Dry Ear Research Articles

A Simple Egg Membrane Patch Bridging Method for Repairing Tympanic Membrane Perforation

Objective: To analyze the clinical effect of a simple egg membrane patch bridging method in repairing tympanic membrane perforation. Methods: A total of 93 tympanic membrane perforation patients admitted to the hospital between September 2022 and October 2023 were selected and divided into two groups according to the random number table method. The control group implemented the conventional treatment (n = 46 cases), and the patch group adopted the simple egg membrane patch bridging method (n = 47 cases). The healing rate of the tympanic membrane, the air-bone gap, the air conduction hearing threshold, the dry ear rate, and the incidence of complications in both groups were compared before and after treatment. Results: The healing rate of the tympanic membrane in the patch group was significantly higher than that of the control group (95.75% vs. 76.09%), with P < 0.05; there was no difference in the air-bone gap and air conduction hearing threshold levels between the two groups before treatment (P > 0.05), and the hearing indexes of the patch group were significantly lower than those of the control group 3 months after treatment (P < 0.05); the dry ear rate in the patch group was significantly higher than that of the control group after treatment (85.11% vs. 67.39%), and the total incidence of complications was also significantly lower than that of the control group (6.38% vs. 21.74%), with P < 0.05. Conclusion: The simple egg membrane patch bridging method is effective in repairing tympanic membrane perforation, which can effectively improve patients’ hearing levels and reduce the occurrence of post-treatment complications. Thus, it is worth popularizing and applying in the clinic.

The Prognostic Value of Active Otitis Media on Tympanoplasty Success Rate-A Systematic Review.

The aim is to investigate the influence of an active otitis media on the success rate of tympanoplasty in patients with a chronic otitis media (COM) and a tympanic membrane perforation. PubMed, Embase and the Cochrane Library. The inclusion criteria were studies on closure rates of tympanoplasty performed in COM patients of any age with a tympanic membrane perforation caused by COM. The exclusion criteria were studies on patients undergoing concomitant mastoidectomy, ossicular chain reconstruction, tuboplasty, adenoidectomy, revision tympanoplasty, patients with perforations due to other conditions than COM, and letters to editors, commentaries, conference abstracts and case reports. The included articles were critically appraised using the QUIPS tool. Data on tympanic membrane closure rate were extracted, odds ratio (OR) and 95% confidence intervals (CI) of the closure rate with a wet versus a dry ear were calculated. The search was performed on 1 February 2023. Of 4671 articles, 16 studies were included and critically appraised. Of these observational studies (nine prospective, seven retrospective), with a total of 1509 patients (dry ear group n = 1003; wet ear group n = 506), two studies stated a significant difference in success rate, one in favour of a dry ear and one in favour of a wet ear at time of surgery. All other studies did not show a statistically significant difference. Overall, the risk of bias was considered moderate to high. We found no significant prognostic value of having an active otitis media during tympanoplasty on tympanic membrane closure rates. Because the overall risk of bias was considered moderate to high, no strong conclusions can be made. To be able to answer this question with higher levels of evidence, high-quality prospective or randomized studies are needed.

Therapeutic effect of β-tricalcium phosphate in mastoid cavity obliterationunder endoscope

