ENDOSCOPIC CARTILAGE TYMPANOPLASTY. OUR TECHNIQUE AND EXPERIENCE OF 157 CASES

Objective: To assess the graft take rate and hearing gain in trans-canal endoscopic tympanoplasty Study Design: Descriptive study. Place and Duration of Study: Pakistan Naval Ship Hafeez, Islamabad Pakistan, form Dec 2015 to Jun 2018 Methodology: All patients with dry central perforations of >3 months history were included in the study. All Patients with perforations of pars tensa were booked for endoscopic cartilage tympanoplasty. All perforations were divided into four types small, medium, large and subtotal or total based on size of the tympanic membrane perforations. Small perforations involving <25% area of Pars Tensa. Medium perforation are Perforations involving 25-50% of Tympanic membrane. Large perforations include Perforations involving 50-75% of pars tensa. Subtotal or total perforations are defined as perforations with >75% perforation of the tympanic membranes. Wet Ears and perforations involving the Pars Flacida were excluded from the study. Preoperative Audiogram was carried out for all patients and A-B Gap were noted for all groups separately so as the demographic data including age and gender. Success was defined as complete closure of Tympanic membrane perforation at 3 months. All patients were operated with 0 Degree 3mm, 14cm rigid endoscope under general anesthesia. Results: Mean age of patients was. 37 years and standard deviation was 12.34 (range 12-58 years). Out of total 157 cases 81 patients male were males (51%) and 76 patients were females (49). Out of 157 ears operated 146 Perforations healed completely an overall success rate of 92%. Patients with small perforations had 100 percent success.....

Endoscopic-Assisted Canal Wall-up Tympanomastoidectomy for Reduction of Residual Cholesteatoma

Introduction The treatment of cholesteatoma is generally surgical, and the major obstacle is the high prevalence of recidivism. The endoscopic ear surgery technique is proposed to minimize this problem. Objectives To utilize endoscopes to visualize and manipulate cholesteatoma residues after microscopic removal Methods Cross-sectional study. Thirty-two patients with cholesteatoma underwent microscopic wall-up mastoidectomy combined with the endoscopic approach. The subjects were assessed for the presence and location of covert disease. Results Of the 32 cases, 17 (53.12%) had residual cholesteatoma in the endoscopic phase. Minimal disease was found, usually fragments of the cholesteatoma matrix. Pars tensa cholesteatomas had more covert disease than pars flaccida cholesteatomas (62.50% vs 43.75%). Posterior recesses (47.05%) and tegmen tympani (41.17%) were the locations with more covert disease (p < 0.05). Conclusion Cholesteatomas of the pars tensa presented more residual disease and were significantly more common in the posterior recesses and tegmen tympani.

High Resolution and Labeling Free Studying the 3D Microstructure of the Pars Tensa-Annulus Unit of Mice

Hearing loss is a serious illness affecting people’s normal life enormously. The acoustic properties of a tympanic membrane play an important role in hearing, and highly depend on its geometry, composition, microstructure and connection to the surrounding annulus. While the conical geometry of the tympanic membrane is critical to the sound propagation in the auditory system, it presents significant challenges to the study of the 3D microstructure of the tympanic membrane using traditional 2D imaging techniques. To date, most of our knowledge about the 3D microstructure and composition of tympanic membranes is built from 2D microscopic studies, which precludes an accurate understanding of the 3D microstructure, acoustic behaviors and biology of the tissue. Although the tympanic membrane has been reported to contain elastic fibers, the morphological characteristic of the elastic fibers and the spatial arrangement of the elastic fibers with the predominant collagen fibers have not been shown in images. We have developed a 3D imaging technique for the three-dimensional examination of the microstructure of the full thickness of the tympanic membranes in mice without requiring tissue dehydration and stain. We have also used this imaging technique to study the 3D arrangement of the collagen and elastic fibrillar network with the capillaries and cells in the pars tensa-annulus unit at a status close to the native. The most striking findings in the study are the discovery of the 3D form of the elastic and collagen network, and the close spatial relationships between the elastic fibers and the elongated fibroblasts in the tympanic membranes. The 3D imaging technique has enabled to show the 3D waveform contour of the collagen and elastic scaffold in the conical tympanic membrane. Given the close relationship among the acoustic properties, composition, 3D microstructure and geometry of tympanic membranes, the findings may advance the understanding of the structure—acoustic functionality of the tympanic membrane. The knowledge will also be very helpful in the development of advanced cellular therapeutic technologies and 3D printing techniques to restore damaged tympanic membranes to a status close to the native.

