Abstract:

Objective To analyze the short-term prognosis value of middle ear risk index (MERI) in predicting the poor hearing recovery 6 months after transcanal endoscopic ear surgery (TEES) for children with cholesteatoma-type middle ear infection and the related factors affecting poor hearing recovery after TEES surgery. Methods A total of 70 children with cholesteatoma-type middle ear infection who underwent TEES were selected as the research subjects, and their outcomes were followed up for 6 months postoperatively. Pure tone audiometry was performed to collect the air-bone-gap (ABG) values of children, and they were divided into two groups according to ABG values: the group with good prognosis (ABG ≤ 20 dBHL, n = 49) and the group with poor prognosis (ABG > 20 dBHL, n = 21). The general information and the postoperative outcomes of MERI, ABG and quality of life improvement (Otitis Media-6, OM-6 score) of the two groups were compared. The independent risk factors for poor hearing recovery of TEES for children with cholesteatoma-type middle ear infection were analyzed by multivariate Logistic regression analysis. Receiver operating characteristic (ROC) curve was developed to study the predictive value of MERI in patients with cholestatomatous otitis media with TEES. Results Compared with the good prognosis group, the disease course of children in the poor prognosis group was longer, the scores of MERI, ABG and OM-6 before and after surgery were higher, the proportion of high-risk was higher (P<0.05). The multivariate Logistic regression analysis showed that longer course of illness, higher MERI, higher preoperative ABG values and higher preoperative OM-6 scores were independent risk factors for poor hearing recovery of TEES for children with cholesteatoma-type middle ear infection. The ROC curve showed that the AUC (95%CI) of MERI predicting poor hearing recovery at 6 months post-TEES in cholesteatoma otitis media children was 0.828 (95%CI: 0.718-0.907), sensitivity was 81.0% and specificity was 75.5%. Conclusion MERI can be used as an effective tool to predict the short-term hearing recovery of children with cholestatoma otitis media undergoing tympanoplasty. The longer the course of disease, the higher the MERI. The higher the preoperative ABG, the higher the preoperative OM-6 score. The higher the risk of poor hearing recovery after TEES operation in children with cholestatoma otitis media, which needs clinical attention.

Key words: otitis media, cholesteatoma, tympanoplasty, quality of life, child, middle ear risk index, hearing recovery