Objective:To investigate the therapeutic effect of β-tricalcium phosphate in mastoid cavity obliteration for middle ear cholesteatoma under endoscope. Methods:Sixty patients with middle ear cholesteatoma admitted to our department from September 2021 to March 2022 were included in this study. The observation group（n=30） received β-tricalcium phosphate during mastoid cavity obliteration. The control group（n=30） received autologous tissue during mastoid cavity obliteration. Pure tone audiometry was performed before surgery and after surgery in both groups, and the air conduction thresholds of 500, 1 000, 2 000 and 4 000 Hz were recorded. The external acoustic meatus cross-sectional area within 1 cm of the external acoustic meatus opening was measured during the operation and after the operation. The differences of postoperative ear drying time, hearing change and mastoid cavity healing were compared between the two groups. Results:The duration of postoperative dry ear in the observation group was 2-14 weeks, with an average of （9.4±2.7） weeks, while that in the control group was 4-26 weeks, with an average of（16.0±5.7） weeks. The difference in dry ear time between the two groups was statistically significant（P<0.05）. In the observation group, the threshold change was -19-27 dB, with an average of（6.4±10.7） dB, and in the control group, the threshold change was -9-17 dB, with an average of （4.7±7.1） dB. There was no significant difference in hearing change between the two groups（P>0.05）. In the observation group, the cross-sectional area of 1 cm inside the ear canal opening was -5.9-8.2 mm², with an average of （-0.6±2.6） mm², and in the control group, the cross-sectional area of 1 cm inside the ear canal opening was -5.5-5.2 mm², with an average of （-0.4±2.3） mm². There was no significant difference in intraoperative cavity changes between the two groups（P>0.05）. Conclusion:The application of β-tricalcium phosphate to fill the mastoid cavity during the operation of endoscopic middle ear cholesteatoma has no adverse effect on the hearing of patients, can shorten the postoperative dry ear time, and results in good postoperative healing, which is worth promoting.

Comparison of the Efficacy of Endoscopic Tympanoplasty and Microscopic Tympanoplasty

Objective of this study is to compare the endoscopic tympanoplasty (ET) and microscopic tympanoplasty (MT) regarding graft uptake, hearing improvement and cost effectiveness. The total number of patients included in the study was 68 full filling inclusion and external criteria. The total number of patients included in the study was 68, among these 50 were males and 18 were females. Mean age was 44 years. Disease was seen in right ear in 43 patients and in the left ear in 35 patients. The main procedure performed was Tympanoplasty Type 1with underlay technique. Patients were divided into two groups, MT (A) and ET (B), each of this was further divided into Tympanoplasty with Cortical Mastoidectomy (A1, B1) and Tympanoplasty without Cortical Mastoidectomy (A2, B2). Among each type, the graft was either taken from Temporalis Fascia (TF); (A1f, A2f, B1f, B2f) or from the tragal cartilage (TC); (A1c, A2c, B1c, B2c). The success rate was determined by average hearing improvement and graft uptake. According to the results, MT with Cortical Mastoidectomy had success rate of 100% and MT without Cortical Mastoidectomy had success rate of 80% (with TF, the success rate is 75% and with TC, it is 100%). ET with Cortical Mastoidectomy had success rate of 100% and ET without Cortical Mastoidectomy had success rate of 85% (with TC). Total number of patients in which tympanoplasty was done with cortical mastoidectomy (all wet ears) was 46. The results were extraordinary and graft uptake was 100%. Total number of patients who underwent tympanoplasty without cortical mastoidectomy, (all dry ears) was 22. Results were only 81.8%. It was found that patients with ET and TF, were more satisfied with the scar as it became invisible in 2 months. The scar was cosmetically unacceptable in patients having undergone cortical mastoidectomy along with either ET or MT with use of TF graft.

An Observational Study to Assess the Outcome of Canal Wall Window Tympanomastoidectomy in Chronic Suppurative Otitis Media.

This study was undertaken to assess the outcome of canal wall window tympanomastoidectomy in chronic suppurative otitis media in a tertiary care centre of central India. A total of 50 patients were taken for this study in which the youngest patient was 13-year-old male and oldest 55-year female. Maximum patients were in between age group 10 to 20 years, 20 (40%) patients and minimum 03 (6%) between age group 51 to 60 year. The study mainly emphasized on: To study the clinical profile of the cases of chronic suppurative otitis media, to study the hearing outcome after 3 months of Canal wall window tympanomastoidectomy technique, to study the post-operative condition of ear after 3 months whether dry or wet and to study the post-operative follow up of cases to assess the graft uptake. Average PTA & ABG improvement of different tympanoplasty was also calculated in our study in which Type I tympanoplasty had 12.20dB gain, Type II of 10.50 and Type III of 10.31dB.An overall average improvement in all patients with tympanoplasty was 11.00dB.At the end of the study 100% dry ears were achieved. The technique of canal wall window tympanomastoidectomy involves formation of a window in the outer attic wall to look at the disease extent which was then closed by a snuggly fitting cartilage.It is a novel technique & without compromising the structural integrity in case of a limited disease which is only extending till attic and aditus good anatomical and hearing results could be gained.

