Central Perforation Research Articles

Outcome of Interlay Type 1 Tympanoplasty for Large Central Perforation

Background: Perforation of the tympanic membrane may occur from various reasons. Most of these perforations heal spontaneously, whereas the remaining long-standing perforations that lead to recurrent ear discharge need tympanoplasty. Interlay Type 1 Tympanoplasty,a newer technique has shown promising results with higher success ratein terms of hearing gain and graft uptake.
 Objective: To analyze the results of interlay Type 1 Tympanoplasty in terms of graft uptake and hearing improvement in cases of inactive mucosal chronic otitis media (COM) with large central perforation.
 Methods: This is a prospective study of 24 months (January 2018 to December 2019) duration conducted in department of E.N.T, Khulna medical college, Khulna and data was collected from the 60 patients admitted for tympanoplasty. Results were calculated in terms of graft accepted or rejected and decrease in air bone gap.
 Result: The graft uptake rate in the present study was found to be 91.67% and the patients reported an improvement in terms of hearing. Pre operatively mean air bone gap was 26.5dBand post operatively after 12 weeks mean air bone gap improved to 17.58dB.
 Conclusion: Interlay Type 1 Tympanoplasty is an effective technique over conventional methods in terms of both graft uptake as well as hearing improvement in large central perforation.
 Bangladesh J Otorhinolaryngol; April 2021; 27(1): 86-91

Treatment of tympanic membrane perforation with topical epidermal growth factor: progress towards clinical application

<p class="abstract"><strong>Background:</strong> Chronic otitis media is a widespread disease of developing countries, especially of the lower socio-economic group. Medical cost in hospitals associated with tympanoplasty for treating CSOM is very high. Our study investigates the efficacy of epidermal growth factor along with chemical cautery in healing of chronic tympanic membrane perforation on an outpatient department (OPD) basis. Hence providing a cheaper and cost effective treatment alternative to the patients.</p><p class="abstract"><strong>Methods:</strong> A total number of 70 patients with signs of COM attending ENT OPD were selected. The patients were randomly assigned into 2 groups each with a sample size of 35. Otoendoscopy and pure tone audiometry was performed. Group A was treated with EGF with chemical cautery and group B was treated with only chemical cautery. Both groups were followed up after 15 days, one month and second month of the procedure in ENT outpatient clinic.</p><p class="abstract"><strong>Results:</strong> The success rate of these non-healing perforation was found to be significantly higher in group A (29 [82.86%]) compared with group B (17 [65.71%]) with P value of 0.0070*.</p><p class="abstract"><strong>Conclusions: </strong>This study shows a statistically significant result with topical application of epidermal growth factor in small to medium non-healing central tympanic membrane perforation. Due to the promising result of epidermal growth factor, it could be considered as office myringoplasty. </p>

A study to compare the outcomes of CO2 laser assisted myringoplasty versus conventional type1 tympanoplasty in small central tympanic perforations

<p class="abstract"><strong>Background:</strong> The standard treatment of tympanic membrane perforation is conventional surgical closure using myringoplasty or a tympanoplasty type 1. In this study the role of cabon dioxide (CO<sub>2</sub>)-laser-assisted de-epitheliazation of perforation margins and application of bioinert silastic sheet. Success rate was compared with conventional microscopic surgery.</p><p class="abstract"><strong>Methods:</strong> This was a comparative study containing 60 patients with small dry tympanic membrane perforation (diameter 1-3 mm). The causes of tympanic membrane perforations were mainly traumatic or the eardrum did not heal after spontaneous perforation caused by an acute otitis media or after surgery. The procedure was performed under local anaesthesia. CO<sub>2</sub> (acupulse) applied along the edge of the perforation until complete de-epitheliazation and application of bioinert silastic sheet in small dry perforation. Closure of eardrum perforation was monitored using an otoendoscope. Success rate of the CO<sub>2</sub> laser myringoplasty was compared with conventional type 1 tympanoplasty. </p><p class="abstract"><strong>Results:</strong> Complete eardrum closure occurred in 24 cases (80%), 06 patients (20%) had a residual perforation. The success rate of this procedure is lower than conventional type 1 tympanoplasty, which is 90-94%. There were no complications during and after the treatment.</p><p class="abstract"><strong>Conclusions:</strong> A closure rate of 80% (24/30) was achieved with a CO<sub>2</sub>-laser-assisted de-epitheliazation. This procedure can be offered carefully to selected cases with perforation size <3 mm, where the CO<sub>2</sub> facility is available before they undergo formal conventional microscopic surgery.</p><p class="abstract"> </p>

