scholarly journals Impact of otorrhoea and ossicular status on the effect of tympanoplasty

2018 ◽  
Vol 4 (6) ◽  
pp. 1366
Author(s):  
M. Rama Sridhar
Keyword(s):  
Middle Ear ◽  
Chronic Otitis Media ◽  
Pure Tone Audiometry ◽  
Functional Results ◽  
Ossicular Chain ◽  
Risk Category ◽  
Hearing Improvement ◽  
Number Of Patients ◽  
General Physical ◽  
A Prospective Study

<p><strong>Background: </strong>The objective of the study<strong> </strong>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</p><p><strong>Methods: </strong>This was a prospective study conducted on 100 patients<strong> </strong>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.<strong></strong></p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>

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

2017 ◽  
Vol 3 (3) ◽  
pp. 705 ◽  
Author(s):  
Yogeshwar Chandrashekar ◽  
Ravishankar Chandrashekar
Keyword(s):  
Otitis Media ◽  
Statistical Significance ◽  
Chronic Otitis Media ◽  
Pure Tone Audiometry ◽  
Inflammatory Cells ◽  
P Value ◽  
Hearing Improvement ◽  
Female Ratio ◽  
Fascia Graft ◽  
A Prospective Study

<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&gt;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&gt;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>

scholarly journals Correlation of the Puretone Audiometry Findings with Intraoperative Findings in Patients with Chronic Suppurative Otitis Media

2015 ◽  
Vol 2 (1) ◽  
pp. 4
Author(s):  
Devashri Uday Patil ◽  
Kiran S. Burse ◽  
Shreeya Kulkarni ◽  
Vandana Sancheti ◽  
Chaitanya Bharadwaj
Keyword(s):  
Hearing Loss ◽  
Otitis Media ◽  
Pure Tone ◽  
Pure Tone Audiometry ◽  
Ossicular Chain ◽  
Chronic Suppurative Otitis Media ◽  
Suppurative Otitis Media ◽  
Number Of Patients ◽  
Operative Findings ◽  
Air Conduction

Chronic suppurative otitis media is one of the common otological conditions in India for which patients seek advice from an otorhinolaryngologist. Chronic suppurative otitis media is recurrent and progressive disease which is characterized with tympanic membrane perforation and suppurative discharge. Pure tone audiometry is the most common test used to evaluate auditory sensitivity. Since hearing loss is a common complication of chronic suppurative otitis media, we designed this study to evaluate preoperative pure tone audiometry findings in patients with chronic suppurative otitis media and its correlation with the intra-operative findings. <strong>Aims and Objectives:</strong> 1] To assess the intra-operative findings in patients with chronic suppurative otitis media. 2] To evaluate the correlation between the preoperative pure tone audiometry findings and intra-operative findings in patients with chronic suppurative otitis media. 3] To assess the type of hearing loss and degree of hearing loss in patients with chronic suppurative otitis media. <strong>Materials and Methods:</strong> This is an Observational study carried over a period of 3 years from August 2011 to August 2013. Total number of patients included in this study was 100. <strong>Result:</strong> Out of 100 patients studied 69 % of patients had Tubo-Tympanic type of CSOM, 31 % of patients had Attico-antral type of CSOM. In patients of Safe CSOM; Central perforation was seen in maximum cases 46.4 %, anterior central perforations was seen in 8.7 % cases, posterior central perforations seen in 20.2 % cases, and subtotal perforations seen in 24.63 % cases. In patients of Unsafe CSOM posterosuperior cholesteatoma was seen in maximum cases 67.74 %, and attic cholesteatoma was seen in 32.2 % cases. In safe CSOM patients all ossicles were intact and mobile whereas in unsafe CSOM patients only 4 patients had intact ossicular chain, while maximum patients had ossicular defect. <strong>Conclusion:</strong> Hearing loss depends on size of perforation. Hearing loss increases as the size of perforation increases. Average air conduction threshold and air bone gap did not differ significantly between various groups of ossicular defect. This shows us that neither air conduction nor air bone gap are reliable parameters on basis of which we can predict ossicular status preoperatively.

scholarly journals Scanning Electron Microscopy in the Evaluation of Defects to the Ossicular Chain in the Course of Chronic Otitis Media

