A Study of Ossicular Pathology in CSOM and Its Management by Various Types of Cartilage Tympanoplasty

INTRODUCTION: CSOM is a chronic suppurative inflammation of mucoperiosteal layer of middle ear cleft. It is a major cause of deafness in India. It leads to ossicular necrosis and tympanic membrane perforation. Temporalis fascia and perichondrium are commonly used for graft. Fascia leads to subsequent failure postoperatively. It has been shown that cartilage grafts are well tolerated and hearing appears to be good. AIM OF THE STUDY: To study about the different types of ossicular pathology in CSOM cases and its management by various cartilage tympanoplasty. OBJECTIVES: 1. To study about different ossicular pathology in CSOM 2. To study about the effect of cartilage tympanoplasty in different ossicular pathologies. MATERIALS AND TECHNIQUES: Study population includes patient with CSOM who attends Dept of ENT, Tirunelveli Medical College Hospital. Patients are randomly selected & explained about the study. Selected patient will be advised to undergo cartilage tympanoplasty. They will be followed post operatively for every 2 weeks for a minimum period of 6 months. They are assessed by otoendoscopy for graft uptake and hearing assessment by PTA. STUDY AREA: DEPT OF ENT, Tirunelveli Medical College Hospital. STUDY PEROID: Nov 2017 - July 2019. METHOD OF STUDY: Prospective study. STUDY POPULATION: A minimum of 50 patients with CSOM randomly selected. INCLUSION CRITERIA: SEX : BOTH, CSOM – both types, Adhesive otitis media, Revision surgeries. EXCLUSION CRITERIA: cases with sensorineural hearing loss cases with complications of chronic suppurative media such as facial palsy, labyrinthitis, intracranial or extracranial complications. Methodology: All patients will undergo routine ENT evaluation in addition to general medical. Ear finding will be noted with emphasis on size, site and margin of perforation, state of drum remnants, state of middle ear mucosa, presence or absence of ear discharge and tuning fork tests. Any septic focus in the form of chronic tonsillitis, sinusitis etc was treated first. All details regarding history, examination, investigations, surgery and follow up findings will be documented on proforma. Clinical Investigations: Pure Tone Audiometry: was conducted in all patients. It formed the baseline investigation for the level of preoperative hearing. Otoendoscopy: with suction clearance was performed in all cases to confirm the otoscopic findings, to clear any discharge and to rule out any epithelial migration into middle ear. X-ray mastoid Schuller’s view: of both mastoids were taken in selected cases to rule out any associated pathology. X-ray paranasal sinuses: were taken in selected cases to rule out sinus pathology. Routine Investigations: such as complete blood count, bleeding time, clotting time, blood grouping, routine and microscopic examination of urine was done. All patients were investigated for fitness for general anesthesia. RESULTS: The study was conducted from Nov 2017 to July 2019 in a tertiary care institute at TVMCH. The CSOM patients was randomly selected of both the sexes were advised to undergo surgery. The patients included in our study we used full thickness cartilage graft. The graft uptake was the same for the different age group was 10 to 60 years. In our study we did surgery on total for 50 patients, Among them 11 patients presented with Recurrent CSOM and 39 patients presented with CSOM for the first time. There was 100% Graft uptake in patients with Recurrent CSOM. In our study the graft uptake was 96%. The ossicular pathology was mostly commonly involved in incus - 76% malleus and incus - 16% malleus – 36%, stapes – 14%, all ossicles - 8%. post op audiological improvement in PTA was 11.34% CONCLUSION: Management of ossicular pathology in Chronic Otitis Media doesn’t have a straightforward protocol. It requires careful pre-operative evaluation, proper planning of the type of tympanoplasty to be executed and that will determine the outcome of surgery. Type of the ossicle eroded are the main determining factor that decide the post-operative air-bone gap outcome. In revision cases, cartilage tympanoplasty was a standout procedure with good graft uptake, improved hearing outcome and less failure with no choices of other procedures