Audiological Success Research Articles

Microscopic versus Endoscopic Stapes Surgery – A Meta-Analysis

Abstract Background The microscope is the conventional method used by ear surgeons to view the middle ear structures, allowing for binocular vision and the freedom of both hands. Its main disadvantage is the need for an unobstructed, direct view of the operating area. The end-aural incision, drilling of the bony auditory canal, and regular repositioning of the patient and the surgeon are a few examples of how the operation has to adapt to the microscope. Nevertheless, the microscope has proven itself as the tool of choice in stapes surgery with reliable outcomes. Objective to compare endoscopic and microscopic interventions in stapes surgery regarding intraoperative and post-operative outcomes. Patients and Methods The review was a meta analytic & systematic review that included randomized controlled trials (RCT), case series and retrospective studies which studied the comparison of microscopic and endoscopic stapes surgery, 15 articles published between 2014 and 2020 were included in our study. Data Sources Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2020. Results Our results showed that the injury to the chorda tympani nerve was significantly higher in microscopic vs endoscopic groups. And also as regard the operative times, it was significant longer in microscopic vs. endoscopic groups. But there is no significant difference as regarde pain, dizziness, perforation of tympanic membrane, delayed conductive hearing & post-operative Air- bone gap improvement and taste disturbance between both groups. Conclusion Endoscopic stapes surgeries are technically feasible, safe and promising. Overall, our study indicates endoscopic and microscopic stapes surgery has similar audiological success, with some data suggesting a lower risk of chorda tympani injury and postoperative taste disturbance with the endoscope. Endoscopic stapes surgery appears to be a reasonable alternative to microscopic stapes surgery, with similar complications (chorda tympani nerve injury, pain, Perforation of tympanic membrane, taste disturbance, Dizziness, and delayed conductive hearing). Shorter operative times shorter and lower postoperative air-bone gap were found in endoscopic stapes surgery. Superior visibility with the endoscope was consistently reported in all the studies. This meta-analysis of the current evidence supports the use of endoscopic techniques for stapes surgery.

Comparison of the Functional and Audiological Success of Temporalis Fascia and Tragal Perichondrium as a Graft in Type 1 Tympanoplasty

Context: Temporalis fascia and tragal perichondrium are the most commonly used graft materials in tympanoplasty, though contradictory reports are available in literature regarding their efficacy. Aims: To investigate the success rates and hearing outcomes of temporalis fascia and tragal perichondrium as grafts used for Type 1 tympanoplasty. Settings and Design: The present prospective study was carried out for a period of 18 months including 60 patients of either sex from 18 to 70 years of age. Subjects and Methods: This prospective study included 60 consecutive cases of chronic otitis media in a tertiary care center randomized in two groups of 30 patients each to be subjected to Type 1 tympanoplasty using either temporalis fascia graft (Group A) or tragal perichondrium (Group B). Graft uptake rates and subjective as well as objective hearing improvement at 1 and 3 months postoperative follow-up were compared. Statistical Analysis Used: IBM-compatible Statistical Package for the Social Sciences (SPSS) version 21.0. Results: The mean age of presentation in Group A was 31.30 years and in Group B was 30.67. In our study, the graft uptake after 3 months of surgery was 87% in the temporalis fascia graft group and 90% in the tragal perichondrium graft group. The mean pre- and postoperative PTA at 1 month and 3rd month postoperatively showed that there was significant improvement in hearing after 1 month in the temporalis fascia graft group compared to the tragal perichondrium graft group. Conclusions: Both temporalis fascia and tragal cartilage perichondrium are suitable graft materials for tympanoplasty. Graft uptake was superior with tragal perichondrium, while hearing improvement was better with temporalis fascia at 1 month postoperatively, although the results were not statistically significant at 3 months postoperative.

Dry versus wet temporalis fascia graft in type-I tympanoplasty: a systematic review and meta-analysis of randomized controlled trials.

