DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20190769

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

Razim Abdul Rasheed, Mubeena ., K. S. Gangadhara Somayaji

Abstract


Background: 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. 

Methods: 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.  

Results: 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).

Conclusions: 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.


Keywords


Chronic otitis media, Ossicular necrosis, Mucosal disease

Full Text:

PDF

References


Acuin J. Chronic Suppurative Otitis Media-Burden of Illness and Management Options. Geneva: World Health Organization. 2004;1:9-10.

Kutz Jr JW. Roland PS, Isaacson B. Office Management of Tympanic Membrane Perforation and the Draining Ear. Otologic Surg. 2016;7:86-97.

Walshe P, McConn Walsh R, Brennan P, Walsh M. The role of computerized tomography in the preoperative assessment of chronic supporative otitis media. Clin Otolaryngol Allied Sci. 2002;27(5):95-7.

Roland PS. The formation and management of middle ear granulation tissue in chronic ear disease. Ear Nose Throat J. 2004;83:5-8.

Jayakumar CL, Inbaraj LR, Pinto GJO. Indian J Otolaryngol Head Neck Surg. 2016;68:462.

Thomsen J, Bretlau P, Balslev Joorgensen M. Bone resorption in chronic otitis media. The role of cholesteatoma, a must or an adjunct?. Clin Otolaryngol Allied Sci. 1981;6:179-86.

Tos M. Pathology of the ossicular chain in various chronic middle ear diseases. J Laryngol Otol. 1979;93:769-80.

Austin DF. Sound conduction of the diseased ear. J Laryngol Otol. 1978;92:367-93.

Joseph BN, Infections: Tympanomastoid compartment Ossicular resorption. Schuknecht’s Pathology of the ear. 3rd ed. 2010: 286-301.

Chole RA, Sudhoff HH Chronic otitis media, mastoiditis and petrositis. Cummings Head And Neck Surgery. 2010;139:1963–78.

Sade J, Berco E, Buyanover D, Brown M. Ossicular damage in chronic middle ear inflammation. Acta Otolaryngol. 1981;92:273-83.

Jareen E, Vedantam R Preoperative predictors of incudal necrosis in chronic suppurative otitis media. Otolaryngol Head Neck Surg. 2010;142:415–20.

Jeng F, Tsai M, Brown CJ. Relationship of preoperative findings and ossicular discontinuity in chronic otitis media. Otol Neurotol. 2003;24:29–32.