Outcome of ear surgeries in dry and wet ear

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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Role of Cortical Mastoidectomy in the Management of Mucosal Chronic Suppurative Otitis Media

International Journal of Research and Review ◽

10.52403/ijrr.20210718 ◽

2021 ◽

Vol 8 (7) ◽

pp. 136-141

Author(s):

Sumit Sharma ◽

Chhavi Gupta ◽

Richa Singh

Keyword(s):

Otitis Media ◽

Chronic Suppurative Otitis Media ◽

Hearing Improvement ◽

Suppurative Otitis Media ◽

Type 1 Tympanoplasty ◽

Cortical Mastoidectomy ◽

Significant Difference ◽

Group A ◽

Group B

This is a comparative study done to evaluate outcome of type 1 Tympanoplasty with and without mastoidectomy in terms of hearing improvement and graft uptake. This is a prospective study done in 100 patients at a tertiary care referral centre during November 2018 to march 2020. Patients were divided in two groups, Group A consists of 50 patients in whom type 1 Tympanoplasty was done and in Group B 50 patients were there who had undergone Type 1 Tympanoplasty with cortical mastoidectomy. Patients were evaluated postoperatively at 2nd wk, 4th wk, 2nd month and 3rd month for graft uptake, disease clearance, and hearing improvement. PTA was done at 3rd month postoperatively. In our study we observed graft uptake in 94% of patients in Group A as compared to 98% of patients in Group B and in terms of hearing improvement there is not much difference in both the groups i.e. in Group A it is 13.996 ± 4.235 while in Group B it is 14.172 ± 5.381 P value is 1 which means there is no statistically significant difference in two groups. Though better results were observed for cortical mastoidectomy with Type 1 Tympanoplasty than Type 1 Tympanoplasty alone but the difference was insignificant. Keywords: Cortical Mastoidectomy; Mucosal Chronic Suppurative Otitis Media; CSOM.

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TO ASSESS THE OUTCOME OF ENDOSCOPIC INTERLAY TYMPANOPLASTY IN TERTIARY CARE CENTER

10.36106/ijsr/5114125 ◽

2021 ◽

pp. 73-75

Author(s):

Pasunuti Shravya ◽

Jyothi Swarup ◽

Vigeshwar RK

Keyword(s):

Success Rate ◽

Otitis Media ◽

Care Center ◽

Tertiary Care ◽

Chronic Otitis Media ◽

Hearing Improvement ◽

Suppurative Otitis Media ◽

Conducting Mechanism ◽

Conductive Hearing ◽

Middle Ear Cleft

Background: Chronic otitis media is an inammatory process in middle ear cleft which is treated by a common otological procedure tympanoplasty to reconstruct the tympanic membrane and to restore sound-conducting mechanism. Rigid endoscope in transcanal interlay tympanoplasty has signicant advantage as it provides magnied, and wide angle view, with better success rate and postoperative hearing gain. The Aims and objectives were to assess the outcome of endoscopic interlay tympanoplasty, in terms of graft uptake, hearing improvement and rate of complications in cases of inactive mucosal chronic suppurative otitis media. Methods: This prospective study was conducted for 1 year at our institution in 50 patients having conductive hearing loss with dry, central perforation. All patients underwent transcanal endoscopic interlay tympanoplasty and were followed up for 3months to determine the graft uptake, hearing improvement and rate of complications. Results: Graft uptake rate in the present study was found to be 98% with residual perforation as a complication in 2% patients and no other complications were encountered. Post operatively air bone gap (ABG) after 12 weeks found to be < 20 dB ABG in 84% patients. Conclusion: Endoscopic interlay tympanoplasty is a effective method with high success rate both in terms of graft uptake as well as post operative hearing improvement and can be implemented in all cases of inactive mucosal COM.

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Type 1 tympanoplasty: does the status of contralateral ear affect the outcome?

