Air-bone Gap Closure Research Articles

Endoscopic push-through technique compared to microscopic underlay myringoplasty in anterior tympanic membrane perforations.

Microscopic myringoplasty is the most frequently performed procedure for repairing tympanic membrane perforations. The endoscopic transcanal approach bypasses the narrow ear canal segment and provides a wider view. An open-label randomised clinical trial was conducted on 56 patients with small anterior tympanic membrane perforations. Perforations were repaired with an endoscopic push-through technique (n = 28) or a microscopic underlay technique (n = 28). Follow up was conducted using endoscopic examination and pure tone audiometry three months' post-operatively. Graft success rate was 92.9 per cent in the endoscopic group versus 85.7 per cent in the microscopic group. The corresponding pre-operative mean air-bone gaps were 17.4 dB and 18.5 dB, improving to 6.1 dB and 9.3 dB post-operatively (p > 0.05). Mean air-bone gap closure was 11.4 dB in the endoscopic group and 9.2 dB in the microscopic group (p > 0.05). Mean operative time and estimated blood loss were 37.0 minutes and 29 ml in the endoscopic group, versus 107 minutes and 153 ml in the microscopic group (both p < 0.05). The endoscopic push-through technique for anterior tympanic membrane perforations is as effective as microscopic underlay myringoplasty; furthermore, it is less invasive and takes less operative time.

Swing-Door Overlay Tympanoplasty: Surgical Technique and Outcomes

Objectives The classical overlay tympanoplasty is technically difficult with some disadvantages and thus less popular. However, it is particularly useful for large, anterior perforations. In this study, we describe the technique of a modified overlay graft in the tympanoplasty coined as the swing-door overlay tympanoplasty and report its outcomes.Methods Retrospective review of patients undergoing the swing-door overlay tympanoplasty at a tertiary referral center between 2003 and 2016 was performed. Patient who had ossicular abnormality, previous tympanoplasty, and profound hearing loss were excluded. The surgical technique is described in detail. The outcomes were evaluated by the graft success rate, complication rate, and hearing results. The hearing level was determined by four pure-tone average at 0.5, 1, 2, and 4 kHz. Air-bone gap closure was mainly assessed.Results A total of 306 patients (110 males and 196 females) were included. The mean age was 49.1±16.6 years. Follow-up periods ranged from 6 to 108 months with an average of 18.4 months. The overall graft success rate reached 98.4%. Five graft failures occurred with reperforation in three cases and lateralization in two cases. Postoperative complications occurred in 12 cases (3.9%). Air-bone gap changes (closures) were 7.8±12.8, 5.2±12.2, 5.7±10.2, and 6.0± 12.8 dB at 0.5, 1, 2, and 4 kHz, respectively (all P<0.001) with an average improvement of 6.2 dB. Postoperative airbone gap was closed to ≤20 dB in 86.9%.Conclusion The swing-door overlay tympanoplasty is a highly successful surgical technique suitable for all types of tympanic membrane perforations. This approach is technically easier than classical overlay tympanoplasty and affords an excellent graft success rate with satisfying hearing results.

Predictive factors in 995 stapes surgeries for primary otosclerosis.

This study sought to identify the predictors of outcome in patients with otosclerosis undergoing primary stapes surgery. Retrospective analysis of medical records. A total of 995 patients with otosclerosis who underwent primary stapes surgery by a single surgeon between January 2006 and December 2016 were included. Logistic regression analysis was performed to examine factors affecting postoperative hearing thresholds at individual frequencies. A postoperative air-bone gap (ABG) closure ≤ 10 dB in the stapes surgery was considered as excellent outcome. Stapedotomies and stapedectomies were conducted in 823 and 172 ears, respectively. The surgeries had an overall success rate of 93.6%. Univariate analysis showed a significantly higher success rate in patients with larger prostheses (diameter = 0.6 mm). According to the results of multivariate logistic regression analysis, preoperative ABG (B coefficient = -0.10), bilaterality (odds ratio [OR] = 2.09), right ear involvement (OR = 2.00), female gender (OR = 1.81), and nonobliterative footplate (OR = 3.69) were significant prognostic factors predicting excellent outcome. Our findings indicated that the functional results were generally good. Based on logistic regression analysis, preoperative ABG and nonobliterative footplate were the most important predictors of hearing outcome after stapes surgery for otosclerosis. The success of the surgery did not depend on the procedure types (stapedotomy vs. stapedectomy) or the diameter of the prosthesis (0.4 mm vs. 0.6 mm). 4. Laryngoscope, 128:2403-2407, 2018.

