|Year : 2017 | Volume
| Issue : 2 | Page : 85-88
Comparative study of type I tympanoplasty with or without mastoidectomy in tubotympanic type of chronic suppurative otitis media patients
Disha Amar Methwani, Prasad T Deshmukh
Department of ENT, JNMC, Wardha, Maharashtra, India
|Date of Web Publication||8-Sep-2017|
Disha Amar Methwani
315, Amar Jyoti Nursing Home, Ruikar Road, Mahal, Nagpur, Maharashtra
Source of Support: None, Conflict of Interest: None
Objectives: The aim is to compare the results of type I tympanoplasty alone and tympanoplasty with cortical mastoidectomy in safe chronic suppurative otitis media (CSOM) patients in terms of graft uptake, improvement in hearing and clinical improvement. Study Design: This was prospective study. Materials and Methods: Sixty cases of safe type of CSOM were included in the study. Type I tympanoplasty was done in thirty cases and tympanoplasty with cortical mastoidectomy was done in another thirty cases. Patients were followed up postoperatively at 3, 6, and 12 weeks for graft uptake and any complication. Pure-tone audiometry was done at 6th and 12th week postoperatively to note the hearing improvement. Results: Graft uptake was 76.67% in tympanoplasty alone group and 83.33% in tympanoplasty with cortical mastoidectomy group. In the present study, pre- and post-operative pure-tone average was compared and the statistical difference between tympanoplasty group and tympanoplasty combined with cortical mastoidectomy group was not statistically significant. Recurrence of discharge was seen in 6 cases of tympanoplasty alone group. Although tympanoplasty combined with cortical mastoidectomy is better in hearing yield, graft acceptance rate, and clinical benefit, but the difference in two groups is statistically insignificant. Conclusion: Hearing outcome, graft acceptance rate, and clinical benefit were statistically unequalled in two groups. Tympanoplasty combined with cortical mastoidectomy will not give an additional advantage in terms of hearing gain, disease clearance, and graft uptake.
Keywords: Air bone gap, chronic suppurative otitis media, graft uptake, mastoidectomy, pure-tone audiometry, tympanoplasty
|How to cite this article:|
Methwani DA, Deshmukh PT. Comparative study of type I tympanoplasty with or without mastoidectomy in tubotympanic type of chronic suppurative otitis media patients. J Datta Meghe Inst Med Sci Univ 2017;12:85-8
|How to cite this URL:|
Methwani DA, Deshmukh PT. Comparative study of type I tympanoplasty with or without mastoidectomy in tubotympanic type of chronic suppurative otitis media patients. J Datta Meghe Inst Med Sci Univ [serial online] 2017 [cited 2018 Aug 20];12:85-8. Available from: http://www.journaldmims.com/text.asp?2017/12/2/85/214201
| Introduction|| |
Tympanoplasty with or without cortical mastoidectomy is a matter of discussion among the ENT society. One hypothesis suggests that type 1 tympanoplasty combined with cortical mastoidectomy in tubotympanic type of chronic suppurative otitis media (CSOM) is useful, whereas another fraction believes that cortical mastoidectomy combined with type 1 tympanoplasty has no inconsequential effects on the surgical result.
Management of tubotymapanic type of CSOM is thus regularly monitored to the potentiality of an institution and to the patients' presumption. In this respect, not only does the vacancy of resources and surgical finesse play a crucial role but also the patients' constancy to follow up.
In light of these incongruent and eccentric views, the present study was carried out firmly to valuate the role of cortical mastoidectomy in the surgical outcome of type I tympanoplasty in patients with CSOM (safe type).
The aim of this study is to contemplate the surgical outcome of type-I tympanoplasty alone and tympanoplasty combined with cortical mastoidectomy.
| Materials and Methods|| |
This study included sixty patients admitted in the Department of Otorhinolaryngology, ABBRH, Sawangi (M), Wardha from July 2014 to July 2016 in the age group of 8–65 years having tubotympanic type of CSOM. Patients with an unsafe type of CSOM, complicated CSOM, sensorineural hearing loss, uncontrolled diabetes or hypertension or any bleeding disorder, previous history of middle ear or mastoid surgery and active infection of nose, throat, and paranasal sinuses were excluded from the study.
