Retraction Pocket Research Articles

Hearing-related problems in children with cleft palate: A single-center cross-sectional study in the sub-Himalayan population

Purpose: Cleft palate is known to cause recurrent otitis media with hearing loss. Various studies have stated the incidence of middle ear disease in patients with cleft palate is around 90%. The anomalous position of the Eustachian tubes in patients with cleft palate leads to otitis media with effusion. If left uncorrected this leads to complications such as cholesteatoma, retraction pockets, and atelectasis leading to permanent hearing loss. In this study, we evaluated the children presenting to our institute with cleft palate for hearing-related issues. Materials and Methods: The study was conducted in our institute from January 2017 to September 2020. It was a cross-sectional study, where 45 children with cleft palate were compared with 36 children with cleft lip who were considered the control group. Hearing of all children was assessed using tympanometry, otoscopy, and brainstem evoked response audiometry (BERA). Results: About 93.3% of children in the cleft palate group had an abnormal tympanic membrane on otoscopy, whereas in the control group only 11.1% of children had an abnormal tympanic membrane on otoscopy. About 97.8% of children in the cleft palate group had a hearing threshold greater than 25 decibels, whereas only 13.9% of children in the control group had a hearing threshold of above 25 decibels. More children in the cleft palate group had an abnormal tympanogram (42.2% had a type B tympanogram and 46.7% had a type C tympanogram) compared to the control group (5.6% had a type B tympanogram and 2.8% had a type C tympanogram). Conclusion: Our study adds to the evidence that there is a high incidence of hearing impairment in children with cleft palate. Hence, we advocate that early identification by screening measures such as otoscopy, tympanometry, auditory brainstem response, and pure tone audiometry during the first visit itself in these children so that early treatment can be initiated.

Application of allogenous dural membrane (brefotissue DM) in surgical treatment of retraction pockets of the tympanic membrane

The tactics of treating patients with retraction pockets of the tympanic membrane is still debatable. When choosing surgical treatment, preference is given to the removal of the retraction pocket with simultaneous reconstruction of the posterior-upper wall of the external auditory canal (retraction area) with a cartilage or fascial flap, autologous bone, or a combination of the above tissues. Considering the well-known negative aspects of the use of all the mentioned grafts, there is a need to find new types of tissues to strengthen the retraction pocket. For example, dura mater brefotissue has good plastic properties, resistance to infection, is easy to prepare, store, and is cheaper than many allografts. Evaluation of the possibility of using dura mater brefotissue in the surgical treatment of patients with retraction pockets of the tympanic membrane. The study included 52 patients who underwent surgery to eliminate the retraction pocket. All of them were divided into 2 groups. In the first - the main (n=25) cartilage of the auricle was used to seal the relaxed part of the tympanic membrane, in the second - the control (n=27) applied tissue of the dura mater. After 1, 3, 6 and 12 months, to assess the result of the intervention, all patients underwent otomicroscopy, audiometry with the calculation of the average sound conduction index for speech frequencies. Fewer cases (4 patients out of 27) had difficulty in graft placement with the use of dura mater compared to the group where cartilage was used (9 patients out of 25). The average duration of graft placement was 8±0.5 minutes in the control group and 2±0.3 minutes in the main group. A stable morphological result was obtained in the group with the use of brefotissue in 26 patients (96%) and only in 20 patients (80%) with the use of cartilage. It is important to note that in the group with the use of brefotissue, in the early postoperative period, there was an increase in the air-bone interval, and 1 month after the operation, the average values increased by 10±0.5 dB. 12 months after the operation, the above parameters returned to preoperative. The conducted study indicates that the dura mater brefotissue, having sufficient strength, the convenience of forming a given shape and placing it in the desired position, can be successfully used in the surgical treatment of patients with retraction pockets of the tympanic membrane.

