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Objective: Endoscopic ear surgery is no longer a promising technique, but a well-established one. This study aims to compare endoscopic and microscopic tympanoplasty based on current literature evidence, in terms of their efficacy and safety characteristics., Data Sources: We conducted a systematic literature search of four medical databases (Pubmed, Cochrane Library, Scopus, ClinicalTrials.gov), focusing on randomized controlled or observational studies comparing microscopic to endoscopic tympanoplasty., Review Methods: Data related to the efficacy and safety of each technique were extracted. Outcome data were summarized using pooled mean differences or pooled odds ratio along with their 95% confidence intervals. The risk of bias was estimated, by using the ROBINS-I and RoB-II assessment tools, while the overall quality of evidence was evaluated according to the GRADE working group., Results: Thirty-three studies, with 2646 patients in total, were included in the meta-analysis. Success rate was evaluated by estimating tympanic graft failure (pooled mean difference:-0.23; 95% CI: -0.61, 0.14, I 2  = 33.42%), and air-bone gap improvement (pooled mean difference:-0.05; 95% CI:-0.23, 0.13, I 2  = 52.69%), resulting in comparable outcomes for the two techniques. A statistically significant difference favoring the endoscopic technique was detected regarding postoperative wound infection (OR: -1.72; 95% CI: -3.39, -0.04, I 2  = 0%), dysgeusia (OR: -1.47; 95% CI: -2.47, -0.47, I 2  = 0%), otitis externa development (OR: -1.96; 95% CI: -3.23, -0.69, I 2  = 0%), auricular numbness (OR: -2.56; 95% CI: -3.93, -1.19, I 2  = 0%), as well as surgical duration (OR: -1.86; 95% CI: -2.70, -1.02, I 2  = 43.95%), when compared to the postauricular microscopic approach., Conclusion: Endoscopic tympanoplasty is an innovative alternative to the microscopic technique, resulting in commensurate outcomes regarding success rate. Furthermore, it offers superior results concerning postoperative complications, while it presents a significant reduction in the duration of surgery, mainly when it is compared to the postauricular microscopic approach., Level of Evidence: NA Laryngoscope, 134:3466-3476, 2024., (© 2024 The American Laryngological, Rhinological and Otological Society, Inc.)

Background: Post-extubation negative pressure pulmonary oedema is a rare, potentially life-threatening complication associated with general anaesthesia. Chest radiography is used as a diagnostic tool, but it implies a non-negligible radiation exposure, a very important consideration, especially for the paediatric population. However, lung ultrasound can overcome this problem and can be used to detect postoperative pulmonary complications., Case Report: A 16-year-old male was scheduled for tympanoplasty. General anaesthesia was conducted, and after extubation, the patient developed a laryngospasm. On arrival at the post-anaesthetic care unit, the patient started to cough, a pink frothy sputum and hypoxemia were noticed, and auscultation revealed crepitations. A bedside lung ultrasound showed more than three B-lines per intercostal window, suggesting an alveolar-interstitial syndrome., Discussion: With this case report, we would like to raise awareness to this clinical entity and demonstrate bedside ultrasound has an important role in the diagnostic and therapeutic assessment during the perioperative period., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: We present the first published case of large foreign body reaction to Biodesign (Cook Medical, Bloomington, IN), an acellular otologic graft matrix derived from porcine small intestinal submucosa, after use in tympanoplasty surgery in a patient without previous exposure to meat products., Methods: A single case report of a 39-year-old female who developed tinnitus, ear drainage, and large fibrotic mass in external auditory canal and extending into middle ear after Type I medial graft tympanoplasty with Biodesign Graft. Left endoscopic microdissection and resection of the tympanic membrane and middle ear fibrotic mass were performed., Main Findings: Surgical excision of the fibrous mass required extensive microdissection to ensure preservation of the ossicles and chorda tympani. Postoperatively, hearing improved and otalgia and otorrhea resolved., Conclusions: We report the first case of post-tympanoplasty reaction with the use of Biodesign acellular porcine graft in a patient with no previous known exposure to meat products. Although this presentation appears to be rare, it reinforces the need for careful patient selection and counseling around the use of porcine or other foreign grafts., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Persistent tympanic membrane perforation is a known complication of pressure-equalizing (PE) tube insertion. Conductive hearing loss and otorrhea can necessitate surgical repair of these perforations. Long-term tympanostomy tube placement can increase the risk of these complications. Patients with velocardiofacial syndrome (VCFS) typically require prolonged PE tube placement and are thought to have higher risk of requiring additional otologic interventions after PE tube placement. To date, no work has established rates of post-PE tube complications requiring myringoplasty or tympanoplasty in patients with VCFS., Methods: A retrospective case review including all patients with VCFS at a single large children's hospital between the years 2000 and 2020 was performed. Number of PE tube insertions required and additional otologic interventions performed were the primary endpoints assessed., Results: Of 212 total patients with VCFS, 66 (31%) underwent PE tube placement. Of these children, 46 (70%) required 2 or more sets of PE tubes. A total of 53 patients (80.3%) required no otologic interventions apart from PE tube insertions. Of the 13 patients (19.7%) requiring additional otologic surgery, 6 (9.5%) underwent myringoplasty, and 9 patients (13.6%) required tympanoplasty. There was no significant difference in tympanoplasty ( P  > 1), myringoplasty ( P  > 1), or other surgical intervention rates ( P  = .7464) between VCFS patients with any type of cleft palate versus those with anatomically normal palates., Conclusion: This work suggests that most VCFS patients that require tubes, require at least 2 sets of PE tubes, and that the rate of post-PE tube complications requiring further otologic surgery is an order of magnitude higher than the rate established at this institution. Counseling for PE tube placement in VCFS patients may require specific dialogue regarding the substantially increased risk of complications and effort to build appropriate expectations for surgical outcomes regardless of palatal status., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background and Objectives : Postoperative nausea and vomiting (PONV) is a common adverse effect of general anesthesia, especially in middle ear surgery. Remimazolam is a newer benzodiazepine recently approved for use in general anesthesia. This study aimed to compare the incidence rate of PONV after tympanoplasty with mastoidectomy between using remimazolam and sevoflurane. Materials and Methods : This study included 80 patients undergoing elective tympanoplasty with mastoidectomy. The patients were randomly assigned to either the remimazolam or sevoflurane group. The primary outcome was the incidence rate of PONV 12 h after surgery. The secondary outcomes were the incidence rate of PONV 12-24 and 24-48 h after surgery, severity of PONV, incidence rate of vomiting, administration of rescue antiemetics, hemodynamic stability, and recovery profiles. Results : The incidence rate of PONV 0-12 h after tympanoplasty with mastoidectomy was significantly lower in the remimazolam group compared with that in the sevoflurane group (28.9 vs. 57.9%; p = 0.011). However, the incidence rate of delayed PONV did not differ between the two groups. PONV severity in the early periods after the surgery was significantly lower in the remimazolam group than in the sevoflurane group. The incidence rate of adverse hemodynamic events was lower in the remimazolam group than in the sevoflurane group, but there was no difference in the overall trends of hemodynamic data between the two groups. There was no difference in recovery profiles between the two groups. Conclusions : Remimazolam can significantly reduce the incidence rate of early PONV after tympanoplasty with mastoidectomy under general anesthesia.

