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Key Clinical Message Color changes of the tympanic membranes without an inflammatory component or perforation are rarely described. They may result from hemorrhage after barotrauma or spontaneously. Other explanatory models include discoloration due to otomycosis. Abstract This is a case of a 61‐year‐old patient with an unexplained incidental of black dots located almost symmetrically on the antero‐inferior quadrant of both tympanic membranes. This harmless anatomical rarity has not been published before. Underlying pathologies should be excluded in the case of discoloration of the tympanic membranes.

Key clinical message Oto‐tricho is associated with the symptoms of gag reflex and non‐neuropathic tinnitus, which can be treated by removing the hair and its follicle. Abstract Oto‐tricho refers to a disorder of hair growth in the tympanic membrane (TM). In its early stages, it can manifest as symptoms such as tinnitus, chronic pain, cough, and nausea. If left untreated, it can potentially lead to tympanosclerosis, TM micro‐perforation, and hearing loss. In this report, we present a case study of a 33‐year‐old male with hair and follicle growth observed on the left TM. Over the course of the past year, the patient experienced various symptoms including tinnitus, dry cough, and chronic pain. An examination with an otoscope revealed the presence of oto‐tricho‐tussia/tinnitus. To address the issue, the hair and hair follicles were surgically removed using direct visual guidance. Subsequent follow‐up was conducted over a period of 5 months, during which no pain or infection was observed at the site of the TM. The patient's previous symptoms were successfully resolved. Furthermore, further observation of the TM revealed no evidence of hair follicles or hair regrowth.

Abstract Background Intratympanic membrane cholesteatoma presents as an asymptomatic, white, round mass on the tympanic membrane, and is usually detected incidentally in children. Case presentation A 12-year-old Korean boy visited our otorhinolaryngology clinic for a whitish mass on the right tympanic membrane. He had a history of traumatic tympanic membrane perforation in the right ear that had occurred 1 year prior, which had healed well with a paper patch placement. The mass was completely removed under local anesthesia during surgery with a microscope. The mass was on the outer epithelial layer of the right tympanic membrane and did not invade the middle fibrous and inner mucosal layers. Cholesteatoma was diagnosed on the basis of histopathology. Conclusion Intratympanic membrane cholesteatoma may not induce symptoms or invade the middle ear because it can grow outwards into the external auditory canal. However, intratympanic membrane cholesteatoma can grow over time, and then after growth, it can compress the tympanic membrane and advance into the middle ear, which can cause symptoms such as hearing loss. Intratympanic membrane cholesteatoma in children should be carefully evaluated and followed, and surgical removal should be considered, even for asymptomatic cases, to minimize potential damage and hearing loss.

Objectives Otitis media is a common infection worldwide. Owing to the limited number of ear specialists and rapid development of telemedicine, several trials have been conducted to develop novel diagnostic strategies to improve the diagnostic accuracy and screening of patients with otologic diseases based on abnormal otoscopic findings. Although these strategies have demonstrated high diagnostic accuracy for the tympanic membrane (TM), the insufficient explainability of these techniques limits their deployment in clinical practice. Methods We used a deep convolutional neural network (CNN) model based on the segmentation of a normal TM into five substructures (malleus, umbo, cone of light, pars flaccida, and annulus) to identify abnormalities in otoscopic ear images. The mask R-CNN algorithm learned the labeled images. Subsequently, we evaluated the diagnostic performance of combinations of the five substructures using a three-layer fully connected neural network to determine whether ear disease was present. Results We obtained the receiver operating characteristic (ROC) curve of the optimal conditions for the presence or absence of eardrum diseases according to each substructure separately or combinations of substructures. The highest area under the curve (0.911) was found for a combination of the malleus, cone of light, and umbo, compared with the corresponding areas under the curve of 0.737–0.873 for each substructure. Thus, an algorithm using these five important normal anatomical structures could prove to be explainable and effective in screening abnormal TMs. Conclusion This automated algorithm can improve diagnostic accuracy by discriminating between normal and abnormal TMs and can facilitate appropriate and timely referral consultations to improve patients’ quality of life in the context of primary care.

