Hearing Evaluation After Myringoplasty At Nepal Medical College And Teaching Hospital

Objective: To evaluate the graft takes rate of the myringoplasties performed by underlay technique using temporalis fascia graft for the last one year and to assess the hearing improvement in the successfully operated cases. Methods: This prospective Study included 52 ears of 50 patients, who underwent myringoplasty. All operations were performed using an underlay technique and mostly by postaural approach. In all the cases, temporalis fascia was used for the reconstruction of TM. The data of all the patients regarding preoperative disease, perforation size and localization, surgical approach, graft material, pre- and postoperative clinical and functional (hearing evaluation by pure-tone audiogram) results were analyzed. Results: Successful closure rate of the TM perforation was 82.69% and the graft failure rate was 17.30%. In this study, lowest and highest age of patients at presentation was 12 and 42 years respectively with a mean age of 25.5 years. The success rate was better with the advancing age. The most common approach was postaural. Medium size and posterior perforations were common and the graft take rate was 80.95%, and 88.89% respectively. The mean pre and post-operative air conduction threshold in the successful cases were 38.69dB and 30.35 dB respectively with a mean audiological improvement of around 8 dB. The improvement in the hearing was achieved in only 67.44% (29 out of 43) among the successful operated myringoplasties. Conclusion: Myringoplasty is a safe and effective technique to improve the quality of life of patients. The most common approach was postaural. The graft takes rate was better with the advancing ages and with the medium size and posterior perforations. The improvement in hearing was also achieved. Journal of Nobel Medical College Vol. 2, No.1 Issue 3 Nov.-April 2013 Page 36-42 DOI: http://dx.doi.org/10.3126/jonmc.v2i1.7671

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Audiometric evaluation of type 1 tympanoplasty for hearing results

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20171188 ◽

2017 ◽

Vol 3 (2) ◽

pp. 332

Author(s):

Mallikarjun S. Tegnoor ◽

Kazim Ali ◽

Sutrave Mithun

Keyword(s):

Uptake Rate ◽

Graft Material ◽

Temporalis Fascia ◽

Closure Rate ◽

Hearing Results ◽

Type 1 Tympanoplasty ◽

Fascia Graft ◽

Air Conduction

Background: To evaluate the graft uptake rate of the type1 tympanoplasty performed by underlay technique using autologous temporalis fascia graft for the last two years and to assess the hearing improvement in the successfully operated cases with respect to age, sex, size and location of perforation. Methods: This prospective Study included 50 patients, who underwent type1tympanoplasty.All operations are performed using an underlay technique and by postural approach. In all the cases, temporalis fascia is used for the reconstruction of TM. The data of all the patients regarding preoperative disease, perforation size and location, surgical approach, graft material, pre and postoperative clinical and functional (hearing evaluation by pure-tone audiogram) results are analyzed. Results: Successful closure rate of the TM perforation is 88% and the graft failure rate is 12%. In this study, lowest and highest age of patients at presentation is 13 and 55 years respectively with a mean age of 26.6 years. Most common approaches is post aural. The mean pre and post-operative air conduction threshold in the successful cases are 33.34 dB and 20.20 dB respectively with a mean audiological improvement of around 13 dB. The improvement in the hearing is achieved in only 88% (44 out of 50) among the successful operated type 1 tympanoplasty. Conclusions: Type 1 tympanoplasty is a safe and effective technique to improve the quality of life of patients. The most common approach is postural. The graft uptake rate is better at three months. The improvement in hearing is noted irrespective of age, sex, size and location of perforation.

