Tubotympanic Type Research Articles

Correlation between degree of hearing loss and intraoperative findings in tubotympanic type of chronic suppurative otitis media

<p class="abstract"><strong>Background:</strong> The aim of tympanoplasty done for tubotympanic type of chronic suppurative otitis media (CSOM) should not only be to achieve a dry ear, but also to give hearing improvement to the patient. Aim of this study was to determine the correlation between size and site of tympanic membrane perforation with degree of hearing loss and correlation between ossicular chain status and degree of hearing loss on pure tone audiometry.</p><p class="abstract"><strong>Methods:</strong> Patients with tubotympanic CSOM with hearing loss upto 60 dBHL undergoing tympanoplasty were examined to know the site and size of tympanic membrane(TM) perforation. Intraoperative findings pertaining to middle ear and ossicles were noted. </p><p class="abstract"><strong>Results:</strong> Out of 52 patients of tubotympanic type of CSOM, hearing loss was least (31.18±7.46 dBHL) in small perforations of the TM and highest in subtotal perforations (48.74±7.83 dBHL) which was statistically significant. Hearing loss was significantly more in posterior perforation (46.61±7.02 dBHL) than in anterior perforation of TM (32.65±8.77 dBHL).<strong> </strong>There was a statistically significant difference in pure tone average hearing loss between intact ossicle group (32.87±9.77 dBHL)<strong> </strong>and eroded ossicle group (43.39±9.60dBHL). Difference in air bone gap was also significant between intact ossicle group (24.09±9.56 dB) and eroded ossicle group (31.02±9.83 dB). Multiple ossicles were eroded in nineteen patients with incus being the most commonly eroded ossicle.</p><p><strong>Conclusions:</strong> In this study, hearing loss increased with increased size of TM perforation and also with posterior perforation. Incus was found to be the most commonly eroded ossicle. Multiple ossicles were seen eroded most commonly when hearing loss was moderate. The surgeon will be better equipped to do ossiculoplasty in view of these preoperative findings and also to counsel the patient better about their expectation of hearing improvement following surgery. </p>

Prevalence and determinants of chronic suppurative otitis media in school going children in Bareilly (Uttar Pradesh)

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Chronic suppurative otitis media (CSOM) is one of the most common ear diseases in the South East Asia having a prevalence of approximately 5.2% in the general population. The objective of the study was to find the prevalence of CSOM in school going children in urban field practice area of tertiary care hospital in Bareilly (UP). </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">Cross-sectional study involving 495 schools going children in Bareilly district of Uttar Pradesh. </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">The prevalence of CSOM was found to be 6.46%, with tubotympanic type constituting majority 81.25% trailed by atticoantral type 18.75%. Most patients presented with moderate hearing impairment (43.75%) and mild hearing impairment (31.25%). With respect to socioeconomic groups, upper lower, groups had 40.63%, and lower group had 34.37% prevalence. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Improvement of health care facilities and awareness among health-care providers would definitely be helpful in reducing the prevalence of ear diseases in the developing countries like India.</span></p>

Efficacy of Empirical Therapy With Combined Ciprofloxacin Versus Topical Drops Alone in Patients With Tubotympanic Chronic Suppurative Otitis Media: A Randomized Double-Blind Controlled Trial.

Background:One of the prevailing otologic infections in our country is chronic suppurative otitis media, especially the tubotympanic type for which various treatment protocols are followed. Usually, oral and topical antibiotics (mainly quinolones) are given alone or in combination. There is a lack of consensus as to whether topical drops alone are effective or a combined oral and systemic therapy should be prescribed. In our study, we have attempted to observe the efficacy of empirical therapy with combined ciprofloxacin versus topical drops only in patients with tubotympanic chronic suppurative otitis media for control of infection.Methodology:A total of 100 patients visiting the outpatient ENT department at our tertiary care hospital with clinically diagnosed chronic suppurative otitis media (tubotympanic type) were enrolled in our study. The study was reviewed and accepted by the ethical review committee. A detailed proforma was filled for all patients. All patients after aural toilet were subjected randomly to one of the 2 treatment methods, ie, topical ciprofloxacin ear drops plus an oral placebo or combined oral and topical ciprofloxacin. These patients were reviewed after 1 week of treatment.Results:It was observed that 48 of 50 (96%) patients responded to treatment in the group receiving topical ciprofloxacin, whereas 49 of 50 (98%) patients responded in the group receiving combined therapy. This difference was not significant. Moreover, age, sex, and duration of discharge did not have any effect on treatment. There were minimal side effects in both groups, which were also not significant and disappeared after discontinuation of treatment.Conclusions:The results of this study show that topical ciprofloxacin drops were as effective as combined oral and topical ciprofloxacin and that the addition of oral drug did not have any beneficial effect and added only to the cost of treatment.