Background: Granular myringitis (GM) is one of the rarer conditions reported in Indian literature. It is defined as a chronic inflammation limited to squamous layer of tympanic membrane. Several names have been given to it such as myringitis granulosa, acute granulomatous myringitis, and chronic myringitis. Aims and Objectives: The objective of our study is to evaluate the results of topical antibiotic with steroids and topical antibiotic alone on disease pathology of GM and its outcome. Materials and Methods: This study was conducted in the department of otorhinolaryngology on 80 patients from the period of September 2020–December 2021 on patients of GM after complete clinical evaluation. This is a prospective study made on two groups of patients. The results were analyzed by visual analog scale. Results: Both the groups after a period of 6 months showed improved results. The outcome with antibiotic with steroid was comparatively faster and superior than antibiotic only ear drops. Conclusion: The result of antibiotic with steroid ear drops is superior to antibiotic only ear drops in the treatment of recurrent GM.

Background. Traumatic rupture of the eardrum is one of the most common cases following traumatic events, requiring medical care and sometimes surgery for treatment, which means the imposition of financial costs on the individual and society. Therefore, the aim of this study was to evaluate the factors influencing treatment duration in patients with traumatic eardrum rupture. Methods. In this cross-sectional analytical study, 100 patients were selected in accordance with the inclusion criteria. Based on the otoscopic examination of the tympanic membrane, a small tear (Pin Point) was defined as a case that was less than 1.4 (quarter) of the tympanic membrane, and a medium tear (Medium) was defined as a rupture that was less than 1.4 (quarter) of the tympanic membrane. Up to half of the tympanic membrane and large ruptures (Large) included more than half of the tympanic membrane and to determine the extent of hearing loss in these patients in decibels, audiogram, tympanogram, ECV, SDS and SRT were performed on all patients. Results. The mean age of the patients was 35.44±11.70 years with a median of 33 years. The minimum age of the patients was 10 years and the maximum was 63 years. 72% of patients were male and 28% were female. Regarding the location of rupture of the eardrum in the studied patients, it was observed that in 60 cases (60%) the rupture was in the lower posterior location, in 38 cases (38%) it was in the upper posterior location and only in 2 cases (2%) it was in the middle location of the eardrum. Eleven percent of patients recovered in the first month, 44 percent in the second month, 21 percent in the third month, and 24 percent did not recover. Conclusion. It can be concluded that eardrum rupture seems to occur most frequently around the age of 30 and is more common in males. Also, the lack of improvement in the present study was 24%. In addition, in the present study, there was a statistically significant relationship between extensive bleeding of the eardrum and the space behind the eardrum and the time of repair. Practical Implications. in traumatic perforation of tympanic membrane proper care and prevention of infection cause high healing rate.

Introduction. The problem of the development of acute post-traumatic otitis media has not lost its relevance. Long-term preservation of the defect of the tympanic membrane contributes to the development of chronic inflammation in the middle ear and a deterioration in the quality of life of patients.Objective. To study the effect of blood plasma enriched with platelet growth factors on the regeneration of the tympanic membrane tissues in patients with acute post-traumatic perforation.Materials and methods. Patients with acute post-traumatic perforation of the tympanic membrane were divided into the main (24 people) and control (19 people) groups. Patients of the main group in the area of perforation of the tympanic membrane were injected once by application with a clot of autoplasma, enriched with platelet growth factors. The control group patients underwent dynamic observation of the processes of natural regeneration of the tympanic membrane tissues. On the 5, 10 and 15th days, the tissue regeneration of the tympanic membranes was assessed subjectively (patient complaints, audiometry) and objectively (otoscopy with the calculation of the dynamics of the relative perforation area, otoacoustic emission).Results. A single application of blood plasma enriched with platelet growth factors to the perforation area was significantly more often accompanied by closure of the tympanic membrane perforation (p ≤ 0.01) and a decrease in the average relative area of the tympanic membrane perforation on days 10 and 15 of the study (p ≤ 0.01). The dynamics of the average relative area of the tympanic membrane perforation reflected a high rate of closure of the tympanic membrane defect in the main group. Better healing of the tympanic membrane in patients of the main group was accompanied by an improvement in the auditory function of the affected ear. The quality of hearing was, on average, significantly better in the patients of the main group than in the patients of the control group, both on the 10th and 15th days of observation (p ≤ 0.01).Conclusion. Clinical use of blood plasma enriched with platelet growth factors has a beneficial effect on the rate, intensity of closure of the tympanic membrane perforation and hearing.

