Air-bone Gap Closure Research Articles

Endoscopic Fascia-Cartilage Composite Grafting in Chronic Suppurative Otitis Media

Objective: To evaluate perforation of an air-bone gap closure success using fascia-cartilage composite graft in endoscopic Trans canal tympanoplasty.
 Study Design: Randomized Control Trial (Clinical Trials.gov Identifier: NCT04945811)
 Place and Duration of Study: ENT Department Combined Military Hospital, Quetta Pakistan, from Apr 2020 to May 2021
 Methodology: One hundred and thirty-three cases of chronic Suppurative otitis media fulfilling the selection criteria were operated upon, and an endoscopic fascia-cartilage composite graft was used. A successful outcome in terms of perforation closure and air-bone gap closure was evaluated in all patients.
 Results: In the 138 patients operated, complete fascia-cartilage composite graft uptake was achieved in 129 (93.5%) patients. Nine (6.5%) patients had graft failure. The pre-operative mean air-bone gap was 36.49 ± 4.61 decibels, and the postoperative mean air-bone gap was 12.57 ± 5.09 decibels. This improvement was found to be significant, with the p-value < 0.001.
 Conclusion: Endoscopic per-meatal fascia-cartilage composite grafting has a high graft uptake and air-bone gap closure percentage in chronic Suppurative otitis media cases.

The Factors Affecting Surgical Outcome of Myringoplasty in Rural Patients Bangladesh

Background: Endaural, post-auricular, and permeatal/transcanal access to the tympanic membrane are the three acknowledged surgical techniques for myringoplasty. In general, the preferred method is determined by the location of the hole and the surgeon's experience. Objective: In this study our main goal is to evaluate the factors affecting surgical outcome of myringoplasty in rural patients Bangladesh. Method: This cross sectional study was done at tertiary medical hospital from Feb 2021 to Feb 2022. Where 100 patients were divided into several groups based on factors like size of perforation (small, medium and large), site of perforation (anterior central, posterior central and central malleolar), surgical approach (post auricular and transcanal). Results: During the study, where 60% cases were Central malleolar and 35% were Posterior central. 45% cases had medium size of perforation. According to improvement of hearing thresholds after myringoplasty in relation to the size of the perforation where The closure of air-bone gap in small, medium and large perforation was 11.15 dB, 20.61 dB and 18.55 dB respectively. The difference of air bone gap closure between small and larger perforation was statistically significant by unpaired t-test (p<0.001). In addition, according to improvement of hearing thresholds after myringoplasty in relation to the site of perforation and surgical approach where closer of air bone gap was maximum (20.90 dB) in central malleolar perforation and minimum (12.11 dB) in posterior central perforation. Which was statistically significant from unpaired t-test (p<0.001). In addition, closure of air bone gap was more in dry ear. The difference between two groups was statistically significant from unpaired t-test (p< 0.02). Conclusion: We concluded from this study that the location and extent of tympanic membrane perforation, as well as the state of the middle ear, influence surgical result following myringoplasty.

Outcomes of Endoscopic Myringoplasty

Introduction: The endoscope has diagnostic and therapeutic role in different otological surgeries. It has excellent view of images where there are difficult nooks and corners. The use of tragal cartilage in the repair of tympanic membrane perforation has its own benefit in graft uptake and hearing results whether long term or short term. The main purpose of the present study was to evaluate the long‑term hearing results in patients who underwent endoscopic sandwich myringoplasty with National Medical college & Teaching Hospital, Birgunj. Objective: To evaluate the graft success rate and postoperative hearing gain for central perforations using endoscopic myringoplasty Materials and Methods: This study is a prospective study in 60 patients with central perforations who underwent endoscopic myringoplasty using tragal cartilage. The hearing was assessed by comparing pre‑. with post‑operative air‑bone gap (ABG) and ABG closure in speech frequencies (0.5 kHz, 1 kHz, 2 kHz, and 4 KHz). Results: Of the 60 patients with central perforation included in this study, the graft success rate was 95% (57/60). The graft uptake in 6 months of follow‑up. The postoperative ABG (13.77 ± 4.94dB) was lesser than preoperative ABG (22.38 ± 6.93 dB) with statistically significant results. Conclusion: Endoscopic myringoplasty is a safe procedure with high‑graft uptake rate and good long‑term hearing results.