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Pre-operative and post-operative audiological evaluation of type 1 tympanoplasty and comparison between temporalis fascia graft and tragal perichondrium graft

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20212128 ◽

2021 ◽

Vol 7 (6) ◽

pp. 1031

Author(s):

Satguru Saran Singh ◽

Sandip M. Parmar ◽

Abhey Sood ◽

Nilank Saroha ◽

Meenu Chaudhary

Keyword(s):

Pure Tone Audiometry ◽

Major Effect ◽

Medium Size ◽

Temporalis Fascia ◽

Suppurative Otitis Media ◽

Type 1 Tympanoplasty ◽

Large Size ◽

Fascia Graft

Background: Aim of the study was to evaluate the hearing improvement of type 1 tympanoplasty performed by using autologous temporalis fascia and autologous tragal perichondrium graft in successfully operated and graft uptake cases, with respect to age, sex, size of perforation and type of graft.Methods: This prospective study consists of total 100 patients with chronic suppurative otitis media (CSOM) tubotympanic disease who have undergone type 1 tympanoplasty. Randomization of patients was done. Every alternate patient was divided accordingly in to two groups-one in temporalis fascia graft group and another in tragal perichondrium graft group. Pure tone audiometry (PTA) was performed preoperatively and 3 months after surgery. Cases with successful graft uptake were included in the study. Statistical comparisons were performed using the t test, and ANOVA test.Results: In this study maximum numbers of patients were found in the age group of 15-30 years. Study showed that audiological benefits were more in males in comparison to females. Large size of perforation showed more improvement due to more air bone gap in comparison to medium size and small size perforation of ears. Audiological improvement occurred in 94% of cases, 3% cases worsened and 3% cases showed no change. More improvement was found in temporalis fascia graft in comparison to tragal perichondrium graft.Conclusions: Type 1 tympanoplasty is a safe and effective technique to improve the quality of life of patients. Size of perforation, type of graft was found to have a major effect on the final outcome of surgery.

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Perichondrium - An Autologous Substitute for Temporalis Fascia in Type I Tympanoplasty: A Comparative Study

Bengal Journal of Otolaryngology and Head Neck Surgery ◽

10.47210/bjohns.2019.v27i2.241 ◽

2019 ◽

Vol 27 (2) ◽

pp. 140-148

Author(s):

Bahnisikha Kayet ◽

Aryabrata Dubey

Keyword(s):

Type I ◽

Graft Material ◽

Inclusion Criteria ◽

Hearing Improvement ◽

Temporalis Fascia ◽

Hearing Results ◽

Fascia Graft ◽

Free Grafts ◽

Better Than

Introduction Temporalis fascia is the commonly used graft material for tympanic membrane reconstruction. Tragal perichondrium share with the fascia the quality of being mesenchymal tissue. In our study we compared perichondrium and temporalis fascia in terms of graft uptake and hearing improvement. Materials and Methods All patients presenting with discharge from ear and decreased hearing were subjected to clinical examination and investigation. Patients satisfying inclusion criteria were included in study with total of 40 patients. Twenty underwent type1 tympanoplasty with temporalis fascia (TF) and another 20 patients with tragal perichondrium (TP). To evaluate success patients are evaluated at end of 6 months for graft uptake and 3 months for hearing results in audiological gain of 10 dB in two consecutive frequencies. Results Mean Pre-op AC Threshold in TF group was 30.75 dB±5.16 and Post-op AC Threshold was 14.15 dB±8.05. Mean Pre-op AC Threshold in TP group was 32.2 dB±4.81 and Post-op AC Threshold was 20.95 dB±7.14. Mean post-op AC Threshold, Mean Post-Op AB Gap and Mean Audiological Gain was statistically significant among 2 groups p=0.0075, p=0.0013, p=0.0294 respectively. Temporalis fascia was better than Tragal Perichondrium. Graft uptake in 2 groups was not significant (p=0.6325). Conclusion From the present study we may conclude that temporalis fascia, tragal perichondrium free grafts provide viable autograft material for tympanoplasty. Both achieve good hearing restoration but the improvement in hearing or audiological gain is better in temporalis fascia graft than in tragal perichondrium graft.