Audiological profile of pre-operative and post-operative results in mucosal diseases of the ear: a comparative study

<p class="abstract"><strong>Background:</strong> The Objectives of the study were to study pre-operative audiological results in mucosal diseases of ear; to study post-operative audiological results in mucosal diseases of ear and to compare pre-operative and post-operative audiological results in mucosal diseases of ear.</p><p class="abstract"><strong>Methods:</strong> A prospective study was done on 60 patients presenting to out-patient department of Otorhinolaryngology and Head and Neck Surgery, S.Nijalingappa Medical College and H.S.K Hospital and Research Centre, Bagalkot from May 2018 to April 2020 with CSOM-mucosal disease. Audiological evaluation was done and compared using pure tone audiometry (Amplaid311TypeIEC645) before and after tympanoplasty with cortical mastoidectomy and mean air conduction (AC) threshold improvement and mean air-bone gap (AB gap) closure was analyzed. </p><p><strong>Results:</strong> Out of 60 patients, 27(45%) patients had medium sized central perforation. Mean pre-operative AC threshold was 44.5958±10.64639 dB HL which improved to 30.100±10.41056 dB HL at 1month and 21.8125±8.6928 dB HL at 3months post-operatively which was statistically significant with p<0.001*. Mean AB gap closure at 1-month was 10.175±6.01098 dB HL and at 3-months was 11.0416±6.3458 dB HL.</p><p><strong>Conclusions:</strong> AC threshold gain and AB gap closure at 1month and 3 months post-tympanoplasty with cortical mastoidectomy for CSOM-mucosal disease are significant. Hence surgery is main basic tool which results in improvement of audiological results in mucosal diseases of ear.</p>

Clinical and radiographic results of eccentric glenoid reaming in anatomical total shoulder arthroplasty using 3D planning and PSI

BackgroundTreatment of deformed type B glenoids with anatomical total shoulder arthroplasty (TSA) can be challenging when using standard imaging and instrumentation. 3D planning and PSI-guided (patient-specific instrumentation) eccentric reaming may substantially aid in both the glenoid correction and implantation of anatomical components in difficult cases. We hypothesized that the implementation of preoperative planning and a PSI-guided anatomical component protocol would result in accurate correction of the glenoid deformity and precise glenoid implant positioning. MethodsTwenty-two consecutive patients with primary glenohumeral osteoarthritis, intact rotator cuff and modified-Walch type B glenoids were treated with anatomical total shoulder arthroplasty. Preoperative 3D planning and PSI were used to guide eccentric reaming and correct glenoid deformity. Postoperative clinical and radiographic outcomes were assessed in all patients with a minimum follow-up of 2 years (mean of 26 months). Postoperative corrections of glenoid version and inclination were measured and the variation between preoperative planning and postoperative implant position was evaluated on CT 3D reconstructions. Similarly, both humeral subluxation in the axial scapular plane and glenoid joint line medialization were compared between preoperative and postoperative computed tomographic imaging. ResultsThe mean age was 57 years (range, 54-68). Significant improvements in pain and functional outcome measurements were seen in all 22 subjects. Mean native glenoid version and inclination were −15° ± 5° and 3° ± 5°, respectively. Postoperatively, version was corrected to −7° ± 6° and inclination to 1° ± 2°. Cortical central peg perforation was noted in 1 case and cement perforation in 3 cases. The mean deviation from the preoperative plan was 3° ± 3° for version and 2° ± 2° for inclination. Humeral head subluxation improved from 68% ± 6% to 37% ± 6% and re-centering on the glenoid implant was achieved in all cases. The mean executed medialization of the glenoid joint line was 6 ± 3 mm and proved accurate to within 1 ± 1 mm of the planned medialization. A strong linear correlation was found between the degree of correction of retroversion and the amount of medialization (R = 0.82; P< .001). Conclusion3D preoperative planning and PSI guided correction of deformed modified-type B glenoids resulted in accurate postoperative correction of the glenoid deformity, correct glenoid component implantation with low deviation from the planned position and excellent short-term functional and radiographic results. Level of Evidence: Level IV; Case Series; Treatment Study.

