Search

Background: Chronic suppurative Otitis Media is a common ear infection in India. Canaloplasty done with tympanoplasty helps to remove bony overhangs and provide complete visibility of fibrous annulus of tympanic membrane. Aim: 1. To determine the hearing outcome in chronic otitis media (mucosal type) patients undergoing type 1 tympanoplasty with canaloplasty. 2. To determine the hearing outcome in chronic otitis media (mucosal type) patients undergoing type 1 tympanoplasty without canaloplasty. 3. To compare the hearing outcome in the above mentioned 2 groups of patients. Materials and Methods: 56 patients of 15–60 years of age with mucosal type of Chronic otitis media, with central dry perforation and intact ossicles were included in our study. They were divided into group 1 (type 1 tympanoplasty + canaloplasty) and group 2 (type 1 tympanoplasty without canaloplasty), on alternate basis. AC, BC, Air bone gap avg was assessed via pure tone audiometry at 4 frequencies preoperatively and postoperatively at 3rd and 6th month, % closure of ABG average was calculated. Results: Type 1 tympanoplasty along with canaloplasty has better hearing improvement in pure tone audiometry compared to type 1 tympanoplasty alone, as % closure of ABG at postoperative 3rd and 6th month holds significant. Conclusion: The canaloplasty provides better surgical exposure via removing bony overhangs, aids in excellent functional outcome in the form of % closure of ABG. Hence canaloplasty is added as an adjunct to routinely performed aural surgeries to enhance hearing outcome. [ABSTRACT FROM AUTHOR]

Objectives: To observe the surgical outcome of type 1 tympanoplasty in paediatric patients in the form of graft uptake and audiological improvement. Materials and methods: A prospective study was done in which 40 paediatric patients in age group 6-16 years, diagnosed of chronic otitis media, were taken up for tympanoplasty under general anaesthesia. Patients were followed in post operative period at 4, 6 and 12 weeks for assessment of graft status and audiological evaluation. Results: In this study, we found surgical success rate in the form of graft uptake in 80% of the cases and audiological improvement in 75% of the cases. Conclusion: Tympanoplasty is safe and effective in children with adequate graft uptake and audiological outcome. [ABSTRACT FROM AUTHOR]

The treatment of persistent tympanic membrane perforation is tympanoplasty. Presence of perforation in the anterior annulus of the patients undergoing tympanoplasty surgery is a commonly encountered problem in the postoperative period. In this study, we investigated the effects of supporting anterior tympanomeatal angle with a secondary layer of temporal muscle fascia graft in the patients undergoing type 1 tympanoplasty on postoperative hearing outcomes and early graft success. Twenty-seven patients from our clinic who underwent surgery due to chronic otitis media (COM) and whose anterior tympanomeatal angles were supported with temporal muscle fascia graft as a secondary layer were included in the study. Twelve of the patients were male and 15 of them were female. The mean age of the patients was 43,1 years. The data obtained with retrospective investigations of the patient files were statistically analyzed. Audiological results of 27 patients were obtained in the postoperative 3rd month and were compared with the preoperative results. Preoperative pure tone average of bone-conduction and air conduction were 14,68 ± 7,08 dB and 41,63 ± 9,83 dB, respectively. Postoperative pure tone averages of bone-conduction and air conduction were determined to be 15,02 ± 6,40 dB and 26,38 ± 12,79 dB, respectively. The grafts of all patients were intact at the postoperative 3rd month. We can describe the technique we used as modified sandwich tympanoplasty. In this study we found that in patients that undergoing type 1 tympanoplasty, supporting the anterior tympanomeatal angle with temporal muscle fascia graft as a secondary layer is successful in terms of hearing outcomes and graft success. [ABSTRACT FROM AUTHOR]

Aims: To determine the best technique to repair anterior skull base defects using various grafts. Materials & Methods: This Ambi-directional cohort study was carried out at a tertiary care hospital from May 2019 to October 2021. A total of 17 patients who underwent Endoscopic Repair of Anterior Skull Base Defects using various grafts were included in the study. Detailed history and clinical evaluation followed by Diagnostic Nasal Endoscopy, Biochemical and Radiological investigations were done for all patients with postoperative follow-up for at least 6 months. Results: Most common site of anterior skull base defect in our study group was the posterior wall of the sphenoid sinus. Various graft materials used in our study were fascia lata, thigh fat, Hadad flap, Septal cartilage, nasal septal bone chip, septal mucosal free flap, surgicel and fibrin glue. The most commonly used sequence of graft materials used is the fat(underlay) - fascia lata - fat(overlay). Various complications that occurred were nasal bleeding, residual CSF leak, localized collection of pus in the Septal region, cerebral oedema and Alar trauma. Conclusions: The success of Anterior skull base defect repair depends on watertight Dural closure with multiple layers of grafts to prevent postoperative CSF leak. Although dependent on the Surgeon's preference, usually the sequence of an underlay fat - fascia lata - overlay fat followed by glue/gel foam/Hadad flap works well. Even after discharging the patient, regular follow-up and evaluation ensure that the graft is in situ and there is no CSF leak or other complication. [ABSTRACT FROM AUTHOR]

Objective: Ossicular reconstruction with autologous materials has been practised for a long time, but the procedure may lead to stiffness of joints and bony ankyloses thus hampering the sound conduction mechanism. This paper describes a novel technique of creating joint capsule around the reconstructed joints with temporalis fascia strips hoping a firm and movable union with full functional restoration. Materials & Methods: This study is a prospective study of 35 patients requiring tympanomastoid surgery with ossicular reconstruction and were studied over a period of 2 years. The newly reconstructed ossicular joints were wrapped with temporalis fascia strips. Post-operatively air-bone gap closure were studied and statistically analysed. Results: A significant air-bone gap closure was achieved in 23 patients, while moderate improvement was seen in remaining cases. Only 1 patient had tympanic membrane graft failure and rest all had well healed tympanic membrane. Conclusion: Fascial arthroplastic ossiculoplasty is a simple and safe procedure and the results are reproducible and more predictable. It provides an ossicular assembly which is near to normal in its physiological functions. [ABSTRACT FROM AUTHOR]

Background: Hearing loss caused by middle ear malformations is treated by tympanoplasty to reconstruct the acoustic conduction system. The mobility of the ossicles plays a crucial role in postoperative success. However, identifying the location of ossicular malformation based solely on preoperative audiograms is challenging due to the complex relationship between fixation location, deformity levels, and ossicular mobility. Methods: Middle ear finite element models for simulating ossicular malformations were created, and the results were compared with the actual preoperative audiograms. Results: This approach objectively diagnosed ossicular fixation and disarticulation, bypassing traditional criteria reliant on physician examination or imaging. Conclusion: This study suggests that future research should focus on developing a diagnostic framework utilizing large-scale data. [ABSTRACT FROM AUTHOR]

