A Comparative Study between Endoscopic and Microscopic Tympanoplasty

A study to compare tympanoplasty between endoscopic and microscopic approach was conducted at NMCTH. Patients diagnosed as chronic otitis media – mucosal type with age of 13 years and above were included in the study. Audiometric test was done before and 6 weeks after surgery. Seventy cases were included for the study with random allocation of cases each in endoscope group and microscopic group respectively. Graft uptake results were assessed after 6 weeks and postoperative hearing were evaluated and compared within and between the two groups. In endoscopic group and microscopic group, the graft uptake rate was 91.4% and 88.5% respectively with no significant difference (p = 0.71) in the graft uptake rate between the groups. The mean pre and post-operative air bone gap in endoscopic group and microscopic group were 34.59 dB±8.02, 21.97±8.60 dB and32.42±10.08 dB, 18.55±8.49 dB respectively. This showed a highly significant difference in both groups(p < 0.001), showing improvement in the hearing after surgery in both the groups. The mean air bone gain were 12.62 dB and 13.87 dB in endoscopic and microscopic group respectively, with no significant difference between the groups (p = 0.553). The graft uptake rate and hearing results with endoscopic technique is comparable to that of microscopic technique. However, the endoscopic technique requires shorter operative time than the microscopic technique. Therefore, we recommend the use of endoscope for tympanoplasty in hospital as well as in camps.

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Outcome of Graft Uptake and Hearing Results between ‘U’ Flap Technique and Conventional Tympanomeatal Flap Technique for Anterior and Subtotal Tympanic Membrane Perforation

Journal of Nepal Health Research Council ◽

10.3126/jnhrc.v16i3.21427 ◽

2018 ◽

Vol 16 (3) ◽

pp. 297-301 ◽

Cited By ~ 1

Author(s):

Sundar Dhungana ◽

Pabina Rayamajhi ◽

Rakesh Prakash Shrivastav

Keyword(s):

Tympanic Membrane ◽

Uptake Rate ◽

Chronic Otitis Media ◽

Tympanic Membrane Perforation ◽

Hearing Results ◽

Flap Technique ◽

Significant Difference ◽

Membrane Perforation ◽

Subtotal Perforation ◽

The Mean

Background: Myringoplasty done for anterior and subtotal perforation needs expertise and practice than conventional underlay myringoplasty. The objective of this study was to compare the graft uptake and postoperative hearing results between ‘U’ flap and conventional tympanomeatal flap technique in anterior and subtotal tympanic membrane perforation.Methods: Sixty three patients of age fifteen years and above with chronic otitis media mucosal type with any sizedanterior and subtotal perforationof tympanic membrane were randomly allocated for myringoplasty by lottery method. There were thirty one cases in ‘U’ flap group and thirty twocases in conventional tympanomeatal flap group. Graft uptake and hearing results were assessed after six weeks and results were compared within and between the groups.Results: Graft uptake rate was 90.3%(28/31) in‘U’ flap group and it was 87.5%(28/32) in conventional tympanomeatal flap group with no statistically significant difference (p= 0.772) between the two groups. The mean pre and post-operative air bone gap in ‘U’ flap group were 23.63dB±7.77dB; 13.26dB±5.50dB and that in the conventional tympanomeatal flap group were 20.88±9.88dB, 9.42dB±6.70dB respectively. There was no statistically significant difference in hearing results between the two groups (p= 0.504).Conclusions: The graft uptake rate and hearing results of ‘U’ flap group were comparable and showed no statistically significant difference to those of conventional tympanomeatal flap group.

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Comparison of Graft Uptake and Postoperative Hearing Results between Butterfly-Cartilage and Temporalis-Fascia Myringoplasty

Journal of Institute of Medicine ◽

10.3126/jiom.v42i1.37416 ◽

2020 ◽

Vol 42 (1) ◽

pp. 7-11

Author(s):

Amiya K Sah ◽

Pabina Rayamajhi ◽

Hari Bhattarai

Keyword(s):