Lamellar corneal patch grafts in the management of corneal thinning and perforations without using extra corneas

ABSTRACT Objectives To report the tectonic role of circular and square-shaped lamellar grafts without using extra corneas. Materials and Methods We retrospectively reviewed 23 lamellar patch grafts performed over a six-year period for various tectonic indications in corneal thinning and perforations. The anterior stroma of corneal endothelium peeled for Descemet Membrane Endothelial Keratoplasty were used to prepare circular lamellar corneal grafts. After punch trepanation of donor corneas for penetrating keratoplasty, the remaining rim of the cornea was used to prepare square-shaped grafts. Results Circular lamellar grafts were used in 13 eyes that had paracentral or central corneal thinning or perforations. Square-shaped grafts were used in 10 eyes, nine of which had peripheral corneal thinning or perforations, and one, limbal. Anatomical success after tectonic grafts was achieved in 22 of 23 eyes (95.6%) at a mean follow-up of 9.83 ± 6.27 months. The mean of the best-corrected visual acuity improved from logMAR 2.29 ± 0.23 preoperatively to logMAR 1.35 ± 0.2 postoperatively, at the final follow-up. Conclusions The main disadvantage of patch grafts is the shortage in corneal supply due to insufficient cornea donation in developing countries like Turkey. By evaluating unused corneal rims, extra corneas will not be required.

Does Successful Myringoplasty Affect Eustachian Tube Function?

The online version contains supplementary material available at 10.1007/s12070-021-02534-8.

Impact of Site, Size and Duration of Tympanic Membrane Perforation on Hearing Loss and Postsurgical Outcome.

This paper aims to assess correlation of site, size and duration of tympanic membrane perforation with hearing loss using pure tone audiogram and surgical outcome in terms of above parameters. The present study was conducted on 100 patients in Department of ENT and HNS, SMGS Hospital, Government Medical College Jammu during a time period of November 2018 to October 2019. All the patients with age 15-60years who presented with tympanic membrane (pars tensa) perforation were included in the study. According to the size of perforation, mean pure tone threshold in group I was 20.87 ± 3.86dB, in group II was 26.45 ± 6.08dB and in group III was 32.6 ± 5.56dB. The difference in hearing threshold between all the three groups was significant statistically. In terms of site, group E had maximum hearing threshold (34.67 ± 4.20dB), followed by group B (32.71 ± 5.88dB). Group A had the lowest hearing threshold of 24.99 ± 6.21dB. The difference between hearing thresholds of group B perforations and group A perforations was statistically significant (p < 0.05). However, the difference between group E and group B was insignificant. This study has shown significant correlation between the size and the site of the perforation to the degree of hearing loss. The bigger the perforation, the greater the hearing loss. The central perforations were associated with more hearing loss than posterior perforations, thus refuting the hypothesis that site and size of a tympanic membrane perforation does not affect the degree of conductive hearing loss. This study did not show any correlation between duration of disease and degree of hearing loss. Surgical and audiometric results obtained in this study can be accepted as satisfactory and as expected by the literature.

Treatment of Traumatic Femoral Neck Fractures with an Intramedullary Nail in Osteoporotic Bones.

