Introduction:
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 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 define the pre reconstruction ossicular status.

Austine Kartush classification:
This classification uses middle ear osscicular status.  Four different groups have been identified:

Group A - Malleus and stapes present (commonly seen status) because of precarious vascularity of incus

Group B - Malleus and foot plate of stapes present

Group C - Malleus absent and stapes present

Group D - Malleus and stapes suprastructure absent

Kartush added three more classes as a modification of this scheme in include ossicular fixity even when all three ossicles are present.

O - Intact ossicular chain

E - Ossicular head fixation

F - Stapes fixation

Middle ear risk index includes:

1. Austin Kartush classification of ossicular defects

2. Ear drum perforation

3. Cholesteatoma

4. Belluci classification

Weightage is given to these 4 parameters to arrive at the middle ear risk index. 

Belluci classification uses otorrohea as an index.

Otorrohea	Risk value
Dry ear	0
Occasionally wet	1
Persistently wet	2
Persistently wet with cleft palate	3

Perforation if present adds a value of 1 to the risk index

Cholesteatoma if present adds a value of 2 to the risk index

Austin Kartush classification

1. M+I+S += 0

2. M+S+=1

3. M-S+ = 3

4. M-S- = 4

5. Ossicular head fixation = 2

6. Stapes fixation = 3

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

History of previous surgery adds 2 to the risk factor

History of smoking adds another 2 to the risk factor

Totalling all these factors adds to the middle ear risk index