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Background: Chronic otitis media is a common middle ear disease that leads to varying degrees of hearing loss and otorrhoea. Tympanoplasty is a common surgery used for the reconstruction of sound conductive pathways in mucosal-type COM. Aims: The study aims to compare the fresh and the dry grafting technique in interlay type-1 tympanoplasty amongst the patients of inactive mucosal type chronic otitis media. Objectives: The objectives of the study are to compare graft uptake rate, pre-op and post-op AB gap, residual hearing loss, and average graft epithelialization time between the fresh and the dry grafting technique in interlay type-1 tympanoplasty. Methods: A retrospective cohort study of 48 patients of COM inactive mucosal-type who underwent interlay type-1 tympanoplasty between July 2020 and March 2022. Results: Out of 48 patients, in 23 patients, the fresh graft was used, while in the rest 25 patients, the dry graft was used. The overall (fresh + dry group) graft uptake rate at the end of three months was 97.9%. The graft uptake rate was 100% with the use of the fresh graft and 96% with the use of the dry graft. The pre-op average air-bone (AB) gap was 12.21 ± 4.23 dB in patients where the fresh graft was used and in patients where the dry graft was used. An overall pre-op average AB gap was 13.35 ± 3.81 dB. The average time for epithelialization was 24.43 ± 4.17 days with the use of the fresh graft and 49.75 ± 6.93 days with the use of the dry graft. It was also statistically significant with a P-value of 0.001. Conclusions: The fresh graft in the interlay type-1 tympanoplasty shows higher graft uptake rates, reduced epithelialization time, and better hearing improvement compared to dry graft. However, different complication rates are similar with the use of both types of grafts. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the current study was to evaluate the efficacy of PRF-augmented fascia tympanoplasty versus cartilage tympanoplasty in repair of large TM perforations. Methods: This randomized clinical trial included 156 patients with dry large tympanic membrane perforations. Patients were randomly allocated into 2 groups, cartilage tympanoplasty group (n = 77) and platelet rich fibrin (PRF) augmented tympanoplasty group (n = 79). Graft take rates, hearing outcomes, operative time, and postoperative complications were documented and compared. Results: Graft take rate was 96.1% in the cartilage group and 93.7% PRF group with no statistically significant difference. Operative time was significantly longer in the cartilage group. No differences in the hearing outcomes and postoperative complications were reported. Conclusion: Application of PRF on the fascia in tympanoplasty promotes healing of the tympanic membrane. PRF is safe, cheap, readily available, and easily prepared and applied. It increases the success rates of large tympanic membrane perforations without the need for cartilage grafts. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to determine the recurrence rate of cholesteatoma in patients who have undergone exclusive endoscopic tympanoplasty at our tertiary referral institution. A secondary objective is to analyze different clinical aspects that could be considered risk factors for recurrence to establish if it is possible to determine when a second-look procedure is indicated instead of a clinical follow-up. Methods: A retrospective study was performed on patients who had undergone exclusive endoscopic tympanoplasty for cholesteatoma in the last eight years and who were followed up for at least one year. The efficacy of the treatment performed only with the exclusive endoscopic technique was analyzed. Then, the anamnestic and intraoperative data were studied to identify possible factors that could increase the risk of recurrence. Results: The recurrence rate (14.5%) in patients (164) who underwent primary surgery with the exclusive endoscopic technique between January 2014 and January 2022 was similar to that in patients who underwent the microscopic technique with mastoidectomy in literature. In addition, we analyzed several clinical factors such as age, ossicular chain erosion, extension and localization of the cholesteatoma finding that only the last one could potentially be a risk factor for recurrence in this selected population. Conclusion: Exclusive endoscopic tympanoplasty has been shown to be effective in removing cholesteatoma in patients without evidence of mastoid involvement, with recurrence rates comparable to traditional microscopic technique and a minimally invasive approach, even considering the patient's age, ossicular chain erosion and extension of the disease. [ABSTRACT FROM AUTHOR]

