Hearing assessment and status of tympanic membrane pre and post-operated tympanoplasty in cases of CSOM.

Objectives: To compare assessment of hearing by PTA and status of tympanic membrane by oto-endoscope, pre-operative and post-operative tympanoplasty. Study Design: Retrospective/ Comparative study. Setting: Two different hospitals in Karachi. 1-Social Security Landhi Hospital Karachi. 2- Al-Tibri medical College & Hospital, Old Thana, Malir, Karachi. Period: July 2017 to June 2018. Material & Methods: 76 patients were included for this study with both genders who had dry tympanic membrane perforations. Age ranges between 18 to 40 years. Made two groups A (pre-operative and B (post-operative). In group-A, examined tympanic membrane perforations. 45 patients had small size (25%) perforations, 15 medium size (50%) and 16 subtotal (75%). Hearing assessment done by Pure tone Audiometry (PTA). After 1. 2 and 3 months post-tympanoplasty, examined grafted tympanic membrane and compared pre-operated status of tympanic membrane with post-operated status of tympanic membrane. PTA done after 3 months and compared it with pre-operated PTA. Results: Examination of tympanic membrane before tympanoplasty performed, perforations noted in all patients with different sizes in their tympanic membrane. PTA (pure tone audiometry) advised before tympanoplasty to all patients. Weber test performed on 1st post-operated day, it was lateralized towards operated ear which indicate the safety of inner ear. Post-operated 1, 2 and 3 months examined tympanic membrane with oto-endoscope. Intact grafted tympanic membrane seen in 70 patients after 1 months. After 2 months 72 patients had intact grafted tympanic membrane and after 3 months 73 patients out of 76 patients had intact grafted tympanic membrane. PTA also advised after 3 months of tympanoplasty and compared it with pre-operated pure tone audiometry (PTA). Air conduction (AC) decreased 15.39dB after tympanoplasty. AB-gap reduction 13.95dB seen in 73 patients which showed hearing improvement. P value is < 0.001 significant. Conclusion: Tympanoplasty is a good and safe procedure for hearing improvement by reduction of AB-gap as well as provide protection of middle ear mucosa from infections due to closure of perforations of tympanic membranes.

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Study of effect of 1% sodium hyaluronate application on tympanic membrane perforation

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20183695 ◽

2018 ◽

Vol 4 (5) ◽

pp. 1246

Author(s):

Dimple Sahni ◽

Bikramjit Singh ◽

K. S. Uppal ◽

Sanjeev Bhagat ◽

Dinesh Sharma ◽

...

Keyword(s):

Tympanic Membrane ◽

Sodium Hyaluronate ◽

Pure Tone Audiometry ◽

Tympanic Membrane Perforation ◽

Medium Size ◽

P Value ◽

Beneficial Effects ◽

Tympanic Membrane Perforations ◽

Membrane Perforation ◽

Traumatic Origin

Background: Topical applications of hyaluronic acid have been found to have beneficial effects on closure of tympanic membrane perforations. The aim of the study was to evaluate the role of 1% sodium hyaluronate in the repair of small or medium sized dry central tympanic membrane perforation and improvement in hearing following closure of tympanic membrane perforation.Methods: 50 patients with dry central perforation of inflammatory or traumatic origin were taken up. Maximum of 4 applications of 1% sodium hyaluronate were given at weekly intervals. Final mapping for closure of tympanic membrane perforation and hearing assessment was done after 3 months. Results: 26 perforations closed completely while 18 perforations showed significant reduction in size. Thus 44 or 88% perforations showed positive response to 1% sodium hyaluronate application. Hearing Improvement was observed on pure tone audiometry with the average hearing gain in patients after complete closure of tympanic membrane perforation was 12.40 dB with p value of 0.001.Conclusions: Study showed the beneficial effects of 1% sodium hyaluronate application in closure of small and medium size perforations of tympanic membrane perforation and improvement in hearing.