Background: Chronic mucosal otitis media is a very common ear disease for which patients attend otolaryngology clinics. Most of these patients present with actively discharging ears., Aims/objectives: This study aims to observe the middle ear space pathology and obtain surgical outcomes as a treatment for patients with advanced chronic mucosal otitis media with a transcanal endoscopic ear surgery approach., Materials and Methods: A prospective study was designed, and patients suffering from chronic mucosal otitis media in the active suppurative phase with an air-bone gap larger than 20 dB were included., Results: 70 operated ears were included. Underlying macroscopic pathology within the middle ear space was observed: Middle ear granulomas at 58.6%; Tympanosclerosis 41.4%. Blockage of the tympanic isthmus was evaluated, obtaining a blockage rate of 81.4%. At 12 months of evaluation after surgery, a postoperative ABG < 20 dB was achieved in 85.7% of the operated ears. An overall closed tympanic membrane was obtained in 88.6% of the patients., Conclusion: This prospective cohort study shows the short-term efficacy of transcanal endoscopic type 3 tympanoplasty with mastoid preservation for managing advanced chronic mucosal otitis media. Clinical trials are required to give more evidence to the present matter.

Background: Chronic suppurative otitis media is a long-standing middle ear infection with a perforated tympanic membrane. Tympanoplasty is the mainstay of treatment. Most surgeons prefer to operate on dry ears; however, this may be difficult to achieve., Objectives: To investigate the effect of otorrhea and positive cultures on the outcome of tympanoplasty., Methods: This retrospective analysis reviewed patients with chronic suppurative otitis media who underwent tympanoplasty 2008-2015. Patients were divided into three groups: active discharge and bacterial growth, active discharge without bacterial growth, and no ear discharge. Surgical outcomes were compared among the groups., Results: Among 101 patients included, 43 ears (42.6%) had discharge preoperatively, 58 (57.4%) were dry. Overall closure rate was 81.2% (82/101). Preoperative active discharge closure rate was 88.3% (38/43) and without discharge 75.9% (44/58). There were 38 positive cultures preoperatively and five negative cultures. Cultures were not obtained in 58 cases. Success rates were 89.5%, 80%, and 75.9%, respectively. No significant difference was found between patients who had positive or negative cultures before the procedure (P > 0.48) or among the three groups (P = 0.25). The most common bacteria were Pseudomonas aeruginosa (n=17), followed by Staphylococcus species (n=10). None was significantly associated with operative failure (P = 0.557). The postoperative air threshold difference was not affected by culture results (P = 0.3)., Conclusions: Tympanoplasty success rates and postoperative air threshold differences were not affected by the presence of preoperative otorrhea or positive ear cultures. Surgery can be performed even when the ear is not dry.

Objectives: To assess the impact of race and ethnicity on 30-day complications after tympanoplasty surgery., Methods: The National Surgical Quality Improvement Program database was queried for tympanoplasty procedures from 2005 to 2019. Demographic, comorbidity, and postoperative complication data were compared according to race using univariate and binary logistic regression analyses., Results: A total of 11,701 patients were included, consisting of 80.3% White, 3.0% Black, 7.7% Asian, 5.7% Hispanic, 2.5% American Indian/Alaska Native, and 0.8% other. Binary logistic regression model indicated that Black patients had increased odds of unplanned readmittance (p = 0.033; odds ratio [OR], 3.110) and deep surgical site infections (p = 0.008; OR, 6.292). American Indian/Alaska Native patients had increased odds of reoperation (p = 0.022; OR, 6.343), superficial surgical site infections (p < 0.001; OR, 5.503), urinary tract infections (p < 0.001; OR, 18.559), surgical complications (p < 0.001; OR, 3.820), medical complications (p = 0.001; OR, 10.126), and overall complications (p < 0.001; OR, 4.545)., Conclusion: Although Black and American Indian/Alaskan Native patients were more likely to have complications after tympanoplasty surgery after adjusting for comorbidities, age, and sex, these results are tempered by an overall low rate of complications. Future studies should be devoted to understanding the drivers of these health inequities in access to otologic care and surgical treatment to improve outcomes and achieve equitable care., Competing Interests: Sources of support and disclosure of funding: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. No funding was received for this article., (Copyright © 2022, Otology & Neurotology, Inc.)

Objectives: Systematic review of the scientific literature dedicated to treatment modalities and results for aural tuberculosis published since the start of the 21 st century., Material and Methods: Search of the Medline, Cochrane and Embase databases for the period 2000 - 2020. Selection of articles in English, French and Spanish devoted to clinical cases and series documenting treatment of auricular tuberculosis. Extraction of data on pre-established files documenting treatment modalities and results. Reading of articles by two authors. Analysis performed according to SWiM guidelines, evaluating cure, tuberculosis-related death, treatment-related complications, improvement in facial palsy, and hearing sequelae rates., Results: One hundred and twenty eight articles: 118 case reports (159 patients) and 10 cohorts (177 patients) from 42 countries were analyzed. Female/male sex ratio was 1.2 with ages ranging from 1 month to 87 years. Medical treatment consisted in 5 to 24 months' antitubercular antibiotic treatment using 2 to 8 antibiotics. Mastoidectomy, tympanoplasty and facial nerve decompression were associated to medical treatment in 64.7%, 17.4% and 6.2% of cases, respectively. Overall rates of cure, death, treatment-related complications, facial sequelae and hearing sequelae were 96.8%, 2%, 9.5%, 35.8% and 75.5%. In case reports, BCG vaccination did not appear to protect against facial palsy and severe intracranial complications (P>0.6). There was no significant correlation (P>0.3) between death and the clinical variables tested, and facial nerve decompression did not appear to influence outcome for facial function (P=0.4)., Conclusion: Medical treatment is very effective but not without risk of death, complications and sequelae. It is the same as for pulmonary tuberculosis. Indications for and benefit of major auricular surgery during medical treatment deserve further studies., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Purpose: To characterize postoperative pain after tympanoplasty and tympanomastoidectomy and correlate between pain severity and various technical aspects of the surgery., Methods: We carried out a prospective cohort study of patients undergoing ear surgery in a tertiary referral center between 7/2018 and 7/2019. Patients filled in a pain questionnaire and scored pain intensity on a visual analog scale preoperatively and on postoperative days (POD) 1-4, 21, and 49. The responses were correlated with clinical and operative data, including surgical technique-related details., Results: Sixty-two patients participated in the study (27 males and 35 females, average age 41.1 ± 20.02 years [range 18-68]). The median preoperative VAS was 5, followed by 6 on POD1, 5 on POD3, and 1 at 3 and 9 weeks. The preoperative questionnaire score normalized to 10 was 4.5 (32/70), 5.1 on POD1, 4.7 on POD3, 0.85 at 3 weeks and 0.85 at 9 weeks. The predictive factors for increased postoperative pain were younger age, the presence of a comorbidity, revision surgery, preoperative dizziness or tinnitus and postoperative tinnitus. The predictive factors for decreased pain were smoking and the addition of a mastoidectomy. None of the factors related to the surgical technique (e.g., surgical approaches, type of reconstruction, specific surgeon) significantly affected the questionnaire responses or the pain VAS intensity scores., Conclusions: We demonstrated that younger age, the presence of a comorbidity, revision surgery, preoperative dizziness or tinnitus and postoperative tinnitus were predictors of increased pain after tympanoplasty and tympanomastoidectomy, while the inclusion of a mastoidectomy was a predictor of decreased pain., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The article presents modern approaches to mastoid obliteration in cases of chronic purulent otitis media with cholesteatoma, published in peer-reviewed russian and foreign journals from 2017 to 2021. The review tells us about effect of mastoid cavity obliteration on reducing the recurrence of cholesteatoma, improving the quality of life of patients according to the results of international questionnaires and the effect of surgery on hearing in the long-term postoperative period. An analysis of the use of autologous and biocompatible materials in middle ear surgery is presented. Their safety and ease of use during surgical intervention were evaluated.