Sufficient anchoring of intramedullary osteosynthesis in the femoral head in a femoral neck fracture is a challenge with increasing age of the patients and decreasing bone quality. For older patients with inferior bone quality, it has not been investigated whether the application of an intramedullary force carrier, as a minimally invasive and rapid intervention, can provide a considerable benefit and reduce the postoperative complication and lethality rate. This retrospective study aimed to investigate the stability and functionality after the acute treatment of a femoral neck fracture in osteoporotic bone using an intramedullary force carrier even with higher grade fracture types. The retrospective analysis was based on a collective of 82 patients over 60years of age with a femoral neck fracture treated with a gliding nail in our centre between 1999 and 2006. The average time to follow-up was 69.05months (median 71.0; minimum 27.0-maximum 108.0). Female patients made up more than two-thirds of the patient collective at 63 of the 82 patients (76.83%). The average age of the patients was 77.76years (median 78.00; range 60.00-93.00).In 66 patients (80.49%), the implantation showed good results and no complications or further treatments. 24/82 patients of our collective had died in our re-evaluation. In no case, a pseudarthrosis or severe impaction with neck shortening occurred (loss of offset).11/82 patients had femoral head necrosis which led to total hip replacement in 8 cases, a hemiarthroplasty in 2 cases and in 1 case a remaining Girdlestone situation because of a deep infection. Another five patients also had to undergo a total hip replacement because of a central perforation of the blade in one case, breakout of the blade after another fall in another two cases and a lateral dislocation of the blade in two cases. The use of an intramedullary force carrier in the osteoporotic bone can mean distinct advantages for the selected patient as a minimally invasive and rapid surgical method compared to extensive surgery, even in the case of severe injuries. However, the advantages and disadvantages for the patient should be considered critically.

Role of Tissue Glue in Overlay Tympanoplasty vs Conventional Overlay Method

ABSTRACT Purpose The purpose of this research is to study the role of tissue glue (TISSEL) in overlay tympanoplasty when compared with the conventional overlay method. Study design A prospective randomized comparative study was carried out at the ENT department of Base Hospital, Delhi, in which 60 patients with dry central perforation underwent overlay tympanoplasty. Out of these, 30 underwent conventional overlay tympanoplasty (control) and in the rest of the 30, overlay tympanoplasty was done with the use of tissue glue (cases). Results Graft take-up rate in control is 90% and in cases 96.7% (p &gt; 0.05). Hearing improvement within 20 dB of A–B gap (at 03 months) in control is 86.70 and 96.70% in cases (p &gt; 0.05). Early hearing improvement (at 6 weeks) in cases was better when compared with the control (p &lt; 0.05). The complication rate in cases is 10% with residual perforation in 01 patient, while that in control is 16.66% with residual perforation in 03 patients (p &gt; 0.05). Conclusion Graft take-up rate in hearing improvement was found to be better in overlay tympanoplasty with the use of tissue glue when compared with the conventional method with no statistically significant difference. The only significant advantage with the TISSEL group was found to be an early hearing improvement at 6 weeks. Tissue glue (TISSEL) was found to be safe and effective. How to cite this article Pimparkar SV, Sethi A, Das A, et al. Role of Tissue Glue in Overlay Tympanoplasty vs Conventional Overlay Method. J Med Acad 2020;3(2):33–37.

An observational study of endoscopic versus microscopic type I tympanoplasty in tubotympanic chronic otitis media in a tertiary health care centre

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Chronic otitis media (COM) is a widespread disease in the developing countries. It is treated by tympanoplasty, traditionally performed with the microscope which limits the visual field in the deep recesses of the middle ear, especially in narrow external auditory canal. Using endoscope has minimised these difficulties by providing a wide field view with angled magnification, reducing the duration of surgery. The advantages and disadvantages of both techniques is evaluated in our study.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; In this observational study, 60 patients of tubotympanic COM between 12-60 years of age with small to medium sized central perforation and air-bone gap of less than 45 decibel were included. They were divided into two groups (group A and group B) of 30 patients each. Group A underwent microscopic type 1 tympanoplasty and group B underwent endoscopic type 1 tympanoplasty. The duration of the surgery, the post-operative improvement in hearing and the graft uptake was analysed after 3 months of surgery. The post-operative hospital stay duration was noted. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The post-operative hearing improvement and the graft uptake after 3 months of the surgery was statistically not significant between the two groups. But the mean duration of the operation and the post-operative hospital stay was significantly lower in the endoscopic group with a p value &amp;lt;0.05.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Endoscopes are better in otological procedures as it reduces the surgical duration, provides better visibility, lessens the post-operative hospital stay, reducing the economic burden of the patient.&lt;/p&gt;

