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Introduction Fat grafts have been in used since 1962 for small central perforations, with a success rate ranging from 86 to 100%. Platelet-rich plasma (PRP) containing platelet concentrations greater than 1 million platelets/μL assist the healing process by various means. Current data suggests improved healing when tympanoplasty is performed using temporalis fascia grafts if PRP is added during surgery.

Objectives: This study aimed to compare the efficacy of labetalol and lidocaine in tympanoplasty surgery, specifically evaluating their impact on hemodynamic changes and perioperative outcomes. Methods: A randomized controlled trial was conducted with 64 patients scheduled for tympanoplasty. Patients were randomly assigned to receive either 0.5–2 mg/min labetalol or 1.5 mg/kg/h lidocaine 1% to achieve controlled hypotension during surgery. The efficacy of the drugs was assessed by comparing the Mean Arterial Pressure (MAP), surgeon's satisfaction, time to target MAP, bleeding volume, postoperative pain scores, the need for analgesic medication in recovery, sedation, and other additional parameters. Results: The hemodynamic parameters showed a similar trend over time in both the labetalol and lidocaine groups. The median bleeding volume in the labetalol group (10 cc) was lower than that in the lidocaine group (30 cc), although this difference was not statistically significant (p = 0.11). Similarly, surgeon's satisfaction level, pain intensity, and sedation level in the recovery room did not show statistically significant differences between the two groups (p > 0.05). The duration of surgery, recovery stay, and extubation time also did not significantly differ between the groups. Both medications took approximately the same time (20 min) to reach the target MAP and exhibited comparable hemodynamic responses (p > 0.05). Conclusion: Both labetalol and lidocaine effectively achieved controlled hypotension during tympanoplasty surgery, thereby improving surgical conditions. The choice of medication should be based on individual patient characteristics and the anesthesiologist's judgment. Level of evidence: II.

Abstract Introduction Tympanoplasty is a surgical method, to eradicate middle ear infection and improve its function. In tympanoplasty graft can be by overlay or underlay technique. In underlay technique the graft material can be placed either medial or lateral to the handle of malleus. Objective: To compare the outcome of the surgery when the temporalis fascia graft is placed medial or lateral to the handle of malleus, in terms of complete take up of the graft and hearing improvement after the surgery. Materials & methods A prospective and comparative hospital-based study was done in the Otorhinolaryngology (ENT) department of a tertiary referral hospital of Kolkata, from 1st January, 2021 to 30th June, 2022 (18 months). 60 patients were included in the study. Results We found that association of tympanic membrane status with group was not statistically significant after 1 month of surgery (p=1.0000) and after 3 months of surgery (p=0.6711). Distribution of mean postoperative hearing gain after 3 months of surgery with group was not statistically significant (p=0.3020). Conclusion We found both the techniques are equally effective in terms of complete graft take up and post operative hearing gain after 3 months follow up.

Objectives. Endoscopic tympanoplasty (ET) provides minimally invasive transcanal access to the middle ear and improves middle ear visibility for the treatment of tympanic membrane (TM) perforations. However, the literature on surgical outcomes for large TM perforations is lacking and limited to small series. This study aimed to evaluate the clinical benefits of ET for large TM perforations. Methods. This retrospective cohort study was conducted at nine tertiary referral hospitals in South Korea, where 252 patients who underwent ET as primary surgery from September 2019 to August 2021 were included. The outcome measures included the graft success rate and pre- and postoperative audiometric data. Results. In 239 patients, the graft success rate of ET for large or subtotal perforations was 86.2% (206 patients), while the graft failure rate was 13.8% (33 patients). The graft failure rate was directly correlated with surgical techniques, including overlay and medial or lateral underlay tympanoplasty (P=0.027). Lateral underlay tympanoplasty showed the most favorable results. Sex, laterality, etiology, site and size of perforation, operation time, and graft materials did not vary significantly between the graft success and failure groups (P>0.05). The mean air-bone gap (ABG) improved significantly in both groups (graft success group: 10.0±0.6 dB and graft failure group: 7.7±0.3 dB; P

Abstract Objective We aimed to compare the graft success rate and hearing outcomes in patients with large tympanic membrane (TM) perforation in underlay and over‐underlay approaches. Methods This is a prospective double‐blind randomized controlled clinical trial with a parallel design. Patients aged 15–75 years old with large TM perforation (more than 50% of TM) who operated at Khalili hospital affiliated with Shiraz University of Medical Science, Iran, were enrolled. Exclusion criteria were recent otorrhea, revision surgery, and pathologic intraoperative findings such as the presence of cholesteatoma, cholesterol granuloma, ear canal polyp, or damaged ossicle. In the first group, the underlay method and in the second group over‐underlay method were performed. Graft success rate, atelectasis, and audiology outcomes were evaluated after 6 months. Results The investigation was conducted on 84 patients in the underlay and 67 patients in the over‐underlay group. Although there was a higher rate of graft failure (9%) in the over‐underlay group in comparison with the underlay group (4.8%), the difference was not statistically significant (p‐value = .34). No atelectasis was seen in both group. Although, between‐groups comparison of the preoperative and postoperative speech reception thresholds (SRT) and air‐bone gaps (ABG) values showed statistically significantly lower SRT and ABG in the over‐underlay technique, the difference was clinically negligible. Conclusion Both techniques provide the same graft success rate, but SRT and ABG were significantly lower in the over‐underlay technique after the operation. Levels of Evidence 1b

Objective:This study aimed to evaluate the outcomes of total transcanal endoscopic cholesteatoma surgery.Methods:Twenty-seven cholesteatoma patients that had undergone transcanal endoscopic ear surgery (TEES) were included in the study. Age, sex, operation date of patients, operated side, need for ossiculoplasty, graft material, and surgical technique were recorded. All patients were evaluated through otoscopic, endoscopic, and audiological examinations and followed up for at least five months after surgery. All patients were staged using the European Academy of Otology and Neurotology/Japan Otological Society (EAONO/JOS) Staging System on Middle Ear Cholesteatoma.Results:Mean age of the patients was 36.4 years (range, 4–67 years). According to the EAONO/JOS Staging System, 11 patients were stage 1, while 11 were stage 2, and five were stage 3. Two had lateral semicircular canal defect, one had facial canal dehiscence, and one had oval window defect. The average follow-up period was 19 months (range, 5–41 months), during which two patients experienced retraction pocket and hearing loss and one patient had perforation. One patient underwent revision surgery during follow-up and no recurrence or residual cholesteatoma was observed. The preoperative and postoperative air–bone gaps were 25.14±13.93 dB and 22.22±12.64 dB with no significant difference.Conclusion:TEES is a minimally invasive and safe procedure with low complication and recurrence rates. As with all surgical procedures, experience is essential, and as experience increases, the capability to perform endoscopic otologic surgery on more complex cases may become possible.

