Tympanomastoidectomy for Chronic Otitis Media without Cholesteatoma

A series of 221 ears with chronic suppurative otitis media without cholesteatoma is presented—84% of the cases were treated using one-stage tympanomastoidectomy and 15% underwent cortical mastoidectomy with planned second-stage tympanoplasty. Mean follow-up period was 6.3 years. Control of infection succeeded in 92% after the primary operation. Failures were most common in ears infected with Pseudomonas aeruginosa. Postoperative cholesteatoma developed in 5 ears (2.2%). Hearing results were unsatisfactory; a postoperative air-bone gap within 20 dB was achieved in only 62%. In revision operations, retained mastoid air cells were found in 64% of ears with recurrent or persistent discharge. Thirty-seven percent of patients with unsuccessful outcome were observed to have a possible underlying or concomitant disease. The importance of intensive preoperative conservative treatment and careful surgical technique is stressed.

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A clinical study of evaluation of tympanoplasty with mastoidectomy in mucosal chronic otitis media

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20195709 ◽

2019 ◽

Vol 6 (1) ◽

pp. 163

Author(s):

Ritesh Mahajan ◽

Nidhi Abraham ◽

Nagaraj T. M.

Keyword(s):

Otitis Media ◽

Disease Process ◽

Chronic Otitis Media ◽

Chronic Suppurative Otitis Media ◽

Suppurative Otitis Media ◽

Medical College ◽

Cortical Mastoidectomy ◽

A Prospective Study

Background: Chronic suppurative otitis media (CSOM) is one of the most common ear diseases in developing countries with a varying incidence of 3% to 57%. It the disease process is further divided into mucosal type and squamosal type depending on clinical presentation. The mainstay of therapy in CSOM remains surgery which aims at eradication of disease and restoring the hearing mechanism. The main objective of our study was to evaluate the changes and impact of tympanoplasty with mastoidectomy as a surgical treatment modality in mucosal type of CSOM.Methods: A prospective study was conducted in Rajarajeshwari Medical College and Hospital between November 2015 and June 2017, involving 50 patients with mucosal type of chronic otitis media. These patients, after complete clinical examination and hearing analysis, underwent tympanoplasty with cortical mastoidectomy. Follow-up of the patients was done at one month and three months after the surgery where the parameters recorded preoperatively were assessed. Results: The graft uptake three months after the surgery was 94%. Patients reported a subjective improvement in symptoms of ear discharge, decreased hearing, earache and tinnitus to 94%, 70%, 86% and 78% respectively. There was hearing improvement in ears that had discharge preoperatively and those ears that did not.Conclusions: Chronic suppurative otitis media is a very common problem and it can lead to recurrent ear discharge and hearing problems. Timely intervention is necessary as early diagnosis results in good surgical outcomes and can make an impact on patient’s quality of life.

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Myringoplasty with and without Cortical Mastoidectomy in Treatment of Non-cholesteatomatous Chronic Otitis Media: A Comparative Study

Clinical Medicine Insights Ear Nose and Throat ◽

10.4137/cment.s17980 ◽

2014 ◽

Vol 7 ◽

pp. CMENT.S17980 ◽

Cited By ~ 5

Author(s):

Hazem Mohammed Abdel Tawab ◽

Fadi Mahmoud Gharib ◽

Tareq M. Algarf ◽

Louay S. EISharkawy

Keyword(s):