Роль кислотозависимых заболеваний желудочно-кишечного тракта в формировании рецидивирующих и необратимых хронических воспалительных явлений в полости среднего уха

Chronic secretory otitis media is one of the most common multifactorial diseases in the otolaryngology practice. The disease characteristic features are the resumption of inflammation, with the formation of otorrhea, which can lead to a hyperplastic, sclerotic, and destructive changes. Of particular interest is the influence of acid-related diseases of the gastrointestinal tract on the formation of recurrent and irreversible chronic inflammatory phenomena in the middle ear cavity. The study included 152 patients (82 women and 70 men) with chronic secretory otitis media who were treated from 2021 to 2022 in the Department of Otorhinolaryngology of St. Petersburg City Hospital No. 26. 142 patients underwent installation of a tympanostomy tube, 10 people received a course of conservative therapy. Observation over time allowed us to compare various outcomes of inflammation in groups of patients with and without gastrointestinal tract diseases. In the group of patients with gastrointestinal tract diseases, relapses of inflammation were observed in 43 (39,1%) people over a 12-month period. In 5 (4,9%) participants, tympanostomy tube extrusion was recorded by the end of 3 months of observation, with the formation of persistent perforation of the tympanic membrane. Further, in 2 patients with extrusion of tympanostomy tube and perforation of the pars tensa, we observed the formation of retraction pocket type I pars flaccida. This study allows us to conclude that inflammatory recurrent diseases of the upper gastrointestinal tract can not only cause dysfunction of the eustachian tube but also contribute to inflammatory-degenerative diseases of the tympanic cavity.

Correlation of Mastoid Pneumatization with Middle Ear Pathology in Unilateral Squamous Type of Chronic Otitis Media

Introduction: Chronic otitis media is chronic inflammation of middle ear cleft followed by permanent abnormality of tympanic membrane. As mastoid a part of temporal bone is in close relation to middle ear; its pneumatization plays an important role in pathogenesis and prognosis of chronic otitis media.
 Aims: To study the pneumatization pattern of mastoid in unilateral chronic otitis media and its relationship with contralateral mastoid, diseased side tympanic membrane and ossicular status.
 Methods: Forty patients of 10-65 year of age diagnosed as unilateral chronic otitis media squamous type were selected. They were otoscopically evaluated for retraction and perforation of tympanic membrane and were subjected to high-resolution computed tomography of temporal bone. High resolution computed tomographies were analyzed for mastoid status of bilateral ear and ossicular involvement. During mastoidectomy ossicular status was noted and correlated with high resolution computed tomography.
 Results: Forty cases were enrolled in the study. Age ranged from10-65 years. On radiological analysis of temporal bones, 21(52.5%) mastoids were sclerotic, 15(37.5 %) mastoid diploic and 4(10%) were pneumatized in the diseased sides. Contralateral side showed pneumatization in 23(57.5%), diploic in 11(27.5%) and sclerotic in 6(15%) Amongst 21 sclerotic mastoid, 11(52.3%) patient had retraction in pars tensa and 9(42.8 %) had retraction of pars flaccida. In total 15 diploic mastoids retraction of pars tensa was in 8(53.3%) and pars flaccid retraction in 8(53.3%) All three ossicles were involved in 8(38%), Malleus and incus were eroded in 3(14%), incus were eroded in 7(33.3%), malleus were eroded in 3(14%) and ossicles were intact in 3(14%)of 21 sclerosed mastoids on high resolution computed tomography. In remaining 19 non sclerotic mastoids all 3 ossicles were eroded in 4 (21%), malleus plus incus eroded in 8 (16%), incus were eroded in 5(26.3%) andossicular chain was intact in 2(10%).
 Conclusion: Mastoid pneumatization pattern not only effect to the pressure of middle ear leading to chronic otitis media but also alter the pathogenesis and outcome of chronicotitismedia. Contralateral mastoid pneumatization is not altered in unilateral Chronic otitis media.

A Case-Control Study of Titanium and Fluoroplastic Ventilation Tubes.