A study on tympanoplasty with or without canaloplasty

BackgroundChronic otitis media is a highly prevalent disease in developing as well as developed countries, causing hearing disabilities to the patients and causing huge problems to the patients in their daily routine lives. The patients are routinely advised for tympanoplasties in the specialized centers. Canaloplasties are routinely performed in such patients to get wide exposure while doing tympanoplasties. The present study seeks to determine the impact of canaloplasty on the outcome of the tympanoplasty.Material and methodsThe study was conducted in Department of Otorhinolaryngology at the Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, between 2018 and 2020, in which 70 patients were included. These patients were randomly divided into two groups. Group A patients underwent type I tympanoplasty with canaloplasty while group B patients underwent type I tympanoplasty alone. Patients in both the groups were followed up with pure tone audiometry and otoscopy at 6 weeks and 12 weeks postoperatively. Hearing was compared in both the groups in terms of air bone gap closure. Air bone gap closure at 12 weeks was considered final. Final analysis was done using SPSS version 21.0.ResultsThe patients were randomly divided into two groups. Group A patients underwent type 1 tympanoplasty with canaloplasty, and group B comprises of case l graft tympanoplasty alone. Graft uptake was better in group A with a success rate of 94.3% as compared to group B which had a success rate of 88.57%. Air bone gap closure was better in group A as compared to group B (15.76 dB ± 6.75 v/s 14.87 dB ± 5.99) at 12 weeks postoperatively.ConclusionTympanoplasty with canaloplasty showed advantageous outcome over tympanoplasty alone and thus should be considered with limited exposures. However, the final decision resides with the operating surgeon.

ENDOSCOPIC TRANSCANAL TRANSTYMPANIC POP THROUGH TECHNIQUE OF MYRINGOPLASTY USING TRAGAL PERICHONDRIUM GRAFT

INTRODUCTION A perforated tympanic membrane is most commonly repaired using temporalis fascia graft by microscope assisted post auricular approach and underlay technique, we present an alternative technique to repair the perforated tympanic membrane using an alternative easily accessible graft material like tragal perichondrium, by endoscope assisted trans canalicular approach, where the graft is placed medial to the tympanic membrane remnant by pop through technique. OBJECTIVE T h e u s a g e o f r i g i d 4 m m e n d o s c o p e f o r myringoplasty allows better visualization, magnification and reconstruction of perforated tympanic membrane using tragal perichondrium is minimally invasive. The purpose of the study is to put across our experience in 69 patients where endoscopic assisted myringoplasty was done using tragal perichondrium graft. The graft was placed medial to the tympanic membrane remnant by trans tympanic pop through technique and tympanomeatal flap was not raised. METHOD This study was done over a period of 3 years, 69 patients with chronic suppurative otitis media fitting into the inclusion criteria underwent endoscopic transcanal myringoplasty using tragal perichondrium as graft material by underlay pop t h r o u g h t e c h n i q u e . T h e p o s t o p e r a t i v e audiological improvement in closure of air bone gap on pure tone audiometry, success in tragal perichondrium graft uptake, and mean operative time was evaluated. RESULTS The study population was 69 with predominantly females, the post operative pure tone audiometry showed that 39.1% had closure of airbone gap of 10db, 17.4% showed air bone gap closure of 20bd and 43.5 % showed air bone closure of 15db. 85% had success of graft uptake (i.e. complete closure of perforation) at 6 weeks post op .The mean operative time was 80 minutes. CONCLUSION Endoscopic assisted trans-canalicular (pop t h r o u g h t e c h n i q u e ) o f s i m p l e u n d e r l a y myringoplasty using tragal perichondrial graft is simple, minimally invasive with good post operative improvement in hearing and can be d o n e a s a d a y c a r e p r o c e d u r e w i t h o u t complications. KEYWORDS Endoscopic myringoplasty, tragal perichondrium , pop in technique.

