Dry Ear Research Articles

A comparative study of temporalis fascia versus tragal perichondrium graft in myringoplasty

<p class="abstract"><strong>Background:</strong> This study aimed to compare the efficacy of temporalis fascia and tragal perichondrium grafts in myringoplasty and to assess the hearing improvement following surgery.</p><p class="abstract"><strong>Methods:</strong> This was a clinical prospective study involving 50 patients of chronic suppurative otitis media inactive mucosal disease who were assigned to two groups. Group I was temporalis fascia group and group II was tragal perichondrium group and subsequently underwent myringoplasty. Patients were followed up at 3 and 6 months.</p><p class="abstract"><strong>Results:</strong> There was a preponderance of ear disease among children, with a male to female ratio of 1:1.63. Preoperative dry ear for 1-6 months was associated with 82.9% success rate (group I 76.5%, group II 87.5%). Patients with cellular mastoids were associated with 100% success rate.</p><p class="abstract"><strong>Conclusions:</strong> In this study we found that patients with cellular mastoids and dry ear for 1-6 months were associated with higher success rates. The study also revealed that in terms of hearing gain postoperatively, the temporalis fascia graft fared slightly better than the tragal perichondrium graft. Tragal perichondrium and temporalis fascia grafts appear to have almost similar graft take rates.</p>

A Multicenter Retrospective Case Review of Outcomes and Complications of S53P4 Bioactive Glass.

Objective:The objective of this multicenter retrospective case review was to assess the natural clinical course, efficacy, and safety of mastoid obliteration with S53P4 Bioactive Glass (bioactive glass).Methods:Retrospective case note review in a regional Tertiary Referral Centre and District General Hospital. Patients undergoing mastoid cavity obliteration as part of primary or secondary procedure with bioactive glass between 2012 and 2018. Outcome measures were assessed from a prospectively collated database and case note review. Primary outcomes were the common morbidities of a mastoid cavity; dry or discharging ear (Merchant’s scale), vertigo in cold air, and a watertight middle ear. Patients were also assessed for audiological outcomes and recidivism.Results:Ninety patients were included. During the follow-up period, (mean, 22 months; range, 6-59 months) cholesteatoma recidivism was observed in 2% of ears (2 patients). An acceptably dry (Merchant Grade 0-1) ear was achieved in 91% of all ears (95% primary cases, 80% secondary cases). Delayed healing of the graft in the external ear canal retaining the S53P4BAG Bioactive Glass (BonAlive Ò (BonAlive Ò Biomaterials Ltd., Turku, Finland)) within the mastoid occurred in 13% (12 ears). However, in all cases, conservative management resulted in complete healing.Conclusions:Bioactive glass provides a safe and effective means of mastoid obliteration. Complications including overlay graft failure and slow epithelialization, resulting in prolonged postoperative discharge (up to 2 months) and dehiscence into the external ear canal, do not preclude full recovery and may be successfully managed conservatively.

Microbiology of Chronic Otitis Media and Shifting Trends of Its Antibiotic Susceptibility: A Prospective Observational Study in a Tertiary Care Institute of Western Rajasthan.

COM is a prevalent disease in lower socio-economic group mainly of a developing country. COM in active stage presents with a discharging ear. The mucopus from an active ear, when put through microbiological culture, yields a variety of aerobic and anaerobic bacteria as well As fungi. Antibiograms provide us with culture specific antibiotics. The study aims to identify prevalent microbes in our region and their sensitivity towards respective antibiotics. A total of 100 patients diagnosed with active COM in the E.N.T. outpatient department of M.D.M. Hospital, Jodhpur from July 2019 to December 2019 were enrolled. 100 swabs were obtained, one from each patient, using sterile cotton swabs and cultured for microbial flora. Antibiotic susceptibility testing of bacterial isolates was done using Kirby-Bauer disc diffusion method. The most common organism isolated were Pseudomonas spp. (58%) and Staphylococcus aureus (25%), while 8% were fungal isolates. The sensitivity pattern of Pseudomonas spp. was maximum for meropenem while that of Staphylococcus species was maximum for linezolid and vancomycin. Both were fairly sensitive to amikacin, cephalosporins and Quinolones. Culture specific antibiotics help us achieve dry ear faster and better. There is a drifting trend in antibiotic susceptibility of both aerobic and anaerobic species, towards higher group of antibiotics. Thereby suggesting emergence of multi-drug resistant strains.