Otitis Media ◽

Uptake Rate ◽

Chronic Otitis Media ◽

Temporalis Fascia ◽

Hearing Results ◽

Pars Tensa ◽

Hearing Status ◽

Significant Difference ◽

The Mean ◽

The Difference

Introduction Myringoplasty is one of the commonest surgeries done in Otology for chronic otitis media- mucosal type (COM-mucosal type). The objective of this study was to compare the graft uptake and post-operative hearing status between butterfly-cartilage and temporalis-fascia myringoplasty. MethodsPatients of age ≥15 years with COM-mucosal type with dry, small to medium sized central perforation of pars tensa with clearly visible perforation margin were randomized into two groups of butterfly-cartilage myringoplasty and temporalis-fascia myringoplasty. Graft uptake and hearing results were assessed after six weeks and results were compared within and between the groups. ResultsThirty-one patients in butterfly cartilage group and twenty-nine patients in temporalis fascia group were analysed. Graft uptake rate was 93.5% (29/31) in butterfly group and it was 86.2% (25/29) in temporalis fascia group with no statistically significant difference (p= 0.34) between the two groups. The mean pre and post-operative air bone gap in butterfly cartilage group were 20.65dB±8.35 dB; 12.86dB±7.39dB and that in the temporalis fascia group were 19.72±6.14dB, 13.16dB±6.26dB respectively. The difference of preoperative and postoperative hearing status, obtained within the two groups was statistically highly significant (p< 0.001). However, there was no statistically significant difference in hearing results between the two groups (p= 0.54). ConclusionThe graft uptake rate and hearing results of butterfly-cartilage group and temporalis-fascia group were statistically significant within the group after myringoplasty but there was no statistically significant difference in between the two methods.

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Effect of Educational Counseling on Knowledge and Attitude of Pregnant Women Towards Sex During Pregnancy

International Electronic Journal of Medicine ◽

10.34172/iejm.2020.09 ◽

2020 ◽

Vol 9 (2) ◽

pp. 52-58

Author(s):

Atefeh Pakray ◽

Atefeh Ahmadi ◽

Younes Jahani ◽

Masoumeh Ghazanfarpour

Keyword(s):

Pregnant Women ◽

Intervention Group ◽

Sexual Relationships ◽

Fisher Exact Test ◽

Random Allocation ◽

Sexual Knowledge ◽

Significant Difference ◽

The Mean ◽

Knowledge And Attitude ◽

And Control

Background: Insufficient information about sex during pregnancy as well as negative attitude towards it may lead to serious problems in the couple’s communication and sexual relationship. Therefore, this study was conducted to determine the effect of educational counselling on sexual knowledge and attitude of pregnant women during 2014-2015. Materials and Methods: This study was performed on 200 pregnant women referred to 5 health care centers in Kerman. The random allocation method was used to assign mothers to intervention (n=100) and control (n=100) groups. Data were collected by demographic information, sexual knowledge, and attitude questionnaires. Data were analyzed by paired and independent t test, Fisher exact test, chi-square test, Mann-Whitney, Wilcoxon, ANOVA, Kruskal-Wallis, and Pearson’s and Spearman’s correlation tests in SPSS software version 22.0. Results: The mean scores of sexual knowledge and attitude before educational counselling in intervention group were 33.7±15.44 and 50.09±10.88, respectively. Before the intervention, no significant differences were observed between the two groups in knowledge and attitude. One month after the counselling, the mean scores of knowledge and attitude in the intervention and control groups were respectively 79.03±8.71 and 67.88±8.62, indicating a significant difference (P<0.0001). Conclusion: The results of this study confirmed the positive role of counseling and education in increasing knowledge and creating positive attitude towards sexual relationships in pregnant women.

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Outcome of Myringoplasty with Temporalis Fascia and Perichondrial-Cartilage Composite Graft in High Risk Perforations

Nepal Medical College Journal ◽

10.3126/nmcj.v21i1.24855 ◽

2019 ◽

Vol 21 (1) ◽

pp. 60-64

Author(s):

Anup Dhungana ◽

RR Joshi ◽

AS Rijal ◽

KK Shrestha ◽

S Maharjan

Keyword(s):