Background Tympanostomy ventilation tube (VT) insertion is one of the most common procedures performed in otorhinolaryngology. VTs have been proven to effectively manage otitis media (OM) with effusion (OME) and to improve the quality of life of children postoperatively. Although there are multiple types of VT shapes, materials, and sizes, few studies have investigated and compared the effects of titanium VT with those of VTs made of other materials. This study aimed to compare titanium VTs and the more commonly used fluoroplastic VTs in a retrospective, age-matched, case-control study. We studied the postoperative outcomes and rates of extrusion, infection, otorrhea, tube obstruction, and residual perforation. Methodology Medical records of patients who underwent myringotomy with VT insertion from January 2018 to December 2020 were reviewed. A total of 34 patients met the inclusion criteria, of whom 17 had undergone titanium VT insertion bilaterally (titanium group) and 17 had undergone fluoroplastic VT insertion bilaterally (control group). Both groups were followed up with regular postoperative examinations for 18 months. Results Postoperative complications were categorized as early and late complications. The most common early postoperative complication was early extrusion of VT(six months or less after insertion) (67.6%); this was documented most often in the titanium group. Other early postoperative complications included transient otorrhea (14.7%), tube blockage (8.8%), and recurrent acute otitis media (AOM) (occurring within one month from completion of therapy of AOM episode) (5.9%); these rates were similar in both groups. Late complications were not significantly variable between groups. Tympanic membrane retraction was the most common late complication (8.8%). Conclusions VT insertion is associated with the risk of complications with varying degrees. Although factors affecting the VT complication rates are multiple and various, these rates were not different between groups in this study. However, further studies including larger population samples are needed to statistically confirm these results and their generalizability.

Epidemiology of Eustachian tube dysfunction and related otologic diagnoses among children with achondroplasia.

To investigate the prevalence of diagnosed Eustachian tube dysfunction and related otologic diagnoses among children with achondroplasia as compared to a control population. The TriNetX Analytics Network, a federated health research network that aggregates the de-identified electronic health record data of over 78 million patients across the United States, was queried for patients 18 years old or younger with achondroplasia. Patients in this group with any occurrence of diagnosed Eustachian tube dysfunction or specified otologic diagnoses were recorded and reported. Out of 2,195 patients 18 years old or younger with diagnosed achondroplasia, 379 (17.27%, 95% CI: 15.71-18.91) had a diagnosis of Eustachian tube dysfunction with an 8.65 (95% CI: 7.89-9.48) times higher risk than children without achondroplasia (n=12,818,655). Children with achondroplasia also had higher risks for diagnosed otitis media (RR: 2.21), tympanic membrane retraction (RR: 7.29), middle ear cholesteatoma (RR: 6.35), cleft palate (RR: 12.24), conductive hearing loss (RR: 12.15), and tympanostomy tube placement (RR: 9.71). Each increased risk was maintained when cleft palate patients were removed from the achondroplasia group. Children with achondroplasia are at a significantly higher risk for diagnosed Eustachian tube dysfunction and related middle ear diagnoses. Atypical craniofacial anatomy among children with achondroplasia may play a role in the dysfunction of the Eustachian tube and thus the observed epidemiology of otologic conditions. Children with achondroplasia should be monitored closely for middle ear conditions and the constellation of symptoms related to a dysfunctional Eustachian tube.

Current Trends in Endoscopic Ear Surgery.

Current Trends in Endoscopic Ear Surgery.

The influence of nasal and oropharyngeal mucosal dysbiosis on the condition of the middle ear in children with congenital cleft palate