To conduct a systematic review and meta-analysis of all randomized controlled trials (RCTs) that examined the efficacy of dry versus wet temporalis fascia graft among patients undergoing type-I tympanoplasty. Web of Science, Scopus, PubMed, and CENTRAL databases were screened from inception until July 2022. The Cochrane risk of bias tool was used to assess the quality of included RCTs. The outcomes were summarized as risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI) in a random-effects model. Eight RCTs with 989 patients (dry group = 514 and wet group = 475) were included. The overall quality was 'low', 'some concerns', and 'high' risk of bias in five, two, and one RCT(s), respectively. There were no significant differences between both groups regarding the surgical success rate (n = 8 RCTs, RR 0.99, 95% CI [0.95, 1.03], p = 0.6), audiological success rate (n = 5 RCTs, RR = 0.93, 95% CI [0.73, 1.13], p = 0.48), mean difference in pure tone average (n = 2 RCTs, MD = 2.73Hz, 95% CI [- 2.31, 7.77], p = 0.29), and mean difference in graft placement time (n = 3 RCTs, MD = - 2.18min, 95% CI [- 5.11, 0.76], p = 0.15). However, the mean difference in operative time was significantly lower in favor of the wet compared with the dry temporalis fascia group (n = 2 RCTs, MD = 2.95min, 95% CI [- 1.80, 4.11], p < 0.001). The surgical success rate was not significantly different between both groups according to the tympanic membrane perforation size and site. The type of temporalis fascia graft (dry or wet) did not influence the clinical outcomes of type-I tympanoplasty.

Outcome of Type 1 Tympanoplasty in Paediatric Patients

Background: Type 1 Tympanoplasty is a widely performed procedure for inactive mucosal COM. Considerable controversy remains in choice of type-1 tympanoplasty in the paediatric patients. Objectives: To assess the outcomes of type-1 tympanoplasty in paediatric patients. Methods: This study was conducted in the Department of Otolaryngology-Head &amp; Neck Surgery, BSMMU, Dhaka, from July 2018 to December 2019, with 44 paediatric patients having an inactive mucosal variety of chronic otitis media. Patients were divided into 10-14 and 15-18 years age group. All patients underwent type-1 tympanoplasty under operating microscope and temporalis fascia used as a graft material. Minimum hearing improvement of 10 dB was regarded as an audiological success and an intact graft at the end of the third month was regarded as graft success. The statistical significance was set to p&lt; 0.05. Results: The graft success rate was 90.9% and audiological improvement was 81.8% in paediatric tympanoplasty. Success rate was higher in 15-18 years age group than 10-14 years of age group which was statistically insignificant. Irrespective of the site, size, duration of discharge showed an insignificant association with outcomes of pediatric type-1 tympanoplasty. Conclusion: Type-1 tympanoplasty showed promising result in paediatric patients. The age of the patients did not significantly affect the postoperative outcome. Bangladesh J Otorhinolaryngol 2022; 28(1): 43-49

Outcome of Limited Attic Cholesteatoma Surgery: Endoscopic vs Microscopic

Background: Endoscope and microscope are exclusively used in different middle ear pathologies as well as patients with attic cholesteatoma. However, straightforward information regarding surgical advances, postoperative results, and information about in which patients and how this surgical technique should be exclusively used is debatable.&#x0D; Aim: To compare the outcome of primary exclusive endoscopic ear surgery with those of the microscopic ear surgery in two groups of patients with cholesteatoma limited to the attic region.&#x0D; Methods: This prospective observational study was conducted in the Department of Otolaryngology-Head and Neck Surgery, BSMMU, Dhaka, from July 2018 to December 2019, with 26 patients having cholesteatoma limited to the attic region. Patients were divided into two groups. One group of patients were submitted to atticotomy with tympanoplasty via microscopic ear surgery (MES) and a second group to exclusive trans-canal endoscopic ear surgery (EES). All the patients were followed up post-operatively up to 3 months with PTA.&#x0D; Results: Mean bone conduction threshold, air conduction threshold, and ABG has been reduced considerably in both groups (endoscopic and microscopic) at the end of three months postoperatively.There was no significant statistical difference between the two groups in terms of graft uptake success rate and the audiological success rate (p-value &gt;0.05).Postoperatively, pain requiring analgesics wassignificantly lower (p&lt;0.033) in theendoscopic group (23.1%) than in the microscopic group (69.2%).&#x0D; Conclusion: Audiological outcome and graft uptake success rates achieved by the endoscopic ear surgery were similar to the results obtained by the microscopic ear surgery in limited attic cholesteatoma.&#x0D; Bangladesh J Otorhinolaryngol 2022; 28(1): 103-111

