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Chronic Otitis Media and Tympanoplasty and Mastoidectomy


Ear, Nose & Throat

19 October, 2021

Chronic suppurative otitis media (CSOM) is a chronic inflammatory disease of the middle ear cleft that includes the tympanic membrane (eardrum), ossicles (middle ear bones responsible for hearing) and the mastoid bone (the aerated bone behind the ear). In simple terms, it can be categorized into two chief types: The mucosal variant involving only eardrum and the squamous variant involving the mastoid bone with or without cholesteatoma. 

Signs and symptoms to know if you have chronic otitis media: 

  • Ear discharge, recurrent or persistent for more than 12 weeks. The discharge can be profuse or scanty, foul-smelling or odourless, thick or thin, blood-stained or greenish discoloured.

  • Hearing loss in affected ears. Can be mild/moderate or severe/profound. 

Such symptoms can extend over months or years in affected ear/s. 

Signs and symptoms of impending complications in chronic ear disease: 

  • Recent onset vertigo or imbalance. 

  • Severe/progressive earache or headache

  • Nausea and vomiting 

  • Weakness or asymmetry of the face on the affected side

  • Pain or swelling behind the ear, particularly in children. 

  • Sudden progression of hearing loss/total deafness. 

  • Fever with headache and neck stiffness/irritability 8. Altered consciousness/drowsiness 

The above signs and symptoms warrant an urgent referral to the ENT surgeon for further management. 

How to Manage Chronic Ear Disease?

The management of chronic ear disease is nearly always surgical except in very elderly or debilitated populations who are poor surgical candidates. 

Tympanoplasty: Tympanoplasty essentially means repair and reconstruction of the perforated or diseased eardrum with or without reconstruction of middle ear hearing/ossicular mechanism. The procedure involves grafting the perforated eardrum using autologous graft tissue (cartilage/fascia). 

Repair of diseased ossicles (ear bones) can be done in the same sitting using middle ear implants. 

Mastoidectomy: Mastoidectomy entails the removal of disease from the mastoid bone by drilling the diseased body cells of this bone behind the ear. Mastoidectomy can be of two essential types namely:

  • style="margin: 0;padding: 0 0 5px;" dir="ltr">Cortical mastoidectomy: This removes diseased mastoid cells in the bone to reduce infective load and is a limited procedure and maintains the normal ear anatomy.


  • style="margin: 0;padding: 0 0 25px;" dir="ltr">Radical or modified radical mastoidectomy: This is an extensive procedure needing removal and exteriorization of the entire middle ear and mastoid system thereby removing extensive disease and converting the entire region into a common cavity approached post-operatively through a widened external ear meatus. The scope, hospital stay and postoperative recovery are different for all these procedures. 


Question 1. How can I get evaluated if I have symptoms? 

Answer: Clinical examination by an otologist/ENT surgeon followed by Examination under a microscope, Audiometry and High resolution computed tomography of the temporal bone. 

Question 2. How much will my hearing recover after surgery? 

Answer: This depends on your preoperative hearing level. Certain hearing loss can be corrected in the same or second surgery whereas some kinds of hearing loss involving inner ear may not be reversible. 

Question 3. How important or urgent is the surgery? 

Answer: While surgery for eardrum perforation or hearing reconstruction is elective, surgery for squamous variants or “unsafe ear” must not be deferred as it is a progressive disease and can lead to ear or brain complications in absence of definitive treatment. 

Question 4. What kind of follow up would I require after surgery? 

Answer: While a normal follow-up after tympanoplasty or cortical mastoidectomy could all be 4-8 weeks with a native ENT surgeon in India, we recommend a lifelong follow-up for patients needing radical or open cavity mastoidectomy. The large cavity status post-operatively makes such patients prone to occasional discharge and wax or fungal collection that can be managed in outpatient using ear suction cleaning and relevant antibacterial or antifungal ear drops. 

Question 5. What are the various methods of hearing reconstruction if I have already undergone tympanoplasty or mastoidectomy and continue to hear less from one or both ears? 

Answer: There are multiple methods of hearing improvement. These range from the use of hearing aids in the elderly or surgical reconstruction of a hearing mechanism using either of these methods: 

  • Ossiculoplasty: Reconstruction of middle ear ossicles/bones using titanium implants. 

  • Bone anchored hearing implants: For patients with open cavities or radical mastoidectomies on both sides.

  • Active middle ear implants (Vibrant Soundbridge): For patients with mixed hearing loss with both conductive and sensorineural hearing loss components and when patients are not comfortable wearing hearing aids. 

  • Cochlear implants: To correct severe to profound hearing loss not amenable to any other non-surgical or surgical modality. 

Manipal Hospital Dwarka is the best ENT hospital in India having the best ENT doctor in Delhi experienced in treating any kind of ENT problems. 


Consultant Otorhinolaryngology



Dr. Ashish Vashishth

Consultant - Otorhinolaryngology, Head and Neck and Cranial Base Surgery, Ear, Nose and Throat

Dwarka - Delhi