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How Does Preoperative Pure Tone Audiometry Relate to the Findings at Surgery to Explain the Hearing Status in Chronic Otitis Media? [Medeniyet Med J]
Medeniyet Med J. 2023; 38(1): 16-23 | DOI: 10.4274/MMJ.galenos.2023.30509  

How Does Preoperative Pure Tone Audiometry Relate to the Findings at Surgery to Explain the Hearing Status in Chronic Otitis Media?

Sharafali KADAMBOTT1, Prasanta KUMAR GURE1, Soumya GHATAK2, Mainak DUTTA1, Chandan SETH3, Saumik DAS4, Ramanuj SINHA1
1Medical College and Hospital, Clinic of Otorhinolaryngology and Head-Neck Surgery, Kolkata, West Bengal, India
2Maharaja Jitendra Narayan Medical College and Hospital, Clinic of Otorhinolaryngology and Head-Neck Surgery, Coochbehar, West Bengal, India
3M. R. Bangur Superspeciality Hospital, Clinic of Otorhinolaryngology and Head-Neck Surgery, Kolkata, India
4North Bengal Medical College and Hospital, Clinic of Otorhinolaryngology and Head-Neck Surgery, Siliguri, West Bengal, India

Objective: Pure tone audiometry (PTA) guides surgical decision-making in chronic otitis media (COM), and PTA values depend upon the type and extent of COM.
Methods: Our cross-sectional study included patients with COM with/without cholesteatoma who were scheduled for surgery. Findings on examination of the middle ear under the microscope and at surgery which could explain the hearing loss were corroborated with preoperative PTA through appropriate statistical methods.
Results: The study included 114 patients (mean age: 31.07 years; range: 7-57). Following preoperative PTA, 50% of patients had moderate hearing loss and ~73% had air-bone gap (ABG) <35 dB. Conductive hearing loss affected 109 patients (97.61%); five had mixed hearing loss. At surgery, 27 patients (23.68%) had ossicular discontinuity, with the incus being the most affected. Twenty-one patients in this group had ABG ≥35 dB. Perforations involving the anterior and posterior halves of the pars tensa, and subtotal perforations, demonstrated the maximum mean hearing loss [45.39±8.29 dB HL (p=0.075), 51.08±12.51 dB HL (p=0.26), respectively]. The mean pure tone average in the intact ossicles group was 43.62±8.07 dB HL and that in the absent/eroded ossicles group was 58.15±11.05 dB HL (p<0.0001); the mean ABG was 27.89±4.77 dB and 38.88±6.47 dB, respectively (p<0.0001).
Conclusions: Hearing loss was significantly associated with the size but not the site of the central perforation. With ossicular discontinuity, hearing loss and ABG deteriorated significantly. The findings re-establish the relationship between preoperative PTA and the middle ear status which should help surgeons plan surgery and counsel patients regarding hearing outcomes.

Keywords: Chronic otitis media, pure tone audiometry, cholesteatoma, conductive hearing loss, mixed hearing loss


Kronik Otitis Mediada İşitme Durumunu Açıklamak için Preoperatif Saf Ton Odyometri ile Ameliyat Bulguları Arasındaki İlişki Nedir?

Sharafali KADAMBOTT1, Prasanta KUMAR GURE1, Soumya GHATAK2, Mainak DUTTA1, Chandan SETH3, Saumik DAS4, Ramanuj SINHA1
1Medical College and Hospital, Clinic of Otorhinolaryngology and Head-Neck Surgery, Kolkata, West Bengal, India
2Maharaja Jitendra Narayan Medical College and Hospital, Clinic of Otorhinolaryngology and Head-Neck Surgery, Coochbehar, West Bengal, India
3M. R. Bangur Superspeciality Hospital, Clinic of Otorhinolaryngology and Head-Neck Surgery, Kolkata, India
4North Bengal Medical College and Hospital, Clinic of Otorhinolaryngology and Head-Neck Surgery, Siliguri, West Bengal, India

Amaç: Saf ton odyometrisi (PTA), kronik otitis mediada (KOM) cerrahi karar vermeye rehberlik eder ve PTA değerleri, KOM’nin tipine ve kapsamına bağlıdır.
Yöntemler: Kesitsel çalışmamıza ameliyat planlanan kolesteatomlu/kolesteatomsuz KOM’li hastalar dahil edildi. Orta kulağın mikroskop altında ve ameliyat sırasındaki işitme kaybını açıklayabilecek bulguları preoperatif PTA ile uygun istatistiksel yöntemlerle desteklendi.
Bulgular: Çalışmaya 114 hasta dahil edildi (ortalama yaş: 31,07 yıl; aralık: 7-57). Preoperatif PTA’yı takiben, hastaların %50’sinde orta derecede işitme kaybı vardı ve ~%73’ünde hava-kemik aralığı (ABG) <35 dB idi. İletim tipi işitme kaybı 109 hastayı etkiledi (%97,61); beşinde mikst işitme kaybı vardı. Ameliyatta 27 hastada (%23,68) ossiküler süreksizlik görüldü ve en çok inkus etkilendi. Bu gruptaki 21 hastanın ABG’si ≥35 dB idi. Pars tensanın anterior ve posterior yarısını içeren perforasyonlar ve subtotal perforasyonlar maksimum ortalama işitme kaybını gösterdi [sırasıyla 45,39±8,29 dB HL (p=0,075), 51,08±12,51 dB HL (p=0,26)]. Ortalama saf ton ortalaması intakt kemikçik grubunda 43,62±8,07 dB HL ve yok/aşınmış kemikçik grubunda 58,15±11,05 dB HL (p<0,0001) idi; ortalama ABG sırasıyla 27,89±4,77 dB ve 38,88±6,47 dB idi (p<0,0001).
Sonuçlar: İşitme kaybı, merkezi perforasyonun yeri ile değil, boyutu ile önemli ölçüde ilişkiliydi. Ossiküler süreksizlik ile işitme kaybı ve ABG önemli ölçüde kötüleşti. Bulgular, preoperatif PTA ile orta kulak durumu arasındaki ilişkiyi yeniden oluşturur ve bu da cerrahların ameliyatı planlamalarına ve hastalara işitme sonuçları konusunda danışmanlık yapmalarına yardımcı olur.

Anahtar Kelimeler: Kronik otitis media, saf ses odyometrisi, kolesteatom, iletim tipi işitme kaybı, mikst işitme kaybı


Sharafali KADAMBOTT, Prasanta KUMAR GURE, Soumya GHATAK, Mainak DUTTA, Chandan SETH, Saumik DAS, Ramanuj SINHA. How Does Preoperative Pure Tone Audiometry Relate to the Findings at Surgery to Explain the Hearing Status in Chronic Otitis Media?. Medeniyet Med J. 2023; 38(1): 16-23

Corresponding Author: Mainak DUTTA, India


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