Purpose: To compare the efficacy and safety of temporalis fascia (TF) with cartilage grafts for primary type 1 tympanoplasty in chronic otitis media (COM) patients. Methods: Computerized search was performed in MEDLINE, Embase, and CENTRAL. Eligible for inclusion were randomized controlled trials (RCTs) comparing TF and cartilage grafts in individuals with non-cholesteatoma COM and intact ossicles requiring type 1 tympanoplasty. Primary outcomes were graft success and hearing improvement, measured by the air–bone gap (ABG) closure. The secondary outcome was the occurrence of complications. Standardized mean differences (SMD) and odds ratios (OR) with 95% confidence intervals were calculated. Results: Eighteen RCTs that enrolled 1273 participants were found eligible. Data were reported at follow-up periods ranging from 6 weeks to 24 months. The pooled effect estimate revealed a higher and statistically significant graft success favoring cartilage grafts at 12 months (OR = 2.24, 95% CI 1.33–3.78) and 24 months (OR = 2.96, 95% CI 1.18–7.43). There was no significant difference between both grafts in post-operative ABG closure across all follow-up periods (6 weeks to 12 months). Conclusions: Compared to TF, primary type 1 cartilage tympanoplasty offers better graft uptake rates and comparable postoperative hearing outcomes for COM patients. [ABSTRACT FROM AUTHOR]

Background: Totally endoscopic ear surgery is a novel method of conducting otological surgery. Hierarchical task analysis and the systematic human error reduction and prediction approach ('SHERPA') are valuable tools that can effectively deconstruct the technical and non-technical skills required to successfully complete a surgical procedure. Methods: Twenty-five endoscopic tragal cartilage tympanoplasties were observed, to identify the tasks and subtasks required for completion of totally endoscopic tragal cartilage tympanoplasty. The systematic human error reduction and prediction approach was used to identify the potential risks and methods, to reduce or remediate these risks. Results: A hierarchical task analysis was performed, identifying 8 tasks and 50 subtasks for a safe approach to completing totally endoscopic tragal cartilage tympanoplasty. A risk score for each subtask was calculated to produce a systematic human error reduction and prediction approach and to highlight potential errors. Conclusion: This hierarchical task analysis allowed for quick reference to a correct method of endoscopic tympanoplasty. The systematic human error reduction and prediction approach was employed to reduce the risks associated with undergoing endoscopic tympanoplasty, to improve patient safety. [ABSTRACT FROM AUTHOR]

There are many factors that affect the results of tympanoplasty in children. Recurrent ear infections, hearing loss, and more serious complications due to cholesteatoma may be observed. This study examined factors affecting the success of type 1 endoscopic tympanoplasty surgery in pediatric patients and investigated recommended procedures to increase the success of the operation. Our study included pediatric patients who underwent type 1 endoscopic tympanoplasty operation for chronic otitis media. Patient files were analyzed retrospectively. Hearing results before and after the operations were recorded.. Patients were divided into groups according to gender, age (<12 age group, ≥12 age group), and perforation type. Hearing results and physical examination findings were compared for each group. A total of 204 pediatric patients were included in our study: 114 were male and 90 were female. Patients' hearing results were compared according to the size and location of their tympanic membrane perforations. Hearing loss was found to increase as the size of the tympanic membrane perforation increased. In addition, it was observed that perforations in the posterior quadrant caused more severe hearing loss than in the other quadrants. The postoperative results of the two groups <12 years old, and ≥12 years old were evaluated according to age. Postoperative improvement was higher in the ≥12 age group compared to the <12 age group. According to the results of this study, tympanoplasty surgeries performed on patients younger than 12 have a decreased success rate. Among the many factors that affect the success of an operation, age is one of the most important. There are many factors that affect the results of the operation, perforation size and localization is one of them. There are many factors that affect the success of surgery such as pediatric patients and adult patients. It is useful to make a personal evaluation and to plan the surgery by evaluating the obstacles such as eustachian tube maturation and difficulty in postoperative care in pediatric patients. [ABSTRACT FROM AUTHOR]

A cholesteatoma is an expansion of keratinizing squamous epithelium that enters the middle ear cleft from the outer layer of the tympanic membrane or ear canal. Choleatomas are always treated surgically. Recurrence of the illness presents another challenge for the patient and the surgeon, though. There have been reports of recurrence rates as high as 30% in adults and as high as 70% in children. Here, we describe a case of persistent recurrent otorrhea following revision surgery, along with acquired recurrent cholesteatoma following canal wall down surgery. Case presentation: A 38-year -male with underlying Diabetes Mellitus and Hypertension presented with left scanty and foul-smelling ear discharge for 2 years and left reduced hearing. He was diagnosed with left chronic active otitis media with cholesteatoma for which he underwent left modified radical mastoidectomy, meatoplasty and tympanoplasty in 2017. Five months post operatively, he presented with left otorrhea. However, he defaulted followed up and presented in April 2018 for similar complaints. Otoscopy examination revealed left tympanic membrane perforation at poster superior quadrant of pars tensa and bluish discoloration behind pars flacida. He was diagnosed as recurrent left cholesteatoma and subsequently he underwent left mastoid exploration under general anesthesia in June 2018. Post-surgery, he developed recurrent ear discharge which was treated with topical antibiotics and ear toileting. Conclusions: We report a case of recurrent Cholesteatoma despite canal wall down procedure requiring a second redo procedure and with persistent recurrent otorrhea after the redo procedure. However, this case demonstrates the need for regular follow ups even after a canal wall down procedure for detecting recurrence of disease. Moreover, this case denotes some of the patient factors and surgeon factors involved in disease recurrence. Furthermore, importance of opting for an imaging study in case of high suspicion of the disease. [ABSTRACT FROM AUTHOR]

To report an adverse event after successful otosclerosis surgery: piston extrusion through the tympanic membrane, and its surgical solution. Four patients with a history of stapes surgery in context of otosclerosis presented with recurrent conductive hearing loss due to piston extrusion. Otoscopy, audiometric assessment and CT-imaging were conducted to assess the encountered conductive hearing loss and extrusion of the prosthesis. Revision stapes surgery was performed with interposition of cartilage between tympanic membrane and piston-loop. Pre- and postoperative audiometry and otoscopic evaluation. Revision surgery resulted in postoperative ABG within 15 dB. No recurrent extrusion was seen after the mentioned surgical procedure including use of cartilage graft. In case of piston extrusion (trans-tympanic membrane), revision stapes surgery with interposition of a cartilage layer between tympanic membrane and piston is advocated to prevent recurrence. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to compare the surgical and functional outcomes, as well as the quality of life, of patients who underwent endoscopic and microscopic type 1 tympanoplasty. Material and Methods: In two groups of patients undergoing endoscopic and microscopic tympanoplasty, pre- and postoperative audiological outcomes, Middle Ear Risk Index, and Chronic Otitis Media Benefit Inventory, a newly designed questionnaire specific for chronic otitis media surgery, were prospectively evaluated. Results: The endoscopic tympanoplasty group had 30 patients, while the microscopic tympanoplasty group had 22 participants. There were no statistically significant differences in demographic parameters, Middle Ear Risk Index, or graft material chosen between the groups, although the time of hospitalization was considerably shorter in the endoscopic tympanoplasty group (p<0.001). In terms of air conduction thresholds and air-bone gap, the difference between pre and postoperative time points was statistically significant in both groups (p<0.001), but not between groups. There was no statistically significant difference between the groups in terms of hearing gain and Chronic Otitis Media Benefit Inventory scores. Conclusion: Although the endoscopic tympanoplasty group is known to decrease early postoperative complaints and shorten hospitalization periods, the equivalent late functional outcomes (audiological and quality of life results) reveal that the two surgical procedures are not superior to each other in the long term. [ABSTRACT FROM AUTHOR]

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.