Objectives: 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. Databases Reviewed: PubMed, Embase and the Cochrane Library. Methods: 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. Results: 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. Conclusions: 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]

Background: The Otitis media is an important and a highly prevalent disease of the middle ear and poses serious health problem world-wide especially in developing countries where large percentage of the population lacks specialized medical care. With a large number of patients frequently undergoing tympanoplasty for chronic suppurative otitis media (CSOM), it is important to assess the severity of the disease and predict the outcome of the surgical management. Materials and Methods: This was a prospective study of 90 cases of chronic otitis media, carried out over one year, who underwent various types of tympanoplasty, carried out in the Department of Ear, Nose, and Throat (ENT), Tertiary Care Teaching Hospital. The selection of cases was by convenience sampling method. All the cases of Chronic Otitis Media (COM), mucosal and squamous, in the age group of 10–80 years, irrespective of gender were included. Patients above 80 years, sensorineural or mixed hearing loss, COM with complications, any co morbid medical condition and unwilling patients were excluded. Result: The clinical profile of cases in present study. Almost all patients (97.8%) have complaint of on and off ear discharge followed by 91.1% cases having complaint of HOH followed by tinnitus (in 24.4% cases). In this study, 11.1% of the patients had active discharge. Maximum patients (48.9%) had ear dry for less than 3 months, rest had dry ear for more than 3 months. Three patients had history of trauma and no history of ear discharge. Ossicular involvement was seen in only 18.9% cases while in 81.1% cases, there was no ossicular involvement. In majority of cases (80%) middle ear mucosa was dry followed by wet mucosa in 13.3% cases. Total number of patients with score 1-3 (mild score) were 64.2%, with score 4-6 (moderate disease) were 27.1% and with score 7-12 (severe disease) were 8.7%. Conclusion: This study concludes that the MERI can be a useful tool in the preoperative evaluation in order to assess the probability of success of tympanoplasty. [ABSTRACT FROM AUTHOR]

Background: The ideal anesthetic drug choice for local infiltration anesthesia under monitored anesthesia care must provide analgesia and patients’ comfort along with a bloodless surgical field for patients. We hypothesized that dexemedetomidine can provide better visibility of the surgical field at a higher dose of 1 µg/kg than 0.5 µg/kg, along with providing sedation and analgesia. Methods: After institutional ethics committee clearance and written informed consent, this prospective, randomized, triple blind study was conducted on ninety patients, between 18- 65 years who were scheduled for tympanoplasty. The patients were randomly assigned to either the dexmedetomidine (DEX) 0.5 group or the DEX 1.0 group, and received 10 ml solution containing 2% lignocaine with 0.5 µg/kg dexmedetomidine, or the 1 µg/kg dexmedetomidine. The operative surgeon performed local infiltration using standardized 5-point infiltration technique around the auricle. The primary objective was to compare the intraoperative bleeding at the surgical site. The comparison of normally distributed variables was conducted using the Student’s t-test, whereas non-normally distributed variables was compared using the Mann-Whitney U test. The analysis of qualitative data was conducted using the chisquare/Fisher’s exact test. A P value less than 0.05 was considered statistically significant. Results: The overall bleeding score was significantly higher in the DEX 0.5 group (3.21 ± 0.727) than the DEX 1.0 group (1.43 ± 0.661) (P value < 0.001). The time to first analgesic requirement and surgeon satisfaction score were also significantly higher in the DEX 1.0 group. Conclusions: Combining dexmedetomidine at a dose of 1 µg/kg with 2% lignocaine for infiltration provided improved analgesia and improved the surgical field during tympanoplasty performed under monitored anesthesia care. [ABSTRACT FROM AUTHOR]