Correlation of intraoperative middle ear status and hearing results in single-stage canal wall down tympanomastoidectomy with PORP—a prospective study

Background Mastoidectomy is one of the common surgical procedures performed by the otologist. It is commonly done for cholesteatomatous chronic otitis media (CCOM) and can be performed as either canal wall up or down techniques. Most of the CCOM is associated with ossicular erosions which require ossicular chain reconstruction (OCR) which can be done either in one stage or multiple stages. A multitude of factors affects postoperative OCR results with tympanomastoidectomy. Among various factors, the status of the tympanic membrane and middle ear mucosa is quite essential. To date, there are no randomized or prospective studies assessing the integrity of pars tensa and status of the middle ear mucosa in hearing outcomes in single-stage tympanomastoidectomy using partial ossicular replacement prosthesis (PORP) in the literature. Therefore, this study is performed to correlate the integrity of pars tensa and middle ear mucosa condition with postoperative hearing results of single-stage canal wall down (CWD) tympanomastoidectomy with PORP. Results Forty-two patients with cholesteatomatous chronic otitis media underwent single-stage canal wall down mastoidectomy (CWD) and partial ossicular replacement prosthesis (PORP) placement. The statistical analysis was done to compare the results of postoperative hearing with the intraoperative integrity of pars tensa and middle ear mucosa status. The mean pre- and postoperative air-bone gaps (ABGs) of all cases were 23.9 dB and 21 dB, respectively, with no statistically significant difference. In the pars tensa intact group, the mean pre- and postoperative ABGs were 21.5 dB and 18.5 dB, respectively, and in the pars tensa not intact group, the mean pre- and postoperative ABGs were 25.7 dB and 22.8 dB, respectively, and both groups had statistically insignificant difference. The pre- and postoperative ABGs in the healthy middle ear mucosa group were 20.7 dB and 19 dB, respectively. Similarly, the pre- and postoperative ABGs in non-healthy middle ear mucosa were 24.4 dB and 21.2 dB, respectively. The differences were not statistically significant in both groups. Conclusion There was a statistically significant improvement in postoperative air conduction threshold (ACT) in all cases. The integrity of pars tensa and middle ear mucosa status did not affect the postoperative hearing outcome in single-stage CWD tympanomastoidecomty using PORP.

Tympanic Membrane Retractions in patients with Williams Syndrome: A Controlled Study

Introduction The role of elastin in tympanic retractions and chronic otitis media is not well established. Williams Syndrome (WS), a pathology related to a mutation in the elastin gene, could generate tympanic retractions. Objective To compare the prevalence of tympanic retractions among patients with WS and controls. Methods WS patients (n = 43 ears) and controls (n = 130 ears) were evaluated by digital otoscopic examination and the degree of tympanic membrane retraction was classified by 2 blinded experienced otolaryngologists. Results The agreement rate between the evaluators was 71.1% for pars tensa and 65% for pars flaccida retraction (p < 0.001). The pars tensa and pars flaccida retractions are present in patients with WS after an adjusted residue of respectively - 2.8 and - 2.6 (p = 0.011 and p = 0.022) compared with controls. Conclusions Tympanic membrane retractions are not more common in the WS group when compared with controls.

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

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.

Study of clinical profile, pathological and functional changes in contralateral ear in patients of chronic suppurative otitis media

<p><strong>Background:</strong> Since unilateral chronic suppurative otitis media (CSOM) does not look to be an isolated entity, but rather a series of constitutional events that affect both ears. The aim of the present study is to study the clinical profile, pathological and functional changes in contralateral ear in patients of CSOM.</p><p><strong>Methods:</strong> Three thundred CSOM patients were studied in the Department of Otorhinolaryngology and Head and Neck Surgery. Patients were examined with otoscope after complete history and sociodemographic taking. </p><p class="abstract"><strong>Results:</strong> CSOM was more prevalent among females (54%) of young age group (41.6%) and with lower socioeconomic status (46%). Right ear was mostly affected (52.66%). Majority had discharge with hearing impairment (49.3%), 32.3% had ear discharge and 13.6% had hearing impairment and majority had pars tensa perforation (82.66%). In mucosal type CSOM, in CLE majority had abnormal tympanic membrane TM, of them majority had thinning (17.33%) and out of 65 patients with pars tensa retraction, majority had Grade I (22.17%). In squamosal type of CSOM, in CLE, 75% had abnormal TM, out of that 34.61% had pars tensa retraction and of that 23.07% had Grade I.</p><p><strong>Conclusions:</strong> Abnormal contralateral ear was more prevalent. Mucous type of CSOM has a chance forming various grades of tympanic membrane retraction, tympano sclerosis, thin healed membrane in the contralateral ear whereas squamous type of CSOM has a greater chance of contralateral ear involvement like, retraction granulation.</p>