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

Poonam K. Saidha, Sahil Kapoor, Arpita Suri, Ayushi Gupta, Vikas Kakkar


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.


MERI score, Tympanoplasty outcome, CSOM, Cortical mastoidectomy

Full Text:



Jahn AF. Chronic otitis media: diagnosis and treatment. Medic Clin North Am. 1991;75(6):1227.

Hayati R, HaRyuna TS. Middle Ear Risk Index Scores as a Predictor for Hearing Threshold after Tympanoplasty in Patients with Chronic Suppurative Otitis Media. J Clinic Diagnost Res. 2018;12(4):MC01-4.

Ahmed A, Sharma SC. Middle Ear Risk Index [MERI] as Prognostic Factor in Tympanomastoidectomy with Tympanoplasty. Madridge J Otorhinolaryngol. 2016;1(1):15-22.

Aggarwal SK, Dev R. Comparative study of tympanoplasty and its outcome in various age groups using the middle ear risk index scale. Ind J Otol. 2020;26:4-8.

Bluestone CD, Cantekin EI, Douglas GS. Eustachian tube function related to the results of tympanoplasty in children. Laryngoscope. 1979;89:450-8.

Yoon TH, Park SK, Kim JY, Pae KH, Ahn JH. Tympanoplasty, with or without mastoidectomy, is highly effective for treatment of chronic otitis media in children. Acta Otolaryngol Suppl. 2007;(558):44‑8.

Becvarovski Z, Kartush JM. Smoking and tympanoplasty: implications for prognosis and the Middle Ear Risk Index (MERI). Laryngoscope. 2001;111:1806-11.

Lakshmi N, Sudhakar S, Shobha K. Correlation between middle ear risk index (MERI) and outcome of tympanoplasty- a prospective study. Int J Scient Res. 2019;8(12):12-4.

Kaur M, Singh B, Verma B.S, Kaur G, Kataria G, Singh S, et al. Comparative evaluation between tympanoplasty alone & tympanoplasty combined with cortical mastoidectomy in non-cholesteatomatous chronic suppurative otits media in patients with sclerotic bone. J Dent Medic Sci 2014;6(1):40-5.

Saboo R, Modwal A, Gautam P. Tubotympanic CSOM: clinical profile of perforation, eustachian tube function and MERI score as parameter for outcome of tympanoplasty. Transworld Med J. 2020;2(2):154159.