Introduction Fat grafts have been in used since 1962 for small central perforations, with a success rate ranging from 86 to 100%. Platelet-rich plasma (PRP) containing platelet concentrations greater than 1 million platelets/μL assist the healing process by various means. Current data suggests improved healing when tympanoplasty is performed using temporalis fascia grafts if PRP is added during surgery. Objective To assess the effect of PRP on fat grafts in small and moderate-sized central perforations. Methods The present prospective observational study was conducted with 36 patients who underwent fat graft tympanoplasty with PRP under local anesthesia. Clinical and audiological observations were carried out after 4, 8, and 12 weeks, and a statistical analysis of the observations was performed. Results We assessed 23 patients with small central perforations and 11 patients with moderate central perforations. An overall success rate of 76.4% was observed, with an 82.6% success rate among patients with small central perforations and 63.6% among those with moderate central perforations. There was no statistically significant difference in the uptake regarding the location of the perforation, but a statistically significant difference was found in terms of hearing improvement following the procedure. Conclusion The morbidity of conventional tympanoplasty in cases of small-to-moderate central perforations in patients with chronic otitis media vis a vis the results of the procedure needs to be revisited, as in the present study fat grafts placed with PRP under local anesthesia could lead to surgical and audiological outcomes that are as good as those reported in the literature. [ABSTRACT FROM AUTHOR]

The study was carried out on 50 patients with central perforation in tympanic membrane (dry & inactive stage). The study was done in the department of ENT, MIMS medical college, Nellimarla, Vizianagaram over a period of one year. The study was done on comparison between tympanoplasty procedure using temporalis fascia as graft versus cartilage composite graft. Precise history was taken from respective patients in detail and were examined clinically. Patients with dry perforation with good cochlear reserve, intact and mobile ossicular chain, functioning Eustachian tube were selected randomly for the operation. Tympanoplasty procedure using temporalis fascia as graft was done in 50% (n=25) patients and tympanoplasty procedure using cartilage composite graft was done in 50% (n=25) patients. In this study the age range of patients were from 13 to 50 years, the mean age was 26.62 years, the number of male and female was equal. Right sided disease was predominant in our study and the mean duration of symptom was 11.24 months. The mean pre-operative hearing loss (pure tone average by pure tone audiometry) was 37.84±4.65 dB and mean pre-operative airbone gap was 22.84±4.65 dB. Post-operative Mean air conduction was 23.48±5.54 dB among them 24.2 ±6.26 dB in the fascial group and 22.76±4.73 dB in the cartilage group. This result is not statistically significant. Post-operative mean air-bone gap was 13.84±5.94 dB among them 14.76±5.6 dB in fascial group and 12.92 ±6.23 dB in the cartilage group which is not significant stastistically. Successful graft take-up rate of 88.00% (n=44). The overall success rate among tympanoplasty using temporalis fascia graft(GROUP A) and tympanoplasty using composite cartilage graft (GROUP B) technique were 84.00% (n=21) and 92.00% (n=23) respectively. 12.00% (n=6) patients were marked as failure cases during postoperative follow up period. The overall failure rate among tympanoplasty using temporalis fascia graft (GROUPA) and tympanoplasty using composite cartilage graft (GROUP B) technique were 16.00% (n=4) and 8.00% (n=2) respectively. So the distribution of surgical outcome in terms of success rate or failure rate was statistically insignificant in the two study groups (p=0.384). So the distribution of surgical outcome in terms of success rate or failure rate cartilage composite graft gives a definitely better result than temporalis fascia graft. However, the two method did not differ significantly in terms of hearing improvement. [ABSTRACT FROM AUTHOR]

