Dry Tympanic Membrane Perforations Research Articles

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.

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.

Analysis of hearing improvement by various ossiculoplasty materials (autologous versus prostheses) in chronic otitis media patients

&lt;p class="abstract" style="display: inline !important;"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The main purpose of surgery in cases of chronic otitis media is to eradicate the infection and restore the middle ear hearing function. Both intact tympanic membrane and ossicular chain are essential for the restoration of hearing in these cases. The world of material science has provided otologists with array of biomaterials for middle ear reconstruction. The use of ossicular graft material in ossicular chain reconstruction has significantly improved hearing results after surgeries for chronic otitis media.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The study involved a total of 50 patients presenting with dry tympanic membrane perforation with ossicular disruption and air-bone gap (ABG) of &amp;gt;25 from July 2014 to December 2019. The patients were randomly allotted into two groups and they underwent tympanomastoidectomy with ossiculoplasty, in one group homologous incus was used as ossiculoplasty material and in the second group Teflon TORP/PORP was used as ossiculoplasty material.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The present study concluded that there was no inter-group difference in post-operative hearing outcome however the two groups individually noted significant post-operative improvement in hearing.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; In present study postoperative hearing improvement was similar in both groups. Although numerous approaches to ossicular reconstruction have been proven to be successful, no single technique has received universal acceptance.&lt;/p&gt;

DEGREE OF HEARING LOSS IN INACTIVE MUCOSAL CHRONIC OTITIS MEDIA AND ITS CORRELATION WITH SITE AND SIZE OF TYMPANIC MEMBRANE PERFORATION- AN OBSERVATIONAL STUDY

Background: Studies have persistently associated the site and size of the tympanic membrane (TM) with the magnitude of hearing loss;however,the results are mixed and inconclusive on the effect of the site of the perforation on the hearing loss. Therefore, we conducted the present study to investigate the relationship between the size and site of TM perforation and hearing loss in inactive mucosal chronic otitis media. Methods: We conducted a hospital-based observational, prospective study in the Postgraduate Department of Otorhinolaryngology, Head and Neck Surgery, Government Medical College Srinagar, and recruited 94 patients diagnosed to have inactive mucosal chronic otitis media with dry tympanic membrane perforation. In addition to the site and size of TM perforation, the magnitude of hearing loss was also estimated. Results: We recruited 94 subjects presenting acute otitis media with TP perforation. The mean age (±SD) of cases was 36.3(±4) and males showed a marginal over-representation over females (male to female ratio: 1.2:1). We observed a positive correlation of the size of TM perforation with the average hearing loss. Moreover, subjects having perforations in the posterior ear reported higher average hearing loss. Conclusion: We report a positive correlation of the size of TM perforation with the average hearing loss and subjects having perforations in the posterior ear reported higher average hearing loss. However, more replicative studies with a larger sample size are warranted to substantiate our findings.

MIDDLE EAR DISORDERS AMONG CLEFT LIP AND PALATE IN CHILDREN: A CONJOINT EXPOSITION

Objective: To analyze the frequency of middle ear disorders among the cleft lip and palate and association with hearing Loss.&#x0D; Study Design: Cross Sectional analytical study.&#x0D; Place and Duration of Study: Audiology Department of Cleft Hospital, Gujrat and ENT department of National Institute of Rehabilitation Medicine, Islamabad, from Oct 2018 to Mar 2019.&#x0D; Methodology: We recruited a sample of 100 cleft lip and palate children of both genders, aged 3 month to 12 years, using nonprobability sampling. Screening was performed with otoscopy, tympanometry and hearing assessment.&#x0D; Results: Out of sample population, 62% were males and 38% females with a mean age of 2.27 ± 2.73 years. The middle ear disorders were found to be 70%. Among these otitis media with effusion was the most common 43 (61.43%), followed by Acute otitis media 8 (11.43%) and Eustachian tube dysfunction 6 (8.57%). Tympanosclerosis and dry tympanic membrane perforation were the least common. Statistically significant association of hearing loss was found with the middle ear disorders (p&lt;0.001).&#x0D; Conclusion: Middle ear disorders especially otitis media with effusion are common in cleft lip/ palate children.

