A Study on Outcome of Ossiculoplasties in Surgeries of Chronic Suppurative Otitis Media with Ossicularerosion

Murugan, N (2020) A Study on Outcome of Ossiculoplasties in Surgeries of Chronic Suppurative Otitis Media with Ossicularerosion. Masters thesis, Madurai Medical College, Madurai.

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Abstract

INTRODUCTION: 60-80% of middle ear disease occurs due to chronic otitis media in developing countries. Improperly treated chronic otitis media will affect the quality of life. In developing countries the most common cause of hearing impairment is chronic otitis media. Ossicular disruption is the most common cause of hearing impairment in CSOM patients making this as a major cause for hearing disability .This is managed commonly with surgeries in two sittings earlier, but in our study with single sitting surgery both the disease clearance and good hearing improvement is achieved. AIMS & OBJECTIVES: 1. The aim of the study is to evaluate hearing outcome in patients of chronic otitis media with ossicular erosion intervened by surgeries with use of autologous materials or synthetic prosthesis (partial ossicular replacement prosthesis/total ossicular replacement prosthesis). 2. To bring back near normal hearing in our patients treated with single stage procedure,also making this procedure both cost effective and disability reduction. MATERIALS AND METHODS: STUDY DESIGN: Prospective cohort clinical study. STUDY PERIOD: September 2017 to September 2019. SAMPLE SIZE: 50 patients. METHOD OF STUDY: The study is conducted on 50 patients presenting with signs and symptoms of chronic rhinosinusitis satisfying the inclusion and exclusion criteria attending ENT OPD in Government Rajaji Hospital, Madurai. Approval of the institutional ethical committee obtained. RESULTS: Totally 50 patients were taken for this study who is a case of CSOM with pure conductive hearing loss. The ages of the patients ranged from 16 to 50 years with mean age of 29.5 years. The minimum age in this study was 17 and the maximum age was 50. Among 50 patients, 27 patients (54%) were males, 23 patients (44%) were females. Among the 50 patients, remodeled incus were used in 13 patients with CSOM mucosal type when remnant incus is available to reconstruct ossicular chain. In 9 patients we used tragal cartilage. Patient with cholesteatoma or postero superior retraction pocket we used synthetic material PORP or TORP made up of Teflon (cost effective). PORP (13 patients) were used when malleus was present and stapes supra structure was present, TORP (15 patients). This analytical study was made in 50 cases which inferred with 13 cases who underwent placement of remodelled incus .among them preop mean ABG found to be 38.3db and post op mean ABG found to be with 26.6 db ABG. Air bone gain is 11.7db. This study also showed results of 9 cases managed with tragal cartilage Placement among 50 selected cases with preop mean ABG value of 36.7db and post op mean ABG value of 26.6db with gain in ABG value of 10.1db. 50 selected cases 13 cases was selected for management with PORP which inferred with preop mean ABG with 40db and post op mean ABG with 25db and Gain in ABG was 15db. Among 50 selected cases 15 cases managed with TORP with inference showing preop mean ABG of 40db and postop mean ABG of 26.7db and finally Gain in ABG was13.3db. On analysis of this study further proved with significant difference between pre and postoperative ABG in air conduction PTA but not in bone conduction PTA. Pre operative mean air bone gap was 38.4 dbhl and post operative mean air bone gap was 26.6 dbhl. Gain in ABG was 11.8 dbhl. This study also showed equal results on both cases treated with autologous ossiculoplasty and usage of synthetic materials like Teflon (PORP & TORP). Teflon treated patients in our study showed acceptable hearing improvement. This study also concentrates on usage of autologous grafts or else synthetic material made of Teflon which is both cost effective and further satisfying results in patients thus increasing the compliance of patients and further reduction in disability in toto. CONCLUSION: This study was conducted mainly to analyze the outcome of ossiculoplasty in chronic suppurative otitis media with ossicular erosion. Final analysis of this study showed significant p value on comparing preoperative and post operative ABG in which there is a gain post operative ABG . Our study was based on usage of different materials such as autologous grafts (tragal cartilage and remodelled ossicles), synthetic materials (teflon - PORP & TORP) which doesn’t show variation in results significantly. Both results were successful and equal. In our study, we used different materials for ossiculoplasty which showed more or less equal results at present .To conclude, there is a gain in ABG for both autologous and synthetic materials post operatively. To make this analytical study still definitive, further long term follow up of cases is necessary.

Item Type: Thesis (Masters)
Additional Information: 221714103
Uncontrolled Keywords: Ossiculoplasty, Otologic Surgical Procedure, Chronic Suppurative Otitis Media, Hearing.
Subjects: MEDICAL > Otolaryngology
Depositing User: Subramani R
Date Deposited: 15 Feb 2021 03:51
Last Modified: 15 Feb 2021 03:51
URI: http://repository-tnmgrmu.ac.in/id/eprint/14224

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