Disturbance of the microbiocenosis of the nasal cavity and oropharynx in children with congenital cleft palate presents serious therapeutic difficulties. Pathobionts colonizing the upper respiratory tract and chronic adenoiditis pose a threat of acute purulent otitis media and chronic otitis media with effusion. The authors studied nasal and oropharyngeal mucosal dysbiosis in patients before elective uranoplasty and the effect of dysbiotic manifestations on the condition of the middle ear in the postoperative period. The results of microbiological examination of 80 swabs from the nasal cavity and oropharynx in patients with congenital cleft palate were analyzed. Among the culture-positive results in patients in clinical and laboratory remission of ENT-infections dysbiosis of 2–3 degrees prevails, the presence of bacterial-bacterial and bacterial-fungal associations is often noted, the predominance of gram-negative microflora is noted. There was an increase in the frequency of perforations of the tympanic membrane in the presence of bacterial and fungal associations, the appearance of retraction pockets in the presence of gram-negative microflora, the relationship between grade 3 dysbiosis and the appearance of purulent otitis media after uranoplasty were revealed.Conclusion. Disturbance of microbiocenosis in patients with congenital cleft palate before uranoplasty requires the inclusion of a microbiological study in the preoperative preparation schedule and a personalized approach to perioperative antibiotic prophylaxis.

Clinical Significance of Körner's Septum in Relation to Occurrence of Squamous Chronic Otitis Media.

The Körner's septum (KS), persistent petrosquamosal lamina, is a bony lamina (developmental remnant) that extends from the articular fossa to the mastoid apex, above the middle ear, and runs inferiorly and laterally to the facial nerve canal. The petrous and squamous bones meet at this septum. The anatomical structure of KS, which most frequently occurs at the level of the head of the malleus and/or the anterior semicircular canal, is described in depth in this work. The embryological elements of the temporal bone development that result in the formation of KS are taken into consideration. Clinically KS is consideredan important anatomical variation, in the development of chronic diseases of the ear like chronic otitis media, especially attic retraction pockets, and cholesteatoma as it can contributeto attic blockage. Also, studies have found a significant association between tympanosclerosis and KS. High-resolution computed tomography (HRCT) and cone-beam computed tomography are the two imaging methods most commonly used to identify KS. It is observed that KS was associated with an increased risk for chronic otitis media, and residual cholesteatoma. The purpose of this review article is to provide a general overview of the KS and its clinical implication, as well as to summarize and discuss the latest clinical data regarding this entity.

Otomicroscopic and functional outcomes after cleft palate repair via Sommerlad intravelar veloplasty vs. modified Veau-Wardill-Kilner push-back.

We aim to compare the modified Veau-Wardill-Kilner push-back technique (VWK) and the Sommerlad intravelar veloplasty (Sommerlad IVVP) in terms of middle ear outcomes and oronasal fistulae frequency in three years old children. For this retrospective cohort study, data were collected and anonymized from consecutive patients with cleft palate (with or without cleft lip) who underwent surgery in our hospital between January 2008 and December 2018. Patients with syndromic diagnoses and patients who underwent surgical treatment elsewhere were excluded. We collected data from 101 children (202 ears) regarding middle ear complications at the age of three, including acute otitis media, middle ear effusion, tympanic membrane retraction, tympanic membrane perforation, tympanic membrane atelectasis and chronic otitis media with cholesteatoma. In addition, the presence of oronasal fistulae and the number of ventilation tubes received by the age of three were recorded. The odds of children having a normal middle ear evaluation were 3.07 (95% Confidence interval (95%CI): [1.52, 6.12]; p<0.05) times higher when children received Sommerlad IVVP compared to modified VWK. With 40.7% compared to 26.7%, a significantly higher incidence of middle ear effusion was present in the modified VWK group compared to Sommerlad IVVP (X2(1)=4.38, p<0.05). Furthermore, this group needed significantly more ventilation tube reinsertions (X2(2)=12.22, p<0.05) and was found to have a significantly higher incidence of oronasal fistula (53.5% vs. 17.2%, X2(1)=14.75, p<0.05). The latter was significantly associated with a higher need for ventilation tube reinsertion (X2(1)=7.34, p<0.05). This study shows superior middle ear outcomes and fewer oronasal fistulae after Sommerlad IVVP compared to modified Veau-Wardill-Kilner push-back at the age of three.