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A study to assess hearing improvement after fat graft myringoplasty

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20210161 ◽

2021 ◽

Vol 7 (2) ◽

pp. 303

Author(s):

Nupur Midha ◽

Gurbax Singh ◽

Rachna Dhingra ◽

Rajwant Kaur

Keyword(s):

Pure Tone ◽

Bone Conduction ◽

Pure Tone Audiometry ◽

Threshold Level ◽

Fat Graft ◽

Hearing Improvement ◽

Suppurative Otitis Media ◽

Bone Conduction Threshold ◽

Tympanic Membrane Perforations ◽

Number Of Patients

Background: Tympanic membrane perforations result mainly from infectious and traumatic etiologies. Postoperative outcomes of reconstructive surgeries of hearing mechanism have routinely been assessed by take up rates and air bone gap closure on pure tone testing. The present study was conducted to assess hearing improvement after fat graft myringoplasty.Methods: The present prospective study was conducted from 1st January 2017 to 30th June 2018. The study population consists of patients of age 18 to 60 years. The subjects with safe or tubotympanic type of chronic suppurative otitis media with small dry central perforation or perforation of the pars tensa less than 3 mm were included in the study. Pure tone audiometry (PTA) was consigned to an audiologist who was blind to the study. Air conduction threshold level was measured at frequencies 0.25 to 8 kHz and bone conduction threshold level was measured at frequencies 0.5 to 4 kHz; average air bone gap of each patient was calculated preoperatively and postoperatively at one and three months at the frequencies 500 Hz, 1000 Hz and 2000 Hz. Results: Among 30 patients, 15 (50.00%) had pre-operative bone conduction threshold in the range of 0-10 dB HL and rest 15 (50.00%) had between 11-20 dB HL. Majority of them i.e. 20 had post-operative air bone gap in the range of 0-10 dB HL whereas 02 had pre op air bone gap in this range, followed by 07 with air bone gap in the range of 11-20 dB HL as compared to 18 in the pre op and 03 in the range of 21-30 dB HL as compared to 10 in the pre op. Paired t test reveals results are significant.Conclusions: Postoperative audiometry at the end of 1 month revealed majority i.e. 14 had air bone gap in range of 0-10 dB HL thus showing improvement in hearing. Postoperative audiometry at the end of 3 months revealed maximum number of patients i.e. 20 in the range of 0-10 dB HL which showed further improvement in hearing in the form of decrease in air bone gap.

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Correlation between degree of hearing loss and intraoperative findings in tubotympanic type of chronic suppurative otitis media

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20180717 ◽

2018 ◽

Vol 4 (2) ◽

pp. 537 ◽

Cited By ~ 1

Author(s):

Ravi Dudda ◽

Sowmya Tumkur Rangaiah ◽

M. Hanumantha Prasad ◽

Nagavara Kalegowda Balaji

Keyword(s):

Hearing Loss ◽

Tympanic Membrane ◽

Otitis Media ◽

Pure Tone ◽

Pure Tone Audiometry ◽

Ossicular Chain ◽

Chronic Suppurative Otitis Media ◽

Hearing Improvement ◽

Suppurative Otitis Media ◽

Significant Difference

Background: The aim of tympanoplasty done for tubotympanic type of chronic suppurative otitis media (CSOM) should not only be to achieve a dry ear, but also to give hearing improvement to the patient. Aim of this study was to determine the correlation between size and site of tympanic membrane perforation with degree of hearing loss and correlation between ossicular chain status and degree of hearing loss on pure tone audiometry.Methods: Patients with tubotympanic CSOM with hearing loss upto 60 dBHL undergoing tympanoplasty were examined to know the site and size of tympanic membrane(TM) perforation. Intraoperative findings pertaining to middle ear and ossicles were noted. Results: Out of 52 patients of tubotympanic type of CSOM, hearing loss was least (31.18±7.46 dBHL) in small perforations of the TM and highest in subtotal perforations (48.74±7.83 dBHL) which was statistically significant. Hearing loss was significantly more in posterior perforation (46.61±7.02 dBHL) than in anterior perforation of TM (32.65±8.77 dBHL). There was a statistically significant difference in pure tone average hearing loss between intact ossicle group (32.87±9.77 dBHL) and eroded ossicle group (43.39±9.60dBHL). Difference in air bone gap was also significant between intact ossicle group (24.09±9.56 dB) and eroded ossicle group (31.02±9.83 dB). Multiple ossicles were eroded in nineteen patients with incus being the most commonly eroded ossicle.Conclusions: In this study, hearing loss increased with increased size of TM perforation and also with posterior perforation. Incus was found to be the most commonly eroded ossicle. Multiple ossicles were seen eroded most commonly when hearing loss was moderate. The surgeon will be better equipped to do ossiculoplasty in view of these preoperative findings and also to counsel the patient better about their expectation of hearing improvement following surgery.

