Relationship of Preoperative Hearing loss with Peroperative Ossicular Discontinuity in Chronic Otitis Media

Background: Chronic Otitis Media (COM) is a common disease in our country. COM with or without cholesteatoma may lead to ossicular discontinuity. However, the discontinuity of the ossicular chain is usually confirmed during operation. The purpose of the study was to find out the correlation between preoperative hearing loss and the status of ossicular chain at surgery. Methods: This cross-sectional study was conducted in the department of otolaryngology- Head & neck surgery, Bangabandhu Sheikh Mujib Medical University from January 2013 to June 2014. At least 113 patients of COM were selected as per inclusion and exclusion criteria. Relevant data were collected in a predesigned data collection sheet and analyzed with standard statistical method. Statistically significant inferred for P value <0.05. No groups whose ability to give voluntary informed consent questionable was not included. No potential risks exist in designed this study. Results: Out of 34 patients with mild degree of hearing loss 31(39.7%) had intact ossicular chain whereas discontinuity was seen in 3(8.6%) cases, 37 patients with moderate degree of hearing loss 16(45.7%) had ossicular discontinuity. Among 23 patients with moderate to severe degree of hearing loss 14(17.9%) had intact ossicular chain whereas ossicular discontinuity was found 9(25.7%), 9 patients of severe degree of hearing loss 7(20%) had ossicular discontinuity. Cases with moderate and severe degree of hearing loss had significant ossicular discontinuity (p<0.05). Air-bone gap > 40 dB was found in 60% cases of ossicular discontinuity, followed by air bone gap 31-40 dB(17.14%), 21-30 dB(14.29%) and 11-20 dB( 8.57%) respectively. So ossicular discontinuity was in higher air-bone gap group and it was statistically significant (p<0.001). Bangladesh J Otorhinolaryngol; October 2019; 25(2): 94-101

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Preoperative predictors of Ossicular Discontinuity in non-Cholesteatoma Chronic Otitis Media

Journal of Dhaka Medical College ◽

10.3329/jdmc.v29i1.51171 ◽

2021 ◽

Vol 29 (1) ◽

pp. 47-52

Author(s):

Kanu Lal Saha ◽

Nibash Chandra Ghosh ◽

Nasima Akhtar ◽

Debesh Chandra Talukder

Keyword(s):

Granulation Tissue ◽

Chronic Otitis Media ◽

Ossicular Chain ◽

Neck Surgery ◽

Cross Sectional Study ◽

Medial Wall ◽

P Value ◽

Cross Sectional ◽

Medical College ◽

Data Collection Sheet

Background: Though ossicular discontinuity is more common in cases of cholesteatoma, it may happen in non-cholesteatoma COM. The long process of incus is more frequently involved ossicle. Peroperative assessment of ossicular integrity is the gold standard way. But the discontinuity of the ossicular chain can be assumed before surgery by analyzing perforation edge adherent to medial wall and wide air-bone gap The purpose of the study was to find out the preoperative findings which can predict the ossicular discontinuity in non-cholesteatoma cases. Methods: This cross-sectional study was conducted in the department of Otolaryngology-Head & Neck Surgery, Bangabandhu Sheikh Mujib Medical University from January 2013 to June 2014. 81 patients of COM without cholesteatoma were selected as per inclusion and exclusion criteria. Relevant data were collected in a predesigned data collection sheet and analyzed with standard statistical method. Statistically significant inferred for P value <0.05. No groups whose ability to give voluntary informed consent questionable was not included. No potential risks exist in designed this study. Results: Air-bone gap > 40 dB was found in 60% cases of ossicular discontinuity, followed by air bone gap 31-40 dB(20%), 21-30 dB(13.33%) and 11-20 dB( 6.67%) respectively. So ossicular discontinuity was more in higher air-bone gap group and it was statistically highly significant (p<0.001). Perforation edge attached to medial wall where ossicular discontinuity was 93.3% and perforation edge free from medial wall was 6.7%.Ossicular discontinuity was higher when perforation edge was found attached to medial wall which was highly statistically significant (p<0.001). Out of 25 granulation tissue cases ossicular discontinuity was found 21(84%) and ossicular chain intact was found 4(16%). That was statistically significant (p<0.01). Conclusion: Non-cholesteatoma COM may cause ossicular disconnection. Majority ossicular discontinuity found when average air bone gap > 40 dB. Ossicular discontinuity was also found more in cases where there is attachment of perforation edge to medial wall, and presence of granulation tissue. If preoperative information can be gathered to determine whether or not the ossicular chain is intact, the patient can be better informed, counseled for ossiculoplasty before surgery. J Dhaka Medical College, Vol. 29, No.1, April, 2020, Page 47-52