High Risk ◽

Tympanic Membrane ◽

Uptake Rate ◽

Pure Tone Audiometry ◽

Composite Graft ◽

Temporalis Fascia ◽

Fascia Graft ◽

Significant Difference ◽

The Mean ◽

And Cartilage

The objective of this study was to compare the graft uptake results and postoperative hearing of myringoplasty with temporalis fascia and cartilage-perichondrial composite graft in high risk perforations. Patients of age 13 years and above with diagnosis of chronic otitis media – mucosal type with high risk perforation that is >50% perforation of tympanic membrane, revision cases, absent/ eroded handle of malleus, oedematous/unhealthy middle ear mucosa and marginal involvement cases were included for myringoplasty. Pure Tone Audiometry was done within 1 week before surgery. 80 cases were included for myringoplasty which were randomly allocated by lottery method with 40 cases each in temporalis fascia group and cartilage perichondrial composite graft group. Graft uptake results were assessed after 6 weeks and postoperative hearing was evaluated and compared within and between the groups. Graft uptake rate in temporalis fascia group and cartilage perichondrial composite graft group was 90% and 92.5%, respectively with no significance difference in the graft uptake rate (p = 0.692) between the groups. The mean pre and post-operative air bone gap in temporalis fascia group and cartilage perichondrial composite group were 30.69dB±10.19,16.36±8.37dB and 33.73±8.07dB, 20.76±9.47dB, respectively with highly significant difference in both groups (p < 0.001) showing improvement in the hearing after surgery in both groups. The mean air bone gain were 14.33dB and 12.97dB in temporalis fascia and cartilage perichondrial composite group respectively with no significant difference between the groups (p=0.469). The graft uptake rate and hearing results after cartilage perichondrial composite graft are comparable to those of temporalis fascia graft. Furthermore, the cartilage perichondrial composite graft is more rigid and thick so it is more resistant than fascia to anatomic deformation and necrosis. Therefore, we recommend the use of cartilage perichondrial composite graft for tympanic membrane reconstruction in high risk perforation without concern about affecting audiometric results.

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OUTCOMES OF CIRCUMFERENTIAL V/S ANTERIOR TUCKING TYMPANOPLASTY TECHNIQUE IN INACTIVE MUCOSAL CHRONIC OTITIS MEDIA WITH SUBTOTAL PERFORATIONS: A PROSPECTIVE OBSERVATIONAL STUDY

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2021.v14i10.42707 ◽

2021 ◽

pp. 95-98

Author(s):

Sultan Singh Rulania ◽

Sushma Mahich ◽

Rekha Harshvardhan

Keyword(s):

Observational Study ◽

Success Rate ◽

Otitis Media ◽

Uptake Rate ◽

Prospective Observational Study ◽

Chronic Otitis Media ◽

Hearing Gain ◽

Group I ◽

The Mean ◽

Group Ii

Objective: The objective of the study is to compare circumferential versus anterior tucking underlay tympanoplasty technique. Methods: In this prospective observational study, 100 patients with chronic otitis media (Inactive mucosal type) were included, who were randomly allocated in two groups; Group I which comprised of 50 patients in which tympanoplasty with anterior tucking was done, and Group II comprised of 50 patients in which circumferential flap tympanoplasty was done. Improvement in the hearing gain and graft uptake success rate was compared. Results: The mean air-bone gap (ABG) changed from 28.74 dB to 11.52 dB after anterior tucking with a mean change of 17.22 dB and this change was found to be statistically significant (p<0.001). Similarly, the mean ABG changed from 28.92 dB to 11.86 dB after a circumferential flap with a mean change of 17.06 dB and this change was also found to be statistically significant (p<0.001). There was a slightly better improvement (17.22 dB) in the anterior tucking group as compared to the circumferential flap (17.06 dB). This difference was, however, not found to be statistically significant (p=0.830). Three-month graft uptake rate in the anterior tucking group was found 92% and in the circumferential group was 94%. (p>0.05). Conclusions: Our study concluded that both techniques have almost the same results with good graft uptake. Results of hearing improvements in both techniques were also comparable.

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Neutrophil Elastase and its Complex with Alpha1-Antitrypsin in the Pathogenesis of Chronic Suppurative Otitis Media

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489492101s1007 ◽

1992 ◽

Vol 101 (10_suppl) ◽

pp. 26-31 ◽

Cited By ~ 6

Author(s):

Yukiyoshi Hamaguchi ◽

Yasuo Sakakura

Keyword(s):

Otitis Media ◽

Neutrophil Elastase ◽

Bacterial Infections ◽

Otitis Media With Effusion ◽

Chronic Otitis Media ◽

Mean Value ◽

Chronic Suppurative Otitis Media ◽

Suppurative Otitis Media ◽

Significant Difference ◽

The Mean

Neutrophil elastase (NE) and its complex with α1-antitrypsin were quantified in ear discharges from 15 patients with chronic suppurative otitis media (CSOM), and their levels were compared to those in middle ear effusions from 10 pediatric patients with chronic otitis media with effusion (OME). The localization of immunoreactive NE was also examined by immunocytologic study. The mean value of total NE was 161.8 ± 29.5 μg/mL in CSOM, which was significantly higher than that in OME (16.5 ± 6.7 μg/mL). The mean value of NE–α1-antitrypsin complex was 13.7 ± 8.8 μg/mL in CSOM and 7.8 ± 4.0 μg/mL in OME. There was no significant difference between culture-positive and culture-negative samples in CSOM. Immunoreactive NE could be observed in the neutrophils of ear discharges, and extracellular release of NE was also observed. Ear discharges in CSOM contain a considerable amount of uncomplexed NE, of which the level does not depend on active bacterial infections. Uncomplexed NE seems to play a role in the chronicity of CSOM.

