A comparative study of myringoplasty versus cortical mastoidectomy with type I tympanoplasty in tubotympanic chronic suppurative otitis media
DOI:
https://doi.org/10.18203/2320-6012.ijrms20260351Keywords:
Chronic suppurative otitis media, Cortical mastoidectomy, Hearing outcome, Myringoplasty, Tubotympanic disease, TympanoplastyAbstract
Background: Chronic suppurative otitis media (CSOM) of the tubotympanic (mucosal) type is a common cause of preventable conductive hearing loss in developing countries. Although myringoplasty remains the standard surgical treatment for dry ears, the role of cortical mastoidectomy combined with type I tympanoplasty in improving anatomical and functional outcomes continues to be debated, particularly in patients with persistent mucosal disease. Objective was to compare the anatomical and audiological outcomes of myringoplasty versus cortical mastoidectomy with type I tympanoplasty in patients with tubotympanic (mucosal) CSOM.
Methods: This prospective comparative interventional study was conducted at a tertiary care centre in rural Telangana over an 18-month period. Eighty patients aged 18 to 65 years with tubotympanic CSOM were enrolled and allocated into two groups: group A (myringoplasty, n=40) and group B (cortical mastoidectomy with type I tympanoplasty, n=40). Baseline demographic variables, disease characteristics, and preoperative air-bone gap (ABG) were comparable between groups. Primary outcome measures included graft uptake and postoperative ear status, while secondary outcomes included audiological improvement assessed by ABG closure and hearing gain. Statistical analysis was performed using appropriate parametric and non-parametric tests, with p<0.05 considered statistically significant.
Results: The overall graft uptake rate was 92.5% in group A and 97.5% in group B, with no statistically significant difference between the groups (p=0.305). Postoperative ear healing at 3 and 6 months showed similar outcomes in both groups. The mean preoperative ABG was comparable between group A (29.55±5.51 dB) and group B (31.45±5.05 dB). However, group B demonstrated significantly greater audiological improvement, with higher mean ABG closure (24.07±3.28 dB versus 21.45±4.25 dB; p=0.003) and hearing gain (22.07±3.28 dB versus 19.53±4.23 dB; p=0.004). Postoperative complications were infrequent and did not differ significantly between the groups.
Conclusions: Both myringoplasty and cortical mastoidectomy with type I tympanoplasty provide high rates of graft uptake and satisfactory postoperative healing in tubotympanic CSOM. However, the addition of cortical mastoidectomy is associated with significantly greater audiological improvement.
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Kesari SP, Paul S, Dey R. To study the burden and risk factors for chronic suppurative otitis media in a population of Sikkim, India: a hospital based study. Indian J Otolaryngol Head Neck Surg. 2022;74(Suppl 3):4117-24. DOI: https://doi.org/10.1007/s12070-021-02855-8
Monasta L, Ronfani L, Marchetti F, Montico M, Brumatti LV, Bavcar A, et al. Burden of disease caused by otitis media: systematic review and global estimates. PLoS One. 2012;7(4):e36226. DOI: https://doi.org/10.1371/journal.pone.0036226
Onifade A, Wa Katolo H, Mookerjee S, Bhutta MF. Epidemiology of chronic suppurative otitis media: systematic review to estimate global prevalence. J Epidemiol Glob Health. 2025;15(1):55. DOI: https://doi.org/10.1007/s44197-025-00396-9
Bhutta MF, Leach AJ, Brennan-Jones CG. Chronic suppurative otitis media. Lancet. 2024;403(10441):2339-48. DOI: https://doi.org/10.1016/S0140-6736(24)00259-9
Kumar N, Chilke D, Puttewar MP. Clinical profile of tubotympanic CSOM and its management with special reference to site and size of tympanic membrane perforation, Eustachian tube function and three flap tympanoplasty. Indian J Otolaryngol Head Neck Surg. 2012;64(1):5-12.
Alam SMM, Tarafdar KH, Rahman SH, Mahfuz MSI. Different types of presentation of chronic suppurative otitis media (CSOM). Saudi J Arts Med Sci. 2020;8(3):916-20. DOI: https://doi.org/10.36347/sjams.2020.v08i03.023
Kumar N, Chilke D, Puttewar MP. Clinical profile of tubotympanic CSOM and its management with special reference to site and size of tympanic membrane perforation, Eustachian tube function and three flap tympanoplasty. Indian J Otolaryngol Head Neck Surg. 2012;64(1):5-12. DOI: https://doi.org/10.1007/s12070-010-0114-5
Sharma DK, Singh S, Sohal BS, Singh B. Prospective study of myringoplasty using different approaches. Indian J Otolaryngol Head Neck Surg. 2009;61(4):297-300. DOI: https://doi.org/10.1007/s12070-009-0086-5
Upadhyay DV. Assessment of hearing outcome in patients undergoing myringoplasty. Int J Life Sci. 2024;13(1):184-8.
