Results of tympanoplasty in reference to the condition of middle ear mucosa and edge of perforation in safe chronic otitis media
Keywords:COSM, Tympanoplasty, Epidermosis, Pure tone audiometry
Background: Chronic suppurative otitis media (CSOM) is an important and a highly prevalent disease of the middle ear and poses serious health problem worldwide especially in developing countries where large percentage of the population lack specialized medical care, suffer from malnutrition and live in poor hygienic environmental conditions. Aim of the study was to study the outcome of tympanoplasty in the light of character of edge of perforation and middle ear mucosa condition.
Methods: This prospective study was conducted in 39 patients who underwent tympanoplasty in the department of ENT and head and neck surgery, Assam medical college and hospital, Dibrugarh between 1st June 2019 to 31st May 2020. Rim of perforated tympanic membrane and middle ear mucosa were sent for HPE. Three post-operatives follow up were done and surgical success was measured in terms of graft uptake and improvement in hearing.
Results: Out of 39 cases, successful graft uptake was seen in 33 (84.62%) cases. Extension of migration of squamous epithelium in the undersurface of tympanic membrane was found in all 6 cases (3 had complete epidermosis while 3 had partial). All the six graft failure cases had diseased middle ear mucosa, mostly infected hypertrophied mucosa and tympanosclerosis with infiltration of chronic inflammatory cells and 1 patient had keratosis flakes with vascular stroma.
Conclusions: Hypertrophic changes with inflammation of middle ear mucosa and epidermosis on the medial surface of tympanic membrane was found to have negative influence on the tympanoplasty outcome.
Baisakhiya N, Deshmukh P, Patil K. Evaluation of different graft material in type 1 tympanoplasty. Indian J Otol. 2014;20(3):106.
Gopen Q. Pathology and Clinical Course of the Inflammatory Diseases of the Middle Ear. In: Gulya A, Minor L, Poe D, editors. Glasscock-Shambaugh Surgery of the Ear. 6th edition. Shelton, Connecticut: People’s Medical Publishing House-USA. 2010;425-36.
Orji F. A survey of the burden of management of chronic suppurative otitis media in a developing Country. Ann Med Health Sci Res. 2013;3(4):598.
Veeranjaneyulu P, Kumar YA, Anisha KR, Devi PK. Clinicopathological correlation in chronic suppurative otitis media. J Clin Diagnostic Res. 2017;11(11):MC01-4.
Chole R, Nason R. Chronic Otitis Media and Cholesteatoma. In: Snow JR JB, Wackym P, editors. Ballenger’s Otorhinolaryngology Head and Neck Surgery. 17th edition. Shelton, Connecticut: People’s Medical Publishing House. 2009;217-27.
Sismanis A. Tympanoplasty: Tympanic Membrane Repair. In: Gulya A, Minor L, Poe D, editors. Glasscock-Shambaugh Surgery of the Ear. 6th Editio. Shelton, Connecticut: People’s Medical Publishing House-USA. 2010;465-88.
Fouad B. The fibrous annulus in myringoplasty. J Laryngol Otol. 1992;106(2):116-9.
Oktay MF, Cureoglu S, Schachern PA, Paparella MM, Kariya S, Fukushima H. Tympanic membrane changes in central tympanic membrane perforations. Am J Otolaryngol-Head Neck Med Surg. 2005;26(6):393-7.
Sharma K, Manjari M, Salaria N. Middle ear cleft in chronic otitis media: A clinicohistopathological study. Indian J Otolaryngol Head Neck Surg. 2013;65(3):493-7.