Pakistan Journal of Medical Sciences

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ISSN 1681-715X

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ORIGINAL ARTICLE

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Volume 25

October - December 2009 (Part-II)

Number  6


 

Abstract
PDF of this Article

Does surgery of chronic otitis media
cause sensori neural hearing loss?

Khosro Iranfar1, Shirin Iranfar2

ABSTRACT

Objective: To determine the relationship of sensori neural hearing loss and surgery for chronic otitis media.

Methodology: This study was designed as a clinical trial on 90 patients with chronic otitis media (COM), who were admitted in hospital for Tympanoplasty and Mastoidectomy who were selected for the study. A pre and post, bone conduction hearing test was performed in frequencies 250 to 4000 HZ. By means of AMPLID319, auditory tests were performed in one audiometric center by one expert audiologist. Other variables like age, gender, kind of surgery, diagnosis of the lesion of the middle ear and duration of drilling were investigated and evaluated too. Then descriptive and inferential statistics were utilized to evaluate hearing level before and after surgery.

Result: Age of subjects was 25.1±10.7. About 53.3% of cases were females. Cholesteatomas was the most common diagnosed disease in middle ear (37.8%). Drilling duration was 31.1±16.5 minutes. There was not a statistically significant difference between the hearing levels in pre and post operated cases except for the frequency of 250 HZ. Also, no significant difference was found between duration of drilling and diagnosis of the lesion of middle ear, and hearing loss.

Conclusion: As the results of the study showed no difference in hearing level was found between pre and post operated cases, therefore, it seems that by observing and considering the primary principles of ear surgery, no more sensory neural hearning loss will appear and there is no need to be worried or be sensitive in this regard.

KEY WORDS: Sensori neural hearing loss, Tympanoplasty, Mastoidectomy, Chronic otitis media.

Pak J Med Sci    October - December 2009 (Part-II)    Vol. 25 No. 6    972-975

How to cite this article:

Iranfar KH, Iranfar SH. Does surgery of chronic otitis media Cause sensori neural hearing loss? Pak J Med Sci 2009;25(6):972-975.


1. Khosro Iranfar,
Assistant Professor / Otolaryngologist,
Kemanshah University of Medical Sciences,
2. Shirin Iranfar,
Lecturer
Kemanshah University of Medical Sciences,
Kermanshah, Iran.

Correspondence:

Dr. Shirin Iranfar,
Flat #2, First floor, Mojtameh Sayeh,
Khiyaban Bargh, 22 Bahman,
Kermanshah – Iran.
Email: siranfar@yahoo.com

* Received for Publication: February 4, 2009

* Revision Received: September 3, 2009

* Accepted: September 7, 2009


INTRODUCTION

Sensori neural hearing loss is considered as a consequence of chronic otitis media, and incidence of a permanent sensori neural hearing loss after surgery is 1.2% to 4.5%. There are about 30-35 million cases per year of otitis media1 which is defined as the inflammation of the middle ear.2 These can be acute or chronic. Chronic otitis media is a persistent inflammation of the middle ear, typically for a minimum of a month. This is a distinction to an acute ear infection that usually lasts only several weeks.1 despite the use of modern antibiotics, chronic otitis media remains a common disease that has a significant health impact on up to 2% of the population.3 As a whole, chronic otitis media is defined as a long- lasting otitis media.2 It may be associated with a chronically draining ear, Mastodoiditis and Cholesteatoma, Meningitis. Severe or chronic otitis media may permanently affect hearing and be associated with Dizziness. The sensori neural hearing loss is typically more severe at high frequencies.1-5 Chronic otitis media can be treated medically and surgically which depends on disease pathology, signs and patients age. Surgical treatment is performed to remove infected cells as well as for improvement of hearing.6 Sensori neural hearing loss is considered as a consequence of chronic otitis media, assumed inflammatory mediators as the substance that can deteriorate the function of the inner ear. Also the risk of deterioration to hearing on the operated ear is one of the most commonly discussed issues when asking for patient consent for middle ear surgery.7-10 The incidence of permanent sensori neural hearing loss after surgery is 1.2 to 4.5%.11,12 Multiple factors may be involved including suction,drill-induced acoustic trauma of the Cochlea, excess manipulation of the ossicles, and inadvertently touching the ossicle with a rotating burr.10

In spite of this, some authors have confirmed that there is relationship between sensori neural hearing loss and chronic otitis media surgery, whereas there is another study which did not confirm this relationship.12-14 Considering this discrepancy and lack of enough data about chronic otitis media surgery and sensori neural hearing loss in Iran, this study was carried out to determine the relationship of sensori neural hearing loss and chronic otitis media surgery at Esfahan University of Medical Sciences in Iran.

