A cross sectional study of ossicular chain disruption in COM patients and associated pre-operative predictors in a tertiary care center

Abstract

Aim: Both types of COM, mucosal as well as squamous may lead to erosion of the ossicles. Pre-operative assumption of ossicular necrosis enables the surgeon to plan surgical steps, duration for surgery and arrangement for specific equipments and materials required for ossiculoplasty. Our objective was to find out magnitude of ossicular chain discontinuity in COM patients and to find out its association with clinical presentation like duration of discharge and hearing loss, otoscopic examination, findings of X- Ray mastoid (lateral/oblique) and pure tone audiometry (PTA).
Method:This is a descriptive type hospital based cross sectional study. 100 patients were included in the study. All the patients underwent preoperative otoscopy, PTA and X ray mastoid. All patients underwent needful otological surgery in form of tympanoplasty or mastoid surgery and findings including ossicular chain status and erosion of the individual ossicles were noted.Results: Ossicular chain was found to be disrupted in 43 cases. Our study showed positive correlation for retraction pathology (p=0.00), long standing history of ear discharge (p=0.269), sclerosed mastoid (p=0.00). Moderate type of conductive hearing loss was also associated significantly with ossicular necrosis (p= 0.00, 0.112). Incudo-stapedial joint exposure had no significant relation with ossicular erosion.Conclusion:We conclude that history, otoscopic findings, PTA and x-ray mastoid can be reliable pre-operative predictors of ossicular erosion.Ossicular chain erosion was more prevalent in patients having cholesteatoma, long duration of ear discharge & hearing loss, retraction pockets as compare to perforation, postero-superior quadrant involvement, moderate CHL and sclerosed mastoid.