Cartilage tympanoplasty is a fast growing technique used to restore hearing in chronic suppurative otitis media. The technique has misnomers such as limited applicability in only small size perforations, interference with sound conducting mechanism and durability. Our experience in out tertiary care Institution with over 100 retrospective study cases prove that there is a scope of proving it to be well established technique. That could be used in par with other tympanoplasty techniques. Our retrospective case series of 100 operated between 2021 and 2024 were taken, having unilateral perforation convenience data collection purpose. The overall success rates of cartilage / button tympanoplasty of varying perforation sizes, having a wide range of pure tone audiometry statuses having successful results were discussed, which is indicated as a percentage format. In our retrospective case series, out of our 100 cases we had 90 successful graft uptake cases. The 10% cases were later followed up in our study. It was analysed and concluded that the technique was not the inhibiting factor but the post operative care had prevented the patients from having the desired results. Our results are in accordance with previous case studies for support. Pure tone audiometry were taken pre operatively and post operatively that support cartilage / button tympanoplasty. Cartilage tympanoplasty is a commonly misunderstood technique which if corrected has a wide scope to be used a s a common treatment modality. Data collected and inference were in concordance with previous studies conducted. Tragal cartilage due to its durability, low inflammatory reaction to tympanic membrane, lesser chances of retraction and long term assurance of withstanding environmental conditions has proven to be technique which can be used in regular basis. Cartilage / button tympanoplasty is a technique that has a shorter learning curve for surgeons. With a high demand of cases in chronic suppurative otitis media-Tubotympanic type, button tympanoplasty technique is an assest. [ABSTRACT FROM AUTHOR]

Introduction: Chronic Suppurative Otitis Media (CSOM) significantly impacts auditory functions and overall quality of life. Although tympanoplasty is recognized for its auditory benefits, its broader psychological impacts in CSOM patients remain underexplored. Method: In this sequential explanatory mixed-methods study, 100 adult CSOM patients undergoing tympanoplasty were evaluated from January 2022 to December 2023. The study integrated quantitative assessments (Pure-Tone Audiometry, Speech Audiometry, COMOT-15, HADS) and qualitative data from semi-structured interviews. Results: Post-tympanoplasty, patients exhibited a notable improvement in auditory functions, with an average decrease in Pure-Tone Audiometry (PTA) thresholds by 30 dB and a 28% increase in speech recognition scores. Psychological assessments reflected a significant enhancement in quality of life, with an average decrease of 25 points in COMOT-15 scores, and reductions in HADS anxiety and depression scores by an average of 7 and 6 points, respectively. Qualitative interviews reinforced these results, emphasizing improved social interactions and emotional well-being. A strong correlation was observed between the auditory and psychological improvements. Conclusion: The study demonstrates that tympanoplasty in CSOM patients leads to significant auditory and psychological improvements, highlighting the necessity of a comprehensive treatment approach. This underscores the importance of considering both physical and mental health in CSOM management. [ABSTRACT FROM AUTHOR]

Aim: This study is aimed to compare the outcomes of the two techniques (endoscopic single flap tympanoplasty- ESFT versus endoscopic double flap tympanoplasty - EDFT) of endoscopic tympanoplasty for repairing large tympanic membrane (TM)perforations with limited anterior remnant. Methodology: In this randomised controlled trial, forty patients with large sized TM perforations were included and randomised in the ESFT and EDFT arms with twenty patients in each group. Both the groups underwent endoscopic tympanoplasty using temporalis fascia graft. The graft uptake rates and hearing results were compared. Results: Graft success rate was 85% (17/20 cases) in the ESFT group and 90%(18/20 cases) in the EDFT group. The ABG (air-bone gap) improvement median with interquartile range(IQR) was 5 dB (3.12 dB-10 dB) in the ESFT group and 8.75 dB (5dB-11.87 dB) in the EDFT group. The difference was not statistically significant. Conclusions: In our study, there was no statistically significant difference in the graft success rate or hearing gain in ESFT or EDFT group. Moreover, there was longer operative time and need for an extra incision while raising the anterior flap. This lack of statistically significant results in our study may be since the study has a very small sample size. Whether the same conclusion is reproducible needs to be further explored by a larger sized randomised controlled trial. [ABSTRACT FROM AUTHOR]