The aim of this study is to evaluate the incidence of delayed facial nerve paresis after total endoscopic ear surgery. This review also aims to describe the possible contributing factors and its management. This is a retrospective review of all patients who had undergone total endoscopic ear surgery for all otologic cases that required endoscopic intervention in a single otologic center from 2014 up to 2020. The delayed facial nerve paresis is defined as deterioration of facial nerve function 72 hours after total endoscopic ear surgery. A total of 56 patients were included in the study. Delayed facial nerve paresis following total endoscopic ear surgery was observed in 2 patients (3.4%). Facial weakness sets in on day 6 post operation and another one developed at day 16 after the surgery. Both patients were investigated and only one of them showed a higher titer of Varicella zoster virus antibody while another patient showed no raise of titer. Thus, explanation of postoperative edema or mechanical compression is discussed. The incidence of delayed facial nerve paresis following total endoscopic ear surgery is rare. It can occur probably several days after surgery up to 3 weeks. Our 2 cases revealed that virus reactivation may not be the only factor for delayed facial nerve palsy after surgery. The overall prognosis for incomplete delayed facial nerve paresis is very good as both patients recovered well few days after treatment with steroids.

Objectives/hypothesis: To compare the hemostatic effects of commonly used concentrations of topical epinephrine in tympanoplasty., Study Design: Prospective, randomized, controlled clinical trial., Methods: Patients undergoing tympanoplasty were randomized to receive topical epinephrine at 1:1,000 or 1:10,000. With the investigators blinded, hemostasis was assessed with a modified Boezaart scale. Vasoconstriction was measured by laser Doppler. Blood pressure and pulse were tracked., Results: Thirty patients, 4 to 84 years old, were studied, with 15 patients per group. Boezaart scores dropped a mean of 67% and 62% with 1:1,000 and 1:10,000, respectively (P = .44). Capillary blood flow decreased a mean of 50.4% and 50.9% with 1:1,000 and 1:10,000, respectively (P = .95). The mean change in heart rate and mean arterial pressure after topical epinephrine exposure were -4.9 and -0.73 beats per minute (P = .15), and -0.60 and -0.73 mmHg (P = .96) for 1:1,000 and 1:10,000 respectively. No adverse events occurred in either group., Conclusions: Topical epinephrine at 1:10,000 has hemostatic efficacy comparable to 1:1,000 in tympanoplasty. Although both concentrations appear safe, use of topical epinephrine 1:10,000 should be considered over 1:1,000 to minimize the potential for adverse events., Level of Evidence: 2 Laryngoscope, 131:2319-2322, 2021., (© 2021 The American Laryngological, Rhinological and Otological Society, Inc..)

Objectives/hypothesis: The objective of this study is to demonstrate that balloon eustachian tuboplasty (BET) is safe and had limited complications in the pediatric patient population., Study Design: Retrospective chart review., Methods: This study analyzed the medical records of 43 consecutive encounters of patients under the age of 18 years old who underwent attempted BET. Charts of patients' postoperative appointments and appointments 30 days following the procedure were reviewed. Any complications that were reported by the surgeons' operative report or documented postoperatively were stratified by the Classification of Surgical Complications as outlined by the American College of Surgeons. Additional data points that were analyzed included concomitant surgical procedures, estimated blood loss, and demographic information., Results: A cohort of 43 pediatric patient encounters were investigated. There was a total of two complications from BET (4.7%) and one aborted case. The complications included epistaxis controlled with oxymetazoline and pressure, and vertigo that was later attributed to vestibular migraines. One case was aborted due to inadequate exposure. The average age of patients evaluated was 12.4 ± 3.2 years old with a range of 6.6 to 17.7 years old., Conclusions: In this retrospective cohort, BET was demonstrated to be a relatively safe intervention with an overall complication rate of 4.7% in patients as young as 6.6 years old with recurrent or chronic eustachian tube dysfunction and/or related issues., Level of Evidence: 4 Laryngoscope, 131:1657-1662, 2021., (© 2020 American Laryngological, Rhinological and Otological Society Inc, "The Triological Society" and American Laryngological Association (ALA).)

Objective: The main aim is to discuss the effect of nasal septal deviation on the postoperative hearing results of patients with tympanosclerosis., Material and Methods: We analyzed the hearing results of patients with tympanosclerosis who were operated on in a tertiary center. Pure tone audiometric results were compared according to the existence of nasal septal deviation., Results: This study included 48 patients with unilateral tympanosclerosis disease. Moderate or severe septal deviation had no significant effect on postoperative hearing results., Conclusion: The nasal septal deviation as the only pathologic factor in patients with tympanosclerosis did not have a deteriorating effect after surgery.

Objective: We investigated the incidence of sensorineural hearing loss (SNHL) after chronic otitis media (COM) surgery and determined the associated factors., Methods: Data were collected via retrospective medical chart review., Results: Of the 192 patients, 82 underwent tympanoplasty, 26 underwent canal wall up mastoidectomy with tympanoplasty, and 84 underwent canal wall down mastoidectomy with tympanoplasty. After surgery, the average air conduction (AC) hearing threshold improved significantly, from 125 to 1000 Hz, but the average high-frequency AC and bone conduction (BC) hearing thresholds deteriorated significantly. In 21 (11%) cases, the BC hearing threshold worsened by more than 15 dB at 4000 Hz. When we compared these 21 cases to patients in whom hearing was preserved, the former group was found to be significantly younger and had a higher frequency of cholesteatomatous otitis media. However, when comparing the severity of inflammation in patients with temporal bone computed tomography, there was no significant difference between the 2 groups., Conclusions: High-frequency SNHL may develop after surgery to treat COM, especially in young patients with cholesteatoma.

Objective: Herein we describe the diagnosis and management of total ossicular replacement prosthesis (TORP) displacement following tympanoplasty with ossicular chain reconstruction (OCR)., Methods: Case report with literature review., Results/case: A 40-year-old male with otorrhea and tympanic membrane perforation underwent a right revision tympanoplasty with OCR using a TORP with a tragal chondroperichondrial graft. On postoperative day (POD) 4, he developed vertigo and profound right-sided hearing loss. Temporal bone computed tomography showed the prosthesis in the vestibule. After a steroid taper with mild improvement in symptoms, the TORP was removed two weeks later and the patient continued to improve., Conclusion: TORP displacement into the vestibule is a very rare complication following OCR. Conservative management with high dose steroids may improve symptoms, however further middle ear exploration and surgical management may be warranted depending on the depth of displacement into the inner ear as well as symptom severity.

We present a rare iatrogenic cholesteatoma of the neck in a ten year old male four years after tympanomastoidectomy, an entity that to our knowledge has not been published in the literature for over 30 years. Furthermore, we discuss the diagnostic uncertainty of typical magnetic resonance imaging protocols for pediatric neck lesions and the improved diagnostic specificity of diffusion weighted magnetic resonance imaging. En bloc surgical extirpation was performed. Laryngoscope, 131:E882-E884, 2021., (© 2020 The American Laryngological, Rhinological and Otological Society, Inc.)

