ASSESSMENT OF HEARING LOSS PROGRESSION IN ADULTS WITH RECURRENT OTITIS MEDIA AND THE EFFECTIVENESS OF EARLY SURGICAL INTERVENTION

Abstract

To ascertain the spontaneous outcome of hearing loss in adults with recurrent otitis media and to ascertain the cost-effectiveness and long term effectiveness of early surgical treatment as compared to conventional medical treatment.    A mixed-method study was carried out including a retrospective cohort analysis  to model the disease progression and a prospective interventional cohort study of early surgical intervention (tympanoplasty or ossiculoplasty within three months) versus medical treatment. Main results were change of air-bone gap ( ΔABG ) at 12 months. The secondary outcomes included the occurrence of timpanae membrane closures, recurrence of otorrhea, quality of life (COMOT-15), the presence of the inflammatory biomarkers , microbial biofilm load, and the cost-effectiveness (incremental cost-effectiveness ratio, ICER). Longitudinal mixed-effects modeling and multivariate regression analyses were performed. The retrospective cohort showed the fact of loss of hearing with +0.28 dB/month . The future trial showed that the ABG improvement of early surgical intervention  was much more than medical management . The Tympanic membrane was closed in 92.6% of surgical patients as compared to 25.0% of medical patients. The recurrence of otorrhea was decreased by 83.5% . Inflammatory cytokines in the middle ear are IL-1 (reduced by 50.5) and TNF-a (reduced by 52.7) and the percentage of bacteria biofilm in the middle ear significantly reduced postoperative. There was a great improvement in quality of life . The ICER was 5, 041/quality adjusted life year and the probability of cost-effectiveness was 98.7 percent with willingness to pay of 50, 000. Multivariate analysis showed that the preoperative, active otorrhea and biofilm formation and TLR4 Asp299Gly polymorphism were independent predictors of poor outcome.Surgical correction of recurring otitis media in adults, done at an early age not only helps in preventing progressive hearing loss, but also cures the inflammation chronicity, decreases the occurrence of the disease and enhances the quality of life vastly. It is very economical and ought to be considered as routine treatment of patients that present with high-risk characteristics that induce a paradigm shift towards long-term medical care.