Comparative evaluation of surgical and audiological outcomes in patients of chronic suppurative otitis media with dry ear treated by myringoplasty with or without simple mastoidectomy

<p class="abstract"><strong>Background:</strong> The study was conducted to compare and evaluate surgical and audiological outcomes in patients of chronic suppurative otitis media with dry ear treated by myringoplasty with or without simple mastoidectomy. Prospective, open label, randomized, comparative study, conducted in the Department of ENT, Ram Lal Eye and ENT hospital, Government Medical College Amritsar, Punjab, India.</p><p class="abstract"><strong>Methods:</strong> This study comprised of 40 patients aged between 15 to 50 years having CSOM (safe type) with dry ears for the last 3 months. Patients were randomly divided into Group A<strong> </strong>treated with<strong> </strong>myringoplasty alone and Group B with standard simple mastoidectomy along with<strong> </strong>myringoplasty using temporalis fascia graft by underlay technique. Patients also subjected to routine hematological, biochemical, radiological and audiological investigation. The audiological comparison done before and after surgery. </p><p class="abstract"><strong>Results:</strong> It was observed that graft uptake rate was better in group B. The average gain in air conduction threshold was more in patients who had undergone myringoplasty along with simple mastoidectomy. However this was not statistically significant. There was no significant improvement observed in the AB Gap in our patients who underwent myringoplasty or simple mastoidectomy along with myringoplasty.</p><p class="abstract"><strong>Conclusions:</strong> Hypocellularity of the mastoid process has a strong correlation with the tubotympanic type of CSOM. Addition of mastoidectomy to simple myringoplasty has a very little beneficial effect on the postoperative hearing gain and graft uptake as it showed no much statistical significance.</p>

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.

English

Chronic suppurative otitis media is defined as inflammation of the mucoperiosteal lining of the middle ear cleft. In chronic suppurative otitis media with central perforation the pathologic process may be due to one of the three types : tubo tympanic, tympanomastoid or permanent perforation syndrome due to epitheliasation of the edges of the perforation. In our study we analyse cases of tubo tympanic type only. Chronic sinusitis acts as a focus of sepsis in the development of chronic suppurative otitis media of tubo tympanic type. That such an inter relationship exists is supported by clinical experience. In the adult population sinusitis is the most important cause of persistent ear discharge in tubotympanic disease. Unilateral ear discharge is associated with sinusitis only on the corresponding side, which is in concurrence with our study. Deviated nasal septum, medialised uncinate and enlarged bulla in order of frequency are the most common anatomical variants of nose and paranasal sinuses predisposing to sinusitis. The clearance of sinusitis has a favourable effect on improving the middle ear mucosal status. The clearance of sinusitis by endoscopic sinus surgery in tubotympanic patients results in good outcome of tubotympanic disease clearance. Functional endoscopic sinus surgery has emerged as an effective and reliable procedure for clearance of sinusitis.

Comparison of efficacy of myringoplasty in dry and wet ears in chronic otitis media of tubotympanic type

<p class="abstract"><strong>Background:</strong> The objective of the study was to compare the outcome of myringoplasty in dry and wet ears in tubotympanic type of chronic otitis media (COM) with respect to graft uptake and hearing improvement.</p><p class="abstract"><strong>Methods:</strong> This is a prospective study done in department of ENT Bangalore Medical College and Research Institute during the study period of November 2014 to May 2016, wherein a total of 60 patients of tubotympanic type COM with 30 cases each of dry and wet ears, aged 15-60 years were included. The hearing impairment was assessed and recorded by pure tone audiometry (PTA). After obtaining informed written consent the patients underwent myringoplasty (temporalis fascia graft, underlay technique). Microbiological examination of discharge in wet ears was done and histopathology of the excised remnant TM analyzed in both groups. Both groups of patients were followed up for 3 months and assessed for graft uptake and hearing improvement. PTA was repeated at 3 months postoperatively. </p><p class="abstract"><strong>Results:</strong> Our study included 60 patients of tubotympanic type of COM with 30 cases each with dry and wet ears who underwent myringoplasty. Majority of our patients were in second decade in both the groups. There was slight female preponderance in our study with male to female ratio of 0.93:1. Discharge from ears in wet ears was mucoid in consistency and were culture negative. Histopathology of excised remnant TM in wet ears revealed evidence of inflammatory cells and vascularization within stroma of fibroblasts while these were absent in dry ear cases. The overall successful graft uptake following myringoplasty was 88.3% with 86.7% for wet ears and 90% for dry ears with no statistical significance (p value of 0.688>0.05) between the two groups. With respect to hearing improvement post-operatively there was significant hearing improvement in both the groups when compared to preoperative hearing with a mean hearing gain (dB) of 3.43±2.81 in wet ear cases to 3.85±3.05 in dry ear cases, but when compared between the two groups, there was no significant statistical difference (p value of 0.582>0.05).</p><p><strong>Conclusions:</strong> The outcome is equally good for myringoplasty in dry and wet ears in tubotympanic type of chronic otitis media with respect to graft uptake and hearing improvement. </p>