Introduction: Tinnitus is a common and annoying symptom characterised by the perception of sound without any corresponding external stimulus. Subjective idiopathic tinnitus is a subjective form of tinnitus where the perceived sound originates from the auditory nervous system, without both aberrant aetiology and external stimuli. Intratympanic injection of steroid (Dexamethasone) is used for the treatment of subjective idiopathic tinnitus by introducing the drug through the tympanic membrane, resulting in reduced systemic toxicity and a higher perilymph steroid level. Aim: To evaluate the efficacy of intratympanic dexamethasone injection in the treatment of subjective idiopathic tinnitus. Materials and Methods: This prospective interventional study was carried out at Madurai Medical College, Madurai, Tamil Nadu, India, from March 2021 to March 2022. A total of 30 patients with subjective idiopathic tinnitus were subjected to intratympanic dexamethasone injection, once per week for three weeks. Improvement in the symptom of tinnitus was assessed by means of subjective evaluation with the help of Tinnitus Handicap Inventory (THI) before and after one week, one month and three months of last injection. Data were statistically analysed using Student’s paired t-test. Results: The results of this study shows that, 53.33% of the population belonged to the age group of 31-40 years. There was 16 females and 14 males. There was a significant reduction in the mean grade of THI at one month and three months after the treatment. The mean THI score was significantly reduced from 50.067 before treatment to 35.733 in one month and 26.933 in three months after the treatment. Conclusion: The intratympanic injection of dexamethasone was found to be effective in the treatment of subjective idiopathic tinnitus. Intratympanic treatment was demonstrated to improve tinnitus scores in the study population.

Background and purpose: Tympanostomy surgery and ventilation tube (VT) placement are reliable methods to reduce the complications of eustachian tube dysfunction and inadequate middle ear ventilation. However, tympanostomy is associated with some complications. This study aimed to investigate the frequency distribution of tympanostomy surgery, success rate, its complications and the demographic characteristics of patients during 2011-2017 in Sari, Iran. Materials and methods: This retrospective descriptive study was performed using data from the records of 512 patients who underwent VT surgery in Sari during 2011-2017. A checklist was used to collect the data and SPSS V24 was used for data analysis. Results: The most common complaint at the time of referral was hearing loss (38.3%). In 79%, bilateral VT was performed and 6.5% had complications after the operation. The most common complication was purulent otorrhea (4.1%). Postoperative success rate of VT was found to be 93%. Conclusion: Given the high success rate of VT surgery, this procedure could be a good method in treatment of hearing loss, acute recurrent middle ear infections, and the adverse effects of tonsillitis and allergy on middle ear.