Abstract Objective This study aimed to evaluate the procedural outcomes and learning curve of type I endoscopic tympanoplasty (ET) performed by a single surgeon. Methods This was a retrospective study of 376 patients who underwent type I ET performed by a single surgeon over 7 years. We evaluated the pre/post air‐bone gap (ABG), time required for surgery, changes in pain after surgery, success, and failure rate of type I ET. Results Hearing results indicated an ABG of approximately 17.8 dB before surgery but decreased significantly to 9.8 dB at 6 months after surgery. The time required for the operation gradually decreased. In particular, the time required for the procedure was 67.6 min in the first year and decreased to 31.5 minutes in the fifth year, a drastic reduction. The graft failure rate up to 6 months after surgery was 13.0% and was the same for both primary and revision surgeries. Graft failure was significantly greater with increasing size of the preoperative tympanic perforation. The success rate varied depending on graft material, and the group with only acellular allogenic dermal matrix showed the lowest success rate. Postoperative pain significantly decreased from 2.01 immediately after surgery to 0.78 points the next day, and there were no severe complications during surgery. Conclusions ET produces superior cosmetic results with minimal pain and is associated with stable hearing improvement and high success rate. The operation time decreased with surgeon experience and continued to decrease until the fifth and final year of this analysis. Level of Evidence 4

Abstract Objective Surgical repair of tympanic membrane perforations has been traditionally performed with autologous soft‐tissue grafts with high success rates. Newer allografts such as porcine small intestine submucosa (pSIS) have been employed as alternatives to minimize donor morbidity and surgical time, and in cases where autologous tissue may not be available. The comparative anatomic and audiometric success rates of these tissues is still unclear. Study design Retrospective case–control series of anatomic and audiometric outcomes of autologous soft tissue versus pSIS graft for primary, isolated transmeatal tympanic membrane repair. Methods Analysis of patients undergoing primary transmeatal tympanic membrane repair with autologous soft tissue or pSIS. Patients with otorrhea, cholesteatoma or retraction pockets, those who had cartilage grafts or ossicular reconstruction, and revision procedures were excluded. Pre‐ and post‐surgery air–bone gaps (ABG) and pure tone averages (PTA) were compared. Graft success was defined as closure of the perforation at 2‐month follow‐up visit. Results The success rate for both the autologous soft tissue and the pSIS arm is 93.8%. There was no statistical significance (p

Abstract Background Platelet-rich fibrin (PRF) which is considered a second-generation platelet-rich plasma having a high content of growth factors could be implied as a sealant and adjuvant to grafting materials during tympanoplasty operation. This work aimed to evaluate the role of autologous platelet-rich fibrin as an adjuvant in type 1 tympanoplasty (myringoplasty) for the closure of central tympanic membrane perforations. A prospective comparative study was conducted including one-hundred patients with chronic suppurative otitis media with dry central TM perforations. The patients were classified into two equal groups: group A (case group) was subjected to myringoplasty operation with the use of autologous PRF added to the temporalis fascia graft, and group B (control group) was subjected to myringoplasty operation using graft only without PRF. Both groups were assessed for successful closure of perforation defined as an intact eardrum, success in terms of hearing defined as closure of air-bone gap down to 10 dB or lesser, and hearing gain at 6 months postoperatively. Results At 6 months postoperatively, the success rate (graft taking) in group A (90%) was significantly higher than in group B (70%). Success in terms of air-bone gap closure (< 10 dB) revealed that in group A, success was achieved in 39 patients (78%), which was significantly higher than in group B 27 patients (54 %). Air-bone gap at 6 months postoperatively was more in the graft taken cases in the case group than in the control group with a significant difference. There was a nonsignificant correlation between graft uptake and either hemoglobin or platelet concentrations in both groups. In addition, there was a nonsignificant correlation between graft uptake and the size of the perforation in both groups. Conclusion Platelet-rich fibrin is a cheap, cost-effective, and completely autologous platelet concentrate with enriched growth factors. It improves the overall success rate of myringoplasty with no noticeable side effects.

Abstract Objective Endoscopic ear surgery (EES) is a growing and well-recognized field in the modern era. EES had a stepwise journey of development. This journey is pretty comparable to the endoscopic sinus surgery development. Methods Online literature search was performed to give a concise review on the development and recent applications of EES and in addition to clarify the reported advantages and disadvantages of EES. Results EES has a more recent application than ESS that started decades after endoscopic sinus surgery (ESS). The use of endoscope in ear surgery gives a wide-angled detailed view of the middle ear structures. It gives the ability to look around the corners offering less disease persistence than the microscopic approaches. EES is useful in cases of narrow and angled external auditory canal as it bypasses the narrowest segment of EAC. However, it lacks the 3D perception and enables one hand surgery which could be difficult to manage bleeding. Applications of EES extended from tympanoplasty, stapedotomy, cholesteatoma surgery, and middle ear ventilation in chronic inflammatory conditions to the neurotologic applications in lateral skull base surgery. Conclusion EES is an extremely growing field with many applications in otology and neurotology. The advantages of endoscopic applications outweigh the disadvantages. It has a stepwise learning curve and offer better teaching ability.

Introduction Tympanoplasty is a reparative surgery that has multiple indications. The aid of a microscope or an endoscope is necessary to carry out the procedure. The classic method utilizes the microscope; however, in the recent decades, the endoscope has been popular. Although many articles try to compare these two techniques, there is still no robust evidence that confirms the superiority of either technique. In the present work, we seek to perform a systematic review contribute with this.

Abstract Objective To compare the indications and efficacy of endoscopic over‐under tympanoplasty versus endoscopic underlay tympanoplasty. Methods Retrospective cohort study of patients undergoing type I endoscopic tympanoplasty via either an underlay or over‐under technique by a single surgeon from 2017 to 2021. Patients were excluded if they had a concurrent mastoidectomy, ossiculoplasty, or advanced cholesteatoma defined by involvement of multiple subsites. Patient demographics, perforation size and location, middle ear status, preoperative and postoperative audiograms, and perforation closure were reviewed. Middle ear status was represented using the Ossiculoplasty Outcome Parameter Score (OOPS). The primary outcome was perforation closure at most recent follow‐up and secondary outcomes were change in postoperative pure‐tone average (PTA) and air‐bone gap (ABG). Results Of 48 patients, 27 underwent endoscopic underlay tympanoplasty and 21 underwent endoscopic over‐under tympanoplasty. Tragal cartilage‐perichondrium graft was used in 90% of procedures. Distribution of OOPS scores was not significantly different between groups. Over‐ under technique addressed significantly larger perforations (mean size of 54% vs. 31%, p

Introduction: Tympanoplasty is a surgical procedure designed to reconstruct the mechanisms of sound transmission in the middle ear. Objective: Analyze, from an audiological point of view, patients with chronic otitis media undergoing type 3 tympanoplasty major columella with total ossicular replacement titanium prosthesis or with cartilage graft stapes columella. Methods: This is a prospective analytical study, carried out at the otorhinolaryngology outpatient clinic in a tertiary care hospital, through the evaluation of 26 patients with chronic otitis media who underwent tympanoplasty using different materials for auditory rehabilitation such as titanium prostheses or cartilage autografts. Results: There was no statistically significant association between the group factors (cartilage or titanium reconstruction) and preoperative variables. There was no statistically significant association between the postoperative characteristics of the patients and the type of reconstruction. Neither subjective improvement (hearing improvement) nor residual perforation were associated with a type of material. The via factor was the only one that showed a statistically significant difference once air-conduction pathway improved more than bone-conduction pathway, decreasing the air-bone gap. Conclusion: There was no statistical difference between the two groups in relation to the audiometric improvement. There was hearing improvement in both groups. More studies must be done with a longer follow-up to better evaluate the outcome.

Abstract Numerous eponymous instruments are regularly used in the otology surgical suite. This manuscript uses a tympanoplasty to highlight 10 frequently used instruments and the remarkable surgeons behind their creation. Many of these names will be familiar, but we hope our readers will gain an appreciation of these landmark figures that have transformed the practice of otology.