Purpose: To report our experience of a sequence of events that resulted in an iatrogenic cholesteatoma originating from the external auditory canal (EAC) years after tympanoplasty that had included a tympanomeatal flap., Methods: Data on the presentation and pathogenesis of iatrogenic cholesteatomas arising from misplaced tympanomeatal flaps during tympanoplasty without mastoidectomy were retrieved from the patients' medical records and analyzed., Results: Five patients were identified with cholesteatomas involving the EAC. They all had recurrent ear infections and varying degrees of conductive hearing loss. Each patient's past surgical history included one or more tympanoplasties in which an ipsilateral tympanomeatal flap had been raised. None had undergone a mastoidectomy. Two patients presented with small cholesteatomas that had developed over an average of 6.5 years after surgery. Three patients had large cholesteatomas that had developed over an average of 33.7 years after surgery. Clinical presentations and imaging studies suggested a misplaced tympanomeatal flap as the most likely source of cholesteatoma., Conclusion: Tympanomeatal flap misplacement may cause iatrogenic cholesteatoma formation originating from the EAC during tympanoplasty even without mastoidectomy. These cholesteatomas can grow substantially before becoming symptomatic as they extend to and through the mastoid. They may not affect the sound conduction system until late in the course of the disease. Meticulous replacement of tympanomeatal flaps and exercising a high index of suspicion postoperatively can reduce the incidence of this complication.

Endoscope is an innovative method for otologists in middle ear surgery. Many previous studies have confirmed the safety and efficiency of the endoscopic technique, as a reliable therapeutic option with very low complication rates, clearly supporting the use of endoscopy in ear surgery. Auricular suppurative perichondritis secondary to exclusive endoscopic ear surgery for tympanoplasty is an extremely rare type of those without any previously reported cases. In this report, we describe the course of auricular suppurative perichondritis of a 55-year-old woman. The patient was ultimately healed through surgical debridement and postoperative dressing with no evidence of recurrence at two months follow-up. There were no auricle deformity or external auditory canal stenosis with six months following-up., (Copyright © 2020. Published by Elsevier Inc.)

Objectives: Some patients complain of apparent auricle protrusion after chronic otitis media (COM) surgery with the postauricular approach. This study investigates whether auricular protrusion could be restored to the preoperative state after COM surgery; if so, the time needed after surgery and whether the degree of auricular of protrusion differed according to the surgical procedure., Materials and Methods: Forty-seven patients who underwent tympanoplasty and canal wall up and canal wall down mastoidectomy between July 2016 and July 2017 were prospectively studied. To examine the degree of auricular protrusion, the longest distance from the head to the helical rim and the distance from the mastoid process to the helical rim in the plane along the level of the upper margin of the tragus were measured 1 day before surgery and 1 day; 2 weeks; and 1, 2, 4, and 6 months, postoperatively., Results: The superior aspect of the auricle returned to the preoperative state within 2 months of surgery, irrespective of the surgical procedure. The middle aspect was restored to the preoperative state within 4 months of tympanoplasty or canal wall up mastoidectomy, and within 2 months of canal wall down mastoidectomy., Conclusion: Postoperative auricular protrusion is a transient phenomenon.

Background/aim: The outcomes of type 1 tympanoplasty in elderly patients remain controversial. Therefore, more studies are needed to clarify the prognosis of elderly patients after tympanoplasty. The purpose of this study was to evaluate the clinical outcomes of type 1 tympanoplasty in elderly patients., Patients and Methods: We retrospectively analyzed data from 116 patients who underwent type 1 tympanoplasty due to chronic otitis media. Seventy-one of the 116 patients were elderly individuals aged 65 years or older (study group). Forty-five patients were younger than 65 years (control group). Due to cochlear intolerance by aging in the study group, we used dexamethasone soaked gelfoam packing in the middle ear and intraoperative dexamethasone injection. To compare the outcomes between groups, we determined the mean hearing levels by averaging the hearing thresholds. The differences in the air-bone gaps before and after tympanoplasty were compared between groups., Results: In the study group, 54 patients had an underlying disease (76%). Hypertension was the most common underlying disease. The postoperative air conduction (AC) and bone conduction (BC) improved in both the study group and the control group. In the control group, postoperative air-bone gap (ABG) was significantly higher than preoperative ABG. Although the postoperative ABG improved in the study group, the improvement was insignificant., Conclusion: Although significant improvement of ABG was not achieved, postoperative AC and BC were improved. Intraoperative dexamethasone injection and dexamethasone soaked gelfoam packing in the middle ear was effective to prevent deterioration of BC after operation., (Copyright© 2020, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Objective: To compare half-thickness tragal cartilage graft with temporalis fascia graft in terms of graft take-up and acoustic outcomes in type-I tympanoplasty., Methods: The randomised control trial was conducted at Lady Reading Hospital, Peshawar, Pakistan, from January to December 2017, and comprised patients aged 16-60 years undergoing tympanoplasty. The patients were divided into two equal groups using systemic random sampling method. In Group A, tympanoplasty type-I was done using half-thickness tragal cartilage graft, while in Group B, it was done using temporalis fascia graft. Data was analysed using SPSS20., Results: Of the 40 patients, there were 20(50%) in each of the two groups. Overall, there were 24(50%) males and 16(40%) females. The mean age of Group A was 28.57±8.00 years, and in Group B it was 27.14±6.18 years. The graft success rate in Group A was 19(95%) and in Group B it was 18(90%) (p>0.05)., Conclusion: The graft success rates for half-thickness tragal cartilage and temporalis fascia were statistically non-significant.

Background: An ear surgery can be performed via transcanal, endaural, or postauricular approach according to the surgeon's desicion. The postauricular one is the most commonly performed approach., Objective: The objective of this study was to evaluate whether preferring postauricular approach during ear surgery cause auricular protrusion in over time., Methods: Thirty-six patients who underwent tympanoplasty operation with postauricular incision were included in this study. Any patient who was under 18 years of age, those with auricular deformity and patients who underwent tympanoplasty operation with mastoidectomy were excluded from this study. The distances from mastoid area to superior and mid-point of helix were measured preoperatively and 1 year postoperatively., Results: A total of 36 patients' data were analyzed. There were 13 males and 23 females. The mean age was 28.2 ± years (18-59). The preoperative mean distance from mastoid area to superior point of helix was 15.03 ± 2.86 mm, whereas it was 17.92 ± 2.96 mm at mid-helix level. At postoperative 1 year, the same distances were measured 14.67 ± 3.12 mm and 17.25 ± 3.17 mm, respectively. There were no statistically significant differences between preoperative and postoperative measures., Conclusion: Although the structures that provide the stability of the auricle are cut during postauricular sulcus incision, long-term follow-up of patients did not show any protrusion of auricula.

Purpose: To investigate and compare the effect of endoscopic and microscopic type 1 tympanoplasty on the cochlear function, to determine if they have a different impact on the inner ear function., Methods: 72 ears treated by transcanal endoscopic type 1 tympanoplasty and 84 ears treated by microscopic type 1 tympanoplasty in 3 tertiary referral centers were enrolled in the study. Microscopic type 1 tympanoplasty were performed by transcanal or retroauricular approach. Only patients with mobile and intact ossicular chain were involved in the study. A retrospective chart review was performed. Main outcome measures were: (1) change in bone conduction thresholds at 250, 500, 1000, 2000, 4000 Hz; (2) change in bone conduction Pure Tone Audiometry; (3) correlation of audiometric outcomes with surgical technique, graft type and graft position., Results: A mild postoperative bone conduction threshold shift was observed at 2000 Hz and 4000 Hz in both groups, without significant differences between the two groups. No statistically significant modifications in bone conduction were observed at any frequencies in patients operated by transcanal endoscopic approach compared with those who underwent transcanal or retroauricular microscopic type 1 tympanoplasty. Moreover, neither the placement nor the type of the graft seemed to influence the cochlear function preservation., Conclusions: The endoscopic and the microscopic approaches have a similar impact on the bone conduction threshold during type 1 tympanoplasty. In particular, the one-handed manipulation of the ossicular chain during the endoscopic technique did not show an increased risk of inner ear damage.

