Dry Tympanic Membrane Perforations Research Articles

A study on correlation of size and site of tympanic membrane perforation with degree of conductive hearing loss in chronic otitis media

<p class="abstract"><strong>Background:</strong> The objective of the study was to evaluate the size and site of tympanic membrane perforation, to assess hearing loss in patients with dry tympanic membrane perforation and to correlate the relationship between degree of conductive hearing loss with the size and site of tympanic membrane perforation.</p><p class="abstract"><strong>Methods:</strong> Study (n=150) done to correlate the site and size of tympanic membrane perforations and conductive hearing loss in cases of inactive tubotympanic COM from October 2013 to December 2015. Size of the tympanic membrane perforation was assessed under microscope using a measuring template. Patients were divided into four groups according to size; based on the site: anterior group, posterior group, combined group and divided in to three groups based on the duration of the disease. </p><p class="abstract"><strong>Results:</strong> Anterior perforations were most common 74 (49.3%). Hearing loss increased as the size of the perforation increased IV>III>II>I [(46.97±6.59)>(38.69±2.63)>(35.13±2.98)>(27.67±1.85) p<0.0001)]. Statistical significance for hearing loss at combined site (41.37±5.9) was higher compared to Posterior (35.21±4.6, p=0.0001) and Anterior (31.7±5.7, p=0.0001). There was statistically significant difference in hearing loss between all three groups (p=0.0001). Degree of hearing loss increased as the duration of the disease increased.</p><p class="abstract"><strong>Conclusions:</strong> Hearing loss is directly proportional to the size of perforation; more for the posterior quadrant perforations when compared to the anterior quadrant perforations of same size; also, hearing loss increases as the duration of the disease process increases.</p>

Correlation Between Sensorineural Hearing Loss and Chronic Otorrhea.

Many studies have been trying to correlate chronic otorrhea, both in children and in adults, with the sensorineural hearing loss in the affected ear, but have been obtaining contradictory results. This loss might be due to the likely toxicity of the bacteria involved, effects of inflammatory cytokines, or constant use of ototoxic antibiotics. All the studies evaluated up to the present date compared the affected ear with the normal contralateral ear. From the digitized archive of otological surgery files of the Department of Otorhinolaryngology, the ears of patients with chronic otorrhea were evaluated visually and compared with the normal contralateral ears. Ears with otorrhea were also compared to ears with dry tympanic perforation of other patients. Ears with suppuration were evaluated for cholesteatoma. The duration of otorrhea was taken into account. The sensorineural hearing threshold was evaluated for the frequencies of 500, 1000, 2000, and 4000 Hz. A total of 98 patients with chronic otorrhea and 60 with dry tympanic membrane perforation were evaluated. From a statistical study, a correlation between sensorineural hearing loss and the chronic otorrhea was observed, in comparison both with contralateral normal ears and with dry perforated ears of other patients. There was no relationship with the duration of suppuration or with whether this was due to cholesteatoma. Sensorineural hearing loss occurs in ears with chronic otorrhea. The duration of otorrhea and the etiology of suppuration did not influence the hearing loss. The great majority of otorrhea cases begin during childhood.

Office myringoplasty by chemical cauterization and paper patching: a prospective study

<p class="abstract"><strong>Background:</strong> Surgery for tympanic membrane perforation entails its own morbidity, risk of anesthesia, psychological trauma, along with long waiting periods for patients, especially in a tertiary care centre like ours. The purpose of this study was to evaluate outcomes of chemical cauterization and patching of perforation, performed as an office procedure in select cases.</p><p class="abstract"><strong>Methods:</strong> The study was conducted in a tertiary hospital from January 2016 to December 2017. The patients were selected based on the inclusion criteria, after thorough clinical assessment, examination under microscope and pure tone audiogram. All cases underwent cauterization of margins of perforation using 10% trichloroacetic acid (TCA), followed by patching with appropriately sized pre-sterilized cigarette paper patch. The patients were followed up weekly till the perforation was completely healed or till 12 weeks. If required, the procedure was repeated. </p><p class="abstract"><strong>Results:</strong> 68 cases were included in the study. Most common site of perforation was antero-inferior quadrant of pars tensa. Most common etiology was inflammatory. Number of applications ranged from 1 to 3. The procedure was successful in 62 cases (91.2%). All cases with traumatic perforation, residual perforation post-surgery and persistent perforation after grommet extrusion healed well. All 6 cases with treatment failure had inflammatory etiology, 4 involving postero-superior quadrant.</p><p class="abstract"><strong>Conclusions:</strong> In patients with small, central, dry perforation of tympanic membrane, chemical cauterization using TCA and paper patching can yield results comparable to that of surgery, while abating the morbidity and psychological trauma of surgery and saving time for both patient and doctor.</p>