METHODOLOGY

This study included 90 patients with chronic otitis media, who were admitted in a hospital of Esfahan University of Medical Sciences for Tympanoplasty and Mastoidectomy. Before and 10-14 days after surgery, bone conduction test was performed on normal and abnormal ear in frequencies 250, 500, 1000, 2000 and 4000 HZ. By means of AMPLID 319, auditory tests were performed in one audiometric center by one expert audiologist. In addition the Tesi-Dent with TIM 20000 model of drill were used for surgery. Surgeries were performed by senior Ear Nose Throat surgeon along with their assistants. An information form was used to collect variables like age, gender, kind of surgery from patients’ files. Other variables were also collected such as diagnosis of the lesion of the middle ear and duration of drilling. The diagnosis was done by senior of E.N.T surgeon. One of the colleagues was responsible for measuring of drilling time from start till end of process. This study was approved by Ethic Commitment of Esfahan University of Medical Sciences and the research objectives were explained to all patient who gave their consent to participate in the study. The descriptive statistics (frequency, correlation) and inferential statistics (paired t-Test, Chi-square) were utilized to evaluate hearing loss after surgery. The significant level was considered at 0.05 in this study.

RESULT

Our findings showed that age of patients was in the range of 10-50 year, with mean age of 25±10.7. About 53.3% of patients were female. The distribution of patients ’job were: housewives 36.5%, students 31.1%, workers 16.2%, staffs 2.7%, Farmers 4.1% and unemployed. The surgery performed included: Modified radical mastoidectomy 37.8%, Mastoidectomy and Tympanoplasy 58.9% and radical mastoidectomy 3.3%. As seen in Figure-1, the most common diagnosis was cholesteatoma in (37.8%) of patients.

Range of drilling duration were 10-90 minutes with mean duration of 31.9±16.5. Duration of diseases was 10-30 years. Table-I shows the means of hearing level before and after surgery. There were not significant differences between various frequencies of hearing level before and after surgery except in frequency of 250HZ (p=0.04).

Table-II and III shows the hearing levels in infected and normal ears before and after surgery. There were significant differences between hearing level in infected and non infected ears in different frequencies but there were no significant difference in frequency of 250HZ before surgery. There were significant different between duration of disease, patients age and hearing level in different frequencies (p<0.001), but there were no significant differences between diagnosis, drilling duration, jobs and hearing level before and after surgery.

DISCUSSION

The result of this study showed that there was significant difference in the frequency of 250 HZ whereas, there were no significant differences in the other frequencies such as 500, 1000, 2000 and 4000 HZ. As regard the frequency of 250 HZ it is not so important clinically and one can say the hearing loss was not affected after middle ear surgery. Pignatero, Volter as well as, Sakagam, Naderipour and their co-workers have confirmed this findings in their studies.15-18 Palva, Tos , Mozafariniya and their co-workers have also pointed out that hearing loss is the consequence of the middle ear surgery.12,13,19 It looks, this discrepancy is due to study duration, sample size, post operation audiometry time, perfection of the audiometrist as well as the instrument type, surgery maneuvers, drill-generated noise and experience of surgeon. Although, experts say that, the possible contribution of drill noise during mastoid surgery to post operative sensori neural hearing loss is controversial. The amount of energy transmitted to the cochlea depends on the noise levels produced and the duration of exposure. Various studies have shown that mastoid drill can produce noise levels exceeding 100 db.20 While most studies fail to demonstrate any permanent sensori neural hearing loss21 in contrast, inadvertent injury to the ossicular chain during mastoid surgery is regarded as a major cause of postoperative permanent sensori neural hearing loss.10 Besides all above,, most of the studies which have showed the sensori neural hearing loss were conducted before 1995, As such it seems, improvement in medical technology as well as meticulous instruments, besides experience of surgeon can be considered as reasons of declining of sensori neural hearing loss after surgery for chronic otitis media.