A tailored approach in cholesteatoma surgery.

In recent years, new techniques have been added to cholesteatoma surgery, and established microsurgical approaches are being reconsidered. This study aims to present the importance of individualized decision-making for the selection of an intact canal wall (CWU) or canal wall down (CWD) surgical procedure for each patient. Using the "ChOLE" classification we categorized 264 operations retrospectively. 162 CWU and 102 CWD surgeries were performed. We focus to determine why a CWD procedure was chosen quite frequently despite some low-stage cases. Furthermore, we evaluated recidivism and hearing outcomes. Smaller cholesteatomas (Ch-stage 1a, 1b & 2a) were found in 182 patients (70%), ossicular chain status feasible for straightforward reconstruction (O-stage 0, 1 & 2) was present in 186 patients (70%), minor complications due to the cholesteatoma (L-stage 1) were infrequent with 28 cases (11%) and a well-pneumatized mastoid was found in 144 cases (55%). Recidivism rates were low (7%) without any difference in both groups and a mean follow-up time of 4 years and 8 months. In primary surgeries there was a significant difference (p < 0.05) in postoperative mean air-bone gap (ABG) between CWU (17dB) and CWD (27dB). The main goals of cholesteatoma surgery remain the avoidance of recidivism and optimal hearing rehabilitation. We recommend a tailored approach in the treatment of cholesteatomas and not a dogmatic one. Surgeons should not hesitate to perform a CWD procedure if required. Performed correctly it results in a dry ear and CWD surgery should remain in the skill set of the otologic surgeon.

Ceftazidime Poloxamer Gel: Expanding the Therapeutic Armamentarium for Ciprofloxacin-Resistant Pseudomonas Mastoid Cavity Otorrhea.

To present and evaluate the treatment of ciprofloxacin-resistant Pseudomonas mastoid cavity otorrhea with a ceftazidime thermosensitive poloxamer gel. A retrospective clinical capsule report. Three patients diagnosed with ciprofloxacin-resistant Pseudomonas otorrhea in the setting of a previous canal-wall-down mastoidectomy between March 2019 and June 2023 visiting our tertiary care institution were retrospectively reviewed. Application of a 2% ceftazidime thermosensitive poloxamer gel to mastoid cavity. No evidence of disease during microscopic inspection of the ear within a month of initial treatment or bacterial eradication on subsequent culture. Two patients had complete resolution of symptoms and achieved a safe and dry ear after topical application of the hydrogel. The second patient had pseudomonal eradication on culture, but persistent otorrhea due to other multidrug-resistant bacteria and an anatomically unfavorable mastoid cavity, which ultimately resolved after revision surgery. This small case series suggests that topical treatment of mastoid cavity otorrhea with a 2% ceftazidime poloxomer gel is a potential therapeutic avenue in patients with ciprofloxacin-resistant Pseudomonas .

Outcome of Myringoplasty with Temporal Fascia and With Sliced Tragal Cartilage Graft-A Comparative Study