A retrospective review of the outcomes of patients who underwent endoscopic myringoplasties in our institution was conducted. The aim was to highlight our results with this procedure. The database of patient records was manually checked, and the patients who had undergone Endoscopic Myringoplasties were identified, and their demographics, admitting notes, operating notes, and discharge summaries were reviewed. Graft failure was considered if the patient had a perforation in the graft during the outpatient follow-up. The information was compiled, and basic statistics were derived. A total of 31 patients were identified who had undergone Endoscopic Myringoplasty. Patients’ age ranged from 14-52 years. None of the patients developed any immediate post-operative complications. Follow-up otoscopic examination showed 28 patients with an intact graft and only one patient with graft failure. ---Continue

Introduction: Chronic Otitis Media (COM) is a major cause of preventable hearing loss. Tympanoplasty is a crucial surgical step in managing COM and restoring hearing loss. Various prognostic factors are believed to influence the success of graft take-up. The Middle Ear Risk Index (MERI) is a numerical grading system used to assess the severity of the disease and predict the outcome of tympanoplasty for individual patients. Aim: To investigate the role of preoperative MERI in the selection of middle ear surgery. Materials and Methods: This cross-sectional study was conducted on a sample size of 40 patients (40 ears) who were treated at the Department of ENT, Acharya Vinobha Bhave Rural Hospital, Sawangi (Meghe), Wardha, Maharashtra, India, from December 2020 to December 2022. Only patients free from comorbidities and COM-related complications who underwent surgical intervention were included. The patients were evaluated for their MERI score, and the outcome of the surgical intervention was then correlated. Statistical analysis was performed with SPSS version 25.0 at a significance level of p

Aims: 1. To compare the outcome of tympanoplasty alone with tympanoplasty combined with cortical mastoidectomy in patients with quiescent Chronic otitis media (COM). 2. To assess gain in hearing in dB. Materials and Methods: Patients diagnosed with mucosal type of chronic otitis media in the quiescent stage were selected. Two groups were formed. Patients were selected randomly and alternately they were included in groups A and B. The patients underwent otomicroscopy. Pure tone audiometry would depict pure conductive hearing of hearing loss. Group A (50% patients) were subjected to tympanoplasty alone and group B (other 50% patients) were subjected to tympanoplasty combined with cortical mastoidectomy. Prior to surgery, all patients underwent routine blood and urine examination, pure tone audiometry, and B/L mastoid X-ray Schuller’s view. Results: In our study, hearing gain in decibels in the tympanoplasty group was 17.1% and in tympanoplasty combined with cortical mastoidectomy was 21.1%. Graft uptake was 94% in the tympanoplasty group and 96% in tympanoplasty combined with cortical mastoidectomy. Recurrence of discharge was seen in three cases of tympanoplasty. Though tympanoplasty combined with cortical mastoidectomy is better in hearing improvement, graft uptake but the difference in two groups is statistically insignificant. Conclusion: Hearing improvement and graft uptake were statistically insignificant in two groups. Combining cortical mastoidectomy with tympanoplasty will not give additional benefits in terms of hearing gain and graft uptake in patients with quiescent mucosal chronic otitis. Media: Clinical significance: Hearing improvement and graft uptake were statistically insignificant in two groups. Combining cortical mastoidectomy with tympanoplasty will not give additional benefits in terms of hearing gain and graft uptake in patients with quiescent mucosal chronic otitis media.

Background: The chorda tympani is frequently harmed during middle ear surgery. Surgery-related chorda tympani injury is rarely associated with impaired taste perception in patients. The use of microscopes marked the beginning of modern tympanoplasty techniques, and the endoscopic tympanoplasty approach is now described in terms of minimally invasive surgery.Aim of the Study: The aim of the current study is to compare chorda tympani nerve [CTN] injuries occurring because of tympanoplasty performed using microscopic and endoscopic methods.Patients and Methods: This prospective study was carried out on 50 patients from Al-Azhar University hospitals who suffered from chronic suppurative otitis media [safe type]. Patients were randomized equally using opaque sealed envelopes into two groups. Group A: 25 patients underwent transcanal endoscopic tympanoplasty with elevation of the tympamomeatal flap. Group B: 25 patients underwent microscopic tympanoplasty by postauricular incision.Results: Chorda tympani nerve was with no injury in 24 [96%] cases in group A and 14 [56%] cases in group B, while 1 [4%] case in group A and 8 [32%] cases in group B had stretched chorda tympani nerve and 3 [12%] cases in group B had transected chorda tympani nerve. The Chorda tympani nerve was significantly less injury, less stretched in group A than group B, and more transected in group B than group A [P value=0.012].Conclusion: In patients undergoing tympanoplasty, Endoscopic ear surgery provides superior visualization, reduces the necessity for extensive manipulation of the chorda tympani, and subsequently lowers the occurrence of CTN injury compared to microscopic ear surgery.

Objectives: To investigated whether endoscopic tympanoplasty and tympanomastoidectomy could present satisfying audiological outcomes for cholesteatoma patients. Methods: This was a retrospective study of 83 patients with cholesteatoma who underwent endoscopic tympanoplasty and tympanomastoidectomy between 2019 and 2021. The preoperative and postoperative audiological evaluations were performed. The evaluation methods included air conduction (AC), bone conduction (BC), and air-bone gap (ABG) procedures. Results: Eighty-three patients were included in the study, all of whom underwent endoscopic tympanoplasty and tympanomastoidectomy. Forty-seven patients presented postoperative ABG≤20 dB (59.49%). The frequencies tested included low-frequency (LF), middle-frequency (MF), high-frequency (HF), and pure-tone average (PTA). All three audiological parameters significantly decreased after surgery (P 0.05). There were also significant differences between the preoperative and postoperative proportions of degree of hearing (P

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

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.

Objective: Various materials have been used for tympanic membrane reconstruction in middle ear surgery. This study aimed to evaluate the difference between the tragal perichondrium and COOK artificial material in patients who underwent endoscopic type 1 tympanoplasty. Method: This retrospective study included patients who underwent endoscopic type 1 tympanoplasty from June 2021 to June 2022 at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine. Patients were divided into group A (tragal perichondrium) and group B (COOK artificial material) according to the material used in the operation. All patients were followed up for 6 months. The differences in age, gender, operation site, disease course, preoperative air-bone gap (ABG), operation time, blood loss, hearing gain, and wound healing rate were compared between the two groups. Results: This study enrolled 197 patients, with 120 patients in group A and 77 patients in group B. There were no significant differences in age, gender, operation site, disease course, or preoperative ABG between groups A and B (p > 0.05). Both groups had significant postoperative improvement in hearing (group A: 30.98 ± 9.58 dB vs. 17.07 ± 9.92 dB, p

