Closure Of Tympanic Membrane Perforations Research Articles

Statistical Evaluation of 231 Ears That Received Tympanic Membrane Perforation Closure Using Carbon Dioxide Laser and Collagen Sponge

AbstractThe tympanoplasty technique reported by Yuasa et al, wherein autologous tissue is fixed to the perforated tympanic membrane using fibrin glue, is widely used. This technique has also led to the development of several simpler surgical methods using artificial materials not involving the use of fibrin glue. We used a carbon dioxide laser device (OtoLAM, Lumenis Be Japan Inc.) during tympanoplasty to refresh the perforation margin of the tympanic membrane and a collagen sponge with a silicone membrane (Terudermis, Alcare Inc.) as the closure material for tympanoplasty. OtoLAM is used to refresh the perforation margin in a short time. By simply fixing Terudermis to the perforated area using the attached silicone membrane, the surgery can be performed in a short time without the need for autologous tissue collection. For the past 9 years and 5 months, from June 2013 to November 2022, we used this method for tympanic membrane perforation closure in 231 ears. The closure rate after a single operation was not high (78/231; 33.8%) but significantly improved with multiple attempts (161/231; 69.7%). The advantages of this technique are that it is simple, can be performed quickly, is economical as it does not involve the use of fibrin glue, and there is no possibility of blood infection, eliminating the need for a detailed explanation to the patient.

Effectiveness of trichloroacetic acid and trichloroacetic acid with gel foam for closure in patients with central perforation of tympanic membrane—a randomized controlled trial

BackgroundThe tympanic membrane (TM) forms the partition between the external auditory canal and the middle ear. Perforations occur as a result of acute otitis media or traumatic causes which undergoes healing spontaneously over 3 to 4 weeks. Non-surgical methods are successful in the closure of small to medium-sized perforations. Chemicals used for the cauterization of the margins of perforation are trichloroacetic acid and silver nitrate. This study was performed in a total of 90 patients. External auditory canal, tympanic membrane, site and size of perforation, and middle ear mucosa status were assessed followed by pure tone audiometry. One group constituting 45 subjects underwent TCA cauterization under sterile precautions. Another group of 45 subjects underwent the same procedure with TCA cautery and gel foam application for perforation closure. The procedure was repeated once a week for about 6 weeks. The effectiveness of these two procedures was compared between the two groups after a waiting period of 2 weeks.ResultsThe mean age of the study population is 41.84 ± 16.71. Of the 90 study participants, 54.4% (N = 49) were less than 40 years of age, gender, cause, and laterality of perforation were not associated with the outcome whereas the size of the perforation was significantly associated with the closure of TM perforation with chi-square value of 7.028 and P value of 0.008 (< 0.05). Overall, TM closure was achieved in 3.56 applications in TCA with gel foam patching whereas in 6.02 applications with TCA alone.ConclusionTCA cauterization with or without gel foam patching can be performed as a first-line treatment in adults with small to medium-sized perforations.

Comparative study of anatomical and functional results of butterfly myringoplasty versus temporalis fascia underlay myringoplasty

Background: Myringoplasty is traditionally been done by using temporalis fascia graft material. But in recent years understanding of physiology and pathology of middle ear cleft is drastically improved with technical advancement in surgical methods. Various grafts have been tried for myringoplasty time to time with varying results. Methods: A case control study was conducted; where 52 patients underwent myringoplasty with butterfly graft and second group of 52 patients underwent myringoplasty with temporalis fascia graft under general anesthesia in major OT. All the patients were followed up for 3 months. The results of the procedure were assessed, with respect to closure of tympanic membrane perforations and improvement in the air bone gap post operatively. Results: Butterfly group had statistically significant number of healed patients and hearing improvement compared to temporalis fascia group at the end of one month and with no statistical significance at the end of three months. The age group less than 18 years showed better uptake with butterfly graft. The difference of mean pre-operative, 1 month and 3 months post-operative air bone gaps in butterfly graft were 35.57±2.87 dB, 27.86±2.53 dB, 24.65±2.66dB and in temporalis fascia were 35.97±2.6dB, 29.36±1.54dB, 25.12±1.73 dB respectively. Conclusions: Butterfly group had statistically significant hearing improvement in patients compared to temporalis fascia group at one month and with no statistical significance at three months post procedure. The age group less than 18 years showed better uptake with butterfly graft.