Introduction: Myringoplasty is the surgical procedure to repair tympanic membrane perforations and thereby improving hearing, providing a dry ear, and reducing susceptibility to infections. Although there are many kinds of techniques and graft materials used, no methods have proven indisputably superior to the other. Therefore, to find out the outcome of myringoplasty using temporal fascia and sliced tragal cartilage in chronic inactive mucosal otitis media was set as an objective of the study. Materials and Methods: This cross-sectional observational study was conducted at the department of Otolaryngology &amp; Head-Neck surgery, Shaheed Suhrawardy Medical College Hospital (ShSMCH) for six months from July 2018 to December 2018, after acceptance of the protocol and approval from IRB. Patients attending in the ShSMCH with complaints of chronic inactive mucosal otitis media were approached for inclusion of the study and final selection were done in according to the selection criteria. Ethical issues were ensured properly throughout the study period and inclusion was confirmed following signing written informed consent. All patients were randomly allocated into two groups where one group were received myringoplasty with temporalis fascia graft and another group received sliced tragal cartilage. Total 50 patients (25 patients in each group) were included, and they were subjected to details history taking, physical examination and necessary investigations. The researcher conducted all the interview and collected data were recorded into a case record form for each patient. Data analysis was done by SPSS 17. Results: Of total, 50 study population, mean age of the 32.30±10.93 SD (years) with 58% male and 42% females respectively. No significant age and gender difference is noted across the group (p&gt;0.05). Patients having temporal fascia graft had significantly higher proportion of graft uptake in comparison to patients having sliced tragal graft (p&lt;0.05). Both groups of the patient improve significantly in term of hearing after operation (p&lt;0.05 in each group) but comparison in between groups showed that the improvement was significantly higher in temporal fascia graft group (p&lt;0.001). Conclusion: Myringoplasty with temporal fascia graft could be a better option than sliced tragal cartilage graft in our population. However, further larger study with longer follow up is necessary to finalize the comment. Medicine Today 2023 Vol.36 (1): 50-54

Kegiatan Pemeriksaan Fisik Kesehatan Telinga dalam Rangka Deteksi Dini Otitis Media Supuratif Kronik pada Populasi Lanjut Usia

Maintaining overall body health, including ear hygiene, is very important. The ear is an important organ in the human balance and hearing system. The human ear has self-cleaning capabilities, facilitated by cerumen, which occurs naturally to protect and keep the ear canal moist. However, too much or too little cerumen production can cause complaints such as decreased hearing, itching, and dry ear canals. Cleaning your ears yourself, which often involves inserting objects into the ear canal, can be dangerous. Improper use of cotton buds can push the cerumen deeper, causing blockages and increasing the risk of injury. This activity employs the PDCA (Plan-Do-Check-Act) method to conduct ear health screening for cerumen and tympanic membranes on 61 participants at the Hana Nursing Home. The physical examination results revealed that we could not assess 6 (9.8%) right tympanic membranes, 8 (13.1%) left tympanic membranes, 19 (31.1%) right ear canals, and 21 (34.4%) right ear canals. The participant's left has prop cerumen. Increased awareness and physical examination of the ear, as early detection can improve ear health and prevent ear injury.

Moisture relationships among conventional and brown‐midrib corn hybrids for silage

AbstractMuch of the corn acreage in New York state is harvested as corn silage and moisture assessment in the field is necessary for predicting harvest timing, but moisture estimation visually is very problematic, particularly for brown‐midrib (BMR) hybrids. Our goal was to assess plant moisture relationships between BMR and conventional (CONV) corn hybrids, and to identify metadata that may assist in the prediction of whole plant moisture based on ear moisture estimations. In 2023, 202 corn fields were sampled in central New York from August 18 to September 27. A total of 41 different corn hybrids were sampled, with relative maturity (RM) ranging from 84 to 112 days, and 29% of the fields sampled were planted to BMR hybrids. Five representative plants per field were evaluated for plant height, ear length and width, and ear, stover, and whole plant moisture. Estimation of dry ear:stover ratio would be helpful in estimating whole plant moisture based on ear moisture. Ear length was not related to ear:stover ratio, while plant height and ear width were weakly but significantly correlated with ear:stover ratio. Ear moisture was highly correlated with ear:stover ratio (BMR, r = −0.95; CONV, r = −0.90), and highly correlated with whole plant moisture (BMR, r = 0.97; CONV, r = 0.98). Ear moisture averaged 1 to 2% units lower throughout the sampling season for BMR compared to CONV hybrids, while stover moisture averaged 1 to 2% units higher for BMR compared to CONV hybrids prior to optimum harvest moisture. Whole plant moisture declined about 0.6%units/day and was relatively similar across RM groups.

Surgical Treatment for Troublesome Mastoid Cavities: Canal Wall Reconstruction With Bony Obliteration Versus Subtotal Petrosectomy.