Background: Chronic Otitis Media (COM) is the term used to describe any chronic inflammatory pathology of the middle ear cleft without reference to etiology or pathogenesis. High resolution computed tomography (HRCT) the temporal bone provide significant advantages in differentiating between the bone and soft tissue in high contrast images. In this research paper, we have studied the pre-operative HRCT effectiveness in identifying the abnormalities and its aid in tympanomastoid surgery. Methodology: This was a cross sectional study conducted in department of ENT, Indira Gandhi Government General Hospital and Postgraduate Institute, Puducherry from January 2019 to June 2020 with Sample size of 35. Patient diagnosis was made and pre-operative HRCT temporal bone done. Patient was then taken up for surgery and Intra-operative findings noted. Conclusion: In this study which included 35 patients of Chronic Otitis Media attending a tertiary care hospital, the following conclusions made. The mean age of presentation is 36.5 years. Visualization of Tympanic membrane is poor as it was tough to differentiate between Retraction and perforation. The involvement of middle ear identification in HRCT is satisfactory. The ossicles were visualized, even when surrounded soft tissue density. However they cannot be reliable on the scans. The visualization of bony structures (tegmen, LSCC) were high except for the facial canal. This may be misleading due to errors in reconstruction. HRCT couldn't differentiate between various soft tissue densities. [ABSTRACT FROM AUTHOR]

There are no reports about comprehensive comparative analysis of the effects after various hearing surgery solutions for congenital malformation of the middle and outer ear (CMMOE). To analyze the improvement of Average Air-Conduction Threshold (AACT) of pure tone after various hearing surgery solutions for CMMOE and provide a reference for the selection of accurate hearing solutions. A retrospective analysis of 159 cases (170 ears) with CMMOE submitted to various ear surgery solutions, including: (1) Three situations of outer ear canal (OEC): ① atresia 85 ears, ② stenosis 28 ears, and ③ normal 57 ears. (2) Three commonly used hearing solutions: eardrum repair 53 ears, Porp 44 ears and Piston 32 ears implantation. (3) Three OEC situations with different hearing solutions: type I. Reconstruction of OEC (r-OEC), type II. r-OEC and/or different tympanoplasty, including ① eardrum repair, ② release of ossicular chain, ③ Porp implantation, and ④ Torp implantation, type III. Piston implantation with fenestration of the inner ear. Compare AACT of postoperative short term (0.5 years) or long term (0.5–10 years) and preoperative in the speech frequency range of 0.5–4 kHz to assess efficacy. If the sample number ≥10, and not subject to normal distribution, the Kruskal–Wallis multi-sample rank sum test is used for the comparison of multiple groups and Wilcoxon's rank sum test for two groups, with P < 0.05 being statistically significant. If the sample size <10, the standard of clinical efficacy is one frequency improvement value ≥15 dB HL, or 10 dB HL ≤2 frequency improvements <15 dB HL at 0.125–8 KHz. Intra-group comparison of AACT: (1) three situations of OEC: atresia, stenosis and normal all had P < 0.05 postoperatively in short term, while in long term only the normal group had P < 0.05. (2) Three commonly used hearing solutions: eardrum repair, Porp and Piston implantation all had P < 0.05 in short and long terms, except for eardrum repair P >0.05 in long term. (3) Three OEC situations with different hearing solutions: 1) Atresia of OEC: Porp and Piston implantation, r-OEC and release of ossicular chain were effective in short term and were not effective in long term, and the eardrum repair was not effective in both short and long term. 2) Stenosis of OEC: eardrum repair, Porp and Piston implantation were effective in short and long term. r-OEC P >0.05 for short and long term, Torp implantation was not effective in long term, 3) Normal of OEC: Porp, Torp and Piston implantation were all P < 0.05 in short and long term except for Torp >0.05 in long term, and release of ossicular chain is both short and long term clinically effective. The AACT values of postoperative in long term for three groups of atresia, stenosis, normal of OEC are over 58.7 dB HL (except Porp implantation 52.5 dB HL), 51.3 dB HL (except Porp implantation 42.5 dB HL), and 37.5 dB HL (except Torp implantation are 32.6 dB HL), respectively. Intra-group comparison of AACT. (1) Three groups of the atresia, stenosis and normal of OEC are all effective in short term, while in long term only the normal group is effective. (2) The three most commonly used surgical solutions of eardrum repair, Porp and Piston implantation are effective in short and long terms, except for long term eardrum repair. (3) Three OEC situations with different hearing solutions: some of surgical solutions were effective in short term or long term for CMMOE, but based on the AACT values of postoperative in long term for three OEC situations, it is better to choose a hearing device for atresia of OEC, comprehensive review of surgical or hearing device for stenosis of OEC. Surgery can be considered for normal OEC. [ABSTRACT FROM AUTHOR]

Background: There is no report on the relationship between congenital malformation of the outer ear and hearing, which makes it possible to predict the hearing level just based on microtia grades. Aims/Objectives: To investigate the correlation between two types of congenital malformation of the outer ear [microtia and Outer Ear Canal Malformation (OECM)] and hearing, as well as the interrelationship among all three variables. Material and methods: A total of 535 cases (598 ears) of congenital malformation of the middle and outer ear (CMMOE) with hearing data, out of which 319 cases (349 ears) microtia with available images and graded by I–V, 449 cases (482 ears) OECM graded by atresia, stenosis and normal, and 87 cases (87 ears) OEC atresia graded I–IV, 301 cases (301 ears) with materials of microtia, OECM and hearing at the same time were carried out correlation analysis. The Average Air-Conduction Threshold of pure tone (AACT) at 0.5–4 KHz was calculated corresponding to the ears with different malformation grades. The differences in AACT among different malformation grades, the correlation between malformation severity and AACT, as well as the relationship among microtia, OECM and AACT were analyzed. The one-way analysis of variance (ANOVA) was employed to compare the differences in AACT, Kendall's tau-b rank correlation coefficient test was used for correlation analysis. A statistical significance level of p < 0.05 was applied. Results: Among the 349 ears with microtia, the corresponding AACT values for grades I to V were 61.6, 63.0, 69.9, 75.4, and 75.0 (dB HL), respectively. Comparing grade III to grades II or IV, both p < 0.05. However, p > 0.05 between grade I and II or between grade IV and V. The correlation coefficient between microtia grades and AACT r = 0.219, p < 0.05. Among the 482 ears of OECM, the distribution was as follows: 73.6% atresia, 19.1% stenosis, and 7.3% normal, the corresponding AACT values were 64.1, 61.7, and 52.5 (dB HL), respectively. Comparing normal to stenosis or atresia, both p < 0.05, while between atresia and stenosis p > 0.05. The correlation between OECM and AACT was r = 0.104, p < 0.05. The AACT values corresponding to grades I to IV of OEC atresia in the 87 ears were 59.9, 65.1, 71.1, and 64.1 (dB HL), respectively. Comparing these grades, all p > 0.05. The correlation between the degree of atresia and AACT r = 0.23, p < 0.05. The correlation coefficients for 301 ears microtia to OECM, microtia to AACT, OECM to AACT were r = 0.339, r = 0.163 and r = 0.128 respectively, with all p < 0.05. Conclusion and significance: There are positive correlations among the degree of microtia, degree of OECM, and AACT values for each other, and so between the degree of OEC atresia and AACT, suggesting that as the severity of microtia or OECM increased, the AACT also tended to be higher, which make it possible to predict the hearing level and the degree of OECM based on microtia grades in clinical practice. Additionally, there are significant differences in AACT values in microtia grade III to grades II or IV, OEC normal to stenosis or atresia, while no differences in microtia grade I to II and grade IV to V, OEC stenosis to atresia, and among the grades I–IV of the OEC atresia. [ABSTRACT FROM AUTHOR]

