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The study was carried out on 50 patients with central perforation in tympanic membrane (dry & inactive stage). The study was done in the department of ENT, MIMS medical college, Nellimarla, Vizianagaram over a period of one year. The study was done on comparison between tympanoplasty procedure using temporalis fascia as graft versus cartilage composite graft. Precise history was taken from respective patients in detail and were examined clinically. Patients with dry perforation with good cochlear reserve, intact and mobile ossicular chain, functioning Eustachian tube were selected randomly for the operation. Tympanoplasty procedure using temporalis fascia as graft was done in 50% (n=25) patients and tympanoplasty procedure using cartilage composite graft was done in 50% (n=25) patients. In this study the age range of patients were from 13 to 50 years, the mean age was 26.62 years, the number of male and female was equal. Right sided disease was predominant in our study and the mean duration of symptom was 11.24 months. The mean pre-operative hearing loss (pure tone average by pure tone audiometry) was 37.84±4.65 dB and mean pre-operative airbone gap was 22.84±4.65 dB. Post-operative Mean air conduction was 23.48±5.54 dB among them 24.2 ±6.26 dB in the fascial group and 22.76±4.73 dB in the cartilage group. This result is not statistically significant. Post-operative mean air-bone gap was 13.84±5.94 dB among them 14.76±5.6 dB in fascial group and 12.92 ±6.23 dB in the cartilage group which is not significant stastistically. Successful graft take-up rate of 88.00% (n=44). The overall success rate among tympanoplasty using temporalis fascia graft(GROUP A) and tympanoplasty using composite cartilage graft (GROUP B) technique were 84.00% (n=21) and 92.00% (n=23) respectively. 12.00% (n=6) patients were marked as failure cases during postoperative follow up period. The overall failure rate among tympanoplasty using temporalis fascia graft (GROUPA) and tympanoplasty using composite cartilage graft (GROUP B) technique were 16.00% (n=4) and 8.00% (n=2) respectively. So the distribution of surgical outcome in terms of success rate or failure rate was statistically insignificant in the two study groups (p=0.384). So the distribution of surgical outcome in terms of success rate or failure rate cartilage composite graft gives a definitely better result than temporalis fascia graft. However, the two method did not differ significantly in terms of hearing improvement. [ABSTRACT FROM AUTHOR]

The present study was undertaken to compare the results of various autogenous tissues: temporalis fascia, sliced tragal cartilage and fascia lata as graft materials for type I tympanoplasty in terms of hearing improvement in safe type of chronic suppurative otitis media. A total of 75 cases with central perforation were considered in the study. Of the 75 cases, temporalis fascia graft was used in 25 cases (Group-A), fascia lata graft in 25 cases (Group-B), and sliced tragal cartilage graft in 25 cases (Group-C). The results were evaluated in the form of hearing improvement with respect to the graft materials. A significant association was observed between the groups, that is, temporalis fascia (Group-A), fascia lata (Group-B), and sliced tragal cartilage (Group-C) in terms of improvement in AB gap (P = 0.047). Improvement in AB gap was statistically significant between groups B and A, but not between the other groups. In the present study, fascia lata showed better graft uptake as compared to temporalis fascia and sliced tragal cartilage. The hearing assessment at post-operative 3rd month showed statistically significant hearing improvement with fascia lata when compared to temporalis fascia. [ABSTRACT FROM AUTHOR]

Background: Tympanoplasty aims to restore hearing by fixing a perforated eardrum. This procedure can be carried out using various techniques and tissue grafts. While there is no agreement on the specific technique or graft to be used, the surgeon's experience and preferences are crucial in determining which repair method to select. Endoscopy allows for sufficient visualization, and even if there are exostoses [bony growths] in the external auditory canal [EAC], the margins of the perforation can be distinctly assessed.Aim of the work: This study aims to compare two surgical techniques of endoscopic type 1 tympanoplasty; Trans canal with or without tympanomeatal flap elevation.Patients and Methods: Fifty-two Patients with tympanic perforation attending Al-Azhar University Hospital, Otorhinolaryngology outpatient clinic with chronic tympanic membrane perforation and they were divided into two equal groups: Tympanoplasty with and without Elevation of Tympanomeatal Flap. The main studied outcomes were success rate of surgery and improvement of hearing.Results: We found significant decrease in post-operative Air Bone gap in group A than group B [p=0.015]. Mean operative time was statistically significant lower operative time in group B than group A [p=0.001]. High success rate was reported in both group without statistically significant difference.Conclusion: The trans-tympanic tympanoplasty is a straightforward method that has success rates similar to those of the tympanomeatal flap technique.

