Comparative Evaluation between Tympanoplasty Alone & Tympanoplasty Combined With Cortical Mastoidectomy in NonCholesteatomatous Chronic Suppurative Otitis Media in Patients with Sclerotic Bone

Abstract

Objectives: To compare the results of tympanoplasty alone and tympanoplasty with cortical mastoidectomy in chronic suppurative otitis media (CSOM) patients with sclerotic bone in terms of graft uptake, perforation closure, improvement in hearing and disease eradication. Study Design:Retrospective study of patients at tertiary referral hospital. Method: 50 cases of non-cholesteatomatous chronic suppurative otitis media were selected. Tympanoplasty alone was done in 25 cases and tympanoplasty combined with cortical mastoidectomy was done in another 25 cases. Patients were reviewed postoperatively at 4, 8 and 12 weeks to inspect the operated ear for graft uptake or any complication. Pure tone audiometry(PTA) was done at 2 nd and 4 th month to evaluate the hearing improvement.Results: In our study, hearing gain in decibel ( dB ) in tympanoplasty group was 7.64 and in tympanoplasty combined with cortical mastoidectomy was 8.84. Graft uptake was 76% in tympanoplasty group and 88% in tympanoplasty combined with cortical mastoidectomy. Recurrence of discharge was seen in 2 cases of tympanoplasty. Though tympanoplasty combined with cortical mastoidectomy is better in hearing improvement, graft uptake and clinical improvement but the difference in 2 groups is statistically insignificant. Conclusion:Hearing improvement, graft uptake and clinical improvement were statistically incomparable in 2 groups. Combining cortical mastoidectomy with tympanoplasty will not give additional benefits in terms of hearing gain, disease clearance and graft uptake.

Factors Influencing Surgical Outcome of Myringoplasty in Tubotympanic Type of Chronic Otitis Media

“…1 In the study conducted by Kaur et al, graft uptake was observed in 76% of cases undergoing myringoplasty. 20 In the study by Mishiro et al, graft success rates were 93.3% in group of tympanoplasty. 22 Balyan et al in the study observed that successful graft uptake was seen in 89.2% cases undergoing myringoplasty.…”

Factors influencing decision making among ENT surgeons on performance of cortical mastoidectomy for CSOM-tubotympanic disease in quiescent/active stage: an opinion based study

“…[8][9][10][11][12][13][14][15][16][17] Traditionally it has been a common belief that tympanoplasty should be done in a totally dry ear to obtain a successful surgery, but slowly surgeons have started performing tympanoplasty alone even for quiescent and of late even for wet ears.…”

“…10 Many other studies as well have opined that role of cortical mastoidectomy in non-cholesteatomatous CSOM is statistically insignificant. [11][12][13][14][15][16] Though most of the studies have shown no evidence of improved outcomes following mastoidectomy compared to tympanoplasty alone when reviewed by Eliades et al, subgroup analysis, including actively discharging ears, extensive mucosal inflammation, large or repeat perforations, or sclerotic mastoids have had overall worse outcomes and these patients have shown a nonsignificant trend towards slightly improved results with mastoidectomy. 17 Hence in this study we intend to study the factors influencing decision making among ENT surgeons on whether or not to perform cortical mastoidectomy as an adjunct to tympanoplasty in patients with CSOM-tubotympanic disease with wet or quiescent ears.…”

“…According to the retrospective studies done by Kaur et al and Torosa et al on patients with sclerotic mastoids, there was no statistically significance between the results of tympanoplasty and tympanoplasty with cortical mastoidectomy group. 15,26 The increased volume provided by the surgical mastoid cavity is considered to have a protective buffering action over any influences that could cause sudden changes in middle ear pressure, which might be beneficial in patients with sclerotic mastoids. This could be the reason for some of the surgeons to opt for cortical mastoidectomy as an adjunct for CSOM patients with sclerotic mastoids.…”

“…But many studies have proven the other way concluding that there is no difference in hearing outcome between tympanoplasty alone and tympanoplasty with cortical mastoidectomy. 8,11,12,14,15,23 …”