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Purpose: Retrospective evaluation of bilateral same-day myringoplasty outcomes. Methods: Patients who underwent bilateral same-day myringoplasty from 2005 to 2019. Results: Thirty-eight patients underwent bilateral myringoplasty. Mean age was 44.5 years and 55.3% patients were male. Tragal perichondrium-cartilage composite graft was the most frequently used graft material (82.9%). Perforation closure was achieved in 78.9%. Postoperative Pure Tone Average and Air–Bone Gap decreased significantly (p < 0.05), except for the Air–Bone Gap of the right ear (p = 0.058). The complications were cholesteatoma (1.3%), otorrhea (6.6%) and tympanic membrane retraction (1.3%). Conclusions: Bilateral same-day myringoplasty is a feasible procedure in selected patients. Good anatomic and functional outcomes, as well as a low rate of complications, are achieved with this procedure, improving patient comfort and allowing for a reduction in operation time and costs. [ABSTRACT FROM AUTHOR]

Purpose: The definitive treatment for chronic suppurative otitis media is surgery. Surgical technique and procedure varies according to individual case findings and pathology and may require mastoidectomies in which the canal wall is preserved or lowered to eradicate disease from mastoid air cells. Surgical treatment of chronic middle ear disease carries a risk of damage to the inner ear. The aim of this study was to investigate whether the noise produced by the tour system following chronic ear surgery causes sensorineural hearing loss, a condition for which not many studies have been published in the literature. Methods: The study consisted of a total of 49 patients with type I, type II and type III canal wall preservation and 62 patients with tympanoplasty with canal wall preservation and lowering. Bone and air thresholds were compared before and after middle ear surgery. Changes in bone and air thresholds were compared according to the type of tympanoplasty. Results: In the ICW-I, ICW-II and ICW-III tympanoplasties, and in the ICW and CWD tympanoplasties, the preoperative and postoperative values of the opposite ear hearing measurements were performed, and did not differ according to the type of surgery. There is no correlation drilling duration and hearing for the opposite ear. Conclusion: The prevention of postoperative sensorineural hearing loss depends on multiple factors, and assessing the magnitude of hearing loss in relation to these factors is important in determining the success of the surgery. [ABSTRACT FROM AUTHOR]

Background Chronic Otitis Media (COM) is one of the leading causes of hearing loss in the world. Tympanoplasty is the surgical treatment to repair the defective tympanic membrane in such patients. Aim To compare the healing and graft uptake using temporalis fascia versus cartilage perichondrium grafts in tympanoplasty type-1. Method A prospective randomized comparative cohort trial was conducted in the Department of Otorhinolaryngology at a Private Medical College in South India in the year 2020. This study compared the effect of two graft materials, tragal cartilage perichondrium and temporalis fascia, in tympanoplasty and evaluated the post-operative healing, among 60 patients randomized into 2 groups. Results 93% cases belonging to the cartilage perichondrium graft group had formation of neotympanum compared to only 53% cases in Temporalis fascia group. Statistically significant difference between the two groups in terms of formation of neotympanum suggests cartilage perichondrium was better in the aspect of healing and graft uptake. Conclusion Results of this study conclude that tragal cartilage perichondrium is significantly better than temporalis fascia in terms of graft uptake in cases of Type I Tympanoplasty. [ABSTRACT FROM AUTHOR]

Cholesteatoma is a benign tumor of the middle ear. Tympanoplasty is performed to remove cholesteatoma, prevent recurrence, and avoid complications. Previously, microscopy was used for tympanoplasty; however, endoscopy has become increasingly popular for this procedure. The effectiveness of endoscopy and the appropriate candidacy for endoscopic ear surgery remain controversial. In this retrospective chart review study, we enrolled 107 patients with cholesteatoma who underwent tympanoplasty and compared the microscopic approach (71 patients) and the endoscopic approach (36 patients) at different stages to clarify the benefits of using endoscopy and to determine candidacy for endoscopic ear surgery. Approach selection, complication rate, recurrence rate, and postoperative hearing threshold were compared between microscopic and endoscopic approaches in stages I, II, and III. Endoscopy was used more often than microscopy for early-stage (stage I) cholesteatoma (p = 0.005) and less frequently for advanced-stage (stage II) cholesteatoma (p = 0.02). Endoscopy surgery resulted in chorda tympani injury less often than microscopic surgery (p = 0.049); however, there were no significant differences between these two groups in terms of recurrence rate or postoperative hearing outcome. Endoscopy is particularly useful for early-stage cholesteatoma, and both approaches show no difference in hearing outcome in stage I and II; nevertheless, further research is required to determine an appropriate approach for more advanced stages (stage III). [ABSTRACT FROM AUTHOR]

Background: This study aimed to explore the impacts of different middle-ear mucosal conditions on the outcomes of type I tympanoplasty. Methods: A retrospective analysis of 164 patients with chronic otitis media was carried out. The patients were divided into 4 groups according to their mucosal condition. Preoperative hearing levels and air-bone gap (ABG) before and after surgery were compared via the Kruskal‒Wallis H test. The chi-squared test and Fisher's exact test were used to assess the postoperative complications and impact factors of functional success. Results: Preoperatively, neither the air conduction nor bone conduction values differed significantly among groups with different mucosal conditions. All of the ABG closed dramatically after type I tympanoplasty (P <.05) regardless of the mucosal conditions. The functional success rates were lower when the intratympanic mucosa was moderately or severely edematous compared with mildly edematous or normal (P <.05). The disease course, perforation site, and perforation size, as well as the status of the opposite ear, were not related to the auditory functional outcome. The differences in postoperative reotorrhea and reperforation among the 4 groups were not statistically significant. Conclusion: Preoperative hearing levels were not affected by middle-ear mucosal conditions. The functional success rate was influenced by mucosal conditions, but hearing levels were significantly enhanced after surgical intervention regardless of the mucosal status. Postoperative complications were not related to the mucosal conditions. Thus, type I tympanoplasty is adoptable for mucosal abnormalities when pharmacotherapy cannot result in a healthy tympanum. [ABSTRACT FROM AUTHOR]

Aim: To determine the effect of platelet rich plasma among patients undergoing type I tympanoplasty with and without topical use of platelet-rich Plasma (PRP) over the graft. Materials and Methods: A randomized, prospective, comparative study was conducted among 60 patients divided into two groups: Cases and control consisting of 30 patients each, having inactive mucosal Chronic otitis media who underwent type I tympanoplasty with the use of PRP for enhancing the graft uptake versus patients without use of PRP: 28 (93%) as compared to control 25(83%). Results: Preoperative and postoperative air-bone gap (A-B gap) was calculated at the end of 3 months and compared, and it was found to be statistically significantly better both in the case and control group (P < 0.05) and mean healing time of 4.64+/- 1.57 in cases in comparison to control group with mean healing time of 6.2+/-1.98. Conclusion: Our study shows that PRP is cheap, easy to prepare, autologous and cost effective. This platelet concentrate is enriched with various growth and healing factors, which helps in faster tympanic membrane closure following tympanoplasty and hence overall improving successful outcomes rate of tympanoplasty by preventing graft migration, with little to no perceivable side effects. [ABSTRACT FROM AUTHOR]

