Endoscopic Myringoplasty Research Articles

A comparison of surgical outcomes of endoscopic versus microscopic myringoplasty

BackgroundThere is a gradual transition from open to minimal access surgeries in Otorhinolaryngology. Myringoplasty can be done with either microscope or endoscope. Use of both the techniques has been reported in literature. However, there is no clear consensus over which is better than the other. The current study was done with the aim of comparing the hearing outcomes post myringoplasty by endoscopic versus microscopic technique. MethodsHundred patients of chronic otitis media mucosal inactive were recruited and divided into two groups, A and B. The patients in group A underwent endoscopic myringoplasty while those in group B underwent conventional microscopic myringoplasty. All patients underwent pure tone audiometry (PTA) and oto-endoscopy prior to and six months post-surgery. The study outcomes in the form of air-bone (AB) gap on PTA, successful closure of tympanic membrane perforation, pain scores, duration of hospital stay and occurrence of complications were compared. ResultsThe post-operative AB gap on PTA and pain score was lesser in the endoscopic technique as compared to microscopic technique. The reduction in AB gap post-surgery, duration of hospital stay, proportion of patients with closure of AB gap to ≤10 dB, successful closure of tympanic membrane perforation, and taste alteration were similar in both groups. ConclusionEndoscopic technique for myringoplasty can be recommended in view of similar or slightly better surgical and functional outcomes, wider field of view and better visualisation of middle ear by the endoscopes.

Tympanic Cavity Packing in Tympanoplasty Type 1: A Meta-Analysis.

Packing of tympanic cavity is generally considered an essential step in myringoplasty. However, each packing material comes with one or another side effect. The objective of this meta-analysis was to compare the results of Type 1 myringoplasty with or without packing. Pubmed, Cochrane database, Embase, Google Scholar, and clinicaltrials.gov were searched using 'tympanoplasty or myringoplasty and packing' as the search query. All RCTs / quasi-RCTs comparing tympanoplasty Type 1 with packing (control) versus without packing (intervention) of tympanic cavity in the human population were included. For dichotomous and continuous outcomes, relative risks (RR) and mean differences (MD) were calculated with 95% confidence interval, respectively. Heterogeneity was assessed using I2 statistics. Publication bias was checked using funnel plot and Egger's test, if applicable. Quality of evidence was assessed for each outcome using GRADE approach. Eleven studies were deemed eligible. For graft uptake and functional success rate, RR of 1.01 and 1.05 were obtained, respectively, showing no significant differences between the intervention and control groups. At 1st and 3rd postoperative month, no-packing group showed 3.86 dB and 2.08 dB better air-bone gap (ABG) closure than the packing group, respectively. Also, intervention with no-packing was 9.28-minute shorter procedure. With RR 0.35, no-packing had significantly lesser postoperative aural fullness. Type 1 tympanoplasty performed with or without packing show comparable results in terms of graft uptake and functional success rate. However, if performed without packing, it takes shorter time, provides early hearing improvement and causes less aural fullness. Key Words: Tympanoplasty Type 1, Packing, Gelfoam, No-packing, Meta-analysis, Endoscopic myringoplasty.

Sometimes less is more: experience with endoscopic myringoplasty.

A retrospective review of the outcomes of patients who underwent endoscopic myringoplasties in our institution was conducted. The aim was to highlight our results with this procedure. The database of patient records was manually checked, and the patients who had undergone Endoscopic Myringoplasties were identified, and their demographics, admitting notes, operating notes, and discharge summaries were reviewed. Graft failure was considered if the patient had a perforation in the graft during the outpatient follow-up. The information was compiled, and basic statistics were derived. A total of 31 patients were identified who had undergone Endoscopic Myringoplasty. Patients' age ranged from 14-52 years. None of the patients developed any immediate postoperative complications. Follow-up otoscopic examination showed 28 patients with an intact graft and only one patient with graft failure. Two patients were lost to follow up. Our success rate with Endoscopic Myringoplasty is 96.6%, which is comparable to the international standard success rate of 80-95%. The results of this study encourage adopting an endoscopic approach where the expertise is available.

