Diagnostic accuracy of intra-operative assessment of de-epithelisation of the malleus by the surgeon in type 1 tympanoplasty compared to histopathological examination

2019 ◽  
Vol 133 (06) ◽  
pp. 462-465 ◽  
Author(s):  
A P Azeez ◽  
V Letha
Keyword(s):  
Diagnostic Accuracy ◽  
Middle Ear ◽  
Microscopic Examination ◽  
Histopathological Examination ◽  
Type 1 Tympanoplasty ◽  
Limited Experience ◽  
Operative Assessment

AbstractObjectiveThis study was undertaken to determine the accuracy of the surgeon's assessment in detecting epithelial remnants over the malleus after de-epithelisation in tympanoplasty.MethodsIntra-operatively, the umbo was assessed for epithelial remnants with the microscope. The umbo was then resected and sent for histopathological examination to detect epithelial remnants.ResultsOut of 42 cases, microscopic examination findings for epithelium were positive in 16 cases and negative in 26 cases. Histopathology findings were positive in 13 cases. The surgeons’ assessment was accurate only in two cases.ConclusionResidents, with their limited experience, are more likely to leave residual epithelium. When the chance of residual epithelium over the umbo is significant, the surgeon has two choices: to place the graft medial to the umbo or to resect the umbo. It is our opinion that the malleus exteriorisation should be incorporated into tympanoplasty training, with the aim of preventing epithelial entrapment in the middle ear.

scholarly journals Is Allergic Rhinitis a Factor That Affects Success of Tympanoplasty?

2016 ◽  
Vol 59 (1) ◽  
pp. 10-13
Author(s):  
Elif Ersoy Callioglu ◽  
A. Sami Bercin ◽  
Hayati Kale ◽  
Togay Muderris ◽  
Sule Demirci ◽  
...  
Keyword(s):  
Allergic Rhinitis ◽  
Success Rate ◽  
Middle Ear ◽  
Success Rates ◽  
Type 1 Tympanoplasty ◽  
Significant Difference ◽  
Patient Groups ◽  
The Difference ◽  
Graft Success

Objective: The aim of the present study was to investigate the effect of allergic rhinitis on the success of the operation in chronic otitis surgery by using score for allergic rhinitis (SFAR). Materials and Methods: In the present study; 121 patients, who underwent type 1 tympanoplasty were examined retrospectively. SFAR of all patients were recorded. The graft success rates of 26 patients with allergic rhinitis (AR) and 95 patients with no allergic rhinitis group (NAR) were compared. Results: While the graft success rate in NAR group was 89.5%, this rate was 80.8% in the AR group. However, the difference between groups was not statistically significant (p = 0.311). Conclusion: These findings suggest that allergic rhinitis decreases the graft success rate of the pathologies occurring in eustachian tube, middle ear and mastoid although statistically significant difference wasn’t found. Prospective studies with larger patient groups are required in order to evaluate this pathology.

scholarly journals Clinical study on type 1 tympanoplasty: anatomical and functional outcomes

2019 ◽  
Vol 5 (5) ◽  
pp. 1197
Author(s):  
A. Kusumanjali ◽  
V. Krishna Chaitanya
Keyword(s):  
Success Rate ◽  
Middle Ear ◽  
Pure Tone Audiometry ◽  
Type I ◽  
Middle Ear Mucosa ◽  
Suppurative Otitis Media ◽  
Type 1 Tympanoplasty ◽  
Cortical Mastoidectomy ◽  
Type I Tympanoplasty