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Myringoplasty With an Ultrathin Cartilage-Perichondrium Complex Graft Versus Temporalis Fascia Graft: A Propensity Score–Matched Analysis

Otolaryngology ◽

10.1177/0194599820965940 ◽

2020 ◽

pp. 019459982096594

Author(s):

Yi-Bo Huang ◽

Lu-lu Hu ◽

Dong-Dong Ren ◽

Zhao Han

Keyword(s):

Propensity Score ◽

Middle Ear ◽

Test Group ◽

Control Group ◽

Temporalis Fascia ◽

Closure Rate ◽

Factors Affecting ◽

Fascia Graft ◽

Endoscopic Myringoplasty ◽

Air Conduction

Objective To compare endoscopic myringoplasty using the cartilage-perichondrium complex as a graft (test group) with temporalis fascia microscopic myringoplasty (control group). Study Design A retrospective cohort study. Setting Department of Otorhinolaryngology in a tertiary Chinese hospital. Methods Data were collected on patients between 2017 and 2019. To balance the baseline characteristics between groups, we performed a propensity score–matched analysis, and 44 patients were included in each group. Hearing improvement and eardrum closure rates were compared, and risk factors affecting them were analyzed. Results In the control and test groups, 90.90% and 86.36% of patients had a mean air-bone gap ≤20 dB after the surgery, respectively ( P = .843). The air conduction (AC) threshold gain at each frequency was similar in the 2 groups ( P > .05). The closure rates were 95.45% and 93.18%, respectively ( P = .645). The air-bone gap improved significantly after surgery, F(1, 61) = 6.729, P = .012. Age, group, middle ear mucosal status, and location of the perforation did not affect the change in air-bone gap or the drum closure rate ( P > .05). However, there was an interaction between the change in air-bone gap and the size of the perforation, F(1, 61) = 11.067, P = 0001. Conclusion Endoscopic myringoplasty using a cartilage-perichondrium complex graft is comparable with traditional surgery. Age, location of the perforation, and middle ear mucosal status did not significantly affect the change in air-bone gap or the drum closure rate. A perforation size ≥50% was always associated with a better air-bone gap improvement.

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Study in the Quality of Clinical Documentation Practice in Chitwan Medical College Teaching Hospital, Nepal

Journal of Nepalgunj Medical College ◽

10.3126/jngmc.v12i2.14469 ◽

2016 ◽

Vol 12 (2) ◽

pp. 11-16

Author(s):

Upendra Pandit

Keyword(s):

Teaching Hospital ◽

Tertiary Care ◽

College Teaching ◽

Final Diagnosis ◽

Pooled Analysis ◽

Medical Documentation ◽

Medical College ◽

Patient Consent ◽

One Year

Background: Primary documentation of a patient is crucial for making effective healthcare decision and improvements in the quality of care. The objective of this study was to assess the quality of current documentation practice in tertiary care hospitals. Materials and methods: This was an assessment of medical documentation practice of one year from the period of January 2010 to December 2010 in Chitwan Medical College, Teaching Hospital. Total 184 patients' discharge files were enrolled and reviewed. Documentation was reviewed in its quality such as completeness, Coherent, consistency and Legibility.Results: In overall pooled analysis, High omission rate was observed in final diagnosis, results (cure, improved, referral and death), hospital stay, and final case summary. Although, satisfactory performance was observed in complete set of forms (72.2%); Patient consent for treatment &release authorization forms (78.2%) and treatment chart (60.8%), the overall pooled performance in ten components showed50% performance gap. Study demonstrated that documentation and its legibility, coherent and consistency in all departments needs substantial improvements in the institution.JNGMC Vol. 12 No. 2 December 2014, Page: 11-16

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A comparative study of preoperative and postoperative hearing after type I tympanoplasty using temporalis fascia graft at Dr. B. R. Ambedkar Medical College, Bengaluru

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20202777 ◽

2020 ◽

Vol 6 (7) ◽

pp. 1258

Author(s):

Muniraju M. ◽

Smita Hegde

Keyword(s):

Disease Duration ◽

Type I ◽

Temporalis Fascia ◽

Hearing Gain ◽

Medical College ◽

Type 1 Tympanoplasty ◽

Fascia Graft ◽

Cortical Mastoidectomy ◽

A Prospective Study

Background: The objective of the study was to identify the factors which significantly influence type 1 tympanoplasty success.Methods: A prospective study was performed on 30 patients who underwent type 1 tympanoplasty via underlay technique using temporalis fascia graft from December 2017 to September 2019 in a teaching hospital. Outcome measures were graft uptake rate and hearing gain. The factors assessed were the age and sex, preoperative condition of the ipsilateral and contralateral ears, perforation size, presence of tympanosclerosis, and whether simultaneous cortical mastoidectomy was performed. Results: None of the factors proved to have a significant influence on tympanic membrane closure or hearing gain.Conclusions: The success rate of a type 1 tympanoplasty is dependent on the skills of the surgeon and the type of graft used. Age, sex, laterality of the disease, duration of dry ear, size of the perforation, presence of tympanosclerosis and simultaneous cortical mastoidectomy have no bearing on hearing gain.

