Surgical Outcomes of Revision Tympanoplasty in Mucosal Type of CSOM: our Experience

INTRODUCTION:  Tympanoplasty is defined as the surgical correction of the tympanic membrane perforation along with reconstruction of ossicular chain.[3]     The results of tympanoplasty almost always depend on the pathological state of the middle ear as well as skill of the surgeon[7,8]. The success rate of revision tympanoplasty for safe type of chronic suppurative otitis media is not uniformly evaluated in literature[6]. Although morphological results for primary and revision tympanoplasty are same,  recurrent tympanic membrane perforations do occur in the field of otology for a long time, and often the failed attempt is due to factors beyond the surgeon’s control[6,9]. In this study the interrelation between multiple pre-operative parameters and post-operative morphological parameters such as closure of perforation and functional-hearing level outcomes were analysed. OBJECTIVE: To evaluate the outcomes  of revision Tympanoplasty. To compare the results of primary and revision tympanoplasty using different graft materials.To analyse the effect of possible influencing factors such as tympanic membrane perforation size, perforation site, and contralateral ear condition on closure of tympanic membrane and hearing improvement. MATERIALS AND METHODS: A prospective study with 30 patients aged between 15-65 years presenting with residual or recurrent central tympanic membrane perforation after previously unsuccessful reconstruction of tympanic membrane and no active infection for at least 3 months and those who had conductive type of hearing loss were included in the study.The study was conducted in the department of ENT after obtaining ethical committee clearance. Details of the patients such as Perforation site and size, middle ear condition, surgical technique, graft material used, pre- and postoperative otoendoscopic findings and functional (pure tone audiometry hearing test) outcomes were analysed. RESULTS: The success rate of the tympanic membrane perforation closure was 83.33% ( 25 of 30 patients) and failure rate was 16.67% ( 5 of 30 patients) in revision Tympanoplasty surgery. Graft uptake was more in cases with smaller size perforation (less than 50% of TM) 90.34% than in cases with large perforation (more than 50% of TM) 72.33%(P value- 0.002,statistically significant). Graft uptake was 91.78% with opposite ear being normal and 76%(P value-0.001,statiscally significant) in defective opposite ear (tympanic membrane retraction without cholesteatoma). We found no notable difference in graft uptake results with usage of different types of graft materials such as cartilage or bone grafts. 80% (24 of 30 patients) showed improvement in air-bone gap of 10-20 decibels while the remaining 20% (6 of 30 patients) did not have any improvement in air bone gap. CONCLUSION: Tympanoplasty is the surgical correction of the tympanic membrane perforation along with ossicular chain reconstruction. The success rate of Revision tympanoplasty depends on the pathological diseased state of the middle ear as well as the surgeon’s skill. Status of Opposite Ear being either diseased or Normal also Plays an important role in Success Rate.  Ultimately Proper and Complete Eradication of middle ear disease , followed by Ossiculoplasty and Myringoplasty plays  an important basis of improved  Success Rate especially in Revision  Surgical  Cases