Objective: Effect of smoking on the Eustachian tube (ET) function is unknown specifically in humans. The literature about smoking as a prognostic factor in chronic otitis media (COM) surgery is showing discrepancies. We evaluated the ET function by the saccharin test. Test results compared between smokers and nonsmokers. Surgical outcomes were assessed between groups according to smoking status and ET function. Material and Methods: A prospective case series was conducted at a tertiary referral center on 83 COM patients undergoing endoscopic Type 1 cartilage tympanoplasty. Patients were classified based on saccharin test results into 3 groups; normal function, partial dysfunction, and gross dysfunction. Smoking status was used to evaluate ET function, and perforations were categorized as anterior, central, or posterior. Surgical success rates were compared between smokers and non-smokers. Results: The saccharin test showed no significant difference in ET function between smokers and non-smokers. Patients with gross dysfunction had more anteriorly localized perforations. Surgical success rates did not significantly differ between smokers and non-smokers, and ET function did not affect outcomes. Conclusion: Anteriorly localized perforations in tympanic membrane should bring to mind the ET dysfunction. Tragal cartilage is a reliable graft material for patients with smoking history and ET dysfunction. [ABSTRACT FROM AUTHOR]

Abstract Background Endoscopic myringoplasty allows full visualization of the external ear canal, tympanic membrane, and middle ear without the need to reposition the patient’s head. The endoscope allows accessing hidden areas and structures not properly viewed by the microscope such as sinus tympani, facial recess, and hypotympanum. It also provides sharp, magnified image and shortens the duration of the surgery. The postoperative pain and morbidity are reduced and hence the hospital stay. The aim of this work was to evaluate the efficacy of the endoscopic-assisted permeatal transperforation “push-through” myringoplasty by assessing the graft take rate and hearing results. Our study included twenty patients (14 females and 6 males) with chronic suppurative otitis media without cholesteatoma that underwent endoscopic-assisted permeatal transperforation myringoplasty. Results The case was considered '”successful'” if there was complete healing of the tympanic membrane and improvement of hearing. Graft uptake success rates were 85% with P-value 0.132. Average air-bone gap (A-B gap) preoperative was 18.20 dB; average A-B gap 1-month postoperative was 7.75 dB. Conclusion Endoscopic transcanal myringoplasty provided sharp, magnified visualization and operability as it avoids retroauricular skin incision and minimizes surgical procedures to expose hidden areas. There is less bleeding, a shorter operating time, less postoperative morbidity, and minimal postoperative care.

Objectives: In this study, the graft success and hearing improvement were compared in patients with subtotal or total tympanic membrane perforations following conchal cartilage-reinforced temporalis fascia graft tympanoplasty (CCRTT) versus traditional tragal island cartilage tympanoplasty (TICT). Material and Methods: Fifty Type 1 tympanoplasties performed for subtotal or total tympanic membrane perforation were classified into 2 groups: CCRTT consisted of 23 patients and TICT consisted of 27 patients. The difference between these 2 groups was analyzed by means of graft success, reperforation, and postoperative hearing gain after 12 months. Results: The graft success rate was 96.3% in TICT group and 91.3% in CCRTT group and there was no statistical difference between 2 groups ( P > .05). Postoperative pure tone average (PTA) gain was 12.9 ± 9 dB for TICT group and 14 ± 8.8 dB for CCRTT group and postoperative air-bone gap (ABG) gain was 11.2 ± 7.7 dB in TCIT group and 11.3 ± 8.5 dB in CCRTT group and again, there was no statistical difference between these 2 study groups considering PTA and ABG gain ( P > .05). Conclusion: Reinforcing tympanic membrane by conchal cartilage in an overlay technique under the anterior tympanic annulus by CCRTT in subtotal and total perforations is as effective as traditional TICT. Considering that graft success is lower in subtotal and total tympanic membrane perforations, both methods can be used interchangeably, depending on the choice of the surgeon., Competing Interests: Declaration of Conflicting InterestsThe author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

To evaluate graft success rate and hearing outcome in type 1 revision tympanoplasty using tragal cartilage graft. It is a prospective observational study conducted at Department of ENT, Bangalore Medical College and Research Institute from July 2017 to June 2019. Forty four patients between the age group 18–60 years undergoing type 1 revision tympanoplasty, with conductive hearing loss were enrolled.There were 27 males and 17 female patients in the study group. Cartilage tympanoplasty was done using thin tragal cartilage graft. Postoperative hearing gain and graft uptake was assessed at third month. Graft uptake and hearing improvement was assessed 3 months postoperatively in 44 patients. Forty patients had graft uptake (90.90%). The postoperative hearing gain was 7.12 ± 2.99 dB (p = 0.001) which was statistically significant. Tragal cartilage is a good option as graft material in revision cases in terms of ease of graft placement, better graft uptake and audiological outcome with no complications like lateralization of graft, medialization of graft, epithelial pearl formation and anterior blunting. [ABSTRACT FROM AUTHOR]

To determine the outcomes of using tragal cartilage in performing tympanoplasty. It was a prospective study of 57 patients with chronic suppurative otitis media. In all patients, pure tone audiometry was done pre-operatively. Tragal cartilage with attached perichondrium as graft material was used for ossicular chain reconstruction. In fifty out of the 57 participants, the outcome was intact ossicular chain. Of the 7 failures, 5 were recorded in the age group of 51–65 years, where graft uptake failed and hearing was not improved. Two of the failed cases required revision tympanoplasty. Post operative audiograms on follow-up revealed reduced air–bone gaps, with dry tympanic cavity and improved hearing. This study concluded that ossiculoplasty using tragal cartilage as a grafting material was an effective and safe surgical method for reconstruction of the ossicular chain and restoration of sound transmission. [ABSTRACT FROM AUTHOR]

