Effect of interlay tympanoplasty on anterior tympanomeatal angle and pure tone audiometry at one month, six month and one year follow up

<p class="abstract"><strong>Background:</strong> The aim of the study was to determine the effect of interlay tympanoplasty on anterior tympanomeatal angle and on puretone average at 1 month, 6 month and 1 year follow up.</p><p class="abstract"><strong>Methods:</strong> This study was done at department of Otorhinolaryngology, RMRI, Bareilly, India, a tertiary-care Teaching hospital. A total number of 187 patients (86 females, 101 males) were included in this study from April 2014 to March 2018. Age range of selected patients was 15 years to 62 years, 133 patients were having subtotal perforation and remaining having perforation in the anterior half extending upto the annulus. </p><p class="abstract"><strong>Results:</strong> The anterior tympanomeatal angle blunting and pure tone audiometry (PTA) at the due follow up time was assessed and results were analyzed in terms of angle of blunting and hearing loss detected by PTA. Anterior tympanomeatal angle (ATA) blunting was categorized in three groups as follows &lt;90^o,90-120^oand &gt;120^o. Only 3 patients were having &gt;120^oATA after one year and mean hearing loss (air bone gap) was significantly less after 1 year follow up. There were only 3 patients with remnant perforation, after 1 year of surgery out of 187 cases, with 98.4% success rate.</p><p class="p1"><strong>Conclusions:</strong> Interlay tympanoplasty was significantly effective in repairing anterior and subtotal tympanic membrane perforations with avoidance of blunting at the anterior tympanomeatal angle and achieved good functional results. </p>

Medial versus Medio-lateral Tympanoplasty in Large Central and Subtotal Perforation – A Prospective Study

Introduction: Large central and subtotal tympanic membrane (TM) perforations are difficult to repair because of less vascularity of anterior TM than posterior TM and the anterior bony overhang that blocks visualization. Some studies reported very encouraging results with the medio-lateral tympanoplasty in such cases. We have undertaken this study to find out efficacy of this technique in large central and subtotal perforations and to compare the results of medio-lateral with medial tympanoplasty. Materials and Methods: The present prospective study was conducted in the Department of Otorhinolaryngology of a medical college and hospital, West Bengal from January 2013 to December 2014. Patients were alternatively divided into two groups. Medial technique was used in Group I and medio-lateral technique was used in Group II. Results: Each group comprised of 40 patients each. Maximum number of patients in each group was in the age group of 15-25 years. The overall graft uptake rate in this study was 95% in medio-lateral technique compared to 80% of underlay technique. Conclusion: The medio-lateral tympanoplasty is suitable for reconstruction of large central or subtotal TM perforation. It takes advantage of both medial and lateral grafting methods while avoiding their pitfalls.

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

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

Comparison of otological and audiological outcome of type-I tympanoplasty using composite tragal perichondrium and temporalis fascia as graft

<p class="abstract"><strong>Background:</strong> The most frequently used technique for the repair of TM perforation is underlay grafting of temporalis fascia in normally ventilated middle ears. In advanced middle ear pathology, large perforations, atelectatic drum or retraction pockets, temporalis facia may cause higher failure rates. In such cases, a more rigid grafting material such as cartilage is preferred because of its increased stability and resistance to middle ear pressure even in cases with chronic eustachian tube dysfunction.</p><p class="abstract"><strong>Methods:</strong> This is a prospective randomized study design on comparison of temporalis fascia and cartilage as graft in patients of CSOM with subtotal perforation. 80 patients, divided randomly into two groups with equal patients, with tragal cartilage (group 1) and temporalis fascia (group 2) as graft. Follow up done at post-operative 3^rd week and 3^rd month for graft acceptance as well as graft health. Audiometric evaluation was conducted at 3rd month. The data obtained was subjected to appropriate statistical analysis using SPSS version 20. </p><p class="abstract"><strong>Results:</strong> Graft uptake rate in group1 and 2 was 93.75% and 90%. The mean AB gap improved in group1from 36.38±6.10 dB to 18.13±5.84 dB. Similarly in group 2 it improved from 28.73±5.82 dB to 15.23±8.14 dB; showed statistically highly significance in both groups (p&lt;0.001).</p><p class="abstract"><strong>Conclusions:</strong> Composite tragal perichondrium graft delivers an excellent audiologic outcome comparable to temporalis fascia graft specially where medialization of graft is expected. It gives ENT surgeons a reliable armamentarium in tympanoplasties for subtotal perforation.</p>

Comparative study of temporalis fascia graft versus cartilage shield tympanoplasty