Background: Rigid telescopes, which provide wider surgical feld imaging, improved resolution, and high magnifcation capabilities, have recently found widespread use in ear surgery. This study aimed to review the outcomes and duration of operations in endoscopic transcanal tympanoplasty and to guide surgeons who have just started endoscopic ear surgery (EES). Methods: This study included 47 outpatient or inpatient volunteers who underwent endoscopic transcanal tympanoplasty surgery at the Otolaryngology clinic between March 2021 and March 2023. The age and sex of the patients, the surgery duration, and the side of the operated ear were reviewed. The first 23 operated patients were compared with the last 24 operated patients in terms of the duration of the operation. Postoperative graft success (anatomical success) in the patients at 6 months was reviewed. Hearing gain in patients was examined postoperatively at 6 months using an audiometry test with hearing thresholds at 0.5, 1, 2, and 4 kHz. Results: Upon examination of the patients at 6 months, the graft success was 89.4%. There was a statistically signifcant recovery in all 4 frequencies based on the preoperative and postoperative hearing tests (P=.00). There was a signifcant decrease in the duration of the operation in patients who were operated in the later stages of the study (P=.00). Conclusion: Although there is a learning curve associated with EES, this type of operation is based on team effort, and the surgery duration decreases over time, with the experience acquired by each healthcare provider included in the team. [ABSTRACT FROM AUTHOR]

To assess changes in middle ear pressures following adenotonsillectomies in children, and to evaluate the possibility of performing tympanoplasty at the same surgical time. Prospective study in which tube function was assessed using tympanometry on the first postoperative day and on the seventh postoperative day after adenotonsillectomies. A total of 39 children aged 6.8 ± 2.6 years were evaluated. On the first postoperative day, 79.5% presented with changes in middle ear pressure. On the seventh postoperative day, only 12.8% maintained this change. Tube dysfunction following adenotonsillectomy is transient and would not preclude an associated tympanoplasty from being performed, thereby reducing costs and risks related to the surgical procedure. [ABSTRACT FROM AUTHOR]

Aim: To compare endoscopic versus microscopic method for tympanoplasty in terms of Graft uptake and hearing outcome. Material and methods: A randomized prospective observational study was done. 60 patients who came to ENT outpatient of tertiary care teaching hospital requiring operative intervention for inactive mucosal chronic otitis media. Randomization was done and patients divided into two groups with Group A undergoing endoscopic tympanoplasty and Group B undergoing microscopic tympanoplasty. Post operative graft uptake and hearing improvement were compared between both groups. Intraoperatively visualization of middle ear structures, surgeon's comfort, duration of surgery, post operative pain, giddiness was compared. in both the groups. Results: Total 60 patients got randomly divided in the two groups. There was no difference in terms post op graft success rate and post operative hearing improvement in both the groups Intra operative visualization of middle ear structures better in the endoscopic group and also the surgical time was significantly less in endoscopic group. Conclusion: On comparing endoscopic versus microscopic tympanoplasty in patients of mucosal chronic otitis media, success rate in terms of graft acceptance and hearing improvement was equal between both groups. However, visualisation of middle ear structures was better in endoscopic method. Operating time was shorter in endoscopic tympanoplasty. [ABSTRACT FROM AUTHOR]

The spectrum of surgical techniques in the repair of nasal septal defects is wide. The objective of this study was to assess the feasibility of using a diced cartilage in fascia (DC-F) graft for successful closure of nasal septal perforations and to evaluate symptom reduction. This was a retrospective study of 18 patients undergoing surgical repair of symptomatic nasoseptal perforations of different etiologies using a DC-F graft from 2020 until 2021. The procedure was feasible in all of the 18 patients. Reconstruction of septal defects with a DC-F graft led to reduction of crust formation, reduction of epistaxis, and improvement of nasal breathing in 13 out of the 18 patients when seen for their 2-month follow-up. Reperforation occurred in three cases, leaving defects of 1, 7, and 5 mm in diameter. In one case, the reperforation was symptomatic. A DC-F graft proved to be a reliable and reproducible method for the closure of nasoseptal perforations of variable sizes, of different locations, and of different etiologies. [ABSTRACT FROM AUTHOR]

Objective: Endoscopic ear surgery is no longer a promising technique, but a well‐established one. This study aims to compare endoscopic and microscopic tympanoplasty based on current literature evidence, in terms of their efficacy and safety characteristics. Data Sources: We conducted a systematic literature search of four medical databases (Pubmed, Cochrane Library, Scopus, ClinicalTrials.gov), focusing on randomized controlled or observational studies comparing microscopic to endoscopic tympanoplasty. Review Methods: Data related to the efficacy and safety of each technique were extracted. Outcome data were summarized using pooled mean differences or pooled odds ratio along with their 95% confidence intervals. The risk of bias was estimated, by using the ROBINS‐I and RoB‐II assessment tools, while the overall quality of evidence was evaluated according to the GRADE working group. Results: Thirty‐three studies, with 2646 patients in total, were included in the meta‐analysis. Success rate was evaluated by estimating tympanic graft failure (pooled mean difference:−0.23; 95% CI: −0.61, 0.14, I2 = 33.42%), and air‐bone gap improvement (pooled mean difference:−0.05; 95% CI:−0.23, 0.13, I2 = 52.69%), resulting in comparable outcomes for the two techniques. A statistically significant difference favoring the endoscopic technique was detected regarding postoperative wound infection (OR: −1.72; 95% CI: −3.39, −0.04, I2 = 0%), dysgeusia (OR: −1.47; 95% CI: −2.47, −0.47, I2 = 0%), otitis externa development (OR: −1.96; 95% CI: −3.23, −0.69, I2 = 0%), auricular numbness (OR: −2.56; 95% CI: −3.93, −1.19, I2 = 0%), as well as surgical duration (OR: −1.86; 95% CI: −2.70, −1.02, I2 = 43.95%), when compared to the postauricular microscopic approach. Conclusion: Endoscopic tympanoplasty is an innovative alternative to the microscopic technique, resulting in commensurate outcomes regarding success rate. Furthermore, it offers superior results concerning postoperative complications, while it presents a significant reduction in the duration of surgery, mainly when it is compared to the postauricular microscopic approach. Level of Evidence: NA Laryngoscope, 134:3466–3476, 2024 [ABSTRACT FROM AUTHOR]