Endoscopic transcanal management of incus long process defects: rebridging with bone cement versus incus interposition

Objectivesto compare hearing outcomes between endoscopic transcanal rebridging with bone cement and endoscopic transcanal incus interposition in patients with incus long process defects secondary to chronic suppurative otitis media (inactive mucosal type).MethodsThis retrospective study was performed on 83 ears of 83 consecutive patients with incus long process defects secondary to chronic suppurative otitis media (inactive mucosal type). According to the extent of incus long process erosion and subsequent ossiculoplasty technique, patients were divided into 2 groups. Patients in group 1 had erosion involving up to two thirds of the length of the incus long process and underwent endoscopic transcanal rebridging with bone cement. Patients in group 2 had erosion involving more than two thirds of the length of the incus long process and underwent endoscopic transcanal incus interposition.ResultsHearing gain (mean ± standard deviation) was 21.39 ± 2.15 dB in group 1 and 19.71 ± 6.12 dB in group 2. A significantly greater hearing gain was achieved in bone cement group than in incus interposition group (P value < 0.001). Successful hearing outcome (post-operative air bone gap closure within 20 dB) was achieved in 81.6% and 71.1% of patients of group 1 and group 2 respectively.ConclusionEndoscopic transcanal rebridging with bone cement offers greater hearing gain than endoscopic transcanal incus interposition. The two techniques remain reliable and cost-effective techniques in management of patients with incus long process defects. The main limitation of this study was the short follow-up period. Further studies with relatively long-term follow-up are strongly recommended.

Functional Results and Learning Curve of Endoscopic Ossiculoplasty

Background and Objectives Endoscopes are recently being used to manage various middle ear surgeries including ossiculoplasty. Here, we investigated hearing results of endoscopic ossiculoplasty and surgeon’ learning curve in gaining endoscopic ossiculoplasty proficiency. We compared the results with those of microscopic ossiculoplasty.Subjects and Method We analyzed 48 patients of ossiculoplasties performed from 2010 to 2020. Patients were divided into three groups: microscopic technique group (n=16); endoscopic early phase group (n=16); endoscopic late phase group (n=16). Operation time and hearing results including postoperative air-bone gap (ABG) and ABG closure were analyzed. Hearing outcomes were considered “successful” when the postoperative ABG was less than 20 dB and considered “excellent” when ABG was less than 10 dB. The learning curve of the outcomes were analyzed.Results Both operation time and postoperative ABG showed decreasing tendency, but only operation time showed statistical significance. The ratio of successful and excellent operations improved, but did not show statistical significance. Improvement in learning curve was not statistically significant presumably due to the lack of patient numbers.Conclusion Surgeon’s proficiency of endoscopic ossiculoplasty was correlated with the improved clinical outcomes, and proficiently conducted endoscopic ossiculoplasty could be used as a surgical technique comparable to microscopic ossiculoplasty.

Comparison of Endoscopic Versus Microscopic Tympanoplasty.

Introduction:Tympanoplasty is a common surgery for chronic otitis media and has conventionally been performed with a microscope for decades. The trend of endoscopic minimally invasive surgeries has been increasing worldwide for the last few decades. Few studies have discussed the outcomes of tympanoplasty with microscope and tympanoplasty with endoscope . This study aims to compare results of tympanoplasty done with microscope vs endoscope in terms of graft take rate and improvement in conductive hearing loss.Materials and Methods:We did a retrospective review of 120 patients (54 male and 66 female) who underwent Type I tympanoplasty at Liaquat National Postgraduate Medical Center from January 2019 to January 2020. We included 60 patients who underwent tympanoplasty with microscope and 60 patients who underwent tympanoplasty with endoscope. Postoperative graft uptake and hearing improvement were studied.Results:Overall mean preoperative hearing loss was 30.24 (±9.61) dB as compared to mean postoperative hearing loss, which was reduced to 19.36 ( ±8.54) dB, and the difference was significant (P-value <0.001. No statistically significant difference was found for air-bone gap closure between the two groups (P-value 0.78). Out of 120 patients, overall successful graft uptake was seen in 109 (90.8%). In tympanoplasty with microscope, graft take was 90.0%, compared to 91.6% in endoscope group. There was no significant difference in graft take in the two groups.Conclusions:The tympanoplasty with endoscope is comparable to tympanoplasty with microscope in terms of graft uptake and hearing improvement.