Otitis Media ◽

Chronic Otitis Media ◽

Suppurative Otitis Media ◽

Tympanic Membrane Perforations ◽

Cortical Mastoidectomy ◽

Significant Difference ◽

Graft Success ◽

A Prospective Study ◽

Department Faculty

Objective To compare the outcome and success of repair of uncomplicated tympanic membrane perforations with myringoplasty alone and when combined with mastoidectomy. Methods A prospective study where 40 patients with non-cholesteatomatous chronic suppurative otitis media (CSOM) were recruited during the period of June 2013 to December 2013 from the outpatient clinic of Otorhinolaryngology department, Faculty of medicine, Cairo University. Patients were managed medically and after dryness of their perforations they were operated upon. Twenty patients underwent simple myringoplasty alone and 20 patients underwent myringoplasty with cortical mastoidectomy. Underlay technique with temporalis fascia was done for all patients. Follow-up period was at least 3 months. Results Hearing improvement was comparable in both groups. There was no significant difference in graft uptake between the myringoplasty alone group (70%) and cortical mastoidectomy group (80%) ( P = 0.7). There was no significant difference in ear dryness between the myringoplasty alone group (75%) and cortical mastoidectomy group (90%) ( P = 0.4). Conclusion Mastoidectomy performed in non-cholesteatomatous CSOM in this study gives no statistically significant benefit over simple myringoplasty as regards graft success rate and dryness of the middle ear with comparable hearing outcome.

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Comparative study of efficacy of graft placement with and without anterior tagging in type one tympanoplasty for mucosal-type chronic otitis media

The Journal of Laryngology & Otology ◽

10.1017/s0022215111002659 ◽

2011 ◽

Vol 126 (2) ◽

pp. 125-130 ◽

Cited By ~ 14

Author(s):

P Hosamani ◽

L Ananth ◽

S B Medikeri

Keyword(s):

Otitis Media ◽

Chronic Otitis Media ◽

Type I ◽

Graft Material ◽

Hearing Improvement ◽

Hearing Results ◽

Graft Placement ◽

Type I Tympanoplasty ◽

Suitable Technique

AbstractObjectives:To assess the efficacy of anterior tagging of graft material with respect to graft uptake and hearing results, in type I tympanoplasty.Study design:Prospective, randomised, cohort study.Methods:Sixty patients with chronic otitis media of the mucosal type, with pars tensa perforations, were included in the study. Patients were randomly allocated to two groups: group one underwent type one tympanoplasty with anterior tagging, while group two underwent type one tympanoplasty without anterior tagging. Follow up included evaluation of graft uptake and hearing improvement.Results:There were 33 patients in group one and 27 patients in group two. The overall incidence of successful graft uptake was 96.96 per cent in group one and 81.5 per cent in group two. Closure of central and posterior perforations was successful in 100 per cent of both groups. Closure of anterior and subtotal perforations was successful in 95.45 per cent of group one and 54.54 per cent of group two.Conclusion:Type one tympanoplasty with anterior tagging of graft material is a suitable technique for anterior and subtotal perforations.

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A five year follow up of incus transposition in relation to the first stage tympanoplasty technique

The Journal of Laryngology & Otology ◽

10.1017/s0022215100120316 ◽

1992 ◽

Vol 106 (7) ◽

pp. 607-609 ◽

Cited By ~ 10

Author(s):

I. Donaldson ◽

D. G. Snow

Keyword(s):

Hearing Level ◽

Hearing Results ◽

Factors Affecting ◽

Ossicular Reconstruction ◽

Second Stage ◽

Cortical Mastoidectomy ◽

Primary Procedure ◽

Set Up

AbstractThis study was set up, prospectively, to determine factors affecting the long-term hearing results of patients undergoing incus transposition as a second stage in ossicular reconstruction, following a successful drumhead repair in non-cholesteatoma ears. Seventy-one patients were entered into the study over five years from 1980–1985, 66 were available to be studied throughout the five year follow-up period.Nine weeks post-operatively, 74 per cent of all patients has an air-bone gap of less than 15 dB (48/66). The type of first stage procedure had a significant effect on the hearing levels in the final five year assessment. The most successful sub-group were those patients who had a cortical mastoidectomy and silastic sheeting inserted in the first staging procedure. The air-bone gap, of less than 15 dB, was maintained in 71 per cent of this group (17/24). The sub-group who had a simple myringoplasty as the primary procedure had a good initial hearing level. By five years, however, only 30 per cent of the patients had maintained the air-bone gap of less than 30 dB (3/11).

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Cortical mastoidectomy in quiescent, tubotympanic, chronic otitis media: is it routinely necessary?

