Hearing Outcomes Following Type III Major Columella Tympanoplasty in Cholesteatoma Surgery

Abstract

Aims and Objectives: Chronic otitis media with cholesteatoma is a significant cause of hearing impairment. It is surgically treated by modified radical mastoidectomy. In patients with absent stapes suprastructure, type III major columella tympanoplasty can be performed. The aim of this study was to assess post-operative hearing outcomes after type-III major columella tympanoplasty in patients undergoing modified radical mastoidectomy.

Methods: This prospective, analytical study was conducted in the Department of ENT–Head & Neck Surgery, Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Kathmandu, Nepal, over an 18-month period from March 2023 to August 2024 after an ethical approval. Twenty-seven patients aged over 14 years with diagnosis of chronic otitis media with cholesteatoma who underwent modified radical mastoidectomy with type III major columella tympanoplasty were included in the study. Pre-operative and three-month post-operative pure tone audiograms (Air conduction Threshold and Air Bone Gap) were analyzed. The paired-t test was used for normally distributed data, and Wilcoxon’s signed-rank test for data which weren’t normally distributed.

Results: The mean pre-operative air conduction threshold was 48.11 dB, and at three months post-operatively, it was 46.60 dB. The mean hearing gain was 1.51 dB which was not statistically significant (p=0.395). The mean air–bone gap decreased from 31.87 dB pre-operatively to 31.15 dB post-operatively, without statistically significant difference (p = 0.68).

Conclusion: The hearing outcomes at three months post-operative period was not significantly better than that in the pre-operative period, following modified radical mastoidectomy with type III major columella tympanoplasty.

Keywords: Cholesteatoma, Hearing, Modified Radical Mastoidectomy, Otitis media, Tympanoplasty