A Hospital Based Study on Impact of Otorrhoea and Ossicular Status on the Effect of Tympanoplasty

Background: The surgical treatment of chronic otitis media primarily aims at complete removal of disease from the middle ear cleft, which is achieved in many of the cases nowadays. Each patient is assigned a numerical score based on the risk factors. The total score is 12.Based on MERI score, the patients are classified as mild disease (1-3), moderate disease (4-6) and severe disease (7- 12). Aim:To study 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 disease. Materials and Methods:A prospective study involving 100 patients of COM being treated surgically at the department of ENT at Nimra Institute of Medical Sciences during the time period February 2019-January 2020 .The patients attending the OPD with otological complaints (otorrhoea, hearing loss) were evaluated clinically. On diagnosis of the case of COM mucosal disease, these patients were counselled for surgery. Patients undergoing surgical correction by tympanoplasty with or without mastoidectomy were assessed pre and intraoperatively by MERI scoring in order to classify and identify the disease category. The patients considered for surgery for COM mucosal disease underwent a detailed general physical and otoneurological evaluation. They also underwent hearing assessment by Pure-Tone Audiometry prior to surgery. Air and bone conduction at frequencies of 0.5, 1, 2, 3 kHz were recorded and a 4 tone average will be calculated. Results:In our study of 100 patients,52% were females and 48% males with majority of patients in the group of 21-30 years.The most common presenting complaint amongst these patients was otorrhoea followed by hearing impairment. 33 % had Right sided disease,57 % had left sided disease and 10% had Bilateral disease. Left sided pathology was more common in our study group. Aural swab was done for culture sensitivity of the organisms in all patients and the most common organism isolated in aural swab culture was Pseudomonas (26%). Maximum number of patients 52% had a dry ear ,48% had occasionally wet ears and 8% had persistently wet ears.Patients presented with history of ear discharge of varying duration ranging from 1 year to 30 years. 50 patients(50%) had an intact ossicular chain. Defects of the Incus alone were seen in 36 patients (36%).Defects in both malleus and incus was seen in 7 patients(7%) and stapes and incus was noted in 7 patients(7 %). Of the total number of patients(n=100), majority of the patients 79% had normal middle ear status while 21% of them had middle ear effusion present,20 of the total patients were smokers and 80 of them were non-smokers. Majority of the patients belonged to the group of Mild risk MERI(1-3) which was 69 patients,26 patients came under the Moderate risk category MERI(4-6) and 5 % patients had Severe risk (7-12). Of the total 100 patients being studied,the graft uptake was successful in 78 patients (78%) and there was a failure in 22% of them. Otorrhoea proved to be a significant factor in the success of surgery asdry ears had a better graft uptake compared to wet ears. ‘p’ value less than 0.05 at 5% level of significance shows there is significant relationship between otorrhoea and graft uptake.Of the total of 100 patients,21 of them had non patent Eustachian tube with middle ear effusion of which 10 of them had graft failure, whereas in case of patent Eustachian tube and normal middle ear cleft the success rate was higher(68 out of the 79 were successful). Those patients with a lower MERI score had successful outcome of surgery whereas those with a higher score had lesser chances of successful surgery. Out of 100, 60 patients belonging to the mild MERI and 17 from the moderate risk group had a successful surgery whereas only 1 patient out of the severe category had a successful surgery. Conclusion:Otorrhoea and status of middle ear cleft proved to be significant factors in the graft uptake and success of Tympanoplasty whereas ossicular status did not play a significant role in the result of surgery.Middle Ear Risk Index proved to be very valuable tool in predicting the outcome of surgery