Outcomes of regenerative treatment for over 200 patients with tympanic membrane perforation

ObjectiveTo evaluate outcomes of a regenerative treatment (RT) for over 200 patients with tympanic membrane perforation (TMP). The RT-TMP method involves a gelatin sponge, basic fibroblast growth factor (bFGF) and fibrin glue. MethodsThe study population included 216 patients and 234 ears (male: female =100:116; age 1–93 years). All enrolled patients were treated with RT-TMP in which TMP edges were disrupted mechanically and a gelatin sponge immersed in bFGF was inserted into the perforation. Fibrin glue was then dripped over the sponge. Patient outcomes including TMP closure rates, change in hearing level, and complications were obtained from retrospective medical chart reviews. The TMP was examined three or more weeks after surgery. The treatment was repeated up to 4 times until complete TMP closure was achieved. ResultsAfter mechanical disruption, the perforation size was Grade I, ≤1/3 of entire TM area in 22 ears (9.4 %), Grade II, 1/3–2/3 of entire TM in 77 ears (32.9 %) and Grade III, ≥2/3 of entire TM area in 135 ears (57.7 %). The overall TMP closure rates were 97.0 % (227/234). Complete TMP closure was achieved in 68.8 % (161/234), 22.6 % (53/234), 4.7 % (11/234) and 0.9 % (2/234) of ears after 1, 2, 3 and 4 treatments, respectively. In 7 of 234 ears (3.0 %), the TMPs were not closed completely after 4 treatments. There was no correlation between TMP size after mechanical disruption and number of treatments required to achieve complete closure (Fisher's exact test p = 0.70). The mean air-conduction hearing threshold at low frequency improved from 57.3 ± 16.7 dB before treatment to 37.3 ± 16.0 dB (p < 0.0001) after closure of TMPs. For middle and high frequencies, the improvement was 49.0 ± 19.3 dB to 36.9 ± 17.9 dB (p < 0.0001) and 57.7 ± 22.9 dB to 49.2 ± 23.3 dB (p < 0.0001), respectively. The mean air-bone gaps also improved significantly, and were within 10 dB at 250 Hz, 500 Hz and 1 kHz, and 11 dB at 2 kHz. One or more complications occurred in 32 patients (32/216; 14.8 %). The most common complication was formation of an epithelial pearl (16 ears; 6.8 %), followed by severe TM retraction (9 ears; 3.8 %) and otitis media with effusion (6 ears; 2.6 %). There were no serious complications that caused deterioration of the patient's general condition. ConclusionOur results showed that RT-TMP had high success rates for TMP closure and good hearing improvement and produced no severe complications that could affect general health status. This novel therapy is simple, safe and minimally invasive, and could help improve the quality of life in patients with TMP.

Tympanoplasty Healing Outcomes With Use of Postoperative Otic Quinolones.

Tympanoplasty usually results in tympanic membrane perforation (TMP) closure, but healing may be suboptimal (e.g., excess scarring). Factors that have been linked to impaired TM healing have become widely adopted (especially, postoperative use of quinolone ear drops). The aim of this study is to assess the frequency of suboptimal tympanoplasty healing with the use of otic quinolones postoperatively. Retrospective chart review. Tertiary care facility. One hundred patients undergoing tympanoplasty for TMP. Tympanoplasty +/- canalplasty. Healing complications (e.g., granulation tissue, TMP, myringitis, bone exposure, lateralization, anterior blunting, medial canal fibrosis, and canal stenosis) and hearing loss. Charts were reviewed for postoperative healing issues and hearing outcomes at 1 to 2 years postoperatively. TMP closure was found in 93.2%, but 34.2% had healing issues at 1 to 2 years postoperatively, with 20.6% having adverse healing outcomes (perforation (6.9%), granulation tissue (6.9%), medial fibrosis (4.1%), and myringitis, bone exposure, and webbing (all 1.4%). Another 13.7% had notable postoperative issues, such as protracted otorrhea (11.0%), otitis externa (9.6%), otitis media (1.4%), and atelectasis (2.7%). No medical, surgical, or patient factors impacted outcomes. Average air-bone gap at 1 to 2 years did not differ between patients with and without healing issues and patients with other postoperative issues ( p = 0.5). Suboptimal healing is common after tympanoplasty. There may be significant opportunity to improve post-tympanoplasty healing beyond improving the TMP closure rate.

