Document Type : Research Article
Background: Chronic otitis media is a common condition in ENT, resulting in hearing loss. Myringoplasty, tympanoplasty with or without mastoidectomy is done to improve hearing and to make the ear dry. Aim of this study was to correlate pure tone audiometric findings with intraoperative findings in patients of chronic otitis media. By doing this correlation we will be able to counsel the patients regarding: Expected postoperative hearing outcome, need for ossiculoplasty and expected cost of surgery.
Objectives of study: To do ear examination including otoscopic examination.
To do Tuning fork test and Pure tone audiometry to assess degree as well as type of hearing loss.
To correlate the preoperative hearing assessment with intraoperative tympanic membrane and middle ear changes.
Methods and Materials
Study area: Tertiary care Hospital having a specialized step up dedicated for ENT.
It has a good influx of patients presenting to the ENT OPD, referred from various rural and urban primary and secondary centers.
Study time: January 2021 till October 2021 is the time frame for collection of data. Four months were used to conduct the analysis of data.
Study population: Patients visiting ENT OPD, both males and females, both urban and rural diagnosed a case of chronic otitis media and undergoing tympanoplasty with or without mastoidectomy.
Sample Size and Sample technique: 80 cases, all the cases diagnosed as chronic otitis media and undergoing tympanoplasty with or without mastoidectomy, fulfilling the inclusion criteria were taken as samples.
Data analysis: The descriptive summaries of variables were presented through frequency distribution as well as mean± Sd. Quantitative variables were expressed as mean ± sd and compared between groups ANOVA/Kruskal-wall is test and unpaired t-test/Mann Whitney Test. Qualitative variables were compared using Chi-square test/Fisher's exact test. A p-value <0/05 was considered statistically significant. The data was tabulated in MS excel and analysis performed using R programming software.
Results: The age range was between 15 and 55. The majority of the cases in our study were between the ages of 21 and 30, with a mean age of 30. 29. This may be because hearing loss
impairs one's ability to work effectively, prompting older folks to seek medical help. The average age of patients with ossicular erosion was 36.79 years old. There were more female patients than male patients. Although bilateral illness was not infrequent, unilateral disease affected the majority of individuals. The average number of years with ear discharge was 11.34. Patients with ossicular erosion had a mean history of ear discharge for 18.74 years, compared to patients without ossicular erosion for a difference of 9.03 years that was statistically significant. Ossicular erosion was discovered in 10 of the 34 individuals that underwent surgery on the left ear. 9 of the 46 individuals whose right ear was operated on developed ossicular erosion.
Discussion: Hearing loss was observed to increase with perforation size, although it was found that patients with attic perforations had the most severe hearing loss. When compared to cases where there was no perforation in these sites, it was discovered that cases with attic perforation and posterosuperior perforation had considerable hearing loss. In every instance where there was attic penetration, osseous degradation was visible. Ossicular erosion was found in 19 cases (23.75%) out of 80 patients. The incus was the most often eroded ossicle, followed by the malleus and the stapes. It was discovered that the mean PTA, which is statistically significant, was 48 dB in instances with ossicular erosion and 32.98 dB in patients with intact ossicles. In none of the tympanosclerosis patients was there ossicular erosion. Ossicular erosion and the presence of granulation tissue were strongly correlated.
Conclusion: One of the likely conclusions that can be derived from our study's results is that there is a connection between the length of an ear discharge and a higher risk of ossicular erosion. The amount of hearing loss that develops is inversely related to the size of the hole that has been created in the tympanic membrane. Patients with substantial hearing loss had holes in both the attic and the poster superior, in contrast to cases where neither site had a perforation. Both of these locations were free of perforations in patients who did not have a substantial hearing loss.