The Journal of Laryngology & Otology ◽

10.1017/s0022215108003708 ◽

2008 ◽

Vol 123 (4) ◽

pp. 383-390 ◽

Cited By ~ 11

Author(s):

K V Bhat ◽

K Naseeruddin ◽

U S Nagalotimath ◽

P R Kumar ◽

J S Hegde

Keyword(s):

Otitis Media ◽

Chronic Otitis Media ◽

Controlled Study ◽

Hearing Improvement ◽

Tertiary Referral Hospital ◽

Suppurative Otitis Media ◽

Disease Eradication ◽

Cortical Mastoidectomy ◽

Randomised Controlled Study ◽

Randomised Controlled

AbstractObjective:This study aimed to compare outcomes for mastoidotympanoplasty and for tympanoplasty alone in cases of quiescent, tubotympanic, chronic, suppurative otitis media.Study design:Single-blinded, randomised, controlled study within a tertiary referral hospital.Methods:Sixty-eight cases were randomly allocated into two groups. In group one, 35 ears underwent type one tympanoplasty along with cortical mastoidectomy. In group two, 33 ears underwent type one tympanoplasty alone. Outcome measures were as follows: perforation closure and graft uptake, hearing improvement, disease eradication, and post-operative complications.Results:There were no statistically significant differences in hearing improvement, tympanic perforation closure, graft uptake or disease eradication, comparing the two groups at three and six months post-operatively.Conclusion:Mastoidotympanoplasty was not found to be superior to tympanoplasty alone over a short term follow-up period. Hence, it may not be necessary to undertake routine mastoid exploration at this stage of disease.

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Outcome of ear surgeries in dry and wet ear

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20172103 ◽

2017 ◽

Vol 3 (3) ◽

pp. 562 ◽

Cited By ~ 1

Author(s):

Shreyash C. S. ◽

Rajneesh . ◽

Rahul S.

Keyword(s):

Success Rate ◽

Otitis Media ◽

Chronic Otitis Media ◽

Success Rates ◽

Hearing Improvement ◽

Suppurative Otitis Media ◽

Time Of Surgery ◽

Type 1 Tympanoplasty ◽

Cortical Mastoidectomy

Background: Chronic suppurative otitis media (CSOM) can present with dry and wet ear (discharging ear). It’s an accepted fact that an actively draining central perforation is not a contraindication for ear surgery. The discharging ear presents the otologists with the dilemma of operating on it or not, this is due to widespread belief that the success rate while doing ear surgeries on wet ears is decidedly inferior. Hence the present dissertation is intended to find the outcome of ear surgeries in dry and wet ear.Methods: The present study comprises of 60 patients who have undergone type 1 tympanoplasty with cortical mastoidectomy, at Fr Muller’s Medical College, Mangalore. These patients were divided into two groups- Wet and Dry, based on the presence or absence of ear discharge at the time of surgery respectively. Inclusion Criteria: Patients of age group 16-60 years and both sexes, with mucosal type of chronic otitis media who underwent type 1 tympanoplasty with cortical mastoidectomy. Exclusion criteria: Patients with squamosal type of chronic otitis media or with ossicular chain erosion. A comparative analysis was done on the hearing improvement and incidence of the graft uptake postoperatively between the two groups.Results: In dry group, complete graft uptake was seen in 90% cases, whereas in wet group, a graft uptake rate of 86.7% was achieved. The graft take up rate is better in high x socio-economic status. Higher take up rates were seen in small and medium perforation compared to subtotal perforations. Hearing improvement, assessed by mean gain of PTA at the end of 6th month postoperatively, was achieved in 86% cases in Wet group and 90% cases in Dry group. There was an average hearing improvement of 13.08 db in speech frequencies in 88.3% cases. The difference between the two groups was statistically insignificant.Conclusions: In our study, we found no statistically significant differences between the success rates of Wet and Dry group, either in terms of graft uptake or the hearing improvement. Thus, from our study, we conclude that the presence of ear discharge at the time of surgery does not affect the success rate of type 1 tympanoplasty.