At present, there are not international unified standards and reports on Congenital Ear Malformation (CEM) in the world, which makes it difficult to transfer information and compare the literature. Through the statistical analysis of a large sample of CEM, a unified standard of all aspects of CEM is proposed and the data are provided for reference, which is convenient for the international work and literature comparison in this field. Based on the author's 30 years of clinical and scientific research work on CEM and the relevant cases of 3231 (4714 ears) in our hospital, and combined with literature, statistical analysis was made. This paper summarizes the classification, definition, epidemiology, embryonic development, pathogenic factors of CEM and elaborates on the clinical manifestations, examination and sequence therapy of representative Congenital Malformation of the Middle and Outer Ear (CMMOE). We also introduce malformation of the auricle and inner ear, so as to cover the outer, middle and inner ear. At the same time, we introduce our achievements and contributions in this field. This study provides reference to the international unified standard and treatment principle of the CEM. [ABSTRACT FROM AUTHOR]

Background: The incidence of re-stenosis or re-atresia after reconstruction of the Outer Ear Canal (OEC) in patients with Congenital Malformation of the Middle and Outer Ear (CMMOE) is very high (up to 48%), and it has been a difficult problem for otologists not being able to solve. Aims/Objectives: To explore new strategies and methods to improve re-stenosis or re-atresia after reconstruction of the OEC in patients with CMMOE. Material and Methods: According to the characteristics of reconstructed OEC (r-OEC) re-stenosis or re-atresia summarized by us, a number of new prevention strategies and methods have been proposed and related patent products have been designed, including the improvement of covering epithelium types and skin grafting methods (7 types), simulated drum ring function to prevent the formation of negative pressure in the cavity, and strengthen postoperative support to reduce skin shrinkage and bone hyperplasia. The postoperative effects of different ages and preoperative OEC malformations are statistically analyzed. Results: The incidence of re-stenosis/re-atresia is 14.3% (5/35) in the thin sectional skin of the temporal scalp overlap splicing skin grafting, which was significantly better than 45.5% (15/33) in the whole piece mosaic splicing and barrel skin grafting from the inner thin sectional thigh skin and overlay splicing other methods, including the inner thigh thin sectional skin, chest medium thick skin and subcutaneous pedicle + chest medium thick skin (p<0.05). The patent artificial drum ring and the model stent of the OEC have obvious effects. The mean operation age of postoperative atresia, stenosis, and good groups are 9.3, 13.1, and 12.5 years old, respectively. The proportion of preoperative atresia is 91.3%, 85.7%, and 57.7%, respectively. The total incidence of re-atresia and re-stenosis of r-OEC for two groups of atresia and stenosis of OEC before surgery is 40.5% (49/121) and 13.3% (8/60), respectively. Conclusions and Significance: The best result is found in overlapping the splicing thin sectional skin of the temporal scalp, combined with artificial drum ring implantation, effective support of postoperative model stent of OEC and post-pubertal surgery selection are new and effective strategies and methods to prevent re-stenosis or re-atresia of r-OEC. Atresia or stenosis of the OEC before the operation is the influence factor of the postoperative effect. [ABSTRACT FROM AUTHOR]

Background: The preoperative evaluation of Congenital Malformation of the Middle and Outer Ear (CMMOE) is very important. Jahrsdoerfer score commonly used at present, based on CT scanning images of the temporal bone, is often unable to accurately evaluate deformity and hearing level. Aims/Objectives: To investigate and promote a straightforward and easily accessible assessment method, pure tone audiometry, for the evaluation of CMMOE. Material and Methods: A total of 223 cases (244 ears) CMMOE with hearing data were retrospectively analyzed. Among them, 180 cases (197 ears) underwent exploratory tympanoplasty with clear conditions: ossicle numbers in 136 cases (147 ears) and morphology in 128 cases (138 ears) and vestibular window development in 137 cases (146 ears), and CT scans of temporal bone in 113 cases (120 ears). 1). The correlation was analyzed between ossicle numbers, ossicle morphology, Jahrsdoerfer score groups and their corresponding Average Air-Conduction Threshold of pure tone (AACT) at 0.5–4 KHz. 2) The AACT difference is compared among the above groups respectively and between the developed and undeveloped groups of vestibular window at 0.5–4 KHz and each frequency of 0.125–8 KHz. Spearman method was used for correlation analysis (calculating coefficient r and p values). For the data followed a normal distribution, a one-way analysis of variance (ANOVA) and t-test were employed, otherwise, Kruskal Wallis multiple local rank coincidence test and Wilcoxon rank sum test were used. p <0.05 was considered statistically significant. Results: 1) The correlation coefficients between the groups of ossicle number scores, ossicle morphology scores, Jahrsdoerfer scores and their corresponding AACT are r = −0.187 (p <0.05), r = −0.073 (p >0.05) and r = −0.079 (p > 0.05), respectively. 2) Comparison of AACT difference based on ossicle number or morphological scores and Jahrsdoerfer scores with p > 0.05 among all groups, respectively. The AACT difference between the developed and undeveloped vestibular window groups is 5.5 (63.5/69.0) dB HL(p <.05) at 0.5–4KHz, out of 0.125–8 KHz frequency 1, 2, 4 KHz were 5.7 (65.0/70.7) dB HL, 8.4 (60.7/69.1) dB HL and 2 (61.5/63.5) dB HL, respectively, all p < 0.05, the other frequencies with all p > 0.05. Conclusions and Significance: 1) Ossicle number was correlated with AACT, but not for ossicle morphology and Jahrsdoerfer scores. 2) There was no significant difference in AACT corresponding to ossicle number or morphology scores and Jahrsdoerfer scores groups, but the patients with undeveloped vestibular window had poorer hearing than those with developed ones. Therefore, the AACT can evaluate the development of ossicle and vestibular window, and more directly reflect the hearing level than Jahrsdoerfer score. Pure tone audiometry is simple, widely used, and easily accessible, which making it a new assessment method of CMMOE. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to compare the surgical outcomes of Polycel® and titanium in ossiculoplasty following tympanomastoidectomy (TM). Methods: A total of 221 patients underwent ossiculoplasty following TM by a single surgeon using either Polycel® or titanium as prosthesis. Hearing was tested preoperatively and postoperatively at 6 months by pure-tone audiometry. Successful surgery was defined if postoperative air-bone gap (ABG) was <20 dB, the gain in air conduction (AC) hearing was >15 dB HL, or postoperative AC was <30 dB HL. Multiple linear regression was conducted to identify the factors associated with the surgical outcomes. Results: In canal wall up mastoidectomy (CWUM), both Polycel® and titanium showed favorable successful rates if partial ossicular replacement prosthesis (PORP) was used (64.3% of Polycel® and 67.6% in titanium). If total ossicular replacement prosthesis (TORP) was used, both represented similar outcomes (54.5% of Polycel® and 75.0% in titanium). In canal wall down mastoidectomy (CWDM), significant ABG reductions were observed only in the titanium group (5.2 ± 14.7 dB of Polycel® [ P =.083] and 7.0 ± 14.2 dB of titanium [ P =.002] in PORP; 4.6 ± 13.5 dB of Polycel® [ P =.097] and 9.5 ± 11.2 dB of titanium [ P <.001] in TORP). In multivariate analysis, titanium had a positive effect on the reduction of postoperative AC thresholds (B: −4.772; 95% CI: −8.706-−0.838). Conclusions: Both Polycel® and titanium showed favorable surgical outcomes for ossiculoplasty following CWUM. Titanium prosthesis is recommended for surgery after CWDM. [ABSTRACT FROM AUTHOR]