2019 ◽  
pp. 014556131987391
Author(s):  
Agnieszka Wiatr ◽  
Katarzyna Swiezy ◽  
Jacek Skladzien ◽  
Maciej Wiatr
Keyword(s):  
Electron Microscopy ◽  
Scanning Electron Microscopy ◽  
Chronic Inflammation ◽  
Otitis Media ◽  
Middle Ear ◽  
Chronic Otitis Media ◽  
Ossicular Chain ◽  
Suppurative Otitis Media ◽  
Ear Ossicles ◽  
Scanning Electron

Objective: Chronic otitis media is a heterogeneous disorder. Chronic suppurative otitis media with cholesteatoma and, to a lesser extent, chronic otitis media with granulation lead to the destruction of bone structures within the middle ear. Bone loss may appear in the prominence of the horizontal semicircular canals and the bony canal of the facial nerve. The inflammatory process may spread to the bony labyrinth of the sigmoidal sinuses and the cranial cavities. Materials and Methods: The analysis comprised the examination of fragments of auditory ossicles removed during surgery in 21 patients with various types of chronic inflammation of the middle ear. The purpose of this study was to evaluate the usefulness of scanning electron microscopy in evaluating the erosion of middle ear ossicles in different types of chronic otitis media. Images captured at various magnifications were used for the best possible illustration of the observed lesions in bone tissue. Results: The observed lesions and the degree of bone surface damage were dependent on the type of chronic inflammation of the middle ear. The largest destructive changes in the ossicular chain were observed in chronic otitis media with cholesteatoma; smaller changes were observed in chronic otitis media with granulation. Conclusion: In the case of damage to the ossicles inflicted by inflammation, the use of a modeled bone block made of a temporal bone taken from outside the tympanic cavity or a biomaterial prosthesis is a good choice in ossiculoplasty.

A study of chorda tympani nerve injury and related symptoms following middle-ear surgery

2005 ◽  
Vol 119 (3) ◽  
pp. 189-192 ◽  
Author(s):  
P Gopalan ◽  
M Kumar ◽  
D Gupta ◽  
J J Phillipps
Keyword(s):  
Prospective Study ◽  
Middle Ear ◽  
Recovery Time ◽  
Middle Ear Surgery ◽  
Chorda Tympani ◽  
Chorda Tympani Nerve ◽  
Ear Surgery ◽  
Number Of Patients ◽  
Prolonged Recovery ◽  
A Prospective Study

This is a prospective study that looks into the prevalence of chorda tympani nerve (CTN) injury and related symptoms following varying degrees of trauma to the nerve during three common types of middle-ear operation: myringoplasty, tympanotomy and mastoidectomy. The number of patients with CTN-related symptoms varied widely between the three groups. Increased occurrence of the nerve related symptoms and a prolonged recovery time were observed in the tympanotomy group. Stretching of the nerve produced more symptomatic cases than cutting it in the myringoplasty and mastoidectomy groups. Recovery was complete in 92 per cent of the symptomatic patients by 12 months. It is important to inform patients about the possibility of CTN injury during middle-ear operations, and it should also be emphasized that symptoms related to CTN injury can occur irrespective of the type of damage to the nerve.

scholarly journals Auditory ossicles in ScanningElectron Microscopy

2020 ◽  
Vol 74 (4) ◽  
pp. 1-7
Author(s):  
Agnieszka Wiatr ◽  
Jacek Składzień ◽  
Maciej Wiatr
Keyword(s):  
Electron Microscope ◽  
Scanning Electron Microscope ◽  
Middle Ear ◽  
Chronic Otitis Media ◽  
Ossicular Chain ◽  
Significant Degree ◽  
Vascular Bundles ◽  
Bone Surface ◽  
Auditory Ossicles ◽  
Scanning Electron

