Cortical Mastoidectomies in Mucosal COM (Chronic Otitis Media) and Its Outcomes –A Study on 50 Cases

Perla Ambikaet al. Cortical Mastoidectomies in Mucosal COM (Chronic Otitis Media) and Its Outcomes –A Study on 50 Cases. Int. J Med. Pharm. Res., 6 (6): 1017‐1022, 2025 1017 International Journal of Medical and Pharmaceutical Research Online ISSN-2958-3683 | Print ISSN-2958-3675 Frequency: Bi-Monthly Available online on: https://ijmpr.in/ Original Article Cortical Mastoidectomies in Mucosal COM (Chronic Otitis Media) and Its Outcomes –A Study on 50 Cases Perla Ambika1, Meesala Tejaswi2, Bhupender Singh Rathod Jatoh3, Adepu Mukesh4 1 Associate professor, Department of ENT, Government medical college, Sangareddy 2 Assistant professor of ENT, Department of ENT, GMC, secunderabad 3 Professor and HOD Department of ENT GMC, secunderabad 4 Post graduate student department of ENT, GMC, secunderabad A B S T R A C T Corresponding Author: Perla Ambika Associate professor, Department of ENT, Government medical college, Sangareddy. Received: 27-10-2025 Accepted: 22-11-2025 Available online: 30-11-2025 Introduction: COM is an inflammation of middle ear cleft, of mucosal and squamosal types, WHO definition is 2 weeks otorrhea, for ENT surgeon it is >3 months, HRCT temporal bones is useful in evaluation along with audiological evaluation to plan the treatment. AIM: To determine the outcomes of cortical mastoidectomies in mucosal COM cases. Background: First mastoid surgery in 1776, suat keskin at al-surgical findings are highly compatable with CT findings, 1921 first use of microscope in ear surgery. Materials and methods: Cross sectional observational study, study population is patients attending to ENT OPD in tertiary centre, sample size 50, patients with dry ear were selected and of safe type investigated and planned for cortical mastoidectomy surgery outcomes are studied in the form of sequential correlation with clinical, audiological, radiological, intraoperative findings. Inclusion and exclusion criteria Patients with safe COM were selected, patients below the age of 15, unsafe types excluded. Sample size 50, cross sectional observational study. Results and conclusion: Patients attending to ENT OPD were screened for safe COM and admitted sent for HRCT, PTA, done with EUM, blood parameters are taken for cortical mastoidectomy surgery and out comes were studied. Major age group is between 15-30, females were little more effected, BPL is of major concern, ear discharge and hard of hearing are major complaints, unilateral perforations are more, mild to moderate CHL is common, unilateral sclerosed mastoids in X-RAY are common, soft tissue density in mastoid cavity, haziness is of <25 %, decided surgery for >90% of cases is CM with Tplasty, intraoperatively CP in pars tensa in >95% cases, OC erosion is less common, FN is intact in 100% cases. Discussion: This study was conducted in tertiary centre patients with ear discharge, HOH as major complaints on examination TM perforation, after audiological and radiological evaluation ,<75% with CHL ,of mild to moderate type,<50% with positive HRCT findings which are correlates with intra op findings >95%, so outcomes with cortical mastoidectomy along with HRCT temporal bone as preop investigation of choice will give >70% better results along with lesser the chance of graft rejection and incomplete disease clearance when compare to tympanoplasty surgery. Copyright © International Journal of Medical and Pharmaceutical Research Keywords: COM,CM, OC,FN, WHO, ENT OPD,TM,HRCT,HOH. INTRODUCTION CSOM is an inflammation of middle ear cleft for long duration -2 types mucosal and squamosal COM. Symptoms are chronic ear discharge, hard of hearing, earache, blocking in ears etc. CT scan of temporal bones –is must for knowing anatomical variations and destructions/erosions hence to avoid any complications during surgery, in generally TM Perla Ambikaet al. Cortical