Objectives: A lesser known after effect of harvesting temporalis fascia is the post-surgical craniofacial pain. The aim of the study was to evaluate this pain after tympanomastoid surgeries and the effectiveness of silastic sheet interpositioning to prevent this pain., Materials and Methods: This pilot study that spanned one year, included patients who underwent tympanoplasty with or without mastoidectomy involving the harvesting of temporalis fascia. At the end of surgery, the wound was closed after silastic sheet was secured over the donor site in cases and without silastic sheet in controls. In the post-operative period, patients scored their temporal pain, tenderness and pain during opening of mouth and mastication on a visual analogue scale (VAS) on day 7, 15, 30 and 90., Results: Visual analogue scale (VAS) scores of the silastic group were lower than the control group on day 7 and 15 after surgery and the difference was statistically significant. In the control group, temporal pain and tenderness were 74% and 81% respectively on day 7. VAS scores of both groups decreased over time and were negligible after 3 months. There were no significant postoperative complications in either group and no reaction or rejection of silastic sheet in the cases., Conclusion: Post-surgical craniofacial pain secondary to the harvesting of temporalis fascia is observed in a majority of the patients. This novel technique involving silastic sheet interposition can decimate early post-operative temporal pain, tenderness and masticatory pain.

Purpose: The best surgical method for the management of adhesive otitis media is controversial. The aim of the study was to explore the feasibility and effectiveness of tympanoplasty combined with fascia grafting catheterization in the treatment of adhesive otitis media., Methods: This was a retrospective study of patients with adhesive otitis media and who underwent tympanoplasty combined with fascia grafting and catheterization between April 2015 and December 2016 at the Eye-Ear-Nose-Throat Hospital Affiliated to Fudan University. All injured ears were examined by pure tone audiometry at 0.5, 1 and 2 kHz before and at 3 months after operation., Results: Thirty-five patients (35 ears) were followed for 12-44 months. The air-conduction pure tone average was 31.7 ± 12.3 dBnHL. Hearing of 28 patients (80%) was improved to a practical level within 40 dBnHL, but 2 patients (6%) had no change in postoperative hearing. Numbers of patients with spontaneous prolapse, artificial removal of tympanic membrane ventilation tube, and unobstructed in place were 15, 12, and 8, respectively. Twenty-seven patients had perforations left after the prolapse and removal of tympanic membrane ventilation tubes, of which 22 (81%) had perforations healing by themselves. All patients had dry ears after operation, without recurrence. Thirty-three patients (94%) had dry ears within 3 months and only 2 patients (6%) for more than 6 months., Conclusion: Tympanoplasty combined with fascia grafting catheterization is effective in the treatment of adhesive otitis media.

Background: Some discussion remains among otologists regarding the best grafts for tympanic membrane closure. It is unclear whether double-layer grafts are superior to single-layer and whether single-layer cartilage is superior to fascia or perichondrium alone. The objective of the current study was to examine the relative efficacy of single-layer versus double-layer tympanic membrane grafting techniques., Materials and Methods: A retrospective review of the medical records was used to address the objective of the study. Patients operated on in an over/under technique by the same surgeon underwent single-layer perichondrium or single-layer perichondrium with a cartilage island, or a double-layer of perichondrium combined with periochondrium with a cartilage island. The outcomes assessed were tympanic membrane reperforation and hearing improvement., Results: A total of 135/177 (76%) perichondrium grafts had no reperforation, and 43/55 (78%) perichondrium with cartilage island grafts had no reperforation; 352/390 (90%) of the double-layer closures had no reperforation. There was no statistically significant difference in reperforation rates between the 2 single-layer techniques ( P = .926). The difference in reperforation rates after the double-layer closure versus the perichondrium single-layer closure was statistically significant ( P = .001), as was the difference in reperforation rates after the double-layer closure versus the cartilage island single-layer closure ( P = .02). All 3 groups showed statistically significant hearing improvement postoperatively ( P < .0001). Preoperative hearing levels ( P = .179), postoperative hearing ( P = .857), and decibels of hearing improvement ( P = .356) were the same for all 3 groups., Conclusion: Double-layer closure gives lower tympanic membrane reperforation rates than does single-layer closure, as well as similar hearing outcomes.

Background: Tympanoplasty is regularly performed in various ages but data about the procedure in elderly is insufficient. Objectives: To compare the success rates and hearing outcomes of fascia and perichondrium grafts used for tympanoplasty in patients >65 years and to evaluate the prognostic factors affecting the success of tympanoplasty. Methods: Reviewing records of 49 elderly patients underwent tympanoplasty, two groups were constituted: perichondrium (25 patients) and fascia (24 patients) groups. Ages, genders, perforation sides, type and location of perforation, graft success rates, functional success rates and air-bone gap (ABG) gains were compared. Results: Overall graft success rate was 85.7%. After a mean follow-up of 23.3 ± 8.32 months, overall mean ABG gain was 11.33 ± 8.42 dB. Overall median postoperative ABG value (9 dB) was significantly lower compared to the median preoperative value (24 dB) ( p  < .001). Graft success rate was higher in perichondrium group (96%) compared to fascia group (75%) ( p  = .04). Functional success rate did not significantly differ between perichondrium (68%) and fascia groups (62.5%) ( p  = .68). Conclusion and significance: Tympanoplasty is an effective procedure with a graft success rate of 85.7% in elderly. Both fascia and perichondrium are suitable materials; however, perichondrium had higher success rate.

Background: A post-auricular cutaneous mastoid fistula is a rare condition that can occur following radical mastoid surgery, chronic suppurative otitis media or spontaneous exteriorisation of cholesteatoma from the mastoid through the post-auricular skin surface. Management of a post-auricular cutaneous mastoid fistula can be challenging for the surgeon., Objective: This paper describes a surgical refinement for post-auricular cutaneous mastoid fistula closure, involving a fibro-muscular-periosteal flap to cover the mastoid cavity, combined with a bilobed flap from the mastoid and lateral neck regions for skin closure., Method and Results: A case of a post-auricular cutaneous mastoid fistula developed after revision tympanoplasty for a cholesteatoma. The condition was successfully treated with the presented technique. Pre- and post-operative photographs are provided for demonstration., Conclusion: The fibro-muscular-periosteal flap combined with a bilobed flap from the mastoid and lateral neck regions, in our view, can be considered a valid option for post-auricular cutaneous mastoid fistula closure.

For otitis media patients with severe mucosal lesions, adhesion is the most common poor prognosis of tympanoplasty. We generally consider tympanic cavity adhesion is due to eustachian tube dysfunction and poor middle ear ventilation. The mechanism of adhesion is unclear so far, which we thought is mainly associated with wounded surface and activation of the fibrinolytic system. To solve the problem of adhesion, several materials have been used in the middle ear surgery, such as plastic sheet, silicone sheet and absorbable material. And there are some benefits. The most widely used is silicone sheet, and there are some researches focused on its thickness, shape and components to achieve better anti-adhesion effect. In this article, we will do a review for the research advances of anti-adhesion materials in tympanoplasty.

Objective: This study was undertaken to determine the accuracy of the surgeon's assessment in detecting epithelial remnants over the malleus after de-epithelisation in tympanoplasty., Methods: Intra-operatively, the umbo was assessed for epithelial remnants with the microscope. The umbo was then resected and sent for histopathological examination to detect epithelial remnants., Results: Out of 42 cases, microscopic examination findings for epithelium were positive in 16 cases and negative in 26 cases. Histopathology findings were positive in 13 cases. The surgeons' assessment was accurate only in two cases., Conclusion: Residents, with their limited experience, are more likely to leave residual epithelium. When the chance of residual epithelium over the umbo is significant, the surgeon has two choices: to place the graft medial to the umbo or to resect the umbo. It is our opinion that the malleus exteriorisation should be incorporated into tympanoplasty training, with the aim of preventing epithelial entrapment in the middle ear.