A chronically discharging modified radical mastoid cavity may require surgical intervention. We aim to explore two techniques. To compare outcomes of subtotal petrosectomy (STP) and canal wall reconstruction with bony obliteration technique (CWR-BOT). Retrospective cohort study. A tertiary referral center. All patients with a chronically discharging mastoid cavity surgically treated at the Radboud University Medical Center by STP or CWR-BOT in 2015 to 2020, excluding patients with preoperative cholesteatoma. Dry ear rate, audiometry, and rehabilitation. Healing time, number of postoperative visits, complications, cholesteatoma, and need for revision surgeries. Thirty-four (58%) patients underwent STP, and 25 (42%) CWR-BOT. A dry ear was established in 100% of patients (STP) and 87% (CWR-BOT). The air-bone gap (ABG) increased by 12 dB in STP, and decreased by 11 dB in CWR-BOT. Postoperative ABG of CWR-BOT patients was better when preoperative computed tomography imaging showed aerated middle ear aeration. ABG improvement was higher when ossicular chain reconstruction took place. Mean follow-up time was 32.5 months (STP) versus 40.5 months (CWR-BOT). Healing time was 1.2 months (STP) versus 4.1 months (CWR-BOT). The number of postoperative visits was 2.5 (STP) versus 5 (CWR-BOT). Cholesteatoma was found in 15% (STP) versus 4% (CWR-BOT) of patients. Complication rate was 18% (STP) and 24% (CWR-BOT) with a need for revision in 21% (STP) and 8% (CWR-BOT), including revisions for cholesteatoma. STP and CWR-BOT are excellent treatment options for obtaining a dry ear in patients with a chronically discharging mastoid cavity. This article outlines essential contributing factors in counseling patients when opting for one or the other. Magnetic resonance imaging with diffusion-weighted imaging follow-up should be conducted at 3 and 5 years postoperatively.

EFFECTIVENESS OF PLANTING TIME ON GROWTH AND PRODUCTION OF SWEET CORN (zea mays saccharata sturt) AND PEANUT (Arachis hypogaea)IN AN INTERCROPPING SYSTEM

The effectiveness of planting time on the growth of production of sweet corn (zea mays saccharata sturt) and peanut (Arachis hypogaea) in an intercropping system, Ruly awidiyantini and Lia Kristiana, Agrotechnology Study Program, Faculty of Agriculture, Islamic University of Madura. peanuts is by several planting treatments and spacing. This study aims to determine the response of several planting treatments and plant spacing to the growth and production of maize (Zea mays) in an intercropping system with peanuts. The research method used a completely randomized design (CRD) consisting of 3 treatment levels, namely P0 planting at the same time, P1 planting a difference of 1 week and P2 a difference of 2 weeks. Parameters observed were plant height (cm), number of leaves (strands), weight of wet ear (g), and weight of dry ear (g). The results showed that the effectiveness of several treatments and planting time of sweet corn (Zea mays) in the peanut intercropping system gave a very significant effect on the parameters of sweet corn height, number of leaves, weight of wet cobs and weight ofdry cobs but had no significant effect on number of branches peanuts. The planting time treatment was still the most effective in responding to sweet corn (Zea mays) in the peanut intercropping system.

Diagnosis and treatment of congenital stenosis of external auditory canal with external auditory canal cholesteatoma complicated with exudative effusion in the middle ear and mastoid process

Background The optimal timing for surgery to promote postoperative recovery in children with congenital stenosis of the external auditory canal with external auditory canal cholesteatoma, who are susceptible to exudative inflammation of middle ear and mastoid process, is still uncertain. Objectives To investigate the treatment of congenital stenosis of external auditory canal with external auditory canal cholesteatoma complicated with exudative inflammation. Material and Methods A retrospective analysis of 45 patients with congenital stenosis of external auditory canal with external auditory canal cholesteatoma complicated with mastoiditis. Based on whether effusion had resolved at the time of surgery, the patients were divided into two groups. Pure-tone audiometry tests were performed before and after surgery for both groups. Results The average postoperative duration of dry ear was 36.38 days in Group 1 and 47.90 days in Group 2 (p < 0.05). Among patients who underwent hearing reconstruction, the average air conduction threshold decreased by 15–36 dBHL in Group 1 and by 7–22 dBHL in Group 2 (p < 0.05). Conclusions and significance The postoperative outcomes of dry ear and hearing improvement can be enhanced by performing operation after effusion resolution in cases of congenital external auditory canal stenosis with external auditory canal cholesteatoma exudative inflammation.

