Hearing Results On Patients With Choronic Otitis Media After Surgical Treatment

Objective To investigate the different influence of the hearing results following surgical treatment in patients of choronic otitis media.Methods 148 cases of choronic otitis media with surgical treatment all by author were followed up retrospectively 3 monthes and 1 year after surgery from March 2007 to May 2008.66 of male cases and 82 of female cases account for all the 148 cases.Otorrhea and progressing hearing decrease were the major symptom in all cases within which 43 of tinitus,26 of ear pain,11 of vertigo,1 of total unilateral deafness,50 of bilateral choronic otitis media and 15 of revision surgery were found.PTA and CT scan were perpetrated for all these cases.Hearing assessment was based on the PTA result and 0.5KHz,1KHz,2KHz were averaged for both air conduction and bone conduction.We use postoperative bone conduction and postoperative air conduction for calculating postoperative ABG.An additional high frequency bone coduction of average value of 2KHz,4KHz was estimated.All values were exhibitted as Mean±SD and statistically worked by SPSS 16.0.All surgery treatment made by author,with canal wall down tympanipalsty on 125 cases,canal wall up tympanipalsty on 17 cases,and myringoplasty on 6 cases.84 of PORP(Partial ossicular reconstruction prothesis),3 of TORP(Total ossicular reconstruction prothesis) and 11 of tragus cartilage were placed into middle ears for ossiccular reconstruction.We regularly interpositioned the cartilage chip between prothesis and tympanic membrane.Results During the follow-up we discovered 3 cases(3/148,2%) of tiny membrane perforation and 27 cases(27/148,18.2%) of tinitus.2 of the cases which received PORP implantation complained the recuurent otitis media and one resulted extrusion of prothesis(1/87,1.1%).Post-AC for 84 of PORP implanted cases was 39.6±14.9dB,improved by 13.9±13.2dB compared with the preoperative outcome;Average ABG was 20.5±8.5dB,improved by 8.8±10.7dB,47 of the 84 cases resulted ABG value less than 20dB(47/84,55.95%);High frequency bone conduction changed by 0.7±10.5dB.Statistically it was different of AC and ABG campared preoperative value with postoperative value(P＜0.001)(tab1).No Statistic difference was found in AC of 0.5KHz,1KHz,2KHz frequency(P＞0.05);Nevertheless ABG of 2KHz showed a unsatisfactory outcome than that of 0.5KHz,1KHz(P＜0.001)(tab2).Table 3 showed the ABG bins for the PORP group.Post-AC for 11 of ossicular reconstruction with autocartilage cases was 47.1±17.3dB,improved by 5.0±19.6dB;ABG was 26.2±12.8dB,changed by 3.2±16.5dB,6 of the 11 cases resulted ABG value less than 20dB(6/11, 54.5%);High frequency bone conduction changed by 3.6±10.9dB.Statistically difference was not found between preoperative value and postoperative value(P＞0.05).Post-AC for 3 of TORP cases was 42.7±16.4dB,improved by 14.4±9.5dB; ABG was 22.8±10.7dB,changed by 12.8±3.5dB,2 of the 3 cases resulted ABG value less than 20dB(2/3,66.7%);High frequency bone conduction changed by 6.7±11.3dB.Statistically difference was not found between preoperative value and postoperative value(P＞0.05).No statistic estimation was committed due to case insufficiency.Post-AC for 6 of myringoplasty cases was 21.1±4.3dB,improved by 13.6±7.2dB;ABG was 11.1±4.2dB,changed by 6.7±4.2dB,6 of the 6 cases resulted ABG value less than 20dB(6/6,100%);High frequency bone conduction changed by 3.8±9.2dB.Statistically difference was not found between preoperative value and postoperative value(P＞0.05).17 cases perpetrated with the canal wall up tympanoplasty in which the ossicular chain was reserved.Post-AC for 17 of that cases was 31.7±9.3dB,improved by 8.2±9.5dB;ABG was 15.8±6.3dB,changed by 3.8±9.4dB.High frequency bone conduction changed by 4.0.±7.9dB.No satistic significance was found in postoperatively hearing results beween noncholesteatoma otitis media and cholesteatoma otitis media(P＞0.05),and no satistic significance beween tympanosclerosis and nontympanosclerosis(P＞0.05),also between revision surgery and first surgery(P＞0.05).There was satistically significance found when comparing unilateral COM with bilateral COM(P=0.048).Conclusions It is satisfactory results for COM with surgical treatment and it is better using hydroxyapatite prothesis for ossicular chain reconstruction with cartilage interpositioned between tympanic membrane and prothesis.Closer follow-up is needed for bilateral COM.