Study of mastoid pneumatization and attic blockage in patients with chronic otitis media with effusion using computed tomography and tympanometry

ABSTRACT

Otitis media with effusion is a leading cause of counductive hearing loss. The organic Sequale of otitis media with effusion are changes in the tympanic membrane such as atrophy, retraction, and tympanosclerosis and changes in the mastoid, middle ear and inner ear. Prolonged otitis media with effusion carries the risk for further progression into adhesive otitis media, chronic supprative otitis media, and cholesteatoma. The development of mastoid air cell system taking place during the first years of life, is disturbed by episodes of acute otitis media and secretory otitis media and the result is hypocellularity, which, accordingly, must be regarded as a sequels to pathologic influence on the middle ear. This study was carried out on 30 patients, with persistent chronic otitis media with effusion. Tympanometry and computerized tomography [CT] scan of the temporal bones were done for all patients pre-operatively. Axial CT, 2 mm slice thickness and 2mm interval were taken preoperatively for assessment of tympanomastoid pneumatization and the condition ofaditus ad antrum. Ventilation tube [VT] insertion with or without adenoidectomy or adenotonsillectomy was performed to the unimproved patient. Every patient was followed up for 6 months with otoscopy and Tympanometry. The first visit was in the first week post operatively, the second visit was in the third month post operatively and the third visit was in the sixth month post operatively. In each visit we check up the presence and patency of each grommet tube by tympanometry [GSI auto Tymp] to measure the postoperative compliances. The result of our study showed that patient with otitis media with effusion [OME] have significant sclerotic mastoid and the ear with high initial and or gradual increase in physical volume test [PVT] with time can be considered one of the prognostic factor in improvement in pathology of the middle ear mastoid. It has been stated that RST decreased the mastoid size and approximately half of the ear with chronic otitis media with effusion in adult have residual soft tissue density [RST] in mastoid cavity. Because of the degree of mastoid preumatization is thought to reflect the gas exchange function of the mastoid cavity the middle ear pressure regulation through the infected mucosa might be impaired and retraction of the tympanic membrane occurred and insertion of V.T equalize the middle ear pressure and reversible mucosal changes are improved