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<p>Predicting surgical outcomes in chronic otitis media remains challenging because conventional indices such as the Middle Ear Risk Index (MERI) primarily emphasize anatomical factors and may not fully incorporate functional and infective determinants of healing. The SPITE (Surgical, Prosthetic, Infection, Tissue, Eustachian tube function) system was developed to address these limitations. This study aimed to compare the predictive accuracy of SPITE and MERI, assess their correlation, and identify a cohort-derived SPITE threshold for preoperative risk stratification. A prospective observational study was conducted on 60 patients with chronic otitis media undergoing tympanoplasty or mastoid surgery at a tertiary care centre. Preoperative MERI and SPITE scores were recorded, and surgical outcomes were evaluated at six months in terms of graft uptake and hearing improvement. Statistical analysis included Pearson’s correlation, ROC curve comparison using the DeLong test, and hierarchical logistic regression to assess incremental predictive value. MERI and SPITE scores showed a strong positive correlation (<i>r</i> = 0.72, <i>p</i> &lt; 0.001). SPITE demonstrated higher predictive accuracy for graft uptake (AUC = 0.84) compared to MERI (AUC = 0.71). Addition of SPITE parameters to MERI improved overall model classification accuracy by 9%. A SPITE threshold score of 6.5 differentiated low-, moderate-, and high-risk categories for postoperative success within the study population. The SPITE system demonstrated higher predictive performance than MERI in this cohort. By integrating infection severity, tissue viability, and Eustachian tube function, SPITE may enhance prognostic stratification as an adjunct to traditional anatomical indices. Further multicentre validation is required before routine clinical implementation.</p>

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Comparative Evaluation of MERI and SPITE Systems in Predicting Surgical Outcomes in Chronic Otitis Media: Clinical and Mechanistic Insights

  • 期刊论文

  • 发表日期：

    2026年6月1日

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  • Srujan Vallur,
  • Sanjay Kumar,
  • Himanshu Swami

摘要

Predicting surgical outcomes in chronic otitis media remains challenging because conventional indices such as the Middle Ear Risk Index (MERI) primarily emphasize anatomical factors and may not fully incorporate functional and infective determinants of healing. The SPITE (Surgical, Prosthetic, Infection, Tissue, Eustachian tube function) system was developed to address these limitations. This study aimed to compare the predictive accuracy of SPITE and MERI, assess their correlation, and identify a cohort-derived SPITE threshold for preoperative risk stratification. A prospective observational study was conducted on 60 patients with chronic otitis media undergoing tympanoplasty or mastoid surgery at a tertiary care centre. Preoperative MERI and SPITE scores were recorded, and surgical outcomes were evaluated at six months in terms of graft uptake and hearing improvement. Statistical analysis included Pearson’s correlation, ROC curve comparison using the DeLong test, and hierarchical logistic regression to assess incremental predictive value. MERI and SPITE scores showed a strong positive correlation (r = 0.72, p < 0.001). SPITE demonstrated higher predictive accuracy for graft uptake (AUC = 0.84) compared to MERI (AUC = 0.71). Addition of SPITE parameters to MERI improved overall model classification accuracy by 9%. A SPITE threshold score of 6.5 differentiated low-, moderate-, and high-risk categories for postoperative success within the study population. The SPITE system demonstrated higher predictive performance than MERI in this cohort. By integrating infection severity, tissue viability, and Eustachian tube function, SPITE may enhance prognostic stratification as an adjunct to traditional anatomical indices. Further multicentre validation is required before routine clinical implementation.