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An audit of hysterectomies at a tertiary care teaching hospital

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20182898 ◽

2018 ◽

Vol 7 (7) ◽

pp. 2874

Author(s):

Parveen Rajora ◽

Seema Grover Bhatti

Keyword(s):

Conservative Treatment ◽

Tertiary Care ◽

National Level ◽

Population Based ◽

Medical College ◽

Child Bearing ◽

Life Saving ◽

Abdominal Route ◽

One Year

Background: Hysterectomy is the second most common major surgical procedure performed on women all over the world next to caesarean section. Emergence of effective medical and conservative treatment for benign conditions in the uterus is now posing a question mark regarding the justification of hysterectomy. It has been realized that uterus should not be considered as a vestigial organ after child bearing. Apart from few population based studies, there is no national level survey done in India which give us the prevalence and indications for hysterectomy in India.Methods: Present study involved all patients who underwent Hysterectomy at Guru Gobind Singh Medical College Faridkot in a span of one year from 1st January 2017 to 31st December 2017.Results: In the year 2017, 250 hysterectomies were done, most common age group was 40-49 years (36.8%) and most common indication was fibroid uterus (40%) followed by ca ovary (19.6%), Abdominal route was most commonly preferred.Conclusions: Hysterectomy was justified in 98% women in our series based on post operative histopathological report of the specimen. However we hypothesize that 20 cases of DUB, 5 cases of CIN and 10 cases of endometriosis and 3 cases of chronic cervicitis could have been managed conservatively. 10 cases of obstetric hysterectomies could have been avoided by disseminating awareness among peripheral centres for early referral and by attempting a rather conservative approach of uterine artery embolizations. As the incidence of carcinoma is increasing in the Malwa region of Punjab people prefer hysterectomies instead of conservative treatment. Hysterectomy is used commonly to improve the quality of life and sometime it is life saving procedure. However it should be justified before taking a direct decision of sacrificing uterus.

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Total Endoscopic Transcanal Cartilage Myringoplasty: A Prospective Study

International Archives of Otorhinolaryngology ◽

10.1055/s-0039-1691758 ◽

2019 ◽

Vol 23 (04) ◽

pp. e440-e444

Author(s):

Dipesh Shakya ◽

Arun KC ◽

Ajit Nepal ◽

Nirmala Tamang

Keyword(s):

Prospective Study ◽

Chronic Otitis Media ◽

Endoscopic Approach ◽

Closure Rate ◽

Hearing Results ◽

A Prospective Study ◽

Lost To Follow Up ◽

Air Conduction ◽

Hearing Evaluation

Introduction Middle ear surgeries, including myringoplasty, have increasingly utilized endoscopes as an adjunct to or as a replacement for the operative microscope. Objectives The objective of the present study was to evaluate the graft uptake rate and to evaluate the hearing results. Methods This is a prospective study. We have analyzed 139 patients who underwent surgery for chronic otitis media (COM) of the mucosal type. All of the surgeries were performed exclusively under total endoscopic transcanal approach using tragal cartilage as graft, underlay technique. We have evaluated the postoperative graft uptake and performed a hearing evaluation at 6 weeks, at 12 weeks, and at 6 months. Results During the study period, 139 patients were included, out of which 13 were lost to follow-up; therefore, only 126 patients were assessed. All of the cases were performed under total endoscopic approach. As for the surgical outcome at the postoperative otoscopy, 3 cases had initial uptake at 3 months and failed later; therefore, complete closure of the perforation was observed in 97.6% (n = 123) of the patients 6 months after the intervention.Four patients presented with preoperative anacusis; therefore, only 122 patients were included for hearing evaluation. The preoperative air conduction threshold (ACT) and airbone gap (ABG) were 43.34 ± 11.53 and 24.73 ± 7.89, respectively.Postoperatively, the ACT and ABG closure were 28.73 ± 15.75 and 11.91 ± 8.41, respectively. This difference was statistically significant (p < 0.001). Conclusion The endoscopic approach for myringoplasty offers excellent visualization; avoids postaural approach, enables a faster recovery, requires less hospital stay, with excellent graft closure rate and improved functional outcomes.

