OUTCOME OF MYRINGOPLASTY WITH AND WITHOUT CORTICAL MASTOIDECTOMY" - A COMPARATIVE STUDY
Dr. Bithi Bhowmik* and Dr. Shamshad Begum
Background: The management of chronic otitis media has witnessed a profound change over the last century. Development in microbiology and availability of better antibiotics together with emphasis on preserving hearing has further modified the approach to its management. Well trained, experienced otologists currently remain divided as to the importance of mastoidectomy in the treatment of uncomplicated otitis media. The use of mastoidectomy as a means to establish drainage of a complicated infection of the ear sparks little controversy. Objective: The aim of the study was to compare the graft take rate and hearing improvement of uncomplicated tympanic membrane perforations with myringoplasty alone and when combined with mastoidectomy. Methods: This was interventional and observational type of cross-sectional study. Purposive samplings of the central perforation and tubotympanic disease patients admitted in Dhaka Medical College Hospital were enrolled for study. Sample size was 60. Detail demographic data were collected from the informant and recorded in structured case record form. Clinical examination and relevant investigation were done meticulously. All collected questionnaire checked very carefully to identify the error in the data. Data processing work consist of registration schedules, editing computerization, preparation of dummy table, analyzing and matching of data. Result: Present study included 60 patients who were divided randomly into two groups; group 1 (myringoplasty alone) included 30 patients and Group 2 (myringoplasty with cortical mastoidectomy) also included 30 patients. Overall demographic features of 60 patients are shown in Table 1. In the study, the maximum incidence was in the age group 12-30 years 43(71.6%), with mean age of the patient was 27.6 ± 7.52 years. Male and female ratio was 1.85:1. Large numbers of respondents came from urban area (51%), and patients of poor class 27(45.0%) comprising the major percentage of the patients, no significant differences was found between groups with respect to age & gender. Preoperatively, in both the groups, majority of cases had AB gap >25 dB (n=12; 40% in Group I and n=11; 36.6% in Group II). Mean AB gap in Group I was 23.7±6.3 as compared to 23.5±6.9 dB in Group II. Statistically, this difference was not significant either for categorical difference (p=0.315) or for mean difference (p=0.076) between the two groups. Conclusion: Chronic suppurative otitis media (CSOM) of tubo-tympanic type is typically a persistent disease of the middle ear cleft, clinically manifesting with deafness and discharge. The management of CSOM safe type includes control of middile ear and mastoid infection with appropriate medical line of therapy, eradication of septic foci followed by closure of tympanic membrane perforation.
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