A STUDY ON CORRELATION OF SIZE AND SITE OF TYMPANIC MEMBRANE PERFORATION WITH DEGREE OF CONDUCTIVE HEARING LOSS IN CHRONIC OTITIS MEDIA

Background: Tympanic membrane perforations are common cause of hearing loss. This study was designed to analyze the relation between tympanic membrane perforation and conductive hearing loss. Materials and Methods: In this prospective study, patients with dry tympanic membrane perforations of safe type were included. The patients were divided into groups in according to size, site and duration of perforation. Based on the inclusion and exclusion criteria a total of 100 patients were included in this study. All the patients clinical data was analyzed statistically using paired t-test. Results:Hearing loss increased as the size of perforation increased. Posterior quadrant perforations were associated with more hearing loss as compared to anterior quadrant perforations. Also duration of disease was in linear relation with mean hearingloss. Conclusions: The degree of conductive hearing loss as a result of tympanic membrane perforation would be expected with the size, site and duration of perforation. Keywords: Tympanic membrane, Conductive hearing loss, Perforation, hearing loss, posterior quadrant, ear.

A study to compare the outcomes of CO2 laser assisted myringoplasty versus conventional type1 tympanoplasty in small central tympanic perforations

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The standard treatment of tympanic membrane perforation is conventional surgical closure using myringoplasty or a tympanoplasty type 1. In this study the role of cabon dioxide (CO&lt;sub&gt;2&lt;/sub&gt;)-laser-assisted de-epitheliazation of perforation margins and application of bioinert silastic sheet. Success rate was compared with conventional microscopic surgery.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was a comparative study containing 60 patients with small dry tympanic membrane perforation (diameter 1-3 mm). The causes of tympanic membrane perforations were mainly traumatic or the eardrum did not heal after spontaneous perforation caused by an acute otitis media or after surgery. The procedure was performed under local anaesthesia. CO&lt;sub&gt;2&lt;/sub&gt; (acupulse) applied along the edge of the perforation until complete de-epitheliazation and application of bioinert silastic sheet in small dry perforation. Closure of eardrum perforation was monitored using an otoendoscope. Success rate of the CO&lt;sub&gt;2&lt;/sub&gt; laser myringoplasty was compared with conventional type 1 tympanoplasty. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Complete eardrum closure occurred in 24 cases (80%), 06 patients (20%) had a residual perforation. The success rate of this procedure is lower than conventional type 1 tympanoplasty, which is 90-94%. There were no complications during and after the treatment.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; A closure rate of 80% (24/30) was achieved with a CO&lt;sub&gt;2&lt;/sub&gt;-laser-assisted de-epitheliazation. This procedure can be offered carefully to selected cases with perforation size &amp;lt;3 mm, where the CO&lt;sub&gt;2&lt;/sub&gt; facility is available before they undergo formal conventional microscopic surgery.&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

Comparative study between fat plug and inlay butterfly cartilage grafts for myringoplasty in adults

BackgroundThis study aims to compare the graft uptake rate and hearing improvement of fat graft versus inlay butterfly tragal cartilage in the repair of perforations in chronic otitis media mucosal in adults.In this retrospective study, twenty-eight patients were included with small dry anteroinferior tympanic membrane perforations (less than 1/3 of the tympanic membrane). The age range was 18 to 44 years old. Myringoplasty was done under general anesthesia for 8 patients with a fat graft (FG) and 20 patients with inlay butterfly cartilage graft (IBCG). Six months postoperatively, a follow-up evaluation was done for successful graft uptake and hearing outcomes.ResultsThe success rate of graft uptake in the first group (fat graft) was 6/8 cases (75%) while in the second group (IBCG) was 19/20 (95%) with no statistically significant difference (P = 0.0148). Also, there was no statistical difference between the two groups as regards postoperative ABG, improvement changes in ABG, and number of patients with improved hearing.ConclusionsInlay butterfly cartilage graft is a useful graft in repairing small tympanic membrane perforations as regard graft take and hearing outcomes.

Comparative study between post-aural and per-meatal approach type-1 tympanoplasty.