Defining deformity thresholds for the use of augmented glenoids in arthritic shoulders with posterior glenoid bone loss

BackgroundDespite increasing utilization, little guidance is offered regarding appropriate indications for posterior augmented glenoid implants. The purpose of this study is to virtually assess the effect of implant selection on glenoid resurfacing and joint line restoration in osteoarthritic shoulders with posterior glenoid wear. MethodsThirty-three CT scans were randomly selected from a cohort of osteoarthritic shoulders with Walch B2 or B3 deformities. Imascap SAS (Wright Medical, Memphis, TN) was used to assess bony deformities and plan glenoid resurfacing. Implants simulated included: standard Pegged Cortiloc, and 15° and 25° half-wedge augments. Each component was planned for a version correction to neutral and 10° retroversion, inclination was maintained within 5° of neutral and the component was medialized until bony support reached 80%. Implantation failure was defined as: greater than 20% cancellous bone support, central peg perforation, or joint line medialization relative to the pathologic joint (accounting for polyethylene thickness). Excessive lateralization was defined as creation of a joint-line >4 mm lateral to the pathologic joint-line. ResultsThe mean retroversion deformity in this cohort was 23.7° (range: 13°-37°). When correcting to neutral, the corrective reaming alone failed in 72.7% (24/33) of cases compared to 15.2% (5/33) when correcting to 10° of implant retroversion. When correcting to neutral version failure was decreased with a 15° (27.3%; 9/33; P < .001) and 25° augment (15.2%; 5/33; P < .001). Receiver operating characteristic (ROC) analysis found that an augment is useful to resolve standard implant failure for retroversion deformities greater than 27° (area under the curve [AUC] = 0.91) and 22° (AUC = 0.77) for correcting version to neutral and 10° retroversion, respectively. When placing a 25° augment, there was high risk of overstuffing the joint for both correction to neutral (27.3%) and 10° retroversion (66.7%). Overstuffing was likely to occur when correcting deformities less than 19° (AUC = 0.96) to neutral with a 25° augment. Likewise, implanting 15° or 25° augmented glenoids in 10° of retroversion is likely to overstuff the joint for pathologic retroversion deformities smaller than 18° (AUC = 0.94) and 28° (AUC = 0.69), respectively. ConclusionThis study helps to clarify the severity of glenoid deformities more appropriately addressed with the use of a half-wedged augmented glenoid. Both the severity of glenoid deformity and the desired implant version affect appropriate indications for the use of augmented glenoids. The risk of excessive joint-line lateralization in shoulders with less severe deformities should not be ignored. These considerations, in addition to individual soft tissue tension should be considered when planning and performing glenoid resurfacing. Level of evidenceLevel III; Treatment Study

Mediastinitis Secondary to Peripherally Inserted Central Catheter Migration and Perforation after Minor Trauma: A Case Report.

IntroductionThe use of peripherally inserted central catheters (PICC) has been integral to the advancement of medical care in both in-patient and out-patient arenas.1 However, our knowledge of PICC line complications remains incomplete, particularly in regard to venous perforation and extraluminal migration. Utilization of displaced catheters harbors lethal complications and is an infrequently reported phenomenon, with traumatic etiologies only referenced as possible mechanisms; however, to date no formal cases have been reported.5,6Case ReportWe report a case of a fall associated with extraluminal PICC migration and perforation causing mediastinitis and severe sepsis after total parenteral nutrition (TPN) infusion in a 54-year-old woman. Our patient required a right-sided PICC for long-term home TPN due to severe malnutrition following gastric bypass surgery. During a routine home care visit our patient was found tachypneic, hypoxic, and short of breath. Computed topography imaging in the emergency department (ED) identified the injury, likely related to the recent fall. The patient experienced a complicated hospital course after removal of the PICC. Although rare, PICC line migrations and perforations cause serious complications that should be considered by emergency physicians evaluating patients with chronic indwelling vascular access.ConclusionGiven the efficacy and widespread use of PICC lines, we present this case as a rarely reported but life-threatening complication that requires particular attention. Emergency physicians should be aware of such PICC line complications when encountering patients with chronic indwelling vascular access.

