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Objective: The objective of this study was to compare the graft outcomes and complications of two endoscopic perichondrium–cartilage graft techniques for repairing large perforations. Study design: Single center blinded randomized controlled trial. Materials and methods: 61 large perforations more than 50% of TM area were prospectively randomized to undergo the free perichondrium and free cartilage graft group (FPFC, n = 31) or perichondrium partial attachment the cartilage graft group (PPAC, n = 30). The primary outcome measures were the operation time; secondary outcome measures were the graft success rate and hearing gain at 12 months postoperatively and postoperative complications. Results: All patients completed follow-up of 12 months. The mean operation time was 38.2 ± 2.3 min in the FPFC group and 37.4 ± 5.6 min in the PPAC group (P = 0.658). At postoperative 3 months, the graft success rates were 96.7% in the FPFC group and 93.3% in the PPAC group (P = 0.976). At postoperative 12 months, the graft success rates were 96.7% in the FPFC group and 83.3% in the PPAC group (P = 0.182). However, the residual and re-perforation rate with no infection was 0.0% (0/31) in the FPFC group and 16.7% (5/30) in the PPAC group (P = 0.056). No significant between-group differences were observed pre- (P = 0.842) or post- (P = 0.759) operative air bone gap (ABG) values or mean ABG gain (P = 0.886). However, granular myringitis has been noted in 6.5% in the FPFC group and in 3.3% in the PPAC group. Conclusions: This study suggested that 12-month graft success and hearing gain were comparable between the perichondrium free and partial attachment the cartilage graft techniques, nevertheless, partial attachment technique could increase residual and re-perforations. [ABSTRACT FROM AUTHOR]

Background: Tympanoplasty is the most common operation performed by an Otolaryngologist worldwide.Type 1 tympanoplasty involves repair of pars tensa of tympanic membrane, when the middle ear is normal. The most widely used method is underlay technique using temporalis facia. In buttonhole tympanoplasty, the temporalis fascia is anchored to the handle of malleus through the buttonhole. Objective: To compare and analyze graft uptake and hearing outcome in button hole technique and underlay technique. Material and Method: It is a comparative study done at tertiary care center, where patients suffering from tubotympanic type of chronic otitis media with medium sized perforation with moderate conductive hearing loss, within age group of 18–60 years,were selected. Results: In Button hole tympanoplasty group the mean hearing gain was 9.3dB, and 8.17 dB in Underlay tympanoplasty group which was statistically significant (p < 0.05) but P value between Button hole and Underlay tympanoplasty was not statistically significant.With regard to graft uptake 96.7% showed graft uptake in Buttonhole tympanoplasty group and in underlay tympanoplasty the graft uptake was 93.3%. Interpretation and Conclusion: Buttonhole technique is better in terms of graft uptake since the graft is anchored to the handle of malleus, and postoperatively medialisation of graft and other complications like lateralization of graft, epithelial pearl formation and anterior blunting is prevented. Both techniques are good in terms of hearing improvement for chronic otitis media with medium sized perforation with moderateconductive hearing loss. [ABSTRACT FROM AUTHOR]

Otitis media is inflammation of middle ear, commonly seen in children of school going age. Chronic otitis media is permanent abnormality of tympanic membrane most commonly as a result previous acute otitis media. Early diagnosis and management of chronic otitis media is important because it may affects hearing of child which in turn may affect cognitive development of children. This is a retrospective observational study done on 60 patients of age between 18 and 60 yrs during the period from May 2019 to November 2019 in ENT department of Katihar Medical College, Katihar, Bihar and assessed success rate of Type I Tympanoplasty using Temporalis Fascia by Underlay technique in safe mucosal COM. Success rate was 90% when preoperative dry ear was for more than one month. Graft taken up properly in 50 patients out of 60 cases i.e. 83.33%. [ABSTRACT FROM AUTHOR]

