Anterior epitympanic attic antrum space obstruction and symptom onset associated with myringosclerosis in benign chronic suppurative otitis media
DOI:
https://doi.org/10.18203/2320-6012.ijrms20202235Keywords:
AAA space obstruction, Benign CSOM, Myringosclerosis, Symptoms onsetAbstract
Background: The AAA (Anterior epitympanic, Attic, and Antrum) space is the space between the mastoid and middle ear which functions to balance the pressure in both organs (buffer). Pathological tissue in the AAA cavity due to chronic infection would disrupt the buffer function and could change the morphology of the mucosa in the tympanic membrane and middle ear. Obstruction in the AAA space measured subjectively by observing the smoothness of the flow using saline solution has been shown to be associated with a plaque in the tympanic membrane (myringosclerosis) in Chronic Otitis Media (COM) patients. This study aims to determine the relationship between AAA space obstructions with myringosclerosis using CT-Scan for an objective result.
Methods: Retrospective study with case-control approach used in this study. Case criterias are Chronic Suppurative Otitis Media (CSOM) patients with myringosclerosis, both men and women and age 15-50 years, while the control group are benign CSOM patients without myringosclerosis. Data were analyzed with the chi-square test to prove the association between the AAA space status and length of symptom onset with myringosclerosis.
Results: During January 2017-December 2019 there were 33 respondents, 19 cases and 14 controls, 21 men and 12 women with an average age of 35 years (cases) and 23.5 years (control). The length of symptom onset more than 5 years (p <0.05, OR 6.94 with CI 0.5-1.5) and AAA space obstruction (p <0.05 OR 34.25 with CI 0.8-1.8) has been shown to be associated with myringosclerosis in people with benign CSOM.
Conclusions: AAA space obstruction and symptom onset more than 5 years significantly associated with myringosclerosis.
References
Mansour S, Magnan J, Haidar H, Nicholas K, Louryan S. Middle ear cavity In: C Zini, Saccardi MS, K Nicholas, S Louryan, eds. Comprehensive and clinical anatomy of middle ear. Springer Cham, Heidelberg; NewYork: Dordrecht London; 2013: 5-7.
Gray S, Lusk RP. Tympanic membrane-tympanostomy tubes. In: Cummings CW, Fredrickson JM, Harker LA, Krause LE, Schuller DE, eds. Otolaryngology-Head and Neck Surgery, 2nd ed. St Louis: Mosby Year Book, 1993: 2971-2977.
Yurttaş V, Ural A, Kutluhan A, Bozdemir K. Factors that may affect graft success in tympanoplasty with mastoidectomy. ENT Updates. 2015 Apr 1;5(1):9-12
Badran HS, Tawab HM, Wahba BM, Abulnasr KM. Myringosclerosis with chronic safe suppurative otitis media: hearing outcome after surgical management according to myringosclerotic patch site and inclusion in the surgery. J Int Adv Otol. 2014 Oct 1;10(3):260.
Pal I, Sengupta A. Clinicopatthological and audiological study of tympanosclerosis. Ind J Otholaryngol Head Neck Surg. 2005;67(3):235-9.
Yetifer S, Hidir Y, Deveci MS. Morphologic changes of middle ear mucosa in chronic otitismedia with or without cholesteatoma. Mediterr J Otol. 2008;4:102-8.
Baghat M. Patency of the Aditus Ad Antrum in Tubotympanic Chronic Suppurative Otitis Media. Available at: http://www.sagepublications.com. Accessed 2 January 2020.
Manjunatth MK, Sworup RJ, Charry G, Shadab MD. Myringosclerosis: An indication of a blocked aditus. Ind J Otolaryngol Head Neck Surg. 2012;64(3):230-2.
Browner WS, Newman TB, Hulley SB. Estimating sample size and power: application and examples. In: Hulley SB, Cummimng SR, Browner WS, Grady DG, Newman TB, eds. Designing Clinical Research 2013 4rd Ed. Philadelpia: lippincott Williams & Wilkins; 2013: 55-81.
Alabassi AM, Alsaimary IE, Najim JM. Prevalence and patterns of chronic suppurative otitis media and hearing impairement in Basarh city. J Medi Sci. 2010;1(4):129-33.
De Antonio R, Yarzabal JP, Crus JP, Schmidt JE, Kleijnen J. Epidemiology of otitis media in children from developing countries: A systematic review. Int J Paediatr Otolaryngol. 2016;85:65-74.
Anggraeni R, Hartanto WW, Djelantik B, Ghanie A, Utama DS, Setiawan EP, et al. Otitis media in Indonesian urban and rural school children. Pediatr Infect Dis J. 2014 Oct 1;33(10):1010-5.
George MV. The mastoid compartment of middle ear cleft-a clinic pathological study in patients with chronic otitis media-mucosal type. Exp Rhinol Otolaryngol. 2018;1(5):85-90.
El-Kady AS, Haroun Y, Kaseem KM, Galal O. The value of computed tomography scanning in assessment aditus ad antrum patency and choice of treatment line in revision myringoplasty. Med J Cairo Univ. 2009;77(2):53-7.
Anbarasu A, Chandrasekaran K, Balakrishan S. Soft tissue attenuation in middle ear on HRCT:pictoral review. Ind J Radiol Imag. 2012;22:298-304.
Gorur K, Ozcan C, Talas DU. The computed tomographic and tympanometrical evaluation of mastoid pneumatization and attic blockage in patients with chronic otitis media with effusion. Int J Pediatr Otorhinolaryngol. 2006;70:481-5.
Marchioni D, Mattioli F, Alicandri-Ciufelli M, Molteni G, Masoni F, Presutti L. Endoscopic evaluation of middle ear ventilation route blockage. Am J Otolaryngol Head Neck Surg Medi Surg. 2010;31:453-66.
Shirai K, Schachern PA, Schachern MG, Paparella MM, Cureoglu S. Volume of the epitympanum and blockage of the tympanic isthmus in chronic otitis media: a human temporal bone study. Otolo Neurotol. 2015;36(2):254-259.
Marchioni D, Grammatica A, Alicandri-Ciufelli M, Aggazzotti-Cavazza E, Genovese E, Pressuti L. The contribution of selective dysventilation to attical middle ear pathology. Medi Hypoth. 2011;77:116-120.
