Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018

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On Sep 2018

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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

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On Aug 2018

Dr. Arundhathi. S
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Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : November | Volume : 17 | Issue : 11 | Page : MC01 - MC04 Full Version

Role of Middle Ear Risk Index in the Selection of Middle Ear Surgery and Factors Determining Outcome: A Cross-sectional Study

Published: November 1, 2023 | DOI:
Manisha Dash, Prasad T Deshmukh

1. Postgraduate Resident, Department of Otorhinola Ryngology, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India. 2. Professor and Head, Department of Otorhinola Ryngology, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India.

Correspondence Address :
Manisha Dash,
S-8, Shalintapg Girls, Hostel, D MIHER, Sawangi (M), Wardha-442004, Maharashtra, India.


Introduction: Chronic Otitis Media (COM) is a major cause of preventable hearing loss. Tympanoplasty is a crucial surgical step in managing COM and restoring hearing loss. Various prognostic factors are believed to influence the success of graft take-up. The Middle Ear Risk Index (MERI) is a numerical grading system used to assess the severity of the disease and predict the outcome of tympanoplasty for individual patients.

Aim: To investigate the role of preoperative MERI in the selection of middle ear surgery.

Materials and Methods: This cross-sectional study was conducted on a sample size of 40 patients (40 ears) who were treated at the Department of ENT, Acharya Vinobha Bhave Rural Hospital, Sawangi (Meghe), Wardha, Maharashtra, India, from December 2020 to December 2022. Only patients free from co-morbidities and COM-related complications who underwent surgical intervention were included. The patients were evaluated for their MERI score, and the outcome of the surgical intervention was then correlated. Statistical analysis was performed with SPSS version 25.0 at a significance level of p<0.05.

Results: The MERI was utilised as a tool for assessing surgical outcomes. A lower MERI score indicated a less invasive choice of middle ear surgical procedure and was associated with a better outcome in terms of graft uptake, which was statistically significant. Patients requiring tympanoplasty alone had mild MERI scores (1-3), while more extensive surgeries such as canal wall up or canal wall down were associated with moderate or severe MERI scores (4-6 or 7-12), and this association was found to be significant (p=0.001). Interestingly, out of the total 40 patients, five with Eustachian Tube (ET) dysfunction had severe MERI scores (7-12) and experienced graft rejection. Patients with lower grades of ET dysfunction had higher chances of graft uptake, and this association was statistically significant (p=0.001).

Conclusion: This study demonstrated that lower MERI scores were associated with better postoperative outcomes. In a country like India, where the cost of surgery and time away from work are major considerations, it is important to establish a standardised approach to predict the surgical outcome, whether it involves tympanoplasty alone or in combination with other middle ear surgeries like cortical mastoidectomy or canal wall down mastoidectomy, and counsel the patient accordingly. This plays a crucial role in informed decision-making.


Chronic otitis media, Tympanomastoidectomy, Tympanoplasty

Manifestation attributed to COM is one of the most common reasons for patients to present to otorhinolaryngologists with ear problems. Conversely, COM represents one of the most common otological problems encountered by otorhinolaryngologists. COM is one of the most important public health concerns, particularly in developing countries (1). It can be due to poor socio-economic standards, poor nutrition, lack of health education, and unhygienic conditions. It is a major cause of deafness in India. Early identification and proper management of these cases are of vital importance, particularly in alleviating complications associated with this disease. According to the World Health Organisation (WHO), the prevalence of COM in the world is 65-330 million people, with 60% of them experiencing hearing loss. The incidence rate is 9 cases per 100,000 population (2).

Tympanoplasty is a relatively common procedure performed by otologists for various indications, such as creating a safe ear, repairing perforated tympanic membranes, removing or eradicating disease, and improving hearing (3). The primary goal of tympanoplasty is the restoration of the integrity of the tympanic membrane (4). In a country like India, where the cost of surgery and time away from work are major considerations, establishing a standard approach to predict the outcome of surgery and counsel the patient accordingly plays a crucial role (5). The MERI is one of the various methods employed to predict the results of surgery. It considers both preoperative and postoperative middle ear conditions (5).