Current outcomes of myringoplasty in a European referral children's hospital

ObjectivesMyringoplasty is a frequently performed procedure in children, with a heterogeneous failure rate. Our study aimed to evaluate the outcome of myringoplasty in a pediatric hospital and to identify which are risk factors for reperforation or poor hearing improvement after surgery. MethodsPreoperative and intraoperative variables between pediatric patients who had undergone myringoplasty with an intact tympanic membrane at follow-up and the cases with reperforation were compared. The same factors were investigated as potential predictors of audiological success. Pre and postoperative PTA and ABG were compared in the whole population, in structural success and failure groups and closure of ABG was calculated and used to compare the audiological outcomes between the two groups. ResultsParameters that affected the postoperative integrity of TM were age, the time between diagnosis and surgery, the intraoperative status of the middle ear, and secondhand smoke exposure. Early perforations occurred mostly after surgeries performed by trainees, while late perforations were more frequently in autumn. Myringoplasty, regardless of the structural outcome, can improve the ABG and PTA. No preoperative and intraoperative parameters affected the audiological outcome. ConclusionPediatric myringoplasty is a safe and successful procedure that can improve hearing, regardless of the structural outcome. In light of our results, parameters to consider before surgery are age, the time between diagnosis and surgery, the intraoperative status of the middle ear, and secondhand smoke exposure.

Comparison of Surgical Outcome between Endoscopic and Microscopic Type 1 Tympanoplasty

Background: Chronic otitis media (COM) is the long-standing infection of a part or whole of middle ear cleft characterized by ear discharge &amp; perforation. The most common presenting symptoms are ear discharge, mild to severe hearing loss, sometimes tinnitus even vertigo. Treatment of COM is mainly operative. The treatment of inactive mucosal variety of COM is Type 1 tympanoplasty. It can be done by microscopic or endoscopic technique. Both methods have some merits and demerits.&#x0D; Objectives: Aim of the study was to compare the surgical outcomes between endoscopic and microscopic type 1 tympanoplasty.&#x0D; Methods: This study was carried out in the Department of Otolaryngology–Head &amp; Neck surgery of Bangabandhu Sheikh Mujib Medical University, Dhaka from March 2017 to June 2019 and 60 (30 in each group) patient were included in the study. All patients underwent type 1 tympanoplasty. In Group A endoscopic tympanoplasty cases and in Group B microscopic tympanoplasty cases were placed. Operation duration, post-operative pain, postoperative hearing status, graft uptake was compared in two groups.&#x0D; Results: There were no significant difference of graft uptake and hearing gain (&gt;0.05). But endoscopic operative time and post-operative pain were less than microscopic group (&lt;0.05).&#x0D; Conclusion: Through endoscopic tympanoplasty is a newer approach and it has some limitations. As endoscopic tympanoplasty requires less time, less pain with similar graft uptake and audiological success. It can be adopted as an alternative method of tympanoplasty.&#x0D; Bangladesh J Otorhinolaryngol; October 2020; 26(2): 109-115

Inlay triple-"C" tympanoplasty: a comparative study for its use in large, marginal perforations.

To compare the efficacy of the inlay, composite chondroperichondrial clip (triple-C) tympanoplasty with conventional underlay cartilage island tympanoplasty, and to evaluate its efficacy in treating large, marginal perforations. The study involved 183 patients that were selected from a retrospective chart review of tympanoplasties performed at our center from March 2016 to June 2018. A tertiary referral center hospital. 65 patients underwent inlay, triple-C cartilage tympanoplasty (inlay group) and 118 underwent underlay cartilage island tympanoplasty (underlay group). Postoperative anatomical success rate, surgical time, hearing outcomes, and complications were analyzed. Focused analysis was performed on large or marginal perforations. Both groups exhibited similar characteristics in demographic distribution, general health status, preoperative anatomical and hearing disabilities. Excellent results were achieved in both groups. Re-perforation occurred for 9.2% of the inlay group and 7.6% of the underlay group (p = 0.71). Hearing improvement was significant in both groups. Within the separate groups, 36% of underlay patients and 60% of inlay patients improved to achieve closure of the air-bone gap (ABG) to less than 10dB (p = 0.1). In large or marginal perforations, both groups performed similarly. No significant complications were seen in this cohort. Nevertheless, a significant reduction in surgical time was observed in the inlay group (38min. vs 58min.; p = 0.0004). Inlay triple-C tympanoplasty is comparable to conventional underlay cartilage island tympanoplasty in both anatomical and audiological success rates, even for large, marginal perforations. Due to its shorter operation time, inlay triple-C tympanoplasty should be considered a good surgical option for all tympanic membrane perforations.