Objective: To assess the prognostic factors for anatomic and hearing success after tympanoplasty in the setting of complex middle ear pathology. Methods: A systematic review was performed in January 2022. English-language articles describing outcome data for tympanoplasty repair variables including underlying pathology, perforation location, smoking status, graft technique, reconstruction material, anatomic success, and hearing success were extracted. Articles were included when tympanosclerosis, retraction pockets, adhesions, cholesteatoma, chronic suppurative otitis media, anterior perforations, and smoking were included. Underlying pathology, perforation location, smoking status, graft technique, reconstruction material, anatomic success, and hearing success were extracted. Any factors analyzed as potential indicators of success were sought out. Results: Data sources included PubMed, OVID, Cochrane, Web of Science, Scopus, and manual search of bibliographies. Ninety-three articles met final criteria, which accounted for 6685 patients. Fifty articles presented data on both anatomic and hearing outcomes, 32 articles presented data on anatomic outcomes only, and 11 articles presented data on hearing outcomes only. This systematic review found that adhesions and tympanosclerosis were prognostic factors for poorer hearing. Additionally, smoking and tympanosclerosis may be predictive of anatomic failure; however, the significance of this finding was mixed in included studies. This analysis is significantly limited by both the heterogeneity within the patients and the lack of controls. Conclusion: Adhesions and tympanosclerosis were prognostic factors for poorer hearing. Clearly documented methods and outcomes for the included pathologies could lead to more definitive conclusions regarding prognostic factors for success. Level of Evidence: 3B [ABSTRACT FROM AUTHOR]

Introduction: Chronic Otitis Media (COM) is a major cause of preventable hearing loss. Tympanoplasty is a crucial surgical step in managing COM and restoring hearing loss. Various prognostic factors are believed to influence the success of graft take-up. The Middle Ear Risk Index (MERI) is a numerical grading system used to assess the severity of the disease and predict the outcome of tympanoplasty for individual patients. Aim: To investigate the role of preoperative MERI in the selection of middle ear surgery. Materials and Methods: This cross-sectional study was conducted on a sample size of 40 patients (40 ears) who were treated at the Department of ENT, Acharya Vinobha Bhave Rural Hospital, Sawangi (Meghe), Wardha, Maharashtra, India, from December 2020 to December 2022. Only patients free from comorbidities and COM-related complications who underwent surgical intervention were included. The patients were evaluated for their MERI score, and the outcome of the surgical intervention was then correlated. Statistical analysis was performed with SPSS version 25.0 at a significance level of p<0.05. Results: The MERI was utilised as a tool for assessing surgical outcomes. A lower MERI score indicated a less invasive choice of middle ear surgical procedure and was associated with a better outcome in terms of graft uptake, which was statistically significant. Patients requiring tympanoplasty alone had mild MERI scores (1-3), while more extensive surgeries such as canal wall up or canal wall down were associated with moderate or severe MERI scores (4-6 or 7-12), and this association was found to be significant (p=0.001). Interestingly, out of the total 40 patients, five with Eustachian Tube (ET) dysfunction had severe MERI scores (7-12) and experienced graft rejection. Patients with lower grades of ET dysfunction had higher chances of graft uptake, and this association was statistically significant (p=0.001). Conclusion: This study demonstrated that lower MERI scores were associated with better postoperative outcomes. In a country like India, where the cost of surgery and time away from work are major considerations, it is important to establish a standardised approach to predict the surgical outcome, whether it involves tympanoplasty alone or in combination with other middle ear surgeries like cortical mastoidectomy or canal wall down mastoidectomy, and counsel the patient accordingly. This plays a crucial role in informed decision-making. [ABSTRACT FROM AUTHOR]

Objectives: To investigate if prophylactic antibiotics (PA) in conjunction with myringoplasty of clean and uninfected ears entails a reduction of postoperative infections within 6 weeks after surgery, and whether it affects the healing rate of the tympanic membrane (TM) at follow‐up, 6–24 months after surgery. Design: A retrospective cohort study of prospectively collected data. Setting: Data extracted from The Swedish Quality Register for Ear Surgery (SwedEar), the years 2013–2019. Participants: All patients in SwedEar with a registered clean conventional myringoplasty (tympanoplasty type I) including a follow‐up visit. Main Outcome Measures: The effect of PA use on TM healing rate at follow‐up and postoperative infection within 6 weeks of surgery. Results: In the study group (n = 1665) 86.2% had a healed TM at follow‐up. There was no significant difference between the groups that had PA administered (87.2%) or not (86.1%). A total of 8.0% had a postoperative infection within 6 weeks. Postoperative infection occurred in 10.2% of the group that received PA (n = 187) compared with 7.7% of the group that did not receive PA. However, this difference was not statistically significant. Postoperative infection within 6 weeks significantly lowered the frequency of healed TMs. Conclusion: PA administered during clean conventional myringoplasty does not improve the chance of having a healed TM at follow up, nor decrease the risk of having a postoperative infection within 6 weeks after surgery. [ABSTRACT FROM AUTHOR]

Objective: Review the effectiveness of surgical and non‐surgical management strategies for isolated pars flaccida and combined pars tensa and flaccida tympanic membrane retractions in preventing progression or recurrence, improving hearing and preventing development of cholesteatoma. Design: Narrative review. Setting: ENT and otology services worldwide. Participants: Patients with non‐cholesteatoma tympanic membrane retractions. Main Ouctome measure: Changes in retraction (progression or resolution, or development of a known sequela such as perforation). Results: Eight full text papers are included: three randomised controlled trials and five case series or cohort studies of more than five patients (a total of 238 ears). Data exists for the use of conservative management, ventilation tubes, laser tympanoplasty, cartilage and fascia tympanoplasty, lateral attic reconstruction as well as mastoid procedures. Conclusion: Few high‐quality studies on the management of isolated and combined pars flaccida retractions exist. For isolated pars flaccida retractions deemed to require surgical intervention, this review suggests that lateral attic reconstruction and cartilage tympanoplasty carries least risk of recurrence. [ABSTRACT FROM AUTHOR]