Endoscopic tympanoplasty is a minimally invasive procedure and may be an alternative to conventional microscopic tympanoplasty with less operative time, producing similar graft uptake. Endoscopic tympanoplasty has a major disadvantage of single handedness which is overcome by a novel concept of "Two-handed technique" using Khan's Justtach (endoholder). The aim was to study the outcomes of two handed endoscopic tympanoplasty in terms of graft uptake and hearing outcome. Two handed endoscopic tympanoplasty was performed in 20 patients with chronic suppurative otitis media between April 2018–April 2019, in the Department of Otorhinolaryngology, M.G.M. Medical college and MYH hospital, Indore. Tragal cartilage graft via palisading supported with perichondrium was used. Postoperative follow up was done at 3rd month's period, graft status and hearing evaluation was done using Pure tone audiometry. Graft uptake was intact in 19 (95%) out of 20 patients and infection and failure in 1 (5%) case, average preoperative A–B gap was 15–25 dB loss (minimal) in 1 (5%) patient, 3 (15%) patients had 25–40 dB loss (mild) and 16 (80%) patients had 40–55 dB loss (moderate) hearing loss. The post-operative improvement was evaluated in which 6 (30%) patient had 15–25 dB loss (minimal), 12 (60%) patients had 25–40 dB loss (mild), and 2 (10%) patients had 40–55 dB (moderate) conductive hearing loss. We used Wilcoxon Signed Ranks Test for audiological evaluation with a 'p value' of 0.000 making the hearing improvement significant. "Two handed endoscopic tympanoplasty" is an emerging technique which can overcome almost all the major issues related with single handed technique with high degree graft uptake and good hearing outcomes. Endoscope holder is a valuable adjunct to conventional endoscopic surgery. [ABSTRACT FROM AUTHOR]

Abstract Background This study was designed to evaluate the effect of mastoid cavity obliteration with bone chips and reconstruction of canal wall with tragal cartilage after canal wall down tympanomastoidectomy with cartilage ossiculoplasty in the same session. Sixty-three patients with cholesteatoma underwent the technique mentioned above; patients were followed for 1 year postoperative. Results No cavity problems, median preoperative air bone gap was 32.86 ± 6.24 db, while the median postoperative air bone gap was 21.67 ± 5.99 db. Conclusions Canal wall down mastoidectomy with obliteration of mastoid cavity is an effective option for the complete removal of cholesteatoma and same session cartilage ossiculoplasty is a viable option.

Aim and Objectives: The aim and objective of the study are to compare results in terms of graft uptake and hearing improvement in cases undergoing tympanoplasty with the use of conchal or tragal cartilage. Materials and Methods: A total of 74 cases of more than 18 and <50 years of age included in this study, where full-thickness cartilage tympanoplasty was performed. Thirty-seven cases included in Group A where tragal full-thickness cartilage was used and 37 cases included in Group B where full-thickness conchal cartilage was used. Results: Thirty-six (97.3%) cases in Group A and 35 (94.6%) cases in Group B had successful and complete graft uptake in this study. Hearing improvement was found to be better with the cases in Group B than Group A. Conclusion: Full-thickness conchal cartilage and tragal cartilage give good graft uptake results and hearing improvement is significantly better with the use of conchal cartilage. [ABSTRACT FROM AUTHOR]

Objective: To assess the graft take rate and hearing gain in trans-canal endoscopic tympanoplasty Study Design: Descriptive study. Place and Duration of Study: Pakistan Naval Ship Hafeez, Islamabad Pakistan, form Dec 2015 to Jun 2018 Methodology: All patients with dry central perforations of >3 months history were included in the study. All Patients with perforations of pars tensa were booked for endoscopic cartilage tympanoplasty. All perforations were divided into four types small, medium, large and subtotal or total based on size of the tympanic membrane perforations. Small perforations involving <25% area of Pars Tensa. Medium perforation are Perforations involving 25-50% of Tympanic membrane. Large perforations include Perforations involving 50-75% of pars tensa. Subtotal or total perforations are defined as perforations with >75% perforation of the tympanic membranes. Wet Ears and perforations involving the Pars Flacida were excluded from the study. Preoperative Audiogram was carried out for all patients and A-B Gap were noted for all groups separately so as the demographic data including age and gender. Success was defined as complete closure of Tympanic membrane perforation at 3 months. All patients were operated with 0 Degree 3mm, 14cm rigid endoscope under general anesthesia. Results: Mean age of patients was. 37 years and standard deviation was 12.34 (range 12-58 years). Out of total 157 cases 81 patients male were males (51%) and 76 patients were females (49). Out of 157 ears operated 146 Perforations healed completely an overall success rate of 92%. Patients with small perforations had 100 percent success rate whereas near total or total perforations had 86% Success rate. Average preoperative A-B gap was 35 db and Average Postoperative A-B Gap was 15db. Ossicular discontinuity was noted in 34 (21.6%) cases and occlusion of ventilation including obstruction of eusthachian-tube opening was noted in 61 (38%) cases. Average Operative was 67 minutes. Incision scar was visible only in 2 patients 3 months after surgery. Conclusion: Endoscopic trans canal cartilage tympanoplasty is scarless safe effective procedure with demonstrable tympanic membrane perforation closure rates and hearing gains in all patients with minimum complications. The Technique is single handed and has steep learning curve. [ABSTRACT FROM AUTHOR]