Mastoidectomies in Mucosal COM (Chronic Otitis Media) and Its Outcomes –A Study on 50 Cases. Int. J Med. Pharm. Res., 6 (6): 1017‐1022, 2025 1018 perforations with mucoid/mucopurulent discharges for a period >3 months are considered as COM cases. WHO definition –requires only 2weeks of otorrhea, ENT surgeons tend to adopt a longer duration >3 months active discharge prior to go for any treatment /systemic therapy. Culture should be obtained for sensitivity, HRCT useful to know complications, ability of CT scan to depict the status of structure of temporal bone, than plain CT represents a major advance in delivering pathology before surgical exploration of ears cases. AIMS AND OBJECTIVES 1. To determine the outcomes of cortical mastoidectomies in mucosal COM cases 2. To study the findings of HRCT temporal bones and intraoperative findings of patients of COM to study the outcomes from CM surgeries 3. To observe the intra operative sides of involvement of TM, middle ear, mastoid air cell system in these patients. 4. To find the difference between radiological and intra operative findings in mucosal type of COM cases LITARATURE REVIEW 2000 years ago Hippocrates compared the PM to spiders web, ear suppuration observation in 460 BC, first mastoid operation in 1776, by Jeen Pefit of paris, german physiologist Johannes Mueller at al coined the term cholestaeatoma, Suat Keskin at al –surgical findings are highly compatabteble with CT findings Berger, a dannish port physician in 1833 suffered from tinnitus Hermann Schwartz and Adlof Eyusell in 1873 –surgical discrpsion of mastroidectomy. Nylen in 1921 – 1st use of micro scope in ear surgery. Curiesh Mishra at al (FEB 2021) HRTC is reliable pre operative multisuergion in case of CSOM. Ashraf Mahmond Khaled at al (june 2022) - HPET is highly reliable – mastoid findings. BRIEF ANATOMY Middle ear cleft – 6 walls, spaces, mucosalfolds, prussack space is important, atic, aditus, antrum, fossa incudis, facial recess, sinus tympany, mastoid auntrum, TYPES – well pneumatised, sclerotic. Temproral bones have 4 parts – squamous, zygomatic, tympanic, styloid process, petromastoid parts CSOM 2 types. 1. Mucosal type, 2. squamosal type Facial nerve – important in attic disease Reading of tempered bone – in HRCT MATERIALS AND METHODS This study is carried out in tertiary care centre in dept. of ENT 1. Study period – 6 months 2. Study design – cross sectional observatory study 3. Study population – patients attending to ENT OPD in tertiary care centre 4. Sample size – 50 INCLUSION CRITERIA 1. Patients above the age of 15 years were included. 2. Patients with safe type of COM were taken EXCLUSION CRITERIA 1. Patients below the age of 15 yrs were excluded. 2. Patients with chronic medical history like CAD, CVA were excluded 3. Patients with squamosal COM were excluded. This study is a cross sectional observational study of HRCT temporal bone and intra operative findings of CSOM in mucosal type of CSOM. Done in dept of ENT at tertiary care centre for a period of 6 months, over 50 patients, patients with dry ear were selected, examined clinically admitted, sent for HRCT, preoperative PTA was done, most of the patients were selected for cortical mastoidectomy and T plasty for minimal disease in middle ear along with perforation which is presented in TM Pars tensa at the time of surgery intraoperative findings were recorded and outcomes were studied. HRCT was performed on siemens SOMATOPOM DR2 whole body scanner contigious (0, 30) and coronal section(70) were taken slice thickness 2mm parameter of evaluation was detected are 1. Extent of pneumatisation 2. Soft tissue extentsion 3. Bone erosion of any rare in safe type 4. Ossicles 5. Facial canal Surgery done, Procedure adapted was cortical mastoidectomy and T plasty if necessary on table extension as done as MRM and also tympanoplasty. OBSERVATION AND RESULTS Perla Ambikaet al. Cortical Mastoidectomies in Mucosal