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Evaluation of hearing status after type I tympanoplasty

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v24i1.45341 ◽

2020 ◽

Vol 24 (1) ◽

pp. 50-55

Author(s):

Mashuque Mahamud ◽

Mani Lal Aich ◽

Abdullah Al Mamun ◽

Rafiul Alam

Keyword(s):

Otitis Media ◽

Chronic Otitis Media ◽

Neck Surgery ◽

Cross Sectional Study ◽

Type I ◽

Cross Sectional ◽

Female Ratio ◽

The Mean ◽

Type I Tympanoplasty ◽

Air Conduction

Objective: To evaluate hearing outcome after type I tympanoplasty in inactive mucous type of chronic otitis media. Methods: It was a cross-sectional study conducted in the department of Otolaryngology & Head Neck Surgery, Sir Salimullah Medical College and Mitford Hospital, Dhaka, from July 2014 to June 2016. 50 cases were selected by matching inclusion and exclusion criteria. Paired t-test and Z test was used to analyze the variables. P values <0.05 was considered as statistically significant. Results: The mean age was found 28.5 years with range from 15 to 41 years and male female ratio was 1.3:1. All patients had intermittent otorrhoea and varying degree of hearing loss. The mean air conduction threshold was 40.2 dB preoperatively and 27.1 dB post-operatively. Air-bone gap was found 26.9 dB in preoperative and 16.1 dB in post-operative group. The differences were statistically significant between preoperative and post-operative group. Thus mean improvement of air conduction threshold was 13.1 dB and air-bone gap was 10.8 dB. Two third (66.%) patients improved <15 db air conduction thresholds and 17(34%) improved ≥15 db air conduction thresholds. Using the proportion of patients with a postoperative hearing within 40 dB as the criterion, this study showed 46(92%) patients achieving this and 40(80%) patients achieving AB gap within 20 db postoperatively. Conclusion: Improvement of air conduction threshold and AB gap after type I tympanoplasty was statistically significant. Thus from this study it can be concluded that type I tympanoplasty is an effective technique for hearing improvement in inactive mucous type of chronic otitis media. Bangladesh J Otorhinolaryngol; April 2018; 24(1): 50-55

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Improvement of Tinnitus following Tympanoplasty and Tympanomastoidectomy Surgeries in Patients with Chronic Otitis Media

Galen Medical Journal ◽

10.31661/gmj.v5i2.647 ◽

2016 ◽

Vol 5 (2) ◽

pp. 63-69

Author(s):

Masoumeh Saeedi ◽

Mohammad Hossein Khosravi

Keyword(s):

Hearing Loss ◽

Otitis Media ◽

Chronic Otitis Media ◽

Cross Sectional Study ◽

Common Symptom ◽

Sectional Study ◽

Chi Square ◽

Cross Sectional ◽

Tinnitus Severity ◽

Spss Software

Background: After otorrhea and hearing loss, Tinnitus is the most common symptom in patients with chronic otitis media (COM). The aim of this study was to evaluate the improvement of tinnitus in COM patients after tympanoplasty and tympanomastoidectomy surgeries. Materials and Methods: This cross-sectional study was conducted on COM patients suffering from Tinnitus referred to Baqiyatallah hospital, Tehran, Iran undergoing tympanoplasty or tympanomastoidectomy surgeries between March 2013 and August 2014. Tinnitus Handicap Inventory (THI) and Visual Analogue Scale (VAS) questionnaires were filled before and two months after surgery by each patient, and considered subjects were compared with each other. Audiometry test was taken from each patient before and two months after surgery. Audiometry results as well as Air-Bone gap were measured and evaluated prior and after surgery. Data were analyzed using SPSS software by ANOVA, sample t-test and Chi-square tests. Results: Eventually, 26 male and 24 female patients with a mean age of 38.62±11.88 years were enrolled. Air conduction at all frequencies was 49.99±17.37 before and 36.98±22.06 after surgery (P<0.001). Severity of tinnitus was 62.92±30.54 before and 30.54±20.08 after surgery based on THI (P<0.001). Also, it was 7.46±1.66 before and 3.5±2.06 after surgery based on VAS evaluations (P<0.001). Tinnitus severity reduction was significantly associated with the improvement of hearing loss and decrement of air-Bone gap (P<0.001). Tinnitus symptoms such as loudness, annoyance, impact on life and perception of Tinnitus significantly reduced after surgery. Moreover, Tympanomastoidectomy was more effective on the improvement of Tinnitus in comparison with Tympanoplasty (P=0.019).Conclusion: It seems that, both tympanomastoidectomy and tympanoplasty surgeries are effective on the improvement of tinnitus in patients with COM; however, Tympanomastoidectom surgery was shown to be more effective.[GMJ.2016;5(2):63-69]

