Pre-operative Indicators of Ossicular Necrosis in Tubotympanic CSOM

Abstract

Ossicular necrosis and erosion is commonly seen in CSOM with cholesteatoma but can also occur in tubotympanic CSOM. This usually comes as a surprise during surgery. Preoperative knowledge of ossicular necrosis helps the surgeon to be better prepared for the surgery and ossicular construction if required. Hence, this study is intended to identify the pre-operative indicators of ossicular necrosis. This cross sectional study was conducted in Father Muller Medical College in Mangalore. Sixty nine consecutive patients with tubotympanic CSOM underwent a detailed clinical examination with pure tone audiometry and subsequently tympanoplasty with or without cortical mastoidectomy. All clinical findings, pure-tone audiometry, and intraoperative otomicroscopic observations were recorded. Incidence of ossicular necrosis was 23 %. The incus was most frequently eroded followed by malleus and then stapes. On bivariate analysis patients age above 30 years (p = 0.05), duration of CSOM more than 10 years (p = 0.02), presence of granulation (p \ 0.05), absence of tympanosclerosis (p = 0.01), moderately severe (45-60 dB) hearing loss (p = 0.01) and an air bone gap of more than 55.7 dB in the right ear and 63.95 dB in the left ear was found to be statistically significant (p \ 0.05). On multivariate analysis only presence of middle ear granulation tissue was found to be the significant predicator [(p = 0.005), OR 14.37, 95 % CI 2.26-90.0]. The presence of granulation tissue and a wide air bone gap on pure tone audiometry were the best indicators of ossicular necrosis. Preoperative identification of these indicators can help the surgeon to be better prepared for the surgery.

Study of Preoperative Indicators of Ossicular Defect in Mucosal Type of Chronic Suppurative Otitis Media

“…15 Adherence of perforation edges to the promontory also had significant association with ossicular necrosis (p <0.05) in the studies of Ebenezer J et al, Jayakumar CL and Srinivas et al studies. [10][11][12] Our finding was consistent with those studies. Jeng et al concluded that, adhesion causes confinement of inflammatory products and granulation tissue to a small blind sac causing hyperemia and increased pressure on ossicles leading to erosion.…”

“…11 While Jayakumar CL et al noted ossicular necrosis in 23.1% cases (in 16 out of 69 patients) and incus was most commonly ossicle (62.5%) followed by malleus(31.2%) and then stapes (6.25%). 12 Srinivas et al noticed ossicular necrosis in only 11% cases (5 out of 47 patients). 13 Jeng et al also found ossicular necrosis in 11.1% (17 out of 153) patients of non-cholesteatomatous ears.…”

“…Jayakumar CL et al noted similar finding on bivariate analysis. 12 This could be due to negligence of patient to seek early treatment or inadequate treatment. As per Tripathi P et al study, those who had disease for more than 5 years were more were prone for incus necrosis.…”

A study on chronic otitis media in tertiary care center

“…11,12 Our study is an exclusive study on female COM patients. Ginni et al observed patients of squamousal COM are mosly affected in 3 rd decade.…”

Ossicular Erosion in Patients with Chronic Suppurative Otitis Media

“…Similar findings have been reported by several other authors where females have outnumbered males. [8][9][10][11][12] Most of the patients had bilateral disease (38.89%), followed by left ear as the only diseased ear. Bilateral affection may be due to the fact that the etiology or risk factors of CSOM are likely to affect both ears.…”