الفهرس 
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Abstract
Chronic suppurstive otitis media is a common disease in Otolaryngeology out patient clinic . It is a chronic inflammation of mucoperiosteal lining of the middle ear cleft characterised by persistent perforation of the tympanic membrane in the presence or absence of ear discharge.
Tympanoplasty is a surgical procedure aiming to reconstruct the tympanic membrane and also hearing . where as myringoplasty is an operation in which the reconstructive procedure is limited to repair of a TM perforation . Great controvery is still present about prognostic factors of successful myringoplasty, therefore, there is a great need of such a work which can help to set the uniform definitive criteria in predicting the optimal outcomes of myringoplasty.
Middle ear risk index (MERI) developed by Kartush generates a numeric indicator of the severity of the middle ear disease to stratify patient groups according to the severity of the disease. A normally functioning Eustachian tube (ET) is an essential physiologic requirement for a healthy middle ear and normal hearing.
In this work middle ear risk index and Eustachian tube function were evaluated as prognostic factors of myringoplasty. Effect of site and size of tympanic membrane perforation and ossicular pathology on hearing loss was also evaluated.
This is prospective study on 40 patients were complaining of CSOM with dry central perforation for at least 3 months . Cases were selected from out patients clinic of Otolaryngology Department in Menoufia University Hospital .
Patients were assessed preoperatively by history as onset, course , duration , last attack, amount and colour of otorrhea, hearing loss,tinnitus and other complains and history of previous surgery or other system affection.
Patients were examined by otoscope and under microscope. Perforation site and size , ossicular pathology , middle ear mucosa pathology and MERI score were documented.
Audiological investigations as PTA, Tympanometery and ETF (tympanometry and The inflation-deflation test) were documuented to identify type of hearing loss, ABG and ETF . Evaluation of relationship between perforation site , size ,ossicular pathology and hearing loss .
Patients underwent underlay myringoplasty with temporalis fascia grafting, through post auricular approach. post operative Follow up visits were at 1weeks,4 weeks, 12weeks and 24weeks .
After 12 and 24weeks follow up , results were documented by otoscopic and microscopic examination , photography of TM , post operative PTA and tympanometry. Myringoplasty was considered successful by achieving postoperative intact tympanic membrane without evidence of a residual perforation and improvement of hearing. comparing of preoperative and postoperative data and statistical analysis of the result was done.
This study was done on 40 patients had tubotympanic CSOM underwent myrigoplasty . Age was between 15 to 50 years old. Sex was 19 male and 21 female. Out of 40 ears, 12 (30%) were having small T.M. perforation, 14 (37.5%) were having medium sized T.M. perforation, 7 (17.5%) were having large T.M. perforation and 7 (17.5% )were having total T.M. perforation. Most of the patients were having pure conductive hearing loss ( 38 ears ,95%). Hearing loss was dependant on size and site of perforation and status of ossicles . It was more in total and posterior perforations than small and anterior perforations. Also hearing loss was more in case of erosion of both long process of incus and handle of malleus than erosion of handle of malleus only.
Graft up take was dependant on size perforation , it was best in small and worse in total perforations . Most residual perforations were anterior. Most patients had mild disease .i.e. MERI 1-3 with more graft up take rate (96%). Half of cases had good Eustachian tube function with more graft up take rate (64 %).
The mean ABG was 24.7±7.8dB pre-operatively and 7.5±3.3 dB post-operatively . pre operative range of ABG was 6-45 dB and postoperative was 0-10 dB . Hearing improvement following succeded myringoplasty was statistically highly significant and dependant on site and size of perforation without significant relation to ETF , as the more ABG closure was found in small and anterior perforation than total and posterior perforations.