A comparative study of the outcome of tympanoplasty in dry and wet ear

<p class="abstract"><strong>Background:</strong> Many factors which influence the success rate of tympanic membrane closure, including age of the patient, size of the perforation, duration of the ear discharge, the presence or absence of infective discharge at the time of surgery. Aim was to find the effect of this discharge from the ear on the success of tympanoplasty. </p><p class="abstract"><strong>Methods:</strong> This is prospective study which was conducted on 100 cases with 50 patients each in dry and wet ear group. The study was conducted on patients of age 6 years to 60 years and of either sex presenting with chronic otitis media. </p><p class="abstract"><strong>Results:</strong> Ear discharge for less than 10 years, 78% in dry ear group and 81% in wet ear group. Around 64% had hearing impairment for<5 years in dry ear group and 60% in wet ear group. The size of perforation in dry ear group, medium size perforation was found predominant 46%, large in 42% and small in 12% patients. In wet ear group 46% patients had medium, 16% patients small and 38% patient’s large perforation. Hearing improvement seen in 35 (70%) cases and worsening in 3 (6%) cases in dry ear group and 38 (76%) hearing improvement, 3 (6%) worsening in wet ear group.</p><p class="abstract"><strong>Conclusions:</strong> Graft failure was 4(8%) in dry ear and 5(10%) in wet ear. Hearing worsened in 6% cases in dry and wet ear group both. No other complications were seen in patients during follow up.</p><p class="abstract"> </p>

Comparison of Endoscopic Cartilage Myringoplasty in Dry and Wet Ears With Chronic Suppurative Otitis Media.

This study compared the rate of graft success, as well as hearing improvement and dry ear time between dry ears and wet ears with otomycosis or without otomycosis in patients with chronic suppurative otitis media (CSOM) after endoscopic cartilage myringoplasty. This retrospective study was conducted in a tertiary hospital in Shanghai. In total, 83 patients with CSOM (43 with dry ears and 40 with wet ears) were included. Among the 40 patients with CSOM and wet ears, 25 exhibited otomycosis. All patients underwent endoscopic myringoplasty, and perforations were repaired using tragal cartilage with a single-sided perichondrium. Patients were followed up for at least 6 months. Pure-tone hearing was examined preoperatively and at 3 months postoperatively. The graft uptake rate, hearing improvement, and dry ear time were compared between the groups. The graft success rate did not differ significantly between the dry-ear and wet-ear groups (95.35% and 90.00%, respectively). Furthermore, the graft success rate also did not differ significantly between patients with wet ears and otomycosis and those with wet ears without otomycosis (92.00% and 86.67%, respectively). Hearing gain did not differ significantly between the dry-ear and wet-ear groups. No significant difference in hearing gain was also found in patients with wet ears with or without otomycosis. However, the time to dry ear was significantly longer in the wet-ear group than in the dry-ear group. Patients with CSOM and wet ears required more time to achieve a completely healthy status. However, the graft success rate and hearing improvement were not affected by a wet middle ear and otomycosis. Thus, endoscopic myringoplasty using tragus cartilage is an effective treatment for refractory CSOM in patients with wet ears and otomycosis.

Secondary Obliteration Surgery for Troublesome Mastoid Cavities: A Prospective Series of 228 Pediatric and Adult Cases.

