Dry Perforation Research Articles

Endoscopic Type 1 Tympanoplasty: Evaluation of Clinical Success and Hearing Improvement.

This study aimed to assess the functional and clinical outcomes of endoscopic Type 1 tympanoplasty in patients with chronic otitis media and tympanic membrane perforations, focusing on hearing improvement and graft success rates. This retrospective study included 46 patients with dry tympanic membrane perforations who underwent endoscopic Type 1 tympanoplasty. Audiometric data, including pure tone averages (PTA) and air-bone gap (ABG) measurements at four frequencies (500, 1000, 2000, and 4000 Hz), were collected preoperatively and postoperatively. Functional success was defined as a postoperative ABG of 20 dB, whereas the integrity of the graft determined clinical success. The mean preoperative ABG was 36.74±7.62 dB, which significantly improved to 15.05±3.82 dB postoperatively (p<0.001). The PTA exhibited an average gain of 28.17±6.87 dB for all frequencies. Functional success was achieved in 42 patients (91.30%), with 17 patients (36.96%) achieving normal hearing and 22 patients (47.83%) presenting with slight hearing loss postoperatively. Anatomical success was achieved in 42 patients (91.30%). Endoscopic Type 1 tympanoplasty is a safe and effective surgical method for treating chronic otitis media, with high rates of both functional and clinical success, significant improvements in hearing outcomes, and minimal postoperative complications.

Platelet rich fibrin augmented tympanoplasty versus cartilage tympanoplasty: a randomized clinical trial.

The aim of the current study was to evaluate the efficacy of PRF-augmented fascia tympanoplasty versus cartilage tympanoplasty in repair of large TM perforations. This randomized clinical trial included 156 patients with dry large tympanic membrane perforations. Patients were randomly allocated into 2 groups, cartilage tympanoplasty group (n = 77) and platelet rich fibrin (PRF) augmented tympanoplasty group (n = 79). Graft take rates, hearing outcomes, operative time, and postoperative complications were documented and compared. Graft take rate was 96.1% in the cartilage group and 93.7% PRF group with no statistically significant difference. Operative time was significantly longer in the cartilage group. No differences in the hearing outcomes and postoperative complications were reported. Application of PRF on the fascia in tympanoplasty promotes healing of the tympanic membrane. PRF is safe, cheap, readily available, and easily prepared and applied. It increases the success rates of large tympanic membrane perforations without the need for cartilage grafts.

Plasminogen - safe for treatment of chronic tympanic membrane perforation: a phase 1 randomized, placebo-controlled study

Background There is a need for a simpler and accessible intervention to heal tympanic membrane perforations than myringoplasty that is todaýs golden standard. Experimental studies have identified plasminogen as a promising agent for medical treatment of chronic tympanic membrane perforation. Aims/Objectives This was a phase 1, prospective, randomized, placebo-controlled study with the main objective to evaluate the safety of injecting plasminogen in the vicinity of the tympanic membrane in subjects with chronic tympanic membrane perforation. Material and Methods Adults diagnosed with a dry chronic tympanic membrane perforation were recruited for an injection schedule with Human plasminogen 10. Adverse events, audiometry, VAS fluctuations and size of perforation, were monitored throughout the length of the study. Results It was possible to perform the injections according to schedule in all subjects. None of the subjects experienced any severe adverse events. Most common adverse event was ear pain. No signs of ototoxicity were reported. Conclusions and Significance This pilot study suggests that plasminogen injections close to the tympanic membrane as treatment for chronic tympanic membrane injections are safe and feasible, encouraging further dose-escalating studies.