Hearing loss in tympanic membrane perforations: an analytic study

<p class="abstract"><strong>Background:</strong> Tympanic membrane perforations are common cause of hearing loss. There are very few systematic studies that have evaluated the size and location of a perforation to the degree of hearing loss, this study correlates the size and location of tympanic membrane perforation to the pattern of hearing loss.</p><p class="abstract"><strong>Methods:</strong> The study design was based on cross sectional study. Ninety-six ears of dry tympanic membrane perforation of CSOM mucosal type were selected. Photographs of the tympanic membrane perforations were taken and size measured using the “Image J” software. The area of perforation was compared to hearing loss measured by pure tone audiometry. </p><p class="abstract"><strong>Results:</strong> Ninety-six patients, aged 15-60 years with perforated eardrums were studied. Size of tympanic membrane perforation showed moderate level of correlation with hearing loss (Pearson r value=0.463). The various locations of perforations were: posterior (23 ears with Mean hearing loss 28.6±7.7 dB), anterior (31 ears with Mean hearing loss 26.5±7.8dB), subtotal (42 ears with Mean hearing loss 34.2±8.2 dB).</p><p class="abstract"><strong>Conclusions:</strong> The hearing loss is frequency dependent, with maximum hearing loss at lower frequencies. Irrespective of size of perforation the hearing loss was the least for frequency of 2000Hz. Magnitude of hearing loss increases with increase in size of tympanic membrane perforation. Perforation posterior to handle of malleus resulted in more hearing loss than perforations involving anterior to the handle of malleus.</p>

Tympanoplasty without mastoidectomy for active otitis media

Objective:The study aims to assess the effect of tympanoplasty without mastoidectomy for the middle ear under different infected states.Method:One hundred and thirteen cases (113 ears) with chronic otitis media (COM) received tympanoplasty without mastoidectomy. All the patients were found inflammatory proliferative lesions in the mastoid and tympanic antrum via CT scan before surgery and were followed up over 1 year. The patients were placed into the infected ear group (72 ears) and uninfected ear group (41 ears) according to the infective condition. We used SPSS statistical software to analyze the efficacy.Result:Of 113 cases, 92 ears had dry ear canals in 1/2 to 1 month after surgery, and the negative air pressure in the tympanum gradually disappeared in 3-6 months after surgery. Of the 72 ears in the infected ear group, 69 ears had postoperative dry ears, and a large amount of intraoperative purulent secretion was seen in the tympanum in 4 cases, which all had dry ear canals. Three cases had relapse, for a dry ear canal rate of 95.8%. Three ears showed dry tympanic membrane perforations, and effective ears with air-bone conduction differences smaller than or equal to 20 dB accounted for 51.4% of cases. Of the 41 ears in the uninfected group, 40 ears had postoperative dry ears, 1 case had relapse, for a dry ear canal rate of 97.6%. Two ears showed dry tympanic membrane perforations. Effective ears with air-bone conduction differences smaller than or equal to 20 dB accounted for 48.8% of cases. No case of facial paralysis, dizziness, formation of invaginations of the tympanic membrane and cholesteatoma were seen in the patients included in this study during the follow-up visits.Conclusion:Whether there are inflammatory proliferative lesions in the mastoidor not, tympanoplasty without mastoidectomy is feasible for chronic active otitis media. Moreover, different infection statuses of the middle ear do not cause difference in the postoperative relapse rate and hearing improvement.

