Dantuluri Ramakrishna Laxmi Narasimha Raju1
Study of various factors influencing the outcome of type 1 tympanoplasty like size of the perforation, active ear discharge and presence of tympanosclerotic patch and comparing the respective preoperative and postoperative audiological results.
In early centuries, ear infection with complication was a life-threatening condition. The introduction of antibiotic and use of operative microscope in surgical field were revolutionary advances in the control of disease. Chronic supportive otitis media is still a major problem in our country. It is a common condition seen in patients attending the otolaryngology clinic. The discharging ear presents the otologist with the dilemma of operating it or not. This is due to the widespread belief that the success rate while doing tympanoplasty on discharging ears is decidedly inferior.
MATERIALS AND METHODS
A total of 106 patients with CSOM tubotympanic disease who underwent type 1 tympanoplasty in the Department of ENT, KS Hegde Medical Academy were studied in the period of two years. A detailed pro forma was filled for each patient with regard to history, clinical examination, investigations, surgical procedures, postoperative period and follow up visits. Audiological evaluation (pure tone audiometry) done preoperatively, 3 months and 6 months after surgery and the results were tabulated.
Audiological benefit was found to correlate with the size of perforation. As the size of perforation increases, the hearing gain was found to improve postoperatively. In our study of 106 cases, 101 (95.2%) cases showed improvement in speech frequency and 83 cases (78.3%) in high frequency; hearing decreased in 3 cases (2.83%) in speech frequency and 19 cases (17.9%) in high frequency. The rest remained unchanged audiologically. Active discharge does not make statistically significant change in the audiological outcome in type 1 tympanoplasty provided it must be mucoid, scanty and culturally negative. Out of 106 cases in 27 cases with tympanosclerosis, the postoperative speech frequency benefit is less (8.393 dB) than those without tympanosclerosis (13.949 dB), which is statistically significant. In high frequency, there is better audiological benefit in cases without tympanosclerosis (7.872 dB) when compared to cases with tympanosclerosis (7.143 dB), which is statistically insignificant.
Size of perforation, presence of tympanosclerosis and status of middle ear at the time of surgery were found to have a major effect on the final outcome of surgery.