To present the results of a 15-year longitudinal study in a pediatric and adult population with secondary obliteration of troublesome mastoid cavities. Prospective longitudinal study. Children (≤16 yrs) and adults who had obliteration surgery (228 ears) between 2000 and 2017. Therapeutic. Tertiary referral center. 1) Incidence of recurrent or residual cholesteatoma; 2) creation of a dry ear at 5 years postsurgery; 3) postoperative complications; 4) waterproof status of ear; 5) number of subsequent ear surgery required. Thirty-one pediatric and 197 adult cases contributed to the study. At 5 years 11 of 98 (10.8%) had been lost to follow-up. Using Kaplan-Meier survival analysis, the residual rate after 5 years was 4.2% (95% CI: 0.3%-8.2%) and the recurrence rate was 1% (95% CI: 0.0%-3.0%). Of the 223 ears available for assessment, 209 (93.7%) achieved a dry state, 6 (2.7%) had intermittent discharge, 6 (2.7%) had flap necrosis requiring flap trimming, and 1 (0.4%) developed meatal stenosis. Using a cross-sectional analysis at 12 months of follow-up, the otorrhea risk was 19.2% and the risk of definitive waterproofing was 10.9%. There was a reoperation risk of 10% within 5 years which included second-stage ossiculoplasty. Secondary mastoid obliteration is a safe and useful technique in treating the troublesome mastoid cavity in both children and adults. It is associated with a low cholesteatoma recidivism rate and high rate of a trouble-free ear in the long term.

Post-operative healing and long-term stability after mastoid cavity reconstruction using the middle temporal artery and inferior musculoperiosteal flaps.

This study aims to evaluate the surgical outcomes with the use of a combination of the middle temporal artery (MTA) flap and the inferior musculoperiosteal (IMP) flap for mastoid obliteration after canal wall down mastoidectomy. Seventy-five patients who have undergone canal wall down mastoidectomy and mastoid obliteration with the MTA and the IMP flaps at a single tertiary hospital were included. Surgical outcomes measured included the creation of a dry mastoid cavity as measured by a previously developed semi-quantitative scale, mastoid cavity epithelization time, rate of revision surgery needed, and rate of recurrent cholesteatoma. Patients were followed up for a median of 29months. The median time to epithelization of the mastoid cavity was 2 months. At 1 and 3 months, 36.0% and 76.0% of patients had grade 0 and grade 1 cavities, respectively, with either a dry cavity or one or less episodes of mild otorrhea or sensation of wetness. Hundred percent of the patients achieved a grade 2 (more than one episode of otorrhea or the presence of granulation tissue that promptly resolved with simple treatment) or better cavity at 3 months. One patient re-presented with a grade 3 cavity with uncontrolled infection and daily otorrhea secondary to an attic perforation that manifested at 6 months, requiring revision surgery. There were no recurrent cholesteatomas during the follow-up period. The use of the MTA and the IMP flaps for mastoid obliteration may be considered as an adjunct to achieving a safe, dry ear after canal wall down mastoidectomy.

Topical versus systemic antibiotics for chronic suppurative otitis media.

Topical versus systemic antibiotics for chronic suppurative otitis media.

Tympanoplasty for Wet and Dry Perforation: A Prospective Comparative Study

Introduction Two types of surgical procedures are performed for the treatment of Chronic otitis media (COM) mucosal disease, namely myringoplasty and tympanoplasty. In the present study, an objective, comparative evaluation between the outcomes of tympanoplasty, performed in the ‘wet ear’ and the ‘dry (non- discharging) ear’ has been undertaken. Materials and Methods A prospective study was conducted in a peripheral referral institute over a period of 37 months wherein a total of 105 patients with tympanic membrane perforation were selected, amongst which 56 patients had moist ear and 49 patients had dry ear. All of the patients underwent tympanoplasty by underlay technique. Final results were analyzed 12 months post operatively. Results In the wet ear group amongst 56 patients, 51 patients had successful graft uptake (91.07%). In dry ear group, among 49 patients, successful graft uptake was seen in 44 cases (89.79%). In the wet ear group 50 out of 56 patients had hearing improvement (89.28%). In dry ear group 44 out of 49 patients had hearing improvement (89.79%). Statistically significant results were obtained postoperatively in each group; however, inter group analyses showed no statistical significance. Conclusion Success rate of tympanoplasty does not depend upon the wet or dry state of middle ear at the time of surgery.