Comparison of Surgical Outcomes Between Ossicle-Cartilage Composite Graft and Synthetic Ossicular Prosthesis for Ossicular Reconstruction.

To propose a modified technique of ossiculoplasty using an ossicle-cartilage composite graft (OCCG) and compare its hearing outcome and protrusion rate with those of a synthetic prosthesis. Autologous tragal or homologous septal cartilage was combined with an ossicle to create an umbrella shape OCCG. A total of 302 ossiculoplasty surgeries performed in a single university hospital between 1997 and 2006 were retrospectively reviewed based on the prosthesis type-OCCG or polymaleinate ionomeric prosthesis (IONOS®). Data includes demographic profiles, audiometric outcomes, intraoperative findings, and post-operative complications and was categorized by the follow-up periods. Ossicle-cartilage composite graft was used for 175 patients and IONOS® for 127 patients. The mean post-operative air-bone gap (ABG) of the OCCG group was 22.36dB, which was better than the IONOS® group of 25.08dB (P = .015). The successful ABG closure rate of less than 20dB was also higher in the OCCG group compared to the IONOS® group (38.3% vs 26.8%, P = .036). The ABG between the pre- and post-operative conditions exhibited a significant difference between the 2 groups (P = .006). In the data divided into 3 groups according to the follow-up period, the OCCG group showed a better outcome in the long-term follow-up with 0 cases of protrusion during the follow-up period in the OCCG group compared to 8 cases of the IONOS® group (P = .018). Ossiculoplasty with OCCG exhibited satisfactory audiometric outcomes and low complication rates. Ossicle-cartilage composite graft can be a good option with sufficient informed consent and preliminary screening of transmitted diseases.

Audiological characteristics and effect of endoscopic surgery for simple congenital malformation of ossicular chain

ObjectiveTo analyze the audiological characteristics and surgical results in patients undergoing surgery for simple congenital ossicular chain malformation, and the effect of endoscopic surgery. MethodsA retrospective review was performed on 86 patients who underwent surgery for the congenital malformation of the ossicular chain. Clinical characteristics and audiometric data were analyzed. Fifty-eight patients had detailed postoperative data, and the preoperative and postoperative audiometric results were compared. The subjects were further divided into endoscopic and microscopic groups, and their surgical effects were examined. ResultsThe preoperative audiometry results in the low-frequency group were worse than those in the high-frequency group (P < 0.05). A postoperative air-bone gap closure to 20 dB or less was achieved in 73.33% of the 60 ears of patients postoperatively. The postoperative air conduction and air-bone gap were significantly better than the preoperative ones (P < 0.05), and the improvement effect was the best in class III patients (P < 0.05). Postoperative hearing had no significant differences between the endoscopic and microscopic groups. However, endoscopic surgery also was more advantageous in terms of operating time (P < 0.05). ConclusionsPreoperative pure tone audiometric results showed moderate or moderate–severe hearing loss, especially in the low-frequency area. The reconstruction of the auditory ossicle chain can achieve satisfactory results, especially in class III patients. Endoscopic and microscopic surgery in the treatment of simple congenital ossicular chain malformations can effectively improve postoperative hearing.

PREDICTING THE SUBJECTIVE HEARING OUTCOME IN TYPE I TYMPANOPLASTY USING BELFAST 15/30DB RULE OF THUMB.