Clinical retrospective study on the efficacy and safety of endoscopic ear surgery for adhesive otitis media

Currently, the optimum surgical approach for treating adherent otitis media is debatable. The traditional treatment is usually performed by microscopic tympanoplasty combined with temporal myofascial tympanic tube placement. In recent years, the application of whole ear endoscopic surgery in the treatment of middle ear diseases has gradually increased, otoendoscopy has been used in the operation of adhesive otitis media, but its safety and effectiveness are still controversial. This study retrospectively analyzed 17 patients with adhesive otitis media treated by endoscopic ear surgery (EES) in our hospital from January 2018 to July 2021 over a 6-month period post-surgery. Of the 17 patients, 8 were males and 9 were females (mean age, 53 years; age range, 24-70 years). There were 12 and 5 cases of adhesive otitis media involving the left and right ear, respectively. The patients had follow-up evaluations 1 week, 2 weeks, 1 month, 3 months, and 6 months after surgery. A total of 17 patients with adhesive otitis were enrolled, including 1 patient with Dornhoffer stage II; 6 patients with stage III; and 10 patients with stage IV. Adhesive otitis media was combined with middle ear cholesteatoma in 4 patients (24%). Fourteen patients (82%) had disruption or interruption of the ossicular chain (8 malleus, 14 incus, and 4 stapes lesions), 11 of whom had artificial ossicular chain reconstruction [8 with partial ossicular reconstruction prosthesis (PORP) and 3 with total ossicular reconstruction prosthesis (TORP) implantation]. All patients had good tympanic membrane and graft morphology, no invaginations, and no perforations. The mean postoperative air-conduction hearing threshold [49.06±22.15 dB hearing level (dB HL)] and mean air-bone gap (19.94±10.00 dB HL) were significantly improved compared with the preoperative values (65.29±21.53 and 32.53±8.21 dB HL, respectively; P<0.05). No recurrences, secondary cholesteatomas, or secondary surgeries were reported. EES seems to be a safe and effective surgical method for the management of adhesive otitis media. The study has limitations due to its small sample size and lack of controlled studies. It still needs to be proven in clinical randomized controlled trials.

A STUDY ON ROLE OF CORTICAL MASTOIDECTOMY IN CASES OF TYPE 1 TYMPANOPLASTY

Chronic otitis media (COM) is an inammatory process in the middle-ear space that results in long term, or permanent changes in the tympanic membrane including atelectasis, perforation, tympanosclerosis, retraction pocket development, or cholesteatoma [1]. COM is a major cause of acquired hearing impairment especially in developing countries.1 According to WHO, prevalence rate of COM in India accounts for 7.8% which is high.2 Perforation in tympanic membrane leads to hearing loss and recurrent ear infections. Persistent perforations occur either due to improper treatment of recurrent otitis media or infected traumatic perforation. Primary goal of treatment for COM (mucosal) is elimination of the chronic inammatory process. The secondary goal is reconstruction of sound conducting mechanism [10]. Tympanoplasty is a procedure to eradicate disease in the middle ear to reconstruct hearing mechanism with or without tympanic membrane grafting [2]. Various types of graft materials including temporalis fascia, cartilage, perichondrium, periosteum, vein, fat or skin have been used in the reconstruction of tympanic membrane (TM) perforation. Although temporalis fascia ensures good hearing is restored, there are signicant concerns that its dimensional stability characteristics may lead to residual perforation, especially where large TM perforations are involved. The “palisade cartilage” and “cartilage island” techniques have been stated to increase the strength and stability of a tympanic graft, but they may result in a less functional outcome in terms of restoring hearing[3]. Smoking habits, the size and site of a perforation, the expertise level of the operating surgeon, age, gender, the status of the middle ear mucosa and the presence of myringosclerosis or tympanosclerosis are all important in determining how successful a graft is[4].

Anatomic and audiometric outcomes of porcine intestinal submucosa for tympanic membrane repair.