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A Prospective Comparative Study between Dry and Wet Tympanoplasty

Annals of Otology and Neurotology ◽

10.1055/s-0038-1676951 ◽

2018 ◽

Vol 01 (02) ◽

pp. 083-088 ◽

Cited By ~ 1

Author(s):

Hepsiba Pothala ◽

Sunita Shukla ◽

Wasim Khan ◽

Ravi Ramalingam ◽

Kombupalayam Ramalingam

Keyword(s):

Comparative Study ◽

Otitis Media ◽

Uptake Rate ◽

Chronic Otitis Media ◽

Hearing Improvement ◽

Temporalis Fascia ◽

Suppurative Otitis Media ◽

Significant Difference ◽

Prospective Comparative Study ◽

Contralateral Ear

Abstract Background Tympanoplasty is the well-established procedure for closure of perforations of tympanic membrane. Study Design This study was a prospective comparative study. Objective The objective of this study was to compare the hearing improvement and graft uptake rate between dry and wet tympanoplasty performed on tubotympanic type of chronic suppurative otitis media. Materials and Methods One hundred forty patients with tubotympanic type of chronic otitis media were selected and categorized into dry and wet ears. Tympanoplasty was performed using temporalis fascia by underlay technique in all cases. Postoperatively, graft uptake rate and hearing improvement were analyzed. Results The graft uptake rate was equal in both dry and wet ears, which was statistically insignificant. There was no statistically significant difference in the hearing improvement between the dry ears and wet ears (χ – 2.39, p = 0.122). Conclusion Factors such as age, sex, and status of the contralateral ear and wet ear did not have any impact on the postoperative graft uptake of tympanoplasty. There was no difference in the graft uptake between the dry and wet ears and there was no statistically significant difference between hearing improvement in both and wet ears.

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Simultaneous Endoscopic and Microscopic Visualization in Microvascular Decompression for Hemifacial Spasm

Operative Neurosurgery ◽

10.1093/ons/opab348 ◽

2021 ◽

Author(s):

Ben G McGahan ◽

Thiago Albonette-Felicio ◽

Daniel C Kreatsoulas ◽

Stephen T Magill ◽

Douglas A Hardesty ◽

...

Keyword(s):

Quality Of Life ◽

Hemifacial Spasm ◽

Microvascular Decompression ◽

Endoscopic Technique ◽

Microscopic Technique ◽

Visualization Technique ◽

Significant Difference ◽

Endoscopic Assistance ◽

Limiting Condition

Abstract BACKGROUND Hemifacial spasm (HFS) is a socially limiting condition leading to decreased quality of life that can be treated with microvascular decompression (MVD). Endoscopy has been described as an adjunct to traditional microscopy for MVD, although the best visualization technique is debated. OBJECTIVE To review the current literature on use of endoscopy in MVD for HFS and to describe the simultaneous microscopic and endoscopic visualization technique along with a video illustration. METHODS Patients who underwent MVD for HFS were retrospectively reviewed from January 2011 to December 2019. The first set of patients in the series were done using traditional endoscopic assisted visualization, followed by a change in technique in the subsequent patients using the simultaneous endoscopic technique. The surgical technique is described as well as illustrated with a video. RESULTS In total, 21 patients underwent 24 MVDs to treat HFS. The simultaneous endoscopic/microscopic technique was used in 48% of cases for visualization. All but one patient had resolution of their symptoms immediately after the procedure. In total, 7 patients had recurrence of HFS, with 4 (17%) resolving spontaneously and 3 (13%) ultimately undergoing redo MVD. Postoperatively 7 patients (29%) had transient complications that all resolved completely. There was no significant difference between the traditional alternating microscopic and endoscopic technique with the simultaneous endoscopic microscopic technique. CONCLUSION Endoscopic assistance during MVD for HFS is beneficial and may be streamlined by using the simultaneous microscope and endoscope visualization technique.

