RESULTS
A total of 108 patients (55 females, 53 males) with a mean age of 51.0
(SD 15.9) were included into the study. Indications for tympanomastoid
surgery were COM with cholesteatoma (epitympanic [n = 39]; pars
tensa [n = 7]), persistent mastoid cavity with recurrent
cholesteatoma (n = 15), COM without cholesteatoma (n = 22), persistent
mastoid cavity without recurrent cholesteatoma (n = 10), revision
ossiculoplasty for hearing restoration (n = 14), and postinflammatory
meatal fibrosis (PIMF) (n = 1). The single patient with meatal fibrosis
was excluded from any further statistical analysis. The mean follow-up
period between surgery and the postoperative follow-up was 183 days (SD
156 days).
Although a trend to hearing improvement for each diagnosis was observed,
no statistically significant differences between pre- and postoperative
AC PTA among the groups were found (Figure 1). No difference among the
groups was found for the AC PTA shift, i.e. the difference between the
pre- and postoperative AC PTA (Figure 1). Further, no significant
difference in the shift between the pre- and postoperative BC PTA was
found in the entire cohort (mean difference 0.4 dB, SD 12.2 dB, p =
0.71).
The mean preoperative ZCMEI-21 total score was 28.8 (SD 13.9) and
decreased to 21.9 (SD 12.9) postoperatively (mean ZCMEI-21 total score
difference: -6.9, SD 0.9, p < 0.0001). The mean preoperative
ZCMEI-21 total score (Figure 2A) in COM with epitympanic cholesteatoma
was 29.3 (SD 15.9), in COM with pars tensa cholesteatoma 9.9 (SD 5.3),
in persistent mastoid cavity with cholesteatoma 27.5 (SD 16.4), in COM
without cholesteatoma 30.9 (SD 9.2), in persistent mastoid cavity
without cholesteatoma 34.1 (SD 7.7), and in revision ossiculoplasty for
hearing restoration 29.6 (SD 10.9). Statistically significant
differences in the preoperative ZCMEI-21 total scores were found between
patients with COM with epitympanic cholesteatoma and COM with pars tensa
cholesteatoma (p = 0.007), between patients with COM without
cholesteatoma and patients with COM with pars tensa cholesteatoma (p =
0.005), between patients with revision ossiculoplasty for hearing
restoration and COM with pars tensa cholesteatoma (p = 0.02), between
patients with COM with pars tensa cholesteatoma and persistent mastoid
cavity without recurrent cholesteatoma (p = 0.004) and between patients
with COM with pars tensa cholesteatoma and persistent mastoid cavity
with recurrent cholesteatoma (p = 0.046) (Figure 2A).
The postoperative ZCMEI-21 scores did not show any statistically
significant differences among any types of CMED (Figure 2B).
Groups showing significantly reduced ZCMEI-21 total scores after surgery
indicating an improvement in HRQoL (Figure 2C) were COM with epitympanic
cholesteatoma (mean reduction -6.6, p = 0.005), COM without
cholesteatoma (mean reduction -8.7, p = 0.0009), and persistent mastoid
cavity without recurrent cholesteatoma (mean reduction -10.9, p = 0.04).
In all of these three groups, differences not only reached statistical,
but also clinical significance as defined by the MCID.
The two symptoms that were hypothesized to be particularly different
among the different types of CMED, i.e. ear discharge and
vertigo/balance problems, were tested separately. Concerning ear
discharge, significant differences among patients with COM with pars
tensa cholesteatoma and patients with persistent mastoid cavity with
recurrent cholesteatoma (p = 0.04) and between patients with persistent
mastoid cavity with recurrent cholesteatoma and patients with revision
ossiculoplasty for hearing restoration (p = 0.02) were found
preoperatively (Figure 3A). Postoperatively, differences were only found
between patients with persistent mastoid cavity with recurrent
cholesteatoma and patients with revision ossiculoplasty for hearing
restoration (p = 0.04) (Figure 3B). Concerning vertigo, significant
differences between patients with COM with pars tensa cholesteatoma and
patients with persistent mastoid cavity with recurrent cholesteatoma (p
= 0.02) and patients with COM with pars tensa cholesteatoma and patients
with persistent mastoid cavity without recurrent cholesteatoma (p =
0.04) were found preoperatively (Figure 3C). Postoperatively, no
differences between the groups were found (Figure 3D).