Objective: To compare the results after tympanoplasty between post-aural and per-meatal approach. Study Design: Comparative study. Setting: Social Security Landhi Hospital, Karachi. Al-Tibri Medical College &amp; Hospital (Isra University Karachi Campus), old thana Malir, Karachi. Period: July 2017 till June 2018. Material &amp; Methods: In this study, 76 Patients of both genders with dry tympanic membrane perforations were included. They were aged between 18 to 40 years. Period of research was one year, study was started since July 2017 till June 2018. Patients were distributed into two groups, group-1 and group-2. 38 patients were included in every group. In group-1, post-aural approach tympanoplasty was done. In group-2, per-meatal approach tympanoplasty was performed. Observed results of both procedures after 1st post-operated day, after 1st post-operated week, after 1st month and after 2nd month post operatively. Variables were intensity of pain, bleeding, PTA (Ac, BC and AB-gap measured by tympanometer) and duration (time period) of surgical procedure. Result: In group-1(post-aural approach tympanoplasty), out of 38 patients, 36 patients had intact grafted tympanic membrane while in group-2 (per-meatal approach tympanoplasty), 37 patients had intact grafted tympanic membrane and 1 patient had residual perforation. Smaller amount of bleeding was noted during surgery and post-operative in group-2, in comparison with group-1. All the dressing gauze were dry in per-meatal approach tympanoplasty group (group-2). Mean time period of surgery was less in per-meatal tympanoplasty (group-2) 65.1 + 3.7 mins and mean time period of post-aural tympanoplasty (group-1) was 82.0 + 5.6 mins. P value was found to be significant i.e. &lt; 0.001. Consumed time period of surgery was also decreased in per-meatal tympanoplasty (group-2). After tympanoplasty, hearing status was also enhanced on PTA in both groups. Post- operatively, it was observed that AB gap was reduced in both groups. On 1st post -operative day, Weber test was done, vibrating sound was heard (lateralized) in post-operated ears which ensured the safety of inner ear apparatus. Conclusion: Results of post-aural and per-meatal tympanoplasty were approximately same but per-meatal approach tympanoplasty is superior as it took shorter amount of time period, minimum post- operative pain and post- operative bleeding.

A study on chemical cauterisation for small tympanic membrane perforation

To study the effectiveness of chemical cautery with patching on chronic tympanic membrane perforations of the pars tensa. Thirty-eight patients with dry tympanic membrane perforations due to inflammatory or traumatic etiology were selected after treating the primary etiological factors like septal deviation and allergic rhinitis. Fifty percentage silver nitrate was used to cauterize the margin and the perforation was covered with thin sterile aluminium foil as a patch. A maximum number of five applications were made, and the patients were followed up for the next 5 years. In this series of 38 patients, highest success was noted among those patients with traumatic perforation, while larger perforations were reduced to small pinhole sizes which were successfully closed by myringoplasty. An overall success rate of 73.75% was achieved. This is a time tested useful method which was popularized by Derlacki (1953), to close small to moderate sized tympanic membrane perforation and should be considered as a first line management in the treatment of tympanic membrane perforation prior to any surgical intervention. Apart from being a simple and economical mode of treatment, it is associated with minimal complications. Though various materials have been used to modify this technique, the principle remains the same and the results obtained in this study is comparable with the previous ones.

Hearing assessment and status of tympanic membrane pre and post-operated tympanoplasty in cases of CSOM.

Objectives: To compare assessment of hearing by PTA and status of tympanic membrane by oto-endoscope, pre-operative and post-operative tympanoplasty. Study Design: Retrospective/ Comparative study. Setting: Two different hospitals in Karachi. 1-Social Security Landhi Hospital Karachi. 2- Al-Tibri medical College &amp; Hospital, Old Thana, Malir, Karachi. Period: July 2017 to June 2018. Material &amp; Methods: 76 patients were included for this study with both genders who had dry tympanic membrane perforations. Age ranges between 18 to 40 years. Made two groups A (pre-operative and B (post-operative). In group-A, examined tympanic membrane perforations. 45 patients had small size (25%) perforations, 15 medium size (50%) and 16 subtotal (75%). Hearing assessment done by Pure tone Audiometry (PTA). After 1. 2 and 3 months post-tympanoplasty, examined grafted tympanic membrane and compared pre-operated status of tympanic membrane with post-operated status of tympanic membrane. PTA done after 3 months and compared it with pre-operated PTA. Results: Examination of tympanic membrane before tympanoplasty performed, perforations noted in all patients with different sizes in their tympanic membrane. PTA (pure tone audiometry) advised before tympanoplasty to all patients. Weber test performed on 1st post-operated day, it was lateralized towards operated ear which indicate the safety of inner ear. Post-operated 1, 2 and 3 months examined tympanic membrane with oto-endoscope. Intact grafted tympanic membrane seen in 70 patients after 1 months. After 2 months 72 patients had intact grafted tympanic membrane and after 3 months 73 patients out of 76 patients had intact grafted tympanic membrane. PTA also advised after 3 months of tympanoplasty and compared it with pre-operated pure tone audiometry (PTA). Air conduction (AC) decreased 15.39dB after tympanoplasty. AB-gap reduction 13.95dB seen in 73 patients which showed hearing improvement. P value is &lt; 0.001 significant. Conclusion: Tympanoplasty is a good and safe procedure for hearing improvement by reduction of AB-gap as well as provide protection of middle ear mucosa from infections due to closure of perforations of tympanic membranes.

