Does concurrent adenoidectomy or tonsillectomy affect the graft success rate of cartilage myringoplasty in adults?

Abstract Background The objective of this study was to evaluate the graft success and hearing outcomes of concurrent adenoidectomy or tonsillectomy and myringoplasty. Methods Medical case notes were reviewed for all adult patients with dry perforations who had undergone myringoplasty, with or without concurrent throat surgery, from December 2015 to February 2018. The study population was divided into concurrent myringoplasty and throat surgery (Group A) and single myringoplasty (Group B) groups. The air–bone gap (ABG) and graft success rate were evaluated in both groups. Results A total of 131 ears of 131 patients were included in this study. In total, 33 ears of 33 patients were assigned to Group A and 98 to Group B. Of the 33 patients in Group A, adenoid residue was detected in 3, chronic tonsillitis in 21, and tonsil hypertrophy in 9. The graft success rate was 96.9 % in Group A and 96.9 % in Group B at 6 months postoperatively (p = 0.993). In addition, the graft success rate was 87.9 % in Group A and 92.8 % in Group B at 24 months postoperatively (p = 0.372). Reperforation occurred in three patients in Group A and four in Group B; the difference was not significant. No significant group differences were observed in preoperative (p = 0.654) or postoperative (p = 0.791) ABG values or mean ABG gain (p = 0.439). No patient in either group developed cholesteatoma of the middle ear. Conclusions Simultaneous adenoidectomy or tonsillectomy and myringoplasty is feasible but does not improve the graft success rate or hearing outcome.

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Comparison of the Functional Success of Fat Myringoplasty and Perifascial Areolar Tympanoplasty in Transcanal Endoscopic Ear Surgery

Ear Nose & Throat Journal ◽

10.1177/0145561320947261 ◽

2020 ◽

pp. 014556132094726

Author(s):

Chien-An Ko ◽

Chao-Hui Yang ◽

Ching-Nung Wu ◽

Pingche Huang ◽

Chung-Feng Hwang

Keyword(s):

Success Rate ◽

Subcutaneous Fat ◽

Type I ◽

Graft Material ◽

Endoscopic Ear Surgery ◽

Ear Surgery ◽

Group A ◽

Graft Success ◽

Group B ◽

Tissue Grafts

Objectives: We compared the functional outcomes of fat myringoplasty and areolar tympanoplasty through a small postauricular incision in patients who underwent transcanal endoscopic ear surgery (TEES). Methods: The study included patients who underwent myringoplasty or type I tympanoplasty using TEES in our Department of Otolaryngology between April 2016 and May 2019. The patients were divided into 2 groups according to the type of graft material used, which was selected based on the available amount of subcutaneous fat and the surgeon’s experience. Results: In total, 63 patients received fat tissue grafts (group A) and 77 received areolar tissue grafts (group B). The median operative time was significantly longer in group B (132 minutes) than in group A (65 minutes); perforations were significantly larger in group B than in group A (61.0% vs 29.7% of the eardrum surface). The postoperative air conduction threshold, air–bone gap, and speech reception threshold values were significantly lower than the preoperative values in both groups. The graft success rate did not significantly differ between groups A (96.8%, 61/63) and B (96.1%, 74/77). In group A, the perforation was > 35% of the eardrum surface in 27.0% (17/63) of the patients; the graft success rate was 100% (17/17). In the remaining 46 patients (perforation > 35%), the graft success rate was 95.7% (44/46); this difference was not statistically significant. Conclusions: Transcanal endoscopic ear surgery increases the usefulness of fat myringoplasty for the repair of perforations > 35% of the eardrum surface. Postauricular fatty and areolar tissues are suitable for this simple and rapid technique, which yields excellent outcomes.

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Endoscopic endonasal dacryocystorhinostomy vs nasolacrimal duct intubation in pediatric nasolacrimal duct obstruction - a comparative study

QJM ◽

10.1093/qjmed/hcab109.029 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Rana Atia ◽

Magda Samy ◽

Sheriff Elwan ◽

Thanaa Helmy ◽

Ashraf Shaat ◽

...