Audiological Outcomes of Stapedotomy: Our Experience

Objective: This study was aimed to sequentially document the patient’s audiological improvement after stapedotomy as measured by pure tone audiometry.Material and Methods: This prospective clinical study was performed in a total of 100 patients (age range: 20 – 63 years), diagnosed with Otosclerosis who underwent Stapedotomy at the Department of Otology, Madras ENT Research Foundation, Chennai between September 2010 to March 2012. Pre-operative and Post-operative audiometric evaluation was done using the same conventional pure tone audiometer with standard calibrations. Post-operative audiometry was sequentially performed at 6 months, 1 year and 2 years. Bone-conduction and air conduction thresholds and the Air-bone gap (ABG), were assessed at each schedule at 0.5 KHz, 1 KHz, 2 KHz and 4 KHz frequencies respectively.Result: All patients had significant audiological improvement as measured by their sequential pure tone audiometries. Overall, the frequency specific pre-operative mean average Air-Bone gap was 52.3dB at 500Hz, 36.5dB at 1KHz, 39.3dB at 2KHz, 38.7dB at 4KHz and the frequency specific postoperative mean average Air-Bone Gap closure was achieved by 27.8dB at 500Hz, 29.6dB at 1KHz, 13.6dB at 2KHz, 11.4dB at 4KHz, by the time of 2 years of follow up. A successful closure of AB gap &gt;10dB was achieved in these speech frequencies in 80% of cases. The frequency specific bone-conduction thresholds were unchanged postoperatively. Two patients developed post-operative vertigo, out of which 1 developed SNHL after 3 weeks of surgery.Conclusion: The study confirms that stapedotomy is a safe and successful procedure in the hands of a well trained otologist, providing long-term hearing improvement to patients with otosclerosis.

An internally validated prognostic model for success in revision stapes surgery for otosclerosis.

To develop a prediction model that can accurately predict the chance of success following revision stapes surgery in patients with recurrent or persistent otosclerosis at 2- to 6-months follow-up and to validate this model internally. A retrospective cohort study of prospectively gathered data in a tertiary referral center. The associations of 11 prognostic factors with treatment success were tested in 705 cases using multivariable logistic regression analysis with backward selection. Success was defined as a mean air-bone gap closure to 10 dB or less. The most relevant predictors were used to derive a clinical prediction rule to determine the probability of success. Internal validation by means of bootstrapping was performed. Model performance indices, including the Hosmer-Lemeshow test, the area under the receiver operating characteristics curve (AUC), and the explained variance were calculated. Success was achieved in 57.7% of cases at 2- to 6-months follow-up. Certain previous surgical techniques, primary causes of failure leading up to revision stapes surgery, and positions of the prosthesis placed during revision surgery were associated with higher success percentages. The clinical prediction rule performed moderately well in the original dataset (Hosmer-Lemeshow P = .78; AUC = 0.73; explained variance = 22%), which slightly decreased following internal validation by means of bootstrapping (AUC = 0.69; explained variance = 13%). Our study established the importance of previous surgical technique, primary cause of failure, and type of the prosthesis placed during the revision surgery in predicting the probability of success following stapes surgery at 2- to 6-months follow-up. 2b. Laryngoscope, 128:2390-2396, 2018.

A comparative study of superiorly based circumferential tympanomeatal flap tympanoplasty with anteriorly anchoring flap tympanoplasty in large, subtotal, and anterior tympanic membrane central perforations in chronic suppurative otitis media of mucosal type