Narayanan S. Graft materials used in myringoplasty: our experience. MIJOENT. 2018;7(3):19-21. DOI: https://doi.org/10.26611/1016733
Villardo RJM, Doyle WJ. Middle ear pressure regulation: complementary active actions of the mastoid and the Eustachian tube. Laryngoscope. 2011;121(2):404-8. DOI: https://doi.org/10.1002/lary.21275
Black B, Gutteridge I. Risk factors for myringoplasty failure. Clin Otolaryngol Allied Sci. 2001;26(2):152-7.
Bajaj AR, Sheikh S, Joshi S, Paike B. Benefit of tympanoplasty with or without cortical mastoidectomy in active mucosal otitis media: a comparative study. Bengal J Otolaryngol Head Neck Surg. 2019;27(1):260-65. DOI: https://doi.org/10.47210/bjohns.2019.v27i1.229
Guthikonda MR, Gude A, Naga R. Role of mastoidectomy with type 1 tympanoplasty in paediatric patients with poor contralateral ear status. Indian J Otolaryngol Head Neck Surg. 2022;74(Suppl 1):631-8. DOI: https://doi.org/10.1007/s12070-021-02457-4
Gayathri H, Balachandran K, Rathnasamy P, Paul CM. Factors influencing decision making among ENT surgeons on performance of cortical mastoidectomy for CSOM-tubotympanic disease in quiescent/active stage: an opinion based study. Int J Otorhinolaryngol Head Neck Surg. 2017;3(1):29-36.
Agrawal A, Bhargava P. Comparative evaluation of tympanoplasty with or without mastoidectomy in treatment of chronic suppurative otitis media tubotympanic type. Indian J Otolaryngol Head Neck Surg. 2017;69(2):172-5.
Aggarwal D, Vemu S, Kapur S. Tympanoplasty with and without cortical mastoidectomy in treatment of inactive mucosal chronic otitis media. Int J Otorhinolaryngol Head Neck Surg. 2019;5(4):858-65. DOI: https://doi.org/10.18203/issn.2454-5929.ijohns20192554
Gayathri H, Balachandran K, Rathnasamy P, Paul CM. Factors influencing decision making among ENT surgeons on performance of cortical mastoidectomy for CSOM-tubotympanic disease in quiescent/active stage: an opinion based study. Int J Otorhinolaryngol Head Neck Surg. 2017;3(1):29-36. DOI: https://doi.org/10.18203/issn.2454-5929.ijohns20163648
Wang PC, Jang CH, Shu YH, Tai CJ, Chu KT. Cost-utility analysis of tympanomastoidectomy for adults with chronic suppurative otitis media. Otolaryngol Head Neck Surg. 2005;133(3):356-362. DOI: https://doi.org/10.1016/j.otohns.2005.05.045
Balyan FR, Celikkanat S, Aslan A, Taibah A, Russo A, Sanna M. Mastoidectomy in noncholesteatomatous chronic suppurative otitis media: is it necessary? Otolaryngol Head Neck Surg. 1997;117(6):592-5. DOI: https://doi.org/10.1016/S0194-59989770038-X
Tawab HMA, Gharib FM, Algarf TM, ElSharkawy LS. Myringoplasty with and without cortical mastoidectomy in treatment of non-cholesteatomatous chronic otitis media: a comparative study. Clin Med Insights Ear Nose Throat. 2014;7:19-23. DOI: https://doi.org/10.4137/CMENT.S17980
Agrawal A, Bhargava P. Comparative evaluation of tympanoplasty with or without mastoidectomy in treatment of chronic suppurative otitis media tubotympanic type. Indian J Otolaryngol Head Neck Surg. 2017;69(2):172-5. DOI: https://doi.org/10.1007/s12070-016-1038-5
Indorewala S, Adedeji TO, Indorewala A, Nemade G. Tympanoplasty outcomes: a review of 789 cases. Iran J Otorhinolaryngol. 2015;27(79):101-8.
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