A study to assess hearing improvement after fat graft myringoplasty

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Tympanic membrane perforations result mainly from infectious and traumatic etiologies. Postoperative outcomes of reconstructive surgeries of hearing mechanism have routinely been assessed by take up rates and air bone gap closure on pure tone testing. The present study was conducted to assess hearing improvement after fat graft myringoplasty.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The present prospective study was conducted from 1&lt;sup&gt;st&lt;/sup&gt; January 2017 to 30&lt;sup&gt;th&lt;/sup&gt; June 2018. The study population consists of patients of age 18 to 60 years. The subjects with safe or tubotympanic type of chronic suppurative otitis media with small dry central perforation or perforation of the pars tensa less than 3 mm were included in the study. Pure tone audiometry (PTA) was consigned to an audiologist who was blind to the study. Air conduction threshold level was measured at frequencies 0.25 to 8 kHz and bone conduction threshold level was measured at frequencies 0.5 to 4 kHz; average air bone gap of each patient was calculated preoperatively and postoperatively at one and three months at the frequencies 500 Hz, 1000 Hz and 2000 Hz. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Among 30 patients, 15 (50.00%) had pre-operative bone conduction threshold in the range of 0-10 dB HL and rest 15 (50.00%) had between 11-20 dB HL. Majority of them i.e. 20 had post-operative air bone gap in the range of 0-10 dB HL whereas 02 had pre op air bone gap in this range, followed by 07 with air bone gap in the range of 11-20 dB HL as compared to 18 in the pre op and 03 in the range of 21-30 dB HL as compared to 10 in the pre op. Paired t test reveals results are significant.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Postoperative audiometry at the end of 1 month revealed majority i.e. 14 had air bone gap in range of 0-10 dB HL thus showing improvement in hearing. Postoperative audiometry at the end of 3 months revealed maximum number of patients i.e. 20 in the range of 0-10 dB HL which showed further improvement in hearing in the form of decrease in air bone gap.&lt;/p&gt;&lt;p class="Default"&gt; &lt;/p&gt;

English

BACKGROUND Active mucosal chronic otitis media (COM) is a disease of the middle ear cleft associated with inflammation and production of pus. The incidence is high in developing countries. It affects all age groups and both genders. If not properly treated, it can lead to complications. The bacterial isolates and their sensitivity pattern vary from place to place and also over time. Early identification of the microorganisms and their antibiotic sensitivity patterns helps in proper selection of antibiotics and quick recovery in COM patients. METHODS Fifty patients with active mucosal COM were selected for the study. The study was conducted over a period of one year. Ear swab from the deep external auditory canal was collected under strict aseptic precautions from these patients before starting antibiotic treatment. Microorganisms were identified by gram staining, growth on different agar plates, and various biochemical tests. Antibiotic sensitivity was done by the Kirby-Bauer method. RESULTS Majority of the patients were in the age group of 21 - 40 years (42 %) with female preponderance (62 %). All patients had a central perforation in the tympanic membrane (100 %). Bacterial growth was seen in 44 samples (88 %). Two samples (4 %) showed fungal growth. Four samples (8 %) showed no growth even after 48 hours of incubation. Single bacterium was isolated in 41 cases (82 %) whereas 3 samples (6 %) showed more than one bacterial growth. The predominant bacteria were Pseudomonas aeruginosa (50 %) followed by Staphylococcus aureus. The other isolates were coagulase negative staphylococci, enterococci, enterobacter, acinetobacter, and E coli. Pseudomonas showed maximum sensitivity to amikacin, imipenem and piperacillin / tazobactam (100 %). The most effective antibiotics for staphylococcus was vancomycin and linezolid. CONCLUSIONS The most common bacteria isolated in active mucosal COM were pseudomonas followed by Staphylococcus aureus. The most effective antibiotics for pseudomonas was amikacin, imipenem and piperacillin / tazobactam. Staphylococcus showed maximum sensitivity to vancomycin and linezolid. KEYWORDS Chronic Otitis Media (COM), Active Mucosal, Ear Swab, Bacteriology, Sensitivity

Effect of pulpal floor perforation repair on biomechanical response of mandibular molar: A finite element analysis.