Introduction: Tympanoplasty techniques with different types of graft have been used to close tympanic perforations since the 19th century. Tragal cartilage and temporalis fascia are the most frequently used types of graft. They lead to similar functional and morphological results in most cases. Although little published evidence is present, nasal mucosa has also been shown to be a good alternative graft. Objective: Surgical and audiological outcomes at the six-month follow-up in type I tympanoplasty using nasal mucosa and temporalis fascia grafts were analyzed. Methods: A total of 40 candidates for type I tympanoplasty were randomly selected and divided into the nasal mucosa and temporalis fascia graft groups with 20 in each group. The assessed parameters included surgical success; the rate of complete closure of tympanic perforation and hearing results; the difference between post- and pre-operative mean quadritonal airway-bone gap, six months after surgery. Results: Complete closure of the tympanic perforation was achieved in 17 of 20 patients in both groups. The mean quadritonal airway-bone gap closures were11.9 and 11.1 dB for the nasal mucosa and temporalis fascia groups, respectively. There was no statistically significant difference between the groups. Conclusion: The nasal mucosa graft can be considered similar to the temporal fascia when considering the surgical success rate of graft acceptance and ultimate audiological gain.

Abstract Objective Many methods have been described for the repair of the tympanic membrane, but there is no general consensus as to the standard method. The aim of this study was to evaluate the effect of the inferior base posterior canal skin flap on the graft success rate in large tympanic membrane perforations. Methods After the post‐auricular incision, the posterior canal skin flap with inferior pedicle was created by two vertical and one horizontal incisions. Then the flap was rotated over the temporalis fascia graft. The graft success rate and postoperation hearing test results were evaluated in 52 patients who suffered from large tympanic membrane perforations. Results We achieved a 92.3% total graft success rate with about 9 dB improvement in speech reception threshold (SRT). Conclusion The rotational inferior base posterior canal skin flap tympanoplasty technique is simple, fast, safe, and effective for the repair of subtotal tympanic membrane perforations.

Abstract Background The latest international trends in healthcare put more emphasis on patients’ perspectives in reporting success in surgical procedures. A holistic approach in measuring surgical outcomes, defined as global success, should include the patient’s perioperative experiences, expectations, and outcome measures. In published literature, surgeons propose several definitions of post-operative successful surgical outcomes following tympanoplasty. Most surgical outcomes and the surgeon’s definition of success exclude the patient’s perspectives. Patient-reported outcomes would allow surgeons to understand and measure the benefit of the several procedures performed from the perspective of the patients. Current definitions of successful tympanoplasty do not capture patient reported outcomes which are important to patients. A divergence is frequently found between outcomes relevant to the patient and to the surgeon. Patient-reported outcomes would complement traditionally measured clinical outcomes by the surgeon to give a true global outcome measuring success. The main aim of the current study was to propose a definition of true global success following tympanoplasty by combining the patient’s and the surgeon’s reported satisfaction rate based on the indication and the goals for the operation. Results A total of 128 procedures were performed on128 ears in 125 patients, of which 52% (n = 57) were done on the right and 48% (n = 61) on the left side. There was no significant difference between the two groups (p = 0.07). There was a female preponderance, with 62% females and 44% males (p = 0.105). The majority of patients, 63% (n = 68), were between the age of 26 and 45 years, while 19% (n = 20) fell into the 46- to 60-year age range, with no significant difference between the groups (p = 0.21). There was complete graft take in 77% (107/128) of the ears in whereas 23% (21/128) of the ears the graft had not taken at the 6-month follow-up period. The true global success satisfaction rate was 92% (chi-square test = 119; p = 0.001) compared to the 77% surgical success. Conclusion In assessing success in tympanoplasty, the patient- and surgeon-reported outcomes, when considered against agreed goals and indications, correlate well statistically. In this cohort, the true global success satisfaction rate was 92% (chi-square test = 119; p = 0.001

Abstract Objectives To identify the predictors of anatomical and functional outcomes following tympanoplasty. Study Design A retrospective cohort study. Methods Patients with chronic suppurative otitis media (CSOM) who underwent a tympanoplasty at Peking Union Medical College Hospital from January 1, 2015 to December 31, 2019 were retrospectively included. Outcome measures included graft success and postoperative pure tone audiometry air‐bone gap (PTA‐ABG) at last follow‐up (≥6 months). PTA‐ABG and MERI were calculated. Descriptive, univariable, and multivariable logistic regression analyses were conducted to evaluate the predictors of the graft and hearing outcomes. Results During the study, 385 patients (167 male, 218 female, median age 44 years) undergoing 413 procedures were studied. Out of this, 219 ears underwent tympanoplasty, 45 ears had tympanoplasty with canal wall up mastoidectomy, and 149 ears had tympanoplasty with canal wall down mastoidectomy. At the last follow‐up, the overall graft success rate was 91.3% (377/413) and the overall hearing success rate was 40% (165/413). Multivariable analysis results showed that the obstructed aditus ad antrum (OR 2.67, 95%CI 1.13‐6.30; P = .025) was an independent prognostic factor for graft failures. Moreover, the obstructed aditus ad antrum (OR 2.18, 95%CI 1.16‐4.08; P = .015) and MERI >3 (OR 6.53, 95%CI 3.55‐12.02; P 20 dB). Conclusions Aditus ad antrum patency was an independent predictor of both graft and hearing success among patients following tympanoplasty. MERI score greater than three was found to be a significant predictor of postoperative hearing and could serve as a useful tool for assisting clinicians in perioperative risk assessment. Level of Evidence 4.

Introduction The diagnosis of chronic otitis media (COM) implies a permanent abnormality of the pars tensa or flaccida. The definitive treatment of it is surgery. Restoration of hearing is by necessity a secondary consideration. Materials and Methods A prospective study was done from December 2017 to August 2019 in Department of ENT in a tertiary health care centre of eastern India. Total 50 patients were included in this study. Results Most of the patients (62%) are females and are within 30 years of age. Commonest ossicular defects are defects with incus. 82% patients gained hearing improvement >15 dB. Conclusion Our study shows that hearing improvement is greatest for type I tympanoplasty followed by cortical mastoidectomy, ossiculoplasty. Hearing improvement is inversely proportional to the incidence of post operative infection and complications.

Introduction The surgical treatment of Chronic Otitis Media by modified radical mastoidectomy usually results in an open cavity, with chronic discharge, hearing loss of 30 to 40 dB, frequent visits to OPD for debris removal and none the less dizziness on cold air exposure. One way to deal with these issues effectively is to obliterate the mastoid cavity. In our study we used vascularised periosteo-temporofascial swing flap with medicated bone dust to obliterate the mastoid cavity. Material and Methods In this prospective study, 50 patients who suffered from chronic otitis media, active squamous (cholesteatoma) disease, and underwent modified radical mastoidectomy with tympanoplasty procedure were and split between two equally sized groups. Group 1 had patients with open mastoid cavity and Group 2 had obliteration of mastoid cavity using vascularised periosteo-temporofascial swing flap with medicated bone dust. Patients were followed at 3rd week, 6th week, 3rd month and 6th month. Results Patients with cavity obliteration had better and statistically significant outcomes in term of discharge status of cavity and epithelization at 3 weeks. Patients with obliteration also had positive and statistically significant results in hearing levels and hearing gain at 6 months follow up. Conclusion Mastoid cavity obliteration with vascularised periosteo-temporofascial swing flap with medicated bone dust is a good and effective method for better post-operative outcomes and curtailing dependency on doctors for cavity care.