To Study the Association of the Size and Site of Tympanic Membrane Perforation with the Degree of Hearing Loss.

Chronic suppurative otitis media is a serious health problem worldwide. It has been a general view that the hearing loss increases with the size of the perforation, more so if it is in the postero- inferior quadrant. The present study is an effort to test the validity of above concepts. With Institutional ethical committee clearance, an observational study was carried at SMS medical college, Jaipur. A total of 90 cases were studied. All cases between the age group 15-50years with dry tympanic membrane perforations were divided into 3 groups Group I (0-9mm²), Group II (9-30mm²), Group III (>30mm²) with 30 in each group based on size of perforation. Hearing loss was calculated as average of hearing loss at 500, 1000, 2000Hz. Similarly the site of perforation was grouped as perforation involving anterior quadrant, posterior quadrant and multiple quadrant as Group A, Group B, Group C respectively. At the end of study, data was compiled systematically and analyzed using Post Hoc test. The age group ranges between 15 and 50years with mean age of 25.6years. Hearing loss was found to be directly proportional to the size of perforation in our study. (p = 0.000, highly significant). We also observed that hearing loss was more in posterior and multiple perforations than in anterior perforations. (p = 0.000, highly significant). Overall this study has shown significant correlation between the size and the site of the perforation to the degree of hearing loss.

Effect of mastoid pneumatization on myringoplasty success: A radiological study

Objectives: The objective of the study was to evaluate the effect of mastoid pneumatization on myringoplasty success. Patients and Methods: Forty-two adult patients with dry central tympanic membrane perforation scheduled for myringoplasty were included in the study. Computed tomography (CT) scans of the temporal bone coronal and axial cuts were done 1–2 days before surgery. The patients were evaluated on the basis of postoperative graft taking. Results: Success rate was 85.7% while failure rate was 14.3%. The mean longitudinal diameter of the mastoid was found to be 2.35 cm in succeeded cases and 1.43 cm in failed cases with near significant difference (P = 0.0636). The mean transverse diameter was 1.44 cm in succeeded cases and 0.83 cm in failed cases with a significant difference (P = 0.0476). The mean depth of the mastoid was 0.4 in both succeeded and failed cases. The mean total mastoid volume was 2.832 ml in succeeded cases and 1.13 ml in failed cases with nonsignificant difference (P = 0.1218). The mean mastoid surface area was 516.9 cm2 in succeeded cases and 448.5 cm2 in failed cases with a significant difference (P = 0.0087). Conclusions: Success rate of myringoplasty is higher in patients with chronic suppurative otitis media (CSOM) having large mastoid system than those having small one. Preoperative CT scans in patients with CSOM undergoing myringoplasty are advisable.

Bilateral same-day endoscopic transcanal cartilage tympanoplasty: initial results

IntroductionSame-day closure of bilateral tympanic membrane perforations is a quick and more comfortable procedure for the patients. However, conventional bilateral same-day tympanoplasty or myringoplasty has been rarely performed because of the theoretical risk of postoperative complications. ObjectiveTo evaluate the advantages and outcomes of bilateral simultaneous endoscopic cartilage tympanoplasty in patients with bilateral tympanic membrane perforations. MethodsFrom February 2012 to March 2013, patients with bilateral dry tympanic membrane perforations who had some degree of hearing loss corresponding to the size and location of the perforation entered the study. There was no suspicion to disrupted ossicular chain, mastoid involvement or other middle or inner ear pathology. Endoscopic transcanal cartilage tympanoplasty was done using the underlay (medial) technique. The graft was harvested from cymba cartilage in just one ear with preservation of perichondrium in one side. A 1.5cm×1.5cm cartilage seemed to be enough for tympanoplasty in both sides. ResultsNine patients (4 males and 5 females) with the mean age of 37.9 years underwent bilateral transcanal cartilage tympanoplasty in a same-day surgery. The mean duration of follow up was 15.8 months. There were detected no complications including hearing loss, otorrhea and wound complication with no retraction pocket or displaced graft during follow-up period. The grafts take rate was 94.44% (only one case of unilateral incomplete closure). The mean of air-bone gap overall improved from 13.88dB preoperatively to 9.16dB postoperatively (p<0.05). ConclusionBilateral endoscopic transcanal cartilage tympanoplasty can be considered as a safe minimally invasive procedure that can be performed in a same-day surgery. It reduces the costs and operation time and is practical with a low rate of postoperative complications.