Keyword(s):

Postoperative Complications ◽

Success Rate ◽

Nasolacrimal Duct ◽

Nasolacrimal Duct Obstruction ◽

Endoscopic Endonasal ◽

Duct Obstruction ◽

Tube Removal ◽

Group A ◽

The Difference ◽

Group B

Abstract Study design; Pilot randomized controlled study. Objective To compare success rates of endoscopic endonasal dacryocystorhinostomy and nasolacrimal duct intubation in congenital nasolacrimal duct obstruction (NLDO) in a trial to define the superiority of either technique. Patients & Methods Sixty-six eyes of 61 patients were diagnosed as having epiphora and mucopurulent discharge due to congenital NLDO. The patients were randomly divided into two groups; Group A; 33 eyes of 28 patients (treated by probing and silicone intubation only (NLDI)) and Group B; 33 eyes of 33 patients (treated by endoscopic endonasal dacryocystorhinostomy and silicone tube intubation (EDCR). All tubes were removed 6 months after the operation. Results The success rate, defined as complete resolution of clinical symptoms and signs after 6 months of follow up, was 72.7 % in Group A and 81.8% in Group B. Although the success rate was higher in Group B, yet the difference was shown to be statistically nonsignificant. Preoperative symptoms were assessed postoperatively after tube removal. Complete cure had a higher rate of occurrence in Group B than in Group A (27eyes (81.8%) versus 25 eyes of 22 patients (75.8%) respectively). Postoperative positive fluorescein dye disappearance test (FDDT) after tube removal was more in Group B than in Group A (27 eyes (81.8) versus 24 eyes of 21 patients (72.7 %) respectively). In Group A, silicone tubes had to be repositioned due to prolapse in 3 eyes of 3 patients (9.1%) and had to be removed early in 3 eyes of 3 patients (9.1%) due to failure of repositioning. In Group B, silicone tubes did not require early tube extraction before the date of removal in any of the patients. Intraoperative, there was only one case (3.0%) of fat prolapse during EDCR in Group B with no subsequent postoperative complications. Hemostasis did not represent a problem in any of the patients. Postoperative complications occurred more in Group B than Group A (21 eyes (63.6%) versus 13 eyes of 13 patients (39.4 %) respectively). Late complications occurred more in Group B than Group A (18 eyes (54.5%) versus 12 eyes of 12 patients (36.4%) respectively) in the form of persistent epiphora and tube prolapse. Conclusion The success rate of pediatric EDCR was higher than that of pediatric NLDI. The difference was statistically non-significant. Complications were comparable between the two groups. The study, being pilot in its comparative aspect between endoscopy and intubation, opens the horizon for further study on a larger group that probably will expand this difference.

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Job Satisfaction and Evidence of Burnout Comparing Arab and Non-Arab Urologists with a Migration Background Working in German Hospitals

Avicenna Journal of Medicine ◽

10.1055/s-0041-1735127 ◽

2021 ◽

Author(s):

Matthias May ◽

Mohammad Shaar

Keyword(s):

Job Satisfaction ◽

Group Differences ◽

Cross Sectional ◽

Significant Group ◽

Intervention Measures ◽

Shortage Of Physicians ◽

Group A ◽

Group B ◽

Study Participants ◽

Prospective Longitudinal

Abstract Background In German hospitals, severe shortage of physicians can currently be partially compensated by hiring foreign physicians. Results on job satisfaction (JS) and physician burnout (PBO) in this important occupational group are currently not available. Methods The cross-sectional “Assessment of their urological work environment by foreign clinicians in Germany (EUTAKD)” study was conducted in 2020 using a 101-item questionnaire among physicians working in German urological departments who were born in a country outside Germany and having non-German citizenship. This study compared JS and the occurrence of PBO between Arab (group A, n = 57) and non-Arab (group B, n = 39) participants. Results Significant group differences with advantages for group B were analyzed in overall JS and also in other JS items. High scores in the PBO dimensions, that is, “emotional exhaustion” and “depersonalization,” were shown by 27.9 and 51.5% of the study participants, respectively, although there were no group differences found (p = 0.972 and 0.237, respectively). Conclusion Prospective longitudinal studies of appropriate intervention measures aimed at increasing JS and decreasing PBO are needed.