OBJECTIVE: Both Otologists and patients mutually hope for an improvement in hearing and a functional benet from an ear surgery to correct unilateral conductive hearing loss that has been reported as the closure of air-bone gap or reduction in air conduction thresholds. While these provide a measure of technical success of the operation, they may not always translate into real life benet for the patient. This is because listening is a binaural task and benet to the patient is determined by numerous factors, of paramount importance is hearing in the non-operated ear. With the aim, to estimate patient benet in terms of subjective hearing gain after type I tympanoplasty, we reviewed the Belfast 15/30 dB rule of thumb. METHOD: A 100 cases of chronic otitis media with inactive mucosal disease having conductive hearing loss, who had undergone type I tympanoplasty were included. Hearing was assessed using pure tone audiogram with average of, .5, 1, 2 &amp; 4Hz and a detailed questionnaire regarding the subjective perception of hearing was obtained pre and 6 month post-operatively which was correlated with Belfast 15/30 dB rule of thumb. RESULT: The predictive value as per pure tone audiometry with Belfast 15/30 dB rule of thumb is 89% with a conclusion that the objective hearing improvement (88.1%) does not necessarily transform into patients' perception of hearing improvement (78.4%) CONCLUSION: Hearing is a binaural function and this should always be kept in mind while operating on unilateral/ asymmetric hearing loss patients as mere closure of air-bone gap or reduction in air conduction threshold might not conclude patients' perception of hearing gain. Belfast 15/30 dB rule of thumb has proved to be a valuable tool in predicting the subjective improvement of hearing

Compare the Outcomes of Underlay and Onlay Myringoplasty

Objective: The purpose of this study is to compare the outcomes of myringoplasty patients who had underlay and onlay procedures in order to establish whether approach is superior. Study Design: Quasi-experimental study Place and Duration: The study was conducted at the department of ENT, Head &amp;Neck Surgery, Lady Reading Hospital MTI Peshawar and Chaudhary Muhammad Akram Teaching and Research Hospital Lahore for the period from May 2021 to October 2021. Methods: This study included a total of 114 patients ranging in age from 14 to 60 years. After obtaining informed written consent, patients' full details including age, gender and BMI were recorded. Chronic otitis media and/or trauma-related tympanic membrane perforation was included. M and N were the designations given to the two sets of patients. 57 patients in Group M received underlay myringoplasty and 57 patients in Group N underwent for onlay myringoplasty respectively. The success rate of grafts was evaluated for both groups. A three-month period was allotted for complete follow-up in both groups. SPSS 24.0 was used to analyze all of the data. Results: Group M had 38 (66.7%) males, but group N had 42 (71.9%) males. There were 26.13±5.39 years and 27.10±3.42 years were the mean ages of the two groups, respectively, for group M and group N. There were 53 (93%) graft successes in group M and 49 (86%) in group N. Group M's medialization was 5.3%, but group N's medialization was 10.5%, with no evidence of lateralization in either group. Mean air bone gap closure was 8.1±4.33 dB in group M and 10.9±7.61 dB in group N. Conclusion: After doing this research, we came to the conclusion that the underlay technique for myringoplasty was more beneficial in terms of graft success and hearing restoration. Overall, both groups had accepted success rate, which is comparable to the national average. Keywords: Myringoplasty, Overlay technique, Underlay technique, Graft success

Evaluating the Role of Middle Ear Risk Indices in Assessing Postoperative Outcome following Tympanoplasty Procedure