Hyperacusis and stapes surgery: An observation in fifty patients after stapedotomy

ObjectiveTo assess hyperacusis after stapedotomy and its possible influencing factors. Study designProspective, interventional, and longitudinal study. SettingA tertiary referral center. PatientsFifty consecutive patients (35 females, mean age = 46.8 years). InterventionAll patients underwent stapedotomy. The validated Portuguese version of the “Hyperacusis Questionnaire” (HQ) was administered before and two weeks and one month after surgery. ResultsNo hyperacusis was reported by any patient before surgery. At two weeks after surgery, all patients experienced hyperacusis, with a mean HQ at 16.88 ± 6.54 (range 4–25). One month after surgery, hyperacusis had already resolved in most patients. Gender, preoperative presentation or surgeon had no influence on HQ scores (p > 0.05). Patients with previous contralateral stapedotomy showed lower HQ scores (p = 0.001). Audiological parameters improvement measured at one month after surgery (PTA, SRT and contralateral SRT) were associated with HQ higher scores. ConclusionThis study confirms that hyperacusis is a common complaint after stapedotomy that usually resolves in one month after surgery. The HQ highest scores were registered among patients with the highest audiological gain after surgery. This suggests that hyperacusis may be a positive prognostic factor for audiological success after stapedotomy.

Translation and Validation of Chronic Otitis Media Benefit Inventory (COMBI) in Turkish Language.

The aim of this study was to translate the Chronic Otitis Media Benefit Inventory (COMBI) into Turkish and evaluate the questionnaire's reliability in assessing benefit outcomes in patients after ear surgery. A total of 30 patients with chronic otitis media who underwent ear surgery were asked to fill out the translated Turkish version of the COMBI questionnaire six months after their surgery twice, 10 days apart. The patients were divided into two groups in two different ways based on surgical and audiological outcomes. These were surgical success (SS), surgical failure (SF), audiological success (AS), audiological failure (AF) groups. Student's -t test was performed to show the differences in the COMBI scores of the groups. Cronbach's alpha value was calculated to test internal consistency, Pearson's correlation coefficient was measured to demonstrate test-retest reliability and factor analysis was run. The average score of the SS group was 51.08 and significantly higher than the score of the SF group (42.40) (p=0.012). There was, however, no statistically significant difference between the average scores of the AS and the AF groups (p=0.330). A Cronbach's alpha value of 0.862 was found. Pearson's r value was calculated 0.810. Factor analysis showed that a three-factor solution explained the 70.2% of the variance. The Turkish version of the COMBI is a valid test with high test-retest reliability. It should be used with objective assessment tools for better understanding how patients benefit from the surgery.

Comparison of clinical outcomes between butterfly inlay cartilage tympanoplasty and conventional underlay cartilage tympanoplasty

ObjectiveTo assess the efficacy of butterfly inlay cartilage tympanoplasty and compare it with conventional underlay cartilage tympanoplasty in terms of success rate and hearing outcomes. Materials and methodsThe study included 35 patients (36 ears) who underwent butterfly inlay cartilage tympanoplasty (inlay group, 23 ears of 22 patients) or conventional underlay cartilage tympanoplasty (underlay group, 13 ears). The anatomical success rate and hearing outcomes were analysed. ResultsRe-perforation occurred in 2 cases (8.7%) in the inlay group and 3 (23.1%) in the underlay group. One patient in the inlay group developed a serious infection, and one in the underlay group developed massive granulation of the tympanic membrane. In the inlay group, the air-bone gap (ABG) decreased from 19.9 (±12.6) dB HL preoperatively to 13.8 (±11.3) dB HL postoperatively (p=0.047), in the underlay group, it decreased from 23.5 (±15.8) dB HL to 18.3 (±20.6) dB HL. Regarding improvement in ABG, the difference between the group was not statistically significant (p=0.968). ConclusionButterfly inlay cartilage tympanoplasty is comparable with conventional underlay cartilage tympanoplasty in both anatomic and audiological success rates. Owing to its simplicity, shorter operation time, and rapid patient recovery, butterfly inlay cartilage tympanoplasty could be considered a favourable surgical option.