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Ear Findings and Hearing analysis in cleft palate patients in Nepal

Asian Journal of Medical Sciences ◽

10.3126/ajms.v10i2.22762 ◽

2019 ◽

Vol 10 (2) ◽

pp. 52-57

Author(s):

Sanjeev Thakur ◽

Baleshwar Yadav ◽

Manish Agrawal ◽

Kailash Khaki Shrestha ◽

Raj Kumar Bedajit

Keyword(s):

Hearing Loss ◽

Cleft Palate ◽

Tympanic Membrane ◽

Pure Tone ◽

Cleft Lip ◽

Conductive Hearing Loss ◽

Pure Tone Audiometry ◽

P Value ◽

Age Group ◽

Conductive Hearing

Background: The orofacial cleft is the most common birth anomaly with a prevalence rate ranging from 1/1000 to 2.69/ 1000. The middle ear diseases are known to be associated with cleft palate, however, the prevalence and the magnitude of the condition is usually underestimated. Aims and Objectives: The purpose of this study was to find out the various exisiting ear abnormalities, to assess the middle ear function and hearing status in patients with cleft palate and confirm the existence of these manifestations and their significance. Materials and Methods: All the patients with cleft palate with or without cleft lip over a one-year duration from January to December 2018 at the teaching hospital were include after informed consent. The patients with only cleft lip were excluded. General ENT examination and Otoscopy was performed. Tympanometry and Pure tone Audiometry was done (in those above 5 years). The degree of hearing loss was categorized using the WHO guidelines. Results: Out of a total of 56 patients, there were 30(53.6%) male and 26(46.4%) female. The age range was from 2years to 31 years. The mean age was 12.8 years. Maximum number of patients were in the 10-20 years age group 29(51.8%) followed by 22 (39.3%) in the less than 10 years age group. 53 (47.3%) of 112 ears examined had dull tympanic membrane, followed by retraction of tympanic membrane in 42 (37.5%) ears. Other findings were central perforation in 5 (4.5%), bulging tympanic membrane in 2 (1.8%) and atticoantral disease in 1 (0.9%) ear. 8 (7.1%) ears had normal findings. There was one case with right ear atresia (0.9%). In Tympanometry findings, the maximum number of ears, 51 (48.1%) had type B curve, followed by 33 (31.2%) ears with type As curve. 16 (15%) of ears had type C curve. 6 (5.7%) ears had type A curve. B type curve was found more common in less than 10 years age group. A chi Square test was performed and the findings had statistically significant association. (P value: 0.03 for Right ear tympanometry ; P value: 0.043 for left ear tympanometry). In Pure tone audiometry findings of 105 ears, 72 (68.6%) ears had mild conductive hearing loss. 10 (9.5%) ears had moderate conductive hearing loss, while 1 (1%) ear had mixed hearing loss. 22 (20.9%) ears had normal hearing level. Conclusion: This study assessed the common ear problems prevalent in cleft patients, along with the hearing loss. Since, ear disease were quite common in these patients, these patients should be evaluated regularly by an otolaryngologist to detect, treat and prevent such problems in these patients so that long term morbidity could be avoided.