Introduction Tympanoplasty is the treatment of choice for patients suffering with Chronic Otitis Media (COM). Outcome of tympanoplasty depends on various factors like size and location of tympanic membrane perforation, ear ossicles, degree of otorrhea, cholesteatoma, smoking history, granulation tissue etc. Prediction of outcome of tympanoplasty procedure prior to surgery with respect to graft uptake and hearing improvement can serve as a crucial factor in decision making in resource limited nations. Hence, a study was conducted to evaluate the role of Middle Ear Risk Indices (MERI) in predicting the outcome among patients undergoing tympanoplasty procedure. Materials and Methods A prospective study at a tertiary care centre was conducted for a duration of 2 years among 60 patients with COM who underwent tympanoplasty. Results The mean age of patients was 25.32 ± 8.43 years with a male to female ratio of 3:2. Majority (78.46%) of the patients had Mild MERI score; 18.46% patients had moderate MERI score and 3.08% patients had severe MERI risk score. The difference in mean Air –Bone (AB) gap in the mild and moderate MERI groups’ pre and post operatively was found to be statistically highly significant (p&lt;0.001). Conclusion Lower MERI scores prior to surgery showed significantly better outcomes with respect to graft uptake, degree of AB gap closure and hearing improvement.

Comparison of surgical results between ‘atticosinuplasty’ and canal wall up mastoidectomy for early-stage cholesteatoma

Background We devised a surgical technique called ‘atticosinuplasty’ (AS) for the treatment of early-stage cholesteatoma. Objective This study analyzed the adequacy and applicability of AS compared to canal wall-up mastoidectomy (CWU) in patients treated for early-stage cholesteatoma. Materials and Methods A total of 187 patients with either AS (n = 89) or CWU (n = 98) were compared in terms of postoperative hearing outcome, recurrence and re-operation rate, and radiologic outcome. Results Hearing gain was significant in the AS group (p < 0.001) but not in the CWU group. Air conduction change, air–bone gap (ABG) change, and ABG closure did not significantly differ between the two groups. The frequencies of cholesteatoma recurrence and revision ossiculoplasty were also similar. Of the 32 patients in the AS group with only attic/sinus involvement preoperatively, 20 (62.5%) showed no haziness and 6 (18.8%) had haziness extending to the mastoid postoperatively. Among the 67 patients in the CWU group who had haziness extending to the mastoid preoperatively, in 54 (80.6%) there was no change postoperatively. Conclusions and Significance AS is a surgical technique worth trying in patients with early stage of attic/sinus cholesteatoma in terms of the rate of recurrence and hearing improvement.

Evaluation of the transmastoid plugging approach for superior semicircular canal dehiscences: a retrospective series of 30 ears.

The classical surgical approach for superior semicircular canal dehiscences (SSCD) is via the extradural middle cranial fossa. This pathway is used to resurface or to plug the SSC. In this paper, we present long-term data on an alternative route: the transmastoid pathway. The predictive factors for a successful surgery are equally presented in this paper. Thirty reports of patients operated between September 2007 to January 2020 were analysed. SSCD was confirmed by the association of concordant complaints, audiometric data, cervical vestibular evoked myogenic potentials (cVEMP) responses and computerized tomography findings. Before and after surgery, the following factors were analysed: auditory and vestibular subjective symptoms, Tullio phenomenon, pure-tone audiometry thresholds for air and bone conduction, air-bone gap, cVEMP threshold, and computerized tomography data, for instance the size of the dehiscence. The follow-up is 21months on average. The transmastoid approach significantly improves all symptoms (although there were less probing results for the vestibular symptoms). Objectively, we can observe, a closure of the audiometric air-bone gap on the low frequencies and an improvement in the cVEMP. The only correlation that was identified was between the preoperative cVEMP results and the postoperative air conduction. The originality of this study is the long postoperative follow-up. It allowed us to evaluate the symptoms in the long term and to determine a predictive factor of postoperative complication, which has not yet been described until today.The transmastoid plugging technique is safe and effective. Additional long-term data with a larger cohort are needed to confirm our results and correlation studies.