Objective: To determine if absorbable gelatin sponge (AGS) can be used to assess the posttympanoplasty microbiome and otic antibiotic exposure. Study Design: Prospective. Setting: Tertiary hospital. Methods: Patients undergoing tympanoplasty were prospectively enrolled. Intraoperatively, AGS was applied to the medial ear canal/tympanic membrane (TM) for 1 minute after canal incision, then saved for analysis. Ear canals were packed with AGS at the end of surgery. Otic ofloxacin was administered until the first postoperative visit, when AGS was collected. Microbial presence was assessed by culture. Ofloxacin levels were assessed by liquid‐chromatography mass‐spectrometry. Results: Fifty‐three patients were included. AGS was collected in 92.9% of patients seen within 21 days compared to 70.8% of those seen at 22 to 35 days. At surgery, AGS yielded bacteria and fungi in 81% and 11%, respectively, including Staphylococcus species (55%) and Pseudomonas species (25%). Postoperatively, AGS yielded bacteria in 71% and fungi in 21% at the meatus, (staphylococci 57% and pseudomonas 25%). TM samples yielded bacteria in 69%, fungi in 6%, staphylococci in 53%, and pseudomonas in 19%. Ofloxacin concentration at the meatus was 248 μg/mL (95% confidence interval [CI]: 119‐377) and at the TM was 126 μg/mL (95% CI: 58‐194). Ofloxacin‐resistant colonies were found in 75% of patients. Conclusion: Analysis of AGS is a viable technique for noninvasively studying healing metrics posttympanoplasty, including the microbiome and otic antibiotic exposure. Despite exposure to a high concentration of quinolones, the tympanoplasty wound is far from sterile, which may impact healing outcomes. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives Databases Reviewed Methods Results Conclusions The aim is to investigate the influence of an active otitis media on the success rate of tympanoplasty in patients with a chronic otitis media (COM) and a tympanic membrane perforation.PubMed, Embase and the Cochrane Library.The inclusion criteria were studies on closure rates of tympanoplasty performed in COM patients of any age with a tympanic membrane perforation caused by COM. The exclusion criteria were studies on patients undergoing concomitant mastoidectomy, ossicular chain reconstruction, tuboplasty, adenoidectomy, revision tympanoplasty, patients with perforations due to other conditions than COM, and letters to editors, commentaries, conference abstracts and case reports. The included articles were critically appraised using the QUIPS tool. Data on tympanic membrane closure rate were extracted, odds ratio (OR) and 95% confidence intervals (CI) of the closure rate with a wet versus a dry ear were calculated.The search was performed on 1 February 2023. Of 4671 articles, 16 studies were included and critically appraised. Of these observational studies (nine prospective, seven retrospective), with a total of 1509 patients (dry ear group n = 1003; wet ear group n = 506), two studies stated a significant difference in success rate, one in favour of a dry ear and one in favour of a wet ear at time of surgery. All other studies did not show a statistically significant difference. Overall, the risk of bias was considered moderate to high.We found no significant prognostic value of having an active otitis media during tympanoplasty on tympanic membrane closure rates. Because the overall risk of bias was considered moderate to high, no strong conclusions can be made. To be able to answer this question with higher levels of evidence, high‐quality prospective or randomized studies are needed. [ABSTRACT FROM AUTHOR]

Objective: To compare the cost-effectiveness of serial non-echo planar diffusion weighted MRI (non-EP DW MRI) versus planned second look surgery following initial canal wall up tympanomastoidectomy for the treatment of cholesteatoma. Methods: A decision-analytic model was developed. Model inputs including residual cholesteatoma rates, rates of non-EP DW MRI positivity after surgery, and health utility scores were abstracted from published literature. Cost data were derived from the 2022 Centers for Medicare and Medicaid Services fee rates. Efficacy was defined as increase in quality-adjusted life year (QALY). One- and 2-way sensitivity analyses were performed on variables of interest to probe the model. Total time horizon was 50 years with a willingness to pay (WTP) threshold set at $50 000/QALY. Results: Base case analysis revealed that planned second-look surgery ($11 537, 17.30 QALY) and imaging surveillance with non-EP DWMRI ($10 439, 17.26 QALY) were both cost effective options. Incremental cost effectiveness ratio was $27 298/QALY, which is below the WTP threhshold. One-way sensitivity analyses showed that non-EP DW MRI was more cost effective than planned second-look surgery if the rate of residual disease after surgery increased to 48.3% or if the rate of positive MRI was below 45.9%. A probabilistic sensitivity analysis at WTP of $50 000/QALY found that second-look surgery was more cost-effective in 56.7% of iterations. Conclusion: Non-EP DW MRI surveillance is a cost-effect alternative to planned second-look surgery following primary canal wall up tympanomastoidectomy for cholesteatoma. Cholesteatoma surveillance decisions after initial canal wall up tympanomastoidectomy should be individualized. Level of Evidence: V. [ABSTRACT FROM AUTHOR]

Introduction: Fat tympanoplasty is repair of small dry tympanic membrane perforations using fat as graft material. It is a simple office procedure with minimal morbidity and manipulation of the middle ear. Materials and Methods: The present study was a prospective review of 60 patients who underwent fat tympanoplasty over the period of 15 months. In all the patients fat was harvested from ear lobule. Results: Patients were kept on follow up for 3 months and evaluated for graft uptake and hearing gain. 86.66% closure rate of tympanic membrane defect was achieved. Postoperative air conduction was 29.6 ± 5.3 while air bone gap was 13.2 ± 6.1. Conclusion: The study concludes that fat plug myringoplasty is a simple, quick, less invasive method to repair small tympanic membrane defects. [ABSTRACT FROM AUTHOR]

Aim: This is a study is to estimate hearing outcome after type 1 tympanoplasty using temporalis fascia as graft by underlay technique and to know about factors influencing outcome like age, gender, affected ear and size of the perforation. It is done by comparing our preoperative and post-operative audiological results with that of previous studies. Method: A total of 33 patients (34 ears) with CSOM who underwent type I tympanoplasty in the department of E.N.T, K.R. Hospital, Mysore were studied during the period of 18 months (January 2021 to June 2022). A detailed proforma was filled for each patient regard to personal details, clinical history, examination, investigations, surgical procedures and post-operative follow up visits. Audiological evaluation using pure tone audiometry was done pre operatively and at 6 and 12 weeks post operatively. Results are tabulated. Statistical analysis is done. Results: In our study of 34 cases, graft take up is 91.17%, mean hearing gain is 12.6dB and mean air bone gap closure is 13.7dB. Incidence of cases is more in the age group of 21-30 years (32.4%). Graft take up and hearing gain in younger age group (93.75% &12.9dB), male patients (100% &13.5dB) are better but this finding is not statistically significant. Patients with normal contralateral ear (100% &14.35dB), perforation size <50% size (90% & 11.5dB) have better graft take up rate and hearing outcome, which are statistically significant. Conclusion: The primary objective of surgery for CSOM is to eradicate infection and disease and make the ear safe and dry and second objective is to restore hearing. For central perforations with good cochlear reserve Type 1 tympanoplasty is good choice. Status of the opposite ear and size of the perforation have a significant role in the outcome of type I tympanoplasty. [ABSTRACT FROM AUTHOR]

