Study of ossicular chain status in chronic otitis media patients at a tertiary care hospital in southern Bihar


  • Ankita Sinha Department of Otorhinolaryngology, Narayan Medical College and Hospital, Jamuhar, Bihar, India
  • Garima Singh Department of Otorhinolaryngology, Narayan Medical College and Hospital, Jamuhar, Bihar, India
  • Ranbir K. Pandey Department of Otorhinolaryngology, Narayan Medical College and Hospital, Jamuhar, Bihar, India
  • Deepak K. Gupta Department of Otorhinolaryngology, Narayan Medical College and Hospital, Jamuhar, Bihar, India
  • Chandrakant Diwakar Department of Otorhinolaryngology, Narayan Medical College and Hospital, Jamuhar, Bihar, India



Ossicular erosion, Chronic otitis media, Ossiculoplasty


Background: The objective is to assess the ossicular status and statistically evaluate the extent of ossicular destruction intraoperatively in chronic otitis media (COM) patients. Knowledge of pattern of involvement of ossicular chain in COM cases may help us to determine the type of reconstruction needed during surgery. The findings of this study could be exploited to predict preoperatively the probability of having ossicular chain destruction in COM ears and thus patients could therefore be properly consented about these potential issues before surgery.

Methods: Prospective observational study conducted over 2 years in diagnosed patients posted for surgical management and fulfilling the inclusion criteria. Intraoperative status of ossicles was noted for various types of COM and outcome was evaluated.  

Results: Out of 92 patients, 59 (64.1%) had mucosal and 33 (35.9%) had squamosal disease. Ossicular chain was eroded in 41 cases (44.6%). 9 out of 59 (15.3%) mucosal cases and 32 out of 33 squamosal cases (97%) reported ossicular erosion. Most frequently involved was long process of incus (44.6%) >stapes (9.8%) >malleus (8.7%). Order of involvement (Austin-Kartush classification) was found as: type A (26.1%)>B (9.8%)>C (8.7%). 67.4% belonged in the group 15-30 years. Male: female ratio=1:1.5.

Conclusions: Degree of ossicular destruction is much greater in squamosal COM, owing to overproduction of cytokines and inflammatory mediators and due to presence of cholesteatoma and/or granulations. The long process of incus was found to be most vulnerable. Malleus was found to be the most resilient among all ossicles.


Gopen Q. Pathology and clinical course of the inflammatory diseases of the middle ear. In: Gulya AJ, Minor LB, Poe DS, editors. Glasscock-Shambaugh’s surgery of the ear, 6th edition. PMPH, USA. 2010;427-8.

Browning GG, Weir J, Kelly G, Swan IRC. Chronic Otitis Media. In: Gleeson M, editor. Scott-Brown's Otorhinolaryngology, Head Neck Surgery. 7th edition. Hodder Arnold, Volume 3. 2008;237c:3395-445.

Mills RP. Management of Chronic Suppurative Otitis Media. In: Kerr, G.A. and Booth, J.B., Eds., Scott Brown’s Otolaryngology, 3rd Edition, Butterworth-Heinemann, Oxford. 1997;1-11.

Proctor B. The Development of the Middle Ear Spaces and their Surgical Significance. J Laryngol Otol. 1964;78(7):631-45.

Thomsen J, Bretlau P, Balslev Jøorgensen M. Bone resorption in chronic otitis media. The role of cholesteatoma, a must or an adjunct? Clin Otolaryngol Allied Sci. 1981;6(3):179-86.

Chole RA. Cellular and subcellular events of bone resorption in human and experimental cholesteatoma: the role of osteoclasts. Laryngoscope. 1984;94(1):76-95.

Chole RA, McGinn MD, Tinling SP. Pressure-Induced Bone Resorption in the Middle Ear. Ann Otol Rhinol Laryngol. 1985;94(2):165-70.

Abramson M. Collagenolytic activity in middle ear cholesteatoma. Ann Otol Rhinol Laryngol. 1969;78(1):112-24.

Amar MS, Wishahi HF, Zakhary MM. Clinical and biochemical studies of bone destruction in cholesteatoma. J Laryngol Otol. 1996;110(6):534-9.

Austin DF. Ossicular reconstruction. Arch Otolaryngol. 1971;94(6):525-35.

Kartush J. Ossicular chain reconstruction: capitulum to malleus. Otolaryngol Clin North Am. 1994;27(4):689-715.

Walsh TE, Covell WP, Ogura JH. The effect of cholesteatosis on bone. Ann Otol Rhinol Laryngol. 1951;60(4):1100-13.

Sade J, Berco E, Bugnover D, Brown M. Ossicular damage in chronic middle ear inflammations. Acta Otolaryngol. 1981;92(3-4):273-83.

Thomsen J, Jorgensen MB, Bretlau P, Kirstensen HK. Bone resorption in chronic otitis media. A histological and ultrastructural study I. Ossicular necrosis. J Laryngol Otol. 1974;88(10):975-81.

Tanaka K, Terayama Y, Hirai T. Electron microscopic study of bone lesions in cholesteatoma otitis. Arch Otorhinolaryngol. 1980;226:85-92.

Varshney S, Nangia A, Bist SS, Singh RK, Gupta N, Bhagat S. Ossicular chain status in chronic suppurative otitis media in adults. Indian J Otolaryngol Head Neck Surg. 2010;62:421-6.

Gomaa MA, Abdel Karim ARA, Abdel Ghany HS, Elhiny AA, Sadek AA. Evaluation of Temporal Bone Cholesteatoma and the Correlation Between High Resolution Computed Tomography and Surgical Finding. Clin Med Insights Ear Nose Throat. 2013;6:21-8.

Datta G, Baisakhiya N, Mendiratta V. Unsafe CSOM still a challenge in rural areas. Otolaryngol Online J. 2014;4:1-16.

Aquino JE, Cruz Filho NA, de Aquino JN. Epidemiology of middle ear and mastoid cholesteatomas: study of 1146 cases. Braz J Otorhinolaryngol. 2011;77:341-7.

Afolabi OA, Salaudeen AG, Ologe FE, Nwabuisi C, Nwawolo CC. Pattern of bacterial isolates in the middle ear discharge of patients with chronic suppurative otitis media in a tertiary hospital in North central Nigeria. Afr Health Sci. 2012;12:362-7.

Dasgupta KS, Joshi SV, Lanjewar KY, Murkey NN. Pars tensa& attic cholesteatoma: are these the two sides of a same coin? Indian J Otol. 2005;11:22-6.

Dasgupta KS, Gupta M, Lanjewar KY. Pars tensa cholesteatoma: the underestimated threat. Indian J Otol. 2005;11:17-20.

Haidar H, Sheikh R, Larem A, Elsaadi A, Abdulkarim H. Ossicular Chain Erosion in Chronic Suppurative Otitis Media. Otolaryngol (Sunnyvale). 2015;5:203.

Tos M. Pathology of ossicular chain in various chronic middle ear diseases. J Laryngol Otol. 1979;93(8):769-80.

Halevy A, Sade J. The aetiology of bone destruction in chronic otitis media. J Laryngol Otol. 1974;88(2):139-436.






Original Research Articles