COM (Chronic Otitis Media) and Its Outcomes –A Study on 50 Cases. Int. J Med. Pharm. Res., 6 (6): 1017‐1022, 2025 1019 During the period of July 2023 to December 2023 patients who are attending to ENT OPD were selected and with COM symptoms was admitted and sent for necessary investigations and done cortical mastoidectomy surgery and outcomes were studied TABLES AND CHARTS AGE DISTRIBUTION AGE IN YEARS 15 -30 30 - 45 45 – 60  60 NO.OF PATIENTS 23 14 10 3 PERCENTAGE 46% 28% 20% 6% SEX DISTRIBUTION SEX MALE FEMALE NO.OF PATIENTS 23 27 PERCENTAGE 46% 54% SOCIO ECONOMIC STATUS S.E STATUS B.P.L A.P.L NO.OF PATIENTS 47 3 PERCENTAGE 94% 6% FAMILY HISTORY FAMILY HISTORY +VE FAMILY HISTORY –VE NO. OF CASES 2 48 PERCENTAGE 4% 96% ADDICTIONS TYPE OF ADDICTION +VE HISTORY PERCENTAGE TADDY DRINKING 4 8% SMOKING 0 0% PAN/GUTKA CHEWING 0 0% -VE ADDICTIONS 46 92% CHIEF COMPLAINTS COMPLAINT TYPE NO. OF PATIENTS % PERCENTAGE EAR DISCHARGE 42 84% HARD OF HEARING 32 64% EAR PAIN 14 28% OTHER (dizziness , giddiness, vertigo, itching ) 8 16% Assosiated complaints like (fever, headache ) Nil 0% PAST HISTORY TABLE TYPE OF HISTORY HTN PM Others CAP , CVD, etc SIMILAR COMPLAINTS NO. OF PATIENTS 3 1 Nil 5 PERCENTAGE 6% 2% 0% 10% EAR MAJOR HISTORY & EXAMINATIONS FINDINGS - NO. OF PATIENTS PERCENTAGE EXTERNAL AUDITORY CANAL - - CLEAR 40 80% DISCHARGE /OTHERS 6 12% FUNGAL SPORES / conjetion , granulations discomated apeterial debris 4 8% TYMPANIC MEMBRANE FINDINGS FINDINGS NO. OF PATIENTS PERCENTAGE Perla Ambikaet al. Cortical Mastoidectomies in Mucosal COM (Chronic Otitis Media) and Its Outcomes –A Study on 50 Cases. Int. J Med. Pharm. Res., 6 (6): 1017‐1022, 2025 1020 PASS TENSA PERCORATION 48 96% PASS FLACCIDA PERFORATION 2 2% TABLE OF CLINICAL FINDINGS IN EFFECTED EAR OF MIDDLE EAR OSSICULAR CHAIN FINDINGS NO. OF PATIENTS PERCENTAGE MIDDLE EAR MUCOSA NORMAL 34 COGESTED/PALE 5 68% 10% OSSICULAR CHAIN ERODED HOM 7 EROSION OF INCUS 3 HYPOPLASTIC STAPES 1 14% 6% 2% FINDINGS OF FACIAL NERVE FINDING NORMAL FACIAL NERVE FN PALSY NO. OF PATIENTS 50 NIL PERCENTAGE 100% 0% CLINICAL HEARING TESTS FINDINGS BONE CONDUCTION AND AIR CONDUCTION TYPE OF TESTS NO. OF PATIENTS PERCENTAGE RINNE –VE 34 68% RINNE +VE 16 32% WEBERS TEST Lateralization to poor ear 48 96% Pure tone Audiometry findings Hearing loss No of patients Percentage Normal hearing 6 12% Mild HL(20-40dB) 30 60% MODERATE(40-55dB) 10 20% MODERATLY SEVERE(55-65) 3 6% SEVERE65-80) 1 2% PROFOUND(>80) - - OCCULISION OF EAC - 30 – 40 DBHL TM PERFORMATION - 10 – 40 DBHL OSSICULAR CHAIN DISORDERS FIXING WITHOUT PERFORATION - 54 DBHL OSSICULAR CHAIN DISORDERS & FIXITY OF TM - 38 DBHL MALLEUS FIXATION - 10 – 25 DBHL CLOSURE OF OVAL WINDOW - 60 DBHL X – RAY MASTOIDS FINDINGS TABLE X – RAY MASTOIDS TYPE OF INVESTEGATION PNEWMATISED B/L U/L SCLEROSED B/L U/L NO. OF PATIENTS 9 23 13 28 PERCENTAGE 18% 46% 26% 56% HRTC TEMPORAL BONE FINDINGS FINDINGS RT PERCENTAGE LT PERCENTAGE 12 24% 8 16% MIDDLE EAR MASTOID CAVITY 7 14% 6 12% OSSICLE 6 12% 5 10% SOFT TISSUE DENSITY 13 26% 7 14% FACIAL NERVE STATUS - 0% 0 0% IMPEDENCE AUDIOMETRY DONE TO 3 PATIENTS SHOWED B TYPE OF GRAPH Perla Ambikaet al. Cortical Mastoidectomies in Mucosal COM (Chronic Otitis Media) and Its Outcomes –A Study on 50 Cases. Int. J Med. Pharm. Res., 6 (6): 1017‐1022, 2025 1021 SURGERY DONE TABLE TYPE OF SURGERY NO. OF PATIENTS PERCENTAGE CORTICAL MASTOIDATOMY WITH TYMPANOPLASY 44% 88% T. PLASTY , (ENDOSCOPIC /CONVENTIONAL ) 6% 12% TABLE OF INTRAOPERATIVE FINDINGS FINDING EAC DISCHAR GE TYMPANIC MEMBRAN E PERFORATI ON GRANULATI ONS /HYPERTROP HY OF MIDDLE EAR MASTOID CAVITY OSSICL ES EROSIO N SOFT TISSUE DENSI TY FALOPIA N CANAL ABNORM AL RARE FINDINGS LIKE HIGH JB, KORNERS SEPTUM,FORW ARD SIGMOID SINUS, MEATOPLASTY DONE ETC NO OF PATIENTS 8 48 11 6 5 - 3 PERCENTA GE 16% 96% 22% 12% 10% - 6% TABLE OF COMPLICATIONS COMPLICATIONS NO OF PATIENTS PERCENTAGE PRESENT 2 4% ABSENT 48 96% PNEUMATIZATION OF MASTOID