Comparative study between fascia lata and temporalis fascia in myringoplasty

BackgroundRepair of a perforated tympanic membrane (myringoplasty) can facilitate normal middle ear function, resist infection, and help re-establish normal hearing. Autogenous graft materials are the most popular graft materials used in myringoplasty because of their easy acceptability by the body. This study is conducted to compare between temporalis fascia graft and fascia lata graft in myringoplasty for patients with tubo-tympanic dry perforation.ResultsA total of 60 patients with persistent dry tympanic membrane perforation were included in our study during the period from January 2018 to May 2020. Patients underwent myringoplasty with temporalis fascia (30 patients as group A) or fascia lata (30 patients as group B). Patients were scheduled for follow-up visits concerning graft status, ear discharge, and audiograms. The mean postoperative air-bone gap in group A was 17.5 ± 4 after 1 month and 8.6 ± 6.9 after 3 months, while in group B, the mean postoperative air-bone gap was 17.6 ± 4.9 after 1 month and 9.4 ± 7.5 after 3 months. There was 90% success in graft uptake in group A, while there was 80% success in group B.ConclusionUsing temporalis fascia is still the best and most trustworthy technique of myringoplasty compared to fascia lata graft. However, fascia lata can be a good alternative to temporalis fascia especially in cases of revision myringoplasty, ears having large perforation, or near-total perforation where the chances of residual perforation are high because of the limited margin of remnant tympanic membrane overlapping the graft.

Comparison of results between cartilage tympanoplasty and temporalis fascia tympanoplasty.

Objectives: To compare the results after performing cartilage tympanoplasty and temporalis fascia tympanoplasty. Study Design: Analytical/Observational study. Setting: Two different hospitals. Social Security Landhi Hospital Karachi and Al-Tibri Medical College &amp; Hospital Malir Karachi. Period: July 2017 to June 2018. Material &amp; Methods: 76 patients were included for this study with both genders who had dry tympanic membrane perforations after taking antibiotics. Age ranges between 18 to 40 years. Patients were divided into two groups, group-I and group-II. In group-I, temporalis fascia tympanoplasty performed under microscope with post aural approach and in group-II, tragal cartilage tympanoplasty performed with the oto-endoscope via permeatal approach. Observed and compare the results of both procedure after 1 day, after 1 week, after 1 month and after 2 months. Variables were bleeding, pain, hearing assessment with pure tone audiometry (PTA) in which air conduction, bone conduction and air-bone gap (AB-gap) measured, Vomiting, vertigo and duration of surgery. Weber test done in all patients on very next day after surgeries in both groups to exclude the damage of vestibulo-cochlear system. Integrity of grafted tympanic membrane examined with oto-endoscope. Results: Weber test performed on 1st post-operated day, it was lateralized towards operated ear which indicate the safety of inner ear. Vomiting and vertigo not found after tympanoplasty in both groups which indicate the safety of vestibular system. There was no blood soaked guaze seen after tympanoplasty in group-II (cartilage tympanoplasty). Bleeding was less in group-II as compare to group-I. 37 patients out of 38 had intact grafted tympanic membrane in group-I while all (38) patients had intact grafted tympanic membrane in group-II. Mean duration of surgery was 65.1 +3.7 minutes in group-II (cartilage tympanoplasty) and mean duration of surgery was 82.0 + 5.6 minutes in group-I (temporalis fascia tympanoplasty). P value was &lt;0.001 is significant. Duration of surgery was less in group-II. Hearing was also improved in both groups after tympanoplasty. Post-operated AB-gap reduction seen in all patients of both groups. Conclusion: Results of both temporalis fascia and cartilage tympanoplasty were almost same but cartilage tympanoplasty is better because it consumed less time, less post-operated bleeding and perception of pain were also less.