Innovative surgical approaches in myringoplasty: A comprehensive evaluation of endoscopic technique without elevating the tympanomeatal flap

Introduction: Chronic otitis media- mucosal type, is a prevalent otological condition. Surgical intervention is often necessary. Various techniques developed over the years. In this study, we investigate the efficacy of endoscopic myringoplasty without tympanomeatal flap elevation,with the use of tragal cartilage.Methodology: A retrospective descriptive study was conducted at General Hospital Ampara, Sri Lanka, from January 2022 to August 2023. The surgical procedures were performed by the same surgeon, Due to the unavailability of pure-tone audiometry (PTA) and Tympanometry facilities, only physical healing outcomes were assessed.Results: The study analyzed 97 cases. Among pediatric patients aged 10 to 14 years, 50% achieved successful outcomes after endoscopic myringoplasty. In the adult group (15 to 60 years), 93.26% experienced successful closure of perforations, with only 6.74% showing residual perforations. Cases above 60 years achieved 100% successful outcomes. The overall success rate for all cases in the study was 92.78%.Conclusion: The study revealed the potential advantages of this surgical technique. Further research and refinement is needed to optimize patient outcomes and enhance the management.

A comparative study of endoscopic myringoplasty versus microscopic myringoplasty at tertiary care center

Background and objectivesMyringoplasty is a surgical procedure performed to repair tympanic membrane perforation which can be performed either using a microscope or an endoscope. The aim of this study is to compare the graft uptake, hearing outcome and operative time of endoscopic myringoplasty (EM) versus microscopic myringoplasty (MM) by underlay cartilage island graft technique. Subjects and methodsIn this prospective comparative study of sixty patients divided into two equal groups with small to medium sized tympanic membrane perforation were included. Tragal cartilage was used as graft material. Both the groups underwent myringoplasty by underlay cartilage island graft using endoscope (n = 30) and microscope (n = 30). The study was conducted between February 2022 to May 2023 after taking ethical approval from IRC of Nepalese Army Institute of Health Sciences. All patients were followed up on 7th postoperative day (POD), 1 and 3 months after surgery. ResultsGraft uptake in was 90 % (27/30) in MM group and 93.33 % (28/30) in EM group. Mean operating time was more in MM group (66.46 ± 6.78min) than EM group (64.53 ± 6.6 min). The improvement in Air Bone Gap (ABG) was better in EM group (12.46 ± 6.58 dB) compared to MM group (10.9 ± 9.01 dB). The differences in graft uptake, operating time and improvement in ABG were not statistically significant. ConclusionThe study concludes that it does not matter which approach is used, good results are predictable and choice of the tool used is up to the individual surgeon.

Efficacy of endoscopic porcine small intestinal submucosa graft myringoplasty: a retrospective comparative study

Background The surgical outcomes following tympanic membrane (TM) repair are affected by many factors. Objectives To evaluate the efficacy of endoscopic porcine small intestine submucosa graft (PSISG) myringoplasty by comparing with endoscopic myringoplasty with temporal fascia (TF) and perichondrium (PC). Methods We conducted a retrospective comparative study that a total of 98 patients with TM perforations were included. The patients underwent endoscopic myringoplasty using PSISG, TF or PC as the graft. The closure rate, hearing outcomes, operative time and complications in three groups were compared. Results At 3 months postoperatively, the closure rate were 85.2% (23/27), 92.1% (35/38) and 87.9% (29/33) in the PSISG, TF and PC groups respectively (p = .667); Hearing improved after surgery in three groups (p < .001), and showed no significant difference among the three groups. The mean operative time of the PSISG group was shorter than autologous TF (p < .001) and PC groups (p < .001) in this study; No operative or postoperative complications were found among the three groups. Conclusion Compare to autologous temporal fascia or perichondrium, the PSISG appears to be an effective and safe material for TM perforations closure. Endoscopic PSISG myringoplasty may be an alternative technique for repairing TM perforations, especially for revision cases.