To determine the predictive factors for residual disease occurring after surgical removal of congenital cholesteatomas and whether these predictive factors differ between microscopic ear surgery (MES) using data from the literature and transcanal endoscopic ear surgery (TEES) using data from our own institution. Twenty-three patients with a congenital cholesteatoma who underwent surgical treatment at Yamagata University Hospital between December 2011 and December 2017 were retrospectively investigated. We divide TEES into three different approaches: non-powered TEES, powered TEES and dual MES/TEES. Main outcome measures were Potsic stage, closed or open congenital cholesteatoma type, TEES surgical approach, appearance of residual disease, tympanoplasty type and hearing outcome. A logistic regression analysis was conducted on the Potsic stage, closed or open type, TEES surgical approach and age to obtain the odds ratio for residual disease. The chance of residual disease significantly increased in the presence of an open-type congenital cholesteatoma (odds ratio: 30.82; 95 % confidence interval: 1.456–652.3; p = 0.0277), but not for any of the other factors including Potsic stage. The timing of the confirmation of residual disease after ossicular chain reconstruction was analyzed using a Kaplan-Meier analysis. The residual disease rate was significantly higher with an open-type congenital cholesteatoma (log-rank test, p < 0.05). In addition, all residual disease occurred within three years after surgery. Our results showed that an open-type congenital cholesteatoma is the strongest predictive factor for residual disease when removing a congenital cholesteatoma by TEES. [ABSTRACT FROM AUTHOR]

Aims: In this study, we attempt to compare the pure tone audiometry findings with ossicular chain status intraoperatively in patients of chronic otitis media. Materials and methods: 102 patients who presented with COM during a period of one year and met the inclusion criteria were included in the study. All patients underwent preoperative pure tone Audiometry and findings were tabulated. All patients were evaluated intraoperatively by the same surgeon and observations were made regarding ossicular chain integrity. Results: Small central perforation was noted in 10%, medium central perforation in 38.57%, large central perforation in 27.14% and subtotal perforation in 24.28%. 71.56% patients had an intact ossicular chain, of which 94.5% was mucosal disease and 5.5% were squamous disease. 29 cases showed eroded/absent ossicles, out of which, 28 had squamous type and 1 case had central perforation. Ossicular status was classified based on Austin Classification. Conductive hearing loss was found to be maximum where all 3 ossicles were eroded/absent, with a mean AB gap of 45.33 and mean air conduction threshold of 60.33. Conclusion: There is a good correlation between the hearing threshold of the patient and the status of ossicular chain. Preoperative knowledge of the degree of hearing loss and status of ossicular chain would allow the surgeon to plan proper ossicular reconstruction and give the patient a better advice regarding prognosis of hearing improvement after surgery. [ABSTRACT FROM AUTHOR]

Primary objective of this study was to compare the role of canalplasty in tympanoplasty, with that of only tympanoplasty, in patients of chronic suppurative otitis media with narrow external auditory canal and moderate to large central perforation, in terms of hearing improvement, graft uptake, intra operative ease. This study included 60 patients with chronic mucosal otitis media with narrow external auditory canal, with moderate to large central perforation, presenting to our institution from September 2019 to August 2021. Group A consisted of 30 patients, who underwent tympanoplasty with canalplasty and Group B consisted of 30 patients, who underwent tympanoplasty without canalplasty. Both the groups were followed up for 3 months, compared and analysed for hearing improvement and graft uptake. The results of our study indicated that Group A achieved 93.3% graft uptake rates compared to group B which achieved 80%. In Group A gain in air bone gap was 12.43 dB, whereas in Group B it was about 9.50 dB. Group A had significant hearing improvement and better graft uptake compared to Group B. It is advantageous to perform canalplasty prior to tympanoplasty in patients with narrow external auditory canal in whom the entire rim of annulus is not visible in one microscopic view. It yields better hearing improvement and graft uptake and prevents lateralization of the graft. [ABSTRACT FROM AUTHOR]

Aims: To study the outcome of cartilage tympanoplasty type I in patients with medium and large perforations using 0.5 mm sliced conchal cartilage reinforced with temporalis fascia grafts with 5 years follow-up. Study Design: Retrospective clinical study. Patients and Method: 120 patients with dry tympanic membrane perforation medium and large size and intact ossicular chain, and with no history of previous ear surgery were selected. An underlay type one tympanoplasty, using 0.5 mm sliced conchal cartilage reinforced with temporalis fascia, was performed during 2018-19. A successful anatomical outcome was considered to comprise full, intact healing of the graft without perforation these patients were evaluated for at least 5 years post-operatively till 2023. Results: In this study graft uptake rate was 95.33% for medium size and 93.66% for large perforations at 3 months and after 5 years of follow-up 92.77% medium size and large size perforations were 89.67.66% (P < 0.001). Residual perforations were there in about 7.29% in medium and 10.33% in large size perfrations. Conclusion: Sliced conchal cartilage reinforced with temporalis fascia is a reliable technique for tympanoplasty, with improved graft uptake results in medium and large perforations in the long-term, also the residual perforations is significantly lower. [ABSTRACT FROM AUTHOR]

Purpose: To compare the audiological outcomes, tympanic membrane (TM) healing rates and complication rates in patients undergoing endoscopic underlay and over–under tympanoplasty type I (TTI). Methods: The study includes 95 patients who underwent endoscopic TTI in the period between 2018 and 2023: 56% of the patients had the underlay technique and 41% had the over–under technique. Data regarding pre- and postoperative hearing, perforation characteristics, surgical procedures, graft types and complications were retrospectively analyzed. Audiometrical assessment included air conduction (AC) and bone conduction (BC) pure tone averages (PTA) and air–bone gap (ABG), pre- and postoperatively. Results: Both underlay and over–under techniques significant improved AC PTA, with a mean ABG improvements of 5.9 dB and 7.2 dB, respectively. There was no significant difference in BC PTA between pre- and post-operative, indicating no inner ear damage in both techniques. The over–under technique showed a significantly higher TM closure rate (94.4%) compared to the underlay technique (80.6%). Complications were rare, with only one case of TM lateralization requiring revision surgery. Conclusions: Endoscopic TTI is an effective treatment in improving auditory function in chronic middle ear diseases. In our cohort, the detachment of the umbo does not negatively influence the postoperative hearing results and does not increase rate of complications. Moreover, the over–under technique demonstrates superior TM closure rates, making it a valuable option for specific cases. However, future prospective studies with larger sample sizes and longer term follow-up are needed to validate these findings and provide more comprehensive insights. [ABSTRACT FROM AUTHOR]