Clinical and audiological study of chronic suppurative otitis media tubotympanic type

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Chronic suppurative otitis media (CSOM), tubotymapanic type, despite a commonly encountered disease in otorhinolaryngology has many controversies involved. This study was aimed at bringing few of these aspects to limelight. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">The study was conducted in Otorhinolaryngology department, Aarupadai Veedu Medical College and Hospital, Pondicherry, India between September 2015 - August 2016. Total of 207 ears of 180 patients with CSOM tubotympanic type were included. Selected patients were subjected to ENT examination and pure tone audiometry after obtaining history. </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">In this study 35.9% patients belonged to 4th decade and 29.4% to 3rd decade. Among patients with discharge for more than 30 years, 68.8% had moderately-severe hearing impairment and those with discharge for less than 10 years, 60.2% had mild hearing loss. Among patients with large central perforation, 51.4% had moderately-severe hearing loss and those with small central perforation, 68.4% had mild hearing loss. Hearing loss was nearly same in anterior and posterior perforations. On chi square test p value was 0.0874 i.e. >0.05, difference insignificant. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">In our study most patients were in 4th decade, incidence is equal in both genders. Hearing loss is directly proportional to disease duration and perforation size. Site of perforation does not influence hearing loss.</span></p>

The efficacy of fat myringoplasty in small central perforation of pars tensa

<p class="abstract"><strong>Background:</strong> In the present study, an attempt was made to study the effectiveness of fat graft material and the improvement in hearing following fat myringoplasty in small central perforations of pars tensa.</p><p class="abstract"><strong>Methods:</strong> This prospective study was carried out in our tertiary centre between October 2014 to October 2015 in 38 patients selected randomly who attended our ENT OPD. Patients with tubotympanic type of chronic suppurative otitis media CSOM (TT), with dry small central perforation involving less than 25% of tympanic membrane (TM) were included. Patients with ossicular fixation or disruption with air bone gap (ABG) >40dB were excluded. All procedures were performed under local anesthesia (LA). Fat graft was harvested from ear lobule and was placed through endomeatal microscopic approach after freshening perforation margin. All patients were followed up to 5months postoperative period and graft status and audiological assessment was made. </p><p class="abstract"><strong>Results:</strong> In 86.8% cases (33 patients) graft was taken up while in 13.2% cases (5 patients) graft was not taken up. Mean pre-operative air conduction in right/left ear was 28.5±7.6/27.1±8.5 and post-operative was 24.9±5.3/23.4±6.9 dB respectively. Similarly, it was seen that mean pre-operative air bone gap in right/left ear was 17.6±7.2/17.0±7.4 and post-operative was 14.0±5.3/13.2±6 dB respectively.</p><strong>Conclusions:</strong> It is a very safe, simpler procedure and in this we don’t disturb the annulus so the chance of lateralization or medialization of graft is nil. During fat myringoplasty the angle of tympanic membrane and anterior recess is maintained in natural position and we don’t disturb acoustics, so fat myringoplasty is an excellent option especially for small perforation.

Comparative Evaluation of Tympanoplasty with or Without Mastoidectomy in Treatment of Chronic Suppurative Otitis Media Tubotympanic Type.