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To assess the hearing improvement in patients of Chronic Otitis Media Tubotympanic type post tympanoplasty

The Journal of Medical Research ◽

10.31254/jmr.2020.6611 ◽

2020 ◽

Vol 6 (6) ◽

pp. 305-308

Author(s):

Harsh Lokhna ◽

◽

Sanjay Kumar ◽

Anshul Bansal ◽

◽

...

Keyword(s):

Hearing Loss ◽

Otitis Media ◽

Pure Tone ◽

Pure Tone Audiometry ◽

Hearing Improvement ◽

Middle Ear Mucosa ◽

Suppurative Otitis Media ◽

Type 1 Tympanoplasty ◽

Significant Difference

Aim: To determine hearing improvement in type- 1 tympanoplasty by comparing mean preoperative air bone gap with mean postoperative AB gap. Material and method: Patients clinically diagnosed as 75 cases of Chronic Suppurative Otitis Media Tubotympanic Type Disease presenting to the ENT OPD of Chhatrapati Shivaji Hospital attached to Subharti Medical College, Meerut were taken up for study. Detailed clinical examination and history was taken. Pure tone audiometry was conducted, hearing loss and mean AB Gap was noted pre-operatively. X-Ray mastoid B/L Schuller’s view was done and findings were noted. Tympanoplasty type 1 with or without mastoidectomy was performed. Cortical mastoidectomy with type 1 Tympanoplasty was performed in patients having granulations & polypoidal middle ear mucosa along with sclerotic mastoid. All these patients were followed up post-operatively at 6 weeks. The status of graft uptake was noted. Pure tone audiometry was performed. Hearing loss and mean AB Gap results were compared with pre-operative findings. Results: In our study out of 75 patients, 33 (44%) patients were affected with Right ear and 42 (56%) patients were affected with Left ear. Hearing loss was the chief complaint in all 75 patients (100%) followed by blocking sensation. Post operatively 58 (77.33%) patients had normal hearing followed by 16 (21.33) patients who had mild hearing loss. Only 1 (1.33%) patient had moderately severe hearing loss. Pre-operatively, mean AB Gap was 46.62+/-7.89dB while post-operatively mean AB Gap was 23.43+/-5.52dB with statistically significant difference as p<0.05. Conclusion: In our study, the post-operative Mean AB Gap was improved significantly as compared to preoperative mean AB Gap.

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Evaluation of Graft Uptake and Hearing Assessment after Palisade Myringoplasty

Journal of Nepal Medical Association ◽

10.31729/jnma.3699 ◽

2018 ◽

Vol 56 (212) ◽

pp. 770-773 ◽

Cited By ~ 1

Author(s):

Poonam KC

Keyword(s):

Tympanic Membrane ◽

Otitis Media ◽

Uptake Rate ◽

Pure Tone ◽

Statistical Significance ◽

Chronic Otitis Media ◽

Pure Tone Audiometry ◽

Long Term Results ◽

Hearing Improvement ◽

Hearing Gain

Introduction: Cartilage as a graft for closure of tympanic membrane has got superior benefits than other usual grafts (temporalis fascia and perichondrium). Cartilage supported myringoplasty with palisade technique has good result of graft uptake rate, even under difficult conditions. This technique brings very good functional and better long-term results. This study is done to assess graft uptake rate and hearing improvement after myringoplasty with cartilage palisade technique. Methods: It is a descriptive, hospital based observational study done at Manipal Teaching Hospital, Pokhara between 2014-2017. A total of 45 patients aged between 13 years and 44 years diagnosed with chronic otitis media-mucosal were taken. Pure tone audiometry was done before and six months after surgery. Graft uptake and Post-operative hearing gain was evaluated after six months. Statistical analysis was done by Statistical Package for Social Sciences version 16.0. Statistical significance was set at P<0.05. Results: Graft uptake rate was 41 (91.1%). The mean pre-and post-operative pure tone average were 26.88dB and 8.44dB respectively. The post-operative hearing gain was 18.36dB. Hearing improvement after surgery was found to be statistically highly significant with P<0.001. Conclusions: Cartilage supported myringoplasty using palisade technique is preferred for chronic otitis media-mucosal with large and sub-total tympanic membrane perforation.

