STUDY OF OSSICULAR CHAIN DEFECTS IN CASES OF CHRONIC SUPPURATIVE OTITIS MEDIA WITH CHOLESTEATOMA AND GRANULATIONS
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Keywords
Ossicular chain, audiometry, cholesteatoma
Abstract
Background: CSOM often leads to significant hearing loss due to damage to the ear drum and ossicular chain. Identifying the extent and type of ossicular chain defects can help in planning effective surgical interventions to restore hearing. The findings from this study can help otologists predict intra-operative findings based on clinical presentation and audiological profiles. This aids in better surgical planning and patient counseling regarding possible outcomes and the need for ossiculoplasty.
Methods: Observational study conducted over a period of 2 years on 70 patients of chronic suppurative otitis media having cholesteatoma and granulation disease who underwent mastoid exploration. Intra-operative middle ear findings including Ossicular chain status, erosion of the individual ossicles, presence of cholesteatoma and granulations were analyzed and noted.
Results: Out of 70 patients Intraoperatively, it was found that maximum number of patients had granulation (only) that is 58.6% while Cholesteatoma (only) was present in 18.6%. Both cholesteatoma and granulations were present in 16 (22.9%) patients.
Malleus was intact in 37 (52.9%) patients, necrosed in 30 (42.9%) patients and absent in 3(4.2%) patients, Incus was intact in 7 (10%) patients ,necrosed in 62 (88.6%) patients and absent in 1 (1.4%) and Stapes was intact in 38 (54.3%) and necrosed in 32 ( 45.7%) of patients.
Handle of malleus was necrosed in majority of patients 18 (25.6%) followed by necrosis of head and handle of malleus combined together in 9 (12.9%) out of total 70 patients studied.
Long process of Incus was necrosed in majority of patients 28 (40%) followed by lenticular process 23 (32.9%) out of total 70 patients studied.
Stapes was Intact in 38 (54.3%) patients whereas erosion of Superstructure of stapes was present in 32 (45.7%) patients.
Necrosed Incus with Malleus and Stapes Intact type of ossicular chain defect was seen in majority of patients (30.3%) followed by necrosis of all three ossicles (Malleus, Incus and Stapes) seen in 22.8% patients out of total 66 ossicles that were found necrosed.
Conclusion: In cases of Chronic Suppurative Otitis Media, ossicular damage is more in the presence of granulations as compared with the presence of cholesteatoma or both cholesteatoma and granulations. Incus is the most common ossicle to get necrosed whereas Malleus is the ossicle which is most resistant to necrosis. Necrosed incus with Intact stapes and malleus is the most common type of ossicular chain erosion seen.
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Kriti Shrivastava
Assistant Professor, Department of Otorhinolaryngology, LNCT Medical College and Sewakunj Hospital, Indore. M.P.
Dr Anubhav Shrivastava
Senior Resident, Department of Otorhinolaryngology, LNCT Medical College and Sewakunj Hospital, Indore, M.P.
Dr Apurva Sharma
Senior Resident, Department of Otorhinolaryngology, LNCT Medical College and Sewakunj Hospital, Indore, M.P.