Objective: The study objective was to study successful graft uptake and hearing gain by using different graft materials in pediatric tympanoplasty. Materials and Methods: Patients younger than 16 years of age who had undergone tympanoplasty between January 2016 and February 2019 were included in this study. Temporalis fascia or perichondrium was used as the graft material in tympanoplasty. Patient details such as age, sex, side of operated ear, operation technique, audiological profile before and after surgery, and the status of postoperative graft were noted. An intact graft and air–bone gap (ABG) ≤25 dB were considered as successful outcome after postsurgical period. Preoperative audiogram and audiogram after 6 months of surgery were advised for comparison.Results: Thirty-six pediatric patients were included in our study. Temporalis fascia graft was used as the graft material in 22 patients and cartilage graft was used as the graft material in 14 patients. The successful graft uptake was 89% in the temporalis fascia group, whereas it was 96% in the cartilage group. In temporalis fascia group, ABG before surgery was 35.53 dB, ABG after surgery was 17.12 dB, and the postoperative gain was 18.41 dB. In the tragal cartilage group, preoperative ABG was 32.42 dB and postoperative ABG was 15.13 dB, with a postoperative gain of 17.29 dB. The comparison between the temporalis fascia and the tragal cartilage groups was statistically significant for successful graft uptake (P = 0.0119) and hearing outcome (P = 0.0484). Conclusion: Temporalis fascia gives better hearing outcome, whereas tragal cartilage gives better graft uptake in pediatric tympanoplasty.

Background: Tympanoplasty is the most common ear surgery that is performed worldwide. From time immemorial, otolaryngologists worldwide used to perform this operation through the conventional post aural route. This technique no doubt is still the most popular, but it also brings in a lot of disadvantages like post-operative scar, increase morbidity and hospital stay. Hence, the need arised for a more effective, quick and robust technique. Aim: This study is to assess the clinical and audiometric success rate of the new tragal cartilage plug or butterfly technique tympanoplasty. Materials and Methods: We assessed 30 patients (ages between16-55 years) who underwent tragal cartilage plug tympanoplasty. It was a one year prospective clinical study. Results: Out of 30 patients, graft was taken up in 27 and in rest 3 there was residual perforation with an overall success rate of 90%. The anatomical success was assessed by otoscopy with graft well set in place. While functional success was analysed by audiogram, which showed decrease in Air-Bone (A-B) gap in 25 patients (83.3%). Conclusion: Considering the results attained, this method of tympanoplasty should be considered as a good alternative treatment option for repair of tympanic membrane perforations.

Introduction: The eradication of the middle ear disease is mentioned as the fundamental principle of tympanoplasty. The presence of some factors related to patient or disease itself forces the physician to classify the chronic ear disease as high-risk perforations. The aim of this study was to present a tri-layer tympanoplasty technique and its otological and audiological outcomes in the ears with high-risk perforations. Materials and Methods: This retrospective study was carried out on a total of 46 eligible ears that had chronic otitis media with high-risk perforations. Preoperatively, 17, 15, and 14 ears were reported with Sade classification grade 4 pars tensa retraction (Group 1), total or near-total tympanic membrane perforation (Group 2), and a history of ear surgery (Group 3), respectively. All the cases had tympanoplasty using the tri-layer technique at a tertiary center during 2008 and 2014. A review of the patients’ chart showed that 46 patients underwent tri-layer tympanoplasty. Regarding the audiological outcomes, the comparison of pre- and post-operative results revealed mean air conduction level and mean air-bone gap (ABG) of 4 different frequencies in dB according to a new standardized format for reporting hearing outcome in clinical trials. Results: The mean value of the follow-up period was reported as 29.22±3.23 months. Graft take rate was 93.4 % in all the cases, as well as 94.1%, 100%, and 85.7% in Group 1, Group 2, and Group 3, respectively. The mean values of ABG were improved from 35.17±6.64 to 23.52±10.4, 30.46±5.89 to 17.20±8.04, and 29.14±8.37 to 16.14±5.02 dB in Group 1, Group 2, and Group 3, respectively (P

Objective: The study aims to evaluate posterior pharyngeal wall augmentation using autologous tragal cartilage graft in adults with velopharyngeal valve insufficiency (VPI).Methods: The study included 23 patients with VPI (grade I, II, III), with ages ranging from 19 to 45 years. Six patients had previously undergone simple palatoplasty for cleft palate, 8 patients had previously undergone adenotonsillectomy and 9 patients had previously undergone uvulopalatopharyngoplasty (UPPP). The procedure was done by implanting a piece of autologous tragal cartilage in the posterior pharyngeal wall. Patients were followed up for 24 months postoperatively. The evaluation of percent of speech intelligibility and grade of the closure of the velopharyngeal valve using video-nasopharyngoscopy was evaluated preoperatively and postoperatively.Results: Highly statistically significant improvement in the grade of the closure of the velopharyngeal valve (P = 0.009) and percent of intelligibility (P = 0.001) was found after surgery. There were no postoperative airway obstruction or sleep apnea.Conclusion: Augmentation of the posterior pharyngeal wall using tragal cartilage is an effective, safe and physiological surgical procedure in the management of VPI in adults who suffered hypernasality following palatal and oropharyngeal surgeries. [ABSTRACT FROM AUTHOR]