A COMPARISON OF OTOENDOSCOPY WITH OTOMICROSCOPY FOR DIAGNOSTIC AND SURGICAL EVALUATION

Introduction: The tympanic membrane is the window into the middle ear, yet simply looking at it with the naked eye is insufcient to identify every condition. To visualize and document middle ear diseases, otologists now use an otomicroscope and an otoendoscope, which are required for surgical treatment [1]. Chronic Otitis Media is one of the common causes of hearing impairment and disability. The microscope revolutionized the surgical management of ear diseases, but the basic optical properties of the microscope have remained the same for the last 30 years [2]. The present study was intended to evaluate and compare the visualization of middle ear structures using an otomicroscope and 0 and 30-degree angled endoscopes in cases of Chronic Otitis Media (mucosal type) and also to make a surgical comparison in terms of advantages and disadvantages of the endoscope with the microscope in myringoplasty. Aims And Objectives: To visualize the middle ear structures by 0- and 30-degree angled endoscope and otomicroscope and to compare the results of endoscopic myringoplasty with that of myringoplasty done by using an operating microscope. Material And Methods: This was a comparative prospective study in which 100 patients, above the age of 15 years were examined by otomicroscopy and otoendoscopy. The visualization of various middle ear structures and the results of myringoplasty done with an endoscope and microscope were compared and statistically analysed. 30-degree angled endosc Results: ope provided better visualization of middle ear structures than with the microscope. Endoscopic myringoplasty showed good results in terms of accessibility, duration of surgery, postoperative pain, and cosmesis. Otoendoscopy provided better visualization of various middle ear Conclusion: structures as well as showed good outcomes in surgical aspects. Thus, endoscopes can be utilized for better diagnosis, and it can be a good alternative to microscopic myringoplasty

Comparative study on microscopic myringoplasty and endoscope assisted myringoplasty in a tertiary care centre in Kanyakumari district

Objective: To evaluate the efficacy of endoscopic myringoplasty and comparison with conventional myringoplasty. Materials and Methods: Sixty cases of clinically diagnosed chronic supportive otitis media with dry central perforation were taken into account of which 30 cases were undergone endoscopic myringoplasty and 30 cases undergone conventional myringoplasty. All patients were followed up on 3rd, 7th, 15th day, 6th weeks, 3rd and 6th months after surgery. Results: The tympanic membrane’s perforation healing rate was 86% (26/30), in conventional group of myringoplasty and 83% (25/30) in endoscopic group of myringoplasty and average hearing gain in conventional group was 13.96 dB and in endoscopic group was 15.03 dB. Conclusion: The surgical outcome of endoscope assisted myringoplasty in terms of graft uptake and hearing improvement was comparable to the conventional microscope assisted myringoplasty, but in terms of cosmesis and postoperative recovery patients in the endoscope group had better results.

Is Endoscopic Tympanoplasty an Alternative to Microscopic Tympanoplasty for Small Central Perforations? A Study

Introduction: Traditional approaches to tympanoplasty involve the use of a microscope. However, with the advent of endoscopes and HD cameras, endoscopic tympanoplasty has appeared as an alternative to microscopic tympanoplasty. Our study was aimed at assessing the success rates of endoscopic tympanoplasty in small dry central perforations of pars tensa. Materials and Methods: 49 patients were enrolled in this study for undergoing endoscopic tympanoplasty and the surgical outcome was analyzed in terms of graft uptake and postoperative air-bone gap closure for 6 months. Results: Among the study population, 45 participants (91.84%) had an intact neotympanum at the end of 6 months, two participants (4.08%) had residual perforation, and two (4.08%) had recurrent perforations due to upper respiratory tract infection. The mean preoperative air-bone gap (AB gap) was 23.63 dB ± 3.9 dB in the study population with a minimum of 16 dB and a maximum of 31 dB (95% confidence interval [CI] 22.43–24.83), whereas the mean postoperative AB gap was 13.84 dB ± 2.79 dB, minimum being 8 dB and maximum being 20 dB (95% CI 12.98–14.69). The difference between the preoperative and postoperative air-bone gap was statistically significant (P &lt; 0.001). Conclusions: We conclude that the endoscopic myringoplasty is an attractive alternative to conventional microscopic myringoplasty in terms of surgical outcomes, graft uptake, and air-bone gap closure.