This study was undertaken for study of anatomical results and hearing improvement in various types of tympanoplasty using conchal cartilage. A total of 100 patients were taken for this study the patients belongs to varying age groups from 1st to 6th decade of life.Maximum patients were in between age group 21 to 30 years, 37 (37%) patients and minimum 02(2%) between age group 51 to 60 years. Out of these an overall average gain of 13.33dB in PTA(pure tone audiometry) as well as ABG(air bone gap) was seen however an overall average deficit of 32.15dB in PTA as well as 16.43dB in ABG was seen. The tympanoplasty performed were with or without any additional surgeries of mastoid like Cortical, Atticotomy, CWW, MRM.The pre and post ABG was mainstay for each of our case and final anatomical result of graft uptake. Key points: Type I Tympanoplasty had an average deficit of 15.26 in ABG. Type II Tympanoplasty had an average deficit of 12.75 dB in ABG. Type III Tympanoplasty had an average deficit of 19.42 dB in ABG. Type IV Tympanoplasty had an average deficit of 24 dB in ABG. An overall average gain of 13.33 dB in ABG was seen. An overall average deficit of 32.15 dB in PTA as well as 16.43 dB in ABG was seen. The main aim of our study is to counsel the patient that there will not be complete improvement of hearing if we have done type III and type IV tympanoplasty in advanced disease. This is also of importance for medicolegal purpose. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the association between mucociliary function of the Eustachian tube using the Saccharin test preoperatively and its correlation with dynamic slow-motion video endoscopy on the outcome of Type-I Tympanoplasty in patients with inactive mucosal chronic otitis media. Methodology: Eighty patients diagnosed with inactive mucosal chronic otitis media who underwent Type-I Tympanoplasty were included in the study. Preoperative assessment of Eustachian tube function was conducted using the Saccharin test. Results of this test were categorized as normal, partial, or gross dysfunction. Dynamic slow-motion video endoscopy was performed to assess motion and pathological factors of the Eustachian tube. Results were evaluated based on a previously validated Visual Analogue Score (VAS). Patients were followed up postoperatively for 3 months. Results: The proportion of patients with surgical failure at the end of the 1st and 3rd month postoperatively was significantly higher in cases of gross Eustachian tube dysfunction compared to those with normal and partial dysfunction (p-value < 0.0001 and p-value = 0.0001, respectively). Preoperative VAS scores in normal Eustachian tubes were significantly higher compared to those with partial dysfunction and gross dysfunction. Conclusion: The Saccharin test is a valuable tool for preoperative evaluation of mucociliary clearance of the Eustachian tube, and dynamic slow-motion video endoscopy serves as a useful adjunct in predicting the outcome of Type-I Tympanoplasty. Routine evaluation of mucociliary clearance function of the Eustachian tube should be included in the preoperative workup for patients undergoing Tympanoplasty to achieve optimal surgical outcomes. [ABSTRACT FROM AUTHOR]

This study was undertaken to assess the outcome of canal wall window tympanomastoidectomy in chronic suppurative otitis media in a tertiary care centre of central India. A total of 50 patients were taken for this study in which the youngest patient was 13-year-old male and oldest 55-year female. Maximum patients were in between age group 10 to 20 years, 20 (40%) patients and minimum 03 (6%) between age group 51 to 60 year. The study mainly emphasized on: To study the clinical profile of the cases of chronic suppurative otitis media, to study the hearing outcome after 3 months of Canal wall window tympanomastoidectomy technique, to study the post-operative condition of ear after 3 months whether dry or wet and to study the post-operative follow up of cases to assess the graft uptake. Average PTA & ABG improvement of different tympanoplasty was also calculated in our study in which Type I tympanoplasty had 12.20dB gain, Type II of 10.50 and Type III of 10.31dB.An overall average improvement in all patients with tympanoplasty was 11.00dB.At the end of the study 100% dry ears were achieved. The technique of canal wall window tympanomastoidectomy involves formation of a window in the outer attic wall to look at the disease extent which was then closed by a snuggly fitting cartilage.It is a novel technique & without compromising the structural integrity in case of a limited disease which is only extending till attic and aditus good anatomical and hearing results could be gained. [ABSTRACT FROM AUTHOR]