Background Chronic suppurative otitis media is a common health problem. It causes tympanic membrane perforation, otorrhea, and conductive hearing loss. Type 1 tympanoplasty is a common otological procedure done to eliminate the infection and improve hearing and quality of life. Objective To compare graft uptake and hearing outcome using autologous grafts (tragal cartilage, temporalis fascia (control group), and tragal perichondrium) in tympanoplasty type 1. Patients and methods A total of 45 patients with chronic suppurative otitis media were included in this comparative study. They were divided into three groups, with 15 patients in each group: group A received tragal cartilage graft, group B received temporalis fascia graft (control group), and group C received tragal perichondrial graft. Patients were subjected to detailed history taking, proper clinical examination, routine blood investigations, audiometry, and tympanometry preoperatively. They underwent underlay tympanoplasty type 1. Postoperative follow-up was done after 3 months by otoscopy to evaluate graft uptake and hearing outcome by audiometry, and results were compared. Results Graft uptake was 93.3% in the cartilage group, 73.3% in fascia (control) group, and 66.7% in perichondrium group. There was hearing improvement in cartilage group than fascia (control) group, which was better than perichondrium group, with no statistically significant difference among the three groups regarding graft uptake (P=0.188) or hearing gain. Conclusion Graft uptake and hearing improvement were better with tragal cartilage graft in comparison with fascia (control group) and perichondrium grafts, with no statistically significant difference between them. [ABSTRACT FROM AUTHOR]

Background: Ideal graft material in revision tympanoplasty is a topic of much research. Cartilage being sturdy and stable even in negative pressure situations, is a viable option. Aims and Objectives: The aim of the present study was to evaluate graft uptake and hearing improvement using the technique of island of tragal cartilage as a graft material in revision tympanoplasty. Materials and Methods: This was a prospective study of total of 60 Type 1 revision tympanoplasty surgeries which were done using tragal cartilage island graft from December 2017 to December 2019 in our institute with a follow-up of 3 months. Results: Graft uptake in our study was found to be 93.33%. Four patients showed a re-perforation during follow-up. The mean preoperative air-bone gap (ABG) was 28.13 dB, while the postoperative mean ABG was 16.83 dB and the mean gain was 12.83 dB. Conclusion: It is thus worthwhile to consider island of tragal cartilage as a graft material in revision tympanoplasty. [ABSTRACT FROM AUTHOR]

Objective: The study objective was to study successful graft uptake and hearing gain by using different graft materials in pediatric tympanoplasty. Materials and Methods: Patients younger than 16 years of age who had undergone tympanoplasty between January 2016 and February 2019 were included in this study. Temporalis fascia or perichondrium was used as the graft material in tympanoplasty. Patient details such as age, sex, side of operated ear, operation technique, audiological profile before and after surgery, and the status of postoperative graft were noted. An intact graft and air–bone gap (ABG) ≤25 dB were considered as successful outcome after postsurgical period. Preoperative audiogram and audiogram after 6 months of surgery were advised for comparison.Results: Thirty-six pediatric patients were included in our study. Temporalis fascia graft was used as the graft material in 22 patients and cartilage graft was used as the graft material in 14 patients. The successful graft uptake was 89% in the temporalis fascia group, whereas it was 96% in the cartilage group. In temporalis fascia group, ABG before surgery was 35.53 dB, ABG after surgery was 17.12 dB, and the postoperative gain was 18.41 dB. In the tragal cartilage group, preoperative ABG was 32.42 dB and postoperative ABG was 15.13 dB, with a postoperative gain of 17.29 dB. The comparison between the temporalis fascia and the tragal cartilage groups was statistically significant for successful graft uptake (P = 0.0119) and hearing outcome (P = 0.0484). Conclusion: Temporalis fascia gives better hearing outcome, whereas tragal cartilage gives better graft uptake in pediatric tympanoplasty. [ABSTRACT FROM AUTHOR]

Objectives: To determine the efficacy of tragal cartilage graft in tympanoplasty type I. Study Design: Quasi-experimental study. Setting: Department of ENT, Head and Neck Surgery, Medical Teaching Institute (MTI), Lady Reading Hospital (LRH), Peshawar, Pakistan. Period: From Jan. 2017 to Dec. 2017 (One Year). Material & Methods: A total of forty four patient fulfilling inclusion criteria were included in this study. All the patients were assessed in terms of detail history, thorough examination focusing on ENT findings. Pure Tone Audiometry (PTA) was performed pre-operative and post-operative at 3 and 6 months interval for the frequencies of 0.5, 1, 2,4 Hz. Data were analyzed using SPSS (version 16). Paired sample t-test of significance was used. The confidence interval was set to 95% and P-value <0.05 was considered significant. Results: Out of 44 patients males were 24 (54.54%), female 20 (45.45%) with Male: Female ratio of 1.2:1. Mean age of the patients was 28. 47 + SD 7.26 Years. There was statistically significant difference between the pre and post-op air conduction (p<.001), and pre-op and post-op air bone gap (p<.001).There was subjectively significant hearing improvement in 31 patients (70.5%). Cartilage graft was taken in 43 patients with success rate of 97.7%. Conclusion: Tragal cartilage is an effective graft material, which yields good results in terms of graft take up, hearing improvement and minimum complication, postoperative healing and acoustic properties. [ABSTRACT FROM AUTHOR]

