Study of outcome of tympanoplasty with and without mastoid antrum exploration in patients with mucosal CSOM

Abhinav Rathi, Kapil Garg


Background: Chronic suppurative otitis media (CSOM) is a major cause of acquired hearing impairment in children. Standard medical treatment of tubotympanic CSOM is aural toilet, topical antibiotics, systemic antibiotics and dry ear precautions. Surgical intervention for safe / tubotympanic CSOM is tympanoplasty. Otologists currently remain divided as to the importance of antrum exploration in the treatment of tubotympanic CSOM. The aim of the study was to evaluate the outcomes of tympanoplasties with and without antrum exploration in cases of tubotympanic CSOM in terms of graft uptake rate and hearing improvement.

Methods: The present study included 60 patients of CSOM with central perforation who underwent surgery at JNU IMSRC from January 2016 to July 2016. Detailed history, clinical examination including tuning fork test, pure tone audiometry was done. All patients were followed up for a period of 3 months.  

Results: Out of the 60 cases of tubotympanic CSOM graft uptake was seen in 53 cases (88.33%). Graft uptake rate was 96.6% in patients who underwent tympanoplasty with antrum exploration which was significantly higher than those who underwent tympanoplasty alone (80%). Hearing improvement was seen in 93.10% of patients who underwent tympanoplasty with antrum exploration as compared to 83.33% of patients of tympanoplasty which was not statistically significant (p=0.263).

Conclusions:Tympanoplasty with antrum exploration is recommended in all patients of CSOM as it inhances the chances of graft uptake. 



Chronic suppurative otitis media, Tympanoplasty, Tubotympanic CSOM, Antrum exploration

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Macfadyen CA, Acuin JM, Gamble C. Systemic versus topical antibiotic treatments for chronically discharging ears with underlying eardrum perforations. Cochrane Database Syst Rev. 2006;25(1):CD005608.

Ruhl CM, Pensak ML. Role of aerating mastoidectomy in non cholesteatomatous CSOM. The Laryngoscope. 1999;109(12):1924-7.

Sheeshy J, Glasscock M. Tympanic membrane grafting with temporalis fascia. Arch Otol. 1967;86:391-402.

Francoise D, Gilles R., Chauvin, Erea-Noel. Myringoplasty in children: Predictive factors of outcome. Laryngoscope. 1999;109:47-51.

Jackler RK, Schindler RA. Role of the mastoid in tympanic membrane reconstruction. Laryngoscope. 1984;94:495-500.

Lasisi AO, Afolabi OA. Mastoid surgery for chronic ear: A ten year review. Int J Head Neck Surg. 2008;2(2).

Mishiro Y, Sakagami M, Takahashi Y, Kitahara T, Kajikawa H, Kubo T. Tympanoplasty with and without mastoidectomy for non‑cholesteatomatous chronic otitis media. Eur Arch Otorhinolaryngol. 2001;258:13-5.

McGrew BM, Jackson CG, Glasscock ME 3rd. Impact of mastoidectomy on simple tympanic membrane perforation repair. Laryngoscope 2004;114:506‑11.

Holmquist J, Bergstrom B. The mastoid air cell system in ear surgery. Arch Otolaryngology. 1978;104:127-9

Nayak DR, Balakrishnan R, Hazarika P, Mathew PT. Role of cortical mastoidectomy in the results of myringoplasty for dry tubotympanic disease. Indian J Otol. 2003;9:11-5.

Balyan FR, Celikkanat S, Aslan A, Taibah A, Russo A, Sanna M. Mastoidectomy in noncholesteatomatous chronic suppurative otitis media: Is it necessary? Otolaryngol Head Neck Surg. 1997;117:592‑5.