Cholesteatoma secondary to tympanic perforation, known as "secondary acquired cholesteatoma" may progress slower than a retraction pocket cholesteatoma, with less bone destruction and fewer intracranial complications. However, complete surgical removal remains difficult because the pathological epithelium on the marginal side of the extension is not covered by the subepithelial layer of the cholesteatoma matrix, making the boundary with the middle ear mucosa difficult to identify. Therefore, considering the pathophysiology of secondary acquired cholesteatoma, suitable preoperative evaluation and surgical techniques are required. In this study, we aimed to evaluate (i) the extension of secondary acquired cholesteatoma according to the size and location of tympanic membrane perforation; and (ii) the microscopic surgical outcomes, including the rate of residual cholesteatoma, requirement for specialized surgical management, and changes in hearing. This retrospective study included data of cases with secondary acquired cholesteatoma (n = 66; 66 ears of 64 patients, 2 patients had bilateral ear involvement), including those who underwent a staged operation (n = 25). The perforation level of the tympanic membrane was associated with the cholesteatoma extension. When the cholesteatoma extended around the stapes, staged operation was chosen. Six cases of spontaneous resolution of stapes lesions at the time of staged surgery were observed. A significant postoperative improvement in hearing was observed; however, five cases experienced sensorineural hearing loss. Surgery, including staged surgery of the stapes lesions, along with careful observation of the perforation, is required in secondary acquired cholesteatoma. For lesions that are visible yet challenging to remove, it is imperative to exercise prudent judgment, taking into account the possibility of spontaneous resolution. [ABSTRACT FROM AUTHOR]

Objective To investigate the relationship between the efficacy of type Ⅰ tympanoplasty and the function of the eustachian tube (ET) in chronic suppurative otitis media (CSOM). Methods One hundred patients diagnosed with CSOM all underwent type Ⅰ tympanoplasty who were divided into a dysfunctional group and a normal group according to the results of preoperative eustachian tube function test. The patients were followed up for 6 months after surgery, and their hearing outcomes and tympanic membrane healing were recorded and analyzed. Results The tympanic membrane healing rate was 91.70% (44/48) in the normal group and 78.80% (41/52) in the dysfunctional group, with a statistically significant difference between the two groups (P<0.05). The pure tone audiometry (PTA) and air-bone gap (ABG) of patients in the ET disorder group and the normal group were all lower than those before surgery (P<0.05). The PTA and ABG differences between the two groups were statistically significant (P<0.05) before surgery and 6 months after surgery respectively, but there was no significant difference in the difference of PTA or ABG before and after surgery between the two groups (P>0.05). Conclusions ET functional status does not have a great effect on hearing recovery after CSOM tympanoplasty, but it affects the healing rate of the tympanic membrane after surgery. Therefore, it is necessary to assess ET function before tympanoplasty to help us initially predict the patient’s recovery after surgery [ABSTRACT FROM AUTHOR]

Chronic suppurative otitis media (CSOM) is a leading global cause of potentially preventable hearing loss in children and adults, associated with socioeconomic deprivation. There is an absence of consensus on the definition of CSOM, which complicates efforts for prevention, treatment, and monitoring. CSOM occurs when perforation of the tympanic membrane is associated with severe or persistent inflammation in the middle ear, leading to hearing loss and recurrent or persistent ear discharge (otorrhoea). Cholesteatoma, caused by the inward growth of the squamous epithelium of the tympanic membrane into the middle ear, can also occur. The optimal treatment of discharge in CSOM is topical antibiotics. In resource-limited settings where topical antibiotics might not be available, topical antiseptics are an alternative. For persistent disease, surgery to repair the tympanic membrane or remove cholesteatoma might offer long-term resolution of otorrhoea and potential improvement to hearing. Recent developments in self-fitted air-conduction and bone-conduction hearing aids offer promise as new options for rehabilitation. [ABSTRACT FROM AUTHOR]

Background: Transcanal endoscopic ear surgery (TEES) reportedly requires a long learning curve and may be associated with more complications and longer operative times than microscopic ear surgery (MES). In this study, we aimed to examine the usefulness and validity of TEES for ossicular chain disruption in the early stages of its introduction in our institution. Methods: TEES was performed on 11 ears (10 with congenital ossicular chain discontinuity and 1 with traumatic ossicular chain dislocation), and MES was performed with a retroauricular incision on 18 ears (6 with congenital ossicular chain discontinuity and 12 with traumatic ossicular chain dislocation) in a tertiary referral center. Postoperative hearing results, operative times, and postoperative hospital length of stay were retrospectively reviewed. The Mann–Whitney U test and Fisher's exact test was performed to compare variables between the TEES and MES groups. Pre- and postoperative air- and bone-conduction thresholds and the air–bone gap of each group were compared using the Wilcoxon signed-rank test. The Mann–Whitney U test and Wilcoxon signed-rank was performed to compare the pre- and postoperative air–bone gaps between the diagnoses. Results: No significant differences in the postoperative air-conduction thresholds, bone-conduction thresholds, air–bone gaps, or incidence of air–bone gap ≤ 20 dB were observed between the TEES and MES groups. The air-conduction thresholds and air–bone gaps of the TEES group significantly improved postoperatively. The air-conduction thresholds and air–bone gaps of the MES group also significantly improved postoperatively. No significant difference was observed in the operative times between the groups (TEES group: median, 80 min; MES group: median, 85.5 min). The TEES group had a significantly shorter postoperative hospital stay (median, 2 days) than the MES group (median, 7.5 days). Conclusions: TEES was considered appropriate for the treatment of ossicular chain disruption, even immediately after its introduction at our institution. For expert microscopic ear surgeons, ossicular chain disruption may be considered a suitable indication for the introduction of TEES. [ABSTRACT FROM AUTHOR]

A study published in Clinical Otolaryngology compares the use of the VITOM-3D exoscope and the traditional operating microscope for major ear surgery. The study finds that the exoscope can be a viable alternative, with similar outcomes in terms of complications, graft status, audiometric results, and cholesteatoma recurrence. However, it is important to carefully select cases for the exoscope and note that it is not compatible with KTP lasers. The study provides valuable insights into the use of this technology in otolaryngology, but further research is needed to address its limitations and fully understand its potential. [Extracted from the article]

Purpose: This multicentric, retrospective study aimed to analyze the short-term safety and effectiveness of the mCLIP Partial Prosthesis. Methods: Patients underwent tympanoplasty with implantation of a mCLIP Partial Prosthesis. Follow-up examination included ear microscopy and pure-tone audiometry to determine the post-operative pure tone average of the frequencies 0.5, 1, 2 and 3 kHz (PTA4). The post-operative PTA4 air bone gap (ABG) was used to evaluate the audiological outcome. A post-operative minimum and maximum follow-up period was not defined. Thus, the follow-up times of each study center were different, which resulted in different follow-up times for the audiological analysis and for adverse events (AE). Results: 72 (66 adults, 6 children) patients were implanted with the mCLIP Partial Prosthesis. 68 (62 adults, 6 children) patients underwent audiological examination; all 72 patients were examined for adverse events. All patients (N = 68): 72.1% of the patients showed a PTA4 ABG of ≤ 20 dB. Individual post-operative bone conduction (BC) PTA4 thresholds were stable in 67 patients. The mean post-operative follow-up time was 78 ± 46 days. Children (N = 6): 5 out of 6 children showed a PTA4 ABG of ≤ 20 dB. None of the children reported a BC PTA4 deterioration of > 10 dB HL after the implantation. The mean post-operative follow-up time was 101 ± 45 days. Adverse events (all patients, N = 72): 15 (14 adults, 1 child) patients had AEs (27 AEs and 2 Follow-Ups). The mean post-operative follow-up time was 375 days. Conclusion: Clinical data show satisfactory audiological parameters after implantation of the mCLIP Partial Prosthesis. The prosthesis is safe and effective for implantation in children and adults. Trial registration number: NCT05565339, 09 September 2022, retrospectively registered. [ABSTRACT FROM AUTHOR]