Introduction. Тo study the microscopic picture of the tissues of the perforated tympanic membrane after the introduction of blood plasma enriched with platelet growth factors into the perforated area of the tympanic membrane in the experiment.Materials and methods. 36 rats (72 tympanic membranes) were examined. The animals were divided into 2 groups, the main and the control. The tympanic membrane was perforated in rats of both groups using sterile play. Animals of the main group were injected with a single application of autoplasm of blood enriched with platelet growth factors into the area of perforation of the tympanic membrane. The animals of the control group underwent only dynamic observation. The rats were withdrawn from the experiment in batches of 6 individuals on day 5, 10, 15 after the tympanic membrane perforation, then a histological assessment of the tissue regeneration of the tympanic membranes was performed. Results. In animals of the main group on the 5th day after perforation of the tympanic membrane, edema and disorganization of connective tissue were significantly less frequently recorded than in animals of the control group (p ≤ 0.05). Fibroblastic infiltration of tympanic membrane tissues was significantly more often observed in rats of the main group compared with rats in the control group (p ≤ 0.05). In rats of the main group on the 10th day after perforation of the tympanic membrane, edema and disorganization of the connective tissue of the tympanic membranes were noted significantly less frequently than in rats of the control group (p ≤ 0.05). Signs of fibroblastic infiltration and neoangiogenesis at the same time in animals of the main group were revealed significantly more often, in contrast to rats in the control group (p ≤ 0.05). In animals of the main group, on the 15th day after perforation of the tympanic membrane, fibroblastic infiltration and neoangiogenesis were revealed in all cases of observation, which significantly exceeded the corresponding indicators in the control group, and leukocyte infiltration in rats of the main group, in contrast to the previous stages of the study, was noted significantly less frequently. than in rats of the control group (p ≤ 0.05).Conclusion. Earlier and complete regeneration of damaged tissues of the tympanic membrane under conditions of its traumatic perforation was noted in rats of the main group under the influence of PCOTFR. In rats of the main group, more organized collagen fibers, the presence of basophilic leukocytes, signs of neoangiogenesis, and extensive fields of fibroblasts were visualized.

Introduction. Matrix metalloproteinase-9 (MMP-9) plays one of the key roles in the migration of inflammatory cells and the destructive behavior of acquired middle ear cholesteatoma. The aim of the study was to determine the expression levels of MMP-9 in chronic otitis media, with and without acquired cholesteatoma, as well as to determine the correlation between them and the pathomorphological changes in the tympanic membrane (TM). Methods. Immunohistochemical study included 178 patients of both sexes, aged 5-75 years, who underwent microsurgical treatment of chronic otitis media (COM) at the Ear, Nose and Throat Department of the University Clinical Center of the Republic of Srpska in Banja Luka from 2015 to 2018. Patients were divided into two groups on the basis of the presence or absence of acquired cholesteatoma: 97 (CCOM) and 81 (COMWC). The samples of the perimatrix of acquired cholesteatoma (n=97) and inflamed middle ear mucosa (n=81) were taken intraoperatively. The presence of retraction and certain types and subtypes of TM perforations were examined by intraoperative exploration. MMP-9 expression levels were determined by immunohistochemical analysis. Results. In the presence of cholesteatoma and highly positive expression of MMP-9, the marginal type of TM perforation was more likely to occur (p

Abstract Hemangiomas are benign vascular tumors frequently located in the head and neck area, but rarely encountered in the ear, often originally misdiagnosed due to their rarity and absence of specific clinical manifestations. We report the second case of a mixed hemangioma involving the external auditory canal in literature to date.

Otic disorders, such as otitis media and hearing loss, affect a substantial portion of the global population. Despite this, oto-therapeutics, in particular those intended to treat hearing loss, have seen limited development and innovation. A significant factor to this is likely a result of the inherent costs and complexities of drug discovery and development. With in vitro 3D tissue models seeing increased utility for the rapid, high-throughput screening of drug candidates, it stands to reason that the field of otology could greatly benefit from such innovations. In this study, we propose and describe an in vitro 3D model, designed using a physiologically based approach, which we suggest can be used to estimate drug permeability across human tympanic membranes (TM). We characterize the permeability properties of several template drugs in this model under various growth and storage conditions. The availability of such cost-effective, rapid, high-throughput screening tools should allow for increased innovation and the discovery of novel drug candidates over the currently used animal models. In the context of this TM permeation model, it may promote the development of topical drugs and formulations that can non-invasively traverse the TM and provide tissue-targeted drug delivery as an alternative to systemic treatment, an objective which has seen limited study until present.