A Novel Combined Cartilage-Fascia Technique for Anterior Perforation in Type-1 Underlay Tympanoplasty

Background: Biomaterials and surgical techniques for reconstructive tympanic membrane surgery are under development. Objectives: The objective of this study is to analyze the functional and surgical outcomes of a novel fascia with cartilage reinforcement technique for anterior tympanic membrane perforation in tympanoplasty. Methods: Records of 198 patients with anterior tympanic membrane perforation who underwent tympanoplasty between August 2018 and March 2021 were prospectively reviewed. Patients with dry anterior quadrant perforations of the tympanic membrane were included and underwent tympanoplasty using two methods: Type 1 tympanoplasty with temporalis fascia only, and tympanoplasty with fascia and cartilage reinforcement. Postoperative functional and surgical outcomes were analyzed. Results: Comparing the pre-operative and post-operative air conduction levels and air-bone gaps showed significant improvement in both groups (P &lt; 0.001). Additionally, no significant difference was observed between air-bone gap closure (P = 0.316) and increase in air conduction levels (P = 0.222) according to graft type. Conclusions: Both temporalis muscle fascia and temporalis muscle fascia with cartilage reinforcement revealed satisfactory functional and surgical outcomes. Furthermore, the novel combined cartilage-fascia technique had a comparable graft take rate and hearing results in anterior perforations, with no significant change in tympanic membrane vibratory properties.

Comparative study of endoscopic underlay myringoplasty with or without tucking of the attached perichondrium graft when repairing large central dry perforations

ObjectiveTo compare the graft success rates and hearing outcomes of underlay myringoplasty with or without perichondrium tucking of the attached perichondrium, graft perforation margins when repairing chronic large central dry perforations. Study designRandomized controlled trial. Material and methodsChronic large central dry perforations were prospectively randomized to tucking perichondrium graft underlay (TPGU) and no-tucking perichondrium graft underlay (NTPG) groups. The graft outcomes and complications were compared between the two groups at 12 months postoperatively. ResultsIn total, 61 patients with large central dry perforations were included. All patients completed 12-month follow-ups. Residual perforations occurred in 0.0 % of the TPGU group and in 12.9 % of the NTPG group (P = 0.129), and re-perforations occurred within 6 months in 0.0 % and 3.2 % of the two groups, respectively (P = 0.987). The graft success rates were 100.0 % (30/30) and 83.9 % (26/31) (P = 0.067). No significant between-group differences were observed in terms of preoperative (P = 0.547) or postoperative (P = 0.612) air bone gaps (ABGs) or mean ABG gains (P = 0.597). No graft-related complications were observed in either group during follow-up. No patients exhibited significant graft blunting or medialization; graft lateralization was noted in one patient of the NTPG group. ConclusionsEndoscopic cartilage with tucking of the attached perichondrium perforation margins during underlay myringoplasty may improve the graft success rate compared to that of the cartilage push-through technique when repairing large central dry perforations; however, the hearing improvements were comparable in the two groups.

Otitis media sequelae and hearing in adolescence after administration of an 11-valent conjugate pneumococcal vaccine in infancy: a prospective cohort study with long-term follow-up of the ARIVAC trial

Pneumococcal conjugate vaccines (PCVs) have been shown in randomised controlled trials and epidemiological studies to prevent acute otitis media caused by vaccine serotype pneumococci, although their role in preventing complications of acute otitis media is less clear. We hypothesised that the 11-valent PCV would reduce the long-term sequelae of acute otitis media, including moderate-to-severe ear disease and hearing loss. This prospective cohort study, referred to as 11PCV study, included follow-up after 16-20 years of children previously enrolled in 2000-04, at age 6 weeks to 6 months, in the randomised, placebo-controlled, ARIVAC trial of 11-valent PCV for the prevention of radiographical pneumonia. The ARIVAC trial and this 11PCV study were conducted at six study centres in Bohol, Philippines. Ear disease was classified using video-otoscopy review and observations derived from the ear exam. The final classification of the worst ear disease was mild (ie, acute otitis media, otitis media with effusion, healed perforation, or tympanosclerosis), moderate (ie, dry perforation or adhesive otitis media), or severe (chronic suppurative otitis media). Hearing loss was assessed following a standard schema and classified according to the worst ear as mild (>15 to 30 dB puretone average) or moderate-to-profound (>30 dB pure tone average). We calculated the relative and absolute risk reduction in the primary outcome of moderate-to-severe ear disease and the secondary outcomes of mild or moderate-to-profound hearing loss in adolescents who previously received the 11-valent PCV compared with those who received placebo during infancy in ARIVAC. Of the 15 593 children assessed for eligibility in ARIVAC, 12 194 were randomly assigned and 8926 were alive and could be located for enrolment in this 11PCV study between Sept 19, 2016, and Dec 13, 2019. 8321 (4188 in the vaccine group and 4133 in the placebo group) completed follow-up of the 11PCV study by March 30, 2020, and had sufficient data to classify ear disease and be included in the primary outcome analysis. The primary outcome of the absolute risk reduction in moderate-to-severe ear disease in the vaccine group (310 [7·4%] of 4188) versus those in the placebo group (356 [8·6%] of 4133) was 1·2% (95% CI 0·0-2·4; p=0·046) and the relative risk reduction was 14·1% (0·0 to 26·0). There were no differences in secondary outcomes of mild hearing loss or moderate-to-profound hearing loss between the vaccine and placebo groups. The absolute risk reduction for moderate-to-severe ear disease in adolescence of 1·2% (12 per 1000 children) was almost three times higher than the 0·45% reduction (4·5 per 1000 children) in radiographical pneumonia in the first 2 years of life shown in ARIVAC. Administration of 11-valent PCV in infancy was associated with absolute and relative risk reductions in the sequelae of acute otitis media 16-20 years after the original ARIVAC trial. Bill & Melinda Gates Foundation.

