|Year : 2021 | Volume
| Issue : 11 | Page : 1641-1644
Effect of type 1 tympanoplasty on the quality of life of patients suffering from chronic otitis media (safe type)
KJ Devi, M Singh, AS Maan, O Thomas, G Kaur, S Arya, J Kaur
Department of Otorhinolaryngology, Government Medical College, Amritsar, Punjab, India
|Date of Submission||15-Jan-2021|
|Date of Acceptance||09-Mar-2021|
|Date of Web Publication||15-Nov-2021|
Dr. M Singh
Professor and Head, Department of Otorhinolaryngology, Government Medical College, Amritsar - 143 001, Punjab
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Chronic otitis media (COM) remains a major public health issue and is associated with relentless discharge from the ear, pain, significant functional limitation of hearing, leading to communication problems and frequent specialist visits. Aims: To assess the improvement in quality of life of patients of COM (safe type) and surgical success in terms of graft uptake and improvement in hearing. Patients and Methods: A prospective questionnaire-based outcome study was directed in 100 patients with COM who were treated with Type I Tympanoplasty at our institution between May 2018 and May 2020. All patients were asked to fill Modified Chronic Otitis Media 4 (COM-4) survey before operation and 3 months after operation. Preoperative and postoperative total ear scores, audiological results, postoperative graft uptake were assessed. Results: The correlation between preoperative and postoperative assessment by questionnaire was statistically critical (P < 0.001). There was significant improvement in hearing postoperatively (P < 0.001). Effective graft uptake was seen in 80%. Conclusion: The current study emphasizes that Type 1 Tympanoplasty fundamentally improves quality of life of patients in terms of physical suffering, hearing loss, emotional distress postoperatively.
Keywords: Chronic otitis media, quality of life, type 1 tympanoplsty
|How to cite this article:|
Devi K J, Singh M, Maan A S, Thomas O, Kaur G, Arya S, Kaur J. Effect of type 1 tympanoplasty on the quality of life of patients suffering from chronic otitis media (safe type). Niger J Clin Pract 2021;24:1641-4
|How to cite this URL:|
Devi K J, Singh M, Maan A S, Thomas O, Kaur G, Arya S, Kaur J. Effect of type 1 tympanoplasty on the quality of life of patients suffering from chronic otitis media (safe type). Niger J Clin Pract [serial online] 2021 [cited 2021 Nov 27];24:1641-4. Available from: https://www.njcponline.com/text.asp?2021/24/11/1641/330457
| Introduction|| |
Chronic otitis media (COM) is characterized clinically as a middle ear inflammatory disorder associated with chronic otorrhoea. Inspite of all the advancement, COM remains a major public health issue. Globally, hearing impairment is the most well-known sensory deficit across the human race. In India, the incidence of COM was shown to be 7.8%. As demonstrated by WHO, since it is not as “dramatic” as other health care problems, it is “easily overlooked and underestimated.” It is now mentioned as a silent epidemic.
It is associated with significant restriction of hearing. This results in problems of correspondence obstructing social communication and expert life. Also withdrawal from social interactions can be found in patients with severe hearing impairment. Further, side effects of COM, such as tenacious release from the ear, discomfort, repeated specialist visits, can contribute to patient weakness in general well-being and prosperity. Therefore, in clinical medicine, the importance of subjectively evaluating quality of life is consistently expanding.
The reason to measure health-related quality of life (HRQL) is that there are always different responses and mental well-being for two people with the same disease and sometimes similar symptoms. These considerations explain why clinicians and healthcare physicians are all keenly interested in the outcome of intervention on HRQL.
In addition to assessing how much the quality of life has improved since intervention, the HRQL targets are to assess those with a better and worse quality of life.
The rationale for investigation was considering that hearing impairment significantly affects social working, ordinary exercises, and patient's perspective state, one of the main objectives of this careful intercession was improvement in patient's personal satisfaction. The subsequent goal was that achieving surgical success in terms of graft uptake, pre versus post-mediation benefits in hearing.
| Materials and Methods|| |
In the Department of Otorhinolaryngology, Government Medical College, Amritsar, a prospective questionnaire-based outcome analysis was carried out. The study consisted of 100 patients between 15 and 50 years of age with chronic otits media (safe type) from May 2018 to May 2020, of either sex.
In the research paper, patients were recruited on the basis of pre-determined requirements for inclusion/exclusion criteria.