Transcanal endoscopic myringoplasty: a retrospective study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Transcanal myringoplasty has the advantages of demanding lower operative time and minimal external incisions. It can be performed using the microscopic or endoscopic approach.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This retrospective study was conducted in the Department of ENT and Head and Neck Surgery, SMGS Hospital, Jammu from January 2018 to January 2020. Patients attending ENT OPD with central dry perforation of tympanic membrane were selected for endoscopic transcanal myringoplasty. Written and Informed consent were taken. During surgery, various parameters were noted including duration of surgery and hospitalization. These patients were followed through a period of 6 months and assessed using pure tone audiometry and graft uptake was seen. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of 40 patients, male: female ratio was 1.2:1. Time taken for surgery was less than 60 minutes in 16 (40%) patients whereas in 24 (60%) patients it was between 60-120 minutes. In our study the patients with small perforation had excellent graft uptake rates (18/19 patients, 94.73%), whereas patients with medium sized perforation showed graft uptake rate of 76.47% (13/17 patients). Objective analysis of cosmetic result was done at the end of six month and revealed that none of the patient had visible scar. Mean pre-operative air bone gap was 24.38 dB whereas mean postoperative air bone gap was 8.34 dB. Mean improvement comes out to be 16.04 dB.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Endoscopic myringoplasty was found to be equally effective, less morbid and very cost effective in small central perforations.&lt;/p&gt;

The utilization of Chronic Otitis Media Questionnaire-12 in chronic otitis media with or without cholesteatoma.

This study aimed to compare patients who had chronic otitis media with and without cholesteatoma in terms of the quality of life related to health. The Turkish version of the Chronic Otitis Media Questionnaire-12 (COMQ-12) was completed by totally 100 healthy subjects and 100 patients who had chronic otitis media (COM). The COM group was divided into cholesteatoma and without cholesteatoma [dry tympanic membrane perforation (TMP) and draining ear] groups. COMQ-12 score = 3.6 for healthy people. The average scores of dry TMP, draining ear, and cholesteatoma groups were 32.90, 27.34, and 45.95, respectively. A significant difference was between the cholesteatoma and without cholesteatoma groups in total scores (p = 0.001). No difference was found between the groups in age (p = 0.518) and gender (p = 0.975). The COMQ-12 could be a useful tool to differentiate chronic otitis media with or without cholesteatoma.

The Pretragal Superficial Musculoaponeurotic System Fascia: A New Graft Material for Transcanal Tympanoplasty.

To compare outcomes of transcanal endoscopic tympanoplasty reconstructed using pretragal superficial musculoaponeurotic system (SMAS) fascia versus temporalis fascia. Retrospective patient review and posttreatment questionnaire survey. Tertiary referral center. Sixty adult patients with chronic dry tympanic membrane perforation. Patients underwent transcanal endoscopic type I tympanoplasty reconstructed using the SMAS fascia between September 2017 and May 2018; outcomes were compared with a matched cohort of patients where the temporalis fascia was used. Tympanic membrane closure rate, audiogram threshold, duration of procedure, and donor site scar satisfaction survey. Sixty patients were included in this study and were evenly divided into the SMAS and temporalis fascia groups. These cohorts were matched for age, sex, side of lesion, perforation size, and preoperative hearing level. The closure rate was 96.7% (29/30) and 93.3% (28/30) (p = 1.0), mean hearing gain was 8.3 ± 6.4 dB versus 8.2 ± 7.1 dB for air-conduction (p = 0.970) and 7.6 ± 5.1 dB versus 8.2 ± 6.8 dB for air-bone gap (p = 0.716), and mean surgical duration was 137.3 ± 23.0 versus 132.2 ± 27.3 minutes (p = 0.432) for the SMAS and temporalis fascia groups, respectively; there were no statistically significant differences for all the parameters listed. The posttreatment questionnaire survey revealed significantly higher acceptance of the SMAS fascia method. This preliminary outcome report of SMAS fascia grafting in transcanal endoscopic type I tympanoplasty showed equivalent surgical outcomes and better cosmetic satisfaction compared with the temporalis fascia. The SMAS fascia is a reasonable alternative to conventional techniques for transcanal tympanoplasty.