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;The main objective of the study was to assess and compare the graft uptake, hearing improvement, complications in large, subtotal, and anterior moderate perforations by each technique viz; superiorly based circumferential tympanomeatal flap tympanoplasty (STT)/full cuff and anterior anchoring flap tympanoplasty (AAT)/anterior tucking. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;In our study of 30 cases age group in the range of 10 years to 60 years. The mean air bone gap for the 8 patients with anterior moderate perforation was 31.75 db, for 17 patients with large central perforations was 38.75 db and for 5 patients with subtotal perforations was 41.4 db. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Mean air bone gap closure after 3 months of surgery in the STT group was 21.4 db while that after 6months of the surgery for the same group was 22.06 db. Mean air bone gap closure after 3 months of surgery in the AAT group was 18.2 db while that after 6months of the surgery for the same group was 18.73 db. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Comparing the air bone gap closure in patients who underwent surgery by AAT and STT technique we found that there is no statistical difference. Both techniques (viz: superiorly based circumferential tympanomeatal flap tympanoplasty and anteriorly anchoring flap tympanoplasty) can be used for the repair of large, subtotal, and anterior tympanic membrane central perforations in chronic suppurative otitis media of mucosal type.&lt;/span&gt;&lt;/p&gt;

A New Reversal Steps Stapedotomy.

To evaluate whether removal of the stapes head and not the entire stapes superstructure prevents footplate complications. Prospective study. One hundred and forty-five patients with otosclerosis were included. Patients were divided into 2 groups as follows: Individuals in group 1 (n = 75) underwent removal of the entire stapes superstructure; individuals in group 2 (n = 70) underwent removal of the stapes head only. These 2 groups were further subdivided into 2 subgroups based on the type of otosclerosis. Group 1a included 55 cases of marginal otosclerosis, while group 1b included 15 diffusive and 5 biscuit otosclerosis cases. Group 2a included 51 marginal otosclerosis cases, while group 2b included 14 diffuse and 5 biscuit otosclerosis cases. Estimations were made regarding statistical correlation between type of reversal steps stapedotomy, otosclerosis type, incidence of footplate complications, and hearing results. There were 9 footplate complications in group 1b and no complications in group 2b. This difference was significant. Air-bone gap closure to within 10 dB was achieved in 65% of cases in group 1b and 94.7% in group 2b. This difference was significant. The new stapedotomy prevented footplate complications and improved hearing results in diffuse and biscuit otosclerosis.

Hearing Outcome in Stapes Surgery Using Various Biomaterial Prostheses

Aims: To assess the hearing outcome in patients who have undergone stapes surgery using polytetrafluoroethylene (PTFE) and Titanium prosthesis at 1 and 3 months post operatively. Material & Methods: Research design: Prospective study. Setting: ENT department, Pushpagiri Medical College. Study population: All age groups with clinical diagnosis of otosclerosis and air-bone gap more than 15 dB irrespective of sex difference. Patients with Meniere’s disease are excluded. Method: A prospective study was conducted for a period of one and a half years from January 2014 to July 2015 to find out the hearing outcome of stapes surgery in patients with otosclerosis using polytetrafluoroethylene (PTFE) and Titanium prostheses, attending our outpatient department. Results: In this study, 84.21% of ears with polytetrafluoroethylene (PTFE) and 81.81% of ears with titanium were able to achieve good results in terms of Air-Bone gap (ABG) closure (ABG < 20 dB). The average post op hearing following stapes surgery at 3 months improved to near normal levels of 34.12 dB ± 8.95 with an average hearing gain of 19.19 dB with PTFE prosthesis and 30.86 dB ± 5.47 with an average hearing gain of 21.2 dB with titanium which were significant. Conclusion: Stapes surgery is the surgical procedure of choice for otosclerosis. In our study, a significant hearing improvement was seen in majority of cases. None of the factors considered relevant for the success of stapes surgery like age, sex, type of prosthesis appeared to affect the post-operative hearing significantly. Hence stapes surgery can be effectively used to improve hearing in otosclerosis.