Ossiculoplasty is one of the commonly done and challenging surgery in otology and has been done using various graft materials. Materials such as autologous cartilage (tragal or conchal) or allograft (homograft) of the same tissue and synthetic materials like polyethylene TORP, ceramic and hydroxyapatite PORP or Titanium prosthesis have been used. But the latter synthetic materials are expensive and have high extrusion rates. Autologous cartilage grafts are selected for Ossiculoplasty as they are easy to harvest at the same site of operation, non-toxic, has less extrusion rate, minimum shrinkage and lateralization. The aim of this study is to know the efficacy of cartilage in ossicular reconstruction and to evaluate hearing outcome. It is a prospective study done on patients attending ENT outpatient department at hospitals attached to J.J.M Medical College, Davanagere. 50 patients were included in the study who underwent ossicular reconstruction either with canal wall up or down mastoidectomy with tympanoplasty. Pre-operative mean ABG was 39.3 db whereas 6 months post-operative mean ABG was 31.6 db with mean ABG improvement of 7.7 db which was statistically significant. Hearing improvement is better in cases where stapes suprastructure was present and also in canal wall up mastoidectomy procedures. This study suggests that cartilage graft (tragal and conchal) is effective in cases of ossicular reconstruction in patients of chronic otitis media and gives good hearing gain. It is also a economical option in developing countries. [ABSTRACT FROM AUTHOR]

Introduction: The eradication of the middle ear disease is mentioned as the fundamental principle of tympanoplasty. The presence of some factors related to patient or disease itself forces the physician to classify the chronic ear disease as high-risk perforations. The aim of this study was to present a tri-layer tympanoplasty technique and its otological and audiological outcomes in the ears with high-risk perforations. Materials and Methods: This retrospective study was carried out on a total of 46 eligible ears that had chronic otitis media with high-risk perforations. Preoperatively, 17, 15, and 14 ears were reported with Sade classification grade 4 pars tensa retraction (Group 1), total or near-total tympanic membrane perforation (Group 2), and a history of ear surgery (Group 3), respectively. All the cases had tympanoplasty using the tri-layer technique at a tertiary center during 2008 and 2014. A review of the patients' chart showed that 46 patients underwent tri-layer tympanoplasty. Regarding the audiological outcomes, the comparison of pre- and post-operative results revealed mean air conduction level and mean air-bone gap (ABG) of 4 different frequencies in dB according to a new standardized format for reporting hearing outcome in clinical trials. Results: The mean value of the follow-up period was reported as 29.22±3.23 months. Graft take rate was 93.4% in all the cases, as well as 94.1%, 100%, and 85.7% in Group 1, Group 2, and Group 3, respectively. The mean values of ABG were improved from 35.17±6.64 to 23.52±10.4, 30.46±5.89 to 17.20±8.04, and 29.14±8.37 to 16.14±5.02 dB in Group 1, Group 2, and Group 3, respectively (P<0.05). Results: The mean value of the follow-up period was reported as 29.22±3.23 months. Graft take rate was 93.4% in all the cases, as well as 94.1%, 100%, and 85.7% in Group 1, Group 2, and Group 3, respectively. The mean values of ABG were improved from 35.17±6.64 to 23.52±10.4, 30.46±5.89 to 17.20±8.04, and 29.14±8.37 to 16.14±5.02 dB in Group 1, Group 2, and Group 3, respectively (P<0.05). [ABSTRACT FROM AUTHOR]

Background: The endoscope has diagnostic and therapeutic role in different otological surgeries. It has excellent view of images where there are difficult nooks and corners. The use of sandwich cartilage perichondrium in the repair of tympanic membrane peroration has its own benefit in graft uptake and hearing results whether long term or short term. The main purpose of the present study was to evaluate the long-term hearing results in patients who underwent endoscopic sandwich myringoplasty with Dhulikhel Hospital (D-HOS) technique. Materials and Methodology: This was a prospective, cohort study performed among 45 patients who underwent endoscopic sandwich myringoplasty with D-HOS technique using tragal cartilage and perichondrium. The hearing was assessed by comparing pre- with post-operative air-bone gap (ABG) and ABG closure in speech frequencies (0.5 kHz, 1 kHz, 2 kHz, and 4 kHz). Results: Among forty-five patients, 42 (93.3%) had graft uptake in 12 months of follow-up. The postoperative ABG (17.0 ± 8.5 dB) was lesser than preoperative ABG (27.3 ± 12.5 dB) with statistically significant results. Conclusion: Endoscopic sandwich myringoplasty with D-HOS technique is a safe procedure with high-graft uptake rate and good long-term hearing results. [ABSTRACT FROM AUTHOR]

Abstract: Cartilage-perichondrium composite graft is used in middle ear surgery for tympanic membrane, ossicular and for soft wall reconstruction. The thickness of the cartilage is thought to interfere with the sound conduction. In our otology practice for tympanic membrane reconstruction, we prefer the sliced cartilage graft to achieve acoustic benefit. At times in the process of slicing, the cartilage gets wasted if not sliced with a precision slicing instrument. We have designed and developed a multi-purpose cartilage slicer for precise reduction of the thickness of the cartilage. To describe the design of our cartilage slicer and to report our preliminary experience with the cartilage slicer. Descriptive study. The technique of slicing with our new cartilage slicer and its usage has been described in detail. A total number of 689 cartilages in tympanoplasty and mastoidectomy have been sliced with it from 2013 to 2017. Our study reports the technique of slicing the tragal cartilage for tympanoplasty, highlighting its advantages and precision of the cartilages slices obtained. Our cartilage slicer is a good option for cartilage slicing in tympanoplasty. Level of Evidence: Level 4. [ABSTRACT FROM AUTHOR]