Use of platelet rich fibrin in tymapnoplasty

An observation study was undertaken at Department of Otorhinolaryngology, AIMSR fromJan 2021 – Aug 2022. The aim of my study the efficiency of use of autologous platelet rich fibrin membrane along with temporalis fascia in closure of tympanic membrane perforation during tympanopasty. All the patients attending ENT OPD at AIMSR within the age group of 11-60 years, irrespective of sex with tubotympanic CSOM either unilateral or bilateral were included in this study. In our study of 50 patients, 42 patients had graft uptake and 8 had failure of graft. Through this study we concluded that. The outcome of tympanoplasty does not depend on age and sex, dry ear of more than 6 month has a better graft.

Negative Outcome of Temporalis Fascia Graft in Tympanoplasty with Excessive Bleeding: A Retrospective Study.

Background and Objectives: Non-autologous graft materials hold promise for tympanic membrane (TM) perforation closure. In the present manuscript, we aimed to evaluate the influence of clinical and surgical (i.e., graft materials) characteristics on tympanoplasty outcome in chronic otitis media (COM). Materials and Methods: We retrospectively reviewed clinical and surgical characteristics of COM patients with TM perforation treated with tympanoplasty and mastoidectomy. Univariate and multivariate appropriate tests were applied. Results: We used xenograft (porcine submucosal collagen) in 163 patients, and temporalis fascia in 210. The mean follow-up time was 37.2 months. Postoperative TM perforation (i.e., negative outcome) was detected in 11.6% of cases with xenograft, and in 12.8% with temporalis fascia. Performing uni- and multivariate analysis, we determined that large (three or all quadrants) TM perforation (p = 0.04) and moderate-to-severe intraoperative bleeding (p = 0.03) were independent prognostic factors of negative outcome. Considering the 197 patients with moderate-to-severe intraoperative bleeding, we disclosed that the use of temporalis fascia (p = 0.03) was an independent risk factor of postoperative TM perforation. Conclusions: According to our results, large TM perforation and moderate-to-severe intraoperative bleeding were independent prognostic factors of negative outcome in adult COM patients treated with tympanoplasty. In the sub-group of COM patients with excessive intraoperative bleeding, use of temporalis fascia was associated with negative outcome; these patients could benefit from xenograft materials. These findings should be tested in large randomized clinical trials.

Study On The Outcome Of Endoscopic Tympanoplasty Versus The Conventional Method.

BACKGROUND : Endoscopic tympanoplasty is an minimally invasive surgery for the repair of tympanic membrane with complete graft survival and hearing outcomes to the conventional microscopic surgery. This study was aimed to evaluate the success rate of endoscopic trans-canal closure of tympanic membrane perforation compared to the conventional post auricular approach using temporalis fascia and tragal cartilage as a graft. METHODS: Our study consisted of 50 patientswith chronic otitis media,with dry ear for last 2 months and all patients were between 18-50yrs of age.All selected patients were subjected to pre operative oto endoscopicand audiological assessment and underwent endoscopic trans canal tympanoplasty using temporalis fascia in some and tragal cartilage in some. RESULTS: Trans canal endoscopic surgery resulted in the successful healing of 97% whereas in conventional method successful healing was only up-to 92%. The average hearing gain was also significantly improved in endoscopic surgery compared to that of conventional method. When the operative time was considered the mean time in endoscopic method was lesser. All patients were followed up for a period of 3 months. CONCLUSION: Comparisons between these 2 groups focused on the surgical outcomes and restoration of hearing, including the duration of surgery. All patients were followed up for a period of 3 months. Using this method not only improves the cosmetic outcome but also reduces the post operative morbidity with shorter operative time. KEYWORDS: Endoscopic Tympanoplasty, Conventional Tympanoplasty, Tympanoplasty