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Sensorineural hearing loss in chronic otitis media: analysis of an overlooked entity!

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20193883 ◽

2019 ◽

Vol 5 (5) ◽

pp. 1355

Author(s):

Kishore C. Shetty ◽

Samatha K. Jayaramaiah ◽

Biniyam Kolathingal ◽

Shravan Alva

Keyword(s):

Hearing Loss ◽

Sensorineural Hearing Loss ◽

Otitis Media ◽

Bone Conduction ◽

Chronic Otitis Media ◽

Public Health Problem ◽

Media Analysis ◽

Sensorineural Hearing ◽

Major Public Health Problem ◽

Cross Sectional

Background: In developing countries, hearing loss continues to be the major public health problem. Among the various causes of hearing loss, chronic otitis media (COM) is one of the commonest. In COM, the presence of sensorineural hearing loss is well established. Our study intends to determine the prevalence of sensorineural hearing loss in chronic otitis media.Methods: This was a cross sectional descriptive study of 151 subjects between the age group of 10 and 60 years. Patients having unilateral chronic otitis media of both mucosal and squamosal types were selected. All patients were evaluated clinically and audiologically. The type, duration of disease and type of perforation is correlated with degree of sensorineural hearing loss. Interaural differences in bone conduction thresholds at 500 Hz, 1 kHz, 2 kHz and 4 kHz were also noted. Results: A statistically significant correlation was noted between type of disease and perforation with hearing loss. A significant interaural difference was noted across the speech frequencies. Sensorineural hearing loss of 19.1% was seen.Conclusions: Significant sensorineural hearing loss is seen in chronic otitis media which was greater in squamosal disease. Statistically significant correlation was noted between type of disease and type of perforation with hearing loss.

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Spectrum of clinical characteristics of chronic suppurative otitis media unsafe type: a retrospective study from a tertiary care teaching hospital in Central India

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20212444 ◽

2021 ◽

Vol 7 (7) ◽

pp. 1105

Author(s):

Rashmi Hansdah ◽

Kavita Sachdeva

Keyword(s):

Hearing Loss ◽

Otitis Media ◽

Tertiary Care ◽

Disease Process ◽

Chronic Otitis Media ◽

Central India ◽

Neck Surgery ◽

Chronic Suppurative Otitis Media ◽

Retropharyngeal Abscess ◽

Suppurative Otitis Media

Background: Chronic suppurative otitis media (CSOM)-unsafe type or atticoantral disease or chronic otitis media-squamosal type is a commonly encountered bone eroding disease of the middle ear whose complications can be potentially fatal.Methods: Retrospective analysis of 80 patients who underwent mastoid exploration in the department of otolaryngology and head and neck surgery, NSCBMCH, Jabalpur between June 2016 and May 2017.Results: Unsafe CSOM is commoner in young males of 16-30-year age group. Foul smelling, scanty, purulent ear discharge was the commonest symptom (97.5%). Attic perforation was the most consistent otoscopic finding (47.5% cases). 15% of our patients had central perforations. Conductive hearing loss was most common (62%) followed by mixed hearing loss (23%) and sensorineural hearing loss (11%). Commonest complication encountered was mastoiditis (27 cases). Mastoidectomy with tympanoplasty was done in almost all cases (97.5%). Attic (96.2%), additus (90%), and antrum (86.2%) were commonly involved by disease process. Incus was found to be most susceptible to erosion (88.5%) while stapes was most resistant (36.25%).Conclusions: Unsafe CSOM presenting late warrant prompt diagnosis and surgical intervention. Unusual presentation like retropharyngeal abscess and trismus should raise suspicion of complicated unsafe CSOM in patients with history of otorrhoea. Canal wall down mastoidectomy with rehabilitation of hearing is the surgery of choice in patients who are unlikely to follow up regularly.

