Patency of Aditus Ad Antrum in Chronic Otitis Media Mucosal Type Undergoing Tympanoplasty

Abstract

INTRODUCTION
Chronic otitis media (COM) mucosal type is a prevalent condition characterized by chronic inflammation of the middle ear, often leading to persistent ear discharge and tympanic membrane perforation. This study aimed to evaluate the patency of the aditus ad antrum in patients undergoing tympanoplasty and assess various factors influencing its blockage. Understanding these factors will help optimize surgical outcomes and reduce the need for repeat procedures.

MATERIAL AND METHODS
A prospective observational study was conducted at the Universal College of Medical Sciences (UCMS), Bhairahawa, Nepal. Sixty patients with COM mucosal type undergoing tympanoplasty after optimal medical management were evaluated based on various  factors. These  factors  included  age,  site  and  size  of  tympanic  membrane  perforation,  duration  of  the  disease, contralateral tympanic membrane status, middle ear mucosa status, and mastoid pneumatization. The patency of the aditus ad antrum was assessed intraoperatively, and data were collected using otoscopic examination and intraoperative findings. Statistical analysis was performed to identify associations between these variables and the blockage of the aditus ad antrum.

RESULTS
Sixty patients were enrolled in the study, comprising 44 males and 16 females, with a mean age of 43.82 years (range: 28-60 years). The average disease duration was 19.93 months (range: 8-60 months). Middle ear mucosa status showed 50% normal, 30.0% edematous, and 20.0% myringosclerosis. The patency status of the aditus ad antrum was not significantly associated with gender, disease duration, contralateral TM status, or mastoid pneumatization, with p-values of 0.243, 0.424, 0.084, and 0.273, respectively. A significant association was found with the middle ear mucosa status. These results indicate that middle ear mucosa status is a significant factor influencing aditus ad antrum patency (p = 0.038).

CONCLUSION
The findings suggest that the necessity of mastoidectomy in tympanoplasty for COM mucosal type should be based on specific middle ear mucosa findings, rather than being a standard procedure for all patients.