Outcome of Myringoplasty in Underlay Technique

Background: Myringoplasty is one of the surgical techniques for the management of chronic supportive otitis media with permanent perforation of tympanic membrane. It is defined as simple surgical repair of tympanic membrane perforation without doing ossicular reconstruction.&#x0D; Objective: To determine the success rate of myringoplasty and to examine whether the hearing improvement is a potential indication for surgery.&#x0D; Methods: This study was conducted in the Department of Otorhinolaryngology and Head and Neck Surgery, Shaheed Suhrawardy Medical College Hospital from January 2017 to December 2017 and 100 patients who underwent myringoplasty in this period were analyzed. About 100 patients with dry central tympanic membrane perforations of various size were included in this study&#x0D; Results: Myringoplasty was performed in 100 patients. Male were (45%) and females were (55%).Twenty one (7%) of them belonged to age group of 10-20 years, 31 (31%) were in the age range of 21-33 years, 38(38%) were the age range 31-40 years while 24 (24%) aged between 41-50 years with mean age of 26.32 ±S.D 9.59 years. Overall success rate of graft uptake was noted in 88 (88%) out of 100 cases&#x0D; Conclusion: Myringoplasty is a safe surgical procedure in achieving intact tympanic membrane and to improve the hearing loss. Therefore, underlay technique being technically simple should be preferred, but the ultimate decision about the technique to be employed depends on the surgeons preference and the site of perforation&#x0D; Bangladesh J of Otorhinolaryngology; October 2018; 24(2): 131-136

Assessment of the role of otoendoscopy in evaluating Eustachian tube and middle ear status during myringoplasty

ObjectiveTo assess the role of otoendoscopy in evaluating Eustachian tube and middle ear status during myringoplasty.BackgroundEustachian tube function has been the center of focus as a prognostic factor for middle ear surgery success because of its primary role in the middle ear aeration and in the pathogenesis of otitis media. Otoendoscopic evaluation of Eustachian tube allows visualization of the protympanic segment of the Eustachian tube and hidden recesses of the middle ear.Patients and methodsIn this prospective study, patients with a persistent dry central tympanic membrane perforation were operated at Otorhinolaryngology Department of Menoufia University Hospital in the period from March 2017 to February 2019. All patients were divided into two groups: group A included 50 cases that underwent otoendoscopic-assisted microscopic myringoplasty, and group B had 50 cases that underwent microscopic myringoplasty.ResultsThis study included 100 patients, with a mean age of 30.2 years. Overall, 42% of the patients were male and 58% of the patients were female. Otoendoscopic examination of middle ear in group A showed 20% of cases with adhesions and secretions at tympanic orifice of the Eustachian tube opening plus 8% of cases with congested mucosa at middle ear apparatus. The success of graft uptake was 94% in group A and 84% in group B.ConclusionThe result of this study supports the use of otoendoscopy in traditional microscopic myringoplasty. Endoscopy could be utilized efficiently to improve the visibility of the Eustachian tube opening and middle ear apparatus and then dealing with any pathology affecting them.

Correlation of tympanic membrane perforations with hearing loss

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Tympanic membrane perforations are common cause of hearing loss. This study was designed to analyze the relation between tympanic membrane perforation and hearing loss.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; In this prospective study, patients with dry tympanic membrane perforations of safe type were included. The patients were divided into groups in according to size, site and duration of perforation. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 49 patients with 70 dry tympanic membrane perforations were studied. Data was analyzed statistically using paired t-test. Hearing loss increased as the size of perforation increased. Posterior quadrant perforations were associated with more hearing loss as compared to anterior quadrant perforations. Also duration of disease was in linear relation with mean hearing loss.&lt;/p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt;The degree of conductive hearing loss as a result of tympanic membrane perforation would be expected with the size, site and duration of perforation.&lt;p&gt; &lt;/p&gt;