Objectives: To analyze and compare the available data about the outcomes of endoscopic and microscopic type I tympanoplasty. Data sources: PubMed, Cochrane library Ovid, Scopus, Google scholar, and ClinicalTrials. Methods: We conducted a meta-analysis in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. We included comparative studies describing type I tympanoplasty, and comparing surgical outcomes of the endoscope with the microscope in terms of efficacy and safety. Results: Our systematic search yielded 22 studies meeting the inclusion criteria and eligible for analysis. The pooled graft uptake rates and audiological results of endoscopic and microscopic tympanoplasty demonstrated non-significant differences. In contrast, endoscopic type I tympanoplasty outperforms microscopic tympanoplasty regarding a highly significant decrease not only in pooled mean operative time but also in the pooled complications rate. Conclusions: Based on our meta-analysis, the surgical outcomes of endoscope-assisted and microscope-assisted type I tympanoplasty in terms of postoperative hearing outcomes and the graft uptake rate were comparable. On the contrary, operative time and complications rate proved to be significantly reduced with endoscopy compared to microscopy. Hence, the endoscope is as efficient as the microscope in type I tympanoplasty but less invasive, fewer in complications and shorter in operative time. Key Points: Can the endoscope be a good alternative to the microscope in type I tympanoplasty? Using the microscope in tympanoplasty has been the conventional procedure for repairing perforated tympanic membranes since the 1950s. However, ear surgeons have increasingly practised endoscope-assisted tympanoplasty since the late 1990s. In this study, surgical outcomes of both techniques in terms of postoperative audiological results and the graft uptake rate were comparable. In contrast, the endoscopic technique was superior to the microscopic one in terms of operative time and complications rate. According to our study, the endoscope-Assisted type I tympanoplasty proved to be as effective as the microscopic technique but safer and less invasive. [ABSTRACT FROM AUTHOR]

Objective: Few reports discuss the characteristics of repeated recidivism of cholesteatoma. We describe the clinical characteristics of patients with cholesteatoma who experienced at least two recidivism episodes after initial surgery for cholesteatoma requiring canal wall reconstruction. Methods: We reviewed the medical records of 11 patients who underwent surgery for cholesteatoma with canal wall reconstruction at our department between April 2008 and March 2018 and subsequently experienced two relapses that necessitated revision surgery involving tympanomastoidectomy with canal reconstruction. Patient age at the time of the first surgery ranged from 6 to 56 (mean, 25.7) years. Seven (63.6%) of the 11 patients were male. These 11 patients were classified according to the type of recidivism, and their characteristics (pathology, operation date, operation method, pattern of relapse, and position of recurrence) were investigated. Results: Four cases involved secondary residual cholesteatoma, with the mean interval between the first revision surgery and the second revision surgery being 23.8 (range, 11–39) months. Secondary residual sites included the anterior tympanic cavity, tympanic sinus, and anterior end of the reconstructed cartilage of the canal wall. The other seven cases involved secondary recurrence, with the mean interval between the first and the second revision surgery being 26.1 (range, 12–57) months. The sites of recurrence were at the edges of the reconstructed cartilage. One notable case involved the cartilage junction, leading us to hypothesize that retraction of the temporal muscle flap and the patulous Eustachian tube was the underlying cause. Conclusion: For residual cholesteatoma, strict measures are necessary to maintain the operation under clear view, and more careful follow-up is necessary in patients who have had previous surgery at another hospital. For recurrent cholesteatoma, it was recognized that Eustachian tube function must be ascertained in advance, and careful observation of the reconstructed cartilage edge is necessary. [ABSTRACT FROM AUTHOR]

Background: Factors related to surgical outcomes of type I tympanoplasty for tympanic membrane (TM) perforation in children are controversial. Objectives: To investigate factors related to anatomical results of type I tympanoplasty for TM perforation 1 year after surgery. Material and methods: We examined 68 ears. Anatomical results were determined based on the presence or absence of re-perforation, atelectasis, and otitis media with effusion. We retrospectively analyzed factors based on age (≤8 and >8 years), cause and size of TM perforation (<50% and ≥50%), history of asthma and cleft palate, and size of mastoid air cell system in bilateral ears before tympanoplasty. Audiological prognosis was evaluated in ears with anatomical success 1 year after surgery. Results: Anatomical success was achieved in 80.9% (55/68) of the ears. No significant differences were observed between these factors and anatomical results. All children with cleft palate had anatomical success. Mean pure-tone average (0.5–4 kHz) was 16.25 dB HL for ears with both TM perforations <50% and ≥50%. Conclusion and significance: We observed no significant relationship between factors considered and surgical outcomes. However, audiological prognosis was favorable for anatomical success regardless of TM perforation size. Accordingly, type I tympanoplasty is considered useful for TM perforation in children. [ABSTRACT FROM AUTHOR]

Objective: Our goal was to examine the impact of head position, which had not been examined before, on cerebral oxygenation in tympanoplasties performed in the reverse Trendelenburg position during controlled hypotension. Methods: This prospective study was conducted in our clinic between July 2020 and November 2020. A total of 81 patients aged 18-59 years, who had an ASA physical condition classification score of 1-2 and were evaluated in two groups according to the type of surgery. In the tympanoplasty group, the head was turned to the contralateral ear and placed in minimal extension while in the septoplasty group, the head was kept in the neutral position. The regional cerebral oxygen saturation (c-rSO2) values of the right and left sides were recorded continuously with O3 regional oximetry probes on both sides throughout the operation. Results: When an overall examination was performed without separating the tympanoplasty group as right/left, the median oxygen saturation level was 69.50% (Q1:61.00-Q3:72.00) for the operated side and 74.00% (Q1:66.00-Q3:79.00) for the contralateral side. The oxygen saturation of the operated side was statistically significant lower (p<0.001). The median oxygen saturation of the operated side in the tympanoplasty group [69.50% (Q1: 61.00- Q3:72.00)] was statistically significantly lower than that of the septoplasty group [72.00% (Q1:65.25-Q3:77.75)] (p=0.004). Conclusion: This study showed that the rotation of the head 45° or above in the revers Trendelenburg supine position causes cerebral desaturation on the opposite side of rotation. [ABSTRACT FROM AUTHOR]