Validation and cross-cultural adaptation of the Arabic version of the Ear Outcome Survey-16 (EOS-16).

The Ear Outcome Survey-16 (EOS-16) has been validated according to the health-related quality of life (HRQol) survey guidelines. It has important compatible aspects in evaluating patients with chronic otitis media (COM) suitable for consultation. This study aimed to develop and standardize the Arabic version of the EOS-16 to be used by clinicians in the Arab world while maintaining the conceptual equivalence. A prospective cross-sectional study was conducted in Damascus between July 2023 and November 2023 to develop an Arabic version of the EOS-16. The translation was produced according to the cross-cultural adaptation guidelines. Both experts' and participants' opinions as regards face validity were obtained in this study. Internal consistency was evaluated by the Cronbach alpha coefficient. Test-retest reliability was assessed using the intraclass correlation coefficient (ICC) and Pearson correlation. A total of 81 patients enrolled in the study, with an average age of 34.75 years and a standard deviation of 11.84 years with a sex ratio of 0.62 for females. All had inactive mucosal COM (dry perforation). The overall score of the EOS-16 survey was 31.72 with a standard deviation of 13.42 suggesting bothering and influencing symptoms in COM patient's daily life. Excellent internal consistency was noted (Cronbach α = .89). Robust correlation was found between test-retest overall scores (r = .90). Reallocation of the items of the EOS-16 improved the internal consistency of the subdivisions in COM patients. The Arabic version of the EOS-16 is a simple, clear, reliable, reproducible, and valid HRQoL survey. It is a useful and important instrument that helps physicians in making decisions regarding the patient's treatment and follow-up.

Outcomes of Minimally Invasive Tympanoplasty: Fat Graft Myringoplasty.

Fat tympanoplasty is repair of small dry tympanic membrane perforations using fat as graft material. It is a simple office procedure with minimal morbidity and manipulation of the middle ear. The present study was a prospective review of 60 patients who underwent fat tympanoplasty over the period of 15 months. In all the patients fat was harvested from ear lobule. Patients were kept on follow up for 3 months and evaluated for graft uptake and hearing gain. 86.66% closure rate of tympanic membrane defect was achieved. Postoperative air conduction was 29.6 ± 5.3 while air bone gap was 13.2 ± 6.1. The study concludes that fat plug myringoplasty is a simple, quick, less invasive method to repair small tympanic membrane defects.

Pediatric Myringoplasty using the Periosteum: An Institutional Overview.

