EFFICACY OF PERMEATAL ENDOSCOPIC MYRINGOPLASTY IN INACTIVE (MUCOSAL) CHRONIC OTITIS MEDIA

Objective: To determine the efficacy of permeatal ednoscopic myringoplasty, in inactive (mucosal) COM regarding, graft take and hearing improvement. Study Design: Quasi-experimental study. Place and Duration of Study: ENT Department, Pak Emirates Military Hospital, Rawalpindi, from Aug 2019 to Feb 2020. Methodology: This was conducted on a sample size of n=100. Patients having inactive (mucosal) COM with dry central small, medium and large perforations were included. Patients were divided in to three groups on the basis of age, group A 15-30 years, group B 31-45 years and group C 46-60 years. All the patients underwent per-meatal endoscopic myringoplasty, without raising the tympano-meatal flap, under general anesthesia. Patients were followed up over a period of six months. Graft take was assessed by microscopy. Hearing was assessed by Pure Tone Audiometry (PTA) with improvement in air bone gap to 15db as primary end point. Data was collected on structured performa. Data was analyzed using SPSS version 17. Results: In this study, 33 (33%) were males and 67 (67%) were females. Age ranged 15-60 years. Out of 5 patients lost to follow up. A total of 95 completed their follow up. Based on age of the patients, in group A, successful graft take was 100%. In group B, it was 91% & in group C it dropped to 46%. On the basis of tympanic membrane perforation size, the graft success rate in small perforations was 94.8%; in medium sized perforations it was 86.8% and in large sized perforations of tympanic membrane it was........

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The outcomes of endoscopic myringoplasty: elevating a tympanomeatal flap or not

The Journal of Laryngology & Otology ◽

10.1017/s002221512000198x ◽

2020 ◽

Vol 134 (9) ◽

pp. 779-783

Author(s):

D Wang ◽

W Wang

Keyword(s):

Blood Loss ◽

Tympanic Membrane ◽

Operation Time ◽

Tympanic Membrane Perforation ◽

Hearing Improvement ◽

Membrane Repair ◽

Group A ◽

Endoscopic Myringoplasty ◽

Group B ◽

Approach Group

AbstractObjectiveThe aim of this study was to compare the differences between the no tympanomeatal flap approach and the tympanomeatal flap approach in endoscopic myringoplasty.MethodA total of 132 patients with tympanic membrane perforation were randomly divided into two groups: the no tympanomeatal flap approach group (group A, 56 ears) and the tympanomeatal flap approach group (group B, 76 ears). A comparison between the two groups was made.ResultsThe average operation time of group A was 36.00 ± 5.24 minutes, which was significantly shorter than that of group B, which was 43.89 ± 4.57 minutes (p = 0.002). The blood loss of group A was 5.08 ± 1.83 ml, which was significantly less than that of group B (9.67 ± 2.29 ml; p < 0.001). There were no differences in the degree of hearing improvement, the rate of hearing improvement, the dry ear time (when the external auditory canal and the operating cavity were dry) after operation and the success rate of tympanic membrane repair when compared between the two groups.ConclusionCompared with group B, group A (no tympanomeatal flap approach) can achieve the same effect but has the advantages of a shorter operation time and less blood loss during the operation.

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The Effect of Epidermal Growth Factor on the Outcomes of Myringoplasty

Annals of Otology and Neurotology ◽

10.1055/s-0040-1715290 ◽

2020 ◽

Vol 3 (01) ◽

pp. 23-26

Author(s):

Kiran Ravindranath Bongale ◽

Vikram Kemmannu Bhat ◽

Mona Yadav

Keyword(s):