A comparative study of hearing outcome in cholesteatoma surgery canal wall up versus canal wall downmastoidectomy in 100 patients

Cholesteatoma is a well-demarcated sac of keratinizing squamous epithelium in the temporal bone, which is commonly characterized as “skin in the wrong place. The major goal of surgery for cholesteatoma is to make the ear safe and dry with increasing concern of the hearing outcome of patients. Two main surgical techniques employed are Canal Wall down (CWD) and Canal Wall up Mastoidectomy (CWU). In the current study, an attempt would be made to evaluate which technique would be better for achieving disease clearance with favorable hearing outcome and dry ear.1. To evaluate the hearing results following CWU and CWD surgery in patient with cholesteatoma.2. To decide surgical approach according to extension of disease.Materials and Methods:This is a prospective study involving 100 patients with cholesteatoma who had undergone CWD and CWU surgery over the period of 3 years.The choice of mastoidectomy, CWD or CWU, was the decision of the surgeon, after completely evaluating the patient, preoperatively and intraoperatively. All cases were followed up &amp; assessed by autoscopic examination &amp; PTA for minimum of 3 months. In the CWD group, mean hearing gain, in 3 months was 12±1.73dB. In the CWU group, hearing gain in 3 month postoperative period was 18±2.06 dB. Also the hearing gain between the two groups was compared and it was found to be statistically significant for the 3 months (p=0.0002) postoperatively; signifying that there was a comparable difference for CWU over CWD mastoidectomy in the matter of Hearing Gain. SNHL was also seen post operatively in both group. Total 3 (6%) patient in CWU had SNHL post operatively in comparison to 7(14%) patients in CWD. From our study results, we think that CWU is superior to the CWD surgery in cases of cholesteatoma because of good post-operative hearing outcome as well as less complication and law morbidity. CWD surgery should be used in cases of extensive cholesteatoma, mental retardation, not sure about follow up and inadequate middle ear space cases.

The socio-demographic determinants of the outcome of type 1 cartilage tympanoplasty in children: Results from a tertiary-care teaching institute in India.

To explore whether and how the established socio-demographic parameters pertaining to a lower-middle income nation influence the outcome of cartilage tympanoplasty in children with chronic otitis media (COM), inactive mucosal variety. In this prospective cohort study, children aged 5-12 years with COM (dry, large/subtotal perforation) were considered for type 1 cartilage tympanoplasty following definite selection criteria. Relevant socio-demographic parameters were noted for each child. These included parents' education (literate/illiterate), living area (slum/village/others), mothers' occupation (laborer/business/housewife or home-maker), family type (nuclear/joint), and monthly family income. Outcome at 6 months follow-up was interpreted as "success" (favorable; anatomically intact and well-epithelialized neograft and dry ear) and "failure" (unfavorable; residual or recurrent perforation and/or discharging ear). The role of individual socio-demographic factor in determining the outcomes was analyzed with relevant statistical methods. The average age of the 74 children included in the study was 9.30±2.13 years. At six months, 86.5% had a successful outcome, with a statistically significant hearing gain (closure of the air-bone gap) of 17.02±8.96dB (p=.003). Mothers' education had a significant influence on the success rate (Chi: 4.13; significant at p<.05); children of ∼97% of the literate mothers had a successful outcome. Living area was significantly associated with success (Chi: 13.94; significant at p<.01); ∼90% of children living in the slum areas had success, compared to 50% of those residing in villages. The family type also significantly influenced the surgical outcome (Chi: 3.81; significant at p<.05); ∼97% of the children belonging to the joint families encountered success, compared to ∼81% of those brought up in the nuclear families. The success also depended on the mothers' occupation (Chi: 6.47; significant at p<.05); ∼97% of the housewife mothers had children who were successful, against ∼77% of mothers engaged as laborers. Another factor significantly associated with success was the monthly household income. Nearly 97% of the children belonging to families with a monthly household income of >₹3000 (cut-off limit set by the median value) experienced success, in contrast to 79% of those having a monthly family income of <₹3000 (Chi: 4.83; significant at p<.05). Socio-demographic parameters are valuable determinants of the outcome of surgical management of COM in children. For type 1 cartilage tympanoplasty, mothers' education and occupation, family type, living area, and monthly family income significantly influenced the surgical outcome.

