DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20184204

Impact of otorrhoea and ossicular status on the effect of tympanoplasty

M. Rama Sridhar

Abstract


Background: The objective of the study was to assess the effect of otorrhoea, osscicular and middle ear status on anatomical and functional results in patients undergoing tympanoplasty with or without mastoidectomy for chronic otitis media mucosal disease

Methods: This was a prospective study conducted on 100 patients with otological complaints (otorrhoea, hearing loss) attending the out-patient Department of ENT, at Mamata Medical College and Research Hospital, Khammam Telangana state during the period from December 2015 to July 2017. All the patients underwent a detailed general physical, otoneurological evaluation, hearing assessment by pure-tone audiometry prior to surgery. As per MERI the patients were evaluated for factors preoperatively and intraoperatively. Postoperatively the patients were followed up at 3 and 6 months to ascertain the structural (graft take up) and functional (hearing improvement) success.

Results: Otorrhoea was the most common complaint observed (48%). As per Belluci's classification of otorrhoea, maximum number of patients (52%) had a dry ear, wet ears (48%) and persistently wet ears (8%). According to Austin-Kartush classification 50 patients had an intact ossicular chain, defects of the incus in 36 patients, defects in both malleus and incus, stapes and incus was seen in 7 patients each. Majority of the patients 79% had normal middle ear status while 21% of them had middle ear effusion present. Majority of the patients belonged to the group of mild risk MERI (l-3) (n=69) patients, moderate risk category MERI (4-6) (n=26) severe risk (7-12) (n=5). Graft uptake was successful in 78 patients and failure in 22 patients. Hearing Improvement was noticed in 78 patients.

Conclusion: Otorrhoea and middle ear cleft status have an impact on the success of the tympanoplasty, while ossicular status did not have a significant effect on the outcome.


Keywords


Otorrhoea, Ossicular status, Tympanoplasty

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References


Acuin J. Chronic suppurative otitis media Burden of Illness and Management Options. Geneva: World Health Organisation. Child and Adolescent Health and Development Prevention of Blindness and Deafness. 2004.

Rajam LK, Vikram VJ, Priyanka C, Indumathi R. A study on chronic otitis media in tertiary care center. Int J Otorhinolaryngol Head Neck Surg. 2018;4:455-8.

Jahn AF. Chronic otitis media: diagnosis and treatment. Med Clin North Am. 1991;75(6):1277–91.

Chronic suppurative otitis media. Burden of Illness and Management Options. Available at: http://www.who.int/pbd/publications/Chronicsuppurativeotitis_media.pdf. Accessed on 14 October 2017.

Kumar N, Madkikar NN; Using Middle Ear Risk Index and ET Function Parameters for Predicting the outcome of Tympanoplasty. Indian J Otolaryngol Head Neck Surg. 2012;64(1):13-6.

Mustafa A, Kuci S, Behramaj A. Management of cholesteatoma complications: Our experience in 145 cases. Indian J Otol. 2014;20:45-7.

Becvarovski Z, Kartush JM. Smoking and tympanoplasty: implications for prognosis and the Middle Ear Risk Index (MERI). Laryngoscope. 2001;111:1806-11.

Glasscock ME. Tympanic membrane grafting with fascia: overlay Vs. undersurface technique. Laryngoscope. 1973; 754-70.

Feroze K, Ebenezer Rejee R and Manonmani Sajilal S . Assessment of factors affecting the outcome of Myringoplasty and type of tympanoplasty. International J Biomed Res. 2014;5:340-3.

Pinar E, Sadullahoglu K, Calli C, Oncel S. Evaluation of prognostic factors and middle ear risk index in tympanoplasty. Otolaryngol Head Neck Surg. 2008;139(3):386-90.

Sarker Z, Ahmed M, Patwary K, Islam R, Joarder AH. Factors affecting surgical outcome of myringoplasty. Bangladesh J Otorhinolaryngol. 2011;17(2):82-7.

Mohammadi G, Naderpour M, Mousaviagdas M. Ossicular Erosion in Patients Requiring Surgery for Cholesteatoma. Iran J Otorhinolaryngol. 2012;24(68):125-8.

Ahmed A. Sharma SC. Middle Ear Risk Index [MERI] as Prognostic Factor in Tympanomastoidectomy with Tympanoplasty. Madridge J Otorhinolar. 2016;1(1):15-22.

Kevin F. Wilson, Nyall R. London, Clough Shelton. Tympanoplasty with intact canal wall mastoidectomy for cholesteatoma: Long-term hearing outcomes. Laryngoscope. 2013;123(12):3168-71.

Yurttafl V, Ural A, Kutluhan A, Bozdemir K. Factors that may affect graft success in tympanoplasty with mastoidectomy. ENT Updates. 2015;5(1):9-12.

Cantrell RW. Myringoplasty failure related to smoking: a preliminary report. Otolaryngologic Clin North America. 1970;3(1):141.

Kalyanasundaram R, Narendran G. Correlation between Middle Ear Risk Index (MERI) and tympanoplasty-A prospective study. Panacea J Med Sci. 2017;7(2):65-7.

Gersdorff M, Garin P, Decat M, Juantegui M. Myringoplasty: long-term results in adults and children. Am J Otol. 1995;16(4):215-8.