Background:Evaluation of the biomechanical response of tooth with perforation repair is important to attain predictable prognosis. It may remain altered even after perforation repair due to the loss of tooth structure.Aim:The aim of this study is to assess and compare the effect of pulpal floor perforation repair of different sites with biodentine, on the biomechanical response of mandibular molar through 3-dimensional (3D) finite element analysis (FEA).Materials and Methods:Five different 3D models were constructed based on the site of perforation on the pulpal floor using cone-beam computed tomographic images of an extracted mandibular molar. Perforation size was standardized and simulated to be repaired with calcium silicate-based cement. A force of 200 N was applied simulating normal occlusal loads. Static linear FEA was performed using the Ansys FEA software. Tensile stresses were evaluated (Pmax).Statistical Analysis Used:The data were evaluated using the independent t-test (P = 0.05).Results:All the simulated models with perforation repair exhibited higher stress values than their equivalent sites in the control group. The Pmax values of the repaired models were highest in central furcal perforation, followed by buccal furcal perforation. However, there was no statistically significant difference in the stress accumulation among the different repaired perforation sites.Conclusion:The site of the pulpal floor perforation affected the stress distribution and accumulation. Central and buccal furcal perforation repairs on the pulpal floor with calcium silicate-based cement in mandibular molar are likely to have an increased risk of fracture.

Study of role of autologous versus homologous cartilage ossicular reconstruction

Background: Chronic otitis media with ossicular discontinuity is most commonly faced otological condition which causes conductive hearing loss. It presents mostly with ear discharge and decreased hearing. The use of cartilage graft material in ossiculoplasty markedly improve the result in hearing. In this study we have used autologous (tragal/conchal) cartilage or homologous (septal) cartilage for ossiculoplasty and temporalis fascia graft for tympanoplasty.Aims: Aim of the study was to compare and analyze the outcome of ossiculoplasty using autologous conchal/tragal cartilage and homologous septal cartilage in terms of hearing results and graft uptake rates. Materials and method: The study was conducted in E.N.T. Department at S.C.L. Hospital, NHLMMC Ahmedabad. 50 patients were randomly selected and divided in 2 groups. 25 patients underwent homologous and 25 patients underwent autologous cartilage reconstruction. All patients underwent detailed ENT examination followed by audiological and radiological assessment of temporal bone, and those patients with evidence of ossicular erosion were subjected to ossiculoplasty with autologous cartilage and homologous cartilage randomly. Results: Majority of the patients have central perforation and retraction pockets in middle ear pathology in both groups. Overall graft taken up rate was 96% in autologous while 92% in homologous ossiculoplasty. Our study shows hearing improvement up to 20-25 dB in 80% and 88% in autologous and homologous ossiculoplasty. Conclusion: Both autologous and homologous cartilage have excellent outcomes and gives equivalent results irrespective of age or sex of the patient or middle ear pathology. In both the groups hearing improvement is similar. Subjective hearing is also improved. No post-op complications like wound infection, facial palsy, dead ear have occurred in either case.

Pattern of pseudomonas aeruginosa infection among Northwestern Nigerians with chronic suppurative otitis media

Background: Pseudomonas aeruginosa has been particularly blamed for the deep-seated and progressive destruction of the middle ear and mastoid structure through its toxins and enzymes. Drug-resistant P. aeruginosa has been found to increase along with its frequency. Aim: This study aimed to assess the antibiotic sensitivity pattern of P. aeruginosa and the effectiveness of ciprofloxacin in chronically discharging ears. Patients and Methods: This was a retrospective review of 180 patients who were managed for chronic suppurative otitis media between January 2009 and December 2018. Results: Out of the 180 patients, majority 67 (37%) were in the age group 1–10 years, range of 1 month to 70 years with mean age of 18 years and standard deviation of ± 16.8 years and M: F of 1.5:1. Most have had ear discharge for more than 6 months and the majority 78 (43.4%) of the patients had bilateral disease. Central tympanic membrane perforation was the predominant finding, 81 (45.0%) with a complication rate of 21.1%. Abscess formation was the most common complication seen among the patients. P. aeruginosa was the most common bacterial isolate, 43 (23.9%) followed by Staphylococcus aureus, 39 (21.7%). In the pediatric population, P. aeruginosa was most sensitive to levofloxacin, as opposed to gentamicin in the adult population. Ciprofloxacin was seen to be more effective in adults than in children. Resistance to ciprofloxacin was seen more in the children than in adults. There was a significant association between gender and occurrence of the organism. Conclusion: P. aeruginosa is most sensitive to levofloxacin and gentamicin in the pediatric and adult population, respectively. Resistance to ciprofloxacin is most common among adults.