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20191738 ◽

2019 ◽

Vol 5 (3) ◽

pp. 722

Author(s):

Arindam Das ◽

Sandipta Mitra ◽

Debasish Ghosh ◽

Arunabha Sengupta

Keyword(s):

Success Rate ◽

Otitis Media ◽

Prospective Observational Study ◽

Tertiary Care ◽

Chronic Otitis Media ◽

Care Hospital ◽

Type 1 Tympanoplasty ◽

The Status ◽

Contralateral Ear

Background: The objective of the study was to investigate the effect of contralateral ear status on the success rate (anatomical closure) of type 1 tympanoplasty.Methods: The study is a prospective observational study comprising of 60 patients diagnosed with chronic otitis media, who underwent type 1 tympanoplasty during 2016-2018 in a tertiary care hospital. Results: In our study, contralateral ear was normal in 40 (66.7%) cases & diseased in 20 (33.3%) cases. Success rate of type 1 tympanoplasty in patients with normal contralateral ear was 90% (n=36) but success rate was only 60% (n=12) in diseased contralateral ear. This was statistically significant (p=0.006).Conclusions: Our study revealed that the status of the opposite ear is an individual prognostic factor for type 1 tympanoplasty. In other words, graft-healing rates are poorer in individuals whose opposite ears are atelectatic or perforated because of chronic otitis media.

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Clinical study on type 1 tympanoplasty: anatomical and functional outcomes

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20193675 ◽

2019 ◽

Vol 5 (5) ◽

pp. 1197

Author(s):

A. Kusumanjali ◽

V. Krishna Chaitanya

Keyword(s):

Success Rate ◽

Middle Ear ◽

Pure Tone Audiometry ◽

Type I ◽

Middle Ear Mucosa ◽

Suppurative Otitis Media ◽

Type 1 Tympanoplasty ◽

Cortical Mastoidectomy ◽

Type I Tympanoplasty

Background: Tympanoplasty is operation to eradicate disease in middle ear and to reconstruct the hearing mechanism. Present study aims at assessment of success rate and hearing improvement following type I tympanoplasty.Methods: 50 patients with chronic suppurative otitis media, tubotympanic type attending department of ENT are taken up for study screened with clinical history and examination. Type I tympanoplasty performed in all patients. Simple mastoidectomy with type I tympanoplasty performed in 8 patients. Patients are followed after surgery on 7th, 14th days and end of 3 months. Anatomical outcome is assessed in terms of graft uptake. Pure tone audiometry was performed at 3 months and air bone gap is considered to assess outcome. Results: Out of 50 cases, 43 cases (86%) showed good success rate by means of graft uptake. Remaining 5 cases showed residual perforation and 3 cases medialization of graft. In 42 patients type1 tympanoplasty is performed, success rate was 80.95% and in cases with where type1 tympanoplasty with cortical Mastoidectomy was done and the success rate was 100%. In the present study mean pre op AB gap was 27.65 dB and mean post op AB gap was 19.07 dB. The difference between the two, i.e., AB gap closure was 8.52 dB which is statistically significant.Conclusions: Type-1 tympanoplasty using temporalis fascia with underlay technique have good surgical success rate with excellent improvement of hearing. Cortical mastoidectomy can be planned depending on the status of the middle ear mucosa.

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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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Comparative study of outcomes of type-1 tympanoplasty with and without anterior tucking

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20201277 ◽

2020 ◽

Vol 6 (4) ◽

pp. 657

Author(s):

Kiran Gangadar S. ◽

G. Priyadarshini

Keyword(s):

Tympanic Membrane ◽

Otitis Media ◽

Chronic Otitis Media ◽

Pure Tone Audiometry ◽

Tympanic Membrane Perforation ◽

Hearing Improvement ◽

Type 1 Tympanoplasty ◽

Membrane Perforation ◽

Group 2

Background: Tympanoplasty is a surgical procedure for closing the tympanic membrane perforation and reconstructing the tympanic membrane and hearing, commonly after trauma and chronic otitis media. The aim of the study was to compare the clinical and audiological outcomes of tympanoplasty with or without anterior tucking.Methods: In this prospective study, 50 patients with chronic otitis media (COM) were divided into two groups. Group 1 underwent type 1 tympanoplasty with anterior tucking method, and group 2 underwent type 1 tympanoplasty without anterior tucking. The result was measured on graft uptake and hearing outcome at 6 months postoperatively by performing pure tone audiometry. Results: The hearing improvement was almost the same in both the groups. Graft uptake was good in type 1 tympanoplasty with tucking (96%) when compared to without tucking tympanoplasty (92%). Complications like residual perforation were seen in both groups equally. Anterior marginal blunting was noted (8%) in type 1 tympanoplasty with tucking.Conclusions: The hearing improvement of type-1 tympanoplasty with anterior tucking and without anterior tucking is the same. Type-1 tympanoplasty with anterior tucking has a better graft acceptance. The only disadvantage of type-1 tympanoplasty with anterior tucking is anterior marginal blunting.