Fat Graft Myringoplasty- Day Care Procedure: Role in Small Central Perforations

Introduction: Day care surgery is the need of hour in the field of otology. Temporalis fascia is the most common material used for closure of tympanic membrane perforation. But it is a lengthy procedure requiring general anaesthesia (GA) or longer sedation, extensive middle ear manipulation and a longer recovery post operatively. Fat is said to have angiogenetic properties. The aim of this study is to evaluate the usefulness of adipose tissue fat for closure of dry small perforations of tympanic membrane as a day care procedure. Materials and Methods: 40 patients with small central dry tympanic membrane perforations were taken up for surgery under sedation using fat graft from ear lobule for closure of perforations. The results were evaluated inta operatively, immediate post operatively and at 1st, 4th , 8th and 12th monthly post operative visit for uptake of graft, hearing improvement and complications of the procedure if any. Results: The results showed that the graft uptake success rate`was high as good as traditional myringoplasty using temporalis fascia. The procedure was minimally invasive, requiring little sedation, taking much less time, cost effective where both ears can be operated in the same sitting and the patients can be discharged on the same day with no major complications. There was considerable hearing improvement noted in the patients in the study. Conclusion: So it can be concluded that fat graft myringoplasty is an effective method for closure of small central dry tympanic membrane perforations.

English

Introduction: Day care surgery is the need of hour in the field of otology. Temporalis fascia is the most common material used for closure of tympanic membrane perforation. But it is a lengthy procedure requiring general anaesthesia (GA) or longer sedation, extensive middle ear manipulation and a longer recovery post operatively. Fat is said to have angiogenetic properties. The aim of this study is to evaluate the usefulness of adipose tissue fat for closure of dry small perforations of tympanic membrane as a day care procedure. Materials and Methods: 40 patients with small central dry tympanic membrane perforations were taken up for surgery under sedation using fat graft from ear lobule for closure of perforations. The results were evaluated inta operatively, immediate post operatively and at 1 st , 4 th , 8 th and 12 th monthly post operative visit for uptake of graft, hearing improvement and complications of the procedure if any. Results: The results showed that the graft uptake success rate`was high as good as traditional myringoplasty using temporalis fascia. The procedure was minimally invasive, requiring little sedation, taking much less time, cost effective where both ears can be operated in the same sitting and the patients can be discharged on the same day with no major complications. There was considerable hearing improvement noted in the patients in the study. Conclusion: So it can be concluded that fat graft myringoplasty is an effective method for closure of small central dry tympanic membrane perforations.

A Comparative Study of Closure of Tympanic Membrane Perforation between Chemical Cauterization and Fat Plug Myringoplasty

The purpose of closure of small dry tympanic membrane perforations is to restore the continuity of the tympanic membrane in order to improve hearing and decrease the incidence of middle ear infections. Small and cost effective procedures like Chemical Cauterization and Fat Plug Myringoplasty have been found to be effective in healing small central perforations with significant hearing improvement. A study was carried out in 69 patients with central perforations in the Department of ENT, Gauhati Medical College & Hospital for the duration of 1 year from August 11 to July 12. Out of 69 patients, 36 underwent Chemical Cauterization and 33 Fat Plug Myringoplasty. Pre-and post-operative hearing assessments of each patient were done and statistically analyzed. The success rate was found to be 83.33% and 90.9% respectively. In both groups, there was statistically significant hearing improvement with a P value 0.01. From our study, it was found that the two procedures are simple, reliable and also lessened the morbidity of the patient. Thus we recommend the use of these two official procedures for the treatment of central perforations of tympanic membrane less than 5 mm.