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The practices and philosophies of cartilage tympanoplasty in difficult and challenging circumstances: audiological and morphological perspectives

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20210171 ◽

2021 ◽

Vol 7 (2) ◽

pp. 358

Author(s):

Apoorva Kumar Pandey ◽

Ajaz U. Haq ◽

Sharad Hernot ◽

Madhuri Kaintura ◽

Aparna Bhardwaj ◽

...

Keyword(s):

Success Rate ◽

Pure Tone ◽

Randomized Study ◽

Chronic Otitis Media ◽

Functional Results ◽

Pure Tone Average ◽

Cartilage Tympanoplasty ◽

The Difference ◽

Graft Success ◽

Hearing Outcomes

Background: The main objective of the study was to assess the anatomical and functional results of cartilage tympanoplasty using full thickness cartilage graft (with or without perichondrium) reinforced with fascia in high risk situations.Methods: This prospective non-controlled, non-randomized study included 124 cases of chronic otitis media who underwent cartilage (reinforcement) tympanoplasty (underlay) and ossicular reconstruction with or without mastoidectomy in following seven groups: revision cases, atelectatic cases, subtotal perforation (dry), larger anterior perforations (dry), tympanosclerosis, cholesteatomatous ear, and wet (discharging) ears . Graft success was accepted labelled as an intact graft at the end of six month postoperatively. At the same time, hearing results were also assessed by comparing pre- and post-operative pure tone average air-bone gap (PTA-ABG) of each group using Student “t” test and p<0.05 was considered statistically significant for the hearing outcomes. Results: Anatomical success rate in this series was 94.36%. The overall mean pre- and post- operative pure tone average air-bone gap (PTA-ABG) were 31.33±10.41 dB and 19.55±12.04 dB, respectively and the difference was statistically significant (p<0.05). Best take up rates were observed in atelectatic and tympanosclerotic group i.e., 100% and 96.55% respectively.Conclusions: This study discusses the results of cartilage tympanoplasty in specifically indicated seven situation and reveals good anatomic results in each group (minimum success rate was 86.66% in wet ears) and statistically significant differences in mean pre- and post op PTA-ABG in groups except cholesteatoma and wet ear group.

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Early versus delayed appendectomy for uncomplicated acute appendicitis.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.04.4183 ◽

2020 ◽

Vol 27 (04) ◽

pp. 842-848

Author(s):

Farhan Javed ◽

Saira Saleem ◽

Ayesha Rehman ◽

Nazim Hayat ◽

Zakariya Rashid ◽

...

Keyword(s):

Acute Appendicitis ◽

Surgical Techniques ◽

Related Distribution ◽

Perforated Appendix ◽

Group A ◽

Study Population ◽

The Difference ◽

And Gender ◽

Group B ◽

Uncomplicated Acute Appendicitis

Study Design: Sectional study. Setting: Madina Teaching Hospital Faisalabad. Period: July 2018 to June 2019. Material & Methods: A sample of 107 patients was selected using non-probability purposive sampling out of all the patients presenting with acute appendicitis. Study population was divided into Groups A and B, former undergoing appendectomy within 8 hours of admission and later undergoing surgery more than 8 hours after admission. Spinal and general anesthesia was used and both Laparoscopic and open surgical techniques were employed. Results: Out of total 107 patients, 62 (57.94%)were placed in group A and 45 (42.06%) in group B. Age and gender related distribution in both groups were similar. 5 patients in group A had perforated appendix and 3 patients in Group B were found to have perforated appendix. The difference between incidence of perforation between the two groups was not statistically significant. Conclusion: in-hospital delay before appendectomy does not significantly increase the risk of perforation in uncomplicated acute appendicitis.

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Effect of mitomycin C-aided trabeculectomy on conjunctival goblet cell density

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v4i1.5854 ◽

1970 ◽

Vol 4 (1) ◽

pp. 68-72 ◽

Cited By ~ 2

Author(s):

S Mukhopadhyay ◽

SKD Thakur ◽

J Dutta ◽

R Prakash ◽

C Shaw ◽

...