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Interlay versus underlay type 1 tympanoplasty: a comparative study of the techniques in 100 cases

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20185071 ◽

2018 ◽

Vol 5 (1) ◽

pp. 64

Author(s):

Nitin Sharma ◽

Pritosh Sharma ◽

V. P. Goyal ◽

Kumar Gaurav Sharma

Keyword(s):

Surgical Technique ◽

Prospective Study ◽

Otitis Media ◽

Chronic Otitis Media ◽

Hearing Level ◽

Hearing Improvement ◽

Medical College ◽

Type 1 Tympanoplasty ◽

Central Perforation

Background: Type 1 tympanoplasty is a surgical technique used to restore the integrity of tympanic membrane as well as to improve hearing level in patients with large central perforations (inactive mucosal chronic otitis media).Methods: This is a randomized prospective study of 12 month duration from January 2017 to December 2017 in 100 patients of chronic otitis media inactive mucosal type with large central perforation admitted in the E.N.T department at Geetanjali Medical College and Hospital, Udaipur. Results: The graft uptake rate in the present study was found to be 96% and 90% respectively in interlay and underlay techniques. Post operatively after 12 weeks mean air bone gap was maximum reduced in Interlay tympanoplasty.Conclusions: The present study showed that Interlay technique had a better graft take rate as well as hearing improvement in large central perforation of chronic otitis media than the underlay technique.

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To assess the hearing improvement in patients of Chronic Otitis Media Tubotympanic type post tympanoplasty

The Journal of Medical Research ◽

10.31254/jmr.2020.6611 ◽

2020 ◽

Vol 6 (6) ◽

pp. 305-308

Author(s):

Harsh Lokhna ◽

◽

Sanjay Kumar ◽

Anshul Bansal ◽

◽

...

Keyword(s):

Hearing Loss ◽

Otitis Media ◽

Pure Tone ◽

Pure Tone Audiometry ◽

Hearing Improvement ◽

Middle Ear Mucosa ◽

Suppurative Otitis Media ◽

Type 1 Tympanoplasty ◽

Significant Difference

Aim: To determine hearing improvement in type- 1 tympanoplasty by comparing mean preoperative air bone gap with mean postoperative AB gap. Material and method: Patients clinically diagnosed as 75 cases of Chronic Suppurative Otitis Media Tubotympanic Type Disease presenting to the ENT OPD of Chhatrapati Shivaji Hospital attached to Subharti Medical College, Meerut were taken up for study. Detailed clinical examination and history was taken. Pure tone audiometry was conducted, hearing loss and mean AB Gap was noted pre-operatively. X-Ray mastoid B/L Schuller’s view was done and findings were noted. Tympanoplasty type 1 with or without mastoidectomy was performed. Cortical mastoidectomy with type 1 Tympanoplasty was performed in patients having granulations & polypoidal middle ear mucosa along with sclerotic mastoid. All these patients were followed up post-operatively at 6 weeks. The status of graft uptake was noted. Pure tone audiometry was performed. Hearing loss and mean AB Gap results were compared with pre-operative findings. Results: In our study out of 75 patients, 33 (44%) patients were affected with Right ear and 42 (56%) patients were affected with Left ear. Hearing loss was the chief complaint in all 75 patients (100%) followed by blocking sensation. Post operatively 58 (77.33%) patients had normal hearing followed by 16 (21.33) patients who had mild hearing loss. Only 1 (1.33%) patient had moderately severe hearing loss. Pre-operatively, mean AB Gap was 46.62+/-7.89dB while post-operatively mean AB Gap was 23.43+/-5.52dB with statistically significant difference as p<0.05. Conclusion: In our study, the post-operative Mean AB Gap was improved significantly as compared to preoperative mean AB Gap.