Comparison of Various Graft Materials in the Reconstruction of Ossicular Chain in Patients with Chronic Otitis Media: A Prospective Hospital Based Study

Introduction&#x0D; Ossicular chain reconstruction is the surgical procedure used to correct the hearing problems in patients with chronic otitis media (COM). In this era, where a large variety of innovative artificial prosthetic materials are being used to replace and reconstruct the ossicular chain, autografts still play a significant role.&#x0D; Materials and Methods&#x0D; The present study included 40 patients. Study population was selected based on inclusion and exclusion criteria. The ossicular reconstructive procedure was done under anesthesia and according to the status of the ossicular chain. Temporalis fascia was used to close the perforation. Mainly two procedures were performed: one is intact canal wall and the other is canal wall down. &#x0D; Results &#x0D; Most of the study population was middle aged and males were more compared to females. Thirty five patients had air bone gap above 30dB. In 38 patients, the incus had undergone necrosis. Most of the patients underwent short columella reconstruction. A closure of air bone gap with in 20 dB was achieved in 72.2% in patients with malleus stapes assembly. In short columella 22.2% of patients had closure of air bone gap within 20 dB. Incus remnant grafts gave better hearing gain.&#x0D; Discussion&#x0D; The published literature on the result of use of sculptured ossicle and cartilage in tympanoplasty have been reviewed&#x0D; Conclusion &#x0D; In the present study, cases with COM showed good hearing results patients implanted with autogenous cartilage and bone.

Evaluation of Results of Cartilage Augmentation in Type III Tympanoplasty

Introduction&#x0D; In conventional Type III tympanoplasty, post operative air-bone gap (ABG) is around 10-60dB. This study aimed to assess the hearing results in patients undergoing canal wall down mastoidectomy with cartilage augmented type III tympanoplasty. &#x0D; Materials and Methods&#x0D; Patients of 6-50 years of age with the diagnosis of Chronic Otitis Media (Squamous) with conductive or mixed hearing loss, requiring canal wall down mastoidectomy and with intact and mobile stapes suprastructure at surgery who underwent cartilage augmentation were included in the study. Pure tone audiometry (PTA) was performed and evaluated. Post- operative hearing was assessed in terms of average air bone gap (ABG) and size of ABG closure.&#x0D; Results&#x0D; The results concluded that mean of pre and post operative air bone gap were 37.5db and 29.7db respectively with net gain of 7.8db.These differences were significant. Also ABG closure was within 30 db in 28 cases (70%).&#x0D; Discussion&#x0D; The results of this study were compared with other reported series. The mechanical and acoustical aspects of canal wall down surgeries as also the probability of variation in results due to differences in surgical procedures and post-operative fibrosis have been mentioned. &#x0D; Conclusion&#x0D; There was significant improvement in postoperative hearing after stapes head augmentation in type III tympanoplasty.

A study of hearing improvement gained after tympanoplasty using various methods in cases of CSOM

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Chronic otitis media (COM), is a common ailment with which patients present to the ENT OPD. In patients with COM, the active infection needs to be controlled following which the definitive line of management is surgery. Tympanoplasty is the surgery performed with the goals of establishing an intact tympanic membrane, eradicating middle ear disease, creating an air-containing middle ear space and restoring the hearing by building a secure connection between the ear drum and the cochlea. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;50 patients presenting with CSOM in ENT OPD at Medical College. Preoperative audiometry was done before tympanoplasty, followed by post-operative audiometry after 3 months. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;The mean air-bone gap closure was 12.06 dB; with type I tympanoplasty with cortical mastoidectomy giving a maximum mean improvement of 16db. Minimum mean improvement of 1db was seen in type IV with modified radical mastoidectomy. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Type I tympanoplasty with cortical mastoidectomy is a far superior method of surgical treatment of CSOM than all other methods.&lt;/span&gt;&lt;/p&gt;

Application of Platelet Rich Fibrin Matrix to Repair Traumatic Tympanic Membrane Perforations: A Pilot Study.

Trauma in the form of instrumentation, slap, blast, accident, and sporting injury can result in tympanic membrane (TM) perforations which spontaneously recover in 53-94%. The closure rates of TM perforation due to above causes do not vary greatly; however, some otolaryngologists prefer to perform immediate microsurgical procedures to accelerate the recovery process. Our aim is to study the efficacy of Trichloroacetic acid (TCA) Chemical Cauterization (50%) and Platelet rich fibrin (PRF) Plug Myringoplasty technique in healing traumatic tympanic membrane perforations. To evaluate the preoperative and postoperative hearing outcome from the procedure and compare them. Study design is prospective study. A pilot study was carried out amongst selected 25 patients with central perforations in the Department of ENT, for duration of 2years from July 13 to July 15. All 25 patients underwent PTA assessment & TCA (50%) and Autologous PRF Plug Myringoplasty technique done and follow up to 6months postoperatively. The success rate traumatic tympanic membrane closure was found to be 92%. Pre- and post-operative hearing assessments of each patient were done & showed statistically significant air-bone gap closure with success rate of 88% (p<0.05). From this study, the closure rate in traumatic tympanic membrane perforation by TCA (50%) and PRF Plug Myringoplasty technique was 92% with statistically significant hearing improvement (88%). This technique can be recommended as a time and cost effective office based procedure for treatment of traumatic tympanic membrane perforations.