Keyword(s):

Success Rate ◽

Mitomycin C ◽

Cell Density ◽

Goblet Cell ◽

Deleterious Effect ◽

Impression Cytology ◽

Group A ◽

The Difference ◽

Group B ◽

Goblet Cell Density

Introduction: Mitomycin C is gaining widespread popularity as an adjunctive with trabeculectomy, as it significantly increases the success rate of the procedure. But it is associated with serious sight-threatening complications. Materials and methods: Twenty eyes planned for trabeculectomy from the glaucoma clinic were enrolled for the study after obtaining an informed consent. The baseline impression cytology was taken. Ten eyes underwent trabeculectomy with mitomycin C (Group A) and the rest underwent trabeculectomy without any antimetabolites (Group B). Impression cytology samples were taken on months 1, 3, 6, 9 and 12. Results: In Group A, the difference between goblet cell density preoperatively and 12 month postoperatively was statistically significant (p < 0.0001). In Group B, the difference was not statistically significant. (p = 0.27). Conclusion: Mitomycin C, though used to augment the success rate of trabeculectomy, has deleterious effect on the conjunctival goblet cell population as is evident from the conjunctival impression cytology. DOI: http://dx.doi.org/10.3126/nepjoph.v4i1.5854 NEPJOPH 2012; 4(1): 68-72

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Effects if co2-baths in the combined concept of the early functional therapy in the cases of reflex sympathetic dystrophy

South African Journal of Physiotherapy ◽

10.4102/sajp.v61i1.169 ◽

2005 ◽

Vol 61 (1) ◽

Author(s):

C. Mucha

Keyword(s):

Reflex Sympathetic Dystrophy ◽

Combined Therapy ◽

Group Differences ◽

Functional Therapy ◽

Significant Group ◽

Beneficial Effects ◽

Group A ◽

Post Traumatic ◽

Group B ◽

Early Functional Therapy

Objective: The effects of the application of CO2-baths for the purposes of the specific early functional combined therapy in cases of reflexsympathetic dystrophy should be differentiated.Subjects: Forty patients suffering from acute post-traumatic reflex sympathetic dystrophy in the hand.Design: A four weeks’ omission test was carried out in group B. The resultswere contrasted to group A. The relevant parameters in the process of regeneration were statistically calculated as a chronological serial analysis.Results: In regard of the multi-variable design the results demonstrated highly significant group differences in the case of the progression of regeneration, at which group A was definitely superior to group B. Group B displayed an additional effect of delay. Conclusion: The potential influences with regard to the effects of the CO2-bath are: better organisation of the exercises and superior progression of regeneration. Obviously there are beneficial effects of the combination therapy.

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SKIN CLOSURE IN LAPAROTOMY

The Professional Medical Journal ◽

10.29309/tpmj/2011.18.04.2574 ◽

2011 ◽

Vol 18 (04) ◽

pp. 552-556

Author(s):

GHULAM SHABBIR ◽

M. SUHAIL AMER ◽

MUHAMMAD UMAIR RASHID

Keyword(s):

Hospital Stay ◽

Wound Infection ◽

Wound Dehiscence ◽

Skin Closure ◽

Significant Group ◽

Qualitative Variable ◽

Wound Closure Techniques ◽

Group A ◽

The Difference ◽

Group B

The aim of this study was to record the outcome of healing in laparotomy wounds, managed by delayed versus primary skin closure in terms of hospital stay, major and minor wound infection. Design and Duration: Quasi experimental study from September, 2006 to March, 2007. Setting: Surgical floor of Allied Hospital, (Punjab Medical College) Faisalabad. Methodology: Detailed data of each patient including presentation, operative findings, procedure performed, post operative outcome was entered on a specially designed proforma. The main outcome measures found significant were major and minor wound infection, time of presentation and advancing age and hospital stay. Results: Sixty patients underwent exploratory laparotomy through vertical abdominal incision during Sep.2006 to Mar.2007. Skin wound of the first thirty patients (group A) were left open and closed on 4th day while that of next thirty patients (group B) closed primarily. Out of sixty patients ten patients developed major wound infection leading to wound dehiscence (16.66 %). Four belonged to group A(13.33%) and six belonged to group B(20 %) (p<0.05). In advancing age the infection rate was significantly high in the same group (p <0.01). Regarding hospital stay of patients of two groups the difference was statistically significant. Group A (mean=7.77, std. dev=2.029 and std. error of mean=0.370). Group B (mean=10.30, std. dev=4.822 and std. error of mean=0.880). Regarding age the difference was not statistically significant between two groups. Group A (mean 30.47, std. dev=10.099 and std error of mean=1.844). The data was analyzed using SPSS 17 Chi-square test was used to test the significance between qualitative variable, p<0.05 was considered significance. Conclusions: No matter how advanced new wound closure techniques are, wound infection is the single most important factor for wound dehiscence and it can be decreased by using delayed skin closure technique and meticulous post-operative monitoring and care.