Abstract Objectives The aim of this study was to evaluate whether intraoperative ciprofloxacin‐soaked gelfoam is safe in tympanoplasty or not. Method In this randomized, double‐blind controlled clinical study, we included 100 patients between 18 and 60 years old, having perforation ≥50% of the tympanic membrane and dry ear for at least 2 months who were a candidate for underlay tympanoplasty via postauricular approach. We used ciprofloxacin soaked gelfoam in the case group and betamethasone soaked gelfoam in the control group for packing the middle ear cavity and external auditory canal during their operation. The graft success rate and tympanogram after 6 months follow‐up period was considered as the primary outcome. Also, we evaluated the postoperative hearing results 6 months after the surgery as the secondary outcomes. Results Postoperative microscopic otoscopy showed a graft success rate of 100% (44/44) and 97.7% (42/43) in the case and control groups, respectively. The level of improvement between the two groups was not significant for air‐bone gap (ciprofloxacin: 9.01 ± 7.89 dB, betamethasone 5.31 ± 10.53 dB, P = .160), and speech reception thresholds (SRT; ciprofloxacin: 10.23 ± 8.62 dB, betamethasone 7.33 ± 12.60 dB, P = .260). 93.2% of all the ears in the case group and 81.4% of those in the control group achieved postoperative air‐bone gap within 20 dB, but the difference between them was not significant (P = .118). Conclusions We found that the application of ciprofloxacin impregnated gelfoam in the middle ear, and the external auditory canal had no adverse effect on the graft success rate in tympanoplasty. Levels of evidence 1b.

Abstract Background Mastoidectomy is one of the common surgical procedures performed by the otologist. It is commonly done for cholesteatomatous chronic otitis media (CCOM) and can be performed as either canal wall up or down techniques. Most of the CCOM is associated with ossicular erosions which require ossicular chain reconstruction (OCR) which can be done either in one stage or multiple stages. A multitude of factors affects postoperative OCR results with tympanomastoidectomy. Among various factors, the status of the tympanic membrane and middle ear mucosa is quite essential. To date, there are no randomized or prospective studies assessing the integrity of pars tensa and status of the middle ear mucosa in hearing outcomes in single-stage tympanomastoidectomy using partial ossicular replacement prosthesis (PORP) in the literature. Therefore, this study is performed to correlate the integrity of pars tensa and middle ear mucosa condition with postoperative hearing results of single-stage canal wall down (CWD) tympanomastoidectomy with PORP. Results Forty-two patients with cholesteatomatous chronic otitis media underwent single-stage canal wall down mastoidectomy (CWD) and partial ossicular replacement prosthesis (PORP) placement. The statistical analysis was done to compare the results of postoperative hearing with the intraoperative integrity of pars tensa and middle ear mucosa status. The mean pre- and postoperative air-bone gaps (ABGs) of all cases were 23.9 dB and 21 dB, respectively, with no statistically significant difference. In the pars tensa intact group, the mean pre- and postoperative ABGs were 21.5 dB and 18.5 dB, respectively, and in the pars tensa not intact group, the mean pre- and postoperative ABGs were 25.7 dB and 22.8 dB, respectively, and both groups had statistically insignificant difference. The pre- and postoperative ABGs in the healthy middle ear mucosa group were 20.7 dB and 19 dB, respectively. Similarly, the pre- and postoperative ABGs in non-healthy middle ear mucosa were 24.4 dB and 21.2 dB, respectively. The differences were not statistically significant in both groups. Conclusion There was a statistically significant improvement in postoperative air conduction threshold (ACT) in all cases. The integrity of pars tensa and middle ear mucosa status did not affect the postoperative hearing outcome in single-stage CWD tympanomastoidecomty using PORP.

Introduction Inactive squamosal disease is unique for having a conflicting treatment protocol, with an age-old debate between early surgical intervention or keeping patients in a long-term follow-up. The shifting paradigm is early intervention to prevent further progress into active disease and improve hearing outcome in its nascent stage. Objective To evaluate recurrence and hearing outcome in cases of inactive squamosal disease after cartilage strengthening tympanoplasty. Methods The study was conducted on 50 patients with inactive squamosal disease. Detailed examination was done to grade the retraction. All patients underwent autologous conchal cartilage tympanomastoidectomy with temporalis fascia grafting. Recurrence and hearing evaluations were done by pure tone audiogram at regular intervals for one year. Results Hearing loss was the most common presenting symptom. Isolated pars tensa retractions were more common (54%) than pars flaccida (12%), or those involving both (34%). Ossicular status was normal in only 14% of the cases, and the most common ossicular damage was to the lenticular process of the incus (52%). Three of the patients (6%) had residual perforation at the 3rd month of follow-up. Subjective improvement in hearing was reported by 42% patients. Hearing improvement greater than 10 dB was found in 24 patients (48%). Air–bone gap reduced from 25.16 ± 8.15 dB preoperatively to 12.90 ± 6.20 at 1 year of follow-up. Recurrence was seen in three patients (6%). Conclusion Early intervention by cartilage strengthening of weakened tympanic membrane and ossicular reconstruction not only offers better hearing results, but also prevents progress to active disease.

Introduction Chronic otitis media (COM) is a common problem affecting 65 to 330 million population worldwide with 50% patients suffering from hearing impairment. In active COM, the usual clinical practice is to wait for the ear to become dry and to consider tympanoplasty with/without cortical mastoidectomy. If cortical mastoidectomy can be avoided without compromising the outcomes, it is desirable. Various prognostic factors have been studied; however, the effect of altitude on the outcome of tympanoplasty has not been commonly studied. High-altitude areas can have poor connectivity and can result in middle ear pressure changes when the patients commute from low-altitude areas. Aim The aim of this article was to assess the surgical outcome in patients undergoing tympanoplasty for active COM mucosal type in comparison to inactive COM mucosal type in a hilly area located at an altitude of 4,757 ft (1,450 m). Objective This article compared the success rate and audiometric improvement in patients undergoing tympanoplasty for active COM mucosal type and inactive COM mucosal type. Materials and Methods This prospective cohort study included 24 patients with 12 patients each in active and inactive groups. At 3 months follow-up, there was significant improvement in all the air conduction threshold frequencies and air bone gap in both the groups. Conclusion The success rate for our tympanoplasties for active and inactive COM performed in a hilly area was 92% and it was comparable to those reported from other centers. Altitude may not negatively affect the outcome of tympanoplasty and that the active ear COM can have similar success rate as inactive COM tympanoplasty. [ABSTRACT FROM AUTHOR]

Abstract Background Eustachian tube function has been regarded as a significant factor in the successful outcome of tympanoplasty. Eustachian tube dysfunction has been attributed to many diseases of middle ear cleft ranging from otitis media with effusion to unsafe chronic otitis media. The aim of this study is to evaluate the effect of Eustachian tube function on outcome of tympanoplasty in safe chronic suppurative otitis media patients and detect the correlation between the type of the used graft and the outcome of tympanoplasty. This study included 60 randomly selected patients diagnosed with safe chronic suppurative otitis media. Eustachian tube function was tested with tympanometry and Toynbee’s test. All patients underwent tympanoplasty type I. Results Successful statistically significant outcome was observed in 83.3 % of patients with normal eustachian tube function, while in 60 % of patients with eustachian tube dysfunction (p < 0.05). Conclusion Eustachian tube function significantly affects the outcome of tympanoplasty surgery. No significant correlation was noted between the type of the used graft and the outcome of tympanoplasty.

