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Laryngology MIDDLE EAR RISK INDEX (MERI)

Otology

Absolute bone Introduction:

conduction test
The term Middle ear risk index is used to predict the success rate of middle ear reconstruction procedures. For accurate prediction of the surgical results
Anatomy of chorda of middle ear ossiculoplasty the status of middle ear and its ossicles must be ascertained. Austine Kartush classification has been used as a method to
tympani nerve define the pre reconstruction ossicular status.

Bell's palsy Austine Kartush classification:

Blood supply of This classification uses middle ear osscicular status. Four different groups have been identified:
cochlea
Group A - Malleus and stapes present (commonly seen status) because of precarious vascularity of incus
Carahart's notch
Group B - Malleus and foot plate of stapes present
Causes of
conductive Group C - Malleus absent and stapes present
deafness
Group D - Malleus and stapes suprastructure absent
Cerumen
Kartush added three more classes as a modification of this scheme in include ossicular fixity even when all three ossicles are present.
Cholesteatoma
O - Intact ossicular chain
chronic otitis
externa E - Ossicular head fixation

F - Stapes fixation
CROS Hearing Aids

Middle ear risk index includes:

Deaf mutism
1. Austin Kartush classification of ossicular defects
Di erence between
Furuncle / ASOM /
2. Ear drum perforation
Acute mastoiditis
3. Cholesteatoma
Di erential
diagnosis of cavity 4. Belluci classification
in x ray mastoid
Weightage is given to these 4 parameters to arrive at the middle ear risk index.
Dorello's canal
Belluci classification uses otorrohea as an index.
Drugs used in
otology and their Perforation if present adds a value of 1 to the risk index
formulations
Cholesteatoma if present adds a value of 2 to the risk index
Endolymphatic
hydrops Austin Kartush classification

Eosinophilic otitis 1. M+I+S += 0

media a literature
review 2. M+S+=1

Facial recess 3. M-S+ = 3

 4. M-S- = 4

5. Ossicular head fixation = 2

Home 6. Stapes fixation = 3

Laryngology Presence of effusion / granulation in the middle ear adds 2 to the risk index

Otology History of previous surgery adds 2 to the risk factor

Absolute bone History of smoking adds another 2 to the risk factor

conduction test
Totalling all these factors adds to the middle ear risk index
Anatomy of chorda
tympani nerve Otorrohea Risk value
Dry ear 0
Bell's palsy Occasionally wet 1
Persistently wet 2
Blood supply of Persistently wet with cleft palate 3
cochlea

Carahart's notch

Causes of
conductive
deafness

Cerumen

Cholesteatoma

chronic otitis
externa

CROS Hearing Aids

Deaf mutism

Di erence between
Furuncle / ASOM /
Acute mastoiditis

Di erential
diagnosis of cavity
in x ray mastoid

Dorello's canal

Drugs used in
otology and their
formulations

Endolymphatic
hydrops

Eosinophilic otitis
media a literature
review

Facial recess