Growth Factor ◽

Epidermal Growth Factor ◽

Chronic Otitis Media ◽

Pure Tone Audiometry ◽

Tympanic Membrane Perforation ◽

Controlled Study ◽

Success Rates ◽

Group A ◽

Epidermal Growth ◽

Group B

Abstract Introduction Chronic otitis media is a widespread disease of developing countries. The burden of the disease continues to be high and so is the demand for surgical myringoplasty. This pilot study aimed to compare in adults the outcomes of myringoplasty with and without the application of epidermal growth factor gel (EGF) with respect to the time taken for graft uptake, improvement of hearing, and complications. Materials and Methods This randomized controlled study was undertaken in a tertiary referral public hospital in a span of 2 years with a sample size of 60 patients. All of them underwent diagnostic nasal endoscopy, otoendoscopy, and pure tone audiometry and treated with conventional underlay myringoplasty using temporalis fascia (Group A—30 cases with EGF, Group B—30 controls without EGF). Patients were followed-up at 15, 30, 90 days postoperatively. Results The average time taken for closure of tympanic perforation and graft uptake by group A was lesser than group B. This difference was found to be statistically significant. Residual perforation at 1 month was commoner in group B as compared with group A. The final improvement of the hearing was the same in both the groups in the healed cases. Conclusion The EGF can be used to improve the outcomes of myringoplasty. It can hasten the closure of tympanic membrane perforation and increase the success rates of the surgery.

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Study on impact of duration of tympanic membrane perforation on hearing loss and audiological outcome after surgery

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20213280 ◽

2021 ◽

Vol 7 (9) ◽

pp. 1462

Author(s):

Raies Ahmad ◽

Gopika Kalsotra ◽

Kamal Kishore ◽

Aditiya Saraf ◽

Parmod Kalsotra

Keyword(s):

Hearing Loss ◽

Tympanic Membrane ◽

Pure Tone ◽

Tympanic Membrane Perforation ◽

Medical College ◽

Time Period ◽

Membrane Perforation ◽

Group A ◽

Duration Of Disease ◽

Group B

Background: The aim of the study was to assess impact of duration of tympanic membrane perforation on hearing loss and postoperative audiological outcome using pure tone audiogram.Methods: The present study was conducted on 100 patients in department of ENT and HNS, SMGS Hospital, Government Medical College Jammu during a time period of November 2018 to October 2019. All the patients with age 15 to 60 years who presented with tympanic membrane (pars tensa) perforation were included in the study. Results: In our study, mean preoperative hearing loss (AC threshold) of group A was 36.23±1.07 dB and of group B was 25.67±6.38 dB. Group C had mean preoperative hearing loss (AC threshold) of 28.78±6.50 dB. Mean preoperative air-bone gap (AB gap) of group A was 12.9±8.05dB and of group B was 13.86±4.19 dB. Group C had mean preoperative air-bone gap (AB gap) of 16.47±5.51 dB. Postoperatively, pure tone threshold at three months was least in group B (15.09±5.80 dB), followed by group C (15.68±4.66 dB) and group A (19.33±2.81 dB). Whereas, postoperative AB gap at 3 months was least in group C (10±3 dB), followed by group C (8.44±3.59 dB). Group B had maximum postoperative AB gap of 8.49±4.34 dB.Conclusions: This study did not show any correlation between duration of disease and degree of hearing loss.

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A Correlative Study Between Size of Tympanic Membrane Perforation, Pure Tone Audiometry and Intraoperative Findings in Tympanoplasty

Bengal Journal of Otolaryngology and Head Neck Surgery ◽

10.47210/bjohns.2018.v26i1.155 ◽

2018 ◽

Vol 26 (1) ◽

pp. 43-47

Author(s):

Santosh U P ◽

Sridurga J ◽

Aravind D R

Keyword(s):