<b>Introduction: </b>Knowledge about the physiology of a healthy middle ear is essential for understanding the activity and mechanics of the ear as well as the basics of ossiculoplasty. Trauma of the epithelial lining of the tympanic cavity as well as the ossicular chain may be the result of chronic inflammation and surgery. Depending on the observed changes of the middle ear lining, there are several types of distinguished chronic inflammatory changes: simple, with cholesteatoma, with the formation of inflammatory granulation tissue, in course of specific diseases. <br><b>Purpose: </b>The aim of the article is presentation of the microstructure and vasculature of the ossicular chain in the Scanning Electron Microscope. Particular attention is drawn to the anatomical aspects of the structure and connections of auditory ossicles as vital elements for reconstruction of the conduction system of the middle ear. <br><b>Material and method: </b>The analysis covered auditory ossicles standardly removed in accordance with the methodology of the investigated surgical procedures. The preparations were evaluated in a scanning electron microscope. <br><b>Results: </b>The exposure of bone surface promotes deep erosion. The advanced process of destruction of bone surface in the case of chronic otitis media correlates with a significant degree of damage to both the lining covering the auditory ossicles and that surrounding articular surfaces. <br><b>Conclusions: </b>(1) The ossicles in the image of the Scanning Electron Microscope are covered with lining. It passes from the surface of the ossicles to the vascular bundles, forming vascular sheaths; (2) Damage to lining continuity on the surface of the auditory ossicles promotes the rapid destruction of bone tissue in the inflammatory process; (3) The dimensions of the individual ossicles are respectively: malleus – 8.36 +/- 0.01, incus – 8.14 +/- 0.0, stapes – 3.23 +/- 0.01 mm. Behavior of the anatomical length of ossicular chain during tympanoplasty appears to be essential to maintaining adequate vibration amplitude of the conductive system of the middle ear.

scholarly journals OSSICULAR STATUS IN CHOLESTEATOMA : A DEPARTMENTAL EXPERIENCE IN A STATE MEDICAL COLLEGE OF WESTBENGAL.

2015 ◽  
Vol 23 (3) ◽  
pp. 116-119
Author(s):  
Somesh Mozumder ◽  
Arunabha Sengupta ◽  
Alok Ranjan Mondal ◽  
Soumik Basu
Keyword(s):  
Otitis Media ◽  
Clinical Examination ◽  
Middle Ear ◽  
Chronic Otitis Media ◽  
Ossicular Chain ◽  
Radiological Evaluation ◽  
Super Structure ◽  
Medical College ◽  
Middle Ear Cleft ◽  
Age And Sex

Introduction: Chronic otitis media is a long standing infection of part or whole of middle ear cleft. Its active squamosal variant (cholesteatoma) is most dangerous due to its bone eroding property. Aims & Objective: Background knowledge of ossicular status in cholesteatoma  will help us in determining the type  of reconstruction needed during the surgery. Material & methods: 60 cases of cholesteama, irrespective of age and sex [diagnosed on the basis of clinical examination , audiological and radiological evaluation] were selected during the study period of two years and their ossicular status were recorded intra-operatively. Results &  analysis: Ossicles and their parts getting involved in cholesteatoma cases , in decreasing order are : Lenticular process (in total 50 cases)>Long process of incus (in total 49 cases) > stapes super-structure(in total 29 cases) > body of incus(in total 26 cases)> head of malleus(in total 23 cases)> handle of malleus(in total 10 cases). Ossicular chain  defeact in decreasing order are : M-I-S- > M+I-S- > M-I-S+ > M+I-S+. Conclusion: In our study it was found that incus is the most vulnerable ossicle to get involved in cases of active squamosal variety of chronic otitis media where as malleus appeared to be the least susceptible one.

scholarly journals A Correlative Study Between Size of Tympanic Membrane Perforation, Pure Tone Audiometry and Intraoperative Findings in Tympanoplasty

2018 ◽  
Vol 26 (1) ◽  
pp. 43-47
Author(s):  
Santosh U P ◽  
Sridurga J ◽  
Aravind D R
Keyword(s):  
Hearing Loss ◽  
Tympanic Membrane ◽  
Otitis Media ◽  
Middle Ear ◽  
Pure Tone ◽  
Chronic Otitis Media ◽  
Pure Tone Audiometry ◽  
Tympanic Membrane Perforation ◽  
Membrane Perforation ◽  
Operative Findings

Introduction             Chronic otitis media (COM) is a most common and prevalent disease of the middle ear. COM has been defined as a longstanding inflammatory condition of middle ear and mastoid, associated with perforation of the tympanic membrane. Tympanoplasties are common surgeries performed for chronic otitis media in inactive mucosal type. Any otological surgery may involve a menace/ hazard of hearing loss post operatively.             In this study, an attempt was made to correlate, size of tympanic membrane perforation, pure tone audiometry and intra-operative findings in tympanoplasties, results were analysed and conclusion drawn. Materials and Methods Forty patients attending ENT OPD with chronic otitis media (COM), inactive mucosal type, with conductive hearing loss undergoing tympanoplasties who were willing to participate in the study were selected.  Ear was examined pre-operatively to assess the size of perforation and then, pure tone audiometry (PTA) was done to assess the type of hearing loss and its severity. During tympanoplasty, middle ear was inspected for ossicular status and any other pathology was noted. Later, the size of tympanic membrane perforation, pure tone audiometry and intra operative findings were correlated with each other and analysed. Result  In small and medium sized perforation, PTA and intraoperative findings correlated with each other. Whereas, in large and subtotal perforation, there was no correlation. Conclusion             In small and medium sized perforation, middle ear inspection may not be necessary. Whereas, in large and subtotal perforation it is necessary. 