Pre-operative evaluation included a detailed history of the patient, examination-general and local, along with EUM, tuning fork tests with 256,512 and 1024 Hz for the degree of hearing loss, and pure-tone audiometry for documentation. Routine blood investigations included complete blood count, bleeding and clotting time, kidney function test, liver function test, random blood sugar, and urine routine, and microscopic examination. They were then subjected to routine preanesthetic checkup. Patients having active disease preoperatively were given medical treatment before taking up for surgery.
Depending on the intervention, two groups were formed. Group 1 (thirty patients), included patients of type 1 tympanoplasty alone and Group 2 (thirty patients), included patients of tympanoplasty combined with cortical mastoidectomy. Various parameters including the surgical results were studied and observation unfolding from the study were documented and evaluated statistically.
Statistical analysis was performed using descriptive and inferential statistics using Chi-square test, and Student's t-test and software used in the analysis were SPSS 1730 version (SPSS Inc., Chicago, IL) and GraphPad Prism 5.0 version (GraphPad Software, Inc., La Jolla, CA, USA) and P < 0.05 is considered to be level of significance (P< 0.05).
| Observations and Results|| |
All the patients were in the age group of 8–65 years. Age-wise distribution of the patients in Group 1 and Group 2 is shown in [Table 1].
In both the groups, females outnumbered males. Male to female ratio of 1:2.3 in Group 1 and 1:1.14 in Group 2 was found.
The duration of discharge was the most common between 1 and 5 years and was noted in 16 patients (53.33%) in Group 1 and 13 patients (43.33%) in Group 2. This was not statistically significant [Table 2].
χ2 = 1.66, P = 0.19, not statistically significant. The difference in both the groups was not statistically significant [Table 3].
Size of perforation was statistically insignificant in both the groups with P = 0.41 [Table 4].
χ2 = 0.41. Graft take up status was statistically similar in both the groups with P = 0.51 [Table 5].
χ2 = 3.24. Clinical improvement after surgery in terms of recurrence of ear discharge was found to be statistically insignificant in both groups with P = 0.07 [Table 6].
In Group 1, pre-and postoperatively pure-tone average was 43.07 dB and 34.23 dB, respectively (9.79, P = 0.0001, significant [S]). Whereas in Group 2, pre- and post-operatively pure-tone average was 42.65 and 34.23 dB, respectively. This is statistically significant. (9.79, P = 0.0001, S) However, when these values are compared between the two groups, P > 0.05, implying no statistical significance among the two groups when hearing improvement is considered [Table 7].
| Discussion|| |
In this study, the cases registered were between in the age group of 8–65 years. It was noted that maximum number of the patients in Group 1 (10 patients, 33.33%) were in the third decade. Like Group 1 most of the patients were found in third decade (9 patients, 30%) Lasisi and Afolabi  scrutinized that maximum number of patients were in the age group of 21–34 years. There is a general unanimity that otitis media has its highest incidence and prevalence in youthful years and it is precipitated with increasing age.
In both the groups, females outvoted males. Male to female ratio of 1: 2.3 in Group 1 and 1: 1.14 in Group 2 was found. Lasisi and Afolabi  and Kaur et al. have revealed female predominance, whereas Biswas et al., in their study, disagreeing with above studies has unfolded male preponderance. However, this difference in occurrence could be totally coincidental or can be accounted to geographical, educational, cultural atmosphere, and overall perception and health awareness of the population.
The duration of discharge was highly observed between 1–5 years, i. e., in 16 patients (53.33%) in Group 1 and 13 patients (43.33%) in Group 2. Kaur et al. in a study of 50 patients observed that 4 (8%) had ear discharge for <1 year, 24 (48%) had for 1–5 years, 10 (20%) patients had for 6-10 years, and 12 (24%) patients had discharge for more than 10 years. The study findings regarding chronicity of ear discharge are compatible with the above study.
In this study, we found small central perforation in 7 patients (15%) in Group 1 and 4 patients (13.33%) in Group 2, large central perforation in 10 (33.33%) in Group 1 and 9 (30%) in Group 2, whereas subtotal perforation was noted in 2 (6.67%) and 6 (20%) in Group 1 and Group 2, respectively. Moderately-sized perforation was found to be the most common. 11 patients (36.67%) patients in each group had moderate perforation. Biswas et al. and Kaur et al. reported moderately-sized perforation to be the most common. The study findings are in congruence with above studies.,
In our study, the graft was accepted in 76.67% in Group 1 and 83.33% in Group 2. A plethora of studies have shown same results of the inappreciably better outcome when mastoid antrum was explored. However, apart from being a hardly noticeable phenomenon, it is statistically insignificant. We feel studies with larger sample size are needed to authenticate our surveillance [Table 8].