Cartilage palisades versus temporalis fascia: a randomised control trial

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Tympanic membrane perforation is a common cause of hearing loss. Various surgical techniques with different graft materials have been described for the treatment of perforations. The most widely used graft materials are the cartilage and temporalis fascia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; We conducted a prospective randomised control longitudinal study to document the post operative hearing outcomes of type 1 tympanoplasty in patients with inactive mucosal chronic otitis media (n=120) using the cartilage palisades tympanoplasty technique (n=60) and temporalis fascia (n=60).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; It was found that the mean AB (air-bone) gap at 5 months post operatively was 12.35±7.17 dB with temporalis fascia and 11.39±7.907 dB in cartilage palisades tympanoplasty. At 12 months the AB gap was 14.98±9.915 dB in temporalis fascia group as compared 11.41±8.288 dB for cartilage palisades group. Thus, hearing improvement was better in cartilage palisades group, but interestingly the comparison of the air conduction gain and subjective improvement at the end of 5 and 12 months between the two techniques was not statistically significant and parallels the above findings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Hence we conclude that both temporalis fascia and cartilage palisades were acceptable graft material for successful closure of tympanic membrane perforation.&lt;/p&gt;

Evaluation of the use of autologous platelet-rich fibrin in myringoplasty operation

BackgroundPlatelet-rich fibrin (PRF) which is considered a second-generation platelet-rich plasma having a high content of growth factors could be implied as a sealant and adjuvant to grafting materials during tympanoplasty operation. This work aimed to evaluate the role of autologous platelet-rich fibrin as an adjuvant in type 1 tympanoplasty (myringoplasty) for the closure of central tympanic membrane perforations. A prospective comparative study was conducted including one-hundred patients with chronic suppurative otitis media with dry central TM perforations. The patients were classified into two equal groups: group A (case group) was subjected to myringoplasty operation with the use of autologous PRF added to the temporalis fascia graft, and group B (control group) was subjected to myringoplasty operation using graft only without PRF. Both groups were assessed for successful closure of perforation defined as an intact eardrum, success in terms of hearing defined as closure of air-bone gap down to 10 dB or lesser, and hearing gain at 6 months postoperatively.ResultsAt 6 months postoperatively, the success rate (graft taking) in group A (90%) was significantly higher than in group B (70%). Success in terms of air-bone gap closure (< 10 dB) revealed that in group A, success was achieved in 39 patients (78%), which was significantly higher than in group B 27 patients (54 %). Air-bone gap at 6 months postoperatively was more in the graft taken cases in the case group than in the control group with a significant difference. There was a nonsignificant correlation between graft uptake and either hemoglobin or platelet concentrations in both groups. In addition, there was a nonsignificant correlation between graft uptake and the size of the perforation in both groups.ConclusionPlatelet-rich fibrin is a cheap, cost-effective, and completely autologous platelet concentrate with enriched growth factors. It improves the overall success rate of myringoplasty with no noticeable side effects.

Endoscopic closure of tympanic membrane perforations by platelet-richplasma laden cartilage with perichondrium

Background: Myringoplasty surgery, also known as tympanic membrane repair, is performed to correct hearing loss brought on by TM perforation and to eliminate recurrent ear discharge. Platelets are the primary players in the process of tissue healing. They provide essential growth factors that stimulate fibroblasts to produce new blood vessels and lay down extracellular matrix. The study aim: Is to assess the efficacy of incorporating plateletrichplasma into tragal cartilage grafts with its perichondrium in order to speed healing and enhance the results of endoscopic transcanalmyringoplasty. Patients, and methods: Fifty people suffer from dry central TM perforation participated in this prospective case-control study. Under local anaesthesia, each of them had endoscopic transcanal myringoplasty by using tragal perichondrium grafts. 25 patients underwent myringoplasty surgery and also received platelet-richplasma (PRP) from the same patient in group A, compared to 25 patients in group B who underwent myringoplasty surgery but did not get PRP. Results: There were 25 patients in each group, and no statistically significant demographic differences existed between the two groups. A p-value of (0.01) indicates that there was a significant difference between the plattelet-rich plasma group's (100%) and the non-plattelet-rich plasma group's (72%) graft absorption success rates.

Patient Factors Predicting Success in Lateral Graft Tympanoplasty.