Objectives: To analyze the etiologies, auditory consequences, diagnostic tools and therapeutic results of three often confused pathologies: acquired fibrous stenosis of the medial part of the external auditory canal (EAC), fibrous anterior tympanomeatal angle blunting, and lateralized tympanic membrane., Material and Methods: Retrospective study of 18 cases operated on over a 16-year period (14 patients: 7 female, 7 male; aged 11-64 years): 8 cases of medial EAC stenosis, 3 of blunting, and 7 of tympanic membrane lateralization., Results: In all 3 pathologies, otoscopic and radiologic diagnosis was easily established, so that they could not be confused. All 3 induced>33dB conductive hearing loss. Medial EAC stenosis was secondary to chronic inflammation of the EAC, aggravated by surgery in 5 cases. Blunting was secondary to surgery altering the anterior tympanic annulus. Tympanic membrane lateralization was secondary to prior surgery without inflammatory process. Underlying EAC cholesteatoma was found in 3 cases of medial stenosis and in 1 case of blunting. Surgical results were disappointing in medial stenosis, with 62.5% recurrence and mean functional gain of 9dB, and in blunting, with 66.7% recurrence and mean functional gain of 6dB; auditory results were, however, good in these 2 pathologies when there was no recurrence of fibrosis. Results were significantly better in lateralized tympanic membrane, with 28.6% recurrence and mean functional gain of 16dB., Conclusion: The good results obtained in tympanic membrane lateralization seem to justify surgery in patients bothered by their hearing loss. The indication is more questionable in cases of medial fibrous stenosis and blunting, although significant auditory improvement is achieved in case of surgical success., (Copyright © 2018. Published by Elsevier Masson SAS.)

Objectives: The optimal timing and technique for repairing chronic tympanic membrane (TM) perforations in pediatric patients remains controversial. The objectives are to determine the surgical and hearing outcomes of pediatric lateral graft tympanoplasty at a tertiary teaching hospital., Methods: A retrospective review was conducted for pediatric lateral graft tympanoplasties performed for chronic TM perforations by a single surgeon over a four-year period. Primary and secondary outcomes were graft failure rate and hearing outcomes, respectively., Results: 78 cases were analyzed. The mean age at time of surgery was 10.3 years (range 5-18 years). Mean follow-up was 11.0 months; 27 patients had follow-up >1 yr. Most patients were non-syndromic (85.9%), had a history of bilateral Eustachian tube dysfunction (ETD) (59%) and presented with marked myringosclerosis (73.1%). Thirty-three percent of cases were revision tympanoplasties. A learner surgeon (resident or fellow) was present in 89.7% of cases. Successful closure of the TM was achieved in 97.4% (76/78) of cases and 92.6% (25/27) of cases with >1-year follow-up. No obvious difference in graft failure was noted with regards to age at time of surgery, perforation size, history of bilateral ETD, presence of a learner surgeon, myringosclerosis, presence of syndromic features, or history of prior tympanoplasty. Ninety-one percent of patients either improved hearing or preserved their conductive hearing deficit. Poorer hearing outcomes were only associated with post-operative blunting., Conclusions: Pediatric lateral graft tympanoplasty is effective in repairing chronic perforations with excellent hearing outcomes. Common quoted predictors of surgical outcome such as age at the time of surgery, syndromic features, history of previous myringoplasty, perforation size, and ETD dysfunction were not associated with graft failure in our series., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Objectives: To evaluate and compare functional outcomes of tympanoplasty procedures with temporalis fascia and four different types of cartilage grafts in chronic otitis media (COM) cases with normal preoperative hearing levels., Methods: Records of patients who underwent type 1 tympanoplasty for non-complicated COM in a tertiary medical center between January 2010 and January 2017 were reviewed. Patients with central or marginal and dry perforations of the tympanic membrane, normal middle ear mucosa, intact ossicular chain and patients with a preoperative pure tone average (PTA) level of 25 dB or less and a word recognition score (WRS) of 88% or greater were included in the study. Graft success rates, preoperative and postoperative functional outcomes, and anatomical results were analyzed., Results: One hundred and forty-four patients who met the inclusion criteria were evaluated in the study. PTA and Air-bone gap (ABG) levels decreased significantly both in TF and CG groups after the surgery (p = 0.001). Similarly, WRS scores increased significantly in both groups (p = 0.001). There was not a significant difference in terms of PTA increase, WRS increase, and ABG closure levels between cartilage and TF groups. Increase in PTA, closure in ABG, and increase in WRS levels were compared among TF, WsCCG, MCG, PCG, and CPIG groups. The increase in PTA levels was also found to be significantly superior in the TF group (p = 0,023). However, the multivariate analysis showed no significant difference for increase in WRS, closure in ABG and increase in PTA levels according to graft type (p = 0.285; p = 0.461; p = 0.106, respectively) and gender (p = 0.487; p = 0.811; p = 0.756, respectively)., Conclusion: In COM cases with normal preoperative hearing, both TF and cartilage lead to superb functional and anatomical outcomes. There was not a significant difference in terms of PTA increase, WRS increase and ABG closure levels between cartilage and TF groups. The graft success rate of cartilage was found to be superior to TF, but there was not a statistically significant difference. Different types of cartilage grafts can be used in cases with normal preoperative hearing without the concern of hearing impairment.

Objectives/hypothesis: To assess the somatosensory dysfunction of the auricle and periotic skin in patients undergoing otitis media surgery., Study Design: Retrospective study., Methods: Symptoms of periotic somatosensory function after surgery were investigated in 100 patients (42 males, 58 females, mean age 41.39 years) who underwent otitis media surgery. Questionnaires on periotic somatosensory disturbance were answered after surgery at least over 1 year postoperatively., Results: Of 100 tympanoplasties, all patients were completed within a postauricular approach. The highest incidence rates of periotic sensory disturbance were found in the postauricular region (75%), followed by the auricular region (20.83%); lower rates were found in the preauricular region (2.08%) and the earlobe (2.08%). Periotic somatosensory dysfunction occurred in 48 patients (48%). The most prevalent somatosensory abnormality was tactile hypoaesthesia/numbness, evident in 28% of the patients; more remarkable, inferior postauricular region. Periotic pain was reported by 21% of the cases, mostly located in the upper auricle. Compared to the recovery time of tactile hypoaesthesia (7.36 months), patients' periotic somatosensory pain improved significantly within 4.07 months, which has obvious statistical significance (P < 0.01)., Conclusion: The likelihood of periotic cutaneous sensory dysfunction should be emphasized to patients undergoing otitis media surgery via postauricular approaches, which occurred in nearly half of patients; the majority recovered within 1 year. Furthermore, the postauricular region is the most vulnerable location to sensory disturbance, followed by the auricular region. Functionally, periotic somatosensory pain was more easily resilient, relative to tactile hypoaesthesia/numbness., Level of Evidence: 4 Laryngoscope, 129:454-458, 2019., (© 2018 The American Laryngological, Rhinological and Otological Society, Inc.)