In the present study, postoperative ear discharge was observed only in 6 cases (15%) in tympanoplasty group while in tympanoplasty with mastoidectomy group, no case on follow up was reported to have ear discharge, but the difference was statistically insignificant. In this study, in Group 1, pre- and post-operatively pure-tone average was 43.07 and 34.23 dB, respectively (9.79, P = 0.0001, S). Whereas in Group 2, pre- and post-operatively pure-tone average was 42.65 and 34.23 dB, respectively. This is statistically significant (9.79, P = 0.0001, S). However, when these values are compared between the two groups, P > 0.05, implying no statistical significance among the two groups when hearing improvement is considered.
In a study by Krishnan et al. postoperative hearing advantage was 75% in both groups alike. Similarly, Balyan et al. in a study carried out on 48 patients with CSOM, treated by tympanoplasty with or without cortical mastoidectomy found an insignificant difference in graft failure rates or hearing results. They also stated that the addition of mastoidectomy had elevated effort and liability to the surgery.
Mishiro et al. and Kaur et al. also promoted the use of tympanoplasty alone safe CSOM with a confluent rate of graft acceptance and hearing outcomes with the addition of a cortical mastoidectomy.
In sheer contrast to our observations, Holmquist and Bergstrom  suggested that mastoidectomy had sharpened the chance of successful tympanoplasty for patients with noncholesteatomatous COM.
Thus, it is evident that cortical mastoidectomy should only be experimented along with tympanoplasty in selected patients. It is proposed that type I tympanoplasty minus mastoidectomy should be carried out in all central perforation with inactive ear, normal middle ear mucosa, and healthy Eustachian tube More Details function.
| Conclusion|| |
We found dicy role of mastoidectomy along with tympanoplasty in safe CSOM and thus clubbing cortical mastoidectomy with tympanoplasty will not give any supplementary benefits. We feel that concomitant mastoidectomy could be time demanding, cost exorbitant (especially in rural setup) and has lurking potential for causing complications.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Lasisi OA, Afolabi OA. :Mastoid Surgery for the Chronic Ear: A Ten Year Review: The Internet Journal of Head and Neck Surgery 2008;2:45-9.
Kaur M, Singh B, Verma BS, Kaur G, Kataria G, Sinh S, et al
. Comparative evaluation between tympanoplasty alone and tympanoplasty combined with cortical mastoidectomy in non-cholesteatomatous chronic suppurative otitis media in patients with sclerotic bone. IOSR J Dent Med Sci 2014;13:40-5.
Biswas SS, Hossain MA, Alam MM, Atif MT, Amin ZA. Hearing evaluation after myringoplasty Bangladesh J Otorhinolaryngol 2010; 16:23-28.
Bhat KV, Naseeruddin K, Nagalotimath US, Kumar PR, Hegde JS. Cortical mastoidectomy in quiescent, tubotympanic, chronic otitis media: Is it routinely necessary? J Laryngol Otol 2009;123:383-90.
Albu S, Trabalzini F, Amadori M. Usefulness of cortical mastoidectomy in myringoplasty. Otol Neurotol 2012;33:604-9.
Krishnan A, Reddy EK, Chandrakiran C, Nalinesha KM, Jagannath PM. Tympanoplasty with and without cortical mastoidectomy – A comparative study. Indian J Otolaryngol Head Neck Surg 2002;54:195-8.
Balyan FR, Celikkanat S, Aslan A, Taibah A, Russo A, Sanna M, et al.
Mastoidectomy in noncholesteatomatous chronic suppurative otitis media: Is it necessary? Otolaryngol Head Neck Surg 1997;117:592-5.
Mishiro Y, Sakagami M, Kondoh K, Kitahara T, Kakutani C. Long-term outcomes after tympanoplasty with and without mastoidectomy for perforated chronic otitis media. Eur Arch Otorhinolaryngol 2009;266:819-22.
Holmquist J, Bergström B. The mastoid air cell system in ear surgery. Arch Otolaryngol 1978;104:127-9.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]