Myringoplasty is still the most performed otological surgery. Nevertheless, the underlay vs. overlay approaches have yet to be determined. The purpose of this study is to compare the surgical and audiological outcomes of underlay and overlay myringoplasty in perforated tympanic membrane patients. A systematic review and meta-analysis synthesizing randomized controlled trials (RCTs), which were retrieved by systematically searching of Web of Science, SCOPUS, PubMed, and Google Scholar until January 25th, 2023. RevMan version 5.4 software was used to pooled dichotomous outcomes using the risk ratio (RR) with the corresponding 95% confidence interval (CI). We registered our protocol in PROSPERO with ID: [CRD42023387432]. We included eight RCTs with 656 tympanic perforation membrane patients. Four RCTs had a low risk of overall bias, two had some concerns, and two had a high risk of bias. The underlay technique was significantly associated with a higher surgical success rate (n = 7 RCTs, RR: 1.21 with 95% CI [1.02, 1.43], P = 0.03) and audiological success rate (n = 4 RCTs, RR: 1.31 with 95% CI [1.18, 1.44], P < 0.00001). This meta-analysis underscores the potential superiority of the underlay technique in managing tympanic membrane perforations, with significant implications for surgical and audiological outcomes. However, more investigations are still necessary to confirm this result. [ABSTRACT FROM AUTHOR]

The Objective of the study was to assess the ossicular status in chronic otitis media (COM)—mucosal and squamosal type and statistically evaluate the extent of ossicular destruction intraoperatively in COM patients. The findings of this study could help us to predict preoperatively the probability of having ossicular chain destruction in COM ears and thus patients could therefore be properly consented about these potential issues before surgery. The study was carried out in ENT department of tertiary health care hospital, between January 2019 to January 2020. All patients of all age groups and both genders, diagnosed with COM Mucosal and Squamosal Type with complaints of ear discharge and hearing loss with good cochlear reserve and requiring surgery were included in the study, after taking informed written consent in vernacular language. All the patients included in the study were evaluated with detailed history, clinical examination including otomicroscopy, tuning fork tests and pure tone audiometry. The patients were then posted for ear surgery and the middle ear status and ossicular chain status were assessed using a microscope intraoperatively. Out of 98 patients, 45(45.9%) had mucosal and 53 (54.08%) had squamosal disease. Ossicular chain was eroded in 69 cases (70.5%). 23 out of 45 (51.1%) mucosal cases and 46 out of 53 squamosal cases (86.7%) reported ossicular erosion. Most frequently involved was long process of incus > stapes > malleus. From our study, we concluded that there is a significant relationship between type of disease pathology in middle ear and ossicular erosion being higher in Squamosal type of COM, with malleus being the most resistant and incus being the most susceptible ossicle. [ABSTRACT FROM AUTHOR]

Introduction: Chronic Otitis Media (COM) is a common ear disorder that predominantly affects underdeveloped countries. It is characterised by persistent middle ear discharge and a perforated Tympanic Membrane (TM). Management typically involves antibiotics and surgical techniques like tympanoplasty to eradicate infections and improve the auditory conduction system. Various graft materials are used, with temporalis fascia being preferred due to its proximity and ease of harvesting. Aim: To evaluate the surgical outcomes of tympanoplasty procedures utilising different graft materials in patients diagnosed with inactive mucosal COM. Materials and Methods: This retrospective cohort study was conducted in the Department of Otorhinolaryngology at Acharya Vinoba Bhave Rural Hospital (AVBRH), Wardha, Maharashtra, India, between June 1, 2013, and May 31, 2023. A total of 165 participants with inactive mucosal COM, who had small to subtotal central perforations of the TM, were included. Tympanoplasty, performed by the same surgeon using the Zeiss surgical microscope model OPMI under general anaesthesia, was the chosen surgical procedure. All cases were executed using the postauricular approach with the underlay technique. A successful anatomical outcome was defined as an intact neo-TM without residual perforation at the end of a three-month follow-up. Results: The age of participants ranged from 10 to 75 years, with a mean age of 32.45±14.06 years. The age group most frequently affected by mucosal COM was between 31-40 years, comprising 41 (24.85%) cases. Large perforations were observed in 79 (47.88%) patients, followed by moderate perforations in 65 (39.39%) patients. Normal ossicular chains were found in 163 (98.78%) patients, while ossicular erosion was noted in 2 (1.22%) patients during surgery. A total of 118 (100%) patients who came for follow-up, 84 (71.19%) who underwent temporalis fascia graft reconstruction showed successful graft uptake. Conclusion: This study found that both fascia and cartilage tympanoplasty are suitable for TM repair due to their availability. [ABSTRACT FROM AUTHOR]

Purpose: The study aimed to evaluate the long-term clinical, radiological, and functional results for subtotal petrosectomy and cochlear implant surgery with closure of the external auditory canal and fat obliteration. Methods: We retrospectively included all consecutive cases of simultaneous subtotal petrosectomy and cochlear implant surgery performed at a tertiary referral center between 2009 and 2016 using the same surgical technique. All patients underwent postoperative high-resolution computed tomography (HRCT) and annual audiological assessments. A 5-year minimum clinical, radiological, and audiological follow-up was performed. The early and late postoperative results were compared. The main outcome measures were complications, postauricular retraction, fat graft reabsorption, and audiological outcomes. Results: Twenty-nine procedures performed in 23 patients (six bilateral) met the inclusion criteria. The mean age of the patients was 67 ± 13.4 years and mean follow-up duration was 7.5 ± 2 years. At follow-up, postauricular retraction was detected in 24 cases (82.8%), including five cases (17.1%) with subcutaneous protrusion of implant and array. Fat graft volume was significantly reduced at late-HRCT in terms of maximum diameter (2.24 ± 1.0 cm vs 3.69 ± 0.7 cm; p < 0.0005) and surface area (1.88 ± 1.2 vs 4.24 ± 1.6 cm2, p < 0.0005). Six patients had extracochlear electrodes at late-HRCT (3/6 had an increased number of extracochlear electrodes), with a lowering of this group's performance of – 15% (p < 0.005) in the follow-up speech comprehension test. Conclusions: Subtotal petrosectomy with cochlear implantation is an effective long-term technique in selected cases. Fat grafts showed significant reabsorption at long-term follow-up with reaeration of the middle ear spaces. Prolonged clinical and radiological follow-up is recommended for monitoring implant performances and late complications. [ABSTRACT FROM AUTHOR]

