Megerian et al developed a disease severity scale for patients with chronic otitis media requiring tympanomastoidectomy. The authors are from the University of Massachusetts and the Albert Einstein College of Medicine.
Preoperative parameters:
(1) perforation/tympanosclerosis resulting in expected total drum replacement
(2) frequent drainage (> 4 times per year)
(3) history of previous chronic ear surgery to the affected ear
(4) clinical evidence of cholesteatoma by clinical examination and/or CT scan
(5) one or more of the following: age > 70 years, current smoker, diabetic, immune dysfunction
Intraoperative parameters:
(6) cholesteatoma medial to incus
(7) canal wall-down procedure
(8) absent stapes superstructure
(9) labyrinthine fistula, or facial nerve involvement by cholesteatoma
(10) granulomatous degeneration of middle ear mucosa
|
Parameter |
Finding |
Points |
|
perforation/tympanosclerosis resulting in expected total drum replacement |
absent |
0 |
|
|
present |
1 |
|
drainage |
<= 4 times per year |
0 |
|
|
> 4 times per year |
1 |
|
history of previous chronic ear surgery to the affected ear |
absent |
0 |
|
|
present |
1 |
|
clinical evidence of cholesteatoma |
absent |
0 |
|
|
present |
1 |
|
cholesteatoma medial to incus |
absent |
0 |
|
|
present |
1 |
|
canal wall-down procedure |
absent |
0 |
|
|
present |
1 |
|
stapes superstructure |
absent |
0 |
|
|
present |
1 |
|
granulomatous degeneration of the middle ear mucosa |
absent |
0 |
|
|
present |
1 |
|
patient factors |
AND (age <= 70, nonsmoker, nondiabetic, immune intact) |
0 |
|
|
OR (age > 70, smoker, diabetic, immune defect) |
1 |
|
complications |
NOR(labyrinthine fistula, facial nerve involved by cholesteatoma) |
0 |
|
|
OR(labyrinthine fistula, facial nerve involved by cholesteatoma) |
1 |
after Table 1, page 1346
severity scale =
= SUM(points for parameters present)
Interpretation:
• minimum score: 0
• maximum score: 10
• The higher the severity scale, the more severe the disease.
• A high severity scale is associated with a longer surgical procedure.
Specialty: Infectious Diseases, Otolaryngology