Background: Tympanoplasty refers to any operation involving reconstruction of the tympanic membrane and/or the ossicular chain. Myringoplasty is a Tympanoplasty without ossicular reconstruction. Chronic otitis media is one of the commonest Otological problems among Sudanese, in both adult and children (43%) and they presented with perforation of the eardrum and different degrees of hearing loss. Aim: To evaluate the audiological and surgical results of tragal cartilage graft in myringoplasty for reconstruction of tympanic membrane perforation. Materials and methods: A total of 25 patients in the age group of 16 - 60 years suffering from chronic suppurative otitis media of tubotympanic type, attending the outpatient department at Rajah Muthiah Medical College and hospital and underwent tragal cartilage myringoplasty between October 2015 to August 2017 were included in the study. Results: The mean preoperative pure tone average was 37 and the postoperative pure tone average was 25.80 at 6th week and 15.60 at 10th week. The calculated p-value was less than 0.001 which was statistically significant. Graft uptake was 92% in our study. There was no postoperative retraction. Postoperative reperforation was seen in 2 (8%) patients. Conclusion: Graft takeup in tragal cartilage myringoplasty has been excellent, hearing results are satisfactory and complications are minimal. Immobility of the transplant during the early stages of the healing process is the most important factor for the successful surgical outcome of myringoplasty. [ABSTRACT FROM AUTHOR]

Objective:Fascia or cartilage can be used as grafts in tympanoplasty; however, the disadvantage of cartilage is that it causes stiffness and rigidity in the newly formed tympanic membrane. The aim of this study was to compare the long-term high-frequency tympanometry and audiometry outcomes of tympanoplasty using cartilage and fascia.Methods:Forty patients in whom tragal cartilage was used in type 1 tympanoplasty and 40 patients in whom temporal muscle fascia was used were included in the study. The preoperative and postoperative audiometries of the two groups were compared. Postoperative high-frequency tympanometry (224, 668, 800, and 1000 Hz) and air volume, compliance, and pressure differences of the two groups were also compared.Results:The mean age of the patients was 31.3±4.5 year. The success rates were 96% in the cartilage group and 92% in the fascia group. In the fascia group, the preoperative mean air bone gap was 27.9±97 decibels (dB), and the postoperative mean air bone gap was 19.1±7.6 dB. The postoperative mean air bone gap improvement was 8.8±9.9 dB; the difference was statistically significant. In the cartilage group, the preoperative mean air bone gap was 28.2±9.6 dB, and the postoperative mean air bone gap was 17.2±10.5 dB. The postoperative mean air bone gap improvement was 10.9±10.3 dB; the difference was statistically significant. When postoperative mean air bone gap improvement was compared, there was no statistical difference between the two groups. When high-frequency tympanogram values were compared, there were no significant differences between the two groups at 224, 668, 800, or 1000 Hz frequencies in terms of air volume, compliance, or pressure values.Conclusion:The use of temporal muscle fascia and cartilage in tympanoplasty is statistically similar when compared in terms of tympanic membrane repair, hearing gain, air volume, pressure, and compliance. For this reason, cartilage graft can easily be preferred in tympanoplasty, especially in revision cases and adhesive otitis media, without fear of stiffness or rigidity effects.

Background: 40 patients with glottic insufficiency over the age of 18 years old who presented to the otorhinolaryngology outpatient clinic at (blinded for peer review) were the subjects of this prospective study. Two equal groups (A&B) of patients were randomly separated. For group (A), the tragal cartilage implants were used to enhance the vocal folds; for group (B), fascia lata implants were utilized. Auditory perceptual assessment of voice (APA), voice handicap index (VHI), and computerized speech lab (CSL) were used for voice assessment, penetration aspiration score (PAS), and dysphagia handicap index (DHI) for aspiration assessment during preoperative and postoperative evaluation., Results: In both groups, there was a statistically significant difference between preoperative and postoperative subjective and objective parameters used for voice and aspiration assessment (APA, VHI, CSL, PAS, and DHI). There was a statistically non-significant difference between the two groups one and 12 months postoperatively except for only noise to the harmonic ratio (N/H ratio) in group A which showed more significant improvement than group B., Conclusion: Vocal fold augmentation using the tragal cartilage and fascia lata grafts in glottic insufficiency patients is effective in improving hoarseness of voice and aspiration. Both grafts result in long-term improvement (at least 12 months), however tragal cartilage graft is easier to implant and more stable postoperatively than the fascia lata graft., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

OBJECTIVE: It is an ongoing debate whether tympanoplasty should be performed in the pediatric age group. The purpose of this study was to analyze and compare the anatomical and functional outcomes of type I cartilage tympanoplasty in children and adults. MATERIALS and METHODS: The file records of patients who underwent type 1 cartilage tympanoplasty were retrospectively reviewed. In total, 133 patients who underwent type 1 tympanoplasty for chronic otitis media were included. Tragal cartilage grafts were used in all patients. The patients were divided into two groups: pediatric (age≤16 years, n=54) and adult (age>18 years, n=79) groups. The graft success rates and hearing results between the two groups were compared. RESULTS: The graft success rate was 90.2% (120/133) in the study group. At the end of the 24-month follow-up, the graft was intact in 48 of the 54 (88.9%) patients in the pediatric group and 72 of the 79 patients in the adult group (91.1%) (p=0.769). The functional success rate (postoperative air-bone gap<20 dB) obtained in the study group was 90.2% (120/133). The functional success rate was 88.9% (48/54) in the pediatric group and 91.1% (72/79) in the adult group (p=0.255). CONCLUSION: The graft success rates and hearing results obtained with cartilage grafts are similar in children and adults. Therefore, cartilage grafts may be safely used in pediatric patients, similar to their use in adults. [ABSTRACT FROM AUTHOR]