Effect of esterified hyaluronic acid as middle ear packing in tympanoplasty for adhesive otitis media

Objectives: The goal of this study was to evaluate the effects of middle ear packing agents (MEPA) on post-operative hearing improvement and complications after tympanoplasty in patients with adhesive otitis media (OM).Materials and methods: Patients with adhesive OM who underwent tympanoplasty surgery were enrolled in the study between January 2012 and January 2015. A total of 205 patients who received canal wall-down tympanoplasty with ossicular chain reconstruction were randomized into one of the three groups with different MEPA. Group 1 (n = 72) received MeroGel as the MEPA, Group 2 (n = 64) cartilage, and Group 3 (n = 69) both. Air conduction (AC) and bone conduction (BC) thresholds at 0.5, 1, 2, and 4 kHz were measured, and air-bone gaps (ABG) were analyzed before and after the surgery for each patient.Results: Mean pre- and post-operative ABG was 30.9 dB and 17.6 dB in Group 1, 31.4 dB and 21.9 dB in Group 2, and 32.2 dB and 19.1 dB in Group 3. The ABG closure was 13.3 ± 7.5 in Group 1, 9.5 ± 5.9 in Group 2, and 13.1 ± 9.3 in Group 3. The improvement of ABG after surgery was statistically significant in all three groups (p < .05). The ABG closure was statistically significantly smaller in Group 2 than in other two groups (p < .05).Conclusions: Tympanoplasty using esterified hyaluronic acid (i.e. MeroGel) or cartilage as the MEPA resulted in improved hearing for patients with conductive hearing loss due to adhesive OM. Using MeroGel as the MEPA appeared to achieve a better post-operative outcome than using cartilage.

Comparison of endoscopic underlay and microscopic underlay tympanoplasty: a prospective research at a tertiary care centre in Gujarat

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Tympanoplasty is an ever evolving surgery with myriad of approaches and tools. Use of endoscope is relatively new and there are few studies evaluating the use of endoscope via microscope because of a big learning curve in using one hand endoscopic technique despite it being minimally invasive.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is a prospective study conducted from June 2016 to May 2017 with a sample size of 44 patients. The study included patients of Chronic Otitis Media (COM) of mucosal inactive type without any co-morbidities in which only Type-1 tympanoplasty was done. The patients were divided into endoscopic or microscopic group using simple random sampling and after taking written and informed consent. The patient’s details regarding audiometric, oto-endoscopic and nasal endoscopic evaluation were recorded. Intra operative findings, duration of surgery and post-operative pain scoring were recorded. The patients were followed up for 3 months and subjected to post-operative audiometry and patient satisfaction questionnaire. The groups were evaluated for graft take up and closure of air bone gap, post-operative complications and patient satisfaction. The results were analysed using descriptive statistics (mean and percentage) and CHISQ test.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Graft was taken up in 21 patients (95%) in microscopic as opposed to 20 in endoscopic group (90%). Mean VAS scoring for pain was 2.5 in microscopic group on first post-operative day and 1.5 for the endoscopic group. The mean improvement in air bone gap post-surgery was 23.68 dB (SD=4.94) for microscopic group and 16.13 dB (SD=6.49) for endoscopic group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Endoscopic tympanoplasty as a technique has a long learning curve. The results indicate that endoscopic technique is as efficacious as and less invasive than microscope surgery for doing tympanoplasty. &lt;/p&gt;

To Evaluate and Compare the Result of Ossiculoplasty Using Different Types of Graft Materials and Prosthesis in Cases of Ossicular Discontinuity in Chronic Suppurative Otitis Media Cases.