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Comparison of two insertion techniques for I-Gel placement in paediatric patients: standard vs rotational methods

Indian Journal of Clinical Anaesthesia ◽

10.18231/j.ijca.2021.071 ◽

2021 ◽

Vol 8 (3) ◽

pp. 373-376

Author(s):

Rahul Yadav ◽

Neeraj Kumar Tiwari ◽

Milind Y Dharmamer ◽

Sanil Mohan ◽

Ajai Chandra ◽

...

Keyword(s):

Success Rate ◽

Randomized Study ◽

Standard Technique ◽

Paediatric Population ◽

Insertion Time ◽

Elective Surgical Procedures ◽

Paediatric Patients ◽

Group A ◽

The Difference ◽

Group B

: I-Gel has found increasing favour amongst anaesthesiologists for securing and maintaining a patent airway during routine as well as emergency surgeries in the paediatric population. The present prospective randomized study was conducted to compare the two techniques (standard and rotational methods) for I-Gel insertion in children; by assessing the first attempt success rate, insertion time and ease of insertion.: ASA I and II paediatric patients (1-6 years old) scheduled for brief elective surgical procedures lasting less than one hour were randomly allocated into two groups viz. Group A (n= 30) employing the standard technique, and Group B (n= 30) utilizing the rotational technique for I-Gel placement.: Group B subjects depicted a significantly higher first-attempt success rate vis a vis Group A subjects (P=0.040). The mean insertion time during the first attempt was longer in Group A (standard technique) as compared to Group B (rotational technique), but the difference was not statistically significant.: This study lends credence to the fact that the placement of I-Gel by employing the rotational method culminates in an increase in the first attempt success rate, suggestive of its potential superiority to the standard method

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COMPARISON BETWEEN TRAGAL CARTILAGE WITH PERICHONDRIUM AND TEMPORALIS FASCIA GRAFT BY UNDERLAY ENDOSCOPIC TYMPANOPLASTY

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71isuppl-3.5819 ◽

2021 ◽

Vol 71 (Suppl-3) ◽

pp. S622-25

Author(s):

Muhammad Tahir ◽

Asim Abbass ◽

Faiz Ul Hassan Nawaz ◽

Syed Asad Shabir ◽

Atif Rafique

Keyword(s):

Success Rate ◽

Tertiary Care ◽

Care Hospital ◽

Temporalis Fascia ◽

Tympanic Membrane Perforations ◽

Fascia Graft ◽

Group A ◽

The Difference ◽

Group B ◽

Endoscopic Tympanoplasty

Objective: To compare the results of tragal cartilage with perichondrium versus temporalis fascia graft in endoscopic tympanoplasty using underlay technique. Study Design: Comparative prospective study. Place and Duration of Study: Study conducted in Tertiary Care Hospital, Karachi, from Jul 2018 to Feb 2020. Methodology: Overall, 34 patients having permanent unilateral tympanic membrane perforations were included in this study, in whom underlay endoscopic tympanoplasty was performed. Group A patients underwent temporalis fascia graft while group B received a tragal cartilage with perichondrium graft. The success rate between groups was compared in respect of reduction in postoperative air-bone gap and healing of perforation. Results: The success rate of graft was 88% (30/34) in group A and 94% (32/34) in group B after 6 months follow-up, the difference was not found to be statistically significant (p=0.368). Hearing improvement in the form of closure of air bone gap in group A was from 24.52 ± 1.73 dB (decibel) to 13.56 ± 5.67s dB and in group B it was from 19.76 ± 3.47dB to 11.94 ± 3.9dB, the difference was not significant statistically (p=0.333). Conclusion: Keeping in view the results of our study, we conclude that both tragal cartilage with perichondrium and temporalis fascia graft are considered equally successful in endoscopic tympanoplasty.

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