Role of tympanometric volume in paediatric tympanoplasty

ObjectiveTo determine the prognostic significance of “Tympaometric Volume” for paediatric tympanoplasty type I in a select age-group of 5–8 years. MethodsA prospective study was conducted in 30 children with chronic suppurative otitis media-inactive mucosal disease of either sex. Pre-operative tympanometric volume was recorded in all the cases and statistically analysed with the graft uptake results post-operatively. All the patients underwent tympanoplasty type I by underlay technique using temporalis fascia graft. An intact graft at the end of 6 months, and a postoperative hearing improvement of 10dB or greater in two consecutive frequencies, was regarded as surgical and audiological success, respectively. The statistical analysis was done using Mantel Haenszel χ2 i.e. Chi square test, and Fisher exact p value test for confirmation. ResultsWe recorded an impressive surgical success rate of 87% and an audiological improvement of 70% in this study. On the basis of mean tympanometric volume of 1.6cm3 the patients were divided into two groups: in Group A (tympanometric volume<1.6cm3), and group B (tympanometric volume>1.6cm3). A graft uptake of 95% and 77% was recorded in Group A & B, respectively. However, the statistical evaluation of the data revealed no significant effect of this factor. ConclusionsIn this study no correlation between the tympanometric volume and the surgical success of paediatric tympanoplasty in select age group of 5–8 years was observed.

Long-term follow up of sudden sensorineural hearing loss patients treated with intratympanic steroids: audiological and quality of life evaluation.

To evaluate the long-term stability of intratympanic steroids and investigate the 'real' impact of sudden sensorineural hearing loss on patients. A total of 14 patients treated with intratympanic steroids were evaluated by audiometric and vestibular examinations. The modified Glasgow Benefit Inventory was used to evaluate quality of life changes after intratympanic steroid treatment. There was no significant difference between pure tone average post-intratympanic steroids and at follow up. The general Glasgow Benefit Inventory score was not significantly associated with the presence of tinnitus or dizziness, or with patient age. The change in pure tone average after intratympanic steroid treatment did not correlate with social or physical scores, but correlated strongly with the general Glasgow Benefit Inventory score (p=0.0023). Intratympanic steroid administration led to a stable improvement in hearing. Quality of life assessment showed that patients can feel satisfaction regardless of the hearing outcome. Patients who regained a social hearing level expressed greater satisfaction than patients without serviceable hearing. Overall, quality of life improvement was not related to hearing improvement. Sudden sensorineural hearing loss is devastating. Considering the audiological effects alone ignores the 'human' perspective. Audiological success can correlate with poor quality of life outcome.

Evaluation of efficacy of otosclerosis surgery on hearing outcomes

In this study we aimed to evaluate the audiologic results and audiologic success rates following otosclerosis surgery and to discuss surgical complications and their management. We retrospectively analyzed 115 ears of 100 patients who were diagnosed with clinical otosclerosis and operated at Kocaeli University, Faculty of Medicine, Department of Otolaryngology between May 2002 and April 2013. Postoperative air-bone gap was used in the evaluation of the success of the hearing results. The postoperative air-bone gap less than 20 dB was accepted as a success criterion. Intraoperative and postoperative complications were recorded. Functional success was achieved in 105 of 115 operated ears (91.3%). Functional success rates according to types of piston for 0.6 mm wire Teflon piston (n=71), fluoroplastic Teflon piston (n=30), K piston (n=12) and Easy piston (n=2) groups were, 88.7%, 93.3%, 100%, and 100% respectively. Six patients (5.2%) underwent revision surgery. Our study results suggest that stapes surgery is a successful and safe treatment modality with high success and low complication rates in the management of otosclerosis.

Evaluation of simultaneous bilateral same day tympanoplasty type I in chronic suppurative otitis media

To evaluate the concept of bilateral same day tympanoplasty type I (BSDT) in accordance with the principle of evidence based medicine. A study with control was carried out in a tertiary care setting in a sample size of 60 patients suffering from chronic suppurative otitis media (CSOM). The patients were divided into two groups of 30 patients each, group-A comprised of unilateral CSOM cases and group-B comprised of bilateral CSOM cases. All the patients underwent tympanoplasty type I by post auricular inlay technique using temporalis fascia graft. BSDT was done in group-B. Graft and audiological success rates were tabulated and put to statistical examination using Student's 't' test. In addition, post-operative pain was measured by visual analogue scale and statistically analyzed. A graft uptake of 90% and 93% was recorded in group-A and B, respectively. 27 (90%) patients reported an air-bone gap of less than 20 dB post-operatively in group-A and 94% (56 of the operated 60 ears) had an air bone gap less than 20 dB post-operatively in group-B. No case of iatrogenic sensorinueral hearing loss was recorded in this study. Further, pain was not found to be a statistically significant factor detrimental to BSDT. Bilateral same day tympanoplasty type I is a feasible treatment option in modern otology for a specific group of patients suffering from CSOM.