Comparison of Hearing Result and Graft Uptake Rate between Temporalis Fascia and Tragal Cartilage in Endoscopic Myringoplasty

Background There are different methods to repair the perforation of the tympanic membrane. Recently cartilage has been used for the repair and results are comparable to temporalis fascia. For surgical procedure endoscope had added good assistance in middle ear surgery. Though the one hand technique the image quality and results are on par with the use of a microscope.&#x0D; Objective To compare the graft uptake rate and hearing results between temporalis fascia and tragal cartilage in endoscopic myringoplasty.&#x0D; Method This is a prospective, longitudinal study conducted among 50 patients who underwent endoscopic myringoplasty using temporalis fascia and tragal cartilage with 25 patients in each group. The hearing was assessed by comparing pre with post-operative ABG (Air bone gap) and ABG closure in speech frequencies (500Hz, 1 KHz, 2 KHz, 4 KHz). The status of graft and hearing results was evaluated on 6 months of follow up in both the groups.&#x0D; Result Out of total 25 patients enrolled for study in both (temporalis fascia and cartilage) groups, 23 (92%) patients in each group had graft uptaken. The audiological gain in the temporalis fascia group was 11.37±0.32 dB whereas in the tragal cartilage group it was 14.56±1.22dB. The audiological gain between the two groups did not show any statistically significant (p = 0.765). However, the pre and post-operative hearing difference was statistically significant in both temporalis fascia and tragal cartilage group.&#x0D; Conclusion Tragal cartilage has similar graft uptake rate and hearing gain when compared with temporalis fascia in endoscopic myringoplasty. Hence, tragal cartilage can be used for myringoplasty whenever required without any fear of deterioration in hearing.

Outcomes of Endoscopic Myringoplasty

Introduction: The endoscope has diagnostic and therapeutic role in different otological surgeries. It has excellent view of images where there are difficult nooks and corners. The use of tragal cartilage in the repair of tympanic membrane perforation has its own benefit in graft uptake and hearing results whether long term or short term. The main purpose of the present study was to evaluate the long‑term hearing results in patients who underwent endoscopic sandwich myringoplasty with National Medical college &amp; Teaching Hospital, Birgunj. Objective: To evaluate the graft success rate and postoperative hearing gain for central perforations using endoscopic myringoplasty Materials and Methods: This study is a prospective study in 60 patients with central perforations who underwent endoscopic myringoplasty using tragal cartilage. The hearing was assessed by comparing pre‑. with post‑operative air‑bone gap (ABG) and ABG closure in speech frequencies (0.5 kHz, 1 kHz, 2 kHz, and 4 KHz). Results: Of the 60 patients with central perforation included in this study, the graft success rate was 95% (57/60). The graft uptake in 6 months of follow‑up. The postoperative ABG (13.77 ± 4.94dB) was lesser than preoperative ABG (22.38 ± 6.93 dB) with statistically significant results. Conclusion: Endoscopic myringoplasty is a safe procedure with high‑graft uptake rate and good long‑term hearing results.