Objective: In this study, graft success, hearing outcome, and complications were compared following the repair of subtotal perforation using a cartilage reinforcement underlay technique (CRUT) versus the traditional cartilage underlay technique (TCUT)., Study Design: Randomized controlled trial., Materials and Methods: Seventy-six patients with subtotal perforations were prospectively randomized to the CRUT (n = 38) or TCUT (n = 38) group. The graft success rate, hearing outcome, and complications were compared at 12 months., Results: The mean operation time was 32.9 ± 4.2 (range: 26-47) min in the CRUT group and 51.8 ± 6.3 (range: 48-73) min in the TCUT group (P < 0.001). At 12 months postoperatively, no residual perforation was seen in either group. The graft success rate was 94.7 % (36/38) in the CRUT group and 92.1 % (35/38) in the TCUT group; the difference was not significant (P = 0.643). The postoperative air bone gap (ABG) was significantly improved compared to the preoperative value in both groups, without significant between-group differences in either the preoperative (P = 0.741) or postoperative (P = 0.865) ABG or the mean ABG gain (P = 0.812). Additionally, there were no significant between-group differences in the preoperative (P = 0.887) or postoperative (P = 0.753) mean bone-conduction pure tone average. In the TCUT group, seven (18.4 %) patients developed temporary hypogeusia and two (5.3 %) had external auditory canal scarring. Graft cholesteatoma was not observed in either group., Conclusion: In the treatment of subtotal perforations, lateral reinforcement of the annulus with additional cartilage is simpler than traditional cartilage underlay for achieving graft and hearing success. The technique also does not involve raising the tympanomeatal flap or removing perforation margins., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Abstract Introduction The objective of this study was to evaluate underlay tympanoplasty technique of perichondrium cartilage graft according to the position of the graft with respect to the handle of malleus and remnant of tympanic membrane. Patients and Methods In all, 150 patients with chronic suppurative otitis media (safe type) underwent tympanoplasty with or without mastoidectomy. The patients were divided into three groups (50 patients in each group). Group I graft was placed medial to the handle of malleus, group II graft was placed at the plane of malleus, group III graft was placed lateral to the malleus between it and remnant of tympanic membrane. Results Success rate (graft taken with no residual perforation) in all cases is 98% (147 cases). Success rate in groups I–III is 98% (49 cases), 100% (50 cases) and 96% (48 cases), respectively. There is significant statistical improvement of postoperative pure tone audiogram. Conclusion Underlay cartilage tympanoplasty was associated with a high rate of graft taken and good hearing results despite the position of the graft in relation to the handle of malleus.

The main aims of tympanoplasty are eradication of chronic middle ear disease, repair of the tympanic membrane, and restoration of hearing. Nitrous oxide (N2O) is not a commonly preferred anesthetic agent for tympanoplasty because this agent may increase middle ear pressure and displace the graft. In this study, we researched the surgical outcomes of the underlay tympanoplasty performed with N2O anesthesia. Patients who underwent tympanoplasty were included in this prospective study. A type 1 tympanoplasty was performed in all patients using the underlay technique. Patients were randomized to groups that did and did not receive N2O. Preoperative and postoperative hearing thresholds were evaluated, postoperative pain scores were recorded, and the differences between the groups were statistically evaluated. There were 44 patients who received N2O and 44 who did not. The graft success rate was 93.2% in the N2O-receiving group and 84.1% in the nonreceiving group (P >.05). Hearing levels improved significantly after surgery in each group (P <.05), but the difference between the groups was not significant (P >.05). The postoperative pain score was 3.72 ± 1.3 in the N2O-receiving group and 4.45 ± 2.3 in the nonreceiving group (P >.05). Nitrous oxide is a cheap, safe, and readily available anesthetic agent that provides acceptable success rates in patients undergoing tympanoplasty. [ABSTRACT FROM AUTHOR]

Background: Chronic suppurative otitis media is one of the most common otological problems in developing countries. It affects all age groups. Type-1 tympanolpasty is simple repair of tympanic membrane. The objectives of this study were to describe the outcome of type-1 tympanoplasty in terms of graft take rate, hearing improvement and complications. Material & Methods: This quasi-experimental study was carried out in Department of ENT, Al-Noor Specialist Hospital, Makkah, Saudi Arabia from February 2005 to July 2005. Patients with dry central perforations were included in the study. Pre-operative audiogram and x-ray mastoid were performed for all the cases. Results: Out of 40 patients, 21(52.5%) were males and 19(47.5%) females. The mean age was 29 (15-45) years. Out of 40 cases, 22(55%) tympanoplasties were performed on right ear and 18(45%) on left ear. Twelve (30%) patients had large size, 24(60%) medium size, one (2.5%) pin hole size and 3(7.5%) had subtotal tympanic membrane perforation. Fourteen (35%) patients had anterio-inferior perforation, 22(55%) had central, and 4(10%) had posterior-inferior perforation of tympanic membrane. The graft was intact in 35(87.5%) patients while it failed in 4(10%) cases. One (2.5%) case had small residual pinhole perforation. Hearing improvement was documented in 26(65%) patients. There were no complications. Conclusion: Type-1 tympanoplasty has a good outcome in the management of chronic suppurative otitis media, using temporalis fascia as graft material by underlay technique. [ABSTRACT FROM AUTHOR]