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Outcome of Graft Uptake and Hearing Results between ‘U’ Flap Technique and Conventional Tympanomeatal Flap Technique for Anterior and Subtotal Tympanic Membrane Perforation

Journal of Nepal Health Research Council ◽

10.33314/jnhrc.v16i3.1143 ◽

2018 ◽

Vol 16 (3) ◽

pp. 297-301

Author(s):

Sundar Dhungana ◽

Pabina Rayamajhi ◽

Rakesh Prakash Shrivastav

Keyword(s):

Tympanic Membrane ◽

Uptake Rate ◽

Chronic Otitis Media ◽

Tympanic Membrane Perforation ◽

Hearing Results ◽

Flap Technique ◽

Significant Difference ◽

Membrane Perforation ◽

Subtotal Perforation ◽

Anterior Perforation

Background: Myringoplasty done for anterior and subtotal perforation needs expertise and practice than conventional underlay myringoplasty. The objective of this study was to compare the graft uptake and postoperative hearing results between ‘U’ flap and conventional tympanomeatal flap technique in anterior and subtotal tympanic membrane perforation.Methods: Sixty three patients of age fifteen years and above with chronic otitis media mucosal type with any sized anterior and subtotal perforation of tympanic membrane were randomly allocated for myringoplasty by lottery method. There were thirty one cases in ‘U’ flap group and thirty two cases in conventional tympanomeatal flap group. Graft uptake and hearing results were assessed after six weeks and results were compared within and between the groups.Results: Graft uptake rate was 90.3%(28/31) in‘U’ flap group and it was 87.5%(28/32) in conventional tympanomeatal flap group with no statistically significant difference (p= 0.772) between the two groups. The mean pre and post-operative air bone gap in ‘U’ flap group were 23.63dB±7.77dB; 13.26dB±5.50dB and that in the conventional tympanomeatal flap group were 20.88±9.88dB, 9.42dB±6.70dB respectively. There was no statistically significant difference in hearing results between the two groups (p= 0.504).Conclusions: The graft uptake rate and hearing results of ‘U’ flap group were comparable and showed no statistically significant difference to those of conventional tympanomeatal flap group. Keywords: Anterior perforation; myringoplasty; subtotal perforation; ‘U’ flap.

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Is Septal Cartilage Graft via Transmastoid Approach Safe Enough in the Repair of Large Tegmen Defects?

ORL ◽

10.1159/000514227 ◽

2021 ◽

pp. 1-7

Author(s):

Kemal Keseroglu ◽

Mehmet Murat Gunay ◽

Sibel Alicura Tokgoz ◽

Bulent Ocal ◽

Cem Saka ◽

...

Keyword(s):

Bone Conduction ◽

Graft Infection ◽

Chronic Otitis Media ◽

Hearing Preservation ◽

Septal Cartilage ◽

Cerebrospinal Fluid Leakage ◽

Cartilage Graft ◽

Hospitalization Time ◽

Significant Difference ◽

The Mean

Introduction: Tegmen defect (TD) has a potential of intracranial spread of middle ear infection, meningoencephalic herniation (MEH), and cerebrospinal fluid leakage (CSFL). Especially the defects >1 cm with MEH or CSFL are generally repaired via the classical middle fossa or minicraniotomy technique. The aim of this study was to show the efficiency of the intracranial, extradural placement of the septal cartilage graft in the closure of the TD larger than 1 cm via the transmastoid (TM) approach. Methods: The demographic, preoperative, intraoperative, and postoperative data of 11 patients with chronic otitis media (COM) who had TD larger than 1 cm were reviewed retrospectively. Hospitalization time and hearing preservation with respect to MEH or CSFL were analyzed. Results: The most common etiology of TD was cholesteatoma (82%), and 91% of the patients had multiple COM surgery history. The mean TD size was 15.4 (10–25) mm. Fifty-five percent of the patients presented with either MEH or CSFL. The mean follow-up of the patients was 22.5 (8–42) months. There was no significant difference between preoperative and postoperative mean bone conduction thresholds. Mean hospitalization time was 5.2 (3–10) days. There was no significant difference in the hospitalization time between patients with MEH or CSFL and without MEH or CSFL. Neither recurrence nor graft infection was encountered. Conclusion: Extradural grafting with the septal cartilage in the large TD up to 25 mm can be repaired efficiently via the TM approach without application of a lumbar drainage.

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