Mastoid surgeries are surgical procedures, wherein surgical failures are prevalent due to the fundamental complexities involved, especially in the understanding of microscopy and pathophysiology of the disease. A revision mastoidectomy is an utmost, a post-procedure decision, wherein the patient continues to exhibit signs and symptoms that are concerning. This is proved by a prospective, cross-sectional research which was conducted upon a group of patients who were referred to a tertiary health care centre. This selection of twenty-three (23) patients who underwent mastoidectomy prior to their participation in this research, were exhibiting signs of recurrent diseases. The observations of trends seen in revision mastoidectomy are detailed and inferences gleaned from it. These trends and observations direct us towards the understanding that the majority of failure of previous mastoidectomy was due to persistent diseased air cells and recurrent or residual cholesteatoma. This is further corroborated by the trends observed from exhausting literature readings of previous similar studies. Revision mastoid surgeries are an important follow-up process, after the mastoidectomy, if the patients continue to exhibit diseased states. [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]

Objective: The purpose of this study is to analyse the effect of half canal wall down tympanomastoidectomy in the treatment of chronic otitis media or cholesteatoma. Method: In this retrospective study, the half canal wall down tympanomastoidectomy technique was used at our hospital for chronic otitis media or cholesteatoma removal in 265 adult patients, representing 271 operated ears, with an average follow-up time of 8.4 years. Results: The post-operative cavities were slightly wider and straighter in 91.9 per cent of the ears. Fifteen per cent of the patients needed cavity cleaning every six months, 25 per cent of them needed cavity cleaning every year and 60 per cent of the patients had a self-cleaning cavity. Only one patient with a cleft palate experienced cholesteatoma recurrence in the mesotympanum. Conclusion: The half canal wall down tympanomastoidectomy technique showed a low-recurrence rate and satisfying operative cavities. The half canal wall down tympanomastoidectomy technique is a good choice for middle ear surgery. [ABSTRACT FROM AUTHOR]

Objective: To investigate alterations in middle-ear mechanics after type 1 cartilage tympanoplasty by comparing the ambient pressure absorbance values of the perforated tympanic membrane, normal tympanic membrane and cartilage-grafted tympanic membrane. Methods: Twenty patients diagnosed with non-suppurative chronic otitis media and 20 healthy controls were included. Pure tone audiometry and wideband tympanometry were performed once in the healthy controls and pre-operatively, one month and three months post-operatively in the patients. Results: Using wideband tympanometry, the patients' three-month post-operative ambient pressure absorbance values were found to be similar to those of the healthy controls at low frequencies, while lower ambient pressure absorbance values were recorded at middle and high frequencies. Air–bone gap and ambient pressure absorbance values showed significant negative correlations at 1000 and 4000 Hz both pre- and post-operatively. Conclusion: Generally, the patients' ambient pressure absorbance values were significantly lower at middle and high frequencies than those of the healthy controls. Post-operative wideband tympanometry is a practical tool for investigating the effects of a repaired tympanic membrane on middle-ear dynamics. [ABSTRACT FROM AUTHOR]

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]