Introduction: Tympanoplasty is the surgical procedure aimed at the reconstruction of the tympanic membrane and restoration of the sound conducting mechanism. It can be performed with several types of access and grafts and is considered successful when it achieves complete closure of the tympanic perforation and sound conduction improvement. Objective: To describe the prevalence of successful closure of tympanic perforations and auditory results of endoscopic tympanoplasty with an inlay tragus cartilage graft. Methods: Retrospective study developed at a tertiary referral hospital. Patients with central tympanic perforations and intact ossicular chains operated with endoscopic tympanoplasty with inlay tragus cartilage graft were included. The neo-tympanum integrity index was evaluated, and the preoperative and postoperative auditory parameters were compared using the paired Student's t-test. Results: We identified 83 endoscopic tympanoplasties with inlay cartilage, of which 63 (76 %) had an intact neo-tympanum and 20 (24 %) had residual perforations. The preoperative air-bone gap was, on average, 18 ± 8.9 dBHL, and the postoperative 11 ± 10 dBHL (p = 0.0005), showing reduction in 71 % and complete recovery in 27 %. The mean preoperative speech recognition threshold was 35 ± 13.5 and the postoperative SRT was 27 ± 14.4 (p = 0.0002). The preoperative tritonal mean was 34 ± 14.3 and the postoperative was 24 ± 15 (p = 0.0002). Conclusion: In this series, endoscopic tympanoplasties with inlay tragus cartilage graft showed a 76 % prevalence of complete closure of the tympanic perforation, with significant improvement in the auditory parameters.

Abstract Objective To assess the effectiveness of tympanoplasty in treating chronic otitis media‐related hearing loss, published literature was systematically reviewed to determine the clinical success rate of tympanoplasty at restoring hearing in chronic otitis media patients at a minimum follow‐up period of 12‐months. Data Sources PubMed, Embase and the Cochrane Library. Methods Two independent reviewers performed literature searches. Publications reporting long‐term (≥12‐month) hearing outcomes and complications data on adult and pediatric patients with chronic otitis media were included and assessed for risk of bias and strength of evidence. To assess how tympanoplasty influences long‐term hearing outcomes, data on pure tone audiometry (air‐bone gap) and complications were extracted and synthesized. Results Thirty‐nine studies met the inclusion criteria. Data from 3162 patients indicated that 14.0% of patients encountered postoperative complications. In adult patients, mean weighted air‐bone gap data show closure from 26.5 dB hearing level (HL) (preoperatively) to 16.1 dB HL (postoperatively). In studies that presented combined adult and pediatric data, the mean preoperative air‐bone gap of 26.7 dB HL was closed to 15.4 dB HL. In 1370 patients with synthesizable data, 70.7% of patients had a postoperative air‐bone gap ˂ 20 dB HL at long‐term follow‐up. Finally, subgroup analysis identified that mean improvement in ABG closure for patients with and without cholesteatoma was 10.0 dB HL and 12.4 dB HL, respectively. Conclusion In patients with chronic otitis media, tympanoplasty successfully closed the air‐bone gap to within 20 dB HL in 7/10 cases and had an overall complication rate of 14.0%. Level of Evidence 2a.

Abstract Objectives To evaluate the reliability of high‐resolution CT scans (HRCT scans) in the diagnosis of tympanosclerosis and to determine its benefit to predict the post‐surgical hearing outcome based on comparing radiological and surgical findings. Methods A retrospective study at a tertiary institute included 940 ears that underwent tyampanoplasty for chronic suppurative otitis media (CSOM) between January 2013 and March 2017. Preoperative temporal bone HRCT scans were analyzed to check for the prediction of tympanosclerosis and ossicular fixation. Intraoperatively, ossicular chain integrity was checked. Preoperative and postoperative audiometric evaluations using air‐bone gap (ABG) were compared. A postoperative pure‐tone ABG of 20 dB or less was considered as a successful hearing result. Results are compared with historical control groups, the study has been reviewed and approved by the IRB at the medical research center in Hamad Medical Corporation; however, it is a retrospective study so no informed consent was obtained from the patients. Results The study included 940 ears that underwent tympanoplasties due to CSOM, where 238 out of 940 (25.3%) of ears showed tympanosclerosis during tympanoplasty, intraoperatively, tympanosclerosis was localized to the eardrum in 174 of the 238 involved ears (73.1%), A 64 out of 238 (26.9%) of the ears with tympanosclerosis showed ossicular fixation, divided as 45 ears with Incudo‐malleal fixation, 14 ears with stapes fixation, and 5 ears with triple ossicular fixation. HRCT scan of the temporal bone was suggestive of ossicular chain fixation in 79 cases distributed as 55 incudo‐malleal fixations, 19 stapes fixation, and 5 complete ossicular fixations, with a sensitivity of 96.8%, and specificity of 98%. The audiological results were analyzed, with a patient follow‐up after 6 months. Conclusions Our study showed that CT scans when combined with the clinical findings can be an informative guide to otolaryngologists for preoperative evaluation and counseling of tympanosclerosis surgeries.

Abstract Objectives The aim of this prospective, randomized‐controlled study is to analyze the outcomes of a new graft technique in tympanoplasty and compare its outcomes with cartilage island graft plus extra perichondrium. Methods A total of 44 patients with noncomplicated chronic otitis media were included in this prospective randomized‐controlled clinical trial. Patients were randomly divided into 2 double‐layer graft groups: The cartilage island graft + cubism graft (study group) and the cartilage island graft + extra perichondrium (control group). The main outcome measures of the study were the air‐bone gap (ABG), ABG gain, and graft status. Results Graft success rate was 100% and 95.5% in the study group and the control group, respectively. There were statistically significant differences in the postoperative first month ABG and ABG gain between study and control groups (P .05). Conclusion This study revealed that both graft techniques have satisfactory functional and morphological results compared to preoperative findings. The use of cubism graft with cartilage island graft has significantly better auditory outcomes in short‐term and similar results in long‐term compared to double‐layered cartilage island graft with extra perichondrium. Cubism graft is a highly promising graft technique with its many advantages. Level of Evidence 1b.

Split-thickness skin graft (STSG) continues to be the preferred means of external auditory canal (EAC) reconstruction. We thus sought to describe our experience using skin from the posterior aspect of the auricle (SPAA) as a donor site in EAC reconstruction. Grafts were, on average, 5 × 10 mm in size and obtained with a No. 10 blade after tumescence injection. The cases of 39 patients who underwent 41 procedures were retrospectively reviewed. Of the 38 patients with both 3- and 6-month follow-ups, no postoperative stenosis or bony exposure occurred. STSG from the SPAA can be a good option in EAC reconstruction. Total EAC/tympanic membrane coverage can be obtained with STSG from the SPAA.

Introduction Tympanic retraction is a condition characterized by the displacement of the tympanic membrane toward the structures of the middle ear. Clinically, tympanic retractions can lead to hearing loss, ear discharge and/or ear pain. In most of the cases, however, tympanic retractions are asymptomatic and are found accidentally during an ear, nose, and throat (ENT) examination. This condition has created numerous debates regarding the optimal choice of treatment, especially in the asymptomatic forms. The main controversy is regarding the relationship between retraction and the development of cholesteatoma, which would justify a surgical intervention performed for preventive purposes. Objectives To study the effectiveness of cartilage tympanoplasty in the management of tympanic membrane retractions by analyzing the results of the studies conducted on the use of cartilage as a reconstruction material. Data Synthesis A literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses group (PRISMA). Study selection, data extraction, and quality assessment were conducted independently by two reviewers. Our initial literature search yielded 2,258 references. Applying the PRISMA flow chart, 1,415 duplicates were excluded, and the remaining 843 abstracts were examined. Afterwards, 794 articles were excluded based on the research protocol criteria. Only 8 papers were included in the review by applying the inclusion and exclusion criteria. Conclusions Despite the limitations of the studies taken into consideration, we can conclude that cartilage tympanoplasty may successfully rehabilitate the atelectatic ear especially in the more advanced stages of retraction, unlike the conservative strategies.