Background: Children with cleft palate oftenly present with otitis media with effusion. The objective of this study was to determine the frequency of otitis media with effusion among cleft palate children. Material & Methods: This cross-sectional study was carried out in the Department of ENT, Pakistan Institute of Medical Sciences, Islamabad, Pakistan from June 2017 to December 2018. Ninety patients were selected through consecutive sampling technique. All children 3-10 years of age with cleft palate were included. Patients with combined cleft palate and cleft lip were excluded. All patients underwent otoscopy and tympanometry. Type B tympanogram was considered as evidence of fluid in the middle ear. Later on patients with only Type B tympanogram underwent myringotomies. Results: Out of 90 (180 ears) patients 61 (67.78%) were males and 29 (32.22%) females. Mean age of the sample was 6.15±2.226 years (3-10, range 7 years). On otoscopic examination, 107/180 (59.45%) ears were suspected to have fluid in the middle ear. Type B tympanogram was detected in 125/180 (69.45%) ears. Only 38/90 (42.20%) patients (76/180 ears), underwent pure tone audiometry. Based on otoscopic, tympanometric and audiometric findings, myringotomies were performed in 125/180 (69.45%) ears. At myringotomy fluid was present in middle ear space of 98/180 (78.4%) ears. Out of total 180 ears the true frequency of otitis media with effusion was 98/180 (54.45%). Conclusions: The frequency of otitis media with effusion in patients with cleft palate is high. Tympanometry is fairly sensitive in diagnosing this condition in these patients.

Objectives Doppler optical coherence tomography (DOCT) is useful for both, the spatially resolved measurement of the tympanic membrane (TM) oscillation and high-resolution imaging. We demonstrated a new technique capable of providing real-time two-dimensional Doppler OCT image of rapidly oscillatory latex mini-drum and in vivo rat TM and ossicles. Methods Using DOCT system, the oscillation of sample was measured at frequency range of 1–4 kHz at an output of 15 W. After the sensitivity of the DOCT system was verified using a latex mini-drum consisting of a 100 μm-thick latex membrane, changes in displacement of the umbo and contacted area between TM and malleus in normal and pathologic conditions. Results The oscillation cycles of the mini-drum for stimulus frequencies were 1.006 kHz for 1 kHz, 2.012 kHz for 2kHz, and 3.912 kHz for 4 kHz, which means that the oscillation cycle of the mini-drum become short in proportional to the frequency of stimuli. The oscillation cycles of umbo area and the junction area in normal TM for frequencies of the stimuli showed similar integer ratio with the data of latex mini-drum for stimuli less than 4 kHz. In the case of middle ear effusion condition, the Doppler signal showed a tendency of attenuation in all frequencies, which was prominent at 1 kHz and 2 kHz. Conclusion The TM vibration under sound stimulation with frequencies from 1 kHz to 4 kHz in normal and pathologic conditions was demonstrated using signal demodulation method in in vivo condition. The OCT technology could be helpful for functional and structural assessment as an optional modality.

Abstract Introduction Chronic suppurative otitis media is a common ailment in developing countries, and it generally presents with otorrhea and hearing loss. Different surgical procedures have been used to treat otitis media; among them is myringoplasty, which is a procedure that includes repair of the tympanic membrane. Platelet concentrates have been used widely in different types of wounds and are found to improve wound healing. Hence, the use of platelet-rich fibrin in myringoplasty will also improve the tympanic membrane healing. Objectives To assess the safety and efficacy of autologous platelet-rich fibrin on graft uptake in myringoplasty. Methods Eighty-six patients were observed during the study period of two years. Forty-three patients in the study group underwent myringoplasty aided with platelet-rich fibrin, and 43 patients in the control group went through the same procedure but without the platelet-rich fibrin. The patients were observed for three months postoperatively by a blinded observer. Results A total of 4.7% of the patients in the study group had postoperative infection, compared with a rate of 19% in the control group (p = 0.039). The graft uptake success rate was found to be 97.7% in the study group as compared with 81% in control group (p = 0.012). The results were found to be statistically significant. Conclusion Being autologous in nature, and by comparing the groups, platelet-rich fibrin is safe for patients. The postoperative graft uptake rate is better in cases in which platelet-rich fibrin was used. The postoperative infection rate was also lower in the same group.