Is the Tragal Cartilage Necessary for Type 1 Tympanoplasties?

The use of cartilage grafts in tympanoplasties is recommended in cases with a higher probability of failure. Many grafting techniques have been reported, including palisade, cartilage island, and cartilage shield grafts. Cartilage minimizes the inflammatory tissue reaction, ensures resistance against infection during the recovery process, and provides good support against the retraction by virtue of its rigidity.This study compared the anatomic and functional results of conchal cartilage, tragal cartilage, and temporal muscle fascia grafts in primary type 1 tympanoplasty. Between January 2007 and January 2011, 79 patients with subtotal dry tympanic membrane perforation and an intact ossicular chain underwent primary type 1 tympanoplasty in our clinic. The postoperative perforation closure ratios, air and bone pure tone averages, and mean air-bone gap (ABG) in the 3 groups were compared with the preoperative values. The improvement in the mean ABG was assessed.The perforation closure ratio was 80.6%, 100%, and 88.5% in the muscle fascia, conchal cartilage, and tragal cartilage groups, respectively, and the mean increase in the ABG was 5.7, 8.9, and 9.7 dB, respectively.The island graft with cartilage perichondrium, which has recently become popular, can be also used in type 1 tympanoplasty. Because it does not require a second incision, conchal cartilage can be used routinely in tympanoplasties performed via a postauricular approach.

A Study of Closure of Tympanic Membrane Perforations by Chemical Cauterisation

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 5years. 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.

Bilateral Type 1 Tympanoplasty in Chronic Otitis Media

A theoretical risk of iatrogenic sensorineural hearing loss during surgery has induced a reluctance to perform bilateral tympanoplasty type I among some otosurgeons. This paper presents results of bilateral surgery in 14 patients (28 ears). Fourteen patients with bilateral, dry tympanic membrane perforations caused by chronic otitis media were selected prospectively for bilateral tympanoplasty type I (28 ears) at a tertiary referral center. All patients had a HL corresponding to the size and localization of the perforation (no suspicion of ossicular chain defect or other pathology). Mean age was 37.5years. There were seven males and seven females in our study. All but five ears were operated through an endaural or endomeatal approach, and five ears operated by postaural approach. The Underlay technique was used in all cases. Total ten cases operated using Fascia Lata and four cases operated using Temporalis fascia as graft material. Follow-up examination and hearing tests (pure tone audiometry) were performed up to 20months after surgery. The graft take rate was 96%, with no retraction pockets or displaced grafts observed during follow-up. One patient had small residual perforation which healed at the end of 3months. Hearing improved significantly, and the air-bone gap was significantly reduced. The air-bone gap was closed to within 10dB in 92% and within 20dB in 100% of the ears. Surprisingly good hearing was found during postoperative, bilateral ear canal gauze packing. Iatrogenic sensorineural HL did not occur. We conclude that bilateral myringoplasty is safe, with good results, reduces costs, and leaves the patient satisfied. The hearing impairment during postoperative ear canal packing is surprisingly modest and readily acceptable by the patients.

Otorhinolaryngological findings and hearing in HIV-positive and HIV-negative children in a developing country

