Hostname: page-component-76d6cb85b7-s74w7 Total loading time: 0 Render date: 2026-07-25T08:15:00.431Z Has data issue: false hasContentIssue false
  • English
  • Français

Otoendoscopy as a better preoperative predictor than pure tone audiometry for ossicular erosion in mucosal chronic otitis media

Published online by Cambridge University Press:  01 May 2024

Abhishek Bhardwaj Open the ORCID record for Abhishek Bhardwaj [Opens in a new window] ,
Kartikesh Gupta ,
Suji PS Open the ORCID record for Suji PS [Opens in a new window] ,
Manu Malhotra ,
Madhu Priya ,
Saurabh Varshney ,
Rachit Sood  and
Arpana Singh
Abhishek Bhardwaj
Affiliation:
Department of Otorhinolaryngology & Head-Neck Surgery, All India Institute of Medical Sciences, Rishikesh, India
Kartikesh Gupta
Affiliation:
Department of Otorhinolaryngology & Head-Neck Surgery, All India Institute of Medical Sciences, Rishikesh, India
Suji PS
Affiliation:
Department of Otorhinolaryngology & Head-Neck Surgery, All India Institute of Medical Sciences, Rishikesh, India
Manu Malhotra*
Affiliation:
Department of Otorhinolaryngology & Head-Neck Surgery, All India Institute of Medical Sciences, Rishikesh, India
Madhu Priya
Affiliation:
Department of Otorhinolaryngology & Head-Neck Surgery, All India Institute of Medical Sciences, Rishikesh, India
Saurabh Varshney
Affiliation:
All India Institute of Medical Sciences, Deoghar, Jharkhand, India
Rachit Sood
Affiliation:
Department of Otorhinolaryngology & Head-Neck Surgery, All India Institute of Medical Sciences, Rishikesh, India
Arpana Singh
Affiliation:
Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, India
*
Corresponding author: Manu Malhotra; Email: manumalhotrallrm@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

To compare the diagnostic accuracy of angled otoendoscopy with pure tone audiometry in predicting ossicular discontinuity in patients of mucosal chronic otitis media.

Methods

Ninety-four patients were included in this prospective study. A 2.7-mm 30° otoendoscope was used to examine ossicular status preoperatively. Hearing thresholds were recorded by pure tone audiometry. Intraoperative ossicular status was recorded as the gold standard. Otoendoscopic findings were recorded as per the criteria has been devised by the authors of this manuscript.

Results

Otoendoscopy was conclusive in 56 (59.6 per cent) patients, with 100 per cent sensitivity, 95.56 per cent specificity, 84.62 per cent positive predictive value, and 100 per cent negative predictive value in the conclusive group. Overall (in 94 patients), diagnostic test values of otoendoscopy were 73.33 per cent sensitivity, 97.47 per cent specificity, 84.62 per cent positive predictive value, and 95.06 per cent negative predictive value. As per the ROC curve, air–bone gap > 38.12dB had the optimal diagnostic test values, with 73 per cent sensitivity, 72 per cent specificity, 33.3 per cent positive predictive value, and 93.4 per cent negative predictive value.

Conclusion

Angled otoendoscopy has better diagnostic accuracy (93.6 per cent) than pure tone audiometry (72.3 per cent; p < 0.001) for preoperative ossicular discontinuity prediction in patients of mucosal chronic otitis media.

Keywords

endoscopyaudiologyhearing lossdiagnosisotitis media

Information

Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 138 , Issue 10 , October 2024 , pp. 1013 - 1017
Copyright
Copyright © The Author(s), 2024. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

Footnotes

Manu Malhotra takes responsibility for the integrity of the content of the paper

References

Ebenezer, J, Rupa, V. Preoperative predictors of incudal necrosis in chronic suppurative otitis media. Otolaryngol Head Neck Surg 2010;142:415–20CrossRefGoogle ScholarPubMed
Horváth, T, Lukács, D, Horváth, B, Ferenci, T, Liktor, B. Does the type of ossicular chain lesion affect outcomes in chronic suppurative otitis media without cholesteatoma? J Int Adv Otol 2019;15:28–33CrossRefGoogle ScholarPubMed
Jayakumar, CL, Inbaraj, LR, Pinto, GJO. Preoperative indicators of ossicular necrosis in tubotympanic CSOM. Indian J Otolaryngol Head Neck Surg 2016;68:462–7CrossRefGoogle ScholarPubMed
Bayat, A, Saki, N, Nikakhlagh, S, Farshad, MA, Lotfinia, M. Ossicular chain defects in adults with chronic otitis media. Int Tinnitus J 2019;23:6–9CrossRefGoogle ScholarPubMed
Albera, R, Dagna, F, Filippini, C, Albera, A, Canale, A. Ossicular chain lesions in tympanic perforations and chronic otitis media without cholesteatoma. J Int Adv Otol 2015;11:143–6CrossRefGoogle ScholarPubMed
Malhotra, M, Priya, M, Bhardwaj, A, Tyagi, AK, Kumar, A, Varshney, S, et al. “Mushroom” autologous partial ossicular replacement prosthesis: long-term results. Otol Neurotol 2021;42:e60–5CrossRefGoogle ScholarPubMed
Carrillo, RJC, Yang, NW, Abes, GT. Probabilities of ossicular discontinuity in chronic suppurative otitis media using pure-tone audiometry. Otol Neurotol 2007;28:1034–7CrossRefGoogle ScholarPubMed
Bhardwaj, A, Anant, A, Bharadwaj, N, Gupta, A, Gupta, S. Stapedotomy using a 4 mm endoscope: any advantage over a microscope? J Laryngol Otol 2018;132:807–11CrossRefGoogle ScholarPubMed
Mohanty, S, Gopinath, M, Subramanian, M, Vijayan, N. Relevance of pure tone average (PTA) as a predictor for incus erosion. Indian J Otolaryngol Head Neck Surg 2012;64:374–6CrossRefGoogle ScholarPubMed
Sheikh, R, Haidar, H, Abdulkarim, H, Aslam, W, Larem, A, Alsaadi, A, et al. Preoperative predictors in chronic suppurative otitis media for ossicular chain discontinuity: a cross-sectional study. Audiol Neurootol 2016;21:231–6CrossRefGoogle ScholarPubMed
Tos, M. Pathology of the ossicular chain in various chronic middle ear diseases. J Laryngol Otol 1979;93:769–80CrossRefGoogle ScholarPubMed
Peake, WT, Rosowski, JJ, Lynch, TJ 3rd. Middle-ear transmission: acoustic versus ossicular coupling in cat and human. Hear Res 1992;57:245–68CrossRefGoogle ScholarPubMed
Tripathi, P, Nautiyal, S. Incidence and preoperative predictive indicators of incudal necrosis in CSOM: a prospective study in a tertiary care centre. Indian J Otolaryngol Head Neck Surg 2017;69:459–63CrossRefGoogle ScholarPubMed
Singh, P, Jain, S, Methwani, D, Kalambe, S, Chandravanshi, D, Gaurkar, S, et al. Study of correlation of pre-operative findings with intra-operative ossicular status in patients with chronic otitis media. Iran J Otorhinolaryngol 2018;30:273–81Google ScholarPubMed
Jeng, FC, Tsai, MH, Brown, CJ. Relationship of preoperative findings and ossicular discontinuity in chronic otitis media. Otol Neurotol 2003;24:29–32CrossRefGoogle ScholarPubMed
Zahnert, T. Reconstruction of the middle ear with passive implants [in German]. HNO 2011;59:964–73CrossRefGoogle ScholarPubMed