Objectives: The aims of this study are to analyze the clinical characteristics of congenital middle ear cholesteatoma (CMC), to evaluate the treatment results according to the types of surgical approach, and to suggest the appropriate surgical treatment option in each stage., Methods: One hundred fifteen children (≤15 years old) with surgically confirmed CMC, who underwent surgery at a tertiary hospital during 1994-2012 and were followed up more than 2 years, were enrolled in this study. CMC was classified into four stages by the staging system proposed by Potsic. Clinical characteristics of CMC were analyzed and its association with the rate of residual disease was evaluated., Results: Based on the location of the lesion, posterior-origin CMCs were detected significantly later (5.5 years old, P = 0.018) and more likely to be in the Stage 3 or 4 (P < 0.001). Residual CMCs were observed in 10 out of 115 cases (8.7%) and were more frequent in the Stage 3 or 4 patients (P = 0.007). However, the rate of the residual disease was not statistically different between anterior- and posterior-origin CMCs (P = 0.101). All 58 cases of CMC in the Stage 1 or 2 were successfully removed by transcanal tympanoplasty with only one residual case (1.7%). In the Stage 3 cases, transcanal tympanoplasty was conducted in 24 out of 29 patients, and the residual disease rate was 12.5% (3 out of 24)., Conclusions: The early stages of CMC were likely to be diagnosed at younger age, and the early diagnosis seemed to show better surgical outcomes with less invasive techniques. Transcanal tympanoplasty can be an effective surgical option for CMCs in the Stage 3., (Copyright © 2018. Published by Elsevier B.V.)

Objectives/hypothesis: To report on the safety and efficacy of cartilage-buttressed T-tube tympanoplasty for long-term middle ear ventilation, specifically by examining duration of tube survival, as well as adverse events associated with prolonged middle ear intubation, including persistent tympanic membrane perforation., Study Design: Retrospective case series of patients undergoing cartilage-buttressed T-tube tympanoplasty between January 2005 and December 2016 in a tertiary-care neurotology private practice., Methods: Patients who underwent cartilage T-tube tympanoplasty with complete pre- and postoperative audiometric data and a minimum follow-up duration of 12 months were analyzed. T-tube survival and adverse events including persistent tympanic membrane perforation were recorded and compared to published data for other long-term middle ear ventilation techniques., Results: The study cohort included 72 cartilage-buttressed T-tube tympanoplasties in 68 patients. Median tube survival was 34 months (range, 2-131 months). Incidence of persistent tympanic membrane perforation (n = 1) was 1.4% CONCLUSIONS: Cartilage-buttressed T-tube tympanoplasty is a safe and effective means of accomplishing long-term middle ear ventilation with a considerably lower rate of persistent tympanic membrane perforation as compared to alternative methods of prolonged middle ear ventilation., Level of Evidence: 4 Laryngoscope, 129:203-208, 2019., (© 2018 The American Laryngological, Rhinological and Otological Society, Inc.)

Purpose: This study aimed to investigate the rate and location of facial canal dehiscence (FCD) observed during surgery for chronic otitis media (COM) with or without cholesteatoma., Material and Method: Operative details of 1296 patients who underwent chronic otitis media surgery from January 2000 to January 2017 by the same surgeon were included in this retrospective study focusing on intraoperative observations of FCD., Results: Because of the type of the surgery, the Fallopian canal could not be seen completely, so 924 of the cases which only involved performing a tympanoplasty were not included in the study. A total of 372 patients (196 males and 176 females) who had a canal wall down (CWD) or canal wall up (CWU) mastoidectomy were included in the study. A CWD mastoidectomy was performed on 250 patients, while 122 patients underwent a CWU mastoidectomy. The prevalence of FCD was 11.29% (42/372 patients). The dehiscence was more common in patients with cholesteatoma (n = 37; 88.1%) than those with non-cholesteatoma (n = 5; 11.9%). The tympanic segment (n = 32; 76.19%) was the most common location for FCD. When we compared the ossicular erosion results of the cases that had FCD, erosion in three ossicles together was more statistically significantly frequent than the other possibilities., Conclusion: It is possible to see FCD because of COM, especially with cholesteatoma. FCD is most commonly seen around the oval window. If stapes or all three ossicles are eroded, the surgeons must be more careful regarding FCD to be more effective in preventing facial nerve damage.

Objectives:: The aim of this study was to assess the feasibility and safety of ossiculoplasty under local anesthesia in an office setting without sedation., Methods:: Between May 2017 and November 2017, patients who presented with conductive hearing loss and known isolated ossicular discontinuities were offered ossiculoplasty under local anesthesia. Inclusion criteria included age ⩾ 18 years, adequate transcanal access, and the ability to lie supine for up to 45 minutes. Exclusion criteria included associated tympanic membrane perforation and the presence of middleear or mastoid cholesteatoma or infection., Results:: Fourteen patients underwent the procedure. The mean age was 48.3 years (range, 19-74 years). Six were primary and 8 revision cases. There were 8 partial and 6 total prosthesis placements. The mean operative time was 34 minutes (range, 26-43 minutes). All patients tolerated the procedure to completion. There were no intraoperative complications. The mean air conduction pure-tone average was 76.6 dB and the mean bone conduction pure-tone average was 27.2 dB, with a preoperative air-bone gap of 49.9 dB. Air conduction pure-tone average significantly improved to 45.2 dB ( P < .0001). Air-bone gap significantly improved to 17.8 dB ( P < .0001)., Conclusions:: Ossiculoplasty using partial or total prostheses can be safely performed in the office setting under local anesthesia without sedation in carefully selected patients. This has potentially significant patient and system benefits.

Objectives: The aim of the study was to evaluate risk factors influencing the results of tympanoplasties on the base of material taken from the Department of Otolaryngology and Laryngological Oncology Collegium Medicum of Nicolaus Copernicus University in Bydgoszcz between 2004-2009. In this period 98 operations were done. The time from operation to hearing examination was 3 to 7 years, mean 5,43. Tympanoplastic operation were divided according to Tos classification. Measuring hearing results, tonal audiometry was done and mean air bone gap on four frequencies was assesed (500, 1000, 2000, 3000 Hz), according to AAO-HNS guidelines (1995). This parameter was compared between groups separated according to risk factors, that could potentially affect the results. Those risk factors were: disfunction of the Eustechian tube, localisation and size of the perforation of the tympanic membrane, damage of the ossicles, the state of the mastoid process, the number of operations, the presence of the cholesteatoma or granulating tissue, chronic otitis media in the opposite ear, smoking cigarettes, mastoidectomy, canal wall down technique. The results were analysed using statistical test., Results: The most impotant risk factor affecting treatment&apos;s results (besides discharge from the ear) is damage of the ossicles, especially the malleus and stapes. Well done operation ensures good hearing results irrespectively of the presence of cholesteatoma or granulating tissue, and also in case of reoperation. For all types of tympanoplasties neither the localisation, nor the size of perforation do not influence on hearing results in long term observation.

Background: The English language literature finds no clear protocols for otologic surgery for HIV+ patients., Objective: To demonstrate that simple tympanoplasty and type III tympanoplasty in HIV+ patients with CD4 >400 cells/cc results in tympanic membrane closures and hearing improvements equivalent to the same procedures in controls., Materials and Methods: This retrospective review documents the otologic conditions and operative results of 32 HIV+ patients and 32 controls. The controls were healthy and had no opportunistic infections or other medications., Results: Genders, ages, sizes of tympanic membrane perforations, severity of air bone gaps, and type of operation were equivalent between the HIV+ and the control groups. Thirty of 32 patients in each group had closure of their perforations after 1 operation. Air bone gaps improved significantly for each group ( P = .001): 22 dB (SD = 11 dB) in the HIV+ group and 26 dB (SD = 10 dB) in the control group. And there was no statistically significant difference in change in hearing between the 2 groups. There were no complications of infection, wound dehiscence, worsened sensorineural levels, dizziness, or facial weakness in either group., Conclusion: HIV+ patients whose CD4 counts are above 400 cells/cc can undergo simple tympanoplasty or type III tympanoplasty with acceptable outcomes.

