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Background
Chronic otitis media is a permanent abnormality of the pars tensa or flaccida [1]. The most common symptoms at presentation are ear discharge and decreased hearing. The diagnosis is made by otoscopy, and hearing loss can be assessed with the help of a Pure Tone Audiogram.
Definitive treatment of COM is performed surgically with the help of tympanoplasty. Tympanoplasty is the surgical procedure performed to repair a perforated tympanic membrane, with/ without reconstruction of the ossicles.
The goals of tympanoplasty as a treatment for chronic otitis media are, to obtain a disease-free ear and to achieve hearing improvement. Prerequisite factors for successful tympanoplasty are normal cochlear reserve and functioning Eustachian tube.
There are various factors which can affect the outcome of tympanoplasty. The most commonly considered factor is otorrhoea. Graft uptake will be better in a dry ear as compared to discharging ear. Patients with history of smoking have a low graft uptake as compared to non-smokers. The presence of cholesteatoma with ossicular discontinuity also has a negative impact on the surgical outcome.
Discontinuity of the ossicular chain and necrosis is also a sequelae of COM. Depending on the severity of the disease, there can be gradual erosion of the ossicles which has a negative impact on the hearing outcome.
Hence, these risk factors can be prognostic indicators for the graft uptake and hearing outcome following ear surgery. These factors can be assessed pre-operatively by the Middle Ear Risk Index.
MERI was developed by Kartush (Table 1). It generates a numeric indicator of the severity of the middle ear disease to stratify patient groups according to the severity of the disease which helps in predicting the outcome of tympanoplasty.
Table 1. MERI
There are very few studies available in literature which are conclusive about the direct correlation of the Middle Ear Risk Index and the outcome on hearing following tympanoplasty. Given the common occurrence of this middle ear pathology and lack of definite verdict on the use of MERI, we decided to take up this study to substantiate the correlation between the Middle Ear Risk Indices and hearing outcome following tympanoplasty.
Methods
This prospective observational study was conducted in the Department of Otorhinolaryngology at KS Hegde Charitable Hospital. Subjects diagnosed with chronic otitis media...