A Study of Surgical Outcomes in Chronic Suppurative Otitis Media Tubo Tympanic [mucosal] Disease treated with Myringoplasty / Cortical Mastoidectomy with Type 1 Tympanoplasty

Sivasankari, L (2009) A Study of Surgical Outcomes in Chronic Suppurative Otitis Media Tubo Tympanic [mucosal] Disease treated with Myringoplasty / Cortical Mastoidectomy with Type 1 Tympanoplasty. Masters thesis, Stanley Medical College, Chennai.

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Abstract

INTRODUCTION: Auditory sensation is one of the vital sensations for existence. When such a great sensation is lost, life naturally loses its charm. Discharging ear and deafness are perpetual source of misery to humankind. Our country, being a developing nation with poor socio-economic status and low environmental conditions, chronic diseases of ear accounts for nearly 5% of population. Chronic suppurative otitis media is found to be the single major cause of recoverable conductive deafness. Surgery for tubotympanic type of chronic suppurative otitis media is the commonest otological surgical procedure in our country. The goal of otologists performing middle ear surgery is to make the patient free of ear discharge, correct the conductive hearing loss, to improve hearing, as well as to provide functional benefit to the patient. Unilateral conductive hearing loss is associated with various disabilities including difficulty in sound localisation, hearing & understanding speech. This is because, listening is a binaural task, while benefit to the patient is determined by factors such as hearing in the non operated ear. Hence, the subjective evaluation of the surgical results speaks better than the objective methods which provide only the technical success of the operation. This study discusses the various pre-operative factors which play a major role in the post-operative success of two various surgeries – myringoplasty and cortical mastoidectomy with type1 tympanoplasty conducted in the Department of ENT in Stanley Medical College for patients presenting with chronic suppurative otitis media – tubotympanic disease. The hearing benefit is determined by Air bone gap closure and also subjective evaluation of hearing is done by applying Belfast rule of thumb. AIM OF THE STUDY: 1. To study the success rate of Myringoplasty in patients with chronic suppurative otitis media – tubotympanic (mucosal) disease with dry ears in relation to – duration of disease, size of perforation and preoperative Air bone gap. 2. To study the success of cortical mastoidectomy with type 1 tympanoplasty in patients with chronic suppurative otitis media – tubotympanic (mucosal) disease with wet and non infected ears in relation to – duration of disease, size of perforation, preoperative Air bone gap and condition of mucosa of mastoid antrum. 3. To evaluate the post-operative hearing benefit in patients with unilateral hearing loss by applying Belfast rule of thumb. MATERIALS AND METHODS: Study Design: Prospective study. Study Place: Department of ENT, Stanley Medical College. Study Period: From March 2007 to August 2008. Sample Size : About 60 patients. Follow up period : one year. Inclusion Criteria: 1. Age: 10 – 50 years, 2. Sex: Both male & female, 3. Condition of ear: Both dry & wet ears, 4. Tuning fork tests & Pure tone audiometry : shows conductive hearing loss. 5. Patients with elimination of focal sepsis. E.g. Adenoidectomy, FESS. Exclusion Criteria: 1. Patients with external auditory canal or middle ear cavity abnormalities, either congenital or acquired. 2. Patients with cholesteatoma or postero-superior marginal retraction. 3. Tuning fork test and pure tone audiometry revealing mixed or sensorineural hearing loss. 4. Prior attempted tympanic membrane / middle ear / mastoid repair. METHODOLOGY: This study was conducted in a group of 60 patients in the department from period March 2007 – August 2008 with a follow up period of one year. Minimum age in the study was 15 and maximum was 50 years. Minimum duration of discharge was 1year and maximum was 15 years. Minimum duration of hearing impairment was 6 months and maximum was 10 years. Both males and females were included in the study. For all patients, under study ear swabs were taken from middle ear and for patients with culture positivity were treated with specific antibiotics prior to surgery. All cases were admitted, pre-operative examination done under microscopy, subjected to endoscopic eustachian tube evaluation (those with normally looking pharyngeal end of eustachian tube orifice were taken up for study) and hearing assessment done with tuning fork tests and pure tone audiogram. All patients were informed about their need for a follow up period of one year. Informed written consent to undergo surgery was obtained from all patients. Mastoid shaving and local preparation was done in the ward prior to surgery. All cases were done under GA. Premedication and local infiltration was same for all cases. RESULTS AND OBSERVATION: Total number of cases registered in this study was 67 patients, who came to the ENT Department with Chronic suppurative otitis media – tubotympanic type, from March 2007 to August 2008.Among them 7 patients did not turn up for follow up and hence they were not included in the study. The overall graft take up rate in both the surgeries was 88.33%. The overall hearing benefit was 90%, excellent with < 10dB ABG in 51.67% and Good with < 20dB in 38.33%.There was no post operative complications, deterioration in hearing or sensorineural hearing loss in all 60 patients. In Group A ,18 were females & 12 were males,22 patients had unilateral and 8 had bilateral disease,23 had medium sized central perforation and 7 had subtotal perforation,10 had good pre-op Air bone gap of 10 to 20 dBHL 20 patients had a fair pre-op Air bone gap of 20 to 30 dBHL. 1. Overall graft take up rate was 86.6%. 2. Otoscopic evaluation of 23 patients with medium sized perforation at the end of 2 months,revealed18 to be intact,5 residual perforation in the antero - inferior quadrant. In 7 patients with subtotal perforation,4 were intact,1 with residual perforation & 2 grafts got rejected because of post-op wound infection. Otoscopic examination at the end of 6months & 1 year revealed – for all 23 patients with medium size perforation, tympanic membrane was intact and out of 7 patients with subtotal 2 were with residual perforation & 2 with rejection of graft and with the same pre operative status. Hence the size of the perforation does have a role in graft take up rate. This is stastistically significant by applying chi square test with p value < 0.05. CONCLUSION: 1. The success of Myringoplasty in terms of graft uptake and hearing improvement is better in patients with lesser duration of disease, less preoperative Air bone gap and with medium sized perforations when compared to subtotal perforations. 2. The success of Cortical mastoidectomy with type 1 tympanoplasty in terms of graft uptake and hearing improvement is better in patients with lesser duration of disease and less pre-operative Air bone gap. The results are better with medium sized perforations when compared to subtotal perforations and in patients with disease free mucosa of mastoid antrum. 3. In post-operative evaluation of patients with unilateral hearing loss, application of Belfast rule of thumb enables the actual hearing benefit of the patient.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Surgical Outcomes ; Chronic Suppurative Otitis Media Tubo Tympanic [mucosal] Disease ; Myringoplasty ; Cortical Mastoidectomy ; Type 1 Tympanoplasty.
Subjects: MEDICAL > Otolaryngology
Depositing User: Devi S
Date Deposited: 27 Mar 2018 02:26
Last Modified: 27 Mar 2018 03:28
URI: http://repository-tnmgrmu.ac.in/id/eprint/6625

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