Introduction: The high incidence of chronic otitis media with effusion and Eustachian tube dysfunction in children with Down syndrome (DS) may predispose them to cholesteatoma formation. Establishing the diagnosis, choosing the appropriate operative intervention, and post-operative care can be challenging., Objective: To describe management strategies for cholesteatoma diagnosis, surgical treatment, and post-operative management in children with Down syndrome., Methods: Retrospective case series of 14 patients (17 total ears) with Down syndrome diagnosed with cholesteatoma over a 9-year period., Results: A total of 14 patients with cholesteatoma (3 with bilateral disease) were analyzed. Thirteen ears (76.5%) had ≥2 tympanostomy tubes insertions prior to cholesteatoma diagnosis, and otorrhea and hearing loss were the most common presenting symptoms. Common pre-operative CT scan findings included mastoid sclerosis and ossicular erosion. The average age at first surgery was 9.8 years, and the average follow-up was 4.3 years. For acquired cholesteatoma, most ears were managed with canal wall up (CWU) approaches, but ultimately 6/15 (40.0%) required canal wall down (CWD) approaches. Postoperatively, 3 (20.0%) ears developed new tympanic membrane retraction pockets, but no recurrent cholesteatoma. Four (26.7%) ears developed recurrent disease, and 3 (20.0%) had residual disease at secondary procedures. Ossiculoplasty was performed in 4 ears. Twelve (70.6%) ears were rehabilitated with hearing aids or FM systems., Conclusions: The diagnosis of cholesteatoma in Down syndrome was associated with otorrhea, hearing loss, and CT scan findings of ossicular erosion and mastoid sclerosis. Most cases were managed with CWU surgical approaches. Hearing aid use was common post-operatively., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objective: There is uncertainty regarding the safety of surgical antiseptic preparations in the ear. A systematic review of the literature was conducted to assess the evidence regarding ototoxicity of surgical antiseptic preparations., Methods: A literature search was conducted using the PRISMA methods. Key words included "ototoxicity" "hearing loss", "antiseptic", "surgical preparation", "tympanoplasty", "vestibular dysfunction", "chlorhexidine", "iodine", "povidone", "ethanol", and "hydrogen peroxide" using Medline, Embase, Cochrane Library, Scopus and Web of Science. We included peer-reviewed papers that 1) objectively measured ototoxicity in humans or animals through hearing, vestibular function or histologic examination, 2) studied topically applied surgical antiseptic preparations, 3) were either in English or had an English abstract. We excluded papers that were 1) in vitro studies, 2) ear trauma studies, 3) studies of ototoxic ear drops intended for therapy, or 4) case reports. Studies included in the final review were screened using the PRISMA method. Current systematic review registration number pending: 83,675., Results: Fifty-six papers were identified as using PRISMA criteria. After applying our exclusion criteria, 13 papers met overall study criteria. Of these, six papers reported ototoxicity of iodine based solutions, five papers reported ototoxicity of chlorhexidine and ethanol and two papers assessed hydrogen peroxide. All papers reviewed were animal studies. Iodine based solutions show least harm overall, while chlorhexidine and high concentrations of alcohol based solutions showed most harm. The evidence on hydrogen based solutions was inconclusive., Conclusions: The overall evidence for anyone antiseptic solution is weak. There is some evidence that iodine, chlorhexidine, hydrogen peroxide and alcohol based antiseptics have ototoxicity. Conclusive evidence for human ototoxicity from any solution is not strong.

: Tympanosclerosis in the middle ear space is common in Ethiopia and often involves the ossicles and particularly the stapes. Ear operations in Ethiopia are relatively expensive in this country of limited medical resources and a low average living wage. In this setting, 2-stage operations using prostheses become prohibitively expensive. Therefore, the recommended 2-stage approach for tympanic membrane perforation with tympanosclerosis and stapes fixation is impractical for Ethiopia.We present a series of 67 patients who had a single stage tympanoplasty, removal of tympanosclerosis from the stapes suprastructure, and ossicular chain reconstruction using ossicular interposition. Crucial is the surgical technique employed for peeling the mound of tympanosclerotic plaque off of the stapes, which we term the stapes release. Controls were 67 patients with similar perforations and air-bone gap, but no tympanosclerosis. Most controls had ossciular discontinuity and were reconstructed with type III tympanoplasty.Air-bone gap improved in both groups: 18 dB (11 dB standard deviation) in the stapes release group, and 23 dB (11 dB standard deviation) in the control group. Paired t test found these improvements in each group significant at p < 0.001. Among the preoperative subjects there were 40 with air-bone gap greater than 45 dB, and none less than 20 dB. Among the postoperative subjects, none had air-bone gap worse than 45 dB, while 25/67 (37%) stapes release and 44/67 (66%) controls had air-bone gap better than 20 dB. Three patients in each group failed to close their perforations completely (96% closure rate).The only complications were two early cases of transient facial nerve weakness, which was avoided in subsequent cases by an alteration in technique. There was no deterioration of sensorineural hearing levels in either group's subjects postoperatively.In conclusion, stapes release with ossicular interposition can be performed at the same time as tympanoplasty without exacerbation of sensorineural hearing loss. Tympanic membrane closure and hearing levels were similar between patients with and without stapes fixation from tympanosclerosis.

Objective: To assess the effectiveness and safety of tympanoplasty in elderly patients and the effect of frailty on the results., Study Design: Retrospective chart review., Setting: Tertiary referral center., Patients: Thirty-one ears in 30 patients aged 65 years and older were included and matched with 31 controls, based on the type of surgery, of a pool of 133 patients aged 35 to 55 years., Intervention: Therapeutic., Main Outcome Measure: Success was defined as tympanic membrane closure and resolution of presenting complaints. Complications were assessed. Frailty was defined by assessing multimorbidity and polypharmacy. Fisher's exact test was used to compare success and complication rates between the age groups. Linear logistic regression analysis using generalized linear models was performed on success and complication rate., Results: Success rates in both the groups were 84%. Complication rate in the elderly group was 16% versus 6% in the control group. This difference was not statistically significant in the Fisher's exact test. In the generalized linear model analysis age group, multimorbidity and polypharmacy had no significant influence on both success and complication rate., Conclusion: There was no difference in success and complication rate in elderly undergoing tympanoplasty compared with younger adults. Having multimorbidity or polypharmacy did not correlate with failure of the tympanic membrane closure or a higher complication rate.

Objective: This study aimed to assess long-term outcomes after performing tympanoplasty without mastoidectomy (TWOM) for active and inactive noncholesteatomatous chronic otitis media (COM) and to estimate the optimal time for surgery., Methods: The patients were placed into an active ear group (group A) and an inactive ear group (group B). All patients were followed up for 5 years after TWOM., Results: Ninety-two cases among 113 achieved dry ears in half a month to 1 month. The tympanic pressure gradually improved 3-6 months after the operation. A total of 69/72 ears achieved dry ears in the active ear group, and 37 ears had effective hearing improvement. In all, 40/41 ears achieved dry ears in the inactive ear group, and 20 ears had effective hearing improvement. There was no difference in the recurrence rate or hearing improvement in the two groups., Conclusion: With good quality control of the surgical treatment of TWOM, there are no differences in long-term outcomes in noncholesteatomatous COM in different chronic infection conditions., (© 2018 The Author(s) Published by S. Karger AG, Basel.)