INTRAOPERATIVE FINDINGS OF OSSICULAR CHAIN STATUS IN CHRONIC OTITIS MEDIA: OUR EXPERIENCE IN A TERTIARY CARE CENTRE

Background: Chronic otitis media (COM) is a permanent abnormality of the pars tensa (PT) or pars accida (PF) which may manifest in the form of atelectasis, perforation, tympanosclerosis, retraction pocket development, cholesteatoma, cholesterol granuloma, ossicular chain disruption etc. It has been further subdivided into active and inactive forms or Safe tubotympanic variety and Unsafe atticoantral variety. COM of all types is associated with erosion of the ossicular chain . The incidence and degree of ossicular destruction is much greater in cases of unsafe COM due to the presence of cholesteatoma and/or granulations .The aim of the present study was to correlate the type of COM, the site of perforation/retraction and the type of disease pathology with the pattern and degree of ossicular chain necrosis. Aims and objectives: AIM OF THE STUDY: To study the ossicular chain involvement in both safe and unsafe types of COM in patients attending to E.N.T. Department of a tertiary care hospital OBJECTIVES: 1. To study the incidence of ossicular chain pathology in both types of COM. 2. To study the frequency and type of involvement of each ossicle. 3. To compare the ossicular chain involvement in tubotympanic and atticoantral variety of Chronic otitis media.. Methodology: A prospective study was performed in 90 cases of COM who were subjected to tympanomastoidectomy in tertiary care hospital for a period of 1year from January2019 to December 2019. Pre-operative clinical and audiometric ndings were compared with per-operative ossicular chain status. Results: Ossicularinvolvement is seen in both types of COM more in unsafe type of COM. Incus is the most commonly affected ossicle while malleus is the least affected ossicle. Conclusion: Ossicular chain status should be checked in all patients with COM. So otolaryngologists should be able to address the ossicular chain reconstruction to give the best hearing outcome to the patient.

Ossicular chain reconstruction: endoscopic or microscopic?

Objective To compare the results of endoscopic and microscopic ossicular chain reconstruction surgery. Methods Patients undergoing ossicular chain reconstruction surgery via an endoscopic (n = 31) or microscopic (n = 34) technique were analysed for age, gender, Middle Ear Risk Index, ossicular chain defect, incision type, ossicular chain reconstruction surgery material, mean air conduction threshold, air–bone gap, air–bone gap gain, word recognition score, mean operation duration and mean post-operative follow up. Results Post-operative air conduction, air–bone gap and word recognition score improved significantly in both groups (within-subject p < 0.001 for air conduction and air–bone gap, and 0.026 for word recognition score); differences between groups were not significant (between-subject p = 0.192 for air conduction, 0.102 for air–bone gap, and 0.709 for word recognition score). Other parameters were similar between groups, except for incision type. However, endoscopic ossicular chain reconstruction surgery was associated with a significantly shorter operation duration (p < 0.001). Conclusion Endoscopic ossicular chain reconstruction surgery can achieve comparable surgical and audiological outcomes to those of microscopic ossicular chain reconstruction surgery in a shorter time.

Comparison of the Hearing Results of Total Ossicular Chain Autogenous Mastoid Cortical Bone Ossiculoplasty and Titanium Total Ossicular Replacement Prosthesis in Patients with Cholesteatoma

Background: No studies have investigated the results of ossicular chain reconstruction using mastoid cortical bone ossiculoplasty (MCBO) and titanium total ossicular replacement prosthesis (TiTORP) in Austin-Kartush Group D cholesteatoma patients with severe middle ear risk index (MERI). Objectives: The present study aimed to compare the hearing results of MCBO and TiTORP in Austin-Kartush Group D cholesteatoma patients with severe MERI who underwent ossicular chain reconstruction during primary surgery. Methods: The hearing results of 28 adult cholesteatoma patients who underwent tympanomastoidectomy and ossicular chain reconstruction with MCBO (n=15) or TiTORP (n=13) were analyzed in the current study. The postoperative hearing was tested 12 months after the surgery. The hearing-related functional success rate was determined in accordance with the American Academy of Otolaryngology-Head and Neck Surgery Foundation criteria. Results: When all patients were taken into account, the mean preoperative and postoperative air-bone gaps (ABG) were reported as 32.2 decibel (dB) and 17.6 dB, respectively, (P<0.001). In 57.1% of the patients, the mean postoperative ABG was ≤ 20 dB. The mean preoperative and postoperative ABGs of the MCBO group were obtained at 29.9 and 16.2 dB, while these values were reported as 35.0 and 19.3 dB in the TiTORP group (P=0.001 and P<0.001, respectively). Hearing-related functional success rates were calculated at 60.0% and 53.8% in MCBO and TiTORP groups, respectively, without any significant difference between the groups (P= 0.743). Conclusion: As evidenced by the obtained results, MCBO and TiTORP can provide similar and successful hearing results in Austin-Kartush Group D patients with cholesteatoma; nonetheless, MCBO is a more cost-effective option in this regard.

Displacement of a Total Ossicular Replacement Prosthesis Following Ossicular Chain Reconstruction

Objective: Herein we describe the diagnosis and management of total ossicular replacement prosthesis (TORP) displacement following tympanoplasty with ossicular chain reconstruction (OCR). Methods: Case report with literature review. Results/Case: A 40-year-old male with otorrhea and tympanic membrane perforation underwent a right revision tympanoplasty with OCR using a TORP with a tragal chondroperichondrial graft. On postoperative day (POD) 4, he developed vertigo and profound right-sided hearing loss. Temporal bone computed tomography showed the prosthesis in the vestibule. After a steroid taper with mild improvement in symptoms, the TORP was removed two weeks later and the patient continued to improve. Conclusion: TORP displacement into the vestibule is a very rare complication following OCR. Conservative management with high dose steroids may improve symptoms, however further middle ear exploration and surgical management may be warranted depending on the depth of displacement into the inner ear as well as symptom severity.