scholarly journals A study to assess hearing improvement after fat graft myringoplasty

2021 ◽  
Vol 7 (2) ◽  
pp. 303
Author(s):  
Nupur Midha ◽  
Gurbax Singh ◽  
Rachna Dhingra ◽  
Rajwant Kaur
Keyword(s):  
Pure Tone ◽  
Bone Conduction ◽  
Pure Tone Audiometry ◽  
Threshold Level ◽  
Fat Graft ◽  
Hearing Improvement ◽  
Suppurative Otitis Media ◽  
Bone Conduction Threshold ◽  
Tympanic Membrane Perforations ◽  
Number Of Patients

<p class="abstract"><strong>Background:</strong> Tympanic membrane perforations result mainly from infectious and traumatic etiologies. Postoperative outcomes of reconstructive surgeries of hearing mechanism have routinely been assessed by take up rates and air bone gap closure on pure tone testing. The present study was conducted to assess hearing improvement after fat graft myringoplasty.</p><p class="abstract"><strong>Methods:</strong> The present prospective study was conducted from 1<sup>st</sup> January 2017 to 30<sup>th</sup> June 2018. The study population consists of patients of age 18 to 60 years. The subjects with safe or tubotympanic type of chronic suppurative otitis media with small dry central perforation or perforation of the pars tensa less than 3 mm were included in the study. Pure tone audiometry (PTA) was consigned to an audiologist who was blind to the study. Air conduction threshold level was measured at frequencies 0.25 to 8 kHz and bone conduction threshold level was measured at frequencies 0.5 to 4 kHz; average air bone gap of each patient was calculated preoperatively and postoperatively at one and three months at the frequencies 500 Hz, 1000 Hz and 2000 Hz.  </p><p class="abstract"><strong>Results:</strong> Among 30 patients, 15 (50.00%) had pre-operative bone conduction threshold in the range of 0-10 dB HL and rest 15 (50.00%) had between 11-20 dB HL. Majority of them i.e. 20 had post-operative air bone gap in the range of 0-10 dB HL whereas 02 had pre op air bone gap in this range, followed by 07 with air bone gap in the range of 11-20 dB HL as compared to 18 in the pre op and 03 in the range of 21-30 dB HL as compared to 10 in the pre op. Paired t test reveals results are significant.</p><p class="abstract"><strong>Conclusions:</strong> Postoperative audiometry at the end of 1 month revealed majority i.e. 14 had air bone gap in range of 0-10 dB HL thus showing improvement in hearing. Postoperative audiometry at the end of 3 months revealed maximum number of patients i.e. 20 in the range of 0-10 dB HL which showed further improvement in hearing in the form of decrease in air bone gap.</p><p class="Default"> </p>

Middle Ear Function in Learning-Disabled Children

PEDIATRICS ◽  
1980 ◽  
Vol 66 (2) ◽  
pp. 254-260
Author(s):  
Forrest C. Bennett ◽  
Susan H. Ruuska ◽  
Roberta Sherman
Keyword(s):  
Otitis Media ◽  
Middle Ear ◽  
Chronic Otitis Media ◽  
Pure Tone Audiometry ◽  
Learning Disabled ◽  
Learning Problems ◽  
Disabled Children ◽  
History Of ◽  
School Learning ◽  
Recurrent Otitis Media

To investigate the possible association of chronic otitis media and school learning problems, past and current middle ear status in 53 learning-disabled (LD) children was compared to that of 56 control children without learning problems. A history of recurrent otitis media was obtained in 23% of the LD children and in 9% of the control children. Thirty-eight percent of LD children and 16% of control children had hearing abnormalities on pure tone audiometry; 49% of LD children and 21% of control children had abnormal tympanometry. LD children had significantly more middle ear malfunction than control children. Chronic, undetected middle ear problems may play a role in the etiology of some school learning disabilities.

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