Galore International Journal of Health Sciences and Research
Vol.4; Issue: 1; Jan.-March 2019
Website: www.gijhsr.com
Original Research Article P-ISSN: 2456-9321
Hearing Outcome Following Myringoplasty for CSOM: A Study of 60
Patients
Dr. Anita Atal1, Dr. Ankit Goyal1*, Dr. Bharti Solanki2
1
Final Year Postgraduate Student, Department Of E.N.T, S.N.M.C, Jodhpur, Rajasthan, India.
2
Professor, Department Of E.N.T., S.N.M.C, Jodhpur, Rajasthan, India.
*Corresponding Author: Dr Ankit Goyal
ABSTRACT accepted of which is the temporalis fascia,
because of its qualities of low metabolic
Introduction: The purpose of this study was to rate, requiring lesser blood supply and is
evaluate hearing outcome using temporalis graft more resistant to infection. [3]
in Tympanoplasty Type I for CSOM using Post Myringoplasty is an operation in
aural approach.
which the reconstructive procedure is
Method: It included 60 patients with chronic
suppurative otitis media (tubotympanic type) limited to repair of tympanic membrane
requiring only tympanic membrane repair with perforation assuming that middle ear
no ossicular reconstruction. Patients were ossicles are functioning normally,
assessed after 3 & 6 months for graft take and Eustachian tube is patent and patient has a
hearing evaluation. good cochlear reserve.
Result: In our study of 60 cases, AB Gap This study analysed hearing outcome
closure of 16.04±6.40 dB & average air using temporalis graft in myringoplasty for
conduction improvement was 16.60±5.76 dB CSOM using Post aural approach.
after 6 months of surgery.
Conclusion: Myringoplasty using temporalis
MATERIALS & METHODS
fascia as graft done by postaural approach is an
This prospective study was
easy technique which gives a good improvement
in hearing. conducted on 60 patients admitted with
diagnosis of CSOM (tubotympanic type)
Key words: Myringoplasty, Tympanoplasty, who underwent myringoplasty using
CSOM, Hearing outcome. underlay temporal fascia graft by postaural
approach for a period of 2 years (1.1.2014 to
INTRODUCTION 31.12 2015).
In early centuries, ear infection with Patients with chronic suppurative
complication was a life threatening otitis media (CSOM) with tubotympanic
condition. The introduction of antibiotics type disease with dry ear (inactive) for more
and use of operative microscope in surgical than 1 month, age more than 10yrs, only
field were revolutionary advances in the conductive hearing loss, no previous history
control of disease. Chronic suppurative of ear surgery were included for study.
otitis media (CSOM) is still a major Patients having wet ear, mixed hearing loss,
problem in our country. Tympanic tympanosclerosis and ossicular chain
membrane(TM) perforations lead to disorder, cholesteatoma (atticoantral type of
recurrent ear infections and hearing loss. [1] CSOM) or systemic disease like Diabetes
Repair of tympanic membrane mellitus, hypertension, tuberculosis etc.
perforation was attempted since many years. were excluded from study . Patients with
Different techniques and different graft history of nasal allergy, other nasal diseases,
materials like temporal fascia, duramater throat problems were appropriately treated
and tragal perichondrium were used, [2] most before taking for ear surgery.
Galore International Journal of Health Sciences and Research (www.gijhsr.com) 9
Vol.4; Issue: 1; January-March 2019
Anita Atal et.al. Hearing Outcome Following Myringoplasty for CSOM: A Study of 60 Patients
A detailed study of each patient Data were analyzed using the chi-
including history, clinical examination, squared test and t-test on a statistical
audiological evaluation using Pure Tone package (version 16.0; SPSS). A P<0.05
Audiometry (PTA), radiological was the level of significance.
examination (X-ray mastoid) and routine
investigations were done. RESULTS
Myringoplasty was done using In our study out of 60 cases, 32
temporalis fascia by post aural approach patients were male and 28 were female with
under general anesthesia. Postoperatively age group varying between 12 to 50 years.
the patients were discharged on 4nd-5rd The mean age of patients was 23.85 years.