Myringoplasty in children with cleft palate and craniofacial anomaly

Objectives Analyze the anatomical and audiological success rates of myringoplasty in children with craniofacial anomaly, cleft palate and compare them to a control group. Methods Retrospective review of medical records for all children who underwent myringoplasty between 1997 and 2007. The following data was recorded: sex, age, perforation side, size, location and etiology, surgical approach, type of myringoplasty, graft material, season of surgery, preoperative status of the operated and contralateral ear, history of previous otologic surgery, and adenoidectomy or tonsillectomy. Results Myringoplasty outcomes of 22 craniofacial anomaly patients (15/22 were cleft palate patients) were compared to 144 controls. Children in the craniofacial anomaly group demonstrated a tendency towards surgery at an older age. Children in the craniofacial anomaly and cleft palate groups had a significant positive history of previous otologic procedures to both operated and contralateral ears. Peroperative subannular ventilation T-tubes were more frequently recorded in patients with craniofacial anomaly than patients in the control group. The craniofacial anomaly, cleft palate and control group had comparable mean preoperative and postoperative ABG and their ABG improvement was statistically significant. Children with craniofacial anomaly, cleft palate and control group shared similar anatomical and audiological success rates (ABG < 20 dB) at 6, 12 and 24 months. Conclusions Although children in the craniofacial anomaly and cleft palate groups are predisposed to middle ear disease, their disease responds well to surgical intervention. Their audiological and anatomical success rates were equivalent to the ones observed in the control group. In light of our results, we recommend that myringoplasty in children with craniofacial anomaly and cleft palate be performed after the age of 12.

Pediatric myringoplasty: A study of factors affecting outcome

Objectives To analyze the success rates of myringoplasty in children, to assess prognostic factors and to evaluate their interactions in the evolution of myringoplasty. Methods Charts of patients who had undergone a myringoplasty between 1997 and 2007 were reviewed for: patient age, sex, perforation side, etiology, size, type and location of perforation, season of surgery, type of myringoplasty, surgical technique, graft material, preoperative status of the operated and contralateral ear, history of otologic surgery to the operated and/or contralateral ear, number of prior surgeries to the operated and contralateral ear, time elapsed between the last otologic procedure and this myringoplasty, history of adenoidectomy or tonsillectomy, time elapsed between the adenoidectomy or tonsillectomy and this myringoplasty. Anatomical success was defined as postoperative intact tympanic membrane(TM). Audiological success was defined as air bone gap less than 20 dB and a postoperative difference of no more than 10 dB in the mean bone conduction (BC) threshold. Results A total of 201 cases of myringoplasty were operated between 1997 and 2007. Anatomical success rates were 94.9%, 84.9% and 70.1% at 6, 12 and 24 months, respectively. The type of previous otologic surgery in the operated ear was found statistically significant for anatomical success. Audiological success rates were attained in 97.4%, 93.4% and 84.9% of patients at 6, 12 and 24 months, respectively. A mean reduction of 9.1 dB of the air bone gap was achieved postoperatively. No sensorineural hearing loss occurred. Children 12 years and older presented with statistically poorer preoperative BC at frequencies ≥2000 Hz when compared to their younger counterparts. These results suggest that the chronicisation of the TM perforation can result in long-term irreversible damage to the inner ear. Conclusion The type of previous otologic surgery in the operated ear was found to have an impact on anatomical success. The outcome for myringoplasty was more favourable when the etiology of the previous surgery was a benign one. We advocate early myringoplasty, preferably above the age of 6. Delaying surgery can cause permanent damage to the inner ear. All other factors evaluated were not found to be statistically significant for anatomical or audiological success.