TYPE WELL PNEUMATIZED IN CT SCAN WELL PNEUMATIZED IN SURGERY SCLEROTIC IN CT SCAN SCLEROTIC IN SURGERY NO OF PATIENTS 32 32 21 10 PERCENTAGE 64% 64% 42% 20% OSSICULAR CHAIN INTEGRITY(AUSTINS CLASIFICATION) OSSICULAR EROSION IN CT IN SURGERY NO OF CASES 11 13 PERCENTAGE 22% 26% DISCUSSION This study conducted in dept of ENT, in tertiary centre for 6 months followed the below said criteria and outcomes were studied. Examination reveals CSOM of safe type (or) unsafe type however radiology is necessary to access the pathology in ear, mastoid, also useful in same middle ear conditions, mastoids, who do not cooperate for examination and also for children.  At the same time audiological evaluation is also useful to perform / to decided the type of surgery to perform anatomy to the status of hearing loss which is mandatory of conductive type and acquired, when you perform a surgery there is achance to stop the hearing loss at that level by doing repair of the tympanic membrane and by visualizing the middle ear ,mastoid antrum,ossicular chain ,intraoperatively and radiologically we can avoid 1.future complications,2.residual disease for repair,3.nessesity of the follow up.  In the present study all the 50 cases who are with central perforations on examination ,hard of hearing,ear discharge as complaints,were sent for audiological and radiological examination in the form of PTA and HRCT temporal bones we assessed the hearing loss type,extent and nature of disease by abnormal soft tissue opacification, ossicular chain erosion,the purpose of ct scan is to know the extent of lesion and its spread to surrounding vital structures,routine scan is helpful in anatomy of middle ear,and mastoid, congenital choleseatoma,single functioning ear etc.  Pneumatization of mastoid-commonly occur in CSOM, it is almost correlating with surgical findings.  Pramod v at al,19 cases had mastoiditis  Sasnita et al,had good sensitivity in the detection of automastoidectomy.  Ossicular destruction –erosion of long process of incus &HOM and head in malleus in CT Perla Ambikaet al. Cortical Mastoidectomies in Mucosal COM (Chronic Otitis Media) and Its Outcomes –A Study on 50 Cases. Int. J Med. Pharm. Res., 6 (6): 1017‐1022, 2025 1022  Ranjith parupalli-OC erosion in 90% cases  Thomson at al-long process of incus erosion in CM  Varshney et al -found malleus is resistant Importance of audiological evaluation in CSOM: For diagnosis and cause of hearing loss, extent of hearing loss, speech understanding ,to guide treatment descision, including surgical evaluation, moniter the effectiveness and treatment, any change in hearing status. CONCLUSION Patients attending to ENT OPD were screened for safe COM with complaints of ear discharge, HOH, and admitted sent for HRCT, PTA,done with EUM, blood parameters taken, patients who need surgical treatment were admitted and planned for cortical mastoidectomy surgery and out comes were studied. Major age group is between 15-30, females are more effected>50%, BPL is of major concern>90%, ear discharge and hard of hearing are major complaints upto 50%,unilateral perforations are more >40%,mild to moderate CHL is common upto 50%,unilateral sclerosed mastoids in X-RAY are common>40%,soft tissue density with mastoid cavity hazyness is of <25 %,decided and done surgery for >90% of cases is CM with T.plasty, intraoperatively CP in pars tensa in >95%cases,OC erosion is less common<20%,FN is intact in 100% cases. so outcomes with cortical mastoidectomy along with HRCT temporal bone as preop investigation of choice will give >70% better results along with lesser the chance of graft rejection and complete disease clearance when compare to tympanoplasty surgery. REFERENCES 1. Matsuda Y, Kurita T, Ueda Y, Ito S, Nakashima T. Effect of tympanic membrane perforation on middle-ear sound transmission. J Laryngol Otol. 2009 May. 123 Suppl 31:81-9. 2. 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