To compare the effects of preoperative medical comorbidities and operative findings on the success of lateral graft tympanoplasty. Retrospective chart review. Tertiary medical center. Ninety-six patients undergoing lateral graft tympanoplasty from December 2008 to November 2020 with at least 2 months follow-up were included. Patient demographics, comorbidities including smoking status, intraoperative findings, and healing, and hearing outcomes were recorded. Lateral graft tympanoplasty. The primary outcome was perforation closure. Secondary outcomes were postoperative complications and change in air-bone gap (ABG). Ninety-nine ears (mean age 40.94 ± 18.44 years) were included. Tympanic membrane perforation closure was achieved in 92 (92.9%) ears. Perforation closure was not associated with diabetes (P > 0.99), smoking (P > 0.99), or the presence of cholesteatoma at the time of lateral graft tympanoplasty (P = 0.10). Increased age (odds ratio [OR] = 1.04, P = 0.31) was also not correlated with tympanic membrane closure rate. An absent malleus resulted in a higher rate of lateralization (31.3% versus 2.1%; OR = 18.41, 95% confidence interval [CI] = 3.09-95.95, P = 0.001) but not blunting (12.5% versus 4.8%; OR = 0.24, 95% CI = 0.49-12.93, P = 0.24). The mean ABG improved 6.82 ± 11.33 dB (P < 0.01). History of prior tympanoplasty was associated with smaller ABG improvement following surgery (ß = 4.038, R2 = 0.262, P = 0.04) but not perforation closure (OR = 3.25, 95% CI = 0.63-16.81, P = 0.24). Diabetes, active smoking, and advancing age were not associated with adverse healing in patients undergoing lateral graft tympanoplasty. Lateralization was more common with an absent malleus.

Endoscopic transcanal myringoplasty with anterior tab flap underlay technique: An analysis of 35 cases

IntroductionThe repair of the tympanic membrane can present a problem, especially in anterior perforation, because the anterior portion was not enough to inadequate contact between tympanic membrane remnant and graft. Various surgical techniques were recommended to achieve an acceptable graft success rate in anterior perforation. Endoscopic transcanal myringoplasty with anterior tab flap could provide the better stability of the graft. ObjectiveThe aim of this study was to report the minimally invasive technique for the anterior tympanic membrane perforation closure and investigate the graft success rate of this technique. Patients and methodsWe performed a prospective, randomized study of 35 patients who consulted the otorhinolaryngology department at the university hospital for surgery of perforation tympanic membrane repair. ResultsThe average age was 35.1 ± 11.9 years. The size of the perforation was dominant at small-size and large-size, 51.4%, 34.3%, respectively. There was a significant difference between the Preoperative air conduction of small and large perforations (34.44 8.68 and 49.79 14.54, respectively). Of 35 patients, 31 (88.6%) had closure of their perforations. The mean preoperative ABG was 24.11 ± 10.79 dB, while The mean postoperative ABG was 13.97 ± 10.03 dB (p < 0.05). Approximately 34.3% patients had ABG within 20 dB preoperatively, which increased to 82.9% after intervention (p < 0.05). ConclusionsThe endoscopic transcanal myringoplasty with anterior tab flap underlay technique is a safe, suitable and effective method for cases with anterior tympanic membrane perforations, and showed improvement in postoperative hearing.

Temporalis fascia versus areolar temporalis fascia in type 1 tympanoplasty

To study outcome of various autologous grafts used in cases of type-1 tympanoplasty. To compare between temporalis fascia and areolar temporalis fascia (Fool's fascia) used as a graft materials in type-1 tympanoplasty.Tympanoplasty is the commonest surgery of the middle ear carried out to improve hearing in patients with conductive hearing loss. Wullstein first coined the term tympanoplasty in 1953(1). Myringoplasty or type 1 tympanoplasty is an operation for reconstruction of a tympanic membrane perforation. Type I tympanoplasty refers to restoration normal anatomy of middle ear. Although the different graft materials are being used for closure of tympanic membrane perforation the most ideal material is unknown yet. Of the autologous materials, temporals fascia is the most frequently used for all perforations due to its easy availability, the abundance of tissue. Various other autologous materials have been used. They are either locally accessible such as periosteum, perichondrium either alone or with attached cartilage, subcutaneous tissue, skin from the external auditory canal (EAC) or elsewhere and also the fat. The fat is harvested usually from ear lobule or post auricular region though it can be from any other site. Fascia lata and vein are distantly located autograft.