Introduction: Various graft materials have been used in the tympanoplasty technique. Cartilage grafts are being used increasingly in recent years. Objective: The aim of this study was to present the comparative outcomes of the perichondrium-preserved palisade island graft technique previously defined by ourselves. Methods: We retrospectively compared the hearing and graft success rates in 108 patients with chronic otitis media, who had undergone cartilage tympanoplasty, where both island and perichondrium-preserved palisade graft techniques were used. Results: The success rates among the study and the control groups with regard to graft take were 97% and 93%, respectively. No significant difference was observed between the groups with regard to the postoperative mean pure tone values, improvement in air-bone gaps and reduction in air-bone gaps to under 20 dB. However, better results were observed in the study group. Conclusion: The perichondrium-preserved palisade island graft technique is an easy method with high graft success rates and hearing outcomes.

Introduction: In days of scar less surgeries it has become necessary for otologists to concentrate on tympanoplasties without external incisions. This study compares the anatomical and functional results of tragal perichondrium graft and perichondrium-cartilage composite graft for transcanal endoscopic tympanoplasties in Himalayan region. Methods and Materials: This prospective study included 60 subjects of chronic otitis media (mucosal type), who underwent transcanal endoscopic underlay type I tympanoplasty and were divided into two groups. In 30 cases tragal perichondrium graft and in rest of 30 cases Tragal perichondrium Cartilage composite graft was used. Anatomical and functional outcomes were evaluated at 6 months time. Results: Hearing gain comparing Audiometric data between the tragal perichondrial graft group and tragal perichondrial cartilage composite graft group at 6 months showed no statistically significant differences (P= 0.9533). Assessment of anatomical outcome indicated a greater number of complications in the tragal perichondrial graft group although it was not statistically significant (P=0.6360 in anterior graft failure group , P =0.1322 in reperforation group and P= 0.1056 in retraction group). Conclusion: Functional results validated both the grafting material while anatomical results are slightly better in tragal perichondrial cartilage composite graft group in term of re perforation and retraction. More over [A1] with[A2] use of tragal grafts endoscopic tympanoplasty fulfils its true meaning as no visible scar and post operative patient morbidity is prevented. [A1]Moreover [A2]delete

Abstract Background Various grafting materials and different techniques have been used for myringoplasty. The aim of the study was to compare the result of tympanoplasty in patients with safe-type chronic suppurative otitis media using periosteum versus tragal cartilage with perichondrium grafts through pre- and postoperative clinical and audiological evaluation. Results There was statistically significant difference for mean air-bone gap for group A (23.4 dB ± 0.03 SD) when compared to group B (19.4 dB ± 4.2 SD) with P value 0.103. Also, there was statistically significant difference in the hearing gain in group A after 6 months (25.53 dB ± 6.26 SD) when compared to group B (19.63 dB ± 9.76 SD) and the P value was 0.003. Graft taken was superior in the periosteal group (95%), compared to the cartilage grafts (90%). Conclusion Tympanoplasty with periosteal graft showed better hearing results and high rates of graft taken than tragal cartilage grafts.

Introduction: Endoscopic tympanoplasty is a minimally invasive surgery that may be performed via a solely transcanal approach. The use of endoscopes in otologic procedures has been increasing worldwide. The endoscopic approach facilitates the transcanal tympanoplasty, even in patients having the narrow external ear canal with an anterior wall protrusion. Objectives: The present study aimed to compare the surgical and audiological outcomes of endoscopic transcanal and conventional microscopic approach in Type 1 tympanoplasty. Methods: The graft success rates, hearing outcomes, complications, and duration of surgery in patients who underwent endoscopic and microscopic tympanoplasty between October 2015 and April 2018 were retrospectively analysed. Results: Graft success rates were 94.8 per cent and 92.9 per cent for the endoscopic and microscopic group, respectively (p > 0.05). Postoperative air-bone gap values were improved significantly in both groups (p

Introduction: The ossicles of the middle ear are affected by the erosive effect of pathology in chronic otitis media. Ossicular reparation can be done via autologous incus or with alloplastic materials. Glass ionomer cement (GIC) is simple to use and saves considerable operative time and expenses especially in developing countries where costly ossicular prosthesis are not affordable for the majority of the patients. Materials and Methods: Twenty-five chronic otitis media patients who underwent surgery were included in this study. The reconstruction material used in this study was glass ionomer cement. All patients had erosion of the long process of incus and a normal stapes. Results: Pure tone average in pre-operative and post-operative period of study patients were 50.09 & 29.92 dB respectively (P=0.01) and the air-bone gap was 24.85 dB preoperatively and 14.05 dB postoperatively. The closure of the air-bone gap was statistically significant (P= 0.01). Conclusion: The study showed that the use of GIC ossiculoplasty is an efficient method for the reparation of the long process of the incus. The results are encouraging and indicate that it is worthwhile to conduct more trials using this method.

Abstract Objective The risk of SARS‐CoV‐2 transmission to healthcare workers through airborne aerosolization during otologic surgery has not been characterized. The objective of this study was to describe and quantify the aerosol generation during common otologic procedures in both cadaveric surgical simulation and live patient surgery. Methods The number concentrations of generated aerosols in the particle size range of 0.30 to 10.0 μm were quantified using an optical particle sizer during both a cadaveric simulation of routine otologic procedures as well as cochlear implant surgery on live patients in the operating room. Results In the cadaveric simulation, temporalis fascia graft harvest using cold techniques (without electrocautery) (n = 4) did not generate aerosols above baseline concentrations. Tympanoplasty (n = 3) and mastoidectomy (n = 3) both produced statistically significant increases in concentrations of aerosols (P

Objective: To compare the rate of graft uptake and postoperative hearing outcomes of Type I tympanoplasty with perichondrium reinforced cartilage palisade to temporalis fascia for large tympanic membrane (TM) perforations over 5 years follow-up period. Materials and methods: This was a retrospective comparative study involving patients with chronic otitis media with large TM perforations. The patients underwent type I tympanoplasty using either perichondrium reinforced cartilage palisade (CP group) or temporalis fascia (TF group) as the graft via a transmeatal approach and under local anesthesia. Morphological and functional results were recorded at three- and five years follow-up. Demographic profiles including age and sex, surgery side, contralateral disease and graft uptake rate, as well as hearing outcomes, were compared between the two groups. Results: At three years follow-up, graft uptake was 94.87% for perichondrium reinforced cartilage palisade and 80.7% for fascia, respectively, (p = 0.67). At five years follow-up, the uptake rate dropped to 87.17% in the CP group, but to 66.6% in the TF group (p=0.019). Hearing improved after surgery in both groups, and showed no significant difference between the two groups. Conclusion: Over long-term, perichondrium reinforced palisade showed a statistically significant better outcome regarding graft uptake than temporalis fascia in type Itympanoplasty for large TM perforations with comparable audiometric results