Introduction: Chronic otitis media (COM) with the perforation of the tympanic membrane, myringoplasty is preferred treatment, but if ossicles are involved, myringoplasty is done with ossiculoplasty which is termed as tympanoplasty. Preoperative assessment of ossicular status is important to decide the type of tympanoplasty. Ossicular chain continuity is generally seen in the patient who has short duration of disease and smaller air–bone gap. Our study was conducted to support the relationship between preoperative clinical, audiological, and other factors in relation to the ossicular chain status. Materials and Methods: This was a prospective, cross‑sectional study conducted at a tertiary care center, for 2‑year duration (November 2019 to November 2021), on 100 patients who presented with COM (mucosal type). Preoperative diagnosis and assessment based on the clinical examination and investigations were compared with operative findings. Results: Thirty percent of the patients had ear discharge duration <1 year, 28% had 1–5 years, and 18% patients had 6–10‑year duration. Hearing loss was present in 80% of the cases. Correlation of pure‑tone average (PTA) with ossicular chain status was significant with P = 0.028. The majority of patients were in the moderate category 31% and 19.36% of patients had ossicular chain defect. The second common category was mild hearing loss (24%), of which 4.17% of patients showed ossicular chain defect. Conclusion: Maximum percentages of patients with severe hearing loss had ossicular chain discontinuity followed by profound hearing loss. Most of cases had moderate to moderately severe conductive hearing loss in PTA. As the air–bone gap increases, the possibility of ossicular discontinuity increases. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to determine the efficacy and safety of platelet‑rich plasma (PRP) as an adjuvant for tympanoplasty for perforations of the tympanic membrane with temporalis fascia versus tympanoplasty with temporalis fascia only. Materials and Methods: A total of 100 patients diagnosed with chronic suppurative otitis media tubotympanic type were divided into groups of 50 each. Patients in group one underwent tympanoplasty with PRP, while those in the second group underwent tympanoplasty without PRP. Pre‑ and postoperative graft status and pure‑tone audiometry were performed for all the patients, and the outcomes were compared. Results: Graft uptake in the case group was 90% and while in the control group was 84%. The result was better in cases that underwent tympanoplasty with PRP. The improvement in the A‑B gap was significantly more in the case group as compared to that of the control group. Conclusion: Temporalis fascia graft alone and along with PRP, both techniques has excellent results. The use of PRP along with temporalis fascia in cases of large central perforation gives an additional benefit in respect to healing time and audiological gain. [ABSTRACT FROM AUTHOR]

Although congenital middle ear anomalies include various types of ossicular anomalies, all of these can be treated by ossiculoplasty or stapes surgery. Transcanal endoscopic ear surgery (TEES) is a minimally invasive surgical method for middle ear disease with an excellent surgical view that has been widely adopted worldwide. To determine the efficacy of TEES for middle ear anomalies, we describe the surgical results and compare the hearing outcomes between patients treated by TEES and microscopic ear surgery (MES). A total of 39 ears with congenital middle ear anomalies were treated surgically at the University Hospital of Kochi Medical School between January 2011 and December 2021. In total, 29 ears of 23 patients were included in the study. Demographics, type of anomaly, surgical methods, pre- and postoperative hearing thresholds, and surgical complications were investigated by retrospective chart review. Of the 29 ears, 11 were treated by MES and 18 were treated by TEES. There were no differences in sex, age, preoperative hearing thresholds, or rate of stapes surgery between the two groups. The mean air-bone gap improvement was 20.6 dB in the MES group and 28.8 dB in the TEES group; these values were not significantly different. The median operation time was not significantly different between the MES and TEES groups (125 and 130 min, respectively). The improvements of air conduction in class 1 and 2 (stapes surgery) and class 3 (ossiculoplasty) cases were also not different between the groups. TEES achieved comparable hearing outcomes to MES without postauricular or endaural incisions. Further, class 1 and 2 anomalies demonstrated hearing improvement similar to class 3 without major complications. Since the surgical field limited around the ossicular chain, coupled with the fact that the middle ear anomaly itself does not exhibit inflammation leading to unfavorable bleeding, TEES is a feasible surgical procedure for all types of congenital ossicular anomalies. [ABSTRACT FROM AUTHOR]

Background: The indications for transcanal endoscopic ear surgery (TEES) for middle ear cholesteatoma have expanded for cases involving mastoid extension. However, TEES is not indicated for all cases with mastoid extension. In addition, predicting the extent of external auditory canal (EAC) removal needed for cholesteatoma resection is not always easy. The purpose of this study was to use augmented reality (AR) to project the lesion onto an intraoperative endoscopic image to predict EAC removal requirements and select an appropriate surgical approach. Methods: In this study, patients showing mastoid extension were operated on using a navigation system with an AR function (Stryker). Results: The results showed that some cases with lesions slightly extending into the antrum required extensive resection of the EAC, while cases with lesions extending throughout the antrum required smaller resection of the EAC, indicating TEES. Conclusions: By predicting the extent of the needed EAC removal, it is possible to determine whether TEES (a retrograde approach) or canal wall-up mastoidectomy, which preserves as much of the EAC as possible, should be performed. We believe that our findings will contribute to the success of middle ear surgeries and the implementation of robotic surgery in the future. [ABSTRACT FROM AUTHOR]

Inflammatory conditions such as chronic otitis media (COM) can cause irreversible impairments in the microarchitecture and functions of the incus, which subsequently leads to conductive hearing loss. To investigate bone mineral density (BMD) of the incus body (IB) and long process (ILP) on preoperative temporal CT in COM patients with and without incudo-stapedial joint discontinuity (ISJD), and also to determine the association between BMD values and the postoperative air-bone gap (ABG) in the ISJD group. The mean IB density (IBD)/occipital bone density (OBD) and ILP density (ILPD)/OBD values were compared between the patients with and without ISJD. The correlation between ABG gain and preoperative incus density values was assessed in the ISJD group. The mean IBD/OBD and ILPD/OBD values were significantly higher in patients with intact ISJ. There was a moderate positive correlation between postoperative ABG gain and ILPD/OBD values in the ISJD group. The decrease in BMD of the incus may involve ILP as well as IB in patients with ISJD caused by ILP lysis in COM. A higher preoperative ILPD/OBD was correlated with a higher postoperative ABG gain in COM patients with ISJD. [ABSTRACT FROM AUTHOR]

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

BACKGROUND: A labyrinthine fistula is a severe complication of middle ear cholesteatoma that can cause profound sensorineural hearing loss and vertigo. However, there is no consensus regarding the transition to postoperative hearing. Although hearing deteriorates gradually with a delay in some cases of labyrinthine fistula, insufficient consideration has been given to this point. We examined perioperative changes in cases of middle ear cholesteatoma with labyrinthine fistulas. METHODS: We retrospectively reviewed the medical records of 578 patients with middle ear cholesteatoma who underwent tympanoplasty at our hospital between 2016 and 2021. Patients with labyrinthine fistulas were selected; their perioperative bone-conduction hearing was assessed. Fistula depth was determined following the classification reported by Dornhoffer et al. The hearing was compared preoperatively, early postoperatively (3-6 months), and 1 year postoperatively. RESULTS: Forty-eight patients (8.3%) had labyrinthine fistulas. Regarding depth, 21 cases were type I, 14 were type IIa, 3 were type IIb, and 10 were type III. Preoperative bone-conduction hearing was significantly poor in invasion type IIb or deeper cases. Cases with type IIb or deeper fistulas, multiple fistulas, or vertigo deteriorated postoperatively. Type III cases or those with multiple fistulas deteriorated further from the early postoperative period to 1 year postoperatively. Concerning frequency, 500 and 2000 Hz showed a delayed deterioration. CONCLUSION: This is a valuable report of delayed hearing loss after surgery in patients with a labyrinthine fistula. This change is associated with the labyrinthine fistula’s depth and multiple fistulas—this is important during preoperative counseling of patients undergoing surgery [ABSTRACT FROM AUTHOR]