Correlation of intraoperative middle ear status and hearing results in single-stage canal wall down tympanomastoidectomy with PORP—a prospective study

Abstract

Abstract Background Mastoidectomy is one of the common surgical procedures performed by the otologist. It is commonly done for cholesteatomatous chronic otitis media (CCOM) and can be performed as either canal wall up or down techniques. Most of the CCOM is associated with ossicular erosions which require ossicular chain reconstruction (OCR) which can be done either in one stage or multiple stages. A multitude of factors affects postoperative OCR results with tympanomastoidectomy. Among various factors, the status of the tympanic membrane and middle ear mucosa is quite essential. To date, there are no randomized or prospective studies assessing the integrity of pars tensa and status of the middle ear mucosa in hearing outcomes in single-stage tympanomastoidectomy using partial ossicular replacement prosthesis (PORP) in the literature. Therefore, this study is performed to correlate the integrity of pars tensa and middle ear mucosa condition with postoperative hearing results of single-stage canal wall down (CWD) tympanomastoidectomy with PORP. Results Forty-two patients with cholesteatomatous chronic otitis media underwent single-stage canal wall down mastoidectomy (CWD) and partial ossicular replacement prosthesis (PORP) placement. The statistical analysis was done to compare the results of postoperative hearing with the intraoperative integrity of pars tensa and middle ear mucosa status. The mean pre- and postoperative air-bone gaps (ABGs) of all cases were 23.9 dB and 21 dB, respectively, with no statistically significant difference. In the pars tensa intact group, the mean pre- and postoperative ABGs were 21.5 dB and 18.5 dB, respectively, and in the pars tensa not intact group, the mean pre- and postoperative ABGs were 25.7 dB and 22.8 dB, respectively, and both groups had statistically insignificant difference. The pre- and postoperative ABGs in the healthy middle ear mucosa group were 20.7 dB and 19 dB, respectively. Similarly, the pre- and postoperative ABGs in non-healthy middle ear mucosa were 24.4 dB and 21.2 dB, respectively. The differences were not statistically significant in both groups. Conclusion There was a statistically significant improvement in postoperative air conduction threshold (ACT) in all cases. The integrity of pars tensa and middle ear mucosa status did not affect the postoperative hearing outcome in single-stage CWD tympanomastoidecomty using PORP.

Keywords

• Chronic otitis media
• Cholesteatoma
• Canal wall down mastoidectomy
• Partial ossicular replacement prosthesis
• Tympanoplasty