<p class="abstract"><strong>Background:</strong> Tympanoplasty is operation to eradicate disease in middle ear and to reconstruct the hearing mechanism. Present study aims at assessment of success rate and hearing improvement following type I tympanoplasty.</p><p class="abstract"><strong>Methods:</strong> 50 patients with chronic suppurative otitis media, tubotympanic type attending department of ENT are taken up for study screened with clinical history and examination. Type I tympanoplasty performed in all patients. Simple mastoidectomy with type I tympanoplasty performed in 8 patients. Patients are followed after surgery on 7<sup>th</sup>, 14th days and end of 3 months. Anatomical outcome is assessed in terms of graft uptake. Pure tone audiometry was performed at 3 months and air bone gap is considered to assess outcome.  </p><p class="abstract"><strong>Results:</strong> Out of 50 cases, 43 cases (86%) showed good success rate by means of graft uptake. Remaining 5 cases showed residual perforation and 3 cases medialization of graft. In 42 patients type1 tympanoplasty is performed, success rate was 80.95% and in cases with where type1 tympanoplasty with cortical Mastoidectomy was done and the success rate was 100%. In the present study mean pre op AB gap was 27.65 dB and mean post op AB gap was 19.07 dB. The difference between the two, i.e., AB gap closure was 8.52 dB which is statistically significant.</p><p class="abstract"><strong>Conclusions:</strong> Type-1 tympanoplasty using temporalis fascia with underlay technique have good surgical success rate with excellent improvement of hearing. Cortical mastoidectomy can be planned depending on the status of the middle ear mucosa.</p>

scholarly journals Comparison of Reinforcement Cartilage Graft and Temporalis Fascia Graft in Type 1 Tympanoplasty

2021 ◽  
Vol 27 (2) ◽  
pp. 104-110
Author(s):  
Md Mainul Islam ◽  
Kanu Lal Saha ◽  
Harun Ar Rashid Talukder ◽  
Md Khalid Mahmud ◽  
Riashat Azim Majumder ◽  
...  
Keyword(s):  
Tympanic Membrane ◽  
Middle Ear ◽  
Uptake Rate ◽  
Cartilage Graft ◽  
Temporalis Fascia ◽  
Hearing Gain ◽  
Type 1 Tympanoplasty ◽  
Fascia Graft ◽  
Cartilage Tympanoplasty

Background: Chronic otitis media (COM) is the long-standing infection of a part or whole of middle ear cleft characterized by ear discharge and perforation. It is the commonest ear problem in adult and children. Most common presenting symptoms are ear discharge, mild to severe hearing loss, sometimes tinnitus even vertigo. Treatment of COM is mainly operative. Inactive mucosal variety of COM presents with the perforation in tympanic membrane with non-inflamed middle ear mucosa. The treatment of inactive mucosal variety of COM is Type 1tympanoplasty. It can be done by conventional temporalis fascia or cartilage graft. Both have some merits and demerits. Objective: To compare the the outcomes between reinforcement cartilage graft and temporalis fascia graft in type -1 tympanoplasty. Methods: 86 (43 patients in each group) patients with COM (inactive mucosal) who were admitted in the department of Otolaryngology – Head and Neck Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka from January 2018 to June 2019, and had fulfilled the inclusion and exclusion criteria were selected for the study. History, examinations, investigations were done. All patients underwent type 1 tympanoplasty. Prior to surgery relevant investigations were done and informed written consent was taken from all patients. In Group-A reinforcement cartilage tympanoplasty cases and in Group-B temporalis fascia tympanoplasty cases were placed. Post-operative graft uptake rate and hearing gain were compared in two groups Results: The surgical outcomes between reinforcement cartilage tympanoplasty in comparison with temporalis fascia tympanoplasty showed no significant difference of graft uptake rate and hearing gain. Conclusion: Cartilage tympanoplasty has been practised for reconstruction of perforated tympanic membrane in COM since long with variable results. Graft uptake rate in cartilage reinforcement is comparatively better than temporalis fascia graft. So, reinforcement cartilage graft can be adopted as an alternative to temporalis fascia graft in type- I tympanoplasty. Bangladesh J Otorhinolaryngol 2021; 27(2): 104-110

scholarly journals A study on endoscopic type 1 tympanoplasty in tubotympanic chronic suppurative otitis media

2019 ◽  
Vol 5 (6) ◽  
pp. 1580
Author(s):  
Kiran A. Deshmukh ◽  
Vinayak Kurle
Keyword(s):  
Hospital Stay ◽  
Otitis Media ◽  
Middle Ear ◽  
Operating Time ◽  
Chronic Suppurative Otitis Media ◽  
Suppurative Otitis Media ◽  
Type 1 Tympanoplasty ◽  
Duration Of Surgery ◽  
The Mean