Role of healing promoting factors in healing of tympanic membrane perforations: a meta-analysis study

Background and Aim Some healing promoting factors, such as epidermal growth factor (EGF), fibroblast growth factor (FGF), hyaluronic acid (HA), and platelet-rich plasma (PRP), have been in use nowadays to assist healing eardrum perforations. Several trials have been conducted to assess their effectiveness. This meta-analysis was conducted to find out the prognostic effects of these factors.Materials and methods The search methods consist of electronic databases and literature references for published and unpublished studies, besides the reference lists of all relevant studies. Selection criteria All types of studies (randomized controlled trials, prospective, retrospective, or case–control). Data collection and analysis Eighteen articles were included after screening by titles and/or abstracts and full-text assessment. They were categorized according to the used healing promoting factor. Data were extracted and analyzed via Cochrane Collaboration’s Review Manager Software.Results EGF and FGFs significantly improved the rate of closure, healing duration, and increased hearing gain. On the contrary, the overall effects of HA and PRP were nonsignificant in this respect.Conclusion EGF and FGF can increase the rate of closure of tympanic membrane perforations, shorten healing duration, and improve hearing gain. PRP and HA do not have a significant effect. This can be attributed to heterogeneity of the studies included to assess the role of each of these two factors.

Topical use of Autologous Platelet Rich Fibrin in Tympanoplasty: A Prospective Interventional Study

Introduction: Tympanoplasty is the surgery performed in Chronic Otitis Media (COM) to improve the hearing function and prevent ear discharge. Platelet Rich Fibrin (PRF) is one of the materials that can be used to improve the graft uptake and hearing outcome. It is obtained by centrifugation of blood. The PRF contains leukocytes, cytokines, structural glycoproteins and growth factors which accelerates healing. It has been used in various surgical procedures to improve the outcome. Aim: To determine the efficacy of autologous PRF in closure of tympanic membrane perforation after tympanoplasty and to study the influence of PRF on the hearing outcome in the study population. Materials and Methods: This prospective interventional study was conducted in Department of Ear, Nose and Throat at SDM Medical College, Dharwad, Karnataka, India, from November 2018 to June 2020. The study included 60 patients with safe type of COM, who underwent tympanoplasty. Two group were made, group A consisted of 30 consecutive patients with safe type COM who underwent tympanoplasty with PRF application and group B, consisted of 30 patients who underwent tympanoplasty without PRF application. The outcome was assessed by endoscopic evaluation every month for 3 months to look for graft uptake. Hearing gain was evaluated by Pure Tone Audiometry (PTA) after 3 months of surgery. Statistical analysis was done using Chi-square test. Results: Group A had 29 cases with complete tympanic membrane closure and only one failure. However in group B, three out of 30 cases had failure. Thus, the overall the success rate was 96.66% in group A and 90% in group B. Postoperative PTA in group A showed that 18 cases (60%) had an improvement of &gt;15 dB whereas in group B, 12 cases (40%) had hearing improvement of &gt;15 dB. Conclusion: Considering the higher success rate of tympanoplasty with group A compared to group B and no noticeable side effects, it is recommended that tympanoplasty with autologous PRF should be preferred.

Middle Ear Packing and External Ear Packing With Fibrin Glue Enhance the Success of Fat Myringoplasty Without Hyaluronic Acid Disc.

Recently, hyaluronic acid disc has been known to enhance the success rate of fat myringoplasty. However, hyaluronic acid disc (Epidisc) is not covered by south Korean medical insurance. To date, fat myringoplasty using middle ear packing has rarely been reported. In this study, we studied whether middle ear packing with dexamethasone soaked gelfoam and fibrin glue over the fat graft could promote the success rate of tympanic membrane perforation (TMP) closure without hyaluronic acid disc, regardless of perforation size. Between January 2005 and July 2020, a total of 209 patients who underwent fat myringoplasty due to chronic TMP at a tertiary referral center were enrolled, and the success rate and audiologic outcomes were analyzed. The mean successful tympanic membrane (TM) closure rate was 88.0%. The success rate by different age groups showed no significant difference. Further, the size of perforation showed no significant difference, and the perforation site (anterior or posterior) was not significant. The preoperative mean thresholds of air conduction (AC), bone conduction (BC), and air-bone gap (ABG) were 55.71, 12.98, and 42.73 dB respectively. The postoperative mean thresholds of AC, BC, and ABG were 23.67, 12.98, and 10.69 dB, respectively. Change in preoperative and postoperative hearing showed was statistically significant. Middle ear packing by gelfoam combined with external ear canal packing using fibrin glue enabled stable adhesion between the remnant TM and the fat graft. Regardless of the size of the TMP, the success rate of the fat myringoplasty by our technique can be enhanced without use of hyaluronic acid disc.

