Efficacy Analysis of Endoscopic Type 1 Tympanoplasty for Chronic Suppurative Otitis Media with Otomycosis.

Abstract

Objective: To analyze the clinical effect of tympanoplasty performed for chronic suppurative otitis media (CSOM) patients with otomycosis under the oto-endoscope. Methods: A retrospective analysis was conducted on the healing of the tympanic membrane and hearing improvement of 431 CSOM patients who underwent endoscopic type 1 tympanoplasty. The patients with CSOM were divided into the control group (n = 203, without otomycosis) and the trial group (n = 184, with otomycosis). The patients were followed up for at least 3 months. The graft uptake rate and hearing improvement were compared. Results: The graft uptake rate was 94.57% (174/184) in the trial group and 96.06% (195/203) in the control group, indicating no significant difference between the 2 groups. The preoperative and postoperative average air-conduction hearing thresholds of CSOM with otomycosis were 42.68 ± 11.46 dBHL and 33.01 ± 11.51 dBHL, respectively (P = .000). Mean air-bone gap (ABG) reduction values were 3.96 ± 7.20 dBHL and 3.34 ± 7.96 dBHL, respectively. There was no significant difference in the average ABG (P = .420) and average air-conduction hearing threshold (P = .649) between the trial group and the control group after operation. The culture results of the CSOM group with otomycosis showed that the most common fungal genus was Aspergillus (87/173), with 32 cases of mixed infection of fungi and bacteria, and the most common mixed infection of bacteria was Staphylococcus epidermidis (9/32). The failure graft uptake was noticed in 8.8% (5/57) cases in the trial group with postoperative fungal infection and 3.9% (5/127) without otomycosis (P = .289). No significant difference was found in the successful healing rate among age, duration, perforation size, fungal type, postoperative fungal infection. Conclusion: CSOM with otomycosis is not a contraindication for endoscopic type 1 tympanoplasty, and external auditory canal fungal infection does not affect postoperative healing and hearing improvement. Intraoperative repeated rinsing with povidone-iodine may reduce the occurrence of postoperative infection.