The MERI score is a prognostic evaluation tool for patients under-going tympanoplasty or middle ear surgeries and is assigned as follows: MERI 0=Normal; MERI 1-3=Mild disease; MERI 4-6=Moderate disease; MERI 7-12=Severe disease. It takes into consideration parameters such as the criteria of Belluci to determine the degree of ottorhoea, Austin/Kartush criteria of ossicular status, perforation, presence or absence of middle ear effusion, granulations, and cholesteatoma (6),(7).

However, it is a common experience that, despite meticulous technique, perfect placement, and utmost care to avoid graft displacement and postoperative infections, residual perforation or persistent discharge continues to be a challenge during postoperative follow-up visits worldwide. Achieving consistent good hearing is still difficult, especially in developing countries where financial constraints are a concern, and a second-stage correction surgery is often out of reach for surgeons. This study aims to help surgeons, predominantly practicing in developing countries where financial constraints exist, to better counsel patients regarding outcomes and provide them with some form of assurance. The aim of this study is to establish the MERI as a preoperative prognostic tool in selecting middle ear surgery. The primary objective is to determine the association between the tool and the outcome of the graft, as well as the type of procedure performed. The secondary objective is to assess the graft uptake and ET function affecting the MERI.

Material and Methods

This is a cross-sectional study conducted on a sample size of 40 patients (40 ears) who were treated at the Department of ENT, Acharya Vinobha Bhave Rural Hospital, Sawangi (Meghe), Wardha, Maharashtra, India, from December 2020 to December 2022. The study focused on patients with COM, specifically squamous COM (active or inactive), who met the inclusion criteria. The study was time-bound, and all eligible subjects during the study period were included. The study was granted ethical approval by the committee with Ref No {DMIMS(DU)/IEC/2020-21/933}, approved on 22/12/2020.

Inclusion criteria: Patients between 15 and 60 years of age, unilateral or bilateral COM ith or without cholesteatoma and with satisfactory cochlear reserve were included in the study.

Exclusion criteria: Patients with sensorineural deafness, those with associated co-morbidities, such as hypertension and diabetes mellitus or with adenotonsillitis, cleft palate, and nasal polyps, or those presenting with complications of COM and the ones not willing to undergo surgical treatment were excluded from the study.

Relevant medical history was obtained, and a clinical ENT examination was performed. Baseline investigations were carried out, including specific examinations such as Ear Examination Under a Microscope (EUM) (KarlKaps D 35614 AsslarEuropastrasse) to assess perforation and retraction, Dynamic Slow Motion Video Endoscopy (DSVE) to evaluate ET function, and pure tone audiometry using ALPS AD 2000 to determine the type and degree of hearing loss. High-Resolution Computed Tomography (HRCT) of the temporal bone was performed when necessary. Surgical interventions were conducted as appropriate.

All selected patients included in the study underwent comprehensive and diligent examinations and investigations. The evaluation of the patients in this study was as follows:

- Comprehensive clinical examination of the ear, nose, and throat.
- Complete blood count and relevant blood investigations.
- Specific investigations, including ear EUM to assess perforation of the tympanic membrane, cholesteatoma, and retraction pockets.
- Pure tone audiometry and impedance audiometry using ALPS AD 2000 and Tympanica Impedance Audiometer, respectively, to assess and grade hearing impairment.
- HRCT of the temporal bone to identify associated abnormalities and any other incidental findings.

The risk factors considered in the study included Belluci criteria to determine the degree of ottorhoea (7), Austin/Kartush criteria for assessing ossicular status (7), presence of perforation, middle ear granulations/effusion, history of previous surgery, and smoking. The MERI score was assigned as follows: MERI 0=Normal; MERI 1-3=Mild disease; MERI 4-6=Moderate disease; and MERI 7-12=Severe disease (7). (Table/Fig 1): Shows the MERI scoring system (7).

The ET dysfunction grading is as follows (6):

- Grade 0: Normal ET with no mucosal oedema or congestion. Medial cartilaginous lamina and lateral wall motions are normal. Tubal lumen opens well during swallowing.

- Grade 1: Oedema and congestion of the mucosa limited to the pharyngeal orifice of the ET. Normal lateral wall motion, and the tubal lumen opens with swallowing.