Efficacy of combination of acetic acid and ciprofloxacin eardrops versus only ciprofloxacin eardrops in achieving dry ears in chronic suppurative otitis media

BackgroundAs per WHO, the chronic inflammatory condition involving the middle ear and mastoid cavity, resulting in recurrent ear discharge, otherwise known as otorrhoea, through perforation of the eardrum or tympanic membrane, is known as chronic suppurative otitis media (CSOM). Recurrent middle ear infections are known to produce a myriad of intracranial and extracranial complications. CSOM is considered a biofilm disease, wherein biofilms are found to be the most prevalent microbial form, playing a crucial role in the chronicity of the infections and observed resistance to antibiotics. Thus disruption of the biofilm layer is necessary for the management of CSOM. This can be achieved by aural toileting and topical 2% acetic ear drops.AimTo study the efficacy of the combination of acetic acid and ciprofloxacin eardrops versus only ciprofloxacin ear drops in achieving dry ears in chronic suppurative otitis media.Materials and methodsSixty-three patients diagnosed with CSOM (mucosal type) were randomly divided into two groups: Group A — who received both 2% acetic acid and ciprofloxacin ear drops and Group B — who received only Ciprofloxacin ear drops; thrice daily. Additionally, both groups received systemic oral antibiotic being tab. ciprofloxacin 500 mg twice daily for 14 days. Weekly follow-up was done for 2 weeks and compared on the basis of otological symptom score.ResultsBoth combination of acetic acid with ciprofloxacin and only ciprofloxacin ear drops significantly reduced the amount of ear discharge (P < 0.001) by the second visit, but the reduction in the amount of otorrhoea in Group A was found to be more significant than in Group B (P = 0.014). Also, the former was significantly more effective in achieving and maintaining dry ears by the third visit (P < 0.001).ConclusionCombination of acetic acid and ciprofloxacin ear drops was found to be more effective than only ciprofloxacin ear drops in achieving and maintaining dry ears while treating CSOM.

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.

MYRINGOPLASTY: SURGICAL OUTCOME AND HEARING IMPROVEMENT IN TERTIARY CARE HOSPITAL

Myringoplasty is one of the commonly performed otologic surgery. Myringoplasty is surgical repair of the tympanic membrane. There are various indications for the myringoplasty, mostly to stop recurrent otorrhea, improve hearing and for social reasons. The aim of our study was to evaluate surgical outcome of myringoplasty in terms of graft uptake and hearing improvement in tertiary care hospital. METHODS: It is a prospective observational study conducted in tertiary care hospital from June 2022 to December 2022. All patients underwent underlay myringoplasty under local anesthesia by single surgeon. The preoperative PTA of patients were compared with postoperative PTA. ABG closure was also calculated. Graft take-up was evaluated at 1 and 3 months. RESULTS: The 96 patients underwent myringoplasty of which 52% were females and 48% were males with mean age of 39.5 years. The graft uptake rate was 97% and average improvement in AC after surgery was 10dB. The average ABG closure after surgery was 8db at 3 months. CONCLUSION: Myringoplasty is a safe otologic surgical procedure which helps the patients to have a dry ear and improve hearing. Myringoplasty have shown high success rate in terms of graft uptake, AC improvement and ABG closure in tertiary care center.