The otorhinolaryngological (ORL) manifestations of Human Immunodeficiency virus (HIV) are common, but remain poorly characterized among children of Sub-Saharan Africa, where 90% of new pediatric infections occur. Our objective was to compare ORL findings and hearing in HIV-positive and -negative children of Luanda, Angola, using a comparative study of 78 outpatients from the HIV polyclinic and of 78 age- and sex-matched controls in a pediatric hospital with interview, general and ORL examination, brainstem auditory evoked potentials, and at age >5years pure tone open-air audiometry. ORL pathology emerged in 92% of HIV-positive and 78% (p=0.02) of control children. HIV-associated ORL findings comprised dental caries (56 vs. 32%; p=0.0009), cervical lymphadenopathy >1cm (45 vs. 10%; p<0.0001), facial skin lesions (32 vs. 5.1%; p<0.0001), chronic suppurative otitis media (26 vs. 3.8%; p=0.0002), dry tympanic membrane perforations (9 vs. 1%; p=0.03), tonsils of Mallampati score 0-1 (87 vs. 64%; p=0.0009), and bilateral hearing loss of >25dB (13 vs. 1%; p=0.009). Other HIV-associated characteristics included ear pain (44 vs. 27%; p=0.006), earlier otorrhea episodes (34 vs. 17%; p=0.004), tuberculosis (29 vs. 2.6%; p<0.0001), and pneumonia (22 vs. 2.6%; p=0.0003). ORL pathology appeared usual in both HIV-positive and -negative children. However, the overall high frequency and severity of the findings among the HIV-positive children require regular inclusion of the ORL area in these children's clinical evaluation.

Comparison between cartilage–perichondrium composite ‘ring’ graft and temporalis fascia in type one tympanoplasty in children

This study aimed to evaluate the anatomical and audiological outcomes of primary type one tympanoplasty performed with a modified cartilage-perichondrium composite 'ring' graft, and to compare them with results for primary type one tympanoplasty performed with temporalis fascia, in children. Retrospective clinical study. Otolaryngology department, Tanta University Hospital, Egypt. Records were evaluated for 82 children with dry tympanic membrane perforation (any size) and intact ossicular chain, and with no history of previous ear surgery except for tympanostomy. Patients of similar age and middle-ear pathology were selected to make the two groups as homogeneous as possible. An underlay type one tympanoplasty, using either a ring graft or temporalis fascia, was performed: 40 children were included in the ring graft group and 42 in the temporalis fascia group. All procedures were performed by the same surgeon. A successful anatomical outcome was considered to comprise full, intact healing of the graft without perforation, retraction, lateralisation or blunting, for at least one year post-operatively. Patients' post-operative pure tone average air-bone gap and speech reception threshold were compared with pre-operative levels, within and between the two groups. Type one tympanoplasty using a ring graft technique resulted in a significantly greater graft acceptance rate (95 per cent) compared with the temporalis fascia technique (76.2 per cent; p < 0.01). Pure tone average air-bone gap and speech reception threshold levels improved significantly in both the ring graft and fascia groups (p < 0.001). There was no significant difference in audiometric results between the two groups (p > 0.05), although there was a trend towards better post-operative results in the ring group. In our paediatric patients, type one tympanoplasty with a modified cartilage-perichondrium composite ring graft yielded good anatomical and functional results. The anatomical results obtained using this graft (with its unique appearance and stability during and after surgery) were superior to those for temporalis fascia. The ring graft group had equivalent, if not better, post-operative audiometric results, compared with the temporalis fascia group. Thus, the ring graft is believed to be effective in enabling both tympanic membrane closure and rapid hearing improvement, in the paediatric population.

CHEMICAL CLOSURE OF CHRONIC TYMPANIC MEMBRANE PERFORATIONS

The purposes of closing chronic dry perforations of the tympanic membrane are to improve hearing and prevent middle ear infections. Before the use of the operating microscope and improved instrumentation, tympanic membrane perforations were closed by application of chemicals or with a temporary patch. Today, although surgery is the treatment of choice, small dry perforations may be successfully closed by chemical means in an office setting. Twenty-eight of the 69 patients with chronic dry tympanic membrane perforations on the surgical waiting list at Hawke's Bay Regional Hospital, Hastings, New Zealand, underwent attempts at chemical myringoplasty. Two techniques were used: (i) cautery of the rim of the perforation with a silver nitrate bead on a metal probe and (ii) application of a urea ointment patch covering and overlapping the perforation. Eighteen of the 28 patients (64%) treated by chemical means experienced closure of their tympanic membrane perforations. Successful closure was achieved in 26% of the patients on the waiting list during the 6-month period. Chemical myringoplasty is not only of historical interest. It is an effective means of tympanic membrane closure in selected patients, thereby reducing the surgical waiting list and saving time and money for the patient, surgeon and hospital.