- Grade 2: Reduced lateral wall motion due to oedema and congestion involving the lumen (2A) and abnormal tubal muscle contraction (2B). Tubal lumen partially opens with swallowing.

- Grade 3: Tubal lumen fails to open with swallowing due to gross oedema (3A) and abnormal tubal muscle contraction (3B).

- Patulous (P): Patulous tubes show a noticeable concavity in the superior portion of the lateral wall of the ET lumen, with persistent patency of the lumen extending toward the isthmus. The medial and lateral cartilaginous lamina remain separate even at rest.

Statistical Analysis

Data were gathered and statistically analysed using the statistical sequencer of the Statistical Package for Social Science (SPSS) version 25.0. The Chi-square (χ2) test of independence was used to examine and compare the qualitative data. Differences were considered statistically significant if the p-value was less than or equal to 0.05.


The demographic parameters assessed included the age group and gender distribution, which are depicted in (Table/Fig 2) and (Table/Fig 3), respectively.

Forty patients were analysed according to the MERI score (0-12). Mild MERI scores (1-3) were observed in 11 patients (27.5%), while moderate (4-6) and severe (7-12) scores were observed in 10 patients (25%) and 19 patients (47.5%), respectively. The mean score of 6 (moderate) was observed in the present study. The patient distribution according to the MERI score is shown in (Table/Fig 4).

Sixteen patients underwent tympanoplasty: Of these, 11 (68.75%) had a mild MERI score, and 5 (31.25%) had a moderate score. Out of the 20 patients who underwent cortical mastoidectomy, 5 (25%) had a moderate MERI score, while 15 (75%) had a severe score. All four patients who underwent canal wall down mastoidectomy had a severe MERI score. Therefore, the study demonstrates a linear relationship between the severity of the score and the magnitude of the procedure. The chi-square value was 30.85, and the p-value was found to be significant (Table/Fig 5).

An attempt was made to determine an association between the MERI score and graft acceptance in this study. Graft acceptance was noted in 9 (81.82%) out of 11 patients with a mild MERI score, 10 (100%) out of 10 patients with a moderate MERI score, and 11 (57.89%) out of a total of 19 patients with a severe MERI score. The association between the MERI score and graft acceptance is shown in (Table/Fig 6).

Out of the 35 patients with normal ET function, 11 (31.43%) patients had a mild MERI score, 10 (28.57%) had a moderate score, and 14 (40%) patients had a severe MERI score. The remaining 5 patients with dysfunctional ET of various grades had a severe MERI score. (Table/Fig 7).

The study aimed to correlate graft acceptance with an increase in the grading of Eustachian dysfunction. Out of the total 40 patients studied, 35 patients had normal ET function. Among these patients, graft acceptance was observed in 30 (85.71%) patients. The remaining five patients who had ET dysfunction experienced graft rejection. The calculated chi-square value was 17.14 with a significant p-value. (Table/Fig 8).


The purpose of this study was to determine the relationship between the preoperative MERI and the planned type of middle ear surgery, as well as the factors influencing the success of tympanic membrane graft uptake. The aim was to assist surgeons, particularly those practicing in developing countries where financial constraints are common, in providing better counseling to patients regarding outcomes. The authros sought to offer reassurance and avoid the need for repeated surgeries for the same condition.

Surgical intervention was performed on all 40 patients in the present study, which involved procedures such as tympanoplasty, canal wall up/cortical mastoidectomy, and canal wall down mastoidectomy. Tympanic membrane reconstruction was carried out for all patients. In this study, the authors attempted to establish an association between the MERI score and the required procedure for each patient. It was observed that a large number of patients (40%) requiring tympanoplasty had a mild and moderate MERI score, while patients requiring canal wall up or canal wall down procedures (60%) had moderate or severe MERI scores. Thus, the present study demonstrated a linear relationship between the severity of the score and the magnitude of the procedure, which was found to be statistically significant (p=0.0001).

