Myringosclerosis: An Indication of A Blocked Aditus

Abstract

Tympanoplasty has been the mainstay of treatment in chronic otitis media. In a non cholesteatomatous chronic otitis media, there has been much debate whether a cortical mastoidectomy is required or not. Creating an aerating mastoidectomy in cases of blocked aditus ad antrum helps in reducing the recurrence. However, the status of aditus is not always known unless a mastoidectomy is performed. In this study we try to find out if there is any clinical clue regarding a blocked aditus ad antrum by looking at the tympanic membrane. Fourty-three cases of cortical mastoidectomies were retrospectively studied in this series. Patency of aditus ad antrum was analyzed with respect to presence of myringosclerosis and the status of middle ear mucosa. In this study myringosclerosis was found to be significantly associated with a blocked aditus while no such association was found with the status of middle ear mucosa. The presence of myringosclerosis may indicate a blocked aditus ad antrum and performing a cortical mastoidectomy in such cases may help in creating an aerated mastoid, thereby possibly reducing the recurrence rate.

Clinical and Radiological Predictability of Aditus Patency in Mucosal COM with Sclerosed Mastoid: An Analytical Study

“…Manjunath et al 9 and Migrov and Volkov 10 in their study confirmed that tympanosclerosis increases probability of blocked aditus.…”

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

“…Manjunath et al, on analysing retrospectively patency of aditus ad antrum with respect to presence of myringosclerosis in 43 patients of CSOM who had undergone tympanoplasty with cortical mastoidectomy, found that presence of myringosclerosis was associated with presence of aditus block (p=0.0022). 21 In our study among group 1 surgeons, 46.16% of the participants considered that tympanoplasty alone would be sufficient even for patients with 1 month dry ear period with ossicular chain discontinuity whereas the rest 53.84% opined that they would perform tympanoplasty with cortical mastoidectomy for such patients. According to the study done by Kakkar et al, ossicular chain disruption was a common association in patients who were found to have mucoid discharge in the middle ear preoperatively.…”

“…Also, the poor follow up of the patients would mean that revision surgery may not be possible indicating the need for a successful operation at the first instance. 21 Hence there is a need for identifying clinical indicators pointing towards probable diseased mastoid air cells, so that cases which may be benefitted by performing cortical mastoidectomy as an adjunct procedure can be identified. Otherwise, the doubt of the possibility of disease harbouring in the mastoid may make surgeons overdo the procedure as long as they are confident in performing the same.…”

Patency of the Aditus Ad Antrum in Tubotympanic Chronic Suppurative Otitis Media

“…Furthermore, marginal and subtotal central perforations and the presence of myringosclerosis increased the probability of an obstructed aditus ad antrum dramatically. The association between myringosclerosis and a blocked aditus was discussed by Manjunath et al, 13 who published a paper confirming that myringosclerosis is an indication of a blocked aditus. The same conclusion was suggested by Migrov and Volkov 14 on the effect of myringosclerosis on the outcomes of tympanoplasty.…”