Hearing Loss ◽

Tympanic Membrane ◽

Otitis Media ◽

Middle Ear ◽

Pure Tone ◽

Chronic Otitis Media ◽

Pure Tone Audiometry ◽

Tympanic Membrane Perforation ◽

Membrane Perforation ◽

Operative Findings

Introduction Chronic otitis media (COM) is a most common and prevalent disease of the middle ear. COM has been defined as a longstanding inflammatory condition of middle ear and mastoid, associated with perforation of the tympanic membrane. Tympanoplasties are common surgeries performed for chronic otitis media in inactive mucosal type. Any otological surgery may involve a menace/ hazard of hearing loss post operatively. In this study, an attempt was made to correlate, size of tympanic membrane perforation, pure tone audiometry and intra-operative findings in tympanoplasties, results were analysed and conclusion drawn. Materials and Methods Forty patients attending ENT OPD with chronic otitis media (COM), inactive mucosal type, with conductive hearing loss undergoing tympanoplasties who were willing to participate in the study were selected. Ear was examined pre-operatively to assess the size of perforation and then, pure tone audiometry (PTA) was done to assess the type of hearing loss and its severity. During tympanoplasty, middle ear was inspected for ossicular status and any other pathology was noted. Later, the size of tympanic membrane perforation, pure tone audiometry and intra operative findings were correlated with each other and analysed. Result In small and medium sized perforation, PTA and intraoperative findings correlated with each other. Whereas, in large and subtotal perforation, there was no correlation. Conclusion In small and medium sized perforation, middle ear inspection may not be necessary. Whereas, in large and subtotal perforation it is necessary.

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MYRINGOTOMY FOR THE TREATMENT OF OTITIS MEDIA WITH EFFUSION; A COMPARISON IN THE OUTCOME WITH AND WITHOUT GROMMET INSERTION

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71isuppl-3.7920 ◽

2021 ◽

Vol 71 (Suppl-3) ◽

pp. S521-25

Author(s):

Sunarays Akhtar ◽

Uzma Gul ◽

Arfat Jawaid ◽

Khalid Azam ◽

Muhammad Sohail Babur Niazi ◽

...

Keyword(s):

Otitis Media ◽

Otitis Media With Effusion ◽

Military Hospital ◽

Quasi Experimental ◽

Group A ◽

Group B ◽

Conductive Hearing ◽

Case Basis ◽

Method Group

Objective: To compare the outcome of myringotomy with and without grommet insertion in the patients of otitis media with effusion in terms of improvement of hearing in a one-month follow-up. Study Design: Quasi experimental study. Place and Duration of Study: Pakistan Airforce Hospital Jacobabad and Combined Military Hospital Lahore Pakistan, from Jan to Dec 2020. Methodology: A total of 28 patients aged 4-12 years diagnosed to have conductive hearing loss due to otitis media with effusion not responding to medical treatment were included. Non probability convenience sampling was done. Children aged less than 4 years and above 12 years were not included in the study. They were randomly divided into two groups of 14 patients each using lottery method. Group A underwent myringotomy alone whereas group B underwent myringotomy with grommet insertion. Patients in both groups also underwent adenoidectomy on case-to-case basis. Both groups were compared in terms of improvement in hearing post operatively in a one-month follow-up. Results: There was statistically significant reduction in air bone gap at the end of follow up period as compared to preoperative air bone gap in group B (p=0.007). In group A there was statistically significant reduction in air bone gap at one week (p=0.002) however this improvement was not maintained at 4 weeks (p=0.386). Conclusion: Myringotomy with grommet insertion had significantly more patients with improved hearing as compared to myringotomy alone after one month.

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Paper patching in traumatic perforation of tympanic membrane

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20185118 ◽

2018 ◽

Vol 5 (1) ◽

pp. 10

Author(s):

Vinod Shinde ◽

Sudeep Choudhary ◽

Mayur Ingale ◽

Paresh Chavan

Keyword(s):