Introduction Myringoplasty is a common otologic procedure to restore the integrity of the tympanic membrane in cases of traumatic or pathologic perforations. Many grafting materials have been used with different techniques. Objective In the present work, we evaluate the surgical and audiological outcomes of periosteal graft overlying the mastoid cortex through a retroauricular incision in a pediatric cohort. Methods A retrospective study was carried out involving all children aged ≤ 16 years who underwent periosteal graft myringoplasty for the treatment of chronic suppurative otitis media with dry central perforation in our hospital from April 2019 to April 2021. All patients were followed up for one year to assess the anatomical success and functional outcomes by comparing the preoperative and postoperative (after six months) results of pure tone audiometry (PTA). Results The sample was composed of 36 patients; 20 of them were female (55.6%) and 16 were male (44.4%) subjects, with ages ranging from 7 to 16 (mean: 12.7) years. Four patients underwent surgery in both ears (with an interval of 6 to 9 months). Out of 40 surgeries performed, 38 ears have shown anatomical success (95%). A highly significant improvement in hearing was obtained (the mean difference between the pre- and postoperative results of the PTA was of 14.6 ± 3.45 dB ( p < 0.001). Conclusion We advocate the use of periosteal graft in the pediatric population as a good alternative for other types of grafts, with comparable and even better functional and anatomical outcomes.

Endoscopic transcanal underlay myringoplasty using a platelet-rich fibrin (PRF) membrane

BackgroundTympanic membrane perforations are among the most common indications for otological surgery. Surgeons from all around the world have made accidental and intentional contributions to find the perfect graft material and the best approach to perform tympanoplasty. Platelet-rich fibrin (PRF) use in myringoplasty has been popular in the last decade among many surgeons. We aimed to evaluate the efficacy of using PRF only as a graft material in myringoplasty.MethodsWe conducted a prospective study including 20 patients with dry central tympanic membrane perforations. The patients underwent endoscopic transcanal myringoplasty using a platelet-rich fibrin membrane by underlay technique. Follow-up was done 3 months postoperatively regarding graft uptake and hearing outcome by audiological assessment using pure tone audiometry.ResultsSixty percent of patients were surgically successful with complete healing of the tympanic membrane, 10% were partially successful with partial healing of the tympanic membrane, and 30% failed with complete loss of graft. The mean air-bone gap closure was 3.5 dB. No major complications were reported.ConclusionEndoscopic myringoplasty using platelet-rich fibrin alone can be performed in cases with tympanic membrane perforations as an alternative to using other autologous grafts. It is a new reliable method for myringoplasty, as well as being an easy, time-saving procedure that avoids the need for any skin incision.

Advancement in Tympanic Membrane Repair: Exploring the Potential of Platelet Rich Fibrin.

To assess the effectiveness of the autologous plasma-rich fibrin plug technique for repairing small tympanic membrane perforations. Platelet rich fibrin (PRF) is also called second generation platelet rich plasma due to its high amount of growth factors which could be used in tympanic perforation closure. Being autologous, it is readily available with no immunogenic reactions. PRF membrane has a strong elastin fibrin structure containing growth factors and hence can be considered as an ideal sealing material or an adjuvant to the graft in repairing tympanic membrane perforations. Ours is a prospective study. A total of 52 patients with dry small tympanic membrane perforation were included in the study. In this technique, 10ml of blood is withdrawn from the patient, processed in a centrifuge machine, and platelet-rich fibrin (PRF) is separated from the mixture for use in the repair of small tympanic membrane defects. Out of the 52 patients, 42 experienced successful repair (full closure) of the tympanic membrane. The mean time of closure of the perforation was around 2weeks. However, five of them encountered failure. Although the size of the perforation decreased compared to the preoperative size. Additionally, two patients developed granulations on the tympanic membrane. No major side effects were noted. Autologous PRF is a product derived from whole blood through the process of centrifugation. It is safe and effective in promoting the natural process of wound healing by incorporating a high concentration of platelet-derived growth factors as well as fibrin into the graft mixture. This facilitates the rapid healing of tympanic membrane perforation.

Platelet Rich Fibrin Graft in Myringoplasty: Pitfalls and Challenges.

Autologous Platelet-rich fibrin (PRF) is an amalgam of fibrin mesh, platelets and growth factors that favour wound healing. It can be easily used as a graft material in myringoplasty, making it a promising, easy to harvest and cost effective alternative compared to cartilage or fascia graft used in conventional myringoplasty. 50 patients of small to medium, dry central perforation underwent myringoplasty using PRF graft (Group 1). Results were compared to 50 patients with similar small to medium perforations who underwent conventional transcanal myringoplasty using temporalis fascia graft (Group 2): Outcome of surgery was measured by closure of perforation and improvement in hearing at 3 months. In group 1, overall closure rate was 70% while in group 2 it was 96%. For both small and medium perforations healing was significantly higher in group 2 compared to group 1, (100% vs 87.5%) for small perforations and (95.45% vs 66.67%) for medium perforations. Hearing gain was comparable in both groups in patients in whom healing of perforation occurred. PRF stands as a suitable graft material for closure of small perforations, but, lack of rigidity and early disintegration of the graft makes it less suitable for larger perforations compared to other conventional grafts such as temporalis fascia.