- Patients in 15--50 years age range
- Patients who have COM (safe type)
- Patients with less than 45 dB of conductive hearing loss
- The ear to be operated on should be dry at least 4 weeks before the procedure
- Patients of less than 15 years of age as the children may not be able to fill questionnaire independently
- Patients with proven sensorineural or mixed hearing loss. For this reason, patients over 50 years of age were not included in the report
- Patients with Atticoantral disease or Cholesteatoma
- Active discharging ear
- Patients with chronic conditions such as diabetes mellitus, chronic smokers, tuberculosis were not included in the study because the result of the surgery could be affected
- Patients requiring revision surgery were also excluded
A comprehensive history and examination was done. All the patients were asked to complete a Modified Chronic Otitis Media-4 questionnaire preoperatively. Before filling the form, the patients were made to understand each question asked in the questionnaire in their own vernacular language. As our sample population was between 15 and 50 years, the questionnaire employed was modification of COM-5 which was a five-item quality of life research related to health, originally employed by Habesoglu in his study on Effect of type 1 Tympanoplasty on the quality of life of the children. Evaluation of each patient was based on four parameters: Physical suffering, hearing loss, emotional distress, and activity limitation.
A score was provided for each answer and all the positive responses were summarized to obtain a final total score. Type 1 Tympanoplasty was performed in all patients. All patients were monitored after 4th, 8th, and 12th week. During the follow-up visit, healing of the surgical wound, presence or absence of any ear discharge, and appearance of any new symptom were assessed. At the end of follow-up period on 12th week, a complete examination of the patient was done with regard to the healing of the surgical wound, ear examination was done to see the progress of the graft uptake. Hearing assessment was done again by pure tone audiometry and patients were asked to fill a postoperative questionnaire to observe change in quality of life in terms of improvement in scores in all parameters used. The data so obtained was collected and analyzed using appropriate statistical tests.
Modified Chronic Otitis Media-4 Questionnaire
| Results|| |
In the current study, the largest cluster (68%) consisted of patients in the age group of 15--30 years and patients in 41--50 years comprised of solely 5%. Patients in the age group of 31--40 years were 27%. The youngest patients (seven patients) listed in our study was 15 years and the mean age was 27 ± 8.70 years.
The patients enlisted in our study showed female predominance. The number of female patients were 67% and the male patients were 33% with a male to female ratio of 1:2.
Graft uptake was evaluated on follow-up otoscopy at the end of 4th, 8th, and 12th week. 97% had fortunate graft uptake at the end of 4th week, 90% at the end of 8th week, and 80% at the end of 12th week [Graph 1].
The mean physical suffering score for preoperative and postoperative was 2.200 (SD 0.400) and 1.00 (SD 0.00).The values obtained were statistically important (P < 0.001). The mean hearing loss score for preoperative and postoperative was 1.700 (SD 0.060) and 1.200 (SD 0.400). Statistically important were the values obtained (P < 0.001). The mean emotional distress score, both preoperative and postoperative was 1.200 (SD 0.400) and 1.100 (SD 0.030).The values obtained were statistically distinct (P < 0.001). But the activity limitation scores for pre and postoperative was 1.000 which was not statistically significant.
The mean pure tone audiometry threshold preoperatively was 34.6 (SD 3.68) and postoperatively was 27.3 (SD 3.55). The mean amendment in preoperative and postoperative was 7.3 (SD 0.13). The mean Air Bone Gap (ABG) within the preoperative was 20.98 (SD 3.31) and postoperative was 14.06 (SD 3.80). The mean change in preoperative and postoperative was 6.92 (SD 0.49). The values obtained were statistically vital (P < 0.001) in the current study [Table 1] and [Table 2].
|Table 1: Correlation of scores between preoperative and postoperative assessment|
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| Discussion|| |
Evaluation of COM outcomes has been restricted to the estimation of recurrence rates and audiological measurement. These measures do not generally compare to the patient's manifestations or the patients view of their ailment and its effect on their life. The use of a patient-based overview subsequently eliminates the working specialists inclination and legitimately measures the impact of the disease and intervention on the person.
The three-domain construct such as “somatic,” “psychological,” and “social” were outlined by Koller and Lorenz. Both the COM-5 (Chronic Otitis Media-5) and COMQ-12 (Chronic Otitis Media Questionnaire-15) questionnaire were assumed to contain all three domains.