Canalplasty using underwater bone drilling in transcanal endoscopic myringoplasty for patients with a narrow external auditory canal

Background Canalplasty is important in microscopic ear surgery, but it has rarely been studied in otoendoscopic surgery. Objectives The aim of this study was to investigate the application of canalplasty due to external auditory canal stenosis caused by bony bulges in endoscopic myringoplasty. Materials and methods The procedures and effects of canalplasties and myringoplasties were analysed. During the canalplasties, depending on the location of the bulges, the meatal skin flaps were elevated in different manners, and the underwater bone drilling technique was adopted to remove the bulges to enlarge the osseous canals. Results Canalplasties were performed in 18.5% (33/178) of myringoplasties. All surgeries were completed exclusively via the transcanal endoscopic approach. No iatrogenic injuries were found. Most of the canalplasties required drilling off bulges on multiple walls. The mean total duration of the canalplasties and myringoplasties was 76.6 ± 4.5 min, and the proportion of time required for the canalplasties was 47.3 ± 2.4%. Conclusion Only approximately one in five endoscopic myringoplasties require antecedent canalplasties due to concurrent canal stenosis. With the underwater bone drilling technique, transcanal endoscopic canalplasty can be safely and efficiently conducted.

Comparison conventional endoscopic myringoplasty with fibrin glue supplemented endoscopic myringoplasty

Introduction: The fibrin tissue glues have been used in many surgeries to reinforce surgical sutures and tissue adhesion. Myringoplasty is the commonly done ear surgery for the perforations of the tympanic membrane, where no suturing is done between remnant membrane and graft. Aim: The aim of the study is to compare the results and effectiveness of this biological fibrin tissue glue in myringoplasty surgeries as a supplementary procedure to conventional endoscopic myringoplasty (CEM) surgeries. Materials and Methods: Seventy patients with chronic suppurative otitis media with tympanic membrane perforation without ossicular and mastoid involvement have been chosen. One group of 35 patients underwent CEM surgeries. In another group of 35 patients, biological fibrin tissue glue, TISSEEL, has been used as supplementary to the CEM surgeries, and the graft uptake rate and hearing improvement were evaluated and compared postoperatively. Results: The graft success rate at 3 months postoperatively was 91.42% in both the groups, that is, 32/35, and these values were not statistically significantly different (P = 1.00). There was a highly statistically significant hearing outcome before and after the surgery in both the CEM and the fibrin tissue glue supplemented endoscopic myringoplasty groups. However, there was no statistically significant change in hearing outcomes between the two groups. Conclusion: In our study, we have got more or less similar results compared with the results of the studies on routine CEM cases. But the high-cost nature of the commercially available fibrin tissue glue makes it difficult to recommend for use in all routine endoscopy myringoplasty cases.

The Feasibility and Treatment Results of Transcanal Endoscopic Myringoplasty

We reported on transcanal endoscopic myringoplasty in 25 cases preliminarily in 2014. Now our number of transcanal endoscopic myringoplasty reached to 209 ears and allowed us to adequately investigate the visibility, necessity of canalplasty, treatment results, and multivariate analysis. A prospective case series. Tertiary referral center. Transcanal endoscopic myringoplasty was performed on 209 ears in 201 patients between 2011 and 2019 and followed up over 1 year. Preoperative endoscopic and microscopic views for the same patient were compared. We examined success rates at 1 year after surgery according to operation type, perforation size, operation side, gender, cause of perforation, and age, and also examined hearing results. Logistic regression analysis was performed to investigate the basic demographic and clinical characteristics of the patients associated with perforation closure. The anterior edge of the preoperative perforation was not visible under microscopy in 14.4% of patients. In contrast, endoscopic views revealed the entire tympanic membrane in one field. However, canalplasty was required in 2.4% of tympanic procedures due to difficulty of manipulation. The overall closure rate for perforations was 90.4%. Logistic regression analysis revealed that age > 11 was the only significant factor associated with perforation closure. The average reduction in air-bone gap was 12.1 dB. The endoscopic myringoplasty produced better visualization, the same or better closure rates, and the same or lower complication rates as compared with traditional microscopic techniques.