It is estimated that hearing loss currently affects more than 1.5 billion people, or approximately 20% of the global population; however, presently, there are no Food and Drug Administration-approved therapeutics or prophylactics for this condition. While continued research on the development of otoprotective drugs to target this clear unmet need is an obvious path, there are numerous challenges to translating promising therapeutic candidates into human clinical testing. The screening of promising drug candidates relies exclusively on preclinical models. Current models do not permit the rapid high-throughput screening of promising drug candidates, and their relevance to clinical scenarios is often ambiguous. With the current study, we seek to understand the drug permeability properties of the cadaveric tympanic and round window membranes with the goal of generating knowledge that could inform the design and/or evaluation of in vitro organotypic models. The development of such models could enable the early high-throughput screening of topical therapeutic candidates and should address some of the limitations of currently used animal models.

Introduction Retraction pocket is a condition in which the eardrum lies deeper within the middle ear. Its management has no consensus in literature. Objective To assess the role of mastoidectomy in the management of retraction pockets added to a tympanoplasty. Methods Prospective study of patients with retraction pocket and referred to surgery. The patients were randomly assigned to two groups: one managed with tympanoplasty and mastoidectomy and the other group with tympanoplasty only. The minimum follow-up considered was 12 months. The outcomes were: integrity of eardrum, recurrence, and hearing status. Results This study included 43 patients. In 24 cases retraction occurred in the posterior half of the eardrum, and in 19 patients there was clinical evidence of ossicular interruption. The two groups of treatment were composed by: 21 patients that underwent tympanoplasty with mastoidectomy and 22 patients had only tympanoplasty. One case of the first group had a recurrence. In 32 cases patients follow up was longer than 48 months. The average air-bone gap changed from 22.1 dB to 5 dB. The percentage of air-bone gap improvement was assessed at 60% in those patients treated with mastoidectomy, and 64.3% in those without it (p > 0.5). Conclusion Tympanoplasty and ossiculoplasty should be considered to treat atelectatic middle ear and ossicular chain interruption. Mastoidectomy as a way to increase air volume in the ear seems to be a paradox; it does not add favorable prognostic factor to management of retraction pockets.

Introduction: There is variation in the size, shape and position of tympanic membrane perforations; the degree of conductive hearing loss depends on the size and position of perforation. Objective: To determine the pattern and causes of tympanic membrane perforation at a private health facility in Tanzania Method: A hospital-based cross-sectional study in the ENT clinic at Ekenywa Specialised Hospital was conducted from January to May 2019. Ears were examined thoroughly by an Otorhinolaryngologist. Data were analysed using SPSS Version 21 Results: Two hundred and fifty patients were examined and 50 (20%) were found to have tympanic membrane perforations. Thirty (60%) were new patients while twenty (40%) were under review. Most 35(70%) were males. Central perforation predominated in 30 (60%), followed by subtotal in 10 (20%), total in 8 (16%) and marginal perforations in 2 (4%). The left ear was more affected in (60%) than the right ear. Bilateral perforations accounted for 5 (10%) of cases. Chronic suppurative otitis media was found in 35 (70%); other causes were acute suppurative otitis media in 13 (26%) and trauma in 2 (4%) patients Conclusions: The clinical picture depicted in this study is similar to that found elsewhere. There is a need for prompt diagnosis of tympanic membrane perforation. Proper education on ear care in patients with perforated tympanic membrane is of paramount importance.

