“OSSICULAR CHAIN STATUS IN CHRONIC OTITIS MEDIA ”- OUR EXPERIENCE

Aim: To clinically evaluate the ossicular chain status in patients with chronic otitis media and to correlate the clinical status of ossicles with radiological ndings using HRCT temporal bone. Objectives: 1. To evaluate the ossicular chain status in middle ear by clinical examination among Chronic otitis media patients 2. To identify the pathologies in ossicles like erosions, dislocations, xations and tympanosclerosis by obtaining a HRCT temporal bone 3. To correlate clinical ndings with radiological ndings Results : In this study, it was observed that majority (48.3%) of study population were in 31 – 40 years of age group; majority (55%) of study population were females and 45% were males. Majority (80%) of study population had war discharge; 66.7% had hearing loss and 58.3% had otalgia. Around 6.6% of study subjects had fever with chills & rigors; 13.3% had vertigo and 25% had tinnitus. Almost 10% had swelling behind ear and 6.6% had facial weakness. In the present study, majority (55%) of study population had conductive deafness and 6.7% had SNHL. Almost 5% had both conductive and SNHL. On oto-endoscopy it was observed that majority (80.4%) of study population had central perforation; 8.9% had marginal perforation, 10.7% had attic perforation and 63.3% had ossicular necrosis. CT scanning revealed that majority (88.3%) of study population had soft tissue mass and 36.7% had intact ossicles. In about 20% of patients attic involvement was seen and 46.7% had mastoid antrum involvement. Around 83.3% had absent aeration mastoid. Almost 40% had malleus erosion, 50% had incus erosion and 41.6% had stapes erosion. Intraoperatively it was observed that majority (78.3%) of study population had soft tissue mass and 31.6% had intact ossicles. In about 20% of patients attic involvement was seen and 41.7% had mastoid antrum involvement. Around 88.3% had absent aeration mastoid. Almost 46.7% had malleus erosion, 55% had incus erosion and 46.7% had stapes erosion. It was observed that CT scanning had highest sensitivity of 100% in identifying intact ossicles, soft tissue mass, attic involvement and highest specicity of 100% in identifying attic involvement, aeration mastoid absence, malleus erosion, Incus erosion, stapes erosion and Cholesteatoma. In this study, highest accuracy (100%) was noted for identication of attic involvement followed by intact ossicles (95.2%) for HRCT temporal bone. In this study, the accuracy of oto-endoscopy in identifying the pathology in CSOM patients was very high. About 100% accuracy was noted for intact ossicles, tympanic membrane perforation and ossicular necrosis. A 95% of accuracy was found for cholesteatoma and 93.3% for attic involvement. In this study, it was also observed that intact ossicles, tympanic membrane perforation, attic involvement and ossicular necrosis can be predicted accurately with otoendoscopy and CT scan prior to uptake of patient for surgery. In this study, it was observed that intact ossi Conclusions: cles, tympanic membrane perforation, attic involvement and ossicular necrosis can be predicted accurately with otoendoscopy and CT scan prior to uptake of patient for surgery. HRCT temporal bone imaging should be used as an investigative tool in pre-operative evaluation of chronic suppurative otitis media attico-antral disease cases. Early diagnosis of the bony status, granulations, discharge, facial canal dehiscence with the help of HRCT temporal bone can help the surgeon in predicting the prognosis of patient better preoperatively.