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

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20212824 ◽

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

Background: 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.Methods: 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. Results: 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.Conclusions: Graft uptake is equally good in cases with gel-foam and without gel-foam. Hearing gain is comparable in both groups of patients.

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Comparison of efficacy of myringoplasty in dry and wet ears in chronic otitis media of tubotympanic type

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20173051 ◽

2017 ◽

Vol 3 (3) ◽

pp. 705 ◽

Cited By ~ 1

Author(s):

Yogeshwar Chandrashekar ◽

Ravishankar Chandrashekar

Keyword(s):

Otitis Media ◽

Statistical Significance ◽

Chronic Otitis Media ◽

Pure Tone Audiometry ◽

Inflammatory Cells ◽

P Value ◽

Hearing Improvement ◽

Female Ratio ◽

Fascia Graft ◽

A Prospective Study

Background: The objective of the study was to compare the outcome of myringoplasty in dry and wet ears in tubotympanic type of chronic otitis media (COM) with respect to graft uptake and hearing improvement.Methods: This is a prospective study done in department of ENT Bangalore Medical College and Research Institute during the study period of November 2014 to May 2016, wherein a total of 60 patients of tubotympanic type COM with 30 cases each of dry and wet ears, aged 15-60 years were included. The hearing impairment was assessed and recorded by pure tone audiometry (PTA). After obtaining informed written consent the patients underwent myringoplasty (temporalis fascia graft, underlay technique). Microbiological examination of discharge in wet ears was done and histopathology of the excised remnant TM analyzed in both groups. Both groups of patients were followed up for 3 months and assessed for graft uptake and hearing improvement. PTA was repeated at 3 months postoperatively. Results: Our study included 60 patients of tubotympanic type of COM with 30 cases each with dry and wet ears who underwent myringoplasty. Majority of our patients were in second decade in both the groups. There was slight female preponderance in our study with male to female ratio of 0.93:1. Discharge from ears in wet ears was mucoid in consistency and were culture negative. Histopathology of excised remnant TM in wet ears revealed evidence of inflammatory cells and vascularization within stroma of fibroblasts while these were absent in dry ear cases. The overall successful graft uptake following myringoplasty was 88.3% with 86.7% for wet ears and 90% for dry ears with no statistical significance (p value of 0.688>0.05) between the two groups. With respect to hearing improvement post-operatively there was significant hearing improvement in both the groups when compared to preoperative hearing with a mean hearing gain (dB) of 3.43±2.81 in wet ear cases to 3.85±3.05 in dry ear cases, but when compared between the two groups, there was no significant statistical difference (p value of 0.582>0.05).Conclusions: The outcome is equally good for myringoplasty in dry and wet ears in tubotympanic type of chronic otitis media with respect to graft uptake and hearing improvement.

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Surgical Outcomes of Pure-Fat Myringoplasty for Small Tympanic Membrane Perforations: A Retrospective Study and Summary of the Literature in the Last 10 Years

Korean Journal of Otorhinolaryngology - Head and Neck Surgery ◽

10.3342/kjorl-hns.2021.00360 ◽

2021 ◽

Vol 64 (10) ◽

pp. 711-719

Author(s):

Min Kyu Lee ◽

Tae Min Kim ◽

Sung Jin Lim ◽

Dong Heun Park ◽

Yoon Chan Rah ◽

...