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Endoscopic myringoplasty: outcome and hearing gain in inactive mucosal chronic otitis media

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20185511 ◽

2019 ◽

Vol 5 (2) ◽

pp. 330

Author(s):

B. T. Subramanya ◽

S. Lohith ◽

B. Sphoorthi

Keyword(s):

Otitis Media ◽

Chronic Otitis Media ◽

Hearing Improvement ◽

Suppurative Otitis Media ◽

Hearing Gain ◽

Endoscopic Myringoplasty ◽

A Prospective Study ◽

Postoperative Scar ◽

Middle Ear Cleft

Background: Chronic otitis media is an inflammatory process in the middle ear cleft that poses serious health problem in developing countries. Myringoplasty is a common otological procedure to reconstruct the tympanic membrane to prevent recurrent otorrhea, and restore sound-conducting mechanism. The use of rigid endoscope in transcanal myringoplasty has significant advantage as it provides magnified, close up as well as wide angle view, less morbidity and early postoperative wound healing with better cosmetic results without compromising success rate and postoperative hearing gain. The aims and objectives of the study were to analyze the results of endoscopic transcanal interlay myringoplasty, in terms of graft uptake and hearing improvement in cases of chronic suppurative otitis media with inactive mucosal disease with central perforation.Methods: This is a prospective study conducted from January 2016 to August 2018 in 30 patients of inactive mucosal chronic otitis media (COM). All patients underwent transcanal endoscopic interlay myringoplasty and patients were called for regular follow up for 12 weeks and results were statistically analysed. Results: The graft uptake rate in the present study was found to be 93.33%. Pre operatively mean air bone gap (ABG) was 27.33 dB and post operatively after 12 weeks mean air bone gap improved to 10.5 dB. Mean ABG gain was 16.33%.Conclusions: Endoscopic transcanal interlay myringoplasty with superiorly based TM flap is an effective technique over conventional microscopic technique in terms of graft uptake, hearing improvement, better postoperative scar and less morbidity in cases of inactive mucosal COM.

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Mobile, one stage, bilateral ear surgery for chronic otitis media patients in remote areas

The Journal of Laryngology & Otology ◽

10.1017/s0022215109005738 ◽

2009 ◽

Vol 123 (10) ◽

pp. 1108-1113 ◽

Cited By ~ 5

Author(s):

P Homøe ◽

H C Florian Sørensen ◽

M Tos

Keyword(s):

Otitis Media ◽

Pure Tone ◽

Chronic Otitis Media ◽

Ear Surgery ◽

Suppurative Otitis Media ◽

Remote Areas ◽

Pure Tone Average ◽

One Stage ◽

Air Conduction

AbstractObjectives:We evaluated the results of mobile, one stage, bilateral ear surgery conducted in Greenland, where chronic otitis media with and without suppuration is prevalent. The study aimed to increase the number of operations conducted and to reduce the cost of ear surgery in remote areas.Materials and methods:The study was longitudinal and prospective, with a two-year follow up. Seventeen East Greenlandic patients with bilateral chronic suppurative otitis media or chronic otitis media were selected. Their median age was 16 years; 53 per cent were female and 47 per cent male. Hearing was assessed using median air conduction pure tone average gain, and the ‘take rate’ (i.e. the percentage of total ears with a closed perforation) was evaluated.Results:All patients attended for follow up. Eighty-two per cent had at least one perforation closed, and the overall take rate was 65 per cent of the 34 ears. The median air conduction pure tone average gain after two years was 18 dB and 13 dB for the right and left ears, respectively. Fourteen patients (82 per cent) obtained an air conduction pure tone average hearing level of ≤25 dB in at least one ear. In total, 71 per cent of the patients were satisfied. There were no hearing hazards.Conclusions:The results of mobile, one stage, bilateral ear surgery conducted in Greenland for long-lasting chronic suppurative otitis media and chronic otitis media were acceptable and safe, and more ears underwent surgery at reduced cost compared with unilateral ear surgery.