To study the role of tympanoplasty alone and tympanoplasty done along with cortical mastoidectomy in CSOM in term of graft uptake, improvement of hearing and removal of disease. This is retrospective study of patient at tertiary referral centre, conducted in between October 2015 and October 2016, study was done on 40 patients of either sex in the age group 20-50years. Tympanoplasty alone was done in 20 cases and tympanoplasty along with cortical mastoidectomy was done in rest 20 cases. Patient were reviewed post operatively on 2, 4, 8 and 16weeks to inspect post operative graft uptake and PTA was done at fourth month to evaluate hearing improvement. Hearing improvement was compared in both the groups in tympanoplasty group was 9.41 and in tympanoplasty combined with cortical mastoidectomy was 12.05. Graft uptake was 80% in tympanoplasty group and 95% in tympanoplasty combined with cortical mastoidectomy. Recurrence of discharge was seen in 4 cases of tympanoplasty. Though tympanoplasty combined with cortical mastoidectomy is better in hearing improvement, graft uptake and clinical improvement but the difference in 2 groups is statistically insignificant. Results of tympanoplasty alone and tympanoplasty along with cortical mastoidectomy in terms of hearing gain and graft uptake were statistically insignificant.

The intraoperative pathological findings in cases of chronic suppurative otitis media with central perforation of tympanic membrane at a tertiary care centre in Eastern Nepal

Background: Chronic suppurative otitis media (CSOM) is the chronic inflammation of the middle ear cleft. The atticoantral type is called unsafe type because of the associated complications due to granulations and cholesteatoma which may be life-threatening. CSOM with central perforation (tubotympanic type) is usually not associated with major complications such as cholesteatoma formation.Aims and Objectives: To find out the intraoperative pathological findings in cases of CSOM with central perforation (tubotympanic type)Materials and Methods: This descriptive, cross sectional study has been conducted in the Department of Ear, Biratnagar Eye Hospital in Nepal over 2 years. Study group includes 172 patients having CSOM with central perforations in the tympanic membranes who underwent different types of procedures. Preoperatively, all the patients were evaluated with otoscopy, microscopy, pure-tone audiometry, and some patients with computed tomography scan. The pathological findings were confirmed with biopsy. The findings were tabulated and analysed.Results: 21(12.2%) patients were having dry central perforation with normal Eustachian tube function. 95 patients, i.e., 55.23% were having granulations in attic, aditus, antrum. 25 (14.53%) cases were having ossicular erosion.5 (2.9%) cases had tympanosclerosis in middle ear. 1 (0.58%) case had facial nerve dehiscence. 16 (9.3%) cases had oedema of middle ear mucosa/aural polyp from middle ear. Surprisingly 9 patients, i.e., 5.23% were having cholesteatoma which was confirmed by histopathological study.Conclusion: This study shows that cholesteatoma can be found in tubotympanic type of CSOM, along with other pathological findings. Hence it is on the part of the surgeon to be careful while planning surgery on their patients with CSOM (tubotympanic type), remembering that all safe CSOM might not always be safe. Asian Journal of Medical Sciences Vol.8(1) 2017 42-47

The intraoperative pathological findings in cases of chronic suppurative otitis media with central perforation of tympanic membrane at a tertiary care centre in Eastern Nepal

Background: Chronic suppurative otitis media (CSOM) is the chronic inflammation of the middle ear cleft. The atticoantral type is called unsafe type because of the associated complications due to granulations and cholesteatoma which may be life-threatening. CSOM with central perforation (tubotympanic type) is usually not associated with major complications such as cholesteatoma formation. Aims and Objectives: To find out the intraoperative pathological findings in cases of CSOM with central perforation (tubotympanic type) Materials and Methods: This descriptive, cross sectional study has been conducted in the Department of Ear, Biratnagar Eye Hospital in Nepal over 2 years. Study group includes 172 patients having CSOM with central perforations in the tympanic membranes who underwent different types of procedures. Preoperatively, all the patients were evaluated with otoscopy, microscopy, pure-tone audiometry, and some patients with computed tomography scan. The pathological findings were confirmed with biopsy. The findings were tabulated and analysed. Results: 21(12.2%) patients were having dry central perforation with normal Eustachian tube function. 95 patients, i.e., 55.23% were having granulations in attic, aditus, antrum. 25 (14.53%) cases were having ossicular erosion.5 (2.9%) cases had tympanosclerosis in middle ear. 1 (0.58%) case had facial nerve dehiscence. 16 (9.3%) cases had oedema of middle ear mucosa/aural polyp from middle ear. Surprisingly 9 patients, i.e., 5.23% were having cholesteatoma which was confirmed by histopathological study. Conclusion: This study shows that cholesteatoma can be found in tubotympanic type of CSOM, along with other pathological findings. Hence it is on the part of the surgeon to be careful while planning surgery on their patients with CSOM (tubotympanic type), remembering that all safe CSOM might not always be safe. Asian Journal of Medical Sciences Vol.8(1) 2017 42-47

Cartilage Myringoplasty: An Ideal Grafting Technique for Complex Perforations.