Power output and hearing performance in osseointegrated auditory devices

Background and objectiveOsseointegrated auditory devices are hearing gadgets that use the bone conduction of sound to produce hearing improvement. The mechanisms and factors that contribute to this sound transmission have been widely studied, however, there are other aspects that remain unknown, for instance, the influence of the processor power output. The aim of this study was to know if there is any relationship between the power output created by the devices and the hearing improvement that they achieve. Materials y methods44 patients were implanted with a percutaneous Baha® 5 model. Hearing thresholds in pure tone audiometry, free-field audiometry, and speech recognition (in quiet and in noise) were measured pre and postoperatively in each patient. The direct bone conduction thresholds and the power output values from the processors were also obtained. ResultsThe pure tone average threshold in free field was 39.29 dB (SD = 9.15), so that the mean gain was 29.18 dB (SD = 10.13) with the device. This involved an air-bone gap closure in 63.64% of patients. The pure tone average threshold in direct bone conduction was 27.6 dB (SD = 10.91), which was 8.4 dB better than the pure tone average threshold via bone conduction. The mean gain in speech recognition was 39.15% (SD = 23.98) at 40 dB and 36.66% (SD = 26.76) at 60 dB. The mean gain in the signal-to-noise ratio was -5.9 dB (SD = 4.32). On the other hand, the mean power output values were 27.95 dB µN (SD = 6.51) in G40 and 26.22 dB µN (SD = 6.49) in G60. When analysing the relationship between bone conduction thresholds and G40 and G60 values, a correlation from the frequency of 1000 Hz was observed. However, no statistically significant association between power output, functional gain or speech recognition gain was found. ConclusionsThe osseointegrated auditory devices generate hearing improvement in tonal thresholds and speech recognition, even in noise. Most patients closed the air-bone gap with the device. There is a direct relationship between the bone conduction threshold and the power output values from the processor, but only in mid and high frequencies. However, the relationship between power output and gain in speech recognition is weaker. Further investigation of contributing factors is necessary.

ASSESSMENT OF HEARING OUTCOME IN ENDOSCOPIC TYMPANOPLASTY BY UNDERLAY TECHNIQUE

AIM: To study the hearing outcome of “Endoscopic Tympanoplasty” by underlay technique. METHODS: This study includes 30 patients presenting with Chronic Suppurative Otitis MediaTubotympanic type. Preoperative assessment includes complete clinical history, thorough ENT examination, X-ray mastoids, Pure Tone Audiogram and routine investigations. Informed and written consent was obtained from all the patients. All the patients were subjected to endoscopic transcanal tympanoplasty by underlay technique using temporalis fascia. Patients were regularly followed up for a period of 3 months and at the end of 3 months pure tone audiogram was done to assess hearing. RESULTS: In our study of 30 patients postoperatively, 80% of the patients had successful graft uptake. In our study, postoperative air-bone gap closure was in the range of 0-10 dB in 55% of patients, 11-20 dB in 20% of patients, 21-30 dB in 5% of patients and 31-40 dB in 20% of patients. CONCLUSION: Transcanal Endoscopic Tympanoplasty is a minimally invasive surgical approach as the endoscope usage provides good exposure of tympanic membrane and improves the visualisation of middle ear structures without canaloplasty

Comparison of the clinical outcome of endoscopic push-through myringoplasty and microscopic overlay myringoplasty: matching co-variated designs

BackgroundThe conventional microscopic overlayer myringoplasty is preferred because it allows a both hands technique, not reducing middle ear space, increasing the blood supply in the repaired area, and providing graft support; however, this technique may be troublesome for the novice surgeon during tympanomeatal flap elevation. Recently, the endoscopic push-through myringoplasty technique has developed. It provides better visualization of the hidden areas and does not require raising tympanomeatal flap. Therefore, the comparison of clinical outcomes between endoscopic push-through myringoplasty and conventional microscopic overlay myringoplasty technique was investigated.MethodsA retrospective case–control hospital-based study was conducted using archival data from the patients who underwent myringoplasty between January 2015 and May 2021 at Srinagarind Hospital and Khon Kaen Hospital, Thailand. The medical records of patients who underwent endoscopic push-through technique or microscopic overlayer technique were chosen by simple randomization and matched 1:1 based on the air conduction threshold, air-bone gap, size of perforation, and experience of the surgeon. The two techniques were compared for clinical outcome success, including tympanic membrane closure, improved air conduction threshold, air-bone gap closure, and operation time duration.ResultsMedical records of 70 patients were retrieved and classified into 35 patients who underwent endoscopic push-through and 35 patients who underwent microscopic overlayer myringoplasty. The size of tympanic membrane perforation and preoperative audiometry were not significantly different between both groups (p > 0.05). The postoperative outcome in endoscopic technique revealed that the air-bone gap and the success rate of tympanic membrane closure were comparable with microscopic techniques (p = 0.420 and p = 0.156, respectively). The operation time was significantly shorter in the endoscopic technique (p < 0.05). Complications were found in one patient with otitis externa in the endoscopic technique group and one patient with graft lateralization in the microscopic technique group.ConclusionsEndoscopic push-through myringoplasty is an alternative minimally invasive technique that may allow the potential outcomes comparable with the microscopic overlayer myringoplasty and with a significantly shorter operation time.

