Abdel-Hakim Fouad Elwany
Asst. Professor
Evaluation of the Middle Ear Risk Index (MERI) as a prognostic tool in cases of tympanoplasty with mastoidectomy
• 2026
Publication Information
Authors
Abd Elhakim Fouad Ghallab1,2, Ahmed Soliman Elkady1,2, Ahmed El‑Sayed Fathy Salman1,2* and
Eslam Farid Abu Shady
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publication.type
International
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Abstract
Background Chronic suppurative otitis media (CSOM) is a long-standing inflammation of the middle ear mucosa
characterized by tympanic membrane perforation and persistent or intermittent otorrhea (discharge lasting a mini‑
mum of 2–6 weeks). Our study aimed to assess the middle ear risk index as a prognostic tool in tympanoplasty
with mastoidectomy cases.
Methods This single-center prospective observational study was performed at a tertiary care center from May 2024
to May 2025 comprising 60 patients with non-complicated safe CSOM candidate for post-auricular canal wall-up
(CWU) tympanomastoidectomy through a post-auricular approach. Patients were assigned according to Austin-Kar‑
tush classification. All patients underwent multislice CT scan and pure tone audiometry (PTA).
Results Hearing improvement was achieved in 39 (65%) patients, and successful graft uptake occurred in 45 (75%).
Higher MERI scores were associated with poorer postoperative hearing outcomes. Spearman correlation demon‑
strated a significant negative association between MERI score and hearing improvement (r=− 0.385, p=0.002). On
multivariate logistic regression analysis, MERI score emerged as the only independent predictor of hearing improve‑
ment (OR=0.600, 95% CI: 0.370–0.990, p=0.048).
Conclusions Elevated MERI scores were significantly associated with unfavorable anatomical and functional out‑
comes, whereas lower scores correlated with successful graft uptake and greater hearing improvement.
characterized by tympanic membrane perforation and persistent or intermittent otorrhea (discharge lasting a mini‑
mum of 2–6 weeks). Our study aimed to assess the middle ear risk index as a prognostic tool in tympanoplasty
with mastoidectomy cases.
Methods This single-center prospective observational study was performed at a tertiary care center from May 2024
to May 2025 comprising 60 patients with non-complicated safe CSOM candidate for post-auricular canal wall-up
(CWU) tympanomastoidectomy through a post-auricular approach. Patients were assigned according to Austin-Kar‑
tush classification. All patients underwent multislice CT scan and pure tone audiometry (PTA).
Results Hearing improvement was achieved in 39 (65%) patients, and successful graft uptake occurred in 45 (75%).
Higher MERI scores were associated with poorer postoperative hearing outcomes. Spearman correlation demon‑
strated a significant negative association between MERI score and hearing improvement (r=− 0.385, p=0.002). On
multivariate logistic regression analysis, MERI score emerged as the only independent predictor of hearing improve‑
ment (OR=0.600, 95% CI: 0.370–0.990, p=0.048).
Conclusions Elevated MERI scores were significantly associated with unfavorable anatomical and functional out‑
comes, whereas lower scores correlated with successful graft uptake and greater hearing improvement.