Surgical and hearing results of the circumferential subannular grafting technique in tympanoplasty: a randomized clinical study

Purpose Circumferential elevation of the anullus away from its bony seat and extension of the graft onto the anterior bony canal increase the bed of the graft anteriorly but may be associated with anterior blunting, and so, a significant conductive hearing loss may result. The purpose of this study was to compare the surgical and audiologic success rates of circumferential subannular grafting with the conventional underlay tympanoplasty. Materials and Methods A randomized clinical study was conducted from September 2007 to December 2010 at a tertiary referral center. Thirty-eight patients underwent circumferential subannular grafting (group A), and 25 patients underwent conventional underlay tympanoplasty with extension of the anterior edge of the graft forward against the lateral wall of the Eustachian tube, and therefore, the anterior sharp tympanomeatal angle remained unbroken (group B). All patients underwent preoperative and postoperative audiogram. Blunting and lateralization of the graft were evaluated 6 months after the surgery. Results The surgical success rate was 97% in group A and 100% in group B patients. Improvement of the air conduction thresholds in all frequencies and closure of the mean air-bone gap were significant and similar among the 2 groups. There were no cases of significant blunting and tympanic membrane lateralization in the 2 groups. Conclusion This study showed underlay tympanoplasty with elevation of the annulus away from the sulcus tympanicus in the anterior sharp tympanomeatal angle and placement of the graft between it and anterior bony canal is not associated with increased risk of blunting and lateralization of the graft, if that sharp angle is adequately restored.

Role of Transtympanic Myringoplasty in Modern Otology

In this era of bottom-line medicine, transtympanic myringoplasty, although in accordance with the principles of minimally invasive (or access) surgery, is still not popular among otologists. This study evaluates the success rate of transtympanic myringoplasty and defines its role in the current era. A prospective study. Dr. Ram Manohar Lohia Hospital, New Delhi, a tertiary care teaching hospital. The technique was carried out in 25 adult patients with chronic suppurative otitis media-mucosal disease under local anesthesia on the basis of day surgery. An intact graft at the end of the third month was considered a success. A 10 dB hearing improvement in two consecutive frequencies in the range of 500, 1000, 2000, and 3000 Hz was regarded as an audiologic success. Furthermore, the patient's perforations were divided into anterior, inferior, and posterior and the success rate was evaluated in each subgroup. Perforations were also classified into small and medium on the basis of surface area and evaluated statistically on the basis of the Fisher exact test. An overall success rate of 84% and 71.5% was recorded in terms of perforation closure and hearing improvement. Statistically, the surface area of the perforation did not influence the outcome of the result, but anteriorly placed perforations showed a poor graft uptake. From the results herein, we find the technique to be convenient, highly cost-effective, time saving, and patient friendly, with closure rates comparable to other standard techniques of myringoplasty

Tympanoplasty type I in children—an evaluative study

A considerable controversy surrounds the subject of paediatric tympanoplasty type I. Conflicting views regarding timing of surgery and various other factors like Eustachian tube, status of contralateral ear, site and type of perforation etc. are presented by various published case series in medical literature. However, very few prospective studies address the issue. Thus, a prospective study was planned to evaluate the success rate of paediatric tympanoplasty type I and analyse the factors suggested to influence the outcome of the said surgery. A cohort study with control was carried out in 40 patients of chronic suppurative otitis media-mucosal disease in a tertiary care teaching hospital. Patients were divided into two groups of 20 cases each, one comprising of paediatric patients (8-14 years) and other comprising of adult patients (more than 14 years of age). All the patients underwent tympanoplasty type I by post auricular inlay technique. An intact graft at the end of 6th month was considered a success and a minimum hearing improvement of 10 db in two consecutive frequencies was regarded as an audiological success. Results were tabulated and statistically analysed using chi2-test (with Yates correction). A success rate of 80% in terms of graft uptake and hearing improvement of 61% was seen in paediatric cases, compared to 85% graft uptake and 65% hearing improvement in adult cases. Statistically, on applying chi2-test, the value of P is >0.05 which is insignificant was obtained, indicating that age does not influence paediatric tympanoplasty type I. Also, the data for evaluating the correlation between Eustachian tube and paediatric tympanoplasty type I showed no statistical significance. In addition, no association between site and type of perforation and paediatric tympanoplasty type I was observed when results were compared to adult patients. However, anteriorly placed perforations were found to give poor results in both adult and paediatric group. The results of this cohort study mitigates against delaying tympanoplasty type I in paediatric population. This study also elucidates that Eustachian tube, contralateral ear pathology, site and type of perforation do not influence the outcome of the said surgery. However, anteriorly placed perforations require vigilance while repair in view of high failure rate. We recommend the age of 8 years for the paediatric tympanoplasty type I, but in view of redundancy of eustachian tube factor, the criteria for delineating minimum age for success of the said surgery is open to debate. More prospective studies are required in this direction.