Tympanic Membrane ◽

Standard Treatment ◽

Tympanic Membrane Perforation ◽

Spontaneous Healing ◽

Medical College ◽

Membrane Perforation ◽

Group A ◽

Inflammatory Drugs ◽

Group B ◽

Random Groups

Background: Traumatic perforations are not new for ENT surgeons. The dictum for treatment is to keep the ear dry and leave the tympanic membrane to heal by itself. Most of the time it heals completely, but if it does not, a tympanoplasty is required.Methods: 144 patients of traumatic tympanic membrane perforation, who reported in the outdoor patient department of Otorhinolaryngology, at Dr. D. Y. Patil Medical college, DPU, Pune, were divided in two random groups; Group A was treated with standard treatment while Group B was treated with patching of perforation as an adjuvant to standard treatment. A simple paper, (from the envelop of gel foam) was used for this procedure. The standard taught and performed treatment for a tympanic membrane perforation is administering antibiotics, antihistaminic and anti-inflammatory drugs and keeping the ear dry; leaving the perforation for spontaneous healing. Results: Group A 75% perforations had healed while in Group B 97.22% perforations healed completely.Conclusions: Paper patching supports the healing tympanic membrane and significantly improves the chances of spontaneous healing thus reducing the requirement of surgical intervention.

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COMPARISON OF THE EFFICACY OF ANTIBIOTIC-STEROID AND ICHTHAMMOL GLYCERINE WICK IN TREATMENT OF ACUTE OTITIS EXTERNA

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71isuppl-3.4556 ◽

2021 ◽

Vol 71 (Suppl-3) ◽

pp. S612-16

Author(s):

Maryam Khan ◽

Kamran Ashfaq Ahmed Butt ◽

Naeem Riaz ◽

Zaheer Ul Hassan ◽

Attique Ahmed ◽

...

Keyword(s):

Experimental Study ◽

Otitis Externa ◽

The Other ◽

Military Hospital ◽

P Value ◽

Similar Response ◽

Quasi Experimental ◽

Group A ◽

Group B

Objective: To compare the efficacy of steroid antibiotic wick with Ichthammol Glycerol wick in the management of Acute Otitis Externa in terms of tenderness and clearance of discharge/debris. Study Design: Quasi-experimental study. Place and Duration of Study: ENT Out Patient department of Combined Military Hospital Peshawar and Hayatabad Medical Complex Peshawar, from May to Nov 2018. Methodology: A total of 250 patients were included and divided into two groups of 125 each. After necessary suction clearance topical Ciprofloxacin/Dexamethasone (Cipotec-D) wick was placed in auditory canal of group A patients and topical Glycerol/Ichthammol wick was placed in group B. Follow up visits were done on 3rd and 7th day of starting the treatment. Results: Group A patients responded better in terms of tenderness (88%) however both groups had similar response in terms of discharge reduction (7.2% vs 6.4%). In terms of efficacy neither of the treatment proved more efficacious compared to the other (p-value 0.058). Conclusion: While steroid antibiotic wick is significantly more efficient in terms reducing tenderness, in terms of overall efficacy and discharge reduction Ichthammol/glycerol is equally effective.

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Comparative study of outcomes of type-1 tympanoplasty with and without anterior tucking

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20201277 ◽

2020 ◽

Vol 6 (4) ◽

pp. 657

Author(s):

Kiran Gangadar S. ◽

G. Priyadarshini

Keyword(s):

Tympanic Membrane ◽

Otitis Media ◽

Chronic Otitis Media ◽

Pure Tone Audiometry ◽

Tympanic Membrane Perforation ◽

Hearing Improvement ◽

Type 1 Tympanoplasty ◽

Membrane Perforation ◽

Group 2

Background: Tympanoplasty is a surgical procedure for closing the tympanic membrane perforation and reconstructing the tympanic membrane and hearing, commonly after trauma and chronic otitis media. The aim of the study was to compare the clinical and audiological outcomes of tympanoplasty with or without anterior tucking.Methods: In this prospective study, 50 patients with chronic otitis media (COM) were divided into two groups. Group 1 underwent type 1 tympanoplasty with anterior tucking method, and group 2 underwent type 1 tympanoplasty without anterior tucking. The result was measured on graft uptake and hearing outcome at 6 months postoperatively by performing pure tone audiometry. Results: The hearing improvement was almost the same in both the groups. Graft uptake was good in type 1 tympanoplasty with tucking (96%) when compared to without tucking tympanoplasty (92%). Complications like residual perforation were seen in both groups equally. Anterior marginal blunting was noted (8%) in type 1 tympanoplasty with tucking.Conclusions: The hearing improvement of type-1 tympanoplasty with anterior tucking and without anterior tucking is the same. Type-1 tympanoplasty with anterior tucking has a better graft acceptance. The only disadvantage of type-1 tympanoplasty with anterior tucking is anterior marginal blunting.

