New research from Ningbo No. 2 Hospital in China highlights the importance of a clear passage in the ear's anatomy for successful surgery in patients suffering from chronic suppurative otitis media (CSOM). Using computed tomography (CT) scans, the study found that patients with a patent aditus ad antrum experienced significantly better outcomes post-tympanoplasty.
The study, conducted between 2015 and 2019, followed 138 patients undergoing tympanoplasty—a surgical procedure aimed at repairing the tympanic membrane and preventing inhalation of infections. Out of the cohort, a blocked aditus was present in 37 patients, representing 26.8% of the study group. Lead author Yuan Ren and colleagues discovered that those with unobstructed aditus had markedly improved hearing results, with better air-bone gap measurements than their obstructed counterparts.
“Patients in the patent aditus group demonstrated a significantly better hearing prognosis compared to those in the obstructed aditus group,” the authors noted, emphasizing a statistical significance (P = 0.002) in hearing outcomes. Furthermore, analysis revealed that the condition of the aditus acts as an independent prognostic factor, alongside the Middle Ear Risk Index (MERI) score, which also influenced hearing success.
During the study, follow-up outcomes were tracked for a median of 11 months, during which researchers noted the overall graft success rate was an impressive 86.2%. Importantly, those with a patent aditus had a preoperative mean air-bone gap of 27.31 dB, significantly lower than the 34.83 dB recorded in those with a blocked passage. Post-surgery, the difference remained pronounced, with post-operative measurements indicating 18.53 dB and 32.04 dB for patent and blocked groups, respectively.
Beyond these findings, the study also delved into the relationship between preoperative conditions and aditus patency. Notably, dry ear status prior to surgery was more common among patients with a patent aditus—77.2% compared to 52.8% in the obstructed group (P = 0.006). Moreover, the prevalence of well-pneumatized mastoids was higher in the patent subgroup, suggesting that a clear aditus contributes to better overall ear health and surgical outcomes.
The presence of granulation tissue, often linked to infection, was more frequently observed in those with obstructed aditus, compounding potential challenges during surgery. As the authors aptly noted, “Granulation tissue may significantly contribute to postoperative graft failure and hearing loss.”
Study co-author Xiaohui Zhu remarked that understanding the role of aditus ad antrum patency could refine the surgical decision-making process. The research highlights the utility of preoperative CT imaging as an essential tool for otologists, not just for anatomical assessment but also for gauging surgical risks.
Despite the study’s insights, researchers acknowledged limitations, particularly in selection bias due to the retrospective nature of the analysis. They concluded that further multi-center prospective studies are needed to strengthen the evidence around aditus patency as a predictor of surgical success.
In summary, the findings underscore that the patency of the aditus ad antrum, observed through HRCT scans prior to surgical intervention, can serve as a meaningful indicator for assessing middle ear risk and predicting postoperative hearing outcomes in patients with CSOM.
