Relationship of preoperative findings and ossicular discontinuity in chronic otitis media

Background: Ossicular discontinuity may result from chronic otitis media, with or without cholesteatoma, and usually cannot be determined unless an operation is performed. If preoperative information can be used to determine whether or not the ossicular chain is intact, the patient can be better informed and the surgeon can be better prepared before surgery. Objective: To examine the correlation between preoperative findings and the status of the ossicular chain at surgery. Study Design: Retrospective. Setting: A tertiary referral center. Patients: Data from 190 patients (212 ears) who were undergoing their first operations for chronic otitis media were reviewed. Intervention: The operations for the cholesteatoma or noncholesteatoma ears were classified into different groups and analyzed separately. Ossicular discontinuity was identified only if the discontinuity of the ossicular chain was confirmed at the time of operation. Results: The cholesteatoma group consisted of 59 ears, and the noncholesteatoma group contained 153 ears. In the cholesteatoma group, two statistically significant preoperative parameters were observed to be significantly correlated with ossicular discontinuity: persistently draining ears (p = 0.026) and a cholesteatoma that extended to the tympanic sinus (p = 0.006). In the noncholesteatoma group, only one parameter was observed to be predictive of ossicular discontinuity. In this group of patients, perforation of the tympanic membrane with an edge adherent to the promontory occurred significantly more frequently in patients with ossicular discontinuity (p = 0.004) than in those with intact ossicular chains. Surprisingly, an airbone gap was not significantly correlated with ossicular discontinuity. The cholesteatoma and granulation tissue in the middle ear cavity may serve as transmission bridges of acoustic energy, resulting in narrowed air-bone gaps. Conclusions: In the cholesteatoma group, both cholesteatoma extension into the tympanic sinus and persistently draining ears were predictive of ossicular discontinuity. In the noncholesteatoma group, perforation edges adhering to the promontory also revealed a higher incidence of ossicular discontinuity. Therefore, all these findings can be considered as potential preoperative predictors of ossicular discontinuity in chronic otitis media.