A PROSPECTIVE STUDY OF HEARING OUTCOME IN CANAL WALL DOWN MASTOIDECTOMY WITH TYMPANOPLASTY

Abstract

Introduction: Tympanoplasty with a mastoidectomy that preserves the bony external auditory canal is referred to as closed technique or integrated approach tympanoplasty. Sheehy and Janson first introduced this method as a way to enhance the traditional mastoidectomy. This dual approach aims to preserve the bone external auditory canal while eradicating infected foci. When compared to a traditional mastoidectomy, this technique avoids leaving the mastoid cavity exposed and does not necessitate routine cleaning of the operative cavity of dry scabs. By wearing hearing aids or participating in water sports, patients' hearing can still be kept in good
condition. This approach so better satisfies the requirements of pathophysiology. Materials and methods: This study is a prospective study conducted on 132 patients at the department of ENT, Rangaraya Medical College, Kakinada, between January 2023 and October
2023. Patients with chronic otitis media with cholesteatoma involving the middle ear and mastoid who will require a canal wall down mastoidectomy with tympanoplasty were included. Patients who were enrolled into the study were thoroughly examined. A complete ENT examination was performed. The involved ear was examined using an ear endoscope and microscope and the findings were recorded. A pure tone audiometry was performed, pure tone thresholds and air bone gap (ABG) in the speech frequencies was determined.
Results: 132 patients were enrolled into the study. There were 76 males and 56 females with a male to female ratio of 1. 35:1. The age ranged from 7 years to 48 years with a mean age of 23. 25 years. Thirty patients underwent canal wall down mastoidectomy with type 3 tympanoplasty. Canal wall down mastoidectomy with tympanoplasty using homograft septal spur cartilage as long columella was done in 72 patients. The hearing results were as follows. The preoperative mean air bone gap was 38. 10 dB and the post-operative mean air bone gap was 29.30 dB with a gain of 8.8 dB.

Conclusion: Canal wall down mastoidectomy with tympanoplasty is a good surgical procedure for chronic otitis media with cholesteatoma. A modest closure of the air bone gap can be expected helping the patient to achieve acceptable social hearing levels.