Comparison of the clinical outcome of endoscopic push-through myringoplasty and microscopic overlay myringoplasty: matching co-variated designs

BackgroundThe conventional microscopic overlayer myringoplasty is preferred because it allows a both hands technique, not reducing middle ear space, increasing the blood supply in the repaired area, and providing graft support; however, this technique may be troublesome for the novice surgeon during tympanomeatal flap elevation. Recently, the endoscopic push-through myringoplasty technique has developed. It provides better visualization of the hidden areas and does not require raising tympanomeatal flap. Therefore, the comparison of clinical outcomes between endoscopic push-through myringoplasty and conventional microscopic overlay myringoplasty technique was investigated.MethodsA retrospective case–control hospital-based study was conducted using archival data from the patients who underwent myringoplasty between January 2015 and May 2021 at Srinagarind Hospital and Khon Kaen Hospital, Thailand. The medical records of patients who underwent endoscopic push-through technique or microscopic overlayer technique were chosen by simple randomization and matched 1:1 based on the air conduction threshold, air-bone gap, size of perforation, and experience of the surgeon. The two techniques were compared for clinical outcome success, including tympanic membrane closure, improved air conduction threshold, air-bone gap closure, and operation time duration.ResultsMedical records of 70 patients were retrieved and classified into 35 patients who underwent endoscopic push-through and 35 patients who underwent microscopic overlayer myringoplasty. The size of tympanic membrane perforation and preoperative audiometry were not significantly different between both groups (p > 0.05). The postoperative outcome in endoscopic technique revealed that the air-bone gap and the success rate of tympanic membrane closure were comparable with microscopic techniques (p = 0.420 and p = 0.156, respectively). The operation time was significantly shorter in the endoscopic technique (p < 0.05). Complications were found in one patient with otitis externa in the endoscopic technique group and one patient with graft lateralization in the microscopic technique group.ConclusionsEndoscopic push-through myringoplasty is an alternative minimally invasive technique that may allow the potential outcomes comparable with the microscopic overlayer myringoplasty and with a significantly shorter operation time.

Review of endoscopic myringoplasty success: comparisons of intra-operative graft material and post-operative packing in terms of graft failure rate.

Myringoplasty success rate is estimated to be between 60 and 90 per cent. Factors predicting success include the choice of graft and use of auditory canal packing. This study aimed to determine the intra-operative factors associated with endoscopic myringoplasty success. A retrospective review of all endoscopic myringoplasty cases between January 2017 and January 2020 was undertaken. Data were collected on: patient demographics, tympanic membrane perforation size, intra-operative details, audiology and post-operative outcomes. There was no significant difference in graft success rates between cases using bismuth iodoform paraffin paste and Spongostan packing (86.7 per cent vs 84.9 per cent, respectively). Conchal cartilage graft had a higher success rate (100.0 per cent) compared with Biodesign grafting biomaterial (66.7 per cent), but was not superior to tragal cartilage (84.6 per cent) or temporalis fat or fascia (80.0 per cent). Spongostan packing is equivalent to bismuth iodoform paraffin paste in terms of endoscopic myringoplasty success rate. Although conchal cartilage graft had higher success rates, it was not statistically significantly different from tragal cartilage.

A comparative study between endoscopic and microscopic type 1 tympanoplasty

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; The current study aims to compare type 1 microscopic tympanoplasty and endoscopic tympanoplasty and draws an evidence-based conclusion regarding the outcome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This randomized controlled clinical study consists of 60 patients, in which 30 cases allocated as group 1 underwent endoscopic myringoplasty, and 30 cases allocated as group 2 underwent conventional myringoplasty. Tympanic membrane (TM), pure tone audiometry (PTA) evaluated preoperatively and at 3 months postoperative follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; Demographic distribution between the groups does not show a significant difference (χ2=6.67, p=0.16). There was no significant difference observed between TM perforation size between the groups (χ2=2.32, p=0.51). For the preoperative AB gap in group 1, the mean ABG was 28.20±2.67 and in group 2 was 28.20±0.80. The postoperative AB gap in group 1, the mean ABG was 17.40±3.01, and in group 2, the mean ABG was 19.67±2.93. The mean difference is 9.13, and it shows a statistically significant difference (p=0.001). The mean duration of surgery in group 1 was 130.83±34.84 and in group 2 was 168.33±16.88 min (p=0.001). In both groups, 90% have intact graft, and in 10% of patients’ residual perforation is present. The mean duration of hospitalization in group1 is 4.10±0.09 days and in group 2 is 4.97±0.18 days.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; By using the endoscopic addition, minimal invasive tympanoplasty can made possible the similar graft success rate with minimal pain. Endoscopic tympanoplasty uses very less operative time than microscopic surgery.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Endoscopic versus Microscopic Myringoplasty in Anterior Central Tympanic Membrane Perforations