Chronic suppurative otitis media, with and without cholesteatoma, frequently results in disruption of the ossicular chain. The present study was designed to compare the outcome using autologous ossicle and titanium prosthesis in two groups of suitable patients presenting with chronic suppurative otitis media for middle ear reconstructive surgeries. A prospective study done from July 2012 to December 2013, at Mahatma Gandhi Medical College and Hospital, Sitapura, Jaipur (Rajasthan). The target group included patients with chronic suppurative otitis media admitted and planned for reconstructive middle ear surgery. The study group patients among the target group requiring certain ossicular reconstruction. The patients included were patients with CSOM with or without cholesteatoma in which there was ossicular discontinuity. The patients were divided in two groups A and B. In group A patients autologous incus was used and in group B titanium prosthesis either TORP or PORP was used for ossicular replacement. Out of 340 patients as target group, 88 patients were included in study group. Further 88 patients of study group, 51 patients were included in group A; rest 37 patients were included in group B. In group B patients partial ossicular replacement platinum prosthesis was used in 31 patients while in rest 6 patients a total ossicular replacement prosthesis was used. Out of 88 patients, 79 were primary cases and 9 were revision cases. Pre and post operative air bone gap were noted. Pre operatively both of the groups were identical in relation to air-bone gap. The postoperative air-bone gap was calculated as the difference between postoperative air conduction and preoperative bone conduction. On comparison of preoperative and post-operative hearing results there was improvement in air conduction threshold and air bone gap in both the groups. Post operatively difference in air bone gap closure between group A and group B was found statistically significant (P value=0.032) suggesting better hearing outcomes after using titanium ossicular replacement prosthesis. On comparing partial or total ossicular replacement prosthesis no significant difference was found for the audiological outcome (P=0.434). Various prognostic factors were also noted for air bone gap closure. Titanium ossicular replacement prosthesis have better outcome, and no significant difference found in audiological outcome for TORP and PORP.

Objective assessment of hearing during second stage of tympanoplasty-surgical technique and measurement methodology presented in ten patients.

In this paper, a complete integrated method of intraoperative monitoring of hearing (IOMH) during ossiculoplasty performed via posterior tympanotomy is presented. The method integrates auditory steady state responses (ASSR) with Laser-Doppler Vibrometry (LDV) and allows intraoperative optimization of ossicular prosthesis positioning and coupling. Both ASSR and LDV are acquired simultaneously. The results of the integrated measurements are analyzed and evaluated automatically on-line which makes this strategy unaffected by individual differences in interpretations of collected recordings. The technique of intraoperative monitoring of hearing, presented in this paper, allows optimal placement of the prosthesis and replacement if needed as well as confirmation of the ossiculoplasty efficiency by intraoperatively defined hearing threshold and air-bone gap closure before the end of surgery. This article is protected by copyright. All rights reserved.

Comparison between clinical and audiological results of tympanoplasty with double layer graft (modified sandwich fascia) technique and single layer graft (underlay fascia and underlay cartilage) technique

IntroductionSurgical repair of the tympanic membrane, termed a type one tympanoplasty is a tried and tested treatment modality. Overlay or underlay technique of tympanoplasty is common. Sandwich Tympanoplasty is the combined overlay and underlay grafting of tympanic membrane. ObjectiveTo describe and evaluate the modified sandwich graft (mediolateral double layer graft) tympanoplasty using temporalis fascia and areolar fascia. To compare the clinical and audiological outcome of modified sandwich tympanoplasty with underlay tympanoplasty. MethodsA total of 88 patients of chronic otitis media were studied. 48 patients (Group A) underwent type one tympanoplasty with modified sandwich graft. Temporalis fascia was underlaid and the areolar fascia was overlaid. 48 patients (Group B) underwent type one tympanoplasty with underlay fascia technique. 48 patients (Group C) underwent type one tympanoplasty with underlay cartilage technique. We assessed the healing and hearing results. ResultsSuccessful graft take up was accomplished in 47 patients (97.9%) in Group A, in 40 patients (83.3%) Group B, and in 46 (95.8%) patients in Group C. The average Air-Bone gap closure achieved in Group A was 24.4±1.7dB, in Group B, it was 22.5±3.5dB and in group C, it was 19.8±2.6dB. Statistically significant difference was found in graft healing rate. Difference in hearing improvement was not statistically significant. ConclusionDouble layered graft with drum-malleus as a ‘meat’ of sandwich maintains a perfect balance between sufficient stability and adequate acoustic sensitivity.