Background: Biomaterials and surgical techniques for reconstructive tympanic membrane surgery are under development. Objectives: The objective of this study is to analyze the functional and surgical outcomes of a novel fascia with cartilage reinforcement technique for anterior tympanic membrane perforation in tympanoplasty. Methods: Records of 198 patients with anterior tympanic membrane perforation who underwent tympanoplasty between August 2018 and March 2021 were prospectively reviewed. Patients with dry anterior quadrant perforations of the tympanic membrane were included and underwent tympanoplasty using two methods: Type 1 tympanoplasty with temporalis fascia only, and tympanoplasty with fascia and cartilage reinforcement. Postoperative functional and surgical outcomes were analyzed. Results: Comparing the pre-operative and post-operative air conduction levels and air-bone gaps showed significant improvement in both groups (P < 0.001). Additionally, no significant difference was observed between air-bone gap closure (P = 0.316) and increase in air conduction levels (P = 0.222) according to graft type. Conclusions: Both temporalis muscle fascia and temporalis muscle fascia with cartilage reinforcement revealed satisfactory functional and surgical outcomes. Furthermore, the novel combined cartilage-fascia technique had a comparable graft take rate and hearing results in anterior perforations, with no significant change in tympanic membrane vibratory properties. [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 The ideal anesthetic drug choice for local infiltration anesthesia under monitored anesthesia care must provide analgesia and patients' comfort along with a bloodless surgical field for patients. We hypothesized that dexemedetomidine can provide better visibility of the surgical field at a higher dose of 1 µg/kg than 0.5 µg/kg, along with providing sedation and analgesia. Methods After institutional ethics committee clearance and written informed consent, this prospective, randomized, triple blind study was conducted on ninety patients, between 18-65 years who were scheduled for tympanoplasty. The patients were randomly assigned to either the dexmedetomidine (DEX) 0.5 group or the DEX 1.0 group, and received 10 ml solution containing 2% lignocaine with 0.5 µg/kg dexmedetomidine, or the 1 µg/kg dexmedetomidine. The operative surgeon performed local infiltration using standardized 5-point infiltration technique around the auricle. The primary objective was to compare the intraoperative bleeding at the surgical site. The comparison of normally distributed variables was conducted using the Student's t-test, whereas non-normally distributed variables was compared using the Mann-Whitney U test. The analysis of qualitative data was conducted using the chi-square/Fisher's exact test. A P value less than 0.05 was considered statistically significant. Results The overall bleeding score was significantly higher in the DEX 0.5 group (3.21 ± 0.727) than the DEX 1.0 group (1.43 ± 0.661) (P value < 0.001). The time to first analgesic requirement and surgeon satisfaction score were also significantly higher in the DEX 1.0 group. Conclusions Combining dexmedetomidine at a dose of 1 µg/kg with 2% lignocaine for infiltration provided improved analgesia and improved the surgical field during tympanoplasty performed under monitored anesthesia care.

Cartilage perichondrium composite grafts (CPCG) have been used in tympanoplasty for many years. Reperforations can be seen because of various problems. The aim of our study is to describe a graft technique to minimise the complications and to evaluate the success of the graft. The ears which underwent type 1 tympanoplasty using CPCG were included in the study. Over-underlay graft technique was used in all operations. They were performed by microscopic transcanal approach and by the same surgeon. Fifty-four ear operations of 48 patients were included in the study. While the preoperative average pure tone- average (PTA) of the ears was 45 (21–75) dB, the postoperative average PTA was 28 (11–58) dB. While the preoperative air bone gap (ABG) of the ears was 23.3 (10-43.3) dB, the postoperative ABG was 11.6 (0-28.3) dB. A significant improvement was achieved in both ABG and PTA values after the operation (p < 0.001). The graft success rate was 94.4%. The cartilage graft modifications such as block cartilage, palisade, cartilage island and butterfly have been applied successfully. We aimed to reduce the risk of reperforation, maximise audiological gain and facilitate the follow-up of postoperative middle ear pathologies by thinning the cartilage island and extending the perichondrium to the external auditory canal in the modification of CPCG. The graft success rate and the audiological success rate are high enough to be compared with the literature. The described CPCG can be used safely in all types of perforations, especially in high-risk perforations. [ABSTRACT FROM AUTHOR]