ENDOSCOPIC CARTILAGE TYMPANOPLASTY. OUR TECHNIQUE AND EXPERIENCE OF 157 CASES

Objective: To assess the graft take rate and hearing gain in trans-canal endoscopic tympanoplasty Study&#x0D; Design: Descriptive study.&#x0D; Place and Duration of Study: Pakistan Naval Ship Hafeez, Islamabad Pakistan, form Dec 2015 to Jun 2018&#x0D; Methodology: All patients with dry central perforations of &gt;3 months history were included in the study. All Patients with perforations of pars tensa were booked for endoscopic cartilage tympanoplasty. All perforations were divided into four types small, medium, large and subtotal or total based on size of the tympanic membrane perforations. Small perforations involving &lt;25% area of Pars Tensa. Medium perforation are Perforations involving 25-50% of Tympanic membrane. Large perforations include Perforations involving 50-75% of pars tensa. Subtotal or total perforations are defined as perforations with &gt;75% perforation of the tympanic membranes. Wet Ears and perforations involving the Pars Flacida were excluded from the study. Preoperative Audiogram was carried out for all patients and A-B Gap were noted for all groups separately so as the demographic data including age and gender. Success was defined as complete closure of Tympanic membrane perforation at 3 months. All patients were operated with 0 Degree 3mm, 14cm rigid endoscope under general anesthesia.&#x0D; Results: Mean age of patients was. 37 years and standard deviation was 12.34 (range 12-58 years). Out of total 157 cases 81 patients male were males (51%) and 76 patients were females (49). Out of 157 ears operated 146 Perforations healed completely an overall success rate of 92%. Patients with small perforations had 100 percent success.....

Use of Collagen Sheets as Graft Material for Myringoplasty.

The purpose of the study is to investigate how Collagen sheet used as graft material in Myringoplasty improves hearing and tympanic membrane tissue repair in patients with tympanic membrane perforation (TMP) in an office based procedure. Total 50 cases included in the study where Collagen sheet used as graft material for myringoplasty in small to moderate size tympanic membrane perforations(TMP) and procedure performed in an office based set up with the help of a High definition endoscope and camera. Cases followed up regularly and results observed in terms of graft uptake and complete closure of TMP and hearing improvement. Out of 50, complete closure of TMP observed in 39 cases and an average hearing gain of 9.9 db noted in these cases. Success rate of 78% achieved and failed cases were subjected to traditional post auricular method of myringoplasty under microscopic guidance. Myringoplasty with the help of collagen sheet material in an office based set up is an easy, minimally invasive and effective technique and it avoids need for major invasive intervention in a significant number of patients.

Comparison of anterior tab flap and underlay tympanoplasty techniques in anterior tympanic membrane perforations

Background/Aim: Closure of anterior tympanic membrane perforation is surgically demanding with high rates of graft failure. The anterior tab flap (ATF) technique is a modification of underlay tympanoplasty which claims higher success rates for repairing anterior and subtotal perforations. Our main aim was to compare graft take rates of ATF and underlay techniques in anterior tympanic membrane perforations. Method: In this retrospective cohort study, 41 patients with anterior tympanic membrane perforations who underwent tympanoplasty at a tertiary referral center were analyzed. The patients were grouped according to the technique used. Demographic, clinical, and follow-up information as well as preoperative and postoperative 6th-month audiometric data were collected and compared between the groups. Results: Four patients were lost to follow-up. Eighteen patients in the ATF arm and 19 patients in the underlay arm were compared. Graft take rates were 94.4% in the ATF group and 73.7% in the underlay group (P=0.180). An air conduction threshold average of 0.05). The postoperative ABG of the ATF and underlay group patients were less than 20 dB in 76.5% and 78.9%, respectively (P>0.05). No graft lateralization, anterior blunting, or cholesteatoma were observed. Conclusion: ATF is a safe and effective technique with a higher success rate for repairing anterior tympanic membrane perforation.