Endoscopic versus Microscopic Myringoplasty in Anterior Central Tympanic Membrane Perforations

Outcome of Endoscopic Transcanal Cartilage Myringoplasty performed in Janaki Medical College Teaching Hospital

Background and Objectives: Myringoplasty is a commonly performed surgical procedure usually with a microscope. Transcanal endoscopic myringoplasty is being widely used procedures nowadays and has the advantages of demanding lower operative time and minimal external incisions. The main objective of our study was to see the graft uptake rate and hearing results after endoscopic cartilage myringoplasty.&#x0D; Material and Methods: This prospective study was carried out on 50 patients from March 01, 2020 till April 30, 2021. All patients presented with central perforation of tympanic membrane which was dry for at least 3 months were subjected to preoperative clinical, endoscopic, audiological assessment. These patients were followed through a period of 6 months and assessed using pure tone audiometry and graft uptake was seen.&#x0D; Results: Out of 50 patients, male: female ratio was 1.9:1 with mean age group of 34 years. In our study the graft uptake rates is 85% (42) and 6 patient has pin hole perforation and 2 has small central re-perforation on 6 month followup. Mean preoperative air bone gap was 28.95 dB whereas mean postoperative air bone gap was 10.63 dB. The maximum number of patient i.e 20 had pre-operative air bone gap in the range of 31 – 40 and 20 has post operative air bone gap in the range of 0-10 which is normal.&#x0D; Conclusions: The endoscopic approach for myringoplasty offers excellent visualization; avoids postaural approach, enables a faster recovery, requires less hospital stay, with excellent graft closure rate and improved functional outcomes.

EFFICACY OF PERMEATAL ENDOSCOPIC MYRINGOPLASTY IN INACTIVE (MUCOSAL) CHRONIC OTITIS MEDIA

Objective: To determine the efficacy of permeatal ednoscopic myringoplasty, in inactive (mucosal) COM regarding, graft take and hearing improvement.&#x0D; Study Design: Quasi-experimental study.&#x0D; Place and Duration of Study: ENT Department, Pak Emirates Military Hospital, Rawalpindi, from Aug 2019 to Feb 2020.&#x0D; Methodology: This was conducted on a sample size of n=100. Patients having inactive (mucosal) COM with dry central small, medium and large perforations were included. Patients were divided in to three groups on the basis of age, group A 15-30 years, group B 31-45 years and group C 46-60 years. All the patients underwent per-meatal endoscopic myringoplasty, without raising the tympano-meatal flap, under general anesthesia. Patients were followed up over a period of six months. Graft take was assessed by microscopy. Hearing was assessed by Pure Tone Audiometry (PTA) with improvement in air bone gap to 15db as primary end point. Data was collected on structured performa. Data was analyzed using SPSS version 17.&#x0D; Results: In this study, 33 (33%) were males and 67 (67%) were females. Age ranged 15-60 years. Out of 5 patients lost to follow up. A total of 95 completed their follow up. Based on age of the patients, in group A, successful graft take was 100%. In group B, it was 91% &amp; in group C it dropped to 46%. On the basis of tympanic membrane perforation size, the graft success rate in small perforations was 94.8%; in medium sized perforations it was 86.8% and in large sized perforations of tympanic membrane it was........