An Exposition on Endoscopic Broad Palisade Cartilage Tympanoplasty: Procedural Illustrations and Connotations in Context of Audiological and Morphological Outcomes.

The objective of this study was to evaluate graft take up rate and hearing improvement in type I and type III endoscopic tympanoplasty using broad palisade cartilage graft and to compare the results with other studies who have used single piece cartilage as graft. This retrospective observational descriptive study was done in a tertiary care hospital. This study included 64 cases, who met the inclusion criteria, which were operated over 2years and were followed for 3years. The results were evaluated using graft uptake rates and hearing improvement comparing the preoperative and postoperative air conduction threshold (ACT) and air bone gap closure (ABG). The graft take rate was 92.1% and 87.5% at the end of 1year and 3years respectively. The preoperative and post-operative air conduction threshold were 35 ± 6.0dB HL and 17.5 ± 2.7dB HL in type I tympanoplasty respectively (p value <0.0001) while in type III tympanoplasty, preoperative and post-operative air conduction threshold (ACT) were 43.3 ± 8.6dB HL and 23.1 ± 4.2dB HL respectively (p value <0.0001). The preoperative and postoperative air bone gap (ABG) were 29.0 ± 5.6dB HL and 14.4 ± 4.20dB HL in type I tympanoplasty respectively (p value <0.0001). In type III preoperative and post-operative air bone gap were 36. 1 ± 7.5dB HL and 16.4 ± 3.3dB HL respectively (p value < 0.0001). Endoscopic broad palisade cartilage tympanoplasty has similar outcomes in morphological and audio logical perspectives as single piece cartilage tympanoplasty. Further studies with long term follow up period are required to corroborate the result of this study.

Comparison between autologous and artificial graft ossiculoplasty in canal wall down tympanomastoidectomy: A 10 year's personal experience

Background: Ossiculoplasty is the reconstruction of ossicular chain: Malleus, incus, and stapes. This procedure attempts to reestablish the continuity between the tympanic membrane and the oval window. Different materials were used in ossiculoplasty; whether to use autologous grafts or synthetic prosthesis. Aims: This study aimed to evaluate hearing changes in patients' undergone ossiculoplasty as a part of Tympanomastoidectomy. Also, to appraise the autologous reconstruction materials used in ossiculoplasty at Jordan University Hospital (JUH) in comparison to other materials. Materials and Methods: A retrospective study done for a total of 100 patients underwent ossiculoplasty using autologous and artificial graft during canal wall down tympanomastoidectomy at JUH from 2009 to 2019. Results: Overall average mean of air-bone gap (ABG) closure (Hearing Gain) for Group A was 11.07 dB, while for Group B was 7.5 dB; this decrease was found to be highly significant (P = 0.002). In Group A, ABG mean was (34.44 dB) preoperative and reduced to 23.37 dB postoperative, while in Group B was (32.95 dB) preoperative and reduced to 25.45 dB postoperative. Conclusions: Autologous grafts can be used safely in reconstruction of middle ear with favorable outcome. Our study is one of the few reports that compare outcome between artificial and autologous graft in ossiculoplasty.