Surgical repair of tympanic membrane perforations has been traditionally performed with autologous soft-tissue grafts with high success rates. Newer allografts such as porcine small intestine submucosa (pSIS) have been employed as alternatives to minimize donor morbidity and surgical time, and in cases where autologous tissue may not be available. The comparative anatomic and audiometric success rates of these tissues is still unclear. Retrospective case-control series of anatomic and audiometric outcomes of autologous soft tissue versus pSIS graft for primary, isolated transmeatal tympanic membrane repair. Analysis of patients undergoing primary transmeatal tympanic membrane repair with autologous soft tissue or pSIS. Patients with otorrhea, cholesteatoma or retraction pockets, those who had cartilage grafts or ossicular reconstruction, and revision procedures were excluded. Pre- and post-surgery air-bone gaps (ABG) and pure tone averages (PTA) were compared. Graft success was defined as closure of the perforation at 2-month follow-up visit. The success rate for both the autologous soft tissue and the pSIS arm is 93.8%. There was no statistical significance (p< .05) between the post-op ABG, change in ABG, post-op PTA, change in PTA, or graft success rate between the two groups with either lumped cohort or matched-pairs analysis. pSIS grafts are effective for repair of tympanic membrane perforations with hearing outcomes and graft success rates comparable to autologous soft tissue. Repair of tympanic membrane perforations is traditionally done using a soft-tissue graft harvested from the patient at the time of surgery. pSIS is a newer graft material that is equally effective in terms of anatomical and audiometric outcomes. Level 3b.

A deep learning approach to the diagnosis of atelectasis and attic retraction pocket in otitis media with effusion using otoscopic images

BackgroundThis study aimed to develop and validate a deep learning (DL) model to identify atelectasis and attic retraction pocket in cases of otitis media with effusion (OME) using multi-center otoscopic images.MethodA total of 6393 OME otoscopic images from three centers were used to develop and validate a DL model for detecting atelectasis and attic retraction pocket. A threefold random cross-validation procedure was adopted to divide the dataset into training validation sets on a patient level. A team of otologists was assigned to diagnose and characterize atelectasis and attic retraction pocket in otoscopic images. Receiver operating characteristic (ROC) curves, including area under the ROC curve (AUC), accuracy, sensitivity, and specificity were used to assess the performance of the DL model. Class Activation Mapping (CAM) illustrated the discriminative regions in the otoscopic images.ResultsAmong all OME otoscopic images, 3564 (55.74%) were identified with attic retraction pocket, and 2460 (38.48%) with atelectasis. The diagnostic DL model of attic retraction pocket and atelectasis achieved a threefold cross-validation accuracy of 89% and 79%, AUC of 0.89 and 0.87, a sensitivity of 0.93 and 0.71, and a specificity of 0.62 and 0.84, respectively. Larger and deeper cases of atelectasis and attic retraction pocket showed greater weight, based on the red color depicted in the heat map of CAM.ConclusionThe DL algorithm could be employed to identify atelectasis and attic retraction pocket in otoscopic images of OME, and as a tool to assist in the accurate diagnosis of OME.

Role of cartilage graft in type 1 tympanoplasty: audiological and otologic outcomes

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Temporalis fascia is the most commonly used graft material for the tympanic membrane perforations. Due to high failure rate of temporalis fascia in adhesive otitis media, large perforations and advanced middle ear pathology alternate graft materials which are more rigid and resistant to infection are being used. Cartilage graft has shown to be a promising graft material in such cases. The purpose of this study was to evaluate the functional and anatomic results with cartilage graft in type 1 tympanoplasty.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The present prospective study was conducted among 40 patients of chronic otitis media between 11-60 years of age requiring tympanoplasty in department of ear, nose and throat (ENT) in Government Medical College and Rajindra Hospital, Patiala. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The overall success rate of type 1 cartilage tympanoplasty was 85% in terms of perforation closure and post operative pure tone audiometry (PTA) at 6 weeks was 37.24 and at 12 weeks PTA was 34.27 The p value was &amp;lt;0.001 which was found to be significant. The AB gap closure at 6 weeks post op was 6.79 and at 12 weeks 9.76±2.12 dB.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Based on the results of this study, it can be concluded that cartilage is more effective graft material in high-risk perforations, chronic ET dysfunction than fascia and audiological improvement with cartilage is found to be comparable with temporalis fascia.&lt;/p&gt;