Purpose: The European and Japanese system for cholesteatoma classification proposed an anatomical differentiation in five sites. In stage I disease, one site would be affected and in stage II, two to five. We tested the significance of this differentiation by analyzing the influence of the number of affected sites on residual disease, hearing ability and surgical complexity. Methods: Cases of acquired cholesteatoma treated at a single tertiary referral center between 2010-01-01 and 2019-07-31 were retrospectively analyzed. Residual disease was determined according to the system. The air–bone gap mean of 0.5, 1, 2, 3 kHz (ABG) and its change with surgery served as hearing outcome. The surgical complexity was estimated regarding the Wullstein's tympanoplasty classification and the procedure approach (transcanal, canal up/down). Results: 513 ears (431 patients) were followed-up during 21.6 ± 21.5 months. 107 (20.9%) ears had one site affected, 130 (25.3%) two, 157 (30.6%) three, 72 (14.0%) four and 47 (9.2%) five. An increasing number of affected sites resulted in higher residual rates (9.4–21.3%, p = 0.008) and surgical complexity, as well poorer ABG (preoperative 14.1 to 25.3 dB, postoperative 11.3–16.8 dB, p < 0.001). These differences existed between the means of cases of stage I and II, but also when only considering ears with stage II classification. Conclusion: The data showed statistically significant differences when comparing the averages of ears with two to five affected sites, questioning the pertinence of the differentiation between stages I and II. [ABSTRACT FROM AUTHOR]

Introduction: In chronic otitis media, the reconstruction of the middle ear's sound conducting system involves repairing the tympanic membrane and filling the space between ossicular chain remnants. The final shape of the prosthesis is usually determined intraoperatively. However, the ossicular chain may be preoperatively measured using computed tomography (CT) scans, and an individualized prosthesis can be designed. Custom 3D printing seems to be an attractive solution for optimal adjustment. Aim: Our study aimed to assess the 3D-printed custom prosthesis movability and compare it to the original ossicular chain. Material and methods: Five fresh-frozen temporal bone specimens were used. Using Cone-Beam CT scans, the incus model was designed individually and 3D-printed. The ossicular chain was reconstructed inside the cadaveric temporal bone. Acoustic stimuli were applied to the external ear canal one frequency at a time. The laser Doppler vibrometer (LDV) measured the intact and 3D-printed prosthesis reconstructed ossicular chain vibrations. Results: At all stimulation frequencies, there was no significant difference in velocity values between the intact and reconstructed ossicular chain at the intensity of 80 dB SPL. The obtained values of the velocity gain were: -7.9 (SD-19) dB, -6.8 (SD- 8.12) dB, -10,9 (SD-5.3) dB, -7.4 (SD-8.16) dB for 500 Hz, 1000 Hz, 2000 Hz, 4000 Hz, respectively. The vibration threshold shift values ranged between --0.57 dB at 500 Hz and 3.81 dB at 2000 Hz. Conclusions: This study analyzed the movability of individualized 3D-printed custom ossicular prostheses using LDV. Compared to the intact ossicular chain, the reconstructed ossicular chain movability was characterized by statistically insignificant reduced movability at all tested frequencies. Because the prosthesis's new design conception as custom 3D individualized printing allows for patient-specific ossiculoplasty, it represents a promising new direction for ossicular chain reconstruction. It seems to be an attractive solution for prosthesis optimal adjustment and, hopefully, better hearing results. [ABSTRACT FROM AUTHOR]

The post-aural incision was selected and a "U" shaped myoperiosteal flap was made from where we elevated the ear canal skin and proceeded to the remnant TM in an encircled manner, these steps spare an extra incision at the external meatus, thus maintaining the integrity of the skin "sleeve." Keywords: canalplasty; chronic otitis media; tympanic membrane perforation; tympanoplasty EN canalplasty chronic otitis media tympanic membrane perforation tympanoplasty 3139 3143 5 10/20/23 20231101 NES 231101 An innovative tympanoplasty method, blending the merits of traditional overlay and underlay techniques while avoiding the pitfalls. DISCUSSION To our knowledge, most tympanoplasty techniques currently involve making an incision in the ear canal to access the TM. This is verified by the outcome that healing rate was 94.9% (37/39) in anterior perforation, 93.2% (55/59) in large perforation, 100% (6 patients) in subtotal perforation, 96.72% (59/61) in anterior large/subtotal perforations. [Extracted from the article]

Introduction: The use of cartilage in type I tympanoplasty is associated with concern about a poor audiological outcome. Slicing the cartilage could be a tool to overcome such a feared problem. Objective: To compare the healing and hearing outcomes of using sliced cartilage to full-thickness cartilage in type I tympanoplasty. Methods: Seventy patients with small to medium-sized central dry tympanic membrane perforation were included in this prospective study. The patients were randomly assigned to one of these two groups: group A: full-thickness cartilage tympanoplasty was done, and group B: partial thickness cartilage tympanoplasty was done. The assessment of healing and hearing was done at 3 and 12 months postoperatively. Results: The healing was achieved in 88.2% and 90.9% in group A and group B, respectively. In group A, the mean ABG was 23.44 dB preoperatively and 14.2 dB, and 12.6 dB in the first and second follow-ups, respectively. In group B, preoperative ABG was 23.58 dB compared to 7.9 dB and 6.93 dB in the two follow-ups, respectively. The results were significantly better in group B rather than group A at both follow-ups. Conclusion: Hearing results are better when sliced cartilage is used in tympanoplasty type I than full-thickness cartilage. [ABSTRACT FROM AUTHOR]

Introduction Tympanoplasty is the main treatment of mucosal type of chronic suppurative otitis media. Objective The aim of the present study was to compare clinical outcomes in terms of healing and audiological outcomes of two groups. The authors used single layer graft (perichondrium with cartilage island) graft in one group and double layer grafts (perichondrium cartilage island composite plus temporalis fascia) were used in the second group. Methods Forty patients complained of chronic suppurative otitis media safe type with subtotal perforation subdivided into two groups. The first group author used single-layer perichondrium with cartilage island graft (composite graft) while in the second group authors used double graft in the form of perichondrium/cartilage island (composite graft) plus temporalis fascia. Results There was no significant difference in the mean Air bone gap (ABG) between pre- and post-operative audiometry in subjects who had single layer tympanoplasty. There was a significant difference in the mean ABG between pre- and postoperative audiometry in subjects who had double layer tympanoplasty. There was a significant difference in in the mean ABG differences between subjects who had single layer tympanoplasty and double layer tympanoplasty. Also, there was a significant difference in the healing of the tympanic membrane between subjects who had single layer tympanoplasty and double layer tympanoplasty. Conclusion Tympanoplasty by double graft (temporalis fascia and tragal cartilage/perichondrium) achieved a considerable improvement in healing of the tympanic membrane ™ with lower risk for residual perforation or graft rejection. [ABSTRACT FROM AUTHOR]

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

Background: The stapedial artery is an embryonic artery that transiently supplies the cranial vasculature of the human embryo. Postnatal persistence of the stapedial artery may cause conductive hearing loss and pulsatile tinnitus due to its course through the middle ear. We describe a patient with a persistent stapedial artery (PSA) managed by endovascular coil occlusion prior to stapedotomy. Methods: A 48-year-old woman presented with left-sided conductive hearing loss and pulsatile tinnitus. Ten years earlier the patient had undergone explorative tympanoplasty, which was aborted due to a large PSA. Digital subtraction angiography was performed to confirm the anatomy and endovascular occlusion of the proximal PSA was achieved by deployment of coils. Results: The pulsatile tinnitus improved immediately after the procedure. The size of the artery subsequently decreased and surgery could be performed with only a minor intraoperative bleeding. Successful stapedotomy resulted in postoperative normalization of her hearing with some minor residual tinnitus. Conclusion: Endovascular coil occlusion of a PSA is feasible and safe in patients with favorable anatomy and facilitates middle ear surgery. It decreases the size of the artery and minimizes the risk of intraoperative bleeding in patients with a large PSA. The future role of this novel technique in the management of patients with PSA-related conductive hearing loss and pulsatile tinnitus remains to be determined. [ABSTRACT FROM AUTHOR]