Systemic antibiotics for chronic suppurative otitis media.

Systemic antibiotics for chronic suppurative otitis media.

Evaluation and comparison of tympanoplasty efficacy with tympanic membrane perforation after chronic suppurative otitis media in dry ear with different microorganisms

ObjectiveTo investigate the distribution of pathogenic bacteria in patients with tympanic membrane perforation after chronic suppurative otitis media (CSOM) in dry ear and its influence on the success rate of tympanoplasty and postoperative infection. Methods740 patients with tympanic membrane perforation after CSOM underwent endoscopic tympanoplasty were selected. The mucosal surface secretion of middle-ear was collected for bacterial culture and drug sensitivity test. The patients were followed up several times from 1 week to 3 months after the surgery. Results740 cases of ear secretions samples, raise the pathogens of 208 cases (28.1%), the success rate of surgery with microorganism grown and with no grown was 93.8% and 91.5%. fungus (14.6%) was the most species among the patients with the positive result, followed by methicillin-sensitive Staphylococcus aureus (4.1%), Pseudomonas (2.0%), Staphylococcus epidermidis (1.9%), methicillin-resistant Staphylococcus aureus (1.6%) and so on. There was no statistical difference in the proportion of perforation and infection in each group. There were no statistically significant differences in gender, age and duration of disease among the groups. ConclusionThere were still microbial colonization in patients with tympanic membrane perforation after CSOM in dry ear, include fungus, Staphylococcus aureus and Pseudomonas aeruginosa. Different microbial colonization had no influence on the success rate of tympanoplasty and postoperative infection.

Comparison of Efficacy of Topical Ciprofloxacin Ear drops (0.6%) Versus a Combination of Systemic with Topical Ciprofloxacin in Treating Chronically Discharging Ears

Objective: To compare the efficacy of topical ciprofloxacin alone, versus a combination therapy ofsystemic with topical ciprofloxacin(0.6%) in achieving dry ears in active mucosal chronic otitis media after two weeks of treatment. Methods: After obtaining permission from ethical committee of Hospital, an over-all of 150 patients (with 75 subjects each, divided into two groups) were included in this study. In Group-A: Topical Ciprofloxacin ear drops (0.6%) 3-4 drops were instilled three times a day, 8 hours apart for 2 weeks. In Group-B: Tab Ciprofloxacin 500mg was given twice a day, 12 hours apart for 14 days along with topical Ciprofloxacin ear drops (0.6%) 3 drops were used thrice a day, 8 hours apart for 14 days. Results: Patients ranged between 15-45 years of age. Mean age of the patients was 30.3±7.4 and 29.2±7.7 years. In group-A, there were 41 males (54.7%) and in group-B 49 males (65.3%). Females were 34 (45.3%) in group-A and 27 (36%) in Group-B. Mean duration of ear discharge was 5.3±1.1 months in group-A while 5.5±1.4 months in Group-B. We could not find any substantial variation among the two group in terms of efficacy (p=0.249). Stratification with regard to age, gender and duration of ear discharge was also carried out. Conclusion: Results of this study showed that topical ciprofloxacin ear drops (0.6%) were equally effective as systemic ciprofloxacin combined with topical ciprofloxacin (0.6%), for treating chronically discharging ears. Keywords: CSOM, ciprofloxacin, nature of discharge

