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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: 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.

Conclusion: The cone beam computed tomography (CBCT) imaging technique has proved to be reliable for assessing the appropriate positioning of the floating mass transducer (FMT) in the round window (RW) niche, although some parameters do not seem to be essential for achieving a satisfactory functional outcome., Objectives: To evaluate the role that specific imaging parameters derived from CBCT of the temporal bone have for predicting the functional outcome after RW vibroplasty (RW-VP)., Methods: CBCT imaging was carried out in a homogeneous group of patients who presented with a mixed type of hearing loss after open tympanoplasty. Three arbitrary radiological parameters were taken into account: the FMT/RW membrane contact, bony contacts of the FMT margins, and the inferior FMT tissue support. The audiological assessment took into consideration the PTA4 (500-4000 Hz), the PTA2 (125-250 Hz), and the word recognition score (WRS) in quiet and in noise., Results: One subject presented with all positive CBCT parameters and showed a good, but not the best auditory performance among the study group. In the majority of the subjects, with a satisfactory postoperative hearing improvement, at least two of the three radiological parameters were present. In comparison with the unaided condition, an improvement in both the PTA4 and PTA2 was found in all the subjects.

Conclusion: Delayed facial palsy after tympanoplasty had no predisposition for gender or side. It seemed that prednisolone alone without antiviral drugs was enough for the treatment of delayed facial palsy after tympanoplasty., Objective: To analyze the clinical characteristics and prognosis of delayed facial palsy after tympanoplasty., Methods: The cases with delayed facial palsy after tympanoplasty treated from January 2005 to January 2014 at our hospital were included in the study, and their clinical characteristics and outcomes were analyzed., Results: The incidence of delayed facial palsy after tympanoplasty was 1.1% (16/1420 cases). Facial palsy occurred between 5 and 14 days (average 7.4 ± 1.8 days) after surgery. The incidence of delayed facial palsy was not different between males and females (p > 0.05). Also there was no significant difference between left and right side (p > 0.05). All patients were treated by prednisolone alone, and their facial nerve recovered to HB grade I after 3 weeks to 2 months without any sequelae.

Conclusion: The results of the present study reject the hypothesis that epithelial inclusions into the ossicles could cause cholesteatoma recurrences, but strongly suggest the performance of a safe cleaning procedure for ossicular remnants to make them usable in ossiculoplasty in patients with partially or non-encapsulated cholesteatoma., Objective: The aim of the study was to define, before any sort of cleaning procedure, if there is any epithelial inclusion inside the ossicles of patients with cholesteatoma and if the findings could be correlated with surgical aspect of cholesteatoma., Methods: The specimens used for this study comprised 19 mallei and 15 incudes, which were obtained intraoperatively from 24 patients. Each ossicle was grouped on the basis of the intraoperative aspect of the cholesteatoma as follows. Grade 1: 10 ossicles obtained from encapsulated cholestatoma, non-invasive, easily cleavable. Grade 2: 14 ossicles obtained from partially encapsulated cholesteatoma, non-invasive, not easily cleavable. Grade 3: 10 ossicles obtained from non-encapsulated cholesteatoma, invasive, not cleavable. Two stapes and one malleus were taken from patients who underwent middle ear surgery for conductive hearing loss and were used as controls. The ossicles were examined histopathologically after removal., Results: Our results do not show any epithelial inclusion inside the ossicles independently from the macroscopic aspect or growing aggressiveness of cholesteatoma. In addition there was no infiltration of inflammatory cells in grade 1, but it was present in one incus (7.1%) of grade 2 and in five ossicles (50%) of grade 3. In ossicles of grade 3 up to four layers of epithelial cells were found on the surface of the ossicles.

Conclusions: The procedure cleared the lesion completely and preserved the physiological function of the external auditory canal., Objective: To develop a novel surgical procedure to treat chronic suppurative otitis media (CSOM). To explore the merit of using pedicled temporalis myofascia (PTM) and reconstruction of the posterior wall of the external auditory canal with pedicled postauricular periosteal flap and intact skin of the external auditory canal., Methods: Forty-seven patients with CSOM were chosen. Open radical mastoidectomy was used to complete clean-up lesions; the fascia of PTM was used to repair the tympanic membrane. The PTM, pedicled postauricular periosteal flap, and intact skin of the external auditory canal were used in the reconstruction of the posterior wall of the external auditory canal. All subjects were followed up for over 2 years. Hearing thresholds, including air conduction (AC), bone conduction (BC), and air-bone gap (ABG) before and after surgery, and after follow-up, were compared., Results: The healing rate of postoperated tympanic membrane was 95.74% and the 2-year healing rate of tympanic membrane perforation was 95.65%. The 46 ears included in the 2-year follow-up showed significant improvement between preoperative and postoperative AC and ABG values.

Objective: The aim of this experimental study was to examine whether recombinant human bone morphogenetic protein-2 (rhBMP-2) could induce new bone formation in a small hole drilled through the temporal bone near the external auditory canal wall in guinea pigs., Material and Methods: A 4-mm diameter hole was made in the center of the temporal bone and a piece of collagen sheet infiltrated with rhBMP-2 was placed in the hole. New bone formation was confirmed by means of X-ray examination and the bone mineral density was quantified using dual-energy X-ray absorptiometry 1, 2 and 4 weeks after treatment., Results: The bone mineral density in the rhBMP-2-treated group was significantly increased compared to the control group., Conclusion: These results suggest that rhBMP-2 induces remarkable new bone formation in the temporal bone and will be useful in clinical ear surgery.

A total number of 281 consecutive children with recurrent acute otitis media (RAOM) or otitis media with effusion (OME) was treated with ventilation tubes (VT), inserted under local anesthesia. Patients were prospectively followed-up for post-tympanostomy otorrhea, classified as "early" if observed within 7 days of the tympanostomy procedure. The age of children ranged from 5 to 16 months (average 10.1 months). VT were placed bilaterally in 279 of 281 children. The average length of otitis media (OM) history prior to tympanostomy was 3.4 months. An episode of OM had been diagnosed 1-2 times in 18.9%, 3-4 times in 68.0%, and at least 5 times in 13.1% of the children. Middle ear effusion (MEE), most often classified as mucoid was present in 65.8% of the ears. Cultures were positive for bacteria in 41 of the 185 ears with MEE (22.2%). The mastoid air cell system was radiographically normal in 9.6% and markedly clouded in 56.6%. Early post-tympanostomy otorrhea was observed in 16.0% of ears, occurring more often when MEE, especially mucopurulent, was present at tympanostomy (p < 0.01). The risk of otorrhea was significantly increased by a positive culture for pathogenic bacteria in MEE (p < 0.01) and highly significantly by the advanced opacification of the mastoid air cell system (p < 0.001). It is concluded that early post-tympanostomy otorrhea in young children is caused by the advanced infectious process in the middle ear cleft, including mastoid cell system rather than by the tympanostomy procedure itself. It may indicate the need for more active treatment in this age group.

Absorbable gelatin sponge (Gelfoam)--commonly used in otosurgery--was gently inserted or firmly packed into the middle ear cavities of rats. The postoperative changes were evaluated 2 to 3 months later when, apart from some air-filled canals leading from the tympanal orifice of the Eustachian tube towards the attic, the middle ear cavity had become filled with newly formed bone and an amorphous mass of adhesions and bridles. The mass consisted of loose connective tissue, with fibroblasts, vessels and inflammatory cells. The tympanic membrane was retracted and fixed to the promontory. There were no signs that any Gelfoam had been removed through the Eustachian tube. The authors proposed that similar tissue reactions may occur in tympano-plasties.