Introduction Tympanoplasty is the treatment of choice for patients suffering with Chronic Otitis Media (COM). Outcome of tympanoplasty depends on various factors like size and location of tympanic membrane perforation, ear ossicles, degree of otorrhea, cholesteatoma, smoking history, granulation tissue etc. Prediction of outcome of tympanoplasty procedure prior to surgery with respect to graft uptake and hearing improvement can serve as a crucial factor in decision making in resource limited nations. Hence, a study was conducted to evaluate the role of Middle Ear Risk Indices (MERI) in predicting the outcome among patients undergoing tympanoplasty procedure. Materials and Methods A prospective study at a tertiary care centre was conducted for a duration of 2 years among 60 patients with COM who underwent tympanoplasty. Results The mean age of patients was 25.32 ± 8.43 years with a male to female ratio of 3:2. Majority (78.46%) of the patients had Mild MERI score; 18.46% patients had moderate MERI score and 3.08% patients had severe MERI risk score. The difference in mean Air –Bone (AB) gap in the mild and moderate MERI groups’ pre and post operatively was found to be statistically highly significant (p

Introduction Postoperative hearing outcome after tympanomastoid surgery may sometimes be disappointing. This study aims to identify the factors influencing hearing outcome in squamous type of chronic otitis media (COM). Materials and Methods Prospective descriptive study on consecutive patients undergoing tympano-mastoidectomy for squamous COM. Results Analysis of 40 ears revealed that 10% had discharge less than one year with majority (75%) having more than three years. Pars flaccida and postero-superior pars tensa retraction pockets were most common findings with frank cholesteatoma only in 10%. Though mean preoperative pure tone average was significantly better (p=0.004) in those with ear discharge less than one year, 50% required type IV tympanoplasty, irrespective of duration of discharge. Type IV tympanoplasty revealed significant worsening of hearing (p=0.05), unlike type I-III where intact stapes suprastructure showed a significant postoperative improvement (p = 0.036). Successful graft uptake with discharge free ear was noted in 97.5% by 12 weeks. Conclusion Majority of our patients availed otolaryngologist opinion after more than three years of onset of discharge. Significant ossicular erosion occurs early in the disease. Preoperative better audiogram is not a predictor of ossicular status. Lack of significant symptoms and subtle clinical finding in the tympanic membrane, overlooked by the patient as well as the primary health care provider are confounding factors for early referral and surgical intervention by otolaryngologist. There appears to be a considerable delay for the common person in reaching the services of otolaryngologist; a relevant issue which need to be addressed at a national level to reduce the burden of the disease.

Conclusions This technique is offered as a convenient and reliable method for cases with anterior TM perforation and inadequate anterior remnant. Objectives Chronic otitis media surgery is one of the most common procedures in otology. Anterior tympanic membrane (TM) perforation with inadequate anterior remnant is associated with higher rates of graft failure. It was the goal of this series to evaluate the anatomical and functional outcomes of a modified underlay myringoplasty technique-the anterior pull-through method. Materials and methods In a retrospective clinical study, 13 patients with anterior TM perforations with inadequate anterior remnants underwent tympanoplasty with anterior pull-through technique. The anterior tip of the temporalis fascia was pulled through and secured in a short incision lateral to the anterior part of the annulus. Data on graft take rate, pre-operative, and post-operative hearing status were analyzed. Results A graft success rate of 84.6% (11 out of 13) was achieved, without lateralization, blunting, atelectasia, or epithelial pearls. The air-bone gap was 21.5 ± 6.8 dB before intervention and 11.75 ± 5.7 dB after surgery (p = 0.003).

Introduction: Tympanoplasty is a surgical treatment of tympanic membrane perforation. Many efforts have been made to increase the success rate of tympanoplasty. Some studies confirmed the positive role of estrogen in wound healing. The current study was conducted to evaluate the effect of topical estrogen on the success rate of tympanoplasty. Materials and Methods: A total of 85 patients were randomly assigned to the case and control groups. Otomicroscopic examination was performed before and 3 months following the operation. At the final stage of tympanoplasty, gelfoam was placed on the lateral side of the graft. It was soaked in dexamethasone in the control group and combination of dexamethasone and estradiol valerate solution in the case group. Hearing thresholds were measured by audiometric tests pre- and postoperatively. Hearing levels were assessed as the mean air conduction (AC) at 500, 1000, and 2000 Hz. The graft status was evaluated using otomicroscopic examination 3 months following the operation. Results: Otomicroscopic examination revealed successful graft healing in 23 of 37 and 29 of 36 patients in the control and case groups, respectively. A higher rate (80.55%) of graft repair was observed in the estradiol group, compared to that (62.16%) reported for the control group; however, the difference was not statistically significant (P=0.08). The average improvement values of the AC levels were 20.45 and 24.7 dB in the control and case groups, respectively (P=0.3). Statistical analysis among the subgroup of patients with small perforations showed that the success rate of tympanoplasty was significantly higher in the estradiol group, compared to that reported for the control group (P=0.03). Conclusion: Although topical estrogen was generally ineffective in increasing the success rate of tympanoplasty, it improved the success rate among patients with small tympanic membrane perforations.

Introduction: Operations on the tympanic membrane of the middle ear, myringoplasty, and tympanoplasty are now widely accepted, and attempts are underway all over the world to standardize the surgical techniques. This study aimed to compare postoperative outcomes of endoscopic and microscopic cartilage myringoplasty in patients suffering from chronic otitis media (COM). Materials and Methods: This clinical trial study compared 130 patients with COM who underwent transcanal endoscopic myringoplasty by repairing perforation using auricular concha cartilage under general anesthesia (n=75) and conventional repairing method by postauricular incision and tympanomeatal flap elevation under microscopic surgery (n=55). Results: According to the results, there was no significant difference between the two groups in terms of hearing gain 1, 6, and 12 months after surgery (P=0.063); however, higher hearing gain scores were observed in the endoscopic group. Moreover, lower recovery time and post-operative pain were reported in patients who underwent the endoscopic approach, compared to those who treated with the conventional repairing method (P

Objectives: The aim of this paper is to review how successful each type of grafts is in tympanoplasty. Methods: Pubmed, Google and the Proquest Central Database at Kırıkkale University were queried using the keywords “graft”, “success” “tympanoplasty”, “success rate” with the search limited to the period 1955 to 2017. Results: Various types of graft materials including temporalis fascia, cartilage, perichondrium, periosteum, vein, fat or skin have been used in the reconstruction of tympanic membrane (TM) perforation. Although temporalis fascia ensures good hearing is restored, there are significant concerns that its dimensional stability characteristics may lead to residual perforation, especially where large TM perforations are involved. The “palisade cartilage” and “cartilage island” techniques have been stated to increase the strength and stability of a tympanic graft, but they may result in a less functional outcome in terms of restoring hearing. Smoking habits, the size and site of a perforation, the expertise level of the operating surgeon, age, gender, the status of the middle ear mucosa and the presence of myringosclerosis or tympanosclerosis are all important in determining how successful a graft is. Conclusion: Although temporal fascia is the most commonly used graft material for tympanoplasty, poor graft stability may cause failure. This failure is due to the inclusion of connective fibrous tissue containing irregular elastic fibers present in the grafted fascia. Cartilage grafts offer better ability to resist infection, pressure, and cope with insufficient vascular supply. This means that cartilage grafts are suitable for use in revision cases.