Tympanoplasty is one of routinely performed surgeries in ENT practice. Using cartilage-perichondrium composite graft in selective cases gives better outcome. To study the outcome and feasibility of cartilage-perichondrium composite graft in repair of complex tympanic membrane perforations. This cross-sectional, intervention study was conducted at SSIMS and RC, Tertiary Care Teaching Hospital, Davangere, Karnataka, Southern India. Study sample consisted of 30 patients with chronic otitis media- tubo tympanic type in inactive stage. Patients were randomly selected and evaluated between January 2015 to June 2016. A detailed history, clinical examination, diagnostic nasal endoscopy, otoendoscopy were done for all patients preoperatively and postoperatively at three weeks, three months and six months. Audiological evaluation was done at six months postsurgery. Cartilage-perichondrium composite graft from tragal and conchal cartilage was used for the repair of tympanic membrane in all the cases. The data were presented in proportions, percentages. Of 30 cases who underwent surgery, 24 patients (80%) had large central and subtotal perforations. Only one patient had a total perforation. The remnant tympanic membrane showed atrophic changes in 16 cases (53%) and sclerotic plaque was seen in 14 cases (46%). In our study, tragal cartilage was used in 17 and conchal cartilage in 13 cases. All the patients underwent type-1 tympanoplasty. Successful graft uptake was seen in 28 cases (93%) by six months. Two patients (7%) had a residual perforation at three months and in four cases (13%), the neotympanum showed anterior blunting by the end of six months. With respect to hearing, maximum air bone gap closure achieved in our study was 21db in one patient and minimum was 3db. Average air bone gap closure achieved was 10.1db. Cartilage-perichondrium composite graft can be considered a good choice in repair of tympanic membrane perforations with specific selective indications.

Present scenario of microbiological pattern in chronic suppurative otitis media and its management guidelines

AIMS: Chronic suppurative otitis media (CSOM) is a common infectious chronic ear disease in India resulting in serious complications, especially hearing impairment. Irrational use of antibiotics for its management has led to the emergence of multidrug-resistant bacterial strains. Considering this, this study was conducted to know the pattern of causative organisms associated with CSOM and their antimicrobial sensitivity. Materials and Methods: Ear discharge from 200 clinically diagnosed cases of CSOM was collected by suction using sterile techniques in a sterilised test tube on wash bottle principle consisting of a glass tube made air tight with the help of a cork with an inlet and outlet facility. All samples were processed in the department of microbiology for the identification of bacterial and fungal isolates and their antimicrobial sensitivity testing. Results: Among the 200 samples of ear discharge, 127 were from ear having tubotympanic (mucosal or safe) type of CSOM while 73 were from ear with attico-antral (squamosal or unsafe) CSOM. Among aerobic isolates, Pseudomonas aeruginosa (35%) was most common followed by Staphylococcus aureus. Other aerobes isolated were Klebsiella spp., coagulase-negative Staphylococcus, Proteus spp. and Escherichia coli. Fungus was isolated in tubotympanic (9.45%) CSOM only. Among anaerobic isolates, Peptostreptococcus (1%) was most common. Conclusion: Monomicrobial isolates, especially P. aeruginosa and Staphylococcus species, were found to be most common in our study. Therefore, evaluation of microbiological pattern and their antibiotic sensitivity pattern in local area becomes helpful in prescribing empirical antibiotics for successful treatment of CSOM.

Socioeconomic impact on prevalence of chronic suppurative otitis media in school going children in a tribal district of India

Background: Chronic suppurative otitis media (CSOM) is one of the most common ear diseases in the South East Asia having a prevalence of approximately 5.2% in the general population. The socioeconomic cost of CSOM can hamper the auditory development of the child, thus putting a burden on the society. Objective: To find the prevalence of CSOM in school going children and its relation with socioeconomic status. Materials and Methods: Descriptive cross-sectional study involving 990 schools going children in Nanded District of Maharashtra. Result: The prevalence of CSOM was found to be 6.4%, with tubotympanic type constituting majority 87.50% trailed by atticoantral type 12.50%. With respect to socioeconomic groups, upper and lower groups had 37.5%, and lower group had 34.37% prevalence. The most patients presented with moderate hearing impairment 43.75% and mild hearing impairment 31.25%. Conclusion: The socioeconomic cost of CSOM puts an immense burden on the growth of a child. Improvement of health care facilities and awareness among health-care providers would definitely be helpful in reducing the prevalence of ear diseases in the developing countries like ours.