A study on fat plug myringoplasty for small tympanic membrane perforation

Introduction: Fat plug myringoplasty is an under-used technique to repair a small central tympanic membrane perforation. It is easy, quick and cost effective way with minimal morbidity. It can be done as an OPD procedure. The fat is readily available from ear lobe, abdomen and buttocks. Fat graft myringoplasty (FGM) is a noninvasive, but underused surgery for perforations of the tympanic membrane. It is also preferable for use in children. Fat tissue has been used as an autogenous material for different surgeries and is known to have a high capacity for resistance. Our study is conducted to evaluate the effectiveness of using fat plug in small central tympanic membrane perforation.Aim: To evaluate the effectiveness of using fat plug in small central tympanic membrane perforation.Materials and Methods: This study was conducted in the ENT department of Sree Mookambika Institute of Medical Sciences, Kulasekharam, Kanyakumari district in a time period from JUNE 2020 to November 2020.The sample size was taken as 30 patients who had presented with complaints of ear discharge, and hearing loss, surgical procedure was done where a fat graft was inserted through the perforation for those patients who fulfilled the inclusion criteria. The study was conducted after obtaining the clearance from Institutional Human Ethical Committee.Study Design: Prospective descriptive study.Results and analysis: 30 patients were included in the study. Age range, 20 to 80 years with a tympanic perforation (size, up to one-quarter of the pars tensa). Out of which 24 % had graft failure due to variety of causes. Success rate was 76% in our study, where as the study conducted by Ringenberg et al. The success rate was 86.5%. Posterior perforations had an overall closure rate of 63%, and in anterior perforations, the overall closure rate was 36%.Conclusion: In conclusion it is simple, safe, quick, economical procedure done under local anesthesia with as success rate as temporalis fascia and minimal or no morbidity and complications. The failure rate in our study was 24% due to infection, detached fat graft and dehiscence due to undersized grafts. Posterior perforations had an overall closure rate of 63%, and in anterior perforations, the overall closure rate was 36%. Pure tone audiometry was used to assess average AB gap pre and post operatively. Postoperatively there was an improvement in hearing compared to preoperative hearing.

Comparative study of Crescentic Cartilage and Anterior Tucking Tympanoplasty

Introduction: This study was undertaken to know the better technique of two methods i.e. cresentric cartilage tympanoplasty (CCT) and anterior tucking tympanoplasty (ATT) operated by single handed endoscopically. Material and Methods: This study was conducted on hundred patients at Shyam Shah Medical College, Rewa, MP. Hundred patients were selected using certain criteria and fifty patients each were operated by cresentric cartilage supported tympanoplasty(CCT) and anterior tucking technique(ATT). Audiometrically results were analysed preoperatively and postoperatively. Results: Maximum patients affected were teens and males. Maximum patients had large central perforation followed by subtotal and then total perforations in both the groups of cresentric cartilage tympanoplasty (CCT) and anterior tucking tympanoplasty (ATT). We operated under local anaesthesia and some under general anaesthesia in both the groups. Discussion: Hearing being special sense organ needs restoration for normal development and personality grooming. Newer method with evolution of medical sciences have devised techniques of reconstruction of hearing mechanism to give better results. Comparative study using cresentric cartilage tympanoplasty (CCT) and anterior tucking tympanoplasty (ATT) was done to know the better outcome and method. Conclusion: Cresentric cartilage tympanoplasty (CCT) is better of the two methods as it doesn’t shrink or change the shape.