Ossicular reconstruction of incudo-stapedial joint by glass ionomer—a study of 24 cases

Background Chronic otitis media is one of the major health issues worldwide resulting in partial or complete loss of conductive hearing mechanism including the tympanic membrane and ossicular assembly. The aim of the study is to assess hearing improvement after reconstructing the incudo-stapedial joint with glass ionomer cement. Here, a prospective observational study was done in a tertiary care hospital. Patients of chronic mucosal otitis media were operated, and intraoperatively incudo-stapedial joint discontinuity was restored using glass ionomer cement. Post-operative follow-up was done at 1-month, 3-month, 6-month, and 1-year intervals, and hearing was evaluated by doing pure tone audiometry with air conduction at 0.5, 1, 2, 3, 4, 6, and 8 kHz and bone conduction at 0.5, 1, 2, 3, and 4 kHz. Tabulation was done by calculating the air-bone gap in each patient. Results In our study, the patients showed statistically significant improvement in air conduction thresholds and near closure of air-bone gap post-operatively. The mean AC threshold is 15 dB with 91.67% patients having closure of ABG < 20 dB at the end of the 3rd month. Hearing was also evaluated at 6-month and 1-year intervals, which showed good improvement in hearing levels. Conclusions Glass ionomer is a simple, physiological, and cost-effective method of tympano-ossicular reconstruction with certain significant post-operative hearing improvement.

Mastoid cavity obliteration with bone dust: a retrospective study of 34 cases

<p><strong>Background: </strong>Chronic suppurative otitis media leads to ear discharge with hearing loss with squamosal type often presents with cholesteatoma and mainstay of treatment is surgical. Modified radical mastoidectomy is the ideal surgical option in these cases but it results in open mastoid cavity formation with certain common cavity problems. This study done to find the results of mastoid cavity obliteration with autologous bone dust and how this technique is effective in avoiding long term cavity problems and assists in ossiculoplasty.</p><p><strong>Methods: </strong>This is a retrospective observational study done in a tertiary care hospital. Patients presented with squamosal type of chronic otitis media were operated for a canal wall down modified radical mastoidectomy.The mastoid cavity was obliterated using bone dust. A follow up of the patients was done and the healing of the cavity with the hearing result assessed.</p><p><strong>Results: </strong>The study includes total of 34 patients. 58.82% were male and 41.18% were female. All patients underwent canal wall down modified radical mastoidectomy and obliteration of the mastoid cavity was done with bone dust. The common cavity problems of discharge, debris were markedly reduced in an obliterated cavity with better healing of the cavity. The middle ear aeration was maintained assisting the ossicular reconstruction.</p><p><strong>Conclusions: </strong>This study showed that mastoid cavity obliteration with bone dust offers significant long term benefits in providing dry, well epithelized cavity at the same time assisting in ossicular reconstruction.</p>

Correlation between functional outcome and the SAMEO-ATO framework

Purpose To evaluate the recently proposed SAMEO-ATO framework for middle ear and mastoid surgery, by correlating it with the functional outcome in a large cohort of patients operated for middle ear and mastoid cholesteatoma in a tertiary referral center. Methods We retrospectively included all surgeries for middle ear and mastoid cholesteatoma undergone in our Department between January 2009 and December 2014, by excluding revision surgeries, congenital and petrous bone cholesteatoma. All surgeries were classified according to the SAMEO-ATO framework. The post-operative air bone gap (ABG) was calculated and chosen as benchmark parameter for the correlation analysis. Results 282 consecutive surgeries for middle ear and mastoid cholesteatoma were released in the study period on a total of 273 patients, with a mean age of 41.2 years. All patients were followed for an average period of 55.3 months. 54% of patients underwent M2c mastoidectomy (Canal Wall Down, CWD), while the remaining underwent Canal Wall Up (CWU) procedures, being M1b2a mastoidectomy the most common one (33%). Mean pre-operative and post-operative ABGs were 29.2 and 23.5 dB, with a significant improvement (p < 0.0001). ‘Mastoidectomy’ and ‘Ossicular reconstruction’ parameters of SAMEO-ATO showed significant association with postoperative ABG, with smaller residual gaps for the classes Mx and On, and worse hearing results for M3a and Ox. Conclusion Our results show the utility of SAMEO-ATO framework, and in particular of ‘M’ (Mastoidectomy) and ‘O’ (Ossicular reconstruction) parameters, in predicting the hearing outcome.

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

<p class="abstract"><strong>Background:</strong> 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.</p><p class="abstract"><strong>Methods:</strong> 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. </p><p class="abstract"><strong>Results:</strong> 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.</p><p class="abstract"><strong>Conclusions:</strong> 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.</p>

Comparing the Incidence of Residual Cholesteatoma Using two Canal Wall Down and Endoscopic-assisted Intact Canal Wall Tympanomastoidectomy Methods

Background: For many years, Canal Wall Down (CWD) tympanomastoidectomy has been the gold standard for treatment of cholesteatoma; however, this method has long-term complications for the patients. The Intact Canal Wall (ICW) tympanomastoidectomy has relatively lower complications, but access to the middle-ear recesses is difficult in this method. Therefore, endoscopy is used to visualize the underexposed recesses. Objective: This study aims to compare the incidence of residual cholesteatoma using the two methods of CWD and endoscopic-assisted ICW. Materials and Methods: In this prospective randomized clinical trial, participants were 40 patients with cholesteatoma in the middle ear and mastoid who were candidates for tympanomastoidectomy. They were randomly divided into two groups. In the first group, ICW was performed with endoscopic assisted visualization, while in the second group, conventional CWD technique was performed without ossicular reconstruction. All the patients were microscopically examined at 3, 6, 9 and 12 months after surgery. Revision middle ear surgery and possible ossicular reconstruction under local anesthesia were performed one year after the surgery. The presence of cholesteatoma pearl in the middle-ear, evaluated by using a 2.7mm 30° endoscope, was recorded as the sign of residual cholesteatoma. Fisher’s exact test and Mann-Whitney U test were used for statistical analysis. Significance level for the tests was set at 5%. Results: The incidence of residual cholesteatoma was not statistically significant between the two groups (P>0.05). In each group, 20% (n=4) had residual cholesteatoma. The difference in time interval from the first to second surgery was not statistically significant between the study groups (P>0.05). Conclusion: Endoscopic-assisted ICW tympanomastoidectomy is comparable with CWD tympanomastoidectomy in eradication of cholesteatoma, having possibly fewer complications. It is recommended that more studies be conducted with a larger sample size and longer follow-up period.