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Study of hearing results of ossiculoplasty in patients with safe chronic suppurative otitis media

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20191465 ◽

2019 ◽

Vol 5 (3) ◽

pp. 617

Author(s):

Prasad A. Kelkar ◽

Jyoti V. Hirekerur

Keyword(s):

Otitis Media ◽

Middle Ear ◽

Chronic Otitis Media ◽

Cost Effective ◽

Ossicular Chain ◽

Suppurative Otitis Media ◽

Hearing Results ◽

Cost Effective Method ◽

History Of ◽

Local Examination

Background: Ossicular discontinuity can occur as a result of erosion by chronic otitis media or due to trauma. Reconstruction of the ossicular chain aims to surgically optimize the middle ear transformer mechanism. The goal of this study was to devise a protocol to manage the ossicular discontinuity, provide good hearing to the patients and to demonstrate that use of ossicle for ossicular reconstruction is a safe, physiological, practical, successful and cost effective method.Methods: The present study is retrospective study of 50 patients who underwent ossiculoplasty in our institute over the period of 2 years. Most patients presented to us with a history of chronic intermittent ear discharge and decreased hearing. Detailed clinical examination included general examination and local examination of ear, nose and throat. Examination of ear included otoscopy, tuning fork tests, and examination under microscope. Results: The average pre-operative air-bone gap in patients with ossicular disruption was 34.95 dB and after ossiculoplasty was 12.93 dB. The mean air-bone closure after surgery was 27.88 dB. In most cases the post-operative air bone closure was within the range of 20 dB. The hearing results in ossiculoplasty are dependent on various factors but middle ear status in one of the most important factor in deciding the final outcome.Conclusions: The ossiculoplasty using autograft has stood the test of time and the results are superior to that of prosthesis. They have less rate of complications, are economic and easily available. The expertise to sculpt the ossicle can be easily developed with practice.

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Otitis Media in Infancy: Tympanometric Findings

PEDIATRICS ◽

10.1542/peds.63.3.435 ◽

1979 ◽

Vol 63 (3) ◽

pp. 435-442

Author(s):

Jessie R. Groothuis ◽

Sarah H. W. Sell ◽

Peter F. Wright ◽

Judith M. Thompson ◽

William A. Altemeier

Keyword(s):

Otitis Media ◽

Acute Otitis Media ◽

Chronic Otitis Media ◽

Normal Pressure ◽

Pressure Curve ◽

Type B ◽

History Of ◽

Life Type ◽

Insight Into

Ninety-one normal infants were followed longitudinally for varying periods from November 1975 to April 1977 to assess the correlation between tympanometry and pneumatic otoscopy and to study the pathogenesis of acute and chronic otitis media early in life. Type A (normal) tympanograms correlated with normal otoscopic findings in 92% of instances. Type B tympanograms, indicating reduced drum compliance with a relatively flat pressure curve, were associated with abnormal otoscopic findings in 93% of cases. The A8 (reduced compliance, normal pressure) and C (normal compliance, negative pressure) tympanograms were less consistent predictors of otoscopic findings. The correlation of tympanometric and otoscopic findings were similar in infants above and below 7 months of age. Tympanometry provided some insight into the natural history of otitis in 71 infants followed 12 to 17 months. Infants who failed to develop otitis had type B curves in only one of 240 determinations (0.4%). This pattern did not appear in those who developed acute otitis media (AOM) until the month preceding the first attack; nine of 29 tests (31%) made under these circumstances were type B. When a type B curve appeared in an asymptomatic study infant who had not previously had otitis, AOM developed within a month in nine of ten instances. At the time of diagnosis of first AOM, 87% of tympanograms were type B with the remainder type A8 or C. Sixty-three percent of tympanograms obtained from 25 infants during the six months following first AOM were type B, indicating that abnormal middle ear function was often prolonged. Fifteen of these 25 developed recurrent otitis during follow-up.

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