Assessment of the Vestibuloocular Reflex in Patients with Unilateral Chronic Middle Ear Disease Using the Video Head Impulse Test: A Preliminary Study

Objectives: This study aims to investigate the usefulness of the video head impulse test (vHIT) as a method for evaluating vestibular function in patients with unilateral chronic middle ear disease.Methods: Nineteen patients with various unilateral middle ear diseases including chronic otitis media (COM), COM with cholesteatoma, and adhesive otitis media successfully underwent preoperative vHIT. The gain of vestibuloocular reflex (VOR) and the presence of corrective saccades were compared between the affected ear and the healthy ear.Results: A total of eight male and 11 female patients with a mean age of 43.1 years were included in this retrospective study. Twelve ears had COM, four had COM with cholesteatoma, and three had adhesive otitis media. A positive history of vertigo or dizziness was reported in 36.8% of the cases. The VOR gain of the affected ears and the healthy ears were 0.97±0.16 vs. 1.00±0.08 in the horizontal canal, 0.91±0.11 vs. 0.87±0.11 in the anterior canal, and 0.87±0.17 vs. 0.99±0.12 in the posterior canal, respectively. Only VOR gain of the posterior canal was significantly decreased compared with healthy ears.Conclusions: The average VOR gains in the patients with chronic middle ear disease were within the pre-defined values of normality; however, when compared quantitatively, posterior canal gain of affected ears was significantly decreased compared to healthy ears. Our results can be explained by the anatomical proximity of the ampulla of the posterior canal and middle ear space.

CLINICAL SIGNS COMMONLY SEEN ON ENT EXAMINATION OF SYMPTOMATIC ACTIVE COVID-19 PATIENTS IN OUR TERTIARY CARE CENTRE

Objectives: The study intends to identify various clinical signs on proper ENT examination. This knowledge will help in successfully identifying infected individuals which can be otherwise missed on screening the patient. Study Design and Setting: This study is a Prospective Cross Sectional Study, a type of an Observational Analytical study. 70 individuals who were admitted in the COVID-19 wards in our Tertiary Care Hospital were subjected to fulfillment of the inclusion and exclusion criteria prepared for this study. Methods: Participants were chosen based on the selection criteria prepared for the study. After obtaining an informed consent, a proper and safe Otorhinolaryngological examination was performed with all necessary precautionary measures. Data was collected as per the designed clinical proforma. Results: 80% of the patients had the presence of clinical signs with respect to Otorhinolaryngology. 43 patients had clinical signs on Throat examination, 35 patients had clinical signs on Nasal examination while 9 patients had Ear related clinical signs. The ENT related clinical signs mostly included Nasal mucosa congestion, Posterior Pharyngeal Wall congestion and presence of Granulations in the Posterior Pharyngeal wall. Reduction of Smell and Taste was also elicited on clinical examination. Other clinical signs also included Tonsil enlargement, n/ Tympanic Membrane retractions and decreased hearing on clinical evaluation. Conclusion: Knowledge of ENT related clinical signs in COVID 19 patients are important while examining patients in the Out Patient Department or Clinic. Focus on ENT related clinical signs are also as important as symptomology.

Cartilage tympanoplasty in the treatment of adhesive otitis media with and without Eustachian tube balloon dilatation

