholesteatoma. KEY WORDS Chronic Otitis Media, Cholesteatoma, HRCT Temporal Bone, Modified Radical Mastoidectomy

Clinicoradiological correlation between preoperative high-resolution computed tomography findings and intraoperative findings in chronic otitis media (squamous type)

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Chronic otitis media is a major health problem with significant morbidity. High-resolution computed tomography (HRCT) is extremely useful for middle ear pathology and extension of the disease. The objective was to study the correlation between preoperative HRCT and intraoperative findings in chronic suppurative otitis media (squamous type).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This analytical study included 61 cases of chronic otitis media (squamous type). Preoperative HRCT findings were correlated with intraoperative findings. Sensitivity, specificity, PPV, NPV and kappa value were estimated.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of 61 cases 32 were males and 29 were females. Presence of cholesteatoma found on HRCT with 80% sensitivity with k value 0.83 suggesting very good agreement. About ossicular status k value of incus, malleus and stapes were 0.76, 0.65 and 0.54 respectively with sensitivity of 91%, 85% and 58% respectively. Other critical areas on HRCT like sigmoid sinus plate erosion, tegmen tympani dehiscence, scutum erosion, lateral semicircular canal erosion, facial canal erosion and jugular bulb were seen with k value was about 1, 0.8, 0.9, 0.82, 0.72 and 0.65 respectively. So, HRCT shows perfect radiosurgical agreement for sinus plate erosion, very good agreement for disease extension, incus erosion, tegmen tympani erosion, scutum erosion and LSCC erosion and fair agreement for malleus erosion, facial canal erosion and jugular bulb dehiscence and poor agreement for stapes erosion.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; HRCT is a reliable preoperative investigation in cases of chronic otitis media, squamosal type which would provide a bird’s eye view in the disease process in the ear.&lt;/p&gt;

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;

Role of HRCT Temporal Bone in Diagnosis of Chronic Suppurative Otitis Media in Correlation with Intraoperative Findings

This study aims to evaluate the role of preoperative HRCT temporal bone in the diagnosis of the disease, itsextension and complications and plan for surgery. The involved structures and also in knowing prognosisis compared with Intraoperative findings made by the surgeon to know its precision in diagnosis. It alsohelps in diagnosing intracranial complications of CSOM at an early stage and help to plan surgery. Patientspresenting/Suspected to have CSOM who were planned for mastoid exploration surgery in Departmentof ENT, within a period of 2 years–from February 2019 to September 2020, were taken up for study. Thepatient will undergo HRCT temporal bone with Aquilon 160 slice CT scanner producing sub millimetric thinaxial scans Following areas of interest were looked up in preoperative scans:-• Pneumatization of mastoid • Extent of disease• Tegmen tympani erosion • Sinus plate erosion• Facial canal dehiscence • Lateral semicircular canal dehiscence• Ossicular status • Disease outside middle ear cleftOut of total 30 patients of CSOM, 26 (52%) were males. Majority of the patients (70%) were in the agegroup of 11 to 30 years. Left ear was involved in 40% of the patients. Majority of the patients (80%)presented with chief complaints of otorrhoea. In the present study, External Auditory Canal (EAC) was seennormal in majority of patients (82%) both radio logically and per operatively. HRCT scan was found to behighly sensitive (100%) in diagnosing cholesteatoma. CT scans diagnosed erosion of malleus with 100%sensitivity and specificity and erosion of incus with 91% sensitivity and 100% specificity.HRCT has a veryhigh reliability for diagnosis of erosion of scutum, erosion of ossicles and its disruption, Pneumatization ofmastoid, anterior lying sigmoid, extent of cholesteatoma in the middle ear and MAC. The study concludesthat HRCT can be recommended not just for symptomatic cases but in all suspected cases in knowing theextent of the disease thereby reducing the morbidity.