<p class="abstract"><strong>Background:</strong> The objective of the study was to demonstrate the comparative study in terms of graft uptake rate &amp; hearing gain between cartilage shield tympanoplasty and temporalis fascia tympanoplasty in patients with moderate/ large/subtotal perforation.</p><p class="abstract"><strong>Methods:</strong> 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 12^th month, a greater than 10-dB closure of air bone gap (ABG) was considered significant. </p><p class="abstract"><strong>Results:</strong> 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.</p><p class="abstract"><strong>Conclusions:</strong> Conchal cartilage is a possible graft material for cartilage shield tympanoplasty, especially in moderate, large &amp; 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.</p>

The role of anterior tucking of graft in subtotal perforation of tympanic membrane

<p class="abstract"><strong>Background:</strong> Tympnaoplasty has been well accepted as the surgery of choice for chronic otitis media. Since the introduction of tympanoplasty, there has been many modifications in terms of technique, approach, and materials used for grafting the tympanic membrane; each with their respective advantages and disadvantages. But irrespective of procedure done, very large and subtotal perforations have always posed a problem with failure after surgery. This demands further modification of the procedure to support the graft. This study was done to know the role of Anterior tucking of graft in subtotal perforation of tympanic membrane in terms of graft uptake rate and hearing outcome.</p><p class="abstract"><strong>Methods:</strong> A systemic retrospective analysis of case files was done. The case files of patient who fulfilled the inclusion criteria were selected. Detailed preoperative and postoperative clinical and audiometric findings were noted down. </p><p class="abstract"><strong>Results:</strong> Total of 40 cases with 3 cases being bilateral, 43 ears were operated by cortical mastoidectomy with tympanoplasty along with anterior tucking of the graft. Our success rate was 95.3% (n=40). 40 patients had showed the improvement in hearing with average air bone gap gain of 12.7 dB HL.</p><p class="abstract"><strong>Conclusions:</strong> Underlay grafting for subtotal perforations of tympanic membrane is a surgically challenging and results in poor outcome. Modification to this method by anterior tucking of the graft is an effective surgical technique with satisfactory outcomes and hence is advocated for the routine practice.</p>

Study of pathology of ossicles in non-cholesteatomatous chronic suppurative otitis media, its repair and outcome

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">If the ears have perforation of long standing durations, even without cholesteatomas, they remain infected. Three times as many operations were performed in the United States in 1978 for this disease as were performed for cholesteatoma. The objective of the study was to study of pathology of ossicles in non-cholesteatomatous chronic suppurative otitis media, its repair and outcome. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">This is a clinical study of patients presented to outpatient, department of Vijayanagar Institute of Medical Sciences, Bellary during the period of November 2004 to November 2005 with non-cholesteatomatous chronic suppurative otitis media. This study is aimed to study the various ossicular abnormalities encountered in non-cholesteatomatous chronic suppurative otitis media and their reconstruction techniques. </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">12 ears (40%) had central and 18 ears (60%) had subtotal perforation. The average hearing loss in patients with isolated erosion of lenticular process of incus was 50.72±6.95 dB. In our study, autologous incus was used for ossicular reconstruction in 14 (46.67%) patients and homologous septal cartilage in 10 (33.33%) cases. Twenty-nine of the 30 cases underwent myringostapediopexy (type IIIb tympanoplasty) with the ossicular graft as short columella between the tympanic membrane graft and the stapes superstructure. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Excellent results were noted only with the autologous incus graft. 28.57% of the total patients with autologous incus graft showed excellent post-operative results. Good results were found for autologous incus, homologous septal cartilage and teflon PORP, with percentage of 28.57, 50 and 25% respectively.</span></p>

Merits and demerits of endoscopic tympanoplasty

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Aim of the study was to evaluate the merits and demerits of endoscopic tympanoplasty compared to conventional microscopic tympanoplasty. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">This prospective comparative study was carried out between October 2015 to September 2016 in our otolaryngology department, for a period of 12 months. Total of 40 patients who fit into inclusion criteria, underwent endoscopic tympanoplasty under local anaesthesia with sedation. All laboratory preoperative testing was done; hearing evaluation was done with audiometry. Postoperative follow up was done at 2^nd and 3^rd month’s period, graft status and hearing evaluation with PTA for all four frequencies 500, 1000, 2000 and 4000 Hz with air conduction and bone conduction thresholds were recorded. </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Out of 40 patients, 16 (40%) were males, and 24 (60%) were females, there were 21 (52.5%) cases had moderate perforation, 15 (37.5%) cases had large perforation and 4 (10%) cases had subtotal perforation. Average time taken was of around 1hour and 30minutes, range was (70-140min.). All patients were evaluated for graft status, hearing gain and cosmetic results. Out of 40 patients, 35 (87.5%) patients had successful graft uptake, 2 (5%) patients had graft infection and 3 (7.5%) patients had residual perforation seen postoperatively. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Use of endoscope not only serves as a great teaching tool, but also helps to visualize the middle ear anatomy and pathology intraoperatively with minimal soft tissue manipulation better cosmesis and reduced postoperative morbidity. In our study, we found that endoscopic tympanoplasty had better graft uptake rate.</span></p>