Ossicular Reconstruction

Ossicular necrosis and erosion is commonly seen in CSOM with cholesteatoma but can also occur in tubotympanic CSOM. This usually comes as a surprise during surgery. Preoperative knowledge of ossicular necrosis helps the surgeon to be better prepared for the surgery and ossicular construction if required. Hence, this study is intended to identify the pre-operative indicators of ossicular necrosis. This cross sectional study was conducted in Father Muller Medical College in Mangalore. Sixty nine consecutive patients with tubotympanic CSOM underwent a detailed clinical examination with pure tone audiometry and subsequently tympanoplasty with or without cortical mastoidectomy. All clinical findings, pure-tone audiometry, and intraoperative otomicroscopic observations were recorded. Incidence of ossicular necrosis was 23 %. The incus was most frequently eroded followed by malleus and then stapes. On bivariate analysis patients age above 30 years (p = 0.05), duration of CSOM more than 10 years (p = 0.02), presence of granulation (p \ 0.05), absence of tympanosclerosis (p = 0.01), moderately severe (45-60 dB) hearing loss (p = 0.01) and an air bone gap of more than 55.7 dB in the right ear and 63.95 dB in the left ear was found to be statistically significant (p \ 0.05). On multivariate analysis only presence of middle ear granulation tissue was found to be the significant predicator [(p = 0.005), OR 14.37, 95 % CI 2.26-90.0]. The presence of granulation tissue and a wide air bone gap on pure tone audiometry were the best indicators of ossicular necrosis. Preoperative identification of these indicators can help the surgeon to be better prepared for the surgery.

Section: Discussionmentioning

confidence: 99%

Pre-operative Indicators of Ossicular Necrosis in Tubotympanic CSOM

Jayakumar

Inbaraj

Pinto

2016

“…This can be explained, as Udaipurwala et al have probably considered the lenticular process to be a part of the long process of incus, since they have not mentioned it separately [15]. Austin reported the most common ossicular defect to be the erosion of incus, with intact malleus and stapes, in 29.50% cases [16]. Kartush found erosion of long process of incus with an intact malleus handle and stapes superstructure (type A) as the most common ossicular defect [17].…”

Section: Discussionmentioning

confidence: 99%

“…Austin reported erosion of stapes at around 15.50% [16]. Sade et al reported stapes involvement in unsafe CSOM to be 36.00% [5].…”

Section: Discussionmentioning

confidence: 99%

Ossicular Chain Status in Chronic Suppurative Otitis Media in Adults

Varshney

Nangia

Bist

et al. 2010

This study was conducted to find out the status of the ossicles in cases of chronic suppurative otitis media (CSOM). One hundred and fifty cases of CSOM, who underwent surgery, were included and their intra-operative ossicular chain findings noted. Ossicular erosion was found to be much more common in unsafe CSOM than in safe CSOM. Malleus was found to be the most resistant ossicle to erosion whereas incus was found to be the most susceptible.

“…However, now most otologists favor Austin's classifi cation [3], which is based on remaining portion of the ossicular system to be reconstructed. It offers a more technical and functional method of describing the state of middle ear, the type of disease and the best choice of graft material.…”

Section: Introductionmentioning

confidence: 99%

Use of autogenic and allogenic malleus in tympanic membrane to footplate assembly — long-term results

Mahadevaiah¹,

Parikh²

2009

The objective of this study was to assess the functional performance and long-term stability of autogenic and allogenic malleus used for ossiculoplasty as tympanic membrane to footplate assembly. A retrospective study of 119 patients who underwent such ossiculoplasty in closed cavity mastoidectomy from 1989-2004 was carried out. There was no extrusion in any of our cases. Serviceable hearing (<20 dB air bone gap closure) was achieved in 24 out of 37 (65%) over long-term follow up of more than 1 year (mean and median for follow up being 37.4 and 30 months respectively). Thus malleus ossicle graft give acceptable long-term hearing results in one of the most difficult ossiculoplasty situations (absence of stapes suprastructure and malleus) with virtually no extrusion problems.