Bilateral Myringoplasty in Chronic Otitis Media

A theoretical risk of iatrogenic sensorineural hearing loss (HL) during surgery has induced a reluctance to perform bilateral myringoplasty/tympanoplasty type I among some otosurgeons. This paper presents results of bilateral surgery in 26 patients. Twenty-six patients with bilateral, dry tympanic membrane perforations caused by chronic otitis media were selected prospectively for bilateral myringoplasty/tympanoplasty type I (52 ears) at a tertiary referral center. All patients had a HL corresponding to the size and localization of the perforation (no suspicion of ossicular chain defect or other pathology). Mean age was 13.3 years, and the male to female ratio was 1.36. All but one ear were operated through a transcanal approach, and the onlay technique was used most frequently (83%), with use of fascia (56%), tragal perichondrium (38%), or cartilage palisades (6%) as graft material. Follow-up examination and hearing tests (pure tone and speech audiometry) were performed at a mean of 13.8 months after surgery. Perforation closure was obtained in 49 (94%) of the 52 ears. Hearing improved significantly, and the air-bone gap was significantly reduced. The air-bone gap was closed to within 10 dB in 92% and within 20 dB in 100% of the ears. Surprisingly good hearing was found during postoperative, bilateral ear canal gauze packing. Iatrogenic sensorineural HL did not occur. We conclude that bilateral myringoplasty is safe, with good results, reduces costs, and leaves the patient satisfied. The hearing impairment during postoperative ear canal packing is surprisingly modest and readily acceptable by the patients.

Cochlear Implantation in Patients with a History of Chronic Otitis Media

Objective—To propose management options for cochlear implantation in chronic otitis media based on our experiences.Material and Methods—A retrospective review of 418 cochlear implantations performed by the 2 senior authors between November 1988 and February 2004 was conducted. Nine patients who had chronic otitis media in the ear to be implanted were included. Of these, three showed active inflammation at presentation; the other six cases had undergone previous tympanomastoidectomy surgery and did not show active inflammation at presentation.Results—Five patients with active inflammation or without an adequate soft tissue layer in the mastoid bowl underwent a two-stage procedure. Four cases who showed inactive inflammation and had an adequate tissue layer to protect the electrode array underwent a single-stage technique, although two of them showed dry tympanic membrane perforation. No local or intracranial inflammation recurred. The electrode was exposed in the mastoid bowl in one case, who was managed with revisional mastoid obliteration with soft tissue.Conclusion—Complete eradication of inflammation and the securing of a strong protective soft tissue layer over the electrode are prerequisites for cochlear implantation in ears with chronic otitis media.

Pediatric Tympanoplasty and the Role of Preoperative Eustachian Tube Evaluation

The optimal timing for repair of a clean and dry tympanic membrane perforation in the pediatric patient remains an issue of concern and controversy. Although a particular “ideal age” for tympanoplasty has not been uniformly identified, it seems clear that one can expect a greater degree of success with advancing age of the patient. Although the definition of success varies, a healed tympanic membraneanda6-monthpostoperative interval free of effusion are frequently cited in defining tympanoplasty success. Causes of failure in the pediatric population are often attributed to immature eustachian tube function or eustachian tube dysfunction. It is therefore logical that many surgeons have used tests of eustachian tube functionpreoperatively topredict success in tympanoplasty. They have also used these techniques as research tools to ascertain whether a favorable test of eustachian tube function should be used as a preoperative screening tool. Although tasting otologic drops instilled through a perforation into the middle ear has not specifically been studied, an affirmative test would suggest a lack of eustachian tube obstruction and possibly a lack of dysfunction. Therefore a reviewof studiesdesigned toaddress the relationship, if any, of preoperative eustachian tube function and subsequent success in tympanoplasty will be examined in an attempt to support or refute the hypothesis.