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Comparative study of type I tympanoplasty using temporalis fascia and tragal cartilage with perichondrium as graft material

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20181873 ◽

2018 ◽

Vol 4 (3) ◽

pp. 789

Author(s):

Arvinder Singh Sood ◽

Pooja Pal ◽

Anshul Singla

Keyword(s):

Tertiary Care ◽

Chronic Otitis Media ◽

Type I ◽

Graft Material ◽

Hearing Improvement ◽

Temporalis Fascia ◽

Tertiary Care Centre ◽

Fascia Graft ◽

Uptake Rates

Background: Temporalis fascia and cartilage are the most commonly used graft materials, though contradictory reports are available in literature as regards their efficacy. The purpose of this study was to compare graft acceptance and auditory outcomes of tympanoplasty using cartilage versus temporalis fascia as graft material.Methods: This prospective study included 40 consecutive cases of chronic otitis media in a tertiary care centre randomised in two groups of 20 patients each to be subjected to tympanoplasty using either tragal cartilage-perichondrium or temporalis fascia graft from January 2011 to November 2012. Graft uptake rates and subjective as well as objective hearing improvement at 2 months and 6 months postoperative follow-up were compared. Results: The mean age of presentation was 34.4 years (range 15-60 years). At 2 months post operatively, the graft uptake was better with tragal cartilage group (95%) than temporalis fascia (90%), while at the end of 6 months graft uptake was better with temporalis fascia (75%) compared to tragal cartilage (70%). Hearing improvement was better for tragal cartilage group compared to the temporalis fascia group at both 2 months and 6 months follow-up. The subjective improvement in hearing at the end of 6 months was also better for tragal cartilage- perichondrium group than the temporalis fascia group.Conclusions: Both temporalis fascia and tragal cartilage–perichondrium are suitable graft materials for tympanoplasty. Graft uptake was superior with temporalis fascia, while hearing improvement was better with tragal cartilage- perichondrium, although the results were not statistically significant.

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Comparative study of temporalis fascia graft versus cartilage shield tympanoplasty

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20182019 ◽

2018 ◽

Vol 4 (4) ◽

pp. 951

Author(s):

Gaurav Chhabra ◽

Amresh K. Saxena ◽

Sanjay Kumar

Keyword(s):

Comparative Study ◽

Uptake Rate ◽

Graft Material ◽

Temporalis Fascia ◽

Fascia Graft ◽

Uptake Rates ◽

Group A ◽

Subtotal Perforation ◽

Group B ◽

The Comparative Study

Background: The objective of the study was to demonstrate the comparative study in terms of graft uptake rate & hearing gain between cartilage shield tympanoplasty and temporalis fascia tympanoplasty in patients with moderate/ large/subtotal perforation.Methods: Cartilage shield tympanoplasty and temporalis fascia tympanoplasty were conducted in Group A and Group B, respectively, each containing 30 patients with moderate/large/subtotal perforations. Pure tone audiogram (PTA) was performed preoperatively and at postoperative visit i.e. at 12th month, a greater than 10-dB closure of air bone gap (ABG) was considered significant. Results: The graft uptake rates were 93.33% and 86.67% in Group A and Group B, respectively, at the end of 10th week. In total, 90% in Group A and 88% in Group B had significant improvement in hearing (ABG ≥10 dB) at 12th week of surgery.Conclusions: Conchal cartilage is a possible graft material for cartilage shield tympanoplasty, especially in moderate, large & subtotal perforation, as it is showed superior autograft as compared to temporalis fascia, not only because of better graft uptake rate and less partial failure but also due to the comparable hearing improvement in terms of mean AB gap in both types of graft materials.

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