Effect of Underwater Insertion on Intracochlear Pressure

Background: The importance of intracochlear pressure during cochlear electrode insertion for the preservation of residual hearing has been widely discussed. Various aspects of pre-insertional, intra-insertional, and post-insertional relevant conditions affect intracochlear pressure. The fluid situation at the round window during electrode insertion has been shown to be an influential factor.Aims/Objectives: The aim of the study was to compare various insertion techniques in terms of the fluid situation at the round window.Material and Methods: We performed insertion of cochlear implant electrodes in a curled artificial cochlear model. We placed and fixed the pressure sensor at the tip of the cochlea. In parallel to the insertions, we evaluated the maximum amplitude of intracochlear pressure under four different fluid conditions at the round window: (1) hyaluronic acid; (2) moisturized electrode, dry middle ear; (3) middle ear filled with fluid (underwater); and (4) moisturized electrode, wet middle ear, indirectly inserted.Results: We observed that the insertional intracochlear pressure is dependent on the fluid situation in front of the round window. The lowest amplitude changes were observed for the moisturized electrode indirectly inserted in a wet middle ear (0.13 mmHg ± 0.07), and the highest values were observed for insertion through hyaluronic acid in front of the round window (0.64 mmHg ± 0.31).Conclusions: The fluid state in front of the round window influences the intracochlear pressure value during cochlear implant electrode insertion in our model. Indirect insertion of a moisturized electrode through a wet middle ear experimentally generated the lowest pressure values. Hyaluronic acid in front of the round window leads to high intracochlear pressure in our non-validated artificial model.

Successful paediatric tympanoplasy – An overview

Paediatric tympanoplasty is regarded by many as being less successful than in adults due to higher incidence of otitis media. In our study, we are trying to determine the pre-operative conditions that influence the success of paediatric tympanoplasty and construct a prognostic index for the same.To determine which pre-operative conditions or surgical technique may influence the success of pediatric tympanoplasty and to construct a prognostic index for the same.40 children between 8-15 years were included in this prospective study between June 2018- August 2019 in Department of ENT, in our institution. Pure Tone Audiograms were recorded pre and post operatively.The positive outcomes measured were integrity of tympanic membrane, minimum of 10decibel gain in auditory threshold and air filled space in middle ear. Higher success rate was observed in cases with elder age group (12-15 years), shorter duration of ear discharge, longer period of dry ear and small size of perforation.Tympanoplasty in children is a current and controversial theme. We have made a novice attempt to define factors that predict success or failure in paediatric tympanoplasty.

A prospective comparative study on the short-term effect of endoscopic myringoplasty in dry and wet ears

Objective:To investigate the success rate, dry ear time and hearing improvement of myringoplasty on chronic suppurative otitis media（CSOM） patients under dry and wet ear conditions. Method:Patients with CSOM who underwent endoscopic type Ⅰ tympanoplasty between January 2018 and October 2019 in West China Hospital were prospectively enrolled. Before the operation, Ear HRCT, oto-endoscope and pure tone audiometry were completed. According to whether there was mucus and purulent secretion of middle ear accompanied with edema of tympanic mucosa, patients were divided into wet ear group（32 cases） and dry ear group（69 cases）. All patients were followed up at half-month, 1 month and 3 months after surgery, with assessment of endoscopy and pure tone audiometry. SPSS 19.0 was used to compare the therapeutic effect of myringoplasty on different condition CSOM patients. Result:Compared with wet ear group, a higher level of perforation healing rate was found in dry ear group, but there was no significant difference between them（97.1% vs. 90.6%, P=0.367）. The rate of dry ear was 98.6% and 93.7% in dry ear group and wet ear group respectively within three months after surgery, among which the rate of dry ear was 14.5%, 52.2% and 31.9% in dry ear group in half month, 1 month and 3 months after surgery, while that in wet ear group was 28.1%, 40.6% and 25.0% respectively. There was no significant difference in the time to dry ear after surgery between the two groups（P=0.172）. Meanwhile, changes of air bone gap（ABG） between pre-operation and 3 months after operation in dry and wet ear groups was similar [（9.87±1.08） dB vs. （12.74±1.77） dB, P=0.154]. When included patients were analyzed as a whole, the ABG at 3 months was significantly lower than 1 month after operation（P<0.01）, similar result was also found when compared the ABG at 1 month after operation with pre-operation（P<0.01）. The air conduction threshold was improved from （42.09±1.74） dB HL before operation to （29.41±1.61） dB HL at 3 months after operation（P<0.01）, however, there was no significant change in bone conduction threshold（P=0.338）. Conclusion:There is no significant difference in the therapeutic effect of myringoplasty on CSOM patients under dry and wet ear conditions. Direct type Ⅰ tympanoplasty on wet ear patients has no adverse effect on the prognosis.