Longitudinal Study of Type I Interlay Tympanoplasty.

The aim of the present study was to access success rate of tympanoplasty and complications with interlay technique of tympanoplasty. This Longitudinal Prospective study was carried out in the Department of Otorhinolaryngology and Head and Neck Surgery, Era's Lucknow Medical College, Lucknow. 50 patients aged between 10 and 50years of chronic otitis media mucosal type disease with dry ears were selected. Otomicroscopic, tunning fork test, pure tone audiometry were done in all patients. All patients underwent interlay tympanoplasty. Patients were followed up regularly for a minimum period of 1.5years. Successful graft uptake was noted in 48 (96%) cases. Interlay tympanoplasty results in excellent graft uptake and good post operative Air Bone Gap closure.

Pediatric Cholesteatoma: Factors Affecting Recurrence Rates and Hearing Outcomes

Objective : Children with cholesteatoma have been reported to have higher rates of recurrence compared to adults. Clinical factors affecting the rate of disease recurrence and ultimate hearing outcomes were analyzed. Methods : Children diagnosed with cholesteatoma between April 1988 and May 2014 were identified. Medical records were reviewed to determine risk factors for disease recurrence and assess the hearing outcome. Results : One hundred and twenty-two children had sufficient data available for inclusion in our study. Three suffered bilateral disease allowing for 125 patient ears to be analyzed. Of these, 67/125 (53.6%) had recurrence after one surgery with a median time to recurrence of 9 months. There was a mean of 2.5 operations per patient. Five-year cholesteatoma free survival rate was 86.29%. Age (8.04 vs. 8.67 yrs old, p =0.36) and origin (congenital vs. acquired cholesteatoma) (54.8% vs. 53.7%, p =1) did not differ in outcomes. Epitympanic and oval window involvement resulted in a significantly higher recurrence rate (64.5% vs. 37.5%, p =0.0053 and 67.3% vs 45.3%, p =0.0178). Children with recurrence demonstrated more extensive disease with a higher number of middle ear sub-sites involved (3.67 vs. 2.82 areas involved, p =0.0061). Most importantly, children whose disease recurred had worse hearing outcomes with lower rates of air-bone gap closure (-5.319 dB vs. 6.351 dB, p =0.0082). Conclusion : While age was not a factor, pediatric patients with more extensive cholesteatoma are more likely to have recurrent disease and worse hearing outcomes.

Comparison of Free-Beam- and Fiber-Type CO2 Laser Delivery Systems in Stapes Surgery.

Background and ObjectivesA free-beam-type CO2 laser, which use a micromanipulator mounted on a microscope as the delivery system, has the merit of not being affected by hand tremor at the time of shooting. However, this delivery system has several disadvantages, including a restricted operation range and a risk of incorrect focusing. A fiber-type CO2 laser uses a hand-held delivery system and has the opposite merits and demerits. We compared the results of stapes surgery with free-beam and fiber type delivery systems.Subjects and MethodsThe study enrolled 36 patients who underwent stapedotomy with free-beam- (n=26) or fiber- (n=10) type CO2 lasers. The air-bone (AB) gap closure, bone conduction (BC) change, and operating time were evaluated. The AB gap closure was calculated by subtracting the preoperative BC thresholds from the postoperative air conduction thresholds. The BC change was calculated by subtracting the postoperative BC thresholds from the preoperative BC thresholds.ResultsThe mean operating time was significantly (p=0.035) shorter in the fiber-type group (72.5±8.2 min) than in the free-beam-type group (80.5±11.4 min). The mean AB gap closure did not differ significantly (p=0.297) between the free-beamand fiber-type groups (5.8±10.1 and 1.4±6.8 dB, respectively). The mean BC change did not differ significantly (p=0.873) between the free-beam- and fiber-type groups (2.4±6.9 and 2.8±5.3 dB, respectively). The hearing outcomes did not differ significantly between the two groups.ConclusionsOperating times were significantly shorter using the fiber-type CO2 laser, while hearing outcomes did not differ significantly between the two groups.