Abstract Background The purpose of this study is to evaluate and compare surgical and hearing outcomes of tympanoplasty using temporalis fascia graft and tragal cartilage with or without mastoidectomy in children with tubotympanic chronic suppurative otitis media. Two hundred children with chronic suppurative otitis media of tubotympanic type with perforation were included in this prospective randomized study. They were divided randomly into four equal groups according to operation done. Group I underwent tympanoplasty using temporalis fascia graft with cortical mastoidectomy, while in the second group, tragal cartilage was used as a graft with mastoidectomy. Groups III and IV were done without mastoidectomy, with tragal cartilage for group III and temporalis fascia for group IV. One-year follow-up was done for all patients to evaluate graft success (means without perforation nor retraction). Audiological evaluation was done for all children preoperatively and 6 months postoperatively for patients with successful graft uptake. Result There were 170 patients (85%) with graft success postoperatively. Tympanoplasty using temporalis fascia graft showed highly statistically significant difference (P < 0.001) when compared to tragal cartilage as regards hearing improvement in patients with successful graft uptake, while there is no statistically significant difference as regards graft uptake (P = 0.039). Also, there is no statistically significant difference between different techniques with or without mastoidectomy (P = 0.165). Conclusion Tympanoplasty using temporalis fascia without cortical mastoidectomy is the surgery of choice in children between 10 and 16 years old with tympanic membrane perforation as it showed highly statistically significant difference when compared to tragal cartilage graft as regards hearing improvement, with no statistically significant difference regarding successfully graft uptake.

Abstract Objective To evaluate the surgical results and complications in a cohort of patients operated on to repair a tegmen bony defect using either transmastoid approach with obliteration using S53P4 bioactive glass granules (TMA‐O), or the classic middle cranial fossa approach (MCFA). Study design A retrospective monocentric study. Methods Twenty‐five cases (24 patients) were included. Data regarding patient demographics, etiology, intraoperative findings, complications, recurrences, audiometric data, and follow‐up were analyzed. Results Seven patients were operated with MCFA and 17 patients with TMA‐O. One patient was operated on using a combined approach (MCFA + TMA‐O). In the preoperative HRCT scan, the size of the defect was estimated to be 6 ± 3.8 mm in the TMA‐O group and 6 ± 3.5 mm in the MCFA group (P = .969). Intraoperatively, in the MCFA group, the location of the defect was mostly anterior (86%) with an intact ossicular chain (86%). A discontinuous chain was observed in 15 patients (88%) in the TMA‐O group. The mean follow‐up time was 22 ± 14 months in the TMA‐O group and 24 ± 15 months in the MCFA group (P = .762). In both groups, there were no early postoperative complications or recurrences during follow‐up. Conclusion Repair of a tegmen bony defect with S53P4 bioactive glass granules seems to be safe and effective, limiting the use of the middle cranial fossa approach to cases with epitympanic defects and with an intact ossicular chain, and it could be used whatever the size of the defect and/or the presence of meningoencephalocele. Level of evidence 4.

Objective: The aim of this study was to translate the Chronic Otitis Media Benefit Inventory (COMBI) into Turkish and evaluate the questionnaire’s reliability in assessing benefit outcomes in patients after ear surgery.Methods: A total of 30 patients with chronic otitis media who underwent ear surgery were asked to fill out the translated Turkish version of the COMBI questionnaire six months after their surgery twice, 10 days apart. The patients were divided into two groups in two different ways based on surgical and audiological outcomes. These were surgical success (SS), surgical failure (SF), audiological success (AS), audiological failure (AF) groups. Student's -t test was performed to show the differences in the COMBI scores of the groups. Cronbach’s alpha value was calculated to test internal consistency, Pearson’s correlation coefficient was measured to demonstrate test-retest reliability and factor analysis was run.Results: The average score of the SS group was 51.08 and significantly higher than the score of the SF group (42.40) (p=0.012). There was, however, no statistically significant difference between the average scores of the AS and the AF groups (p=0.330). A Cronbach’s alpha value of 0.862 was found. Pearson’s r value was calculated 0.810. Factor analysis showed that a three-factor solution explained the 70.2% of the variance.Conclusion: The Turkish version of the COMBI is a valid test with high test-retest reliability. It should be used with objective assessment tools for better understanding how patients benefit from the surgery.

Objectives. To evaluate the results of transcanal endoscopic tympanoplasty for pediatric patients with chronic otitis media (COM) and compare them to that of the previously standard microscopic assisted tympanoplasty technique. Methods. The patients were divided into two groups based on the operative method. Group 1 underwent tympanoplasty with a totally endoscopic assisted technique (n=21, 24 ears), and group 2 underwent tympanoplasty with the conventional microscopic technique (n=14, 15 ears). We used a transcanal approach in group 1 and a postauricular approach in group 2. In group 1, there were 15 cases of simple COM and nine cases of adhesive otitis media. In group 2, only 15 cases of simple COM were present. We analyzed the outcomes in terms of the hearing gain according to the surgical method and COM type, operation time, hospital stay after surgery, and graft success rate. Results. Postoperative hearing gain results including air conduction (AC) thresholds and air-bone gap (ABG) were not significantly different between the two groups (P>0.05). In both the groups, significant improvement in the postoperative AC and ABG was observed compared to the preoperative hearing. The hospital stay after surgery was significantly shorter in group 1 than the group 2: 2.1±0.4 days and 4.8±0.9 days (P0.05). There was neither intra- nor postoperative complications. Conclusion. Transcanal endoscopic ear surgery technique is more conservative than microscopic approach and can be performed in pediatric patients under 15 years of age with COM. Moreover, it offers similar surgical results compared to traditional microscopic technique, and a shorter operative time and hospital stay after surgery are the advantages of this technique.

Objective:Transcanal endoscopic type 1 tympanoplasty is a minimally invasive procedure that enables better visualization of deep and narrow spaces compared to conventional microscopic methods. In our study, we aimed to evaluate air-bone gap difference, graft success, and hearing gain according to the perforation size and location in pediatric patients who underwent transcanal endoscopic type 1 cartilage tympanoplasty.Methods:Fifty pediatric patients who underwent transcanal endoscopic type 1 cartilage tympanoplasty for chronic otitis media were included in the study. Tragal cartilage grafts were used in all patients. Air conduction pure tone audiometry hearing results (500, 1000, 2000, and 4000 Hz), mean air-bone gap levels, operating times, postoperative gap closure, and graft success rates were evaluated.Results:Mean operating time was 43.34±8.56 minutes. Overall graft success was 94% (47/50). Mean hearing levels at all frequencies (500, 1000, 2000, and 4000 Hz) were found to have significantly improved after the operation (p

Introduction Mastoid dressings are conventionally used in patients who undergo Tympanoplasty using post auricular approach. The rationale behind using a mastoid dressing is that the said dressing prevents haematoma formation and acts as a protective covering during the post-operative period. This study aims to understand the significance of mastoid dressing in patients undergoing Cortical Mastoidectomy and Tympanoplasty and its role in preventing post-operative wound complications and patient comfort. Materials and Methods A total of 77 patients were enrolled in the study over a one year period and were randomised into dressing and no dressing groups with the aim of deciphering any advantage of the mastoid dressing over a smaller dressing. Results Our data revealed no added advantage of conventional mastoid dressing over a small gauze piece dressing in terms of haematoma/seroma formation, contusion and wound dehiscence. However, there was significantly reduced patient discomfort and sleeping difficulties post-operatively in the no dressing group. Conclusion We conclude that smaller dressing is more favourable than the bulkier conventional mastoid dressings.