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Single centre experience of ossiculoplasty using different materials: a subjective and objective evaluation

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20204632 ◽

2020 ◽

Vol 6 (11) ◽

pp. 2058

Author(s):

Vijay Kumar ◽

Kranti Bhavana ◽

Bhartendu Bharti

Keyword(s):

Hearing Loss ◽

Otitis Media ◽

Chronic Otitis Media ◽

Objective Evaluation ◽

Neck Surgery ◽

Postoperative Result ◽

Ossicular Reconstruction ◽

Single Centre Experience ◽

Associated Symptoms ◽

Air Conduction

Background: Chronic otitis media has serious impact over the ossicular integrity in middle ear resulting in ossicular necrosis and various grades of hearing loss along with other associated symptoms. Tympanomastoidectomy with ossicular reconstruction using various materials can improve the symptoms.Methods: A retrospective study of 50 patients underwent tympanomastoidectomy with ossiculoplasty in Department of ENT and Head and Neck Surgery at AIIMS Patna from April 2017 to 2018. Patients with chronic otitis media having ossicular necrosis with ABG (air bone gap) more than 25 dB were included in this study. PORP (partial ossicular reconstruction prosthesis) and TORP (total ossicular reconstruction prosthesis) were used as ossicular reconstruction after clearance of disease. This study was expressed as subjective and objective evaluation following ossiculoplasty. Results: Fifty patients having chronic otitis media with decreased hearing and other associating symptoms were included in this study. Preoperative air conduction threshold was 55.32 dB with preoperative ABG was 44.24 dB. Postoperative result was summarised as postoperative AC threshold was 32.72 dB with gain of 22.60 dB with ABG 25.45 dB.Conclusions: Chronic otitis media may lead to ossicular necrosis and various grade of hearing loss. A proper technique and skilled tympanomastoidectomy with ossiculoplasty can improve the symptoms of chronic otitis media.

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Assessment of Patch Test in Predicting Ossicular Status in Chronic Otitis Media

Journal of Nepalgunj Medical College ◽

10.3126/jngmc.v15i2.22817 ◽

2017 ◽

Vol 15 (2) ◽

pp. 10-12

Author(s):

Shama Bhandari ◽

S. Parajuli ◽

R. K. Saxena

Keyword(s):

Hearing Loss ◽

Patch Test ◽

Otitis Media ◽

Chronic Otitis Media ◽

College Teaching ◽

Medium Size ◽

Moderate Degree ◽

Medical College ◽

Mild Degree ◽

Cigarette Paper

Objectives: To assess the reliability of paper-patch test in predicting the intra-operative ossicular status of patients with tympanic th membrane perforation from small to medium size. Methods: This is a hospital based prospective study conducted from 30 April, st 2016 to 1 May, 2017 in the Department of Otorhinolaryngology of Nepalgunj Medical College Teaching Hospital. The patients of chronic otitis media with small to medium sized central perforation were subjected to complete history taking and thorough examination. Audiological evaluation was done before patching, then after patching the perforation with cigarette paper. The result was recorded to predict the ossicular status. Result: The most common age group affected by the disease was 20-30 years with 21(42%) patients. Most of them were females 28(56%). Left ear was affected more 19(38%) than right ear 16(32%) and bilateral 15(30%). All the patients had conductive type of hearing loss out of which moderate degree of hearing loss was present in 36(72%) and mild degree of hearing was present in 14(28%). Following patch test, the hearing improved and in 7(14%) of patients the hearing came to normalcy. Majority of patients had mild degree of hearing loss, i.e., 36(72%) and moderate degree of hearing loss was seen in 7(14%). It was found that in those patients in whom there was less improvement in hearing that i.e. less than 10 dB, the mobility of the ossicles was restricted intra-operatively. Conclusion: The type of hearing loss was conductive hearing loss out of which most common was moderate degree of hearing loss in 36(72%) followed by mild degree of hearing present in 14(28%). Following patch test, it was found that in those patients in whom there was less improvement in hearing i.e., less than 10 dB,ossicular discontinuity was noted intra-operatively and thus ossicular reconstruction by tympanoplasty procedures had to be undertaken.