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Comparison of graft uptake in patients undergoing myringoplasty/ tympanoplasty by overlay and underlay procedure.

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.11.2913 ◽

2019 ◽

Vol 26 (11) ◽

pp. 1861-1865

Author(s):

Muhammad Arshad ◽

Ambreen Shahnaz ◽

Madiha Bashir ◽

Akhtar Zaman

Keyword(s):

Uptake Rate ◽

Chronic Otitis Media ◽

Retraction Pockets ◽

Group A ◽

Overlay Technique ◽

One Year ◽

Group B ◽

Technique Comparison ◽

Study Setting

Objectives: To determine which method underlay or overlay has higher results in graft uptake in Tympanoplasty. Study Design: It was experimental study. Setting: it was carried out at ENT Department of Benazir Bhutto Hospital, Rawalpindi. Period: One year from March 2017 to February 2018. Material and Methods: It consisted of a total of 27 patients presenting with chronic otitis media with dry perforation. Two groups of patients were made. Group A had 14 members who undergone underlay technique while the 13 patients in group B undergone overlay technique. Comparison was made on basis of successful graft uptake the main criteria of which was absence of lateralization, atelectasis, blunting or formation of retraction pockets by the end of 6 weeks of follow up. Result: Out of the 27 surgeries, 70.37% of the Myringoplasties were successful. The percent graft uptake came out to be 61.5% with overlay and 78.5% with underlay myringoplasty. In 15 out of the 27 surgeries temporalis fascia was used with a graft uptake rate of 80%, the 12 grafts taken from tragus had a graft uptake rate of 58.33%. Conclusion: Underlay myringoplasty technique has higher results than overlay myringoplasty technique.

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A study to evaluate and compare the outcomes of endoscope versus microscope assisted myringoplasty

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20212121 ◽

2021 ◽

Vol 7 (6) ◽

pp. 988

Author(s):

K. Sharath Babu ◽

R. Shankar

Keyword(s):

Sinus Tympani ◽

Graft Take ◽

Post Operative Pain ◽

Duration Of Surgery ◽

Group A ◽

Prospective Comparative Study ◽

The Difference ◽

One Year ◽

Group B

Background: In microscope assisted middle ear procedures surgeons can only observe the parts of the tympanic cavity, the hidden areas, such as the facial recess and sinus tympani, would not be visualised which needs to be exposed for performing tympanoplasty. The aim of the study was to compare the outcomes of microscope versus endoscope assisted myringoplasties in terms of duration of the procedure, graft take up, improvement in hearing and incidence of any complications.Methods: A prospective comparative study was conducted for a period of one year. A total of 72 patients with CSOM were randomised into two groups of 36 each. Group A patients (n=36) underwent traditional myringoplasty under a microscope and group B patients (n=36) endoscopic assisted myringoplasty was performed. Post-operatively all the patients were followed up for a period of one year. During the follow-up period patients were assessed for the graft take up, hearing improvement, incidence of complications and recurrence rate between the two groups.Results: Successful graft uptake was observed in 88.8% among patients underwent microscope assisted myringoplasty and it was 94.4% in endoscopic assisted myringoplasty. The mean duration of surgery was 123 mins in microscopic assisted group compared to 92 mins in endoscopic assisted group and the difference was found to be statistically significant. Similarly, the cosmetic results and the post-operative pain were more favorable for endoscopic assisted group than microscopic assisted group and the difference was found to be statistically significant.Conclusions: Enoscopic assisted procedure could be considered as a better alternative for microscopic assisted myringoplasty.

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