PurposeTo compare cartilage tympanoplasty (CT) combined with eustachian tube balloon dilatation (ETBD) and cartilage tympanoplasty alone as a surgical treatment modality for adhesive otitis media (AdOM) in terms of graft healing, audiological outcomes, and impact on life style, using Chronic Otitis Media Outcome Test 15 (COMOT-15). Methods50 patients with AdOM were randomly classified into 2 groups: 25 patients for cartilage tympanoplasty only (CT group) and 25 patients for cartilage tympanoplasty combined with eustachian tube balloon dilatation (CT + ETBD group). Clinical outcomes in both groups were compared at 3 and 6 months of follow up. ResultsThere was no significant difference in graft healing between the two groups. Postoperative COMOT-15 scores significantly decreased in both groups with a significant difference between the groups with regard to the decrease in COMOT-15 scores at 3 and 6 months of follow-up (P < 0.05). Hearing improvement was achieved, as the mean preoperative ABG was 26.5 ± 5.4 and 27.1 ± 4.6 dB, and the mean postoperative ABG at 6 months was 19.4 ± 4.4 and 14.6 ± 3.9 dB in the CT and the CT + ETBD groups, respectively. The difference in the magnitude of ABG reduction in the two groups was significant at 3 and 6 months of postoperative follow-up (P < 0.05) in favour of the CT + ETBD group. ConclusionETBD can increase the success rate of cartilage tympanoplasty in patients with AdOM by enhancing the audiological outcome and quality of life.

Mastoidectomy in surgical procedures to treat retraction pockets: a single-center experience and review of the literature

PurposeRetraction pocket (RP) is a common event affecting the middle ear when a negative pressure within it causes a retraction of a single part of the tympanic membrane (TM). Patients can be asymptomatic or can experience hearing loss, fullness feeling and/or ear discharge. RP can be stable or develop a cholesteatoma; aim of the study was to investigate if mastoidectomy may play a role in the surgical management of patients suffering from RP, both reporting our experience and discussing the existing literature.MethodsFifty-one patients affected by RP were referred for surgery and randomly divided into two groups. Patients of G1 group underwent tympanoplasty with mastoidectomy, patients of G2 group underwent tympanoplasty only. A systematic review of the literature was then carried out by applying the PRISMA guidelines.ResultsThe mean follow-up lasted about 36 months. The G1 and G2 groups reached a postoperative mean air–bone gap (ABG) of 7.1 dB HL and 5.1 dB HL, respectively, with a mean ABG improvement of 13.2 dB HL and 12.4 dB HL. An ABG improvement was observed in the 59.7% of the G1 group and in the 63.2% of the G2 group, respectively (p > 0.5). Only one case of long-term complication was recognized in the G1 group. We combined, integrated and analyzed results of our prospective study with results of the literature review.ConclusionsBased on the combined results of our study and literature review we may conclude that there is no evident benefit in performing mastoidectomy for the treatment of RP. In fact, no differences in ABG improvement or in RP recurrence were reported between the two groups.

Endoscopic transcanal surgery of pars tensa cholesteatoma: Preliminary results

Introduction and objectivesThe aim of the present study is the assessment of exclusive endoscopic ear surgery for the management of primarily acquired pars tensa cholesteatoma, which is commonly linked to the failure of the Eustachian tube leading to the formation of retraction pockets. Materials and methodsPatients suffering from primarily acquired pars tensa cholesteatoma, who underwent primary surgery in our clinic, between 2014 and 2018 were included in this retrospective study. The disease was classified according to the EAONO/JOS system. Exclusive endoscopic ear surgery was performed for patients without mastoid involvement, while a microscopic–endoscopic tympanoplasty was carried out in case of mastoid extension. We assessed the recidivism rate during the follow-up. ResultsCholesteatomas belonged to stage I in 28% of cases, to stage II in 68% and only one patient was stage III. Only a portion of the pars tensa was involved in 13 instances, the whole pars tensa in 3 and both the tensa and the flaccida in 9. 17 out of 25 patients underwent exclusive endoscopic ear surgery and 8 needed a combined approach. We discovered 1 recurrence and 6 residual diseases. ConclusionsWith only one case of recurrence in our series, we showed how pars tensa cholesteatoma cannot be exclusively explained through Eustachian tube dysfunction, but also through a ventilation blockage between the Eustachian tube and other mesotympanic areas due to the formation of intratympanic folds. Endoscopic ear surgery proved highly effective in the control of recurrences and it should be considered the treatment of choice.