Purpose: Endoscopic type I tympanoplasty was originally introduced in the 1990s and the extensive spread of this practice can be easily observed. The conventional technique performed involves the repair of a tympanic membrane perforation and is defined as microscopic type I tympanoplasty. The aim of this study is the comparison of quality-of-life (QoL) outcomes with endoscopic to that with microscopic type I tympanoplasty. Methods: All patients, or in the case of children with the aid of a parent, were asked to complete a novel QoL questionnaire drafted by our study group. The analysis was performed with descriptive statistics—mean, SD and relative frequency—and with a mixed model (generalized least squares fit). A two-sided p value of < 0.05 was regarded as statistically significant. Results: A total of 83 patients completed the questionnaire, 38 in the endoscopic group and 45 in the microscopic group. Every question represented a different. A statistically significant result was found in favor of the endoscopic approach regarding average hospitalization rate (p = 0.003) and cosmetic outcomes (p = 0.015). No statistically significant difference was otherwise observed between the groups. Conclusions: Based on our prospective cohort study, the QoL outcomes of endoscopic type I tympanoplasty in terms of postoperative pain, headache, nausea, vomiting, dizziness, taste disorder and hearing were comparable to the microscopic type I tympanoplasty. In regard to cosmetics, an increase in desirable results was achieved in the endoscopic group, particularly the average hospitalization rate proved to be statistically significantly lower than in the microscopic group. [ABSTRACT FROM AUTHOR]

Background: Various modifications in tympanomeatal flap elevation in tympanoplasty were described by otolaryngologist all over the world to achieve best surgical outcome. In this study, the surgical and audiological outcomes of circumferential (full cuffed) tympanomeatal flap elevation and over-under technique of flap elevation were compared in type 1 tympanoplasty. Objective: The aim of this study is to compare surgical outcomes of two techniques of tympanomeatal flap elevation in tympanoplasty. Materials and Methods: This prospective randomized study included 200 patients. Patients were randomly allocated in 2 groups. Patients were followed for 3 months and compared surgical and audiological outcomes in 2 groups. Results: In full-cuffed underlay (Group A) techniques, the overall success (97.3%) and anterior blunting (9.1%) were more, whereas residual perforation (2.7%), granulation formation (2.7%), and lateralization (0.0%) were less common as compared to over-underlay technique (Group B). In over-underlay technique (Group B), success, residual perforation, lateralization, and anterior blunting were seen in 82.2%, 17.8%, 4.4%, and 2.2%, respectively. Conclusion: Both full-cuffed underlay and over-underlay techniques of tympanoplasty are effective surgical technique with satisfactory outcome. [ABSTRACT FROM AUTHOR]

Aims and Objectives: The aim of this study is to compare the outcomes of type 1 tympanoplasty in terms of graft uptake, hearing improvement, operative time, and healing time in patients operated with posterior canal skin preservation or without it. Materials and Methods: This is a prospective study of 100 patients operated for type 1 tympanoplasty surgery at a tertiary care hospital from August 2021 to June 2023 and operated by a single surgeon. Patients were divided into two groups and were randomly allocated (one with posterior canal skin preservation and other without it). Inclusion criteria were all patients operated for tympanoplasty between 12 and 50 years of age. Exclusion criteria were patients with mixed hearing loss or sensorineural hearing loss and patients who had to undergo ossicular chain reconstruction and revision cases were also excluded from the study. The outcomes were evaluated on follow-up by otoendoscopy and pure-tone audiometry. Observation and Discussion: In terms of graft uptake at 3-month postoperative period, no significant difference was found between both the groups. In terms of hearing improvement and healing time, P > 0.1 was noted, and hence the difference was not significant. However, the operative time was significantly lower for the group with posterior canal wall skin removal. Conclusion: Removal of skin from posterior surface of external auditory canal improves visualization during tympanoplasty. It reduces operative time and provides same success rates in terms of graft uptake and hearing improvement. It has almost the same healing time, and granulations or other canal-related complications are minimal. Graft medialization or lateralization is also minimal when anterior tucking and lateral tucking of graft is done. [ABSTRACT FROM AUTHOR]

Context: Temporalis fascia and tragal perichondrium are the most commonly used graft materials in tympanoplasty, though contradictory reports are available in literature regarding their efficacy. Aims: To investigate the success rates and hearing outcomes of temporalis fascia and tragal perichondrium as grafts used for Type 1 tympanoplasty. Settings and Design: The present prospective study was carried out for a period of 18 months including 60 patients of either sex from 18 to 70 years of age. Subjects and Methods: This prospective study included 60 consecutive cases of chronic otitis media in a tertiary care center randomized in two groups of 30 patients each to be subjected to Type 1 tympanoplasty using either temporalis fascia graft (Group A) or tragal perichondrium (Group B). Graft uptake rates and subjective as well as objective hearing improvement at 1 and 3 months postoperative follow-up were compared. Statistical Analysis Used: IBM-compatible Statistical Package for the Social Sciences (SPSS) version 21.0. Results: The mean age of presentation in Group A was 31.30 years and in Group B was 30.67. In our study, the graft uptake after 3 months of surgery was 87% in the temporalis fascia graft group and 90% in the tragal perichondrium graft group. The mean pre- and postoperative PTA at 1 month and 3rd month postoperatively showed that there was significant improvement in hearing after 1 month in the temporalis fascia graft group compared to the tragal perichondrium graft group. Conclusions: Both temporalis fascia and tragal cartilage perichondrium are suitable graft materials for tympanoplasty. Graft uptake was superior with tragal perichondrium, while hearing improvement was better with temporalis fascia at 1 month postoperatively, although the results were not statistically significant at 3 months postoperative. [ABSTRACT FROM AUTHOR]

Introduction: Eustachian tube (ET) also known as pharyngotympanic tube connects nasopharynx with the middle ear. Evaluation of ET anatomy is aimed in patients with chronic otitis media. Materials and Methods: In a study of 53 patients, HRCT Temporal bone was done on 128 dual source simens somatom definition flash machine on 5mm cut section and tympanoplasty was carried out. Results: ET angle is one of the important factors for middle ear aeration. Outcome of tympanoplasty at 12th week was 88.7%. In the patients with vertical Eustachian Tube (i.e., more Eustachian Tube angle with the horizontal plane), better graft uptake in tympanoplasty was observed which was statistically significant. However, graft uptake did not correlate with the length of the Eustachian tube. Conclusion: It was concluded that on measuring ET length on HRCT, majority of the patients had bony length of 10-12 mm, cartilaginous length of 15-19 mm and total ET length of 28-32 mm. Majority of the patients had ET angle of 21-30 degrees with the hard palate. [ABSTRACT FROM AUTHOR]