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Determinants of Change in Air-Bone Gap and Bone Conduction in Patients Operated on for Chronic Otitis Media

Maciej Wiatr, Agnieszka Wiatr, Jacek Składzień, Paweł Stręk

(Department of Otolaryngology, Head and Neck Surgery, Jagiellonian University, Cracow, Poland)

Med Sci Monit 2015; 21:2345-2351

DOI: 10.12659/MSM.894087

BACKGROUND: Middle ear surgery aims to eliminate pathology from the middle ear, improve drainage and ventilation of the postoperative cavity, and reconstruct the tympanic membrane and ossicles.
The aim of this work is to define the factors that affect ABG (air-bone gap) and bone conduction in the patients operated on due to chronic otitis media.
MATERIAL AND METHODS: A prospective analysis of patients operated on due to diseases of the middle ear during 2009–2012 was carried out. The cases of patients operated on for the first time due to chronic otitis media were analyzed.
The analysis encompassed patients who had undergone middle ear surgery. The patients were divided into several groups taking into account the abnormalities of the middle ear mucous and damage of the ossicular chain observed during otosurgery.
RESULTS: A significant hearing improvement was observed in patients with type 2 tympanoplasty in the course of chronic cholesteatoma otitis media and in patients with simple chronic inflammatory process in whom a PORP was used in the reconstruction. Granulation tissue was an unfavorable factor of hearing improvement following tympanoplasty.
A significant improvement of bone conduction was observed in the patients with dry perforation without other lesions in the middle ear.
The elimination of granulation lesions was a positive factor for the future improvement of the function of the inner ear.
CONCLUSIONS: The presence of granuloma-related lesions in the middle ear spaces is likely to impede hearing improvement.
Damage to the ossicular chain rules out the possibility of bone conduction improvement after surgery.
The prognosis on tube-related simple chronic otitis media after myringoplasty, with the preserved continuity of the ossicular chain, consists of closing the ABG and leads to significant improvement of bone conduction.

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