Comparative study of type I tympanoplasty with or without mastoidectomy in tubotympanic type of chronic suppurative otitis media patients

Objectives: The aim is to compare the results of type I tympanoplasty alone and tympanoplasty with cortical mastoidectomy in safe chronic suppurative otitis media (CSOM) patients in terms of graft uptake, improvement in hearing and clinical improvement. Study Design: This was prospective study. Materials and Methods: Sixty cases of safe type of CSOM were included in the study. Type I tympanoplasty was done in thirty cases and tympanoplasty with cortical mastoidectomy was done in another thirty cases. Patients were followed up postoperatively at 3, 6, and 12 weeks for graft uptake and any complication. Pure-tone audiometry was done at 6th and 12th week postoperatively to note the hearing improvement. Results: Graft uptake was 76.67% in tympanoplasty alone group and 83.33% in tympanoplasty with cortical mastoidectomy group. In the present study, pre- and post-operative pure-tone average was compared and the statistical difference between tympanoplasty group and tympanoplasty combined with cortical mastoidectomy group was not statistically significant. Recurrence of discharge was seen in 6 cases of tympanoplasty alone group. Although tympanoplasty combined with cortical mastoidectomy is better in hearing yield, graft acceptance rate, and clinical benefit, but the difference in two groups is statistically insignificant. Conclusion: Hearing outcome, graft acceptance rate, and clinical benefit were statistically unequalled in two groups. Tympanoplasty combined with cortical mastoidectomy will not give an additional advantage in terms of hearing gain, disease clearance, and graft uptake.

Tympanometric assessment of Eustachian tube function as a prognostic indicator in myringoplasty

Aim To determine eustachian tube function in tubo-tympanic type of chronic ear disease and correlate it with pathological changes in middle ear. Objective To ascertain whether eustachian tube function had any demeanor upon the outcome of myringoplasty. Backgound The prevailing interest in the patho-physiology of the eustachian tube has been stimulated by the persistent incidence of middle ear effusion and chronic otitis media. The ongoing sophistication in current middle ear reconstructive surgery has added more dimensions to the study of eustachian tube and its effects in the course of reconstructive middle ear surgery. One of the prime elements accountable for failure of reconstructive middle ear surgery has been tubal dysfunction. Method In the present study eustachian tube function was evaluated in in 30 patients who were undergoing myringoplasty for tubo-tympanic type of chronic suppurative otitis media having central perforation by tuning fork tests, microscopic evaluation of the middle ear mucosa and Impedance audiometry. Results 70% of the myringoplasty cases had good surgical outcome and of the 24 cases that had good eustation tube function 87.5% had successful surgical outcome remaining cases had recurrence of otorrhea. Conclusion The results were validating good eustachain tube function as a criterion for electing cases under middle ear reconstructive surgery and Impedance audiometer assures a superlative means of appraising Eustachain tube function.

Factors influencing decision making among ENT surgeons on performance of cortical mastoidectomy for CSOM-tubotympanic disease in quiescent/active stage: an opinion based study

<p class="abstract"><strong>Background:</strong> As the role of cortical mastoidectomy as an adjunct to tympanoplasty in the management of CSOM tubotympanic type - quiescent stage remains controversial even today; we intend to study the factors that influence the decision of ENT surgeons on whether or not to perform cortical mastoidectomy in patients with CSOM (chronic suppurative otitis media) - active or quiescent ear.</p><p class="abstract"><strong>Methods:</strong> During May to August 2016, 60 ENT surgeons within Chennai were asked to answer a pre-framed questionnaire on CSOM based on their personal surgical experience. The answers were collected by direct questionnaire method and the data subjected to appropriate statistical analysis.</p><p class="abstract"><strong>Results:</strong> 65% surgeons expected a minimum dry ear period of ≤30 days before considering tympanoplasty alone (group 1) and the rest 35% members expected more than 30 days of dry ear period (group 2). Surgeons ≤40 years of age expected lesser duration of dry ear period prior to consideration of tympanoplasty alone (p =0.016). Group 2 surgeons performed cortical mastoidectomy in more number of cases (>50%) when compared to group 1 surgeons (p =0.03) for patients who presented first to them with a wet ear. There was a mixed opinion among surgeons within group 1 itself on whether or not they would do cortical mastoidectomy when they encountered patients who had congested remnant tympanic membrane, congested middle ear mucosa, myringosclerosis, ossicular chain discontinuity, sclerotic mastoids or treated septic foci in spite of the ear being dry for a month.</p><p><strong>Conclusions: </strong>Though many surgeons consider that 30 days of dry ear period is sufficient to consider tympanoplasty alone, there is a division of opinion among themselves while facing specific clinical scenarios.</p>