To Study the Outcome of Cartilage Tympanoplasty Type I in Patients with Medium and Large Perforations Using 0.5mm Sliced Conchal Cartilage Reinforced with Temporalis Fascia Grafts with 5 Years Follow-up.

To study the outcome of cartilage tympanoplasty type I in patients with medium and large perforations using 0.5mm sliced conchal cartilage reinforced with temporalis fascia grafts with 5 years follow-up. Retrospective clinical study. 120 patients with dry tympanic membrane perforation medium and large size and intact ossicular chain, and with no history of previous ear surgery were selected. An underlay type one tympanoplasty, using 0.5mm sliced conchal cartilage reinforced with temporalis fascia, was performed during 2018-19. A successful anatomical outcome was considered to comprise full, intact healing of the graft without perforation these patients were evaluated for at least 5 years post-operatively till 2023. In this study graft uptake rate was 95.33% for medium size and 93.66% for large perforations at 3 months and after 5 years of follow-up 92.77% medium size and large size perforations were 89.67.66% (P < 0.001). Residual perforations were there in about 7.29% in medium and 10.33% in large size perfrations. Sliced conchal cartilage reinforced with temporalis fascia is a reliable technique for tympanoplasty, with improved graft uptake results in medium and large perforations in the long-term, also the residual perforations is significantly lower.

Full-thickness versus sliced cartilage in type I tympanoplasty, comparative study

IntroductionThe use of cartilage in type I tympanoplasty is associated with concern about a poor audiological outcome. Slicing the cartilage could be a tool to overcome such a feared problem.ObjectiveTo compare the healing and hearing outcomes of using sliced cartilage to full-thickness cartilage in type I tympanoplasty.MethodsSeventy patients with small to medium-sized central dry tympanic membrane perforation were included in this prospective study. The patients were randomly assigned to one of these two groups: group A: full-thickness cartilage tympanoplasty was done, and group B: partial thickness cartilage tympanoplasty was done. The assessment of healing and hearing was done at 3 and 12 months postoperatively.ResultsThe healing was achieved in 88.2% and 90.9% in group A and group B, respectively. In group A, the mean ABG was 23.44 dB preoperatively and 14.2 dB, and 12.6 dB in the first and second follow-ups, respectively. In group B, preoperative ABG was 23.58 dB compared to 7.9 dB and 6.93 dB in the two follow-ups, respectively. The results were significantly better in group B rather than group A at both follow-ups.ConclusionHearing results are better when sliced cartilage is used in tympanoplasty type I than full-thickness cartilage.

Transcanal Microscopic vs Endoscopic Type 1 Tympanoplasty in Dry Central Perforation: A Comparative Retrospective Study

Transcanal Microscopic vs Endoscopic Type 1 Tympanoplasty in Dry Central Perforation: A Comparative Retrospective Study

