Middle Ear Risk Index [MERI] as Prognostic Factor in Tympanomastoidectomy with Tympanoplasty

Background: The objective of the study was to assess the effect of otorrhoea, osscicular and middle ear status on anatomical and functional results in patients undergoing tympanoplasty with or without mastoidectomy for chronic otitis media mucosal diseaseMethods: This was a prospective study conducted on 100 patients with otological complaints (otorrhoea, hearing loss) attending the out-patient Department of ENT, at Mamata Medical College and Research Hospital, Khammam Telangana state during the period from December 2015 to July 2017. All the patients underwent a detailed general physical, otoneurological evaluation, hearing assessment by pure-tone audiometry prior to surgery. As per MERI the patients were evaluated for factors preoperatively and intraoperatively. Postoperatively the patients were followed up at 3 and 6 months to ascertain the structural (graft take up) and functional (hearing improvement) success.Results: Otorrhoea was the most common complaint observed (48%). As per Belluci's classification of otorrhoea, maximum number of patients (52%) had a dry ear, wet ears (48%) and persistently wet ears (8%). According to Austin-Kartush classification 50 patients had an intact ossicular chain, defects of the incus in 36 patients, defects in both malleus and incus, stapes and incus was seen in 7 patients each. Majority of the patients 79% had normal middle ear status while 21% of them had middle ear effusion present. Majority of the patients belonged to the group of mild risk MERI (l-3) (n=69) patients, moderate risk category MERI (4-6) (n=26) severe risk (7-12) (n=5). Graft uptake was successful in 78 patients and failure in 22 patients. Hearing Improvement was noticed in 78 patients.Conclusion: Otorrhoea and middle ear cleft status have an impact on the success of the tympanoplasty, while ossicular status did not have a significant effect on the outcome.

Section: Discussionsupporting

confidence: 92%

Impact of otorrhoea and ossicular status on the effect of tympanoplasty

Sridhar

2018

“…Owing to its high prevalence rate, we do come across large number of cases and frequent undertaking of surgeries in order to clear the disease and restore the hearing is mandatory. 7 Trying to establish a uniform system to predict the outcome of surgery and counsel the patient accordingly plays an important role in country like India, especially where the cost of surgery and absence from work are major issues.…”

Section: Resultsmentioning

confidence: 99%

Assessment of middle ear risk index in predicting the outcome of treatment of CSOM

Harugop¹,

Abhilasha²,

Desai³

2020

Background: Chronic suppurative otitis media (CSOM) accounts for highly prevalent and serious health problems especially in developing countries. Even though there are good numbers of studies demonstrating the success rate of the procedures to treat CSOM, there is lack of uniformity in assessing the predictors for the outcome of the same. If we can predict the outcome of the surgical procedure depending upon the pathologic condition of the middle ear, the cost effectiveness of the surgery can be improved, and this will also improve the patient’s compliance. The objective of this study is to evaluate a group of patients who underwent surgical treatment for chronic CSOM with reference to the prognostic significance of Middle ear risk index (MERI).Methods: It is a retrospective observational study of patients who underwent surgical treatment for CSOM from the year 2008 to 2020.Results: Out of 1010 surgeries done, total of 287 cases were included in study. In our study the success rate in mild risk index was 76.9%, moderate was 62.2% and only 18% in severe risk index.Conclusion: The outcome of surgery in the patients who undergo surgical treatment for CSOM can be predicted well using MERI. Presence of cholesteatoma and granulation tissue reduces the favourable outcome of surgery justifying the numerical value given in the score. However, presence of ear discharge and history of smoking doesn’t alter the outcome of surgery as long as complete clearance of disease is done.

“…Aftab Ahmed et al also showed lower success rates with larger perforations, but the difference was not statistically significant (p= 0.35). 3 In 2001, MERI score was modified to include smoking as a risk factor. 3,7 According to our study, 11 (22%) cases were smokers while 39 (78%) were non-smokers with p value of 0.000.…”

Section: Discussionmentioning

confidence: 99%

“…The success of tympanoplasty is dependent on the surgical principle along with the pathological factors associated with disease. 3 There are a number of factors which influence the success rate of tympanoplasty such as age of the patient, size and site of the perforation, status of the ear (dry or discharging), ossicular status and the surgical technique, but their real role is still unclear. 4 Therefore, the success rate of tympanoplasty, as reported, can range from 35% to 92%.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Evaluation of the role of middle ear risk index as a prognostic tool in cases of tympanoplasty in chronic suppurative otitis media

Saidha

Kapoor

Suri

et al. 2021

Background: In chronic suppurative otitis media (CSOM), the success rate of tympanoplasty, can range from 35% to 92% and is influenced by a number of factors such as age of patient, size and site of perforation, status of ear, ossicular status and surgical technique. The middle ear risk index (MERI) of a CSOM patient is an effective numerical grading system helpful in predicting the outcome of surgery. Methods: A prospective observational study was conducted in 50 patients over a period of 1 year including all cases of CSOM in age group of 18-55 years with conductive hearing loss that underwent tympanoplasty with or without cortical mastoidectomy and role of MERI was analysed for the outcome of the surgery. Results: Successful graft uptake was seen in 92% cases while in 8% cases graft was rejected. Of these 46 cases, 32 cases had mild MERI score, 10 had moderate MERI score and 4 had severe MERI score. It was observed that higher the MERI score, lower the graft uptake. Conclusions: Our study comprised of 50 patients of CSOM which were categorized into mild, moderate and severe on the basis of MERI score preoperatively. All the patients underwent tympanoplasty with or without cortical mastoidectomy and surgical outcome in terms of graft uptake was found to be significant. Higher the MERI score, lower was the graft uptake while lower the MERI score, higher was the graft uptake. Hence, MERI is a useful tool to ascertain the prognosis of tympanoplasty.