Abstract Introduction Tympanic membrane perforation is a relatively common problem that predisposes patients to varying degrees of conductive hearing loss. Objective The objective of this study is to evaluate and analyze the frequency dependence hearing loss in tympanic membrane perforation based on the size and the site of perforation. Methods For the study, I selected 71 patients' (89) ears for the cross-sectional study with tympanic membrane perforations; I examined the size and the site of perforations under the microscope and classified them into small, moderate, large, and subtotal perforations, and into anterior central, posterior central, malleolor central, and big central perforations. I measured mean level of speech frequencies hearing loss, and its relation with the site and the size of the perforation analyzed. Results The mean hearing loss at different sizes of the perforation at all speech frequencies was 37.4 dB, with ABG of 26.6 dB, and its maximum loss was detected in subtotal perforation of 42.3 dB, with ABG of 33.7 dB, at 500 Hz frequency, while in relation to the sites, it was 38.2 dB, with ABG of 26.8 dB, and its maximum loss was detected in big central site perforation of 42.1 dB, with ABG of 33.6 dB, at 500 Hz frequency. Conclusions The hearing loss was proportionally related with the sizes of the perforations, and the posterior site had greater impact on the hearing than anterior site perforations. This was also applied to the frequency dependence hearing level, as was detected to be worse at lower frequencies as 500 Hz, than those of 1000–2000 Hz.

New generation oral anticoagulants — rivaroxaban, apixaban and edoxaban — represent an important medical achievement. Their therapeutic effectiveness and ease of use make them essential in the management of thromboembolic conditions. However, as warfarin, they have known haemorrhagic risks. This paper reports the case of a 50-year-old female who presented with ear pain and spontaneous blood discharge in her right ear, after a two-week treatment with rivaroxaban. The physical examination revealed a spontaneous tympanic haematoma in the inferior quadrants, adjacent to the umbus. She denied any manipulation of the ear canal. Our goal is to alert for a presumable side effect of this drug in clinical practise.

Introduction: Perforation of the tympanic membrane primarily results from middle ear infections, trauma or iatrogenic causes. The perforation causes conductive hearing loss by reducing the surface area available for sound transmission to the ossicular chain. Objective: The objective was to analyze the characteristics of tympanic membrane perforations in relation to hearing loss and to determine the type and degree of hearing loss. Materials and methods: We analyzed audiometric, otoscopic findings and medical reports of 218 patients, 114 males (52.3%) and 104 females (47.7%), aged 9 to 75 years (mean age of 47.9 years), examined during the period of November 2012 to October 2015. For statistical data analysis we used Chi-square test with level of significance p

The loss of hearing structures and loss of advertisement calls in many terrestrial breeding frogs (Strabomantidae) living at high elevations in South America are common and intriguing phenomena. The Andean frog genus Phrynopus Peters, 1873 has undergone an evolutionary radiation in which most species lack the tympanic membrane and tympanic annulus, yet the phylogenetic relationships among species in this group remain largely unknown. Here, we present an expanded molecular phylogeny of Phrynopus that includes 24 nominal species. Our phylogeny includes Phrynopus peruanus, the type species of the genus, and 10 other species for which genetic data were previously unavailable. We found strong support for monophyly of Phrynopus, and that two nominal species—Phrynopus curator and Phrynopus nicoleae—are junior synonyms of Phrynopus tribulosus. Using X-ray computed tomography (CT) imaging, we demonstrate that the absence of external hearing structures is associated with complete loss of the auditory skeletal elements (columella) in at least one member of the genus. We mapped the tympanum condition on to a species tree to infer whether the loss of hearing structures took place once or multiple times. We also assessed whether tympanum condition, body size, and body shape are associated with the elevational distribution and habitat use. We identified a single evolutionary transition that involved the loss of both the tympanic membrane and tympanic annulus, which in turn is correlated with the absence of advertisement calls. We also identified several species pairs where one species inhabits the Andean grassland and the other montane forest. When accounting for phylogenetic relatedness among species, we detected a significant pattern of increasing body size with increasing elevation. Additionally, species at higher elevations tend to develop shorter limbs, shorter head, and shorter snout than species living at lower elevations. Our findings strongly suggest a link between ecological divergence and morphological diversity of terrestrial breeding frogs living in montane gradients.