Ear health and hearing in urban Aboriginal children

ObjectiveEvaluate ear health and hearing among urban Aboriginal children and quantify relationships with child, family and social factors. MethodsBaseline questionnaire and ear health examinations from 1430 children with diagnoses (0.5-18 years) attending Aboriginal Health Services enrolled in SEARCH. Ear health outcomes were Otitis Media (OM), and hearing loss (three-frequency average hearing loss >20dB) diagnosed using pneumatic otoscopy, tympanometry, and audiometry. ResultsHalf the children 0.5-3 years had OM (51.5%, 136/264). One third 0.5-18 years (30.4%; 435/1430) had OM, including 1.8% (26/1430) with perforation (0.8% chronic suppurative OM, 0.6% dry perforation and 0.4% acute OM with perforation). One quarter 0.5-18 years (25.7%; 279/1087) had hearing loss; 12.4% unilateral, 13.2% bilateral (70.6% with bilateral loss had concurrent OM). OM was associated with: younger age (0.5-<3 years versus 6-18 years) age-sex-site; adjusted prevalence ratio (aPR)=2.64, 95%, 2.18-3.19); attending childcare/preschool (aPR=1.24, 95%CI, 1.04-1.49); foster care (aPR=1.40, 95%CI, 1.10-1.79); previous ear infection/s (aPR=1.68, 95%CI, 1.42-1.98); and ≥2 people/bedroom (aPR=1.66, 95%CI, 1.24-2.21). Hearing impairment was associated with younger age (0.5-<6 years vs. ≥6 years aPR=1.89, 95%CI, 1.40-2.55) and previous ear infection (aPR=1.87, 95%CI, 1.31-2.68). ConclusionsHalf the urban Aboriginal children in this cohort had OM and two-thirds with hearing impairment had OM. Implications for Public HealthFindings highlight importance of early detection and support for ear health, particularly in pre-school-aged children with risk factors.

Plasma-Rich Fibrin-Regenerative Material in Tympanic Membrane Surgery.

Background and Objectives: Platelet-rich fibrin (PRF) membrane plays an important role in cell proliferation and aids in healing. This study aimed to assess the safety and efficacy of the addition of PRF to the graft in tympanoplasty. Materials and Methods: A retrospective study was conducted involving 47 patients with chronic dry eardrum perforation, who were candidates for different types of tympanoplasty (type I-IV). The study took place in the ENT department, County Emergency Clinical Hospital of Cluj-Napoca. In group 1 (27 patients) tympanoplasty was performed with a cartilage graft, while in group 2 (20 patients) a cartilage graft was used with the addition of a PRF membrane. The PRF clot was extracted and transformed into a thin membrane. Postoperative evaluation included otoendoscopy and otomicroscopy at 1, 3, 6, and 12 months after surgery, as well as pure-tone audiometry at 12 months. Results: Postoperative follow-up at 1, 3, 6, and 12 months showed a higher rate of graft survival in the PRF group than in the non-PRF group. At the 12-month mark, a successful outcome was observed in 95.0% of patients in the PRF group, while the success rate in group 1 was 70.4% (p < 0.05). The postoperative hearing threshold value was statistically significantly lower in the group with PRF, compared to the non-PRF group, being 18.4 ± 10.4 dB and 27.6 ± 16.2 dB (p < 0.001), respectively. Although the postoperative air-bone gap value did not differ significantly between groups, there was a greater improvement in the PRF group (p < 0.7). The PRF was well tolerated, and the incisions healed perfectly. Conclusions: The PRF membrane increases the rate of autograft survival and is therefore an effective material for patients with chronic perforations of the tympanic membrane.

A Comparative Study to Determine Hearing Outcome in Type 1 Tympanoplasty With and Without Canaloplasty in Tubotympanic Type of Chronic Suppurative Otitis Media.

Chronic suppurative Otitis Media is a common ear infection in India. Canaloplasty done with tympanoplasty helps to remove bony overhangs and provide complete visibility of fibrous annulus of tympanic membrane. 1. To determine the hearing outcome in chronic otitis media (mucosal type) patients undergoing type 1 tympanoplasty with canaloplasty. 2. To determine the hearing outcome in chronic otitis media (mucosal type) patients undergoing type 1 tympanoplasty without canaloplasty. 3. To compare the hearing outcome in the above mentioned 2 groups of patients. 56 patients of 15-60 years of age with mucosal type of Chronic otitis media, with central dry perforation and intact ossicles were included in our study. They were divided into group 1 (type 1 tympanoplasty + canaloplasty) and group 2 (type 1 tympanoplasty without canaloplasty), on alternate basis. AC, BC, Air bone gap avg was assessed via pure tone audiometry at 4 frequencies preoperatively and postoperatively at 3rd and 6th month, % closure of ABG average was calculated. Type 1 tympanoplasty along with canaloplasty has better hearing improvement in pure tone audiometry compared to type 1 tympanoplasty alone, as % closure of ABG at postoperative 3rd and 6th month holds significant. The canaloplasty provides better surgical exposure via removing bony overhangs, aids in excellent functional outcome in the form of % closure of ABG. Hence canaloplasty is added as an adjunct to routinely performed aural surgeries to enhance hearing outcome.

