Aponte RH, Desentis VE, Vargas AA

Language: Spanish
References: 22
Page: 22-28
PDF size: 239.73 Kb.

ABSTRACT

Background: Chronic otitis media is one of the most important and frequent infectious diseases of the ear. The term chronic otitis media implies a permanent perforation of the tympanic membrane.
Objectives: To assess which factors and middle ear conditions in patients with chronic otitis media, influence the hearing improvement after tympanoplasty.
Material and methods: Review of medical histories of 60 patients with chronic otitis media without cholesteatoma, to whom tympanoplasty with lateral technique was practiced within the otolaryngology department of Hospital de especialidades Centro Médico Nacional Siglo XXI between January 2002 and January 2004.
Results: Regarding the size of the tympanic membrane perforation and the hearing improvement, the larger the perforation the less hearing improvement was reported. Regarding the conditions of the middle ear mucosa and hearing improvement, in a total of 42 patients with normal mucosa, 31 (73.8%) registered an improvement in hearing capability. Three (37.3%) of 8 patients with abnormal middle ear mucosa registered postoperative improvement. Ten patients were excluded, in 48 of the 50 patients studied, primary tympanoplasty was performed, 2 patients reported with revision surgery improved. Patients with a positive history of smoking have 6.75-fold risk of not getting any postoperative improvement.
Conclusions: Many factors can contribute to the outcome in otologic surgery, ranging from adequate Eustachian tube function to postoperative care. In this study the size and location of the tympanic membrane perforation represent a considerable factor in the postoperative hearing outcome. Smoking, trough generating pathologic conditions at the middle ear mucosa, while contributing to inadequate clearance of the middle ear rise the risk of no hearing improvement after tympanoplasty. It is possible to assume that, to get better postoperative results, reconstructive surgery of ear drum requires a thorough preoperative evaluation assessing risk factors. Middle ear risk index is a useful and simple tool to asses the factors that will contribute to otologic surgery outcome.

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