To evaluate the success rate, in terms of anatomical and functional results, in our technique of cartilage support for fascia graft in type I tympanoplasty. Retrospective study of tragal cartilage support for fascia graft in tympanoplasty for large central perforation in 748 patients was carried at an academic institution during January 2004 to March 2012. Patients' age ranged from 11 to 65 years. 325 (43.4 %) male and 423 (56.6 %) female patients were operated and mean post-operative follow up was of 24 months (range 6-48 months). The inclusion criteria were large central or subtotal perforation, anterior quadrant perforation, anterior tympanosclerotic patch with perforation and revision myringoplasty. Small central perforation, posterior perforations, traumatic perforations and Ossiculplasty were excluded from this study. In this technique, a piece of tragal cartilage carved in semi lunar shape is inserted medial to anterior remnant of tympanic membrane. Temporalis fascia graft is sandwiched between cartilage and anterior remnant of tympanic membrane. Post-operative closure of perforation was noted. Pure-tone average pre and post-operative air-bone gap in dB at 250, 500, 1000, 2000, and 4,000 Hz were compared. The overall success rate of our technique was 98.3 % in terms of graft uptake and within 13.35 ± 5.22 dB of air bone gap closure in terms of hearing improvement. This study reveals that cartilage support for fascia graft in type I tympanoplasty is a highly reliable technique and gives significant improvement in graft take-up and hearing status. [ABSTRACT FROM AUTHOR]

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Though single sitting myringoplasty using temporalis fascia under general anesthesia has been documented in many studies, but ours is the first center to have started using tragal cartilage harvested from one ear to do bilateral myringoplasty in one sitting using local anesthesia with excellent results including very good graft uptake rate and audiological improvement without significant complications. [ABSTRACT FROM AUTHOR]

Introduction: Various graft materials have been used to close tympanic membrane perforations. In the literature, there are few studies in pediatric populations comparing different graft materials. To our knowledge, there is no reported study that measured the thickness of the tragal cartilage in pediatric tympanoplasties. The tragal cartilage is not of uniform thickness in every patient., Objective: To compare anatomical and functional outcomes of temporalis fascia muscle and full-thickness tragal cartilage in type 1 pediatric tympanoplasties., Methods: In total, 78 patients (38 males, 40 females; average age 10.02±1.98 years; range, 7-18 years) who underwent type 1 tympanoplasties in our clinic were included. Demographics, anatomical, and functional outcomes were collected. Temporalis fascia muscle and tragal cartilage were used as graft materials. Tragal cartilage was used without thinning, and the thickness of tragal cartilage was measured using a micrometer. Anatomical and functional outcomes of cartilage and fascia were compared. Audiometric results comparing the cartilage and fascia groups were conducted at 6 months, and we continued to follow the patients to 1 year after surgery. An intact graft and an air-bone gap≤20dB were regarded as a surgical success. Results with a p-value<0.05 were considered statistically significant., Results: The graft success rate was 92.1% for the cartilage group compared with 65.0% for the temporal fascia group. In the fascia group, the preoperative air-bone gap was 33.68±11.44 dB and postoperative air-bone gap was 24.25±12.68dB. In the cartilage group, the preoperative air-bone gap was 35.68±12.94dB and postoperative air-bone gap was 26.11±12.87dB. The anatomical success rate in the cartilage group was significantly better than that for the fascia group (p<0.01). There was no statistically significant difference in functional outcomes between the fascia and cartilage groups (p>0.05). The average thickness of tragal cartilage in the pediatric population was 0.693±0.094mm in males and 0.687±0.058 mm in females., Conclusions: Our data suggest that the anatomical success rate for a cartilage tympanoplasty was higher than for a fascia tympanoplasty. Functional results with cartilage were not different than with fascia, even though we did not thin the tragal cartilage. However, further studies should focus on the interaction between the thickness of the tragal cartilage and the tympanoplasty success rate., (Copyright © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.)

Cartilage is the grafting material of choice in advanced disorders of the middle ear while the indications for its routine use remain controversial due to the possible detrimental effect on post-operative hearing. Aim of the present study was to report personal experience with "tragal cartilage shield" tympanoplasty. The study focused on 306 adult patients (236 primary procedures and 70 revisions from January 2003 to June 2007). Mean post-operative follow-up was 37 months (range 1-66). The following parameters were evaluated: graft take, change between the pre- and post-operative pure-tone average air-bone gap (PTA-ABG), post-operative complications. Graft take was achieved in 304 patients (99.35%) and there were no immediate post-operative complications. The overall average pre-operative pure-tone average air-bone gap was 43.79 +/- 7.07 dB, whereas the post-operative (1 year after surgery) pure-tone average air-bone gap was 10.43 +/- 5.25 dB (p < 0.0001). Statistically significant improvement was observed up to 5 years after surgery. This study reveals that tragal cartilage shield tympanoplasty is a reliable technique, in fact it has a high degree of graft take and hearing results are satisfactory. Furthermore, the cartilage is a satisfactory grafting material because it is easily accessible, easy to adapt, resistant to negative middle ear pressures, stable, elastic, well tolerated by the middle ear, resistant to resorption. Therefore, we also recommend its use in less severe middle ear disorders, in which the functional outcome is more essential.