An Investigation on the Fibrin Glue's Impact on Myringoplasty's Success Rate: A Randomized Controlled Study

Objective: The study's goal is to evaluate the success rates of graft uptake in platelet-rich fibrin-assisted underlay myringoplasties employing temporalis fascia grafts to those in traditional underlay myringoplasties. Methods: This study was conducted in Mayo Hospital in Lahore's ENT department carried out this double-blind, randomized, controlled trial investigation. We recruited 60 individuals with dry central tympanic membrane perforations. Patients with co-morbidities such as diabetes and sensorineural hearing loss were not included. Probability basic random sampling was used. The patients were split into two groups using a lottery system. With the help of SPSS version 26, statistical analysis was carried out. The P-value was calculated using the chi-square test. Results: There were 60 patients, of whom 38 were males and 22 were women. The control group's average age was 27.53 ± 11.41 years, but the study group's average age (Fibrin) was 31.77 ± 12.43 years. At the 2-month follow-up, the grafts were successfully absorbed by every patient in the platelet-rich fibrin group. 23 out of 30 patients in the control group who underwent the conventional method successfully absorbed their grafts, however, the remaining 7 patients had different issues that led to graft rejection. Practical Implication: The tympanic membrane would mend more quickly if platelet-rich fibrin was used after ear procedures. Fibrin glue in tympanoplasty has been tried in several locations throughout the globe. [7,8] When concentrated fibrinogen solutions are combined with thrombin, fibrin glue is created. It may also be made from platelet-rich plasma. Our research compares platelet-rich fibrin-assisted underlay myringoplasties employing temporalis fascia grafts to traditional underlay myringoplasties to see which has a higher graft uptake success rate. Conclusions: The use of platelet-rich fibrin on the anterior ligament grafting line and perforation edges during underlay myringoplasty has greatly increased the success rate of the graft. Keywords: platelet-rich fibrin, temporal fascia graft, myringoplasty

A PROSPECTIVE OBSERVATIONAL COMPARATIVE STUDY FOR POST OPERATIVE RESULTS IN ENDOSCOPIC TYMPANOPLASTY V/S MICROSCOPIC TYMPANOPLASTY

Objective: Chronic suppurative otitis media is a widespread disease in developing countries. Hence treating CSOM with surgical treatment by tympanoplasty is the commonest procedure in ENT practice. In this study we aim to study the advantages and disadvantages of microscopic and endoscopic tympanoplasty. This study also aims to compare the merits and demerits of microscopic and endoscopic tympanoplasty. A Prospective Subjects And Methods: observational study for endoscopic tympanoplasty and microscopic tympanoplasty was conducted on 102 patients of age 20-60 years attending OPD and admissions under the Department of otorhinolaryngology and M.Y.H Hospital, Indore. Subjects with dry central perforation due to CSOM were selected for microscopic tympanoplasty. Similar subjects were selected for Endoscopic tympanoplasty except those with tortuous anatomy of external ear canal. Patients with unsafe CSOM, SNHL, and active infection were excluded. In our study majority (44%) of patients Results: belonged to age group of 25-35 years. Most of the patients were having medium central perforation ( MCP) (32%) followed by subtotal perforation (22.5%). Small central perforation (SCO) 19%, Large central perforation (LCP) 18%, Total perforation 10% respectively. According to quadrant involving perforation which is mainly AIQ, followed by Anterior superior quadrant ( ASQ), Posterior inferior quadrant (PIQ) and posterior superior quadrant (PSQ). Mean operative time for Endoscopic tympanoplasty procedure was 56+/-15 mins with SD of 12.05 and for microscopic tympanoplasty procedure was 117.8+/- 20 mins with SD of 7.17 having a p value (0.0003) which was found to be significant. Conclusion: In our study, we have concluded that endoscopic tympanoplasty scores over microscopic tympanoplasty. Endoscopic tympanoplasty has helped patients achieve faster recovery, a shorter hospital stay, and a lower financial burden, which was especially helpful for developing countries like ours. Unlike the microscope, the endoscope is easily transportable and hence is ideal for use in remote places to conduct ear surgery camps.