These findings align with the observations made by Pinar E et al., who reported a significantly higher mean MERI score in canal wall down tympanoplasties compared to canal wall up tympanoplasties (8). Zhu X et al., also noted an increased need for more extensive surgeries, such as canal wall down, with higher MERI scores (9). The requirement for canal wall down surgery increased in the low-risk, intermediate-risk, and high-risk categories, respectively. Similar observations were echoed in a study by Shishegar M et al., (10).

On associating the acceptance of graft with the MERI score, which is divided into mild, moderate, and severe, the authors found that graft acceptance was 9/11 (81.82%) and 10/10 (100%) with mild and moderate MERI scores, respectively. However, it dwindled to 11/19 (57.89%) in patients with a severe MERI score. Since the MERI score represents a cumulative version of risk factors, we can state that as the risk factors increase, the chances of graft acceptance decline. In the present study, this difference was found to be statistically significant with a p-value of 0.037.

Studies by Pinar E et al., Sevil E and Doblan A, and Zhu X et al., have also observed that graft acceptance is highest with a mild MERI score and declines with moderate/severe MERI scores [8,9,11]. These observations align with the findings of the present study. In contrast to our findings, a study by Verma JK et al., did not find a significant difference in graft success rates among the three groups (12).

Regarding the association between the MERI score and ET function, all patients with ET dysfunction had a severe MERI score. In patients with normal ET function, the distribution of MERI scores was as follows: mild in 11 (31.43%) patients, moderate in 10 (28.57%) patients, and severe in 14 (40%) patients. The association between MERI score and ET function yielded a p-value of 0.38, which was not statistically significant. However, the authors did not come across a study that specifically relates the MERI score to ET function, hence comparison was not possible. This aspect requires further research since ET function is a major criterion in understanding the pathogenesis, development, and severity of middle ear infection, as well as determining the outcome of corrective surgeries.

ET dysfunction has been attributed to many diseases of the middle ear cleft, ranging from Serous Otitis Media (SOM) to squamosal (unsafe) COM, and is considered one of the most important factors in determining the success of tympanoplasty. Out of the 40 patients, 35 had normal ET function, and graft acceptance was observed in 30 of these patients (85.71%). However, graft rejection was observed in all cases. This difference was found to be statistically significant (p-value=0.001). Shiromany A and Belaldavar B observed that out of 37 patients with normal ETF, 33 (90.2%) had a gratifying outcome, while failure was observed in four patients (9.8%) (13). Among the 11 patients with partial dysfunction of the ET, a success rate of 63.6% (7 patients) was observed. Studies conducted in the past have shown that there is an association between the surgical outcome of the disease and all the other pathological factors in consideration (14),(15). However, a majority of the studies in the literature have focused on a single factor exclusively (16),(17),(18),(19),(20). Therefore, such prognostic factors should be taken into consideration prior to surgeries to determine the candidacy of the patient for a specific type of surgery and estimate the expected outcome.


The study had certain limitations, such as a small sample size of patients included in both age groups, the absence of histopatho-logical correlation and the fact that it was not a multicenter study.


The MERI was used as a tool for surgical outcomes. Diseases requiring tympanoplasty alone had a mild MERI (1-3), while more extensive middle ear surgeries were associated with moderate or severe MERI scores (4-6 or 7-12), which were found to be significant. Graft acceptance was highest with mild and moderate MERI scores, but it decreased in patients with severe MERI, which was also found to be significant. Interestingly, all patients with ET dysfunction had a severe MERI score (7-12) and experienced graft rejection. The association of graft acceptance with ET function was statistically significant with p<0.05. In a country like India, where the cost of surgery and time away from work are major considerations, it is important to establish a standardised approach to predict the surgical outcome, whether it involves tympanoplasty alone or in combination with other middle ear surgeries like cortical mastoidectomy or canal wall down mastoidectomy, and counsel the patient accordingly. This plays a crucial role in informed decision-making.


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DOI and Others

DOI: 10.7860/JCDR/2023/64048.18641

Date of Submission: May 21, 2023
Date of Peer Review: Jun 19, 2023
Date of Acceptance: Oct 05, 2023
Date of Publishing: Nov 01, 2023

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: May 22, 2023
• Manual Googling: Jul 05, 2023
• iThenticate Software: Oct 03, 2023 (17%)

ETYMOLOGY: Author Origin


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