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Single Sitting Bilateral Myringoplasty: Outcomes and Complications

QJM ◽

10.1093/qjmed/hcaa047.016 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

M A Hassan ◽

M S Hassaballah ◽

P M Mikahail ◽

M S D Mahmoud

Keyword(s):

Hearing Loss ◽

Success Rate ◽

Tympanic Membrane ◽

Otitis Media ◽

Chronic Otitis Media ◽

Psychological Trauma ◽

Single Stage ◽

Hearing Improvement ◽

Suppurative Otitis Media ◽

Graft Take

Abstract Background Tympanoplasty is the standard and well established procedure for closure of tympanic membrane perforations. Traditionally each ear drum is taken up for grafting sequentially in two different sittings. The reluctance to deal with both sides at the same sitting has been primarily due to a theoretical risk of iatrogenic sensory-neural hearing loss, need of bilateral ear canal gauze packing and chances of graft intake failure. Chronic Suppurative Otitis Media (CSOM) is a widely prevalent public health problem presenting with discomfort, hearing loss, otorrhea and psychological trauma. CSOM is characterized by an inflammatory process of the middle ear often associated with irreversible tissue alterations. It may be further classified into safe chronic otitis media and unsafe chronic otitis media according to the absence or presence of a cholesteatoma. Aim This study aim at assessing the single stage bilateral surgical procedure in bilateral tympanic membrane perforation caused by chronic otitis media as regard the graft take and hearing improvement as outcomes. Methodology A meta-analysis study is done to assess the feasibility and the possibility of operating the bilateral perforation in tympanic membrane in chronic otitis media cases on same session rather than doing it in separate sessions. The outcomes that were selected to evaluate such approach are graft take and hearing improvement. Hospital stay, cost of the operation and time were supposed to be evaluated however, there was no sufficient data to treat such outcomes in this meta analytic study upon that these outcomes are going to be appraised and stated bases on the available data. Results The graft take was evaluated on the bases paper by ototscopic examination post operative from 3 weeks to 3 months by closure of the perforation. It was estimated in this study to be 88%. This percent is matching the result obtained by Ihsan et al 2016 “who operated on 50 patients with a graft uptake rate of 86 %”, Olusesi et al, 2017 " with a total of 38 participants underwent either bilateral sequential same-day tympanoplasty (18 patients, 36 ears) or bilateral sequential different-day tympanoplasty (20 patients, 40 ears). The overall graft take rate was 88 per cent (32 out of 36 ears in the same-day tympanoplasty group, 35 out of 40 ears in the different-day tympanoplasty group; p = 0.96, odds ratio = 0.984)" (88 %), and Katsura et al, 2005 who revised the SUM using a 17 patients who underwent bilateral same-day surgery with a success rate of (85%). Conclusion Simultaneous bilateral myringoplasty is safe and effective as a single-stage operation with a high success rate as regard the graft take and hearing improvement.

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Assessment of the outcome of myringoplasty with cortical mastoidectomy in dry and wet mucosal type of chronic otitis media

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20204621 ◽

2020 ◽

Vol 6 (11) ◽

pp. 2001

Author(s):

Sreeshma Balan ◽

Prakash M. D.

Keyword(s):

Success Rate ◽

Otitis Media ◽

Statistical Significance ◽

Chronic Otitis Media ◽

P Value ◽

Hearing Improvement ◽

Cortical Mastoidectomy ◽

Significant Difference ◽

Group A ◽

Group B

Background: Chronic otitis media (COM) is an inflammatory process in the middle ear space that results in long-term changes in the tympanic membrane including atelectasis, dimeric-membrane formation, perforation, tympanosclerosis, retraction pocket or cholesteatoma. COM can be classified into healed, inactive (mucosal or squamosal), active (mucosal or squamosal). Myringoplasty is tympanoplasty without ossicular reconstruction. Cortical mastoidectomy is usually accompanied by tympanoplasty. Aim was to assess and compare the efficacy of myringoplasty with cortical mastoidectomy in dry and wet mucosal type of COM, in terms of graft uptake and hearing improvement.Methods: A prospective study, where 30 patients each of wet and dry mucosal-type COM were included. Patients underwent myringoplasty with cortical mastoidectomy. All were followed up for 6 months, both the groups were statistically compared. Results: In our study, mean age of patients in group A (wet COM) was 34.13 years and group B (dry COM) was 33.36 years. Group A had success rate of 90% and group B had success rate of 86.6%. There was no statistical significance (p value- 0.53) on comparing both groups with respect to graft uptake. There was significant hearing improvement post-operatively in both the groups (p<0.05). However, there was no significant difference between the groups (p value- 0.66). This shows that presence of discharge at the time of surgery does not interfere with the results of cortical mastoidectomy with myringoplasty.Conclusions: We conclude that, there is good outcome in both wet and dry COM following myringoplasty with cortical mastoidectomy with respect to graft uptake and hearing improvement.

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