ObjectivesTo evaluate endoscopic push-through technique cartilage myringoplasty results.MethodsThis prospective study was performed on patients with anterior tympanic membrane perforations and endoscopic push-through technique cartilage myringoplasty was performed between 2011 and 2013. The patients who did not have any cholesteatoma or otorrhea in the previous 3 months, and had an air bone gap ≤25 dB in their preoperative audiograms were included in the study. They were followed up with endoscopic examination and audiograms at 2nd, 6th, 12th, and 24th postoperative months. Pure tone averages were calculated at 0.5, 1, 2, and 4 kHz frequencies.ResultsOf 32 patients, 19 were females and 13 were males. The mean age was 40.3 years (range, 16 to 62 years), and the mean follow-up period was 12.4 months (range, 6 to 24 months). Graft success rate was 87.5% in this study. Preoperative mean air conduction hearing threshold was 25.9 dB, and the mean air-bone gap was 11.9 dB while these values improved to 19.5 dB and 5.3 dB respectively in the postoperative period. The mean hearing gain was 6.4 dB. The analysis of preoperative and postoperative mean air conduction thresholds and air bone gap values of the patients revealed statistically significant differences.ConclusionUnderlay cartilage myringoplasty with endoscopic push-through technique in anterior quadrant tympanic membrane perforations is an effective, minimally invasive and feasible method.

Our aim in this study is to show the efficacy of trichloracetic acid cauterization in the tympanic membrane perforations. Between January 2002 and January 2012 central perforations in 160 ears of 142 cases were tried to be closed by repeated trichloracetic acid cauterization in one week interval followed by the placement of a piece of cigarette paper to the perforation site. In 98 of 137 ears (71.5 %) that followed-up for a desired period of time, perforation was closed after an average of 4.2 applications. No statistical relation was found between the success of treatment, and the age of patient, the site of perforation and previous history of otorrhea. It was shown that the width of perforation is an important factor in the success of treatment. [Med-Science 2016; 5(2.000): 544-6]

Introduction: Chronic Suppurative Otitis Media (CSOM) is one of the main causes for preventable hearing loss and is characterised by permanent perforation of tympanic membrane and ear discharge. Observing histopathological changes in middle ear and mastoid in CSOM can help in planning the surgical procedure and outcome of the disease. Aim: To study the relationship between various clinical features of CSOM and the histopathological findings and to study if this relationship helps in assessing the treatment protocol and surgical planning of the cases. Materials and Methods: The procedures followed were in accordance with the ethical standards of the Institutional Ethical Committee and with the Helsinki Declaration of 1975 that was revised in 2000. After obtaining informed and written consent regarding their willingness to participate in the study, patients of CSOM were taken for the study. CSOM was diagnosed after eliciting proper history, thorough clinical examination and after performing relevant investigations. Mucosa of middle ear was obtained from all such cases and sent for histopathological examination. The surgical patients were followed up every week for three weeks, fortnightly for the next month and monthly for the next six months. The patients were examined for any aural discharge, during their postoperative follow up, the condition of the graft was assessed and PTA for hearing evaluation was done after a month. CSOM patients attending ENT Outpatient Department (OPD) or admitted in ward, with a willingness to participate and on regular followup for six months. Patients not willing to participate in the study, with uncontrolled systemic diseases, and with predisposing factors and who missed the postoperative follow up. Results: Histopathological examination of the cases showed changes corresponding to chronic inflammation with lymphoplasmacytic infiltrations in most of the cases, with few cases showing granulation tissue. Patients with granulation tissue are associated with ossicular necrosis. Conclusion: The present study helps in comprehensive management of CSOM considering the various clinical and pathological features. Amount of hearing loss is correlated with the size of perforation. Granulation tissue is associated with mucopurulent discharge. Ossicular necrosis is seen in 50% of cases with granulation tissue. The study helps in better understanding of clinical and pathological course of CSOM and helps in rationalising the treatment protocol and in surgical planning.