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A study of status of contralateral ear in unilateral chronic otitis media in 500 patients

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20195579 ◽

2019 ◽

Vol 6 (1) ◽

pp. 34

Author(s):

Prabaakharan Jambunathan ◽

Arvinder S. Maan ◽

Karan Sharma

Keyword(s):

Hearing Loss ◽

Tympanic Membrane ◽

Otitis Media ◽

Chronic Otitis Media ◽

Pure Tone Audiometry ◽

Cross Sectional Study ◽

High Resolution Computed Tomography ◽

Cross Sectional ◽

Mixed Hearing Loss ◽

Contralateral Ear

Background: The aim of this study was to examine the contralateral ear clinically, audiologically and radiologically and compare the findings with squamous and mucosal type of chronic otitis media (COM).Methods: A cross sectional study conducted in patients attending ENT Department, Government Medical College, Amritsar between December 2016 to November 2018. The study was conducted in 500 patients of either sex aged between 8 to 60 years with unilateral COM without perforation or history of ear discharge in the contralateral ear. Otoscopy, pure tone audiometry and X-ray mastoid or high-resolution computed tomography temporal bone were done on the patients. The results were recorded and analysed with SPSS software. Results: 82% patients were found to have some abnormalities in the contralateral ear. On otoscopy abnormalities in contralateral ear includes retraction of tympanic membrane, thinning and tympanosclerotic patch, most common abnormality being retraction of tympanic membrane. Radiological analysis of contralateral mastoids showed 39% diploic and 22.8% sclerotic mastoids. Hearing status in the contralateral ear showed 45.6% patient with normal hearing, 48.6% with conductive hearing loss and 5.8% with mixed hearing loss. 40.4% contralateral ears had mild, 12% had moderate and 2% had severe hearing loss.Conclusions: Contralateral ear pathologies were more in those who had squamosal type of COM than who had mucosal type in the diseased ear. The contralateral ear shows unmistakable predilection towards developing COM in the future.

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Role of pure tone audiometry in assessing ossicular status in patients with mucosal type of chronic otitis media

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20201674 ◽

2020 ◽

Vol 6 (5) ◽

pp. 853

Author(s):

Deepthy Das ◽

Gurumani Sriraman ◽

Valli Rajasekaran

Keyword(s):

Otitis Media ◽

Pure Tone ◽

Chronic Otitis Media ◽

Pure Tone Audiometry ◽

Ossicular Chain ◽

Cross Sectional Study ◽

Cross Sectional ◽

Suppurative Otitis Media ◽

Significant Difference

Background: Chronic suppurative otitis media (CSOM) is the disease of the middle ear cleft, which presents as hearing loss and ear discharge. This study aimed to assess the role of pure tone audiometry (PTA) in analysing the ossicular erosion in mucosal type of CSOM subjects.Methods: The current cross-sectional study was conducted among 60 people with mucosal CSOM. Preoperative hearing was assessed by PTA. The surgeries were done and intra operative ossicular status were recorded. IBM SPSS 20 software was used for the analysis. Student t-test was used to correlate ossicular status and PTA findings. Results: Among 60 subjects, 12 (20%) patients had eroded incus and 53 (88.3%) had normal stapes. The malleus was preserved in all patients. The result of our study showed that an average ABG of 58 dB at 500 Hz, 47 dB at 1 kHz, 41 dB at 2 kHz and 41 dB at 4 kHz in patients with ossicular erosion. ABG for 500 Hz and 1 kHz were statistically significant for eroded incus. ABG for 500 Hz, 1 kHz, 2 kHz and 4 kHz were all statistically significant for eroded stapes.Conclusions: There is a significant difference between the PTA findings at different frequencies between intact and eroded ossicular chain. Pre-operative ABG helps us to assess the status of incus and stapes.

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

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20190769 ◽

2019 ◽

Vol 5 (2) ◽

pp. 396

Author(s):

Razim Abdul Rasheed ◽

Mubeena . ◽

K. S. Gangadhara Somayaji

Keyword(s):

Otitis Media ◽

Middle Ear ◽

Granulation Tissue ◽

Chronic Otitis Media ◽

Ossicular Chain ◽

Bivariate Analysis ◽

Middle Ear Mucosa ◽

Cross Sectional ◽

Suppurative Otitis Media ◽

Wide Range

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.

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