Factors Influencing Surgical Outcome of Myringoplasty in Tubotympanic Type of Chronic Otitis Media

Abstract

BACKGROUNDChronic otitis media is an inflammatory process of the mucoperiosteal lining of the middle ear space and mastoid. Infection of the middle ear has been a problem encountered in the human race, and is as old as humanity itself. Chronic suppurative otitis media (CSOM) is one of the most common causes of ear infection in developing countries particularly in South-east Asian countries. Chronic middle ear disease is a major problem in India especially in the rural areas. It is estimated that 6% of Indian population suffers from chronic ear disease. The term "Tubotympanic disease" is sometimes used to describe COM with a central perforation. The two principal aims of management of tubotympanic chronic otitis media are the eradication of infection and improvement of hearing by the closure of the tympanic membrane perforation which can be achieved either conservatively or by surgery. The surgical treatment of CSOM is still controversial. Some surgeons advice only repair of central perforation of tympanic membrane in non-cholesteatomatous tubotympanic chronic otitis media using graft i.e. myringoplasty to achieve a dry ear with improved hearing. This study aims to determine the factors responsible for successful surgical outcome of myringoplasty. MATERIALS AND METHODSThis hospital-based prospective study was done in the Dept. of ENT, Assam Medical College and Hospital, Dibrugarh from 1 st January 2015 to 31 st December 2015 in diagnosed cases of tubotympanic variant of CSOM. Thirty patients were included in this study after fulfilling inclusion and exclusion criteria. The surgical outcomes were assessed in terms of hearing gain, graft uptake and dryness of ear. RESULTSThirty patients of tubotympanic type of CSOM reviewed in the study with mean age group of 35.16 + 12.75 years underwent myringoplasty. Successful graft uptake post-operatively at 3 rd followup (12 th week) was seen in 83.33%. Dry ear was achieved at the end of 12 th week in 86.67% and gain in hearing at 3 rd post-operative review was 9.90 + 1.81 dB. 5 cases had graft failure, 4 cases failed to achieve dry ear. Extremity of ages, lower socio-economic status, postoperative URTI and ET dysfunction, disease in contralateral ear were associated factors in determining graft uptake and dry ear. CONCLUSIONMyringoplasty has been established as a very effective surgical management of tubotympanic variant of CSOM. Success of myringoplasty can be measured in terms of gain in hearing, graft uptake and dry ear. Our study acknowledges that successful outcome of surgery is determined by a range of factors like lower socio-economic status particularly in rural population with unhygienic living conditions, presence of nidus of infection in the upper airway along with eustachian tube dysfunction, otitis externa, disease in contralateral ear may be considered as some of the possible factors responsible for influencing the outcomes of surgery in tubotympanic type of chronic otitis media. But we emphasised that more cases or study population for longer duration...