The aim of present study was to observe the effect of topical application of manuka honey in healing in the healing of postoperative mastoid cavity. A total of 100 patients diagnosed with chronic suppurative otitis media with cholesteatoma underwent canal wall down mastoidectomy, Manuka honey-soaked roller gauze pack was placed on Day 10 and was removed on day 17 and manuka honey was applied on day 17. Cavity was assessed on day 47 and day 90 on follow-up. Otoendoscopy was done on every visit to assess mastoid cavity. The primary outcome measure was the creation of a dry cavity as measured by a semi-quantitative scale as described by Merchant et al. Then Mastoid Cavity Healing Score was calculated on every visit and scoring was done at the end. On intragroup comparison it appeared that both the treatment methods exhibited improvised merchant grade score with the course of time (p-value = < 0.001). At 47th day and 90th day, the healing score in Group A was significantly higher than in Group B [p-value = < 0.001 and 0.001] respectively. We recommend Manuka honey as an adjunct to achieve a safe, dry ear in view of faster epithelization after mastoidectomy. [ABSTRACT FROM AUTHOR]

A significant change in the seasonal patterns of ear infections has been observed due to the modification of aquatic leisure habits, also altering the etiology of the most frequently causing otitis in its various forms of presentation. This work aims to become the largest series documenting ear infections by this bacterium, carrying out a characterization and considering the possibility that the mechanism of action occurs both through contact with contaminated waters and colonization of the middle ear. [ABSTRACT FROM AUTHOR]

Objectives: To assess quality of life (QOL) outcomes after canal wall up (CWU) and canal wall down (CWD) tympanomastoidectomy in the pediatric population. Methods: A retrospective review tabulated pediatric patients undergoing CWU and CWD tympanomastoidectomy for cholesteatoma by 2 senior surgeons at a single tertiary academic referral center between March 2017 and March 2023. Chronic Ear Survey (CES) and cosmetic survey outcomes were collected post-operatively. Results: A total of 77 ears in 75 patients were identified, with 35 undergoing CWU and 42 undergoing CWD as the most recent (index) otologic surgery. Seventeen patients (23%) participated in the survey. Of this cohort, the mean age was 14.6 years, 12 (71%) were male, and 10 (59%) had CWD as the most recent otologic surgery. The mean time from index surgery to survey completion was 3.4 years (range, 0.1-6.7 years). Regarding QOL outcomes, there were no statistically significant differences in total CES score, CES subscores, and cosmetic survey scores between groups when categorizing by gender or index surgery. Total CES, symptom subscale, medical resource subscale, and cosmetic survey scores showed a tendency to decrease with an increasing number of surgeries (R = −.18, −.28, −.53, and −.56, respectively). Pediatric total CES scores appeared comparable to those reported in the published adult literature. Conclusions: It does not appear that there are worse QOL outcomes for pediatric patients who undergo CWD tympanomastoidectomy compared to those who undergo CWU tympanomastoidectomy. There appears to be no difference in QOL outcomes between pediatric and adult patients undergoing tympanomastoidectomy. [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]

Objective: The study aimed to compare ipsilateral and contralateral electrically evoked stapedial reflex thresholds in children with a unilateral cochlear implant surgically implanted either through Veria or posterior tympanotomy approaches. Methods: Forty-nine children using cochlear implants were studied, of whom 27 underwent the Veria approach and 22 underwent the posterior tympanotomy approach. The electrically evoked stapedius reflex thresholds were measured ipsilaterally and contralaterally by stimulating four equally spaced electrodes. Results: The ipsilateral electrically evoked stapedius reflex threshold was absent in all four electrodes in the children implanted using the Veria approach. However, the ipsilateral electrically evoked stapedius reflex threshold was present in 70 per cent of the children implanted using the posterior tympanotomy approach. The contralateral electrically evoked stapedius reflex threshold was present in most of the children for both surgical approaches. Conclusion: The presence of the ipsilateral electrically evoked stapedius reflex threshold varies depending on the surgical technique used for cochlear implantation. However, contralateral reflexes are present in the majority of children using cochlear implants, irrespective of the surgical approach. [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]

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]

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]

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

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]