In the current study, the graft uptake was 80% at the end of 12th week. This was in concordance with the study done by Shaik et al. report with 81% graft uptake and Malick et al. with 80% graft uptake without gelfoam and 80.6% with gelfoam.
In the present study, the mean change in preoperative and post-operative air conduction threshold was 7.3 (SD 0.13). The mean change in air bone gap in preoperative and postoperative was 6.92 (SD 0.49). The values obtained were statistically significant. This was in concordance with study done by Naderpour et al. and Black et al. [Graph 2].
While most patients postoperatively have good graft uptake and hearing gain, we found that some patients had complications such as graft uptake failure, insufficient hearing gain, or retraction of the graft postoperatively. This may be because of many factors, one of which is inadequate middle ear ventilation.
The correlation between preoperative and postoperative physical suffering, hearing loss, and emotional distress scores were studied in the current research and found to be statistically significant. This suggests that there has been postoperational change in the quality of life. Similar results have been reported by Testa and Simonson, Habesoglu et al., Bhatia et al., and Nadol et al.
In the present analysis, however, the preoperative and postoperative mean activity limitation scores obtained were not statistically relevant. This was because most patients had no pre-operative activity limitation, making the score for activity limitation negligible.
| Conclusion|| |
To conclude, the present study emphasizes that Type 1 Tympanoplasty considerably improves quality of lifetime of patients in terms of physical suffering, hearing loss, emotional distress postoperatively. There was significant correlation between preoperative and postoperative scores. Our research also concluded that there was significant improvement in hearing postoperatively. Therefore, to understand the issues from the perspective of patients, it is vital to work out HRQL measures.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Fukuchi I, Cerchiari DP, Garcia E. Tympanoplasty: Surgical results and a comparison of the factors that may interfere in their success. Braz J Otorhinolaryngology 2006;72.2:267-71.
World Health Organization. Deafness and hearing impairment. 2010. [Last accessed on 2019 Jul 15].
Kamal-Eldiri AA-E. The other ear in unilateral chronic suppurative otitis media. Saudi J Otorhinolaryngol Head Neck Surg 2007;9:24-6.
World Health Organization. The Global Burden of Disease: 2004 Update. Geneva; 2008. [Last accessed on 2015 Aug 18].
Baumann J, Gerendas B, Plinkert PK. General and disease specific quality of life in patients with chronic suppurative otitis media – a prospective study. Health Qual Life Outcomes 2011;9:48.
Wennberg JE. Outcomes research, cost containment, and the fear of health care rationing. N Engl J Med 1990;323:1202-4.
Kirshner B, Guyatt GH. A methodologic framework for assessing health indices. J Chronic Dis 1985;38:27-36.
Habesoglu TE, Habesoglu M, Deveci I. Effect of type 1 tympanoplasty on the quality of life of children. Ann Otorhinolaryngology 2011;120.5:326-30.
Smyth GD, Patterson CC. Results of middle ear surgery: Do patients and surgeon agree? Am J Otol 1985;6:276-9.
Koller M, Lorenz W. Quality of life: A deconstruction for clinicians. J R Soc Med 2002;95:481-8.
Shaikh AA, Onali MA, Shaikh SM, Rafi T. Outcome of tympanoplasty type-I by underlay technique. JLUMHS 2009;8:80-4.
Malick N, Gadag RP, Vidyashree KM, Puthukulangara S. Comparative study of type 1 tympanoplasty with and without gelfoam in the middle ear. International Journal of Otorhinolaryngology and Head and Neck Surgery 2017;3:1036-41.
Naderpour M, Shahidi N, Hemmatjoo T. Comparison of tympanoplasty results in dry and wet ears. Iran J Otorhinolaryngol 2016;28:209.
Black JH, Hickey SA, Wormald PJ. An analysis of the results of myringoplasty in children. Int J Ped Otorhinolaryngol 1995;31:95-100.
Testa MA, Simonson DC. Assessment of quality-of-life outcomes. N Engl J Med 1996;334:835-40.
Bhatia K, Valid L, Tameka HC. Effect of type 1 tympanoplasty on the quality of life of CSOM patients. Indian J Otolaryngol Head Neck Surgery 2016;68:468-74.
Nadol Jr JB, Staecker H, Gliklich RE. Outcomes assessment for chronic otitis media: The Chronic ear survey. Laryngoscope 2000;110:32-5.
[Table 1], [Table 2]