1. Ossicular Chain Status in Unsafe Chronic Suppurative Otitis Media
Dr. Navjot Kaur (JR)
Dr. Dinesh Kumar (AP)
Dr. Jagdeepak Singh (Professor)
Dr. Sania Arya (JR)
Department of ENT, Government Medical College Amritsar

2. Introduction
The present study comprised of forty patients of either sex in the age group of 0-60 years with evidence of attico-antral type of pathology in the middle ear cleft were recruited.
They were subjected to clinical, audiological, radiological and laboratory examination.
The patients underwent canal wall down mastoidectomy. The surgical procedure involved completely exenterating the disease from middle ear cleft.

3. Age-wise distribution of patients
Maximum number of patients (52.5%) were in the 11 to 20 years age group followed by 42.5% patients who more than 20 years of age.
Age-wise distribution of patients

4. Symptoms at the time of presentation
All the patients had history of ear discharge and 75% patients had complaint of difficulty in hearing.
Symptoms at the time of presentation

5. Duration of symptoms at the time of presentation
In 75.0% patients the duration of symptoms was ten years or less whereas in 20% patients the symptoms were present for more than fifteen years.
Duration of symptoms at the time of presentation

6. Major Otoscopic Findings
The most common findings on Otoscopic examination were erosion of outer attic wall and retraction pockets. Most of the patients had more than one finding on Otoscopic examination.
Major Otoscopic Findings

7. Pre-operative Pure Tone Audiometry Values
72.5% patients had moderate to severe hearing loss
Pre-operative Pure Tone Audiometry Values

8. In more than half of the patients malleus was found to be either eroded or absent
Status of Malleus

9. Incus was completely absent in 30% of patients and eroded in another 35%.
Status of Incus

10. Stapes was intact in 80% of patients.
Status of Stapes

11. Comparison of status of the ossicles
Incus was eroded or absent in 65% patients
Malleus was eroded or absent in 55% patients
Stapes was eroded or absent in 25% patients
Comparison of status of the ossicles

12. Comparison with a similar study
Ossicle
Malleus
Incus
Stapes
Study
Present Study
Varshney
et al
Present
Intact
45.0%
55.0%
35.0%
15.0%
80.0%
48.33%
Eroded
52.5%
35.%
17.5%
51.67%)
Absent
2.5%
10.%
30.0%
40.0%
---

13. Operative Findings
Cholesteatoma and granulations were two most common pathological entities encountered.
These occurred either alone or in conjunction with one another.
There was a varied involvement of various regions of middle ear cleft (MEC) such as mastoid antrum, aditus, epitympanum, mesotympanum or hypotympanum by these two entities.

14. Operative Findings
Cholesteatoma was the predominant pathology in epitympanum, aditus and mastoid antrum either alone or in conjunction with granulations.
Both in epitympanum and aditus, it was present in conjunction with granulations in 72.5% patients.
In mastoid antrum and mesotympanum, this ominous combination was present in 65% and 37.5% cases respectively.

15. Discussion
It has been suggested that destruction of ossicles is the most common complication of cholesteatomas.
The type of destruction depends on the original site and expansion of the cholesteatoma.
Cholesteatomas in the portion under tension have a 90% erosion rate.
The incus has been found to be the most affected ossicle, followed by the malleus and the stapes.

16. A necrotic bone may remain in place for years without being resorbed.
Discussion
It is currently thought that ossicle defects result from active bone resorption processes, rather than necrosis.
This theory assumes that live cells participate in the mechanisms of bone demineralization, erosion, and destruction.
A necrotic bone may remain in place for years without being resorbed.

17. Conclusion
Cholesteatoma was the predominant pathology in epitympanum, aditus and mastoid antrum either alone or in conjunction with granulations.
Destruction of middle ear ossicles was the predominant complication that accompanied cholesteatoma or chronic granulation tissue.

18. Conclusion
Incus was the most commonly involved ossicle. In % patients, it was seen to be completely absent or eroded by the active bone resorption processes that occur in presence of above mentioned pathological entities.
Next most commonly affected ossicle was malleus which was eroded or absent in 55% cases.
Stapes supra-structure was next in line that was partially or completely eroded in 20 % patients. However foot plate of stapes offered maximum resistance to erosive processes.

19. Thankyou!