In conclusion our study has shown that the middle ear surgery in chronic otitis media did not cause the sensori neural hearing loss. It is suggested that all ENT surgeon should do chronic otitis media surgery without being worried, but must take all the precaution.

ACKNOWLEDGMENT

We take this opportunity to thank all surgeons who supported us in this study. We are also grateful to all patients as without their help, this study was not possible.

REFERENCES

1. Perlslein D, Shiel WC. Otitis Media. December 30, 2007. From: www./http:dizziness and balance.com.

2. Timothy C. Chronic Otitis Media. January 10, 2008. From: www.http:Dizziness and balance.com.

3. Nadol J, Staecker H, Gliklich H. Outcomes Assessment for Chronic Otitis Media: the Chronic ear surgery. The Laryngoscop 2000;110(4):32-5.

4. Kirtan MV, Merchant SN, Rang AR, Zantye SP, Shah KL. Sensorineural hearing loss in Chronic Otitis Media. A statistical evaluation. J Post Grad Med 1985;31,4:183-6. From:www.http:jpgmonline.com

5. Papp Z, Rezes S, Jokay I, Sziklail. Sensorineural hearing loss in Chronic Otitis Media. Otology and Neurolotogy 2003;24(2):141-4.

6. Cummings CW, Fredrickson T, Harker LA, Kranse CJ, Richardson MA, Schuller DE. Otolaryngology head & neck surgery. Fourth Edition. St Louis: Mosby 2005;30-6.

7. Guo JW, Chen W. Endotoxic damage of the stria vasculariz: the pathogenesis of sesonrineural hearing loss secondary to otitis media? Larngol Otol 1994;108:310-13.

8. Lee SH, Woo HW, Jung TT, Premeability of arachidonic acid metabolites through the round window membrane in Chinchillas. Acta Otolaryngol 1992;493(suppl):165-9.

9. Morizono T, Tono T. Middle ear inflammatory mediators and cochlear function. Otolaryngol Clin North Am 1991;24:835-43.

10. Jiang D, Bibas A, Santili C, Donnelly N, Jeronimidis G, Fitzgerald A. Equivalent Noise level generated by drilling on to the ossicular chain as measured by laser Doppler vibrometry: A Temporal Bone study. The Laryngoscope 2007;117(6):1040-5.

11. Palva T, Karj J, Palva A. High tone sensorineural hearing losses following chronic ear surgery. Arch Otalaryngol 1973;98:176-8.

12. Tos M, Lau T, Palate A. Sensorineural hearing loss loss following chronic ear surgery. Ann Otal Rhinol Laryngol 1984;93:403-9.

13. Mozafarniya K, Kohastoni H. Sensor-neural hearing loss and middle ear surgery. ENT J Mashahad Uni Med Sci 2000;12(2):15-20.

14. Timethy TR, Jang, Hanson. Classification of Otitis Media & surgical Principles. Otolarynngol Clin North Am 1999;32(3):125-6.

15. Volter C, Baier G, Schon F, Muller J, Helms J. Inner ear depression after middle ear interventions. Laryngorhinoologie 2000;79(5):260-5.

16. Sakagm M, Agasawara H, Node M, See T, Mishiro Y. Sensorineural hearing loss caused by middle ear surgery. Nippon Jibiinkoka Gakka Kaiho 1997;100(7):740-6.

17. Pignatero L,Cappacio P,Laghis A. Myringoplasty in children: Anatom,Coland functional result. Laryngol Otol 2001;115(5):369-74.

18. Nadripour M. Sensori neural hearing loss after middle ear surgery. Ardabil Medical Sciences Journal 2005;4:362-6.

19. Palva A, sorri M, Can operation of deaf ear be dangerous for hearing? Acta Otalaryngol 1989;360:115-7.

20. Kylen P, Stgernrall JE, Arlinger S. Factors affecting the drill-generated noise levels in ear surgery. Acta Otolarygol 1997;84:252-9.

21. Needham AJ, Jiang D, Biabas AG. The effect of mass loading the ossicles with a floating mass transducer on middle ear transfer function. Otol Neurolo 2005;26:216-24.


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