post-operative day. Systemic antibiotics and Incidence of bilateral ear discharge was seen
antihistaminics were routinely administered in 20 cases of the cases. In patients with
for 7 days. Analgesics were prescribed bilateral disease, the ear with more hearing
symptomatically. A decongested nasal drops loss and extensive disease was operated
was prescribed for 2-3 weeks. Meatal pack first. Unilateral ear discharge was present in
was removed after 3 weeks, neodrum was 40 cases out of which, it was right ear in 28
inspected, and patients were told to follow- cases & it was in left ear in 12 cases.
up regularly at weekly intervals to note the Our study showed an overall success rate of
uptake of graft for 3 months and 6 months. 90 % as far as the graft take was concerned,
Surgical outcome of myringoplasty was i.e. out of 60 cases, in 54 cases the
measured on the basis of the condition of perforation was closed on examination at
the graft taken or failure. Hearing the interval 6 months.
improvement was assessed by closure of air
-bone gap and Air threshold gain.
Table 1: Air Conduction Threshold level pre operative and post operative at 3 rd & 6th months
Air conduction Threshold levels Pre Operative Post Operative
( in dB ) ( no. of patients ) ( no. of patients )
( at 3rd Months ) (at 6th month )
0 – 25 0 23 51 (85%)
26 – 40 42 (70% ) 37 9 (15%)
41 – 55 18 (30%) 0 0
Mean 39.16 26.77 22.55
In our study, preoperatively 42 patients had threshold in 60 cases was 26.77±3.48 dB
mild deafness (26-40 dB) and 18 patients and 22.55±5.08 dB respectively. Hence,
had moderate deafness (16-25 dB). After 6th postoperatively at 6 month of surgery an
month of follow up post operatively, 85% average Air- thresholds gain of 16.60±5.76
cases were shifted to the 0-25 dB of hearing dB was observed, which is significant.
while 15% cases had 26- 40 dB (mild
deafness). Table 3 : Mean Air – Bone closure
Air Bone Gap Mean dB (n=60) P value
Table 2 : Hearing gain Pre Operative 28.24±3.58
Air Thresholds level Mean dB (n = 60) P value Post Operative 3 months 16.44±3.83
Pre Operative 39.16±2.82 Post Operative 6 months 12.00±5.56
Air- Bone closure 11.82±4.93 <0.0001
Post Operative 3 months 26.77±3.48
<0.0001 (3rd Month )
Post Operative 6 months 22.55±5.08
Air- Bone closure 16.04±6.40
Mean Air threshold level gain 12.38±3.86
(6th Month)
(3rd months)
Mean Air threshold level gain 16.60±5.76
( 6th months)
In our study average pre-operative Air-
Bone gap in 60 cases of CSOM was
In our study, average pre-operative 28.24±3.58 dB. Postoperatively, at 3th
Air threshold in 60 cases of CSOM was month and 6th month of surgery average
39.16±2.82 dB. Postoperatively, at 3th Air- Bone gap in 60 cases was 16.44±3.83
month and 6th month of surgery average Air dB and 12.00±5.56 dB respectively. Hence,
Galore International Journal of Health Sciences and Research (www.gijhsr.com) 10
Vol.4; Issue: 1; January-March 2019
Anita Atal et.al. Hearing Outcome Following Myringoplasty for CSOM: A Study of 60 Patients
postoperatively at 6 month of surgery an CONCLUSION
average Air- Bone closure of 16.04±6.40 dB Myringoplasty using temporalis
was observed, which is significant. fascia as graft done by postaural approach is
an easy technique which gives a good
DISCUSSION improvement in hearing.
Myringoplasty is a simple, easy
otologic surgery with good overall outcome. BIBLIOGRAPHY
This procedure is done to prevent recurrent 1. Wasson JD, Papadimitriou CE, Pau H.
infection of the middle ear & to improve Myringoplasty: impact of perforation size
hearing. on closure and audiological improvement. J
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How to cite this article: Atal A, Goyal A,
in their study of 193 cases of Solanki B. Hearing outcome following
Tympanoplasty, the mean pre operative myringoplasty for CSOM: a study of 60
while the mean postoperative air conduction patients. Galore International Journal of Health
average was 25 dB, thus average air Sciences & Research. 2019; 4(1): 9-11.
conduction improvement was 10 dB.
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Vol.4; Issue: 1; January-March 2019