Keyword(s):

Retrospective Study ◽

Success Rate ◽

Tympanic Membrane ◽

Surgical Outcomes ◽

Pure Tone ◽

Current Knowledge ◽

Tympanic Membrane Perforations ◽

The Mean ◽

Hearing Outcomes ◽

Paired T Test

Background and Objectives Fat myringoplasty is a simple, fast, and effective procedure for repairing tympanic membrane (TM) perforations. The aim of this study is to evaluate the surgical outcomes of pure-fat myringoplasty for small TM perforations at our hospital and review the current knowledge regarding fat myringoplasty, with consideration of the effectiveness of additional substances used in the treatment of small TM perforations.Subjects and Method We retrospectively studied 41 patients who underwent pure-fat myringoplasty at our hospital from March 2008 through April 2019 and were followed up for at least 2 months thereafter.Results Of 41 patients, 16 were males and 25 were females, with the mean age of 48 (male, 9-75 years; female, 16-65 years). All perforations were classified as small perforations, ranging from 1% to 17% of the TM. The overall success rate was 92.7%, with the TMs of 3 patients (7.3%) failing to close. Air-bone gap (ABG) decreased in 19 out of 24 patients who underwent both preoperative and postoperative pure tone audiometric examinations. The mean ABG was 4.42 dB (n=24; paired-t test, p=0.001; 95% confidence interval, 1.77-7.07). The literature review revealed that TM closure success rate of over 80% was associated with pure-fat myringoplasty, while the TM closure success rate for fat myringoplasty with additional substances was 85% to 100%.Conclusion Our study revealed a high TM closure success rate and good hearing outcomes are associated with pure-fat myringoplasty. Pure-fat myringoplasty seems to be sufficient for repairing small TM perforations.

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Over-Underlay technique of myringoplasty.

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.03.5628 ◽

2021 ◽

Vol 28 (03) ◽

pp. 282-286

Author(s):

Mirza Khizar Hameed ◽

Seema Naveed ◽

Amir Akbar ◽

Areesha Manzoor ◽

Ansa Umara Akram ◽

...

Keyword(s):

Success Rate ◽

Bone Conduction ◽

Previous History ◽

Pure Tone Audiometry ◽

Sampling Technique ◽

Successful Outcome ◽

Middle Ear Mucosa ◽

Surgical Microscope ◽

Fascia Graft ◽

Hearing Assessment

Objective: To observe the success rate of Over-underlay technique of myringoplasty in patients with inactive tubo-tympanic type of CSOM. Study Design: Descriptive, Observational study. Setting: ENT Department Fauji Foundation Hospital Rawalpindi. Period: December 2018 to December 2019. Material & Methods: A total of 80 patients with inactive tubo-tympanic type of CSOM, from both genders, within age range of 15-45 years, having pure conductive hearing loss with an Air-Bone gap of not less than 15 dB were selected by convenient sampling technique. Patients having an active ear disease or previous history of ear surgery, an active sinus or URT disease, or any comorbidity were excluded from the study. Complete general and head-neck examination was done after taking history. Patients’ affected ears were examined under surgical microscope to see the drum perforation, condition of middle ear mucosa and the status of the ossicles. Hearing assessment was done by Pure Tone Audiometry through both air and bone conduction. Temporalis fascia graft myringoplasty was done in all these patients by over-underlay technique, and they were discharged on 5th post-operative day, and were followed up in ENT OPD after 3 weeks. Status of graft was seen under surgical microscope after removing the BIPP. After three months the patients were reviewed for graft status and hearing assessment. Successful outcome was taken as those patients in whom graft uptake was successful with complete closure of perforation, and secondly, closure of the Air-Bone gap by at least 10 dB. Data was analyzed by SPSS 19. Results: Mean age of the patients (n = 80) was found to be 30.8 Years. Gender distribution showed 57 (71.25%) Males and 23 (28.75%) Females with a M:F ratio of 2.5:1. Success rate was found significantly better among younger aged males. Graft uptake was successful in 74 (92.5%) of the patients. With respect to closure of A-B gap, post-operative mean difference in Air-Bone gap was found to be 9.6 dB ± 3.9 SD as compared to preoperative mean A-B gap of 28.5 dB ± 4.2 SD, thus a closure of A-B gap by 18.9 dB ± 2.4 SD. Conclusion: Over-underlay technique is found to be a successful technique for myringoplasty in terms of graft uptake and improvement in hearing thresholds in the patients with inactive tubo-tympanic type of CSOM.

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