DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20173051

Comparison of efficacy of myringoplasty in dry and wet ears in chronic otitis media of tubotympanic type

Yogeshwar Chandrashekar, Ravishankar Chandrashekar

Abstract


Background: The objective of the study was to compare the outcome of myringoplasty in dry and wet ears in tubotympanic type of chronic otitis media (COM) with respect to graft uptake and hearing improvement.

Methods: This is a prospective study done in department of ENT Bangalore Medical College and Research Institute during the study period of November 2014 to May 2016, wherein a total of 60 patients of tubotympanic type COM with 30 cases each of dry and wet ears, aged 15-60 years were included. The hearing impairment was assessed and recorded by pure tone audiometry (PTA). After obtaining informed written consent the patients underwent myringoplasty (temporalis fascia graft, underlay technique). Microbiological examination of discharge in wet ears was done and histopathology of the excised remnant TM analyzed in both groups. Both groups of patients were followed up for 3 months and assessed for graft uptake and hearing improvement. PTA was repeated at 3 months postoperatively.  

Results: Our study included 60 patients of tubotympanic type of COM with 30 cases each with dry and wet ears who underwent myringoplasty. Majority of our patients were in second decade in both the groups. There was slight female preponderance in our study with male to female ratio of 0.93:1. Discharge from ears in wet ears was mucoid in consistency and were culture negative. Histopathology of excised remnant TM in wet ears revealed evidence of inflammatory cells and vascularization within stroma of fibroblasts while these were absent in dry ear cases. The overall successful graft uptake following myringoplasty was 88.3% with 86.7% for wet ears and 90% for dry ears with no statistical significance (p value of 0.688>0.05) between the two groups. With respect to hearing improvement post-operatively there was significant hearing improvement in both the groups when compared to preoperative hearing with a mean hearing gain (dB) of 3.43±2.81 in wet ear cases to 3.85±3.05 in dry ear cases, but when compared between the two groups, there was no significant statistical difference (p value of 0.582>0.05).

Conclusions: The outcome is equally good for myringoplasty in dry and wet ears in tubotympanic type of chronic otitis media with respect to graft uptake and hearing improvement. 


Keywords


Chronic otitis media, Tubotympanic, Dry ear, Wet ear, Pure tone Audiometry, Myringoplsty

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References


WHO/CIBA Foundation Workshop. Prevention of hearing impairment from chronic otitis media. WHO/PDH/98.4. London: CIBA Foundation, 1996.

Browning GG. Aetiopathology of inflammatory conditions of the external and middle ear. In: Kerr AG (ed.). Scott-Brown’s Otolaryngology. Chapter 3. 6th edition. Volume 3. London: Arnold Publishing; 1977.

Browning GG. Chronic otitis media The Ear, Hearing And Balance. In: Michael Gleeson editor. Scott-Brown’s Otorhinolaryngology, Head and Neck Surgery. 7th edition. Volume 3. London: Arnold Publishing; 2008: 3412-3423.

Paperella M, Froymowich O. Surgical advances in treating otitis media. Ann Otol Rhinol Laryngol Suppl. 1994;103:49-53.

Vijayendra H, Rangam CK, Sangeeta R. Comparative study of Tympanoplasty in wet perforation v/s totally dry perforation in tubotympanic disease. Indian J Otolaryngol Head Neck Surg. 2006;58(2):165-7.

Jackson CG, Kaylie DM, Glasscock ME, Strasnick B. Tympanoplasty- Undersurface graft technique. In: Brackmann DE, Shelton C, Arriaga MA, editors. Otologic Surgery. 3rd ed. Saunders, Elsevier; 2010: 149-160.

Nagle S, Jagade M, Gandhi S, Pawar P. Comparative study of outcome of type I tympanoplasty in dry and wet ear. Indian J Otolaryngol Head Neck Surg. 2009;61(2):138-40.

Bunzen D, Campos A, Sperandio F, Neto SC. Intra-operative Findings Influence in Myringoplasty Anatomical Result. Int Arch Otorhinolaryngol. 2006;10(4):284-8.

Shankar R, Virk R, Gupta K, Gupta A, Bal A, Bansal S. Evaluation and comparison of type I tympanoplasty efficacy and histopathological changes to the tympanic membrane in dry and wet ear: a prospective study. J Laryngol Otol. 2015;129(10):945-9.

Mills R, Thiel G, Mills N. Results of myringoplasty operations in active and inactive ears in adults. Laryngoscope. 2013;123(9):2245-9.

Dhar G, Basak B, Chandra Gayen G. Outcome of myringoplasty in dry and wet ear – a comparative study. IOSR JDMS. 2014;13(3):1-3.

Hosny S, El-Anwar M, Abd-Elhady M, Khazbak A, Feky A. Outcomes of Myringoplasty in Wet and Dry Ears. J Int Advan Otol. 2015;10(3):256-9.