Overall outcome of Modified Radical Mastoidectomy (MRM)

Aims: To compare overall findings of our Modified Radical Mastoidectomy (MRM) practice with the available contemporary standards of international recognition. Design and Methodology: The cohort included the patients who underwent Modified Radical Mastoidectomy from 2013 to 2018 by the author, who were subjected to a retrospective study. The details obtained from clinic reports were preoperative and postoperative hearing (documented to the end of the fourth post op year), and findings that were documented intraoperatively and post operatively in successive clinic visits. The parameters analysed were hearing improvement, disease extension, anatomical variations, immediate and late post-operative complications. Result: There were no evidence of recurrence following the surgical intervention. Postoperative mean air-bone gap had reduced by 9.5dBHL, 5dBHL, 7.44dBHL, 4.9dBHL, 4.1dBHL, 3.75dBHL and 8.18dBHL at 0.125kHz, 0.250kHz, 0.5kHz, 1kHz, 2kHz, 4kHz and 8kHz respectively. Disease involvement was found in Attic, Antrum, Sinus tympani, facial recess, mesotympanum, oval window and posterior sinus, supra tubal recess, sinodural angle cells, sinus sub tympanum, external ear canal, in the descending order of occurrence. 36 audited patients achieved dry ears by the end of second year though some had at least one intermittent wet episode and 4 had continuous persistent wet ears. Intraoperative findings analysis showed 2.5% were observed with perilymph leak, 27.5% had erosion of malleus head by disease, 55% had erosion of incus, 90% intact suprastructure, 97.5% had intact stapes foot plate, 15% had significant dural overhang, 10% had exposed facial nerve, 10% had anterior sigmoid sinus and 2.5% had exposed dura. Immediate post intraoperative complications of 7.5% HB grade 1 facial nerve palsy, 42.5% taste alteration, 5% CSF leak, 25% complaining of disturbing head ache, 7.5% having exposed dura (iatrogenic), 7.5% had dressing removed due to risk of pressure necrosis of pinna or developing Facial nerve palsy and 2.5% (one) patient had the meatus migrating downward due to a connective tissue problem of skin. During post-operative period stitch abscess was noted among 5%, achieved self-cleaning dry ear in 15%, wax build up in the dry ear in 10%. However, over 50% patients had minimum of 1 episode of wet ear in this period. Meatal stenosis and keloid development was noted among 10% and, graft perforation among 20% and 2.5% (one) wound dehiscence. During post-operative period 7.5% developed BBPV and similar percentage had caloric effect during packing of the cavity while 22.5% developed caloric effect during suction of the cavity. Conclusions: The improvements in hearing when adjunct with Tympanoplasty in this audit keep up with recent compared studies. Further its ability to safely achieve a disease free ear is endorsed and complemented by the low complication rates.

Outcomes of canal wall down mastoidectomy in cholesteatoma: a 5-year experience

BackgroundCholesteatoma is an atticoantral disease that potentially causes life-threatening complications. Therefore, canal wall down mastoidectomy is a well-established technique to eradicate the disease, especially in extensive cholesteatoma.AimTo evaluate the status of dry ear and hearing outcome post-retrograde canal wall down mastoidectomy.MethodsA retrospective study of patients with cholesteatoma who underwent modified radical mastoidectomy (MRM), a form of canal wall down mastoidectomy between January 2014 and December 2018.ResultsFifty-seven patients were included with a mean age of 40 years. The majority of cases were adults, 86%, and 14% were children. Most of them complained of ear discharge (73.7%), followed by hearing loss (31.6%). Intraoperatively, cholesteatoma was primarily found in cases involving mastoid air cells, antrum, attic, and mesotympanum (47.4%). The presence of granulation tissue with cholesteatoma was noted in 57.9% of cases. Furthermore, 73.7 % of ossicular chain erosion cases involved erosion of all ossicles (47.6 %). In 26.3 % of cases, tegmen erosion was identified. Facial canal dehiscence accounted for 15.8% of MRM cases, sclerotic mastoid was noted for 10.5%, and lateral semicircular canal dehiscence involved 5.3%. Up to 3 months of follow-up post-MRM showed 70.2% had a dry ear. After 6 months, there were 15.8% complaints of ear discharge in the subsequent follow-up. In this study, 33 out of 57 patients underwent a postoperative hearing evaluation, and 21.2 % of patients showed an improvement in the air-bone gap.ConclusionCanal wall down mastoidectomy is a treatment of choice in extensive cholesteatoma to achieve a dry and safe ear with maintaining functional hearing outcomes.