A Simple Technique to Obliterate Canal Wall Down Mastoid Cavity Concurrently in Squamosal Otitis Media: Our Experience.

Chronic suppurative otitis media is a type of otitis media defined as a long standing infection of a part or whole of the middle ear cleft. Squamosal type of CSOM involves parsflaccida characterised by the formation of cholesteatoma. The present study is retrospective analysis of records of patient who underwent canal wall down mastoidectomy with obliteration of cavity using posteroinferiorly based musculoperiosteal flap with autogenous cartilage and bone pate. Study include patients who underwent canal wall mastoidectomy with cavity obliteration at Tertiary care Hospital Yavatmal, Maharashtra, India; during 2year period of 2016-2018. 41 patients (42 ears) who underwent canal wall down mastoidectomy with cavity obliteration procedure were included and 06 patients were excluded as they failed to follow up. The outcomes were measured by Marchant et al. grading scale. As per the study it was observed that 88% (37 out 42 ears) got adequate control of infection with dry cavity, while 12% (5 ears) failed to attain dry ear. So it's been concluded that canal wall down mastoidectomy is an effective surgical procedure in management of squamosal type of CSOM and mastoid obliteration is proved technique to improve outcomes of canal wall down procedure. Technique used to develop posteroinferiorly based flap to obliterate cavity in our study is simple modification of routine surgical steps commonly practiced by otologist helpful in reducing cavity size and promoting healthy epithelization. Cavity obliteration technique used in study is very effective and simple to develop dry and trouble free cavity in around 90% cases.

Aural toilet (ear cleaning) for chronic suppurative otitis media.

Aural toilet (ear cleaning) for chronic suppurative otitis media.

The outcomes of endoscopic myringoplasty: elevating a tympanomeatal flap or not.

The aim of this study was to compare the differences between the no tympanomeatal flap approach and the tympanomeatal flap approach in endoscopic myringoplasty. A total of 132 patients with tympanic membrane perforation were randomly divided into two groups: the no tympanomeatal flap approach group (group A, 56 ears) and the tympanomeatal flap approach group (group B, 76 ears). A comparison between the two groups was made. The average operation time of group A was 36.00 ± 5.24 minutes, which was significantly shorter than that of group B, which was 43.89 ± 4.57 minutes (p = 0.002). The blood loss of group A was 5.08 ± 1.83 ml, which was significantly less than that of group B (9.67 ± 2.29 ml; p < 0.001). There were no differences in the degree of hearing improvement, the rate of hearing improvement, the dry ear time (when the external auditory canal and the operating cavity were dry) after operation and the success rate of tympanic membrane repair when compared between the two groups. Compared with group B, group A (no tympanomeatal flap approach) can achieve the same effect but has the advantages of a shorter operation time and less blood loss during the operation.

Topical antibiotics with steroids for chronic suppurative otitis media.

Topical antibiotics with steroids for chronic suppurative otitis media.

Online crop height and density estimation in grain fields using LiDAR

Crop height and density estimation ahead of the combine harvester have been investigated over the last 30 years, but they remain a challenge. LiDAR technology is increasingly being investigated for phenotyping and monitoring of cereals. However, so far, little has been published about the influence of laser mounting position and robust online measurement of height and density from a single LiDAR scan. Therefore, the influence of the angle and height of the LiDAR mounting on crop height and density estimation in wheat and barley was investigated in this study. Tests were conducted in different crop heights, densities, moisture levels and varieties. The crop height was estimated with a root mean squared error of 0.082 m at an angle of 90° between the LiDAR scanning plane and the horizontal. Two methods were compared for crop density estimation. The inter-percentile and the transversal variance method both successfully predicted the crop density, but the variance based method performed better with a coefficient of determination (R2) of 0.77 and a root mean squared error of 82 g [dry ears] m-2. When considering only one variety, the performance improved to reach an R2 of 0.8 and a root mean squared error of 44 g [dry ears] m-2. Variation in mounting angle of the sensor had less effect on the prediction accuracy than the mounting height.