<p class="abstract"><strong>Background:</strong> Chronic suppurative otitis media (CSOM) attributes to 71.6% of hearing impairment in which most of them only have central perforation without any ossicular erosion or middle ear pathology. Tympanoplasty has evolved to provide and reconstruct better hearing mechanism, avoid complications as well as recurrence. Traditionally over the decades, tympanoplasty has been done using an operating microscope. Middle ear endoscopy was first introduced by Mer and colleagues in 1967, since then middle ear surgeries which were traditionally done using the microscope can be done using the endoscope also.</p><p class="abstract"><strong>Methods:</strong> This prospective study was conducted at Basaweshwar Teaching and General Hospital, Kalaburagi between March 2016 to November 2017. Endoscopic type 1 tympanoplasty was performed in all the cases using temporalis fascia.</p><p class="abstract"><strong>Results:</strong> There were 30 patients between 15-65 years with average being 29.6 years in which 17 were females and 13 were males. Pre and post-operative PTA at 1, 3 and 6 months were analyzed. The mean duration of surgery was 50.13 mins. The mean duration of hospital stay was 2.23 days. The mean duration of wound healing was 12.23 days. The average pre-operative PTA was 32.47±4.79 dBHL and postoperative PTA at 1, 3 and 6 months was18.3±3.22 dbHL, 16.5±2.2 dbHL and 16.35±2.22 dBHL. The graft uptake at end of 6 months was 100%.</p><p class="abstract"><strong>Conclusions:</strong> We here by conclude that endoscope can be a better alternative for microscope in type 1 tympanoplasty as it provides a wide panoramic view, less operating time and hospital stay with minimal visible scar post operatively.</p>

scholarly journals Treatment choice for repair of sound-conducting apparatus with isolated ossicular anomalies

2021 ◽  
Vol 20 (1) ◽  
pp. 8-17
Author(s):  
I. A. Anikin ◽  
Keyword(s):  
Middle Ear ◽  
Anesthetic Management ◽  
Functional Results ◽  
Successful Development ◽  
Surgical Interventions ◽  
Type 1 Tympanoplasty ◽  
Auditory Ossicles ◽  
Sound Conduction ◽  
Technical Solutions

Over the last decades, attention to the study of the possibilities of pediatric otorhinolaryngology has increased. The constantly evolving technologies in reconstructive surgery and advances in the field of anesthetic management have made it possible to carry out the necessary surgical interventions at the earliest possible time. Even such traditionally complex areas like treatment of isolated middle ear abnormalities receive more and more opportunities for successful development. In order to achieve maximal results of hearing in isolated ossicular abnormalities, various approaches to their reconstruction are used. In our work, we aimed to find out which of the two most topical technical solutions is optimal in terms of functional results’ achievement. To do this, we analyzed two independent groups of patients in whom different approaches to the repair of the sound conduction was applied. On the basis of the study, it can be argued that attempts to preserve a deformed, but movable chain of the auditory ossicles, that is, performing type 1 tympanoplasty with an intact stapes with anomalies in the development of auditory ossicles did not prove their feasibility. Performing surgery using a simpler technique, namely with the removal of deformed ossicles and the use of partial titanium prostheses, allows you to achieve the best anatomical and functional results.

scholarly journals Evaluation of Prognostic Factors and Middle Ear Risk Index in Type 1 Tympanoplasty

2021 ◽  
Vol 83 (1) ◽  
pp. 1569-1574
Author(s):  
Mohamed Modather Abd ElNaem ◽  
Ahmed Aboulwafa Abdul Jaleel ◽  
Asmaa Nabil Mohamed
Keyword(s):  
Prognostic Factors ◽  
Middle Ear ◽  
Risk Index ◽  
Type 1 Tympanoplasty

scholarly journals Comparative study of type 1 tympanoplasty with and without gel-foam in the middle ear

2021 ◽  
Author(s):  
G. Abhinav Kiran ◽  
Y. Prabhakara Rao ◽  
B. Shanthi Priyanka ◽  
Supreety .
Keyword(s):  
Tympanic Membrane ◽  
Middle Ear ◽  
Pure Tone Audiometry ◽  
Hearing Improvement ◽  
Tertiary Referral Hospital ◽  
Suppurative Otitis Media ◽  
Type 1 Tympanoplasty ◽  
Hearing Assessment ◽  
One Year