The purpose of this retrospective study was to evaluate the hearing outcomes using temporalis fascia graft for tympanic membrane reconstruction in type 1 tympanoplasty. It included 100 patients with tubotympanic type of chronic suppurative otitis media requiring only tympanic membrane reconstruction. Patients requiring ossicular reconstruction or with attico antral disease were excluded. Patients were assessed after 3, 6 months and 1 year for graft status and hearing outcome. Hearing evaluation was done using tuning fork tests and pure tone audiometry. In total, 88 out of 100 patients had intact and completely healed grafts at 1 year postoperatively (success rate of 88 %). The Hearing gain achieved was 14.55 dBs and the mean air bone gap reduction was 11.94 dBs. This reduction was statistically significant when compared to the pre operative hearing conditions. [ABSTRACT FROM AUTHOR]

Introduction: The repair of the tympanic membrane can present a problem, especially in anterior perforation, because the anterior portion was not enough to inadequate contact between tympanic membrane remnant and graft. Various surgical techniques were recommended to achieve an acceptable graft success rate in anterior perforation. Endoscopic transcanal myringoplasty with anterior tab flap could provide the better stability of the graft., Objective: The aim of this study was to report the minimally invasive technique for the anterior tympanic membrane perforation closure and investigate the graft success rate of this technique., Patients and Methods: We performed a prospective, randomized study of 35 patients who consulted the otorhinolaryngology department at the university hospital for surgery of perforation tympanic membrane repair., Results: The average age was 35.1 ± 11.9 years. The size of the perforation was dominant at small-size and large-size, 51.4%, 34.3%, respectively. There was a significant difference between the Preoperative air conduction of small and large perforations (34.44 8.68 and 49.79 14.54, respectively). Of 35 patients, 31 (88.6%) had closure of their perforations. The mean preoperative ABG was 24.11 ± 10.79 dB, while The mean postoperative ABG was 13.97 ± 10.03 dB (p < 0.05). Approximately 34.3% patients had ABG within 20 dB preoperatively, which increased to 82.9% after intervention (p < 0.05)., Conclusions: The endoscopic transcanal myringoplasty with anterior tab flap underlay technique is a safe, suitable and effective method for cases with anterior tympanic membrane perforations, and showed improvement in postoperative hearing., Competing Interests: We have no known conflict of interest to disclose., (© 2022 The Authors.)

Conclusion: Acellular dermal matrix (ADM) can be used as a substitute for tympanic membrane (TM) reconstruction. Objective: To investigate the effectiveness of ADM in the treatment of TM perforations. Methods: Fifty guinea pigs were used to create TM perforations. The perforations of the left TM were repaired with ADM by patch technique in 28 guinea pigs and by underlay technique in 22 guinea pigs. The right ears were used as the control group by establishing TM perforation but without TM reconstruction. The morphological and structural status of the grafts was observed by immunohistochemistry and scanning electron microscopy. Results: There was no statistically significant difference in TM perforation closure between the ADM patch technique group and the ADM underlay technique group, but these groups had a higher success rate in closing TM perforation than the control group. The healed TMs with ADM had the same characteristics as normal TM on histological examination. [ABSTRACT FROM AUTHOR]

Objective: To compare the outcome of underlay versus overlay myringoplasty procedure in the management of otitis media. Methodology: This comparative study was conducted at the Department of Ear, Nose, Throat, Head & Neck Surgery, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar from January 2008 to December 2009. It included eighty-six patients with dry ears for at least six weeks and no focus of infection in nose, sinuses or throat were included in the study. Forty three patients underwent underlay technique while other 43 patients were operated through onlay techniques. Results: Myringoplasty was performed in total of 86 patients. Male were 69 (80.02%) and females were 17 (19%). Thirty-five (40.70%) of them belonged to age group of 10-25 years. Thirty (34.88%) were in the age range of 26-35 years, while 21 (24.42%) aged between 36-45 years with mean age of 27.48 ± S.D 10.20 years. Overall success rate of graft uptake was noted in 70 (81.40%) out of 86 cases. All 86 cases were equally divided into two group's i.e. 43 patients in each group. Thirty-eight out of 43 perforated drums were treated with underlay techniques having success rate of 88.37% as compared to 32 out of 43 patients with only techniques where the graft uptake was 74.4%. Conclusion: Underlay technique is more successful statistically as compared to overlay technique of myringoplasty in all age groups. [ABSTRACT FROM AUTHOR]