CHRONIC OTITIS MEDIA AND OSSICULOPLASTY

Ossiculoplasty refers to the surgical process of restoring the hearing system between the tympanic membrane and oval window. The aim of an Ossiculoplasty surgery is to reform the faulty ossicular chain (chain of three bones: Malleus, Incus and Stapes) in the middle ear cavity. The severity of ear discharges prior to the surgery, preoperative mastoid cellularity, the presence of disease, and the surgical procedure have proven to be significant prognostic factors.

With advances in technology and the developing doctoral understanding of middle ear processes, the results and patient’s hearing outcomes following Ossiculoplasty are improving and are often more successful in experienced hands. Aster Hospital’s very own ENT (Ear, Nose and Throat) Specialist, Dr. Amit Goel administered one such case which proved to be highly successful and effective.

A young woman aged 23, visited the ENT outpatient department at Aster Hospital, Mankhool suggesting experiences of hearing difficulties in both ears and recurring purulent discharge. The woman complained that her hearing loss was significant and often disrupted her daily routine. Upon examination, it was reported that the tympanic membrane of both ears showed large central perforation. The patient underwent a Pure Tone Audiometry (PTA) assessment for a subjective calculation of the hearing loss. The PTA report revealed moderate-severe conductive hearing loss in the left ear and mild conductive hearing loss in the right ear (Image 1). With this, a diagnosis of Bilateral Chronic Suppurative Otitis Media (tubotympanic type) with Chronic Mastoiditis was made. Otitis Media indicates an inflammation of the middle ear which occurs as a result of an infection. This can occur in one or both ears. Following this diagnosis, the patient underwent left ear Tympanoplasty with Cortical Mastoidectomy and Cartilage Ossiculoplasty under general anesthesia.

The goal of an Ossiculoplasty surgery is to better hearing, most typically for conversational speech. Ideally, this surgery is executed to improve or sustain the conductive portion of hearing loss. For this young woman the long process of Incus was necrosed with aditus blockage. Thereby, the Incus was removed under surgery and conchal cartilage was used for the ossicular reconstruction. It is studied that using cartilage as a graft material in the reconstruction of the ossicular chain has considerably improved hearing for Chronic Otitis Media after a Tympanoplasty surgery. Even though otologists have several options to choose from, they often find it challenging to identify the perfect middle ear implant. For this young woman, the implant procedure followed by Dr. Amit proved to be ideal. A thin rectangular piece of cartilage was placed between the handle of malleus and stapes head, and upon placement the assembly was found secure. For one year following the surgery, the patient came for regular follow-ups and upon reviewing the post-operation pure tone audiogram assessment, the report showed mild conductive hearing loss in the left ear (Image 2). She showed significant hearing improvement in the operated ear which consecutively improved her quality of life and job performance, considerably!

Dr. Amit Goel 

Specialist ENT 

Aster Hospital, Mankhool

 

                                           Audiometry Reports

Image 1 (Pre Op)                                            Image 2 (Pre Op)