<p class="abstract"><strong>Background:</strong> Chronic suppurative otitis media is a widespread disease for which tympanoplasty is frequently undertaken. Gel-foam may cause adhesions and fibrosis and improper packing may physically alter the structure of the tympanic membrane leading to failure of tympanoplasty. The graft can be placed without any middle ear supporting agent wherein the graft is held in position by the surface tension between the novel graft placed and the remnant tympanic membrane. The objectives of this study were to assess the graft uptake and hearing improvement following type 1 tympanoplasty with gel-foam in the middle ear and without gel-foam in the middle ear and to compare and assess results.</p><p class="abstract"><strong>Methods:</strong> This was a randomized control trial done for a period of one year conducted in the department of ENT, at a tertiary referral hospital. 40 patients with dry perforation underwent type 1 tympanoplasty without gel-foam in the middle ear and 40 patients with dry perforation underwent type 1 tympanoplasty with gel-foam in the middle ear. Post-operative follow-up was done to look for graft uptake. Hearing assessment by pure tone audiometry was done 90 days post-operatively.  </p><p class="abstract"><strong>Results:</strong> Graft uptake was 82.5% in type 1 tympanoplasty without gel-foam in the middle ear and 85% with gel-foam in the middle ear. Both types of surgeries had significant hearing improvement.</p><p class="abstract"><strong>Conclusions:</strong> Graft uptake is equally good in cases with gel-foam and without gel-foam. Hearing gain is comparable in both groups of patients.</p>

scholarly journals Comparative study of type 1 tympanoplasty with and without gelfoam in the middle ear

2017 ◽  
Vol 3 (4) ◽  
pp. 1036
Author(s):  
Nabeel Malick ◽  
Raveendra P. Gadag ◽  
Vidyashree K. M. ◽  
Shruthi Puthukulangara
Keyword(s):  
Tympanic Membrane ◽  
Middle Ear ◽  
Pure Tone Audiometry ◽  
Randomised Control Trial ◽  
Hearing Improvement ◽  
Suppurative Otitis Media ◽  
Type 1 Tympanoplasty ◽  
Impedance Curve

<p class="abstract"><strong>Background:</strong> Chronic suppurative otitis media is a widespread disease with a significant cause of morbidity with a greater burden in the poor communities of the developing countries for which tympanoplasty is frequently undertaken. Gelfoam may show detrimental effects such as adhesions and fibrosis and improper packing may physically alter the structure of the tympanic membrane leading to failure of tympanoplasty. The graft can be placed without any middle ear supporting agent wherein the graft is held in position by the surface tension between the novel graft placed and the remnant tympanic membrane. This provides the added advantage of facilitating middle ear ventilation through the Eustachian tube. The objectives of the study were to assess the graft uptake and hearing improvement following type 1 tympanoplasty with gelfoam in the middle ear and without gelfoam in the middle ear and to compare and assess results for complications</p><p class="abstract"><strong>Methods:</strong> This was a randomised control trial done for a period of one year conducted in the department of otorhinolaryngology and head and neck surgery, Karnataka Institute of Medical Sciences, Hubballi which is a tertiary referral hospital. 30 patients underwent type 1 tympanoplasty without gelfoam in the middle ear and 31 patients underwent type 1 tympanoplasty with gelfoam in the middle ear. Post-operative follow up was done to look for graft uptake, hearing assessment by pure tone audiometry and impedance audiometry was done 90 days post-operatively.  </p><p class="abstract"><strong>Results:</strong> Graft uptake was 80% in type 1 tympanoplasty without gelfoam in the middle ear and 80.6% with gelfoam in the middle ear. Both types of surgeries had significant hearing improvement, and complications like retraction and residual perforation were also comparable. Ad type of impedance curve is most common post operatively.</p><p><strong>Conclusions:</strong> Graft uptake is equally good in cases with gelfoam and without gelfoam. Hearing gain is comparable in both groups of patients. No significant complications occurred in our study. ‘Ad’ is the most common type of impedance curve after surgery. Long term follow up is important in these patients. </p>

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