A Clinical Study on the Influence of Sinusitis in Chronic Suppurative Otitis Media

Introduction
 Diseases of the nose and paranasal sinuses are known to influence the middle ear conditions. In the evaluation of the patients with chronic otitis media, radiological, endoscopic, and other auxiliary diagnostic tools may have their roles in the objective assessment of the patients, and to rule out lesions of the nasal cavity and the nasopharynx as potential aetiological factors.
 Materials and method
 This cross sectional observational study was conducted for a period of two years to establish the role of sinusitis as focus of sepsis in patients with tubotympanic type of CSOM. All patients in the age group of 20-40 years with more than 2 months of ear discharge and with a hearing loss of 25- 40 db and diagnosed as tubotympanic type of CSOM were included in our study. Patients who had features of mastoiditis on X-ray and also with persistent ear discharge even after treatment with oral and topical antibiotics were subjected (n=70) to diagnostic nasal endoscopy and computed tomography of paranasal sinuses. 
 Result
 Among the 100 patients of CSOM, 70% had features suggestive of sinusitis. Deviated nasal septum (40%) was the most common pathology among the study population. Majority (54%) of them had mucopurulent type of ear discharge. The CT findings of the paranasal sinuses revealed that 48.5% of the study population had grade I type of involvement of the PNS. 54.2% of the patients had a large central perforation and the middle ear mucosa was found to be edematous for 65.7% of the patients.
 Discussion
 Coexistence of deviated nasal septum and chronic rhinosinusitis with discharging CSOM is at par with several other studies conducted in other parts of the world.
 Conclusion
 Deviated nasal septum, enlarged middle turbinate, medialised uncinate associated with sinusitis are the predisposing factors in the development of CSOM. So assessment for sinusitis in the treatment of CSOM should become a routine practice.

Effect of Type 1 Tympanoplasty on the Quality of Life of CSOM Patients.

Chronic suppurative otitis media (CSOM) continues to be an important public health problem despite significant advances in medical science. Ear discharge, pain, discomfort, difficulty in hearing, limitation of routine activities and emotional problems due to CSOM cause a significant impact on the health and general well being of the patient. We have done Type 1 tympanoplasty in tubotympanic type of COM to reconstruct the tympanic membrane and alleviate the symptoms of the patients. This study presents an analysis of the impact of the surgery on the patient subjectively and its correlation with objective outcomes. 45 patients were selected to fill the chronic otitis media-5 (COM-5) questionnaire and underwent pure tone audiometry preoperatively. All the patients underwent Type 1 tympanoplasty by using temporalis fascia graft. The status of the ossicles was checked and documented intraoperatively. Patients requiring ossicular reconstruction or with attico antral disease were excluded. Patients were followed up for a period of 6months and those with an intact graft after 6months were included in the study. These patients were again made to fill the questionnaire and undergo pure tone audiometry postoperatively. 37 out of 45 patients (82%) had an intact graft 6months after surgery. Marked improvement was observed in subjective scores as documented by the questionnaire, pre- and postoperatively with the mean improvement in total scores being 7.89±4.81 on a Visual Analogue Scale. Also significant improvement was achieved in closure of air-bone gap with the mean improvement being 14.73±8.58dB. Significant correlation was found between subjective and objective scores in most patients. This study showed that Type 1 tympanoplasty brings about a significant improvement in the quality of life of chronic suppurative otitis media patients. Most patients showed a marked improvement in subjective scores which correlated